October 22   2015, Thursday
EDITORIAL
Dr KK Aggarwal
mHealth Generation: An era of bringing healthcare to smartphones and ensuring its successful implementation
Dr KK Aggarwal
Delegates from almost 60 national medical associations attended the annual General Assembly of the WMA in Moscow, which was held from 14th to 17th October. And all of them insisted on the importance of a few improvisations required for successfully leveraging Mobile Healthcare in the country. Not only it will help developing countries, but it will also help in wholistically improving the healthcare model in developed countries as well.

In today’s time, technology and the world both are developing at the highest pace. And the best example of this is the evolving movement of smartphones. Smartphones have made our lives easier by making things easily accessible and simultaneously saving our time. Not only, they have successfully transformed our lives but have also brought necessities much closer. For instance, how well the concept of mHealth (Mobile Health) has resonated with people from all across the globe.

According to WMA, “Mobile health (mHealth) is used to define the utilization of state-of-the-art technology in medical care. More specifically, it has been described as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other devices intended to be used in connection with mobile devices. It includes voice and short messaging services (SMS), applications (apps), and the use of the global positioning system (GPS) for the successful deliverance of medical services.”

mHealth is a broad concept and encompasses services like measurement or manual input of medical, physiological, lifestyle, activity and environmental data in order to fulfill their primary purpose. All this will result in data generation, which can be used for research into effective healthcare delivery and disease prevention. However, this data can also be misused if the required security checks are missed.

Although, there are a plethora of policies that safeguard the whole idea of mobile health and ensure security as certain levels including the collection, storage, protection and processing of data of mHealth users, especially health data. The Government should focus on educating people about how their personal data is collected, stored, protected and processed. Prior to any confirmation, consent must be obtained prior from the users to any disclosure of data to third parties, e.g. researchers, governments or insurance companies. These steps will help in avoiding any discrepancies, which may hinder the successful implementation of Mobile Health technology.

Mobile Health will be huge hit if monitoring and evaluation are done in accordance to stated rules and regulations. This will avoid any possibilities in breach of information and as well as the user’s trust. Additionally, timely monitoring and evaluation will help in avoiding any misuse of this technology and will also make it easier tomeasure the performance records with predetermined standards.

The Mobile Health should be made a universal concept and the access shouldn’t be denied based on factors like caste, financial status or lack of technical expertise. And wherever possible, social or healthcare services should facilitate access to mHealth technologies as part of basic benefit packages, while taking all the required precautions to guarantee data security and privacy.

Why is mHealth important?

• Mobile technologies, being easily accessible can provide individual level support to health care consumers

• It will promote healthcare, as apps that can track daily calorie intake, calories burn, exercises done and much more. All this will educate people on when they should stop

• It will help people to get a top physician’s advice in emergency situations like sudden pain in case of pregnant women

• With more and more giant tech players investing in a developing country like India, the smartphone network is likely to expand. Mobile Health will make it easier for people to access healthcare services from anywhere at anytime. Although the usage and availability may vary in some places.

Nowadays, multinational tech giants are making efforts towards manufacturing low-cost smartphones keeping purchasing power of the Indian population in mind. More and more people are adapting the smartphone craze, as they are getting all the hi-tech services and features in minimum amount. Additionally, these numbers are going to increase in the near future as India continues to develop and emerge as a global power.

The idea of mHealth has the remarkable potential to supplement the healthcare delivery model in a country, which has a population of 1.27 billion people. This will help in improving various fronts like patient self-management, establishing base for electronic interactions between patients and physicians and reducing the cost of the healthcare services.

The future of mHealth depends on new coordinated and well researched the plan of action will be. The decisions that have been taken before for the implementation of Mobile healthcare system has been way too experimental in nature and doesn’t have any guarantee of data security and privacy. The technological arrangement should be such that it enables in achieving the ultimate desired results.An extensive plan and comprehensive approach is what is currently required for the successful integration of this technology into the regular healthcare infrastructure.

WMA guidelines:

• Although, the WMA recognizes the advantages of mHealth, the patient should always opt for face-to-face interaction and treatment whenever possible

• The need to eliminate deficiencies in the provision of care and to improve the quality of healthcare should be the two main objectives behind mHealth

• Physicians and patients both should be aware about the potentials risks of using mHealth and should follow the guidelines strictly

• A physician and a patient should clearly understand the difference between the use of mHealth for lifestyle purposes and the ones that require medical supervision and observation

• The information provided must be clear, reliable and non-technical, and therefore comprehensible to lay people

• Concerted work must go into improving the interoperability, reliability, functionality and safety of mHealth technologies, e.g. through the development of standards and certification schemes

• Comprehensive and independent evaluations must be carried out by competent authorities with appropriate medical expertise on a regular basis in order to assess the functionality, limitations, data integrity, security and privacy of mHealth technologies

• Suitable reimbursement models must be set up in consultation with national medical associations and healthcare providers to ensure that physicians receive appropriate reimbursement for their involvement in mHealth activities

• A clear legal framework must be drawn up to address the question of identifying potential liability arising from the use of mHealth technologies

• Physicians who use mHealth technologies to deliver healthcare services should heed the ethical guidelines set out in the WMA Statement on Guiding Principles for the Use of Telehealth for the Provision of Health Care
Breaking news
FDA approves a topical drug combination for plaque psoriasis

The US Food and Drug Administration (FDA) has approved a foam containing calcipotriene and betamethasone dipropionate (Enstilar, Leo Pharma Inc) for topical treatment of plaque psoriasis in adults 18 years of age and older, according to a company news release. Enstilar is an alcohol-free foam formulation of the two drugs in a pressurized spray that permits application across large areas of plaque psoriasis. It is applied once daily to affected areas for up to 4 weeks. Patients should stop using it when control is achieved and should be instructed not to use more than 60 g every 4 days
Dr Good Dr Bad
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Specialty Updates
• A new study suggests that use of blood stored for up to 42 days is safe for transfusion in heart surgery patients. The study is published in

• Researchers have created a test that could boost in vitro fertilization success rates to as much as 80%. The test, called MitoGrade, measures the levels of abnormal mitochondrial DNA present in embryos, allowing doctors to determine which embryos are most viable for a successful pregnancy.

• Survival rates of the rare anaplastic thyroid carcinoma, which has a very poor prognosis, show significant improvement when patients are treated with an aggressive combined-modality therapy, although the toxicities associated with such therapies can take their toll, suggests new research presented at the 2015 International Thyroid Congress and Annual Meeting of the American Thyroid Association (ITC/ATA).

• A new study, published online in the American Journal of Epidemiology, suggests that when one spouse becomes obese, the other's risk of obesity almost doubles. This could be due to similar changes in diet, physical activity or other behaviors that impact obesity.

• Treatment of nonalcoholic steatohepatitis (NASH) with vitamin E and pentoxifylline leads to improvements in liver enzymes, suggests a new study presented at the American College of Gastroenterology meeting.

• New research from the Department of Pulmonary Medicine and Sleep Disorders and All India Institute of Medical Sciences, India suggests that yoga exercises provide improvements that are as effective as traditional pulmonary rehabilitation methods in improving pulmonary function, exercise capacity, and indices of systemic inflammation in patients with COPD.

• Taking a probiotic strain of Bifidobacterium longum reduced physiologic and psychological stress and led to a modest improvement in memory in a small pilot study of healthy men, presented at the Society for Neuroscience (SfN) 2015 Annual Meeting.

• Sleep apnea may increase the risk of developing gout, reported a new study published in Arthritis & Rheumatology.

• Rafael D. Romo, PhD, RN, from the Division of Geriatrics, University of California, San Francisco, and colleagues report in a research letter published online October 19 in JAMA Internal Medicine that older people do not have a good sense of their own life expectancies, nor are they adept at predicting their own prognoses. They suggest that these findings have implications for decision making around future health interventions, and for communication strategies to help facilitate informed decisions

• In a study that included 106 patients given NASH-specific therapy, those in the treatment group (vitamin E and pentoxifylline) had median decreases in alanine aminotransferase (ALT) of 58.4% compared with a decline of 42.7% in the no-treatment group (P=0.029), reported Naim Alkhouri, MD, of the Cleveland Clinic in a poster session at the American College of Gastroenterology meeting.
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Media
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eSPIRITUAL
Why Lakshmana could not kill Ravana?
We need to understand Ramayana in the language of Internal Ramayana taking place in the body every day, wherein Rama represents consciousness, Sita the body and Lakshmana, the determined mind with an aim.

Ravana is synonymous with ego, which the determined mind (Lakshmana) cannot kill. Only the consciousness can kill the ego. Consciousness gets activated only in parasympathetic mode, which in turn takes over only when the person has control over the breathing. Control over breathing in mythology means your friendship with Hanumana which represents the Prana Vayu.
Protect the girl child: What our rituals teach us

Dr KK Aggarwal
The 9-day Navratri fast is broken on the eight (ashtami) or the ninth (navami) day of Navratri by worshipping 8 or 9 girl children, of prepubertal age and older than 2 years. This ritual is called ‘kanya puja’.

The tenth day of the festival is celebrated as Dussehra in the country as the day when Lord Ram killed Ravana. The burning of effigies of Kumbhkaran, Meghnath and Ravana symbolize killing of one’s tamas, rajas and ahankar denoting the victory of good over evil.

The nine girls worshipped during ‘kanya puja’ are regarded as the nine forms of ‘Devi’ or ‘Durga’ or mahashakti, which regulates creation, preservation and destruction on earth.

This ritual of ‘kanya puja’ not only has religious significance, it has social relevance too. With the increasing violence against female child in the form of female feticide, infanticide or sexual abuse, this ritual gives the message that every girl child needs to be protected from abuse of any kind, be it physical or mental.

A vrata or fast means ‘to vow’; it teaches self-control or control over desires. The festival of Navratri is the process of detoxification of body, mind and soul, at the end of which a person attains purification of soul and learns to exercise restraint. Since ages, this festival has spread the values and stresses the need to protect and take care of the girl child.
Legal Quote
Jacob Mathew v. State of Punjab SC / 0457 / 2005: (2005) 6 SCC 1 (iii).

An error of judgment on the part of a professional is not negligence per se.
Medicofinance
Asset protection: Personal residence

Assets owned by a doctor through an LLC or a limited partnership are not deemed owned by the doctor because these legal entities have their own separate legal existence. If a doctor transfers the ownership of his apartment building into an LLC, the doctor will no longer be treated as the owner of the apartment building. He will now be treated as the owner of a membership interest in the LLC. This means that a plaintiff suing the doctor will no longer be able to reach the apartment building directly, he would no have to pursue the doctor’s interest in the LLC.

(Source: IJCP)
Industry News
India adds 5.21 lakh jobs in a year: According to the ‘25th Quarterly Report on Changes in Employment’ by the Labour Bureau, eight sectors including IT/BPO, automobiles, gems & jeweler and textile saw a rise in employment by 5.21 lakh last fiscal. However, job creation in these eight sectors which also include handloom/power loom, leather, transport and metal remained little stressed in the January-March quarter at 64,000 over the previous quarter… (Asian Age – PTI)

Monetary benefits losing importance for employees: According to the compensation and benefits report published by Top Employers Institute, salary and bonus continue to lose importance as compared to non-monetary compensations like flexible hours and recognition. The survey was based on a sample size of 600 companies in 96 countries. "While salary is still hugely important, non-monetary elements like flexible hours, learning and development and recognition have become decisive factors in job offers and employee retention," Top Employers Institute CEO David Plink said. (Deccan Herald – PTI)

Meru becomes first Indian radio cab company to enter the global market: Radio taxi operator Meru Cabs has formed an alliance with eCab, which is a part of French taxi service provider Taxis G7, to expand its service offering to global markets. Under the partnership, Meru's customers can use eCab's services during international travel in 50 major cities of countries, including France, Belgium, the Netherlands, Ireland and Canada. Similarly, eCab mobile app users can avail of Meru's services when they visit India. (DNA India)

IRDAI issues guidelines on FDI in insurance firms: IRDAI issued guidelines to bring in more clarity on the issue of compliance with the manner of Indian-owned and-controlled companies. It said that total foreign investment, both direct and indirect, in Indian insurance companies cannot exceed the limit of 49 per cent. As per the Insurance Laws (Amendment) Act 2015, the foreign investment cap in the insurance sector has been increased to 49 per cent, as well as permitting overseas reinsurers to open branch offices to carry out reinsurance business in India. The applicablity of these guidelines may come into existence after notification of the Act. (Financial Express – PTI)
Inspirational Story
Two Traveling Angels

Two traveling angels stopped to spend the night in the home of a wealthy family. The family was rude and refused to let the angels stay in the mansion’s guest room. Instead the angels were given a small space in the cold basement. As they made their bed on the hard floor, the older angel saw a hole in the wall and repaired it. When the younger angel asked why, the older angel replied, "Things aren’t always what they seem." The next night the pair came to rest at the house of a very poor, but very hospitable farmer and his wife.

After sharing what little food they had the couple let the angels sleep in their bed where they could have a good night’s rest. When the sun came up the next morning the angels found the farmer and his wife in tears. Their only cow, whose milk had been their sole income, lay dead in the field.

The younger angel was infuriated and asked the older angel, "How could you have let this happen? The first man had everything, yet you helped him." she accused. "The second family had little but was willing to share everything, and you let the cow die." "Things aren’t always what they seem." the older angel replied.

"When we stayed in the basement of the mansion, I noticed there was gold stored in that hole in the wall. Since the owner was so obsessed with greed and unwilling to share his good fortune, I sealed the wall so he wouldn’t find it. Then last night as we slept in the farmer’s bed, the angel of death came for his wife. I gave him the cow instead. Things aren’t always what they seem."

Sometimes that is exactly what happens when things don’t turn out the way they should. If you have faith, you just need to trust that every outcome is always to your advantage. You might not know it until sometime later…

Should you find it hard to get to sleep tonight, remember the homeless family who has no bed to lie in.

Should you find yourself stuck in traffic, don’t despair; there are people in this world for whom driving is an unheard–of privilege.

Should you have a bad day at work, think of the man who has been out of work for many months struggling to feed his family.

Should you notice a new gray hair in the mirror, think of the cancer patient in chemo who wishes she had hair to examine.

Should you find yourself at a loss and pondering what is life all about, asking, "What is my purpose?", be thankful, there are those who didn’t live long enough to get the opportunity.
eWELLNESS
Long term use of painkillers can cause kidney cancer

A study published in the journal Archives of Internal Medicine has shown that people who regularly take painkiller drugs like ibuprofen or naproxen are 51 percent more likely to develop kidney cancer. There is no increased risk from taking aspirin or paracetamol. The mechanism through which painkillers could cause kidney disease is the inhibition of prostaglandin synthesis with resulting papillary and tubular injury, and ultimately damage to DNA.

The study analyzed data from 77,525 women in the Nurses’ Health Study and from 49,403 men in the Health Professionals Follow–up Study. The risk was related to the duration of use of the painkillers. There was a decrease in the risk by 19% if the painkiller was used for less than four years. There was a 36 per cent increase in risk of kidney cancer for people who used them regularly for 4 to 10 years. The risk increased almost three times for those who used these drugs regularly for 10 years or more.

The good news is that kidney cancer is uncommon so the risk is small for average users.

Two other important causes of kidney cancer are obesity and smoking. So people on painkillers should not smoke and should also keep their weight under control to prevent kidney cancer.
eMEDIPICS
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National Consultation on Private Health Sector Engagement for a TB-Free India
MTNL Perfect Health Mela 2015.

Pls click here for details
IMA Digital TV
eMEDI QUIZ
All of the following features can be observed after the injury to axillary nerve except:

1. Loss of rounded contour of shoulder.
2. Loss of sensation along lateral side of upper arm.
3. Loss of overhead abduction.
4. Atrophy of deltoid muscle.

Yesterday’s Mind Teaser: Referred pain from ureteric colic is felt in the groin due to involvement of the following nerve:

1. Subcostal.
2. Iliohypogastric.
3. Ilioinguinal.
4. Genitofemoral.

Answer for Yesterday’s Mind Teaser: 4. Genitofemoral

Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr K V Sarma, Dr Jainendra Upadhyay, Dr K Raju, Dr Arvind Jain Diwaker.

Answer for 20th October Mind Teaser: 1. Buccinator.

Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Poonam Chablani, Dr K V Sarma, Dr K Raju, Dr Avtar Krishan.
Humor
The chemical formula for water

Little Johnny's teacher asks, "What is the chemical formula for water?" Little Johnny replies, "HIJKLMNO"!! The teacher, puzzled, asks, "What on earth are you talking about? Little Johnny replies, "Yesterday you said it was H to O!"
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
Biotechnological Tools should be put increased use to address the Problem of Malnutrition: Dr Harsh Vardhan, Minister for Science & Technology

Union Minister of Science & Technology and Earth Sciences Dr. Harsh Vardhan has said that scientists should endeavour to put biotechnological tools to address the problems related to quality of food and that of malnutrition. The Minister was speaking to newspersons while on a visit to two institutes of national importance namely National Agri-Food Biotechnology Institute (NABI) and the Center of Innovative and Applied Bio processing (CIAB) in Mohali today. While interacting with the faculty, Dr. Harsh Vardhan emphasized the need for quantitative output that can reach common man in form that is easily perceived. He counselled researchers to shift from routine to out of the box thinking and to dream big so that the research outcome could be translated to great innovations.
MAKE SURE
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National Consultation on Private Health Sector Engagement for a TB- Free India
Dr Jagdish Prasad- Director General Health Services, Government of India; Shri Anshu Prakash (IAS) , Joint Secretary – MoHFW; Dr Sunil D Khaparde, DDG TB – Central TB Division, Dr. A. Marthanda Pillai, National President, Indian Medical Association Dr K K Aggarwal, Honorary Secretary General, Indian Medical Association, Mr. Xerses Sidhwa, Deputy Director, Health Office, USAID India called upon Private practitioners to come forth with scope & solutions and help India meet the goals of the End TB strategy.

Speaking on the occasion, Dr Jagdish Prasad- DGHS, Ministry of Health & Family Welfare, Government of India, said “It is difficult for Govt. of India to fight alone the menace of TB. I am happy with the support extended by The Union, IMA and USAID in the area of TB Control & Care. We need the support of the private health sector to be able to reach the missing patients. If we can have wide participation of private practitioners in our mission, we are sure to realise the dream of TB Free India.” Focusing on the need for private sector involvement, Shri Anshu Prakash (IAS) , Joint Secretary – MoHFW lauded the role played by the Private Health Practitioners and called upon a more concerted effort to notify each and every case of TB. Shri Prakash said, “STCI was formulated after extensive consultation with professionals and experts. The need of the hour is extensive sensitization of all health professionals to ensure that standard protocols/ regimens of treatment are followed across the country.” Mr. Xerses Sidhwa, Deputy Director, Health Office, USAID India said that he is encouraged by the incredible participation of multiple professional associations of health practitioners. He said that USAID is committed to support the Government in its endeavours to make India TB Free and offered to partner with IMA and other associations to further the effort.

Dr A. Marthanda Pillai, National President, IMA and Dr K K Aggarwal, Hon. Sec. General, IMA in a joint statement said that that all the doctors from all the National Medical associations should adhere to a common TB protocol to ensure a TB- Free India. The participant Professional Medical and Allied Associations committed action and pledged support for a TB Free India.

The Union South-East Asia Office has been tasked to lead the U.S. Agency for International Development’s (USAID) flagship program for TB, Challenge TB in India. The Call to Action for a TBFree India Is the key focus of the Challenge TB project in India.
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?
Delhi government asks schools to issue swine flu advisory: The Hindu

Kritika Sharma Sebastian

The Delhi government has directed schools in the Capital to issue an advisory on swine flu and display public notices about the respiratory disease on their notice boards. “All heads of government, government-aided, and unaided recognised schools are directed to display the message, enclosed as ‘public notice’, on notice boards to educate students on the symptoms of swine flu and precautions to be taken,” a circular issued by the Directorate of Education (DoE) said.

“During morning assembly, children should be made aware of the do’s and don’ts with respect to the H1N1 virus. They should be encouraged to practise personal hygiene. Lastly, children with flu symptoms should be advised to stay home until they are completely cured,” it said. It also asked the schools to display the list of facilities, including hospitals and laboratories, where treatment for the H1N1 influenza virus is available. “For students of Class I to VIII, competitions like slogan writing, poster making, and debate may be organised at school-level to create awareness of swine flu and importance of hand washing,” the circular further said.

Dr. K K Aggarwal, president, Heart Care Foundation of India, suggested an awareness drive in schools. At an event, he said, “With the surge in swine flu cases, it is essential that awareness be raised of its prevention, especially among schoolchildren, who run the risk of contracting the disease from their schoolmates. Prevention involves taking precautionary steps while coughing, and maintaining hand hygiene.”

Meanwhile, the Delhi government has decided to double the number of hospital beds to step up preparedness against swine flu, which experts say will see a rise as temperature dips. Two people have succumbed to the disease in the Capital this season. Swine flu had assumed epidemic proportions last season and continued till mid-April this year, afflicting over 4,259 people and claiming 12 lives in the city.
(With inputs from Bindu Shajan Perappadan)
World’s largest database of toxins

Venomics, a project financed by the European Commission has created the largest database of toxins in history after analyzing 203 species of poisonous animals, which will in turn help develop new medicines, with focus on cardiovascular diseases, obesity and diabetes. To create it, venom was extracted from the various species and analysed to obtain small amounts of toxins in order to determine their potential uses. Species including snakes, tarantulas, wasps, sea anemones and a very poisonous blue octopus were collected for study during the 2012 and 2013 expeditions to such places as French Guiana, Mayotte and Polynesia. This project was developed with the goal of speeding the development of drugs by using high-yield omics technologies with a budget of 6 million euros ($6.8 million). Rebeca Miñambres, a project director Sistemas Genomicos, a Spanish company which is part of the project said, "The main achievement has been to show that the use of these new omics technologies eliminates much of the complexity of the process and also the time, because using classic procedures would have taken us years. The technology used can be valid for more industries than pharmaceuticals." (The Pioneer - IANS/EFE)
Study reveals poor affordability of common drugs for heat disease

According to the Prospective Urban Rural Epidemiology (PURE) study published in the October 21 issue of The Lancet, almost 60% of Indian households cannot afford the four common medicines that can prevent heart attacks most of the time putting them at risk. The World Health Organisation has proposed that four common medicines to prevent recurrent cardiovascular disease — aspirin, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors, and statins — should be used by 50% of patients by the year 2025. But a survey conducted across 18 countries, which collected data from pharmacies in 596 communities, shows while these medicines were available in many places, they were unaffordable to a majority of the population, particularly in the low and middle income nations, including India. The medicines were potentially unaffordable for less than one percent households in high-income countries compared to 59% of households in India. In low income countries, they are out of reach for 60% households.

Indian results are based on a survey in 90 communities involving 16,874 households, where 686 patients with cardiovascular disease were reported. Almost 19 per cent of these patients use at least one medicine, while another 11 per cent uses either two or three of these medicines. India and other low-income countries showed did not differ much in the use of aspirin; but, beta blockers, ACE inhibitors, and statins were used more often in India.

“Unless governments in low and middle-income countries begin initiatives to make these essential heart medicines available and provided free — as is done for HIV — then their use is always going to be far less than optimal,” said principal investigator Salim Yusuf, director of the Population Health Research Institute, Hamilton Health Sciences and McMaster University, Canada, and president of the World Heart Federation, Geneva. (Deccan Herald – Kalyan Ray)
Coronary artery pressure flow measurements

• The term ‘intermediate stenoses’ refers to those lesions of the coronary artery that are neither critically stenosed nor minimally narrowed (nonsignificant) on coronary angiography. These typically have narrowing (diameter reduction) in the range of 40-80%.
• Fractional flow reserve (FFR) is the clinical standard for the invasive physiologic assessment of the hemodynamic significance (ie, ischemic potential) of intermediate stenoses.
• FFR is superior to intravascular ultrasound for clinical decision making in cases in which the hemodynamic impact of a lesion(s) is in question. In many cases, it is also superior to noninvasive stress radionuclide myocardial perfusion imaging.
• In cases of intermediate stenoses where there is a question of whether revascularization should be carried out, and there are no prior useful noninvasive physiologic data to guide decision making, FFR should be measured before the decision to implant a stent. (Source: Uptodate)
IMA JIMA
IMA Digital TV
GP Tip: Outstretched arms equal height

In a patient who cannot stand by himself or herself because of orthopedic problems, measure the distance between the end of the third finger of one hand and the end of the third finger of the other hand.
(Source: IJCP)
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Readers column
Dear Sir, emedinews is very informative. Regards: Dr Shagun
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Press Release
Happy Dussehra: Fighting your health demons for a healthy life!

This Vijaydashmi, people should find ways to beat key lifestyle evils like stress, depression, insomnia, obesity, smoking, alcohol and drugs

New Delhi, 21st October 2015: Dussehra is one of the most important Hindu festivals, which marks the triumph of good over evil. During the festival, devotees worship Lord Rama, who ended the rule of Ravana thereby reinstating goodness in the World. Likewise, this Dusshera, each one of us should try and fight the evils within us for a healthy and long life.

A balanced state of mind and a healthy lifestyle can go a long way in preventing lifestyle diseases such as diabetes, hypertension, cardiac ailments and obesity. The life of the 21st century Indian is found plagued with evils such as unhealthy eating habits, a sedentary lifestyle, excessive stress, consumption of tobacco and alcohol. The time has come to reverse this trend and make necessary lifestyle changes. Simple everyday lifestyle modifications can do the trick.

Speaking about these, Padma Shri Awardee Dr A Marthanda Pillai – National President Indian Medical Association and Padma Shri Awardee Dr K K Aggarwal – Honorary Secretary General IMA and President Heart Care Foundation of India said, “This Dusshera, we must take a pledge to eliminate evils like smoking and drinking from our lives. To restrict the consumption of food containing high levels of trans fat, sodium and refined sugar. We must deal with stress through a holistic approach and to do away with anger and negativity from our lives. Most lifestyle diseases are preventable and manageable, only when necessary precautionary measures are taken. We must work towards beating obesity, heart disease, hypertension and diabetes. Only when we do, will the true meaning of a victory of good over evil can be achieved.”

Some healthy alterations that one can make:

• To avoid stress, you should start taking short breaks at regular intervals whenever working at the office or even at home. Eat foods like brown bread for carbohydrates instead of white bread, oranges and lemons for vitamin C and spinach for magnesium. A healthy diet and sufficient sleep help release chemicals like serotonin, which helps to reduce stress

• More often than not, people think that smoking helps in reducing stress, which is nothing more but a myth. Excessive smoking aggravates blood pressure, increases heart rate and reduces the supply of the oxygen to the brain. You should immediately quit smoking for a disease free life

• Alcohol is one of the most dangerous evils prevailing in our society; it is responsible for a plethora of medical ailments. Alcohol can worsen heart problems and cause cirrhosis of the liver. It triggers obesity and depression.

• The majority of lifestyle diseases stem from our irregular and unhealthy eating habits. People who indulge in overeating and consume primarily junk food can develop long-term chronic diseases like diabetes, high blood pressure, heart issues due to increased cholesterol and obesity. A balanced diet is a key; consume healthy meals, which have the required nutritional meals you body needs to function efficiently. Consuming small but frequent meals, which contain a sufficient quantity of fruits and vegetables, is key. One should reduce the intake of high trans fat, sugar and sodium laden food.

• Exercise daily; include a 5-minute brisk walk and a 10-minute stretching in your things to do list whenever you get time. Regularly exercising also helps keep a check on hypertension and obesity.
Digital IMA