March 21  2015, Saturday
editorial
Heart Diseases in children
Dr KK AggarwalMany different types of heart diseases can affect children, ranging from congenital heart diseases to acquired heart diseases.

About one percent of children are born with congenital heart disease, which can be classified as a blue baby or a non–blue baby. There was a time when no cure was available for congenital heart disease but today, many hospitals are performing surgeries in children with congenital heart disease with excellent outcomes.

Rheumatic heart disease means involvement of valves of the heart because of a bacterium, which causes sore throat. It usually occurs in school going children who present with sore throat with no cough and sneezing. A sore throat is a red angry–looking throat with pain on swallowing. If ignored and not treated in time, the infection can bite the heart and lick the joint (rheumatic fever). There may be sore or swollen joints and fever, which may disappear but the valves of the heart may be permanently damaged causing rheumatic heart disease. The affected children require valve replacement, which if not done in time may even result in death. A large number of children with congenital heart disease and rheumatic heart disease die because of non-availability of operative facilities in the country, especially for complex congenital heart disease. Many of them die as they cannot afford the cost of treatment including surgery.

The following options are available for children with heart diseases who cannot afford treatment:
  • Sameer Malik Heart Care Foundation Fund, an initiative of Heart Care Foundation of India, Helpline no. 09958771177, which is open from Monday to Saturday and provides assistance to the needy and underprivileged children for free surgery.
  • Various Rotary Clubs in the country provide free surgery to children with heart disease.
  • ‘Being Human’, the organization run by the cine actor Salman Khan also provides financial assistance to children with congenital heart diseases.
  • Most states provide assistance of up to Rs 1 lakh for congenital heart disease to children if they possess BPL or equivalent card in the state.
  • The Delhi State Government also provides free heart treatment to children whose parents have annual income of less than Rs 3 lakhs.
  • Parents can apply through legal counsel to municipal corporations for assistance, through their local MLA or through their MP to the Prime Minister Relief Fund.
  • Children can also approach Puttaparthi Heart Centre at Bengaluru, which provides free surgeries to such children.
  • Various NGOs and associations also provide free treatment; for example, Maheshwari Club provides free treatment to Maheshwari families.
  • People can also approach their religious organizations like Gurudwaras, Mosque committees and Hindu Mahasabhas etc. for free assistance in respective category.
  • Under Article 21 of the Constitution of India, people can also approach respective High Courts for directions to respective state heart departments to avail free surgeries.
  • In every state, there are government hospitals, which provide free surgeries; for example, GB Pant Hospital provides free surgery to everyone with heart disease.
  • Safdarjung Hospital, New Delhi provides free heart surgery to all BPL patients from across the country.
  • People can also approach various PSUs for assistance under their CSR policy.
  • People can also approach various large private companies for assistance under their CSR policy.
The end result is – no children in India should die of curable heart disease just because he or she cannot afford it.
eMedipics IMA,IJCP,HCFI
Press conference at IMA on drug resistant TB
News
  • A two-step strategy to managing chronic pain in US military veterans was associated with improved function and decreased pain severity, resulting in 30% improvement in pain-related disability, suggested a new study published online in JAMA Internal Medicine. Step 1 included 12 weeks of analgesic treatment and optimization according to an algorithm, in association with pain self-management strategies. Step 2 comprised 12 weeks of cognitive-behavioral therapy.
  • New research has correlated light and sound sensitivity experienced by some patients with migraine who have heightened connectivity within primary sensory cortices, the pons and the anterior insula (AI). The research is published in the journal Neurology.
  • Mongersen, a drug that restores transforming growth factor β1 (TGF-β1) signaling, is highly effective in Crohn’s disease, suggests a randomized controlled trial published in the March 19 issue of the New England Journal of Medicine. The data also suggest the drug has longer-lasting effects in patients with Crohn's disease than existing anti–tumor necrosis factor a therapy.
  • Outpatients with uncomplicated skin infections who took clindamycin or a trimethoprim–sulfamethoxazole combination (TMP-SMX) reported similar benefits and risks, thus suggesting that the antibiotic regimens were essentially equivalent, reported a randomized controlled trial published in the March 19 issue of the New England Journal of Medicine.
  • New guidance on the management of diabetes and its complications in pregnancy has been issued by the National Institute for Health and Care Excellence (NICE). Besides advising on gestational diabetes, the new NICE guidelines also address the management of type 1 and type 2 diabetes both preconception, during pregnancy and birth, and after delivery, as well as neonatal care.
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Dr KK Spiritual Blog
Vedic principles behind cognitive behavior therapy

1) What is counseling?
A: The mental process involves generation of a thought or idea, which is analyzed and then acted upon. Thought, analysis and action therefore are the primary three processes of human mind. Counseling involves actions at all three levels.

2) What are different types of counseling?
A: Counseling involves basically two principles – Cognitive counseling and behavioral counseling. Behavioral, when the concentration is only on the actions and cognitive, when the concentration is on the changes in either the thought process or in the interpretation of the thought process.

3) What is cognitive behavior therapy?
A: As against a pure behavior therapy where a person is counseled to do pre–defined things on regular intervals, cognitive behavior therapy involves changing the actions by changing observations of the interpretation of a particular situation.

4) What is the origin of counseling in India?
A: The origin of counseling goes back to Vedic era. Upanishads were basically text books on counseling based on the original knowledge of Rigveda, Yajurveda, Samveda and Atharvaveda.

5) Is there a relationship of Bhagavad Gita with Counseling?
A: Bhagavad Gita is counseling done by Krishna to resolve the conflict in Arjuna’s mind whether to fight or not. At that time there were no doctors and hence counseling was done by the elders in the family.

6) Are the principles of Bhagavad Gita followed today?
A: All the principles of cognitive behavior therapy today are basically principles that have originated from Bhagavad Gita.

7) What is the first principle?
A: The first principle is that "counseling cannot be done in 1 or 2 sessions." It requires up to 18 sessions which is what Krishna did in Bhagavad Gita. Bhagavad Gita contains 702 dialogues in the form of Shlokas. Therefore, a proper counseling involves in–depth conversation between the counselor and the patient.

8) What is the second principle of counseling?
A: The second principle of counseling is to listen to the patient in the first session in great detail and this is what Krishna did in Bhagavad Gita. In Chapter 1, only Arjuna speaks and Krishna does not utter a word. A patient listening is half the healing done.

9) What is the third principle?
A: As per the third principle, the second (first interactive) session between counselor and the patient should be the longest one. Chapter 2 of Bhagavad Gita is the gist of Krishna’s counseling.

10) What is the fourth principle?
A: The fourth principle is that after giving a detailed counseling in the second session, it is expected that the patient will be confused. This is what happens in start of Chapter 3 where Arjuna says to Krishna "I am confused. Sometimes you are talking about one path and other time you are talking about another path. Guide me again." The third counseling session therefore, is the most important where one has to counsel slowly and in great detail.

11) What is the fifth principle?
A: The next principle is to give reasoning to the counseling. One should not take the patient for granted. Krishna discusses each and every aspect of life with Arjuna in great detail giving scientific reasoning at every stage.

12) What is the sixth principle?
A: Reassure the patient again and again. During his counseling, Krishna assures Arjuna on multiple occasions that you do your job and do not worry. I am with you.

13) What is the seventh principle?
A: The seventh principle involves creating some fear in the patient’s mind. This is what Krishna does while showing his virat swaroop. This especially works in patients of addiction. Some degree of fear with re–assurance from the counselor always works.

14) What is the eight principle?
A: The summing up counseling session should be as long as the second session. The Chapter 18 of Bhagavad Gita is as big as Chapter 2 where the whole Bhagavad Gita is summarized again.

15) What are the ingredients of counseling?
A: Counseling basically involves in-depth knowledge of dharma, artha, kama and moksha. They are greatly described in Dharmashastra, Arthashastra, Kamasutra and Upanishads through various Vedas.

16) What is stress?
A: Stress is the reaction of the body or the mind to the interpretation of any situation.

17) How can stress be managed?
A: Stress can be managed by either changing the response of the body through yogic living, or changing the interpretation by understanding the principles of counseling or change the reaction by willful actions.

18) Are different nitis of our scriptures based on counseling?
A: Yes. Vidur Niti was the counseling given by Vidur to Dhritarashtra when he was not sleeping and Chanakya Niti was based on how to rule a country. Yoga Vashishtha was the counseling given by Vashishtha to Rama to acquire higher levels of spiritual knowledge.
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Cardiology eMedinewS
  • Previous studies have shown that transcatheter aortic-valve replacement (TAVR) is an effective alternative to surgical aortic-valve replacement (SAVR) for patients with severe aortic-valve stenosis who are at high risk for surgery. However, results from the Nordic Aortic Valve Intervention Trial (NOTION) suggest that it may be a viable option for low-risk patients, too. The findings were presented at a featured clinical-research session at the American College of Cardiology (ACC) 2015 Scientific Sessions.
  • Another study presented at the American College of Cardiology (ACC) 2015 Scientific Sessions revealed that patients with heart failure and reduced ejection fraction (HF-REF) who were implanted with the Barostim neo (CVRx) device, which stimulates baroreceptors in the carotid artery and carotid sinus, had greater functional improvements at 6 months compared with their peers who received optimal medical therapy only.
Pediatrics eMedinewS
  • The 13-valent pneumococcal conjugate vaccine (PCV13) is well tolerated and immunogenic in preterm infants, with most babies mounting immunoglobulin G (IgG) antibody levels and functional antibody responses likely to protect them against invasive disease, suggests a new study published online in Pediatrics.
  • The US Food and Drug Administration (FDA) has approved ivacaftor for children aged two to five years with cystic fibrosis (CF) who have one of 10 mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.
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Make Sure
Situation: Doctor, this patient has developed acute renal failure (ARF).
Reaction: Oh my God, I forgot that he was on furosemide. I gave him full dose of amikacin.
Lesson: Make sure, before calculating the dose of aminoglycoside (amikacin) that furosemide and other loop diuretics, which enhance its nephrotoxicity are not being given.
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

Negligence must be gross for the criminal charge–Supreme Court

The judgment given by the Honorable Supreme Court of India, consisting of a three judges bench, in October 2005, ruled that doctors should not be held criminally responsible unless there is prima facie evidence before the court in the form of a credible opinion from another competent doctor, preferably a Government doctor in the same field of medicine, supporting the charges of rash and negligent act.
  • We have noticed that cases of doctors being subjected to criminal prosecution are on the rise; such prosecutions are filed by private complainants or by the police on an FIR lodged and cognizance taken.
  • The criminal process once initiated, subjects the medical professional to serious embarrassment and harassment. The doctor has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge, but the loss he has suffered in his reputation cannot be compensated by any standard.
  • It’s a laudable judgment in the light of criminal procedures filed against them in trivial cases under Sections 304 and 304–A of IPC where prima facie, there seems to be no neglect in these medical treatments.
  • Section 304–A of IPC reads as "Causing death by negligence–whoever causes the death of any person by doing any rash or negligent act not accounting to culpable homicide shall be imprisoned with imprisonment of either description for a term which may extend to two years or with fine or both.
  • Degree of negligence required to prosecute them under the charge of criminal negligence, must be gross or even high degree.
  • Lord President Clyde observed "the true test for establishing negligence in diagnosis or treatment on the part of the doctors is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would have been guilty of, if acting with reasonable care and this is concise definition of medical negligence."
Dr Good Dr Bad
Situation: A patient came with classical benign postural vertigo.
Dr Bad: Take these drugs.
Dr Good: Do Epley maneuver.
Lesson: Epley maneuver in most situations can cure benign postural vertigo.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
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eMedi Quiz
A patient using contact lens develops corneal infection. Laboratory diagnosis of acanthamoeba keratitis was established. The following is the best drug for treatment:
1. Propamidine.
2. Neosporine.
3. Ketocanazole
4. Polyhexamethylene biguanide.

Yesterday’s Mind Teaser: A 20-year-old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is:
1. Macular edema.
2. Sympathetic ophthalmia.
3. Optic nerve avulsion.
4. Delayed vitreous hemorrhage.

Answer for yesterday’s Mind Teaser: 2. Sympathetic ophthalmia.
Correct Answers received from: Dr KV Sarma, Daivadheenam Jella, Dr Avtar Krishan.
Answer for 19th March Mind Teaser: 1. The sample should be kept at 4°C.
Correct Answers receives: Raju Kuppusamy, Dr Poonam Chablani.
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
Sonal Namaste
When should you wash your hands?
  • After sneezing
  • Before, during and after preparing food
  • Before eating food
  • Before and after caring for someone who is sick
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage
Facts about Tuberculosis (TB)
How important is a chest X ray in the diagnosis of pulmonary TB?
  • Abnormalities on chest X-ray may be suggestive but are never diagnostic of TB unlike smear examination in which TB bacteria are seen.
  • Several diseases such as Pneumonia, Silicosis, Bronchiectasis etc. can mimic TB on X-ray.
  • X-rays do not help in differentiating between active and healed TB lesions.
  • Studies have shown that there is wide interobservation variation in reading of X-rays for diagnosis of TB thus limiting the use of this investigation.
  • X-rays therefore play only a supportive role in the diagnosis of pulmonary TB, mainly in cases where sputum smear result is negative.
Delhi medical council appointment stayed
TNN | Mar 20, 2015, 02.29 AM IST

New Delhi: In a blow to the Delhi government, the high court on Thursday stayed its notification appointing new members to the Delhi Medical Council.

HC said it will examine if the composition of the Council can be changed and examine the laws in this regard. "Accordingly, till the next date of hearing, the notification dated March 13, 2015, is stayed," Justice Rajiv Shakdher said, on a plea by a doctor, Vinay Aggarwal.

The petitioner alleged that four people including him were dropped as members of the Delhi Medical Council by the state government. "It will have to be examined if the respondents could have changed the composition in the manner in which they have done without taking recourse to the relevant provisions of the acts and the rules framed," the court said.

Aggarwal argued that his appointment as a member of the Council was cleared by the lieutenant governor when Delhi was under President's rule, but the new Delhi government went ahead and appointed new people. Once a member is elected or nominated to the council, he can only be removed if he attracts disqualification and disability under the provisions of the Medical Council Act, Aggarwal maintained, saying that removing members by way of a notification is illegal.
HC stays Delhi government notification on appointments in medical council
Thursday, 19 March 2015 - 8:11pm IST | Place: New Delhi | Agency: PTI

The Delhi High Court on Thursday stayed the notification of city government regarding appointments of new members in the medical council saying it will examine whether the composition could be changed without taking recourse to relevant provisions of law.

The Delhi High Court on Thursday stayed the notification of city government regarding appointments of new members in the medical council saying it will examine whether the composition could be changed without taking recourse to relevant provisions of law.

"The concerns of the court as to what would happen to matters presently pending and those that may be filed in intercession before the council, is thus, in a sense taken care by virtue of the circumstances being in place. Accordingly, till the next date of hearing, the notification dated March 13, 2015, is stayed," a single judge bench of Justice Rajiv Shakdher said.

The court's order came on a plea of Vinay Aggarwal who claimed that his and three other names as members of the Delhi Medical Council has been dropped from the notification dated March 13, 2015 by the new city government.

"It will have to be examined whether the respondents could have changed the composition in the manner in which they have done without taking recourse to the relevant provisions of the Acts and the rules framed," Justice Shakdher said.

Aggarwal claimed that he was appointed by the Lieutenant Governor (LG) as a member to the Council when Delhi was under the President rule and the new city government had not issued the notification earlier about the nomination and election of new members to the Council even though it was complete by then.
High Court stays Delhi government notification on DMC appointment
Thursday, March 19, 2015

New Delhi (IANS): The Delhi High Court on Thursday stayed a notification issued by AAP government on March 13 on appointing the new members of the Delhi Medical Council, a statutory body regulating doctors and other medical practitioners.

Justice Rajiv Shakdher stayed the notification appointing 22 members to the council.

Posting the matter for April 21, the court also issued notice to Delhi government on the issue and asked it to file response.

As the previous council’s term ended in December 2014, elections for the new council were held in November. Since Delhi was then under President’s rule, Lieutenant Governor Najeeb Jung nominated four doctors to the council – Dr Ambrish Mithal, endocrinologist from Medanta Medicity, AIIMS professor Dr Manoj K Singh, Dr Vinay Aggarwal, former president of Indian Medical Association, and paediatrician Dr Ravi Malik, who is also IMA’s joint secretary general.

But the notification of Delhi government does not contain their names. Two of the nominated doctors approached the court challenging the notification and said notification is completely “illegal”.

“Once a person is elected or nominated, he can only be removed if he attracts disqualification and disability,” argued senior advocate Sandeep Sethi appearing for Dr Vinay Aggarwal and asked the court to declare the notification illegal.

The court said it will examine whether the government could have changed the composition in the manner in which they have done without taking recourse to the relevant provisions.

The court stayed the notification saying: “In my view, this aspect will have to be examined. I am also informed that it is not as if there is no council in place, as the previous council continues to operate.”

“The concerns of the court, as to what would happen to matters presently pending, and those that may be filed in the intercession, before the council, is thus, in a sense, taken care of by virtue of the circumstance being in place. Accordingly, till the next date of hearing, notification dated March 13, 2015 is stayed,” the court said.

Zubeda Begum, standing counsel of Delhi government told the court that notification has been published in the gazette.
IMA hails HC stay on DMC notification
Press Trust of India | New Delhi March 19, 2015 Last Updated at 22:42 IST

The Indian Medical Association (IMA) today hailed Delhi High Court's decision to put on stay the notification of Delhi Medical Council (DMC) where the government notified 22 instead of 23 members and also changed the names of 4 nominated persons, earlier nominated by the Lieutenant Governor.

"Medical profession should be beyond politics and government should nominate members only on merit and once nominated, should not change them unless they are removed on disciplinary ground and that too abiding the constitution," IMA Secretary General, K K Aggarwal said.

In the present case, the IMA felt that the earlier nominated members were people of eminence and should not have been removed without a valid reason, said Aggarwal.

When Delhi Assembly elections were held, the Medical Association appealed the public to support all the doctor-members of the Association who were fighting the elections, including Dr Atul Kumar (AAP), Dr A K Walia (Congress) and Dr S C L Gupta (BJP).

The IMA has appealed the Chief Minister of Delhi, Arvind Kejriwal to help maintain the dignity of the medical profession and not allow it to die in the hands of political parties.
PMC blacklists Fortis Hospital
Tribune News Service/ Ludhiana, February 25

The Punjab Medical Council (PMC) has blacklisted Fortis Hospital here for blatantly violating the ethical norms set by the Medical Council of India in a gazette notification of 2002.

Dr GS Grewal, president of the PMC, said: “Fortis Hospital, Ludhiana, has been blacklisted by the PMC. In spite of making a commitment in an affidavit that the hospital authorities will not violate the ethical norms, they are still indulging in it. It is therefore resolved that no credit hours will be granted to any academic activity done or sponsored by Fortis Hospital.”

“Besides, we will seek the registration number of all doctors working at Fortis Hospital and observe if they are also indulging in unethical activities,” added Dr Grewal.

The hospital has been blacklisted under section 5.1 of the Medical Registration Act Amendment 1977 and the same shall apply to any other hospital which, after committing to the council, continues to flout the ethical norms, said Dr Grewal.

Public Relations Officer of Fortis Hospital Amarjeet Kaur said they had been following all rules relating to advertising. "Our advertisements are just for creating awareness and it is mentioned at the bottom of every advertisement. We are not giving names of any doctor in the advertisements, so we are not flouting any norms," she said.
Media
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Events
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Inspirational Story
The Quarrel of the colors

Once upon a time the colors of the world started to quarrel. All claimed that they were the best…the most important, the most useful, the most beautiful and the favorite.

Green said: "Clearly I am the most important. I am the sign of life and of hope. I was chosen for grass, trees and leaves. Without me, all animals would die. Look over the countryside and you will see that I am in the majority."

Blue interrupted: "You only think about the earth, but consider the sky and the sea. It is the water that is the basis of life and drawn up by the clouds from the deep sea. The sky gives space and peace and serenity. Without my peace, you would all be nothing."

Yellow chuckled: "You are all so serious. I bring laughter, gaiety, and warmth into the world. The sun is yellow, the moon is yellow, and the stars are yellow. Every time you look at a sunflower, the whole world starts to smile. Without me there would be no fun."

Orange started next to blow her trumpet: "I am the color of health and strength. I may be scarce, but I am precious for I serve the needs of human life. I carry the most important vitamins. Think of carrots, pumpkins, oranges, mangoes, and papayas. I don’t hang around all the time, but when I fill the sky at sunrise or sunset my beauty is so striking that no one gives another thought to any of you."

Red could stand it no longer he shouted out: "I am the ruler of all of you. I am blood – life’s blood! I am the color of danger and of bravery. I am willing to fight for a cause. I bring fire into the blood. Without me, the earth would be as empty as the moon. I am the color of passion and of love, the red rose, the poinsettia and the poppy."

Purple rose up to his full height: He was very tall and spoke with great pomp: "I am the color of royalty and power. Kings, chiefs, and bishops have always chosen me for I am the sign of authority and wisdom. People do not question me! They listen and obey."

Finally Indigo spoke, much more quietly than all the others. But with just as much determination: "Think of me. I am the color of silence. You hardly notice me, but without me you all become superficial. I represent thought and reflection, twilight and deep water. You need me for balance and contrast, for prayer and inner peace."

And so all the colors went on boasting to each other. Each convinced of his or her own superiority. Their quarreling became louder and louder.

Suddenly there was a startling flash of bright lightening, thunder rolled and boomed. Rain started to pour down relentlessly. The colors crouched down in fear, drawing close to one another for comfort.

In the midst of the clamor, the Rain began to speak: "You foolish colors, fighting amongst yourselves, each trying to dominate the rest. Don’t you know that you were each made for a special purpose, unique and different? Join hands with one another and come to me."

Doing as they were told, the colors united and joined hands.

The Rain continued, "From now on, when it rains, each of you will stretch across the sky. In a great bow of color as a reminder that you can all live in peace. The Rainbow is a sign of hope for tomorrow."

And so, whenever a good rain washes the world and a Rainbow appears in the sky, let us remember to appreciate one another.
Wellness Blog
High HgbA1c linked to hypoglycemia in diabetics with kidney failure

A retrospective study of patients with diabetes enrolled in a large hemodialysis program found an association between high baseline HbA1c and an increased risk for hypoglycemia hospitalization. Higher baseline HbA1c was also associated with greater variability in HbA1c levels.

The investigators suspect that the greater risk of severe hypoglycemia associated with high HbA1c may derive from glucose variability during treatment for hyperglycemia. The study is published in Hemodialysis International.
IMA in Social Media
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Science Lesson

Miss Jones had been giving her second–grade students a lesson on science. She had explained about magnets and showed how they would pick up nails and other bits of iron.

Now it was question time, and she asked, "My name begins with the letter ‘M’ and I pick up things. What am I?"

Little Johnny in the front row proudly said, "You’re a mother!"
Quote of the Day
I feel sorry for people who don’t drink. When they wake up in the morning, that’s as good as they’re going to feel all day. Frank Sinatra
Reader Response
The Editorial for the emedinews edition dated 20th March ‘Vedic Science behind a divorce’ is excellently drafted. I have been reading eMedinewS from day 1. It is a very good magazine being drafted in a holistic approach. Thanks: Dr RSN Murty, Cardiologist, Bhubaneswar, Odisha.
World TB Day on 24th March
PADMA Celebrities to join for a social cause
IMA saved government over 30 crores by preventing development of drug resistant TB
Padma Awardees of the country will join hands for social causes of National Interest. Addressing a press conference here, Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General INA and Padma Shri Awardee Ashok Chakradhar, Noted Kavi said that efforts are being made to have Padma Awardees meet regularly and do something collectively for the society. The first on the line will be endorsing the health concern about drug resistant TB. The duo said that the best treatment of drug resistant TB is its prevention. If TB is partially or wrongly treated 3% of them will become drug resistant requiring more than 2 years of treatment and more than 2 lac worth drugs.

Padma Awardes, Birju Maharaj, Sonal Man Singh, Purshottal Lal, Uma Sharma, Amjad Ali Khan, Naresh Trehan, Ambrish Mithal, Ashok Seth, T S klair, Neelam Klair, Arvind Lal, Sudhir Tailang, Sovna Narayan, Geeta Chandran, Satpal, Surinder Sharma, Ashok Chakradhar and many others will support the combined social campaign, said Dr Aggarwal and Dr Chakradhar.

All patients of TB needs to be notified and followed up till they are cured, added Padma Shri Awardee Dr AM Pillai National President IMA and Dr.Vinay Aggarwal, Past National President IMA.

Patients notified in private sector if lost in follow up could result in multi drug resistant TB, added Dr Suresh Gutta National Coordinator TB IMA. Efforts of IMA have helped in identifying, follow, treat and cure one lakh (104000 to be exact) out of one million missing TB cases in India. Out of these 33913 cases were sputum positive and infectious to the community. Each sputum positive case spreads infection to 15 other healthy persons and ten percent of all TB infected persons develop clinical disease.

IMA has been able to avert about 508695 new TB infections due to reduction of TB transmission by treating infective TB cases. Out of these ten percent, 50870 cases could have developed clinical TB disease. Three percent of them, 1526 cases could have become drug resistant over time.

Treatment of 1526 drug resistant cases could have caused the government extra cost of over 30.52 crores ( Rs 2 lac per treatment). Apart IMA's contribution has been able to check impending Drug resistant TB epidemic.

                                            -2-

Apart IMA has also trained and provided a TB faculty cum experts of over 16000 doctors in the country and has been able to sensitize over one lac private doctors. All these doctors follow one TB treatment protocol adhering to Standards of TB Care in India. This itself further checks the development of MDR TB.

IMA has brought the private sector to the forefront to shoulder the efforts of Government in TB Control, said Dr Aggarwal.

IMA activity has helped linking the Government machinery to private sector doctors and hospitals of these one lakh patients. Patients are benefitted as they get an opportunity for free drugs and facilities for Drug susceptibility testing. These patients are not just being referred to Government sector for treatment, but gets managed by the private sector following standards of TB care in India.

IMA also released it slogan for the general practitioners" I have notified a TB patient today: have you. Do it today

IMA is also linking private doctors and private doctors owned clinical establishments into the loop of DOTS centers by way of establishing peripheral health institutes. A PHI is a center in private sector linked to government DOTS and provided confidential and free treatment to the public. Over 1700 such centers have been established by IMA so far. IMA hospital Board of India has been rope in by IMA to expand its scope of PHI centers. HBI has over 10000 member.

Talks are also on with National Accreditation Board of Hospitals to accreditate PHI in regards to quality and safety.
Rabies News (Dr A K Gupta)
How is RIG injected locally? What is the mode of administration of full dose of RIG?

It is important to infiltrate all wounds with rabies immunoglobulin (RIG). Intramuscular (IM) administration of RIG is of very little value. The previous recommendation to give antirabies serum half into wounds and half IM no longer holds true and may lead to treatment failure. As much of the calculated dose of RIG as is anatomically feasible should be infiltrated into and around all the wounds. In the event that some volume of RIGs is left over after all wounds have been infiltrated, the same should be administered by deep IM at a site distant from the vaccine injection site.

If the calculated dose of RIG is insufficient to infiltrate all wounds, sterile saline can be used to dilute it 2 or 3 fold to permit thorough infiltration.