January 23 2015, Friday
Why Promote Day Care and Home Care Health Care

There is a shortage of hospital beds in the country. The international requirement is one bed for every 800 patients and in India the number is one bed for every 2500 patients.

Few issues

1. Are we really short of doctors: As per international standards doctor work for no more than 48 hours and sees no more than 8-10 patients in day. In India where doctors see over 50 patients a day these shortage may not be real.

2. Are we really short of beds: The World Health Statistics say that India ranks among the lowest in this regard globally, with 0.9 beds per 1,000 population - far below the global average of 2.9 beds. India's National Health Profile 2010 says India has a current public sector availability of one bed per 2012 persons available in 12,760 government hospitals — around 0.5 beds per 1,000 population.

This shortage of beds can be tackled by bringing the concept of minimum hospitalization days and promoting day care and home care.

3. Minimum Hospitalization days: Hospitals are not hotels and prolonged hospitalization should be discouraged.

Healthy people, especially children should not be allowed to stay in the hospital.

There should be a separate night shelter away from the sick patients unit.

The discharge process should be quick so that the patients stay is shortened.

Package days does not mean one has to stay for that long.

Pre op admissions should be avoided just for investigations.

Post op care should be day care, clinic care or home care based.

Rehab care should not be in the settings and vicinity of serious patients.

Mediclaim does not recognize day care treatment for all conditions and in ot networked nursing homes or hospitals. Minimum 24 hour hospitalization is needed for most conditions. For example if a person gets admitted at 7 pm in the evening and gets stabilized in few hours will remain in the hospital till next evening to complete 24 hours and invariably will gets discharged the next morning, consuming two night stay in place of 4 hours stay. A bed unnecessarily gets blocked for two nights apart from more charges and more chances of infection.

4. Promoting day care and home care?

In Ganga Ram Hospital alone in the year 2014, out of total 29494 surgeries 12473 surgeries were done as day care (13223 out of 28666 in the year 2013; 11942 out of 27186 in 2012 and 9955 out of 25135 in 2011). They have been able to reduce the need of beds by promoting day care surgeries.

Day care will also reduce the hospital acquired and health case associated infections and subsequent need for more beds. Longer the duration of treatment more will be the chances of infections.

Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one Hospital Acquired Infection. The estimated rate in USA was 4.5% in 2002, corresponding to 9.3 infections per 1000 patient-days and 1.7 million affected patients, with 99.000 deaths annually. The European centre for Disease Prevention and Control reports an average prevalence of 7.1% in European countries. The cumulative incidence of infection an adult high-risk patients is 17.0 episodes per 1000 patient-days. HAI in low- and middle-income countries; at any given time, the prevalence of HAI varies between 5.7% and 19.1%.

Day and home care will have early IV to oral switch in antibiotics with less resultant cost and less antibiotic resistance.

Dr K K Aggarwal, Padma Shri Awardee, Honorary Secretary General IMA
Health Check Up and CPR 10 Camp at G B S.S.School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014
IMA in the News
Government to supply 500 low-cost Jan Aushadhi Drugs in local stores from July

ET Bureau Jan 20, 2015: NEW DELHI: You may be able to buy nearly 500 low-cost drugs supplied by the government at your neighbourhood pharmacy from July under Jan Aushadhi brand if a plan proposed by an expert panel is implemented.

The drugs are likely to cost 50-95 per cent less than their private branded counterparts, members of the expert committee told ET, adding that the medicines selected under the scheme span six therapeutic categories including cardiovascular, diabetes, respiratory and antibiotics
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Dear Sir, Very informative News. Regards: Dr Karan.
Sterilization Menace an International Concern
Dr KK Aggarwal Some concerns of World Medical Association, answered by IMA.

Q1: Some doctors would be offered compensation to do as many sterilizations as possible in the camp. Is this the case? if so, this would constitute a clear unethical inducement, not placing the health of their patients as their first consideration.

A: Ministry has targets for the government doctors. Normally private doctors do not do such camps. Central Council decision of IMA on 27th December: "IMA has asked for defined protocols for medical professionals for organizing medical and surgical camps. IMA is against any unrealistic targets given to government doctors.

As per IMA guidelines which are also consistent with Govt. guidelines, in one day, more than 30 such surgeries should not be done. IMA wrote to Shri Lov Verma, Health Secretary, Deptt. of H&FW, in early January, to ensure that no unrealistic targets are given to any government doctor in any state.

As per MCI ethics regulation 1.7 it is the duty of a doctor to expose the unethical acts of others.
MCI 1.7 Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.

Q2: Women would undergo surgeries in very questionable hygienic conditions (on the ground, without sterilized medical instruments). Here again, by doing so, doctors would obviously not place the health of their patients as their primary consideration. In addition, this would clearly be contrary to the dignity of the women. Has the Indian Medical Association checked these facts?

A: IMA has written to the health ministry regarding this. Hygienic conditions gets worse only if they surpass their targets. In the present Vilaspur case there were some cases of infections. IMA is in process of uploading its and governments guidelines regarding infection control in camps.

As per MCI ethics regulation 2.4 the patients once taken charge must not be neglected.

MCUI 2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.

Q3: Some doctors would do as many sterilizations as possible under pressure by the State for fear of losing their position. Doctors would then be coerced, undermining their autonomy to carry out their mission according to medical ethics principles. Have you investigated such a potential coercive action by government authorities?

A: See answer to first column as the IMA response. Also only a doctors can put pressure under the junir one and here the MCI ethics regulation 1.7 apply.

Q4: Women would be proposed sterilization as the only contraception method. Can you confirm these information? This would touch upon the right to information of the patients. How can women make a decision on such a key and intimate issue without other options offered? Linked to this, the issue of consent of the patients should also be investigated: the women being sterilized would be living in poverty and be illiterate. In these conditions, are they not likely to be influenced (if not manipulated), potentially lacking the capacity to take the best decision for their health and well-being? There is a clear scope to question the validity of the informed consent of the patients. Has the Indian Medical Association inquired about these facts?

A: Weather in government or in private sector in India no surgery can be done without informed consent. As per MCI ethics regulations 7.16 Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed. In the informed consent all women are given choices of all forms of contraception. Failed sterilization also has a compensation clause.

Q5: All these factors would bring us to the conclusion of cases of forced and coerced sterilization condemned by the WMA as well as by other health and human rights organisation. The recent inter agency statement (WHO, UNICEF, OHCHR, UN Women, UNAIDS, UNDP, UNFPA). Eliminating forced, coercive and otherwise involuntary sterilization goes along the same line.

A: IMA is against forced, coercive and otherwise involuntary sterilization so is Indian government.

Q6: Therefore, the issue of the spurious drugs supplied by the Government in these camps that you mention in your response is just one amongst many other issues that are of very serious concerns to us. If the reports are correct, we see various reasons to raise our voice, given the severe violations of medical ethics and unprofessional behavior as potentially coercive action by government authorities.

A: The issue of spurious drugs is under criminal investigations. Law will takes its own action. Soon in all government supply only government quality approved drugs are to be supplied.
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Quote of the Day
Ambition is the path to success. Persistence is the vehicle you arrive in. Bill Bradley
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CPR 10
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Situation: A patient on dialysis and on oral antacid developed aluminum toxicity.
Reaction: Oh my God! You should have put him on magaldrate preparations?
Lesson: Make sure to remember that magaldrate preparations do not cause aluminum toxicity in patients undergoing dialysis.
The Year in Medicine 2014: News That Made a Difference
Flood of New Drugs for Hepatitis C (and High Prices)
Approximately 1% of US residents are infected with chronic hepatitis C virus (HCV), according to findings of a survey published in the March 3 issue of the Annals of Internal Medicine.(55) Several new hepatitis drugs have flooded the global market in 2014, providing promise for making HCV infection a rarity in about 20 years.(56) Simeprevir (Olysio, Janssen Pharmaceuticals) was the third protease inhibitor for hepatitis C to hit the market in November 2013, (57) and it was also approved in Europe in May, (58) but it still needed to be combined with ribavirin and interferon, which could cause serious adverse effects. Sofosbuvir (Sovaldi, Gilead), the first nucleotide analogue inhibitor, was approved in December 2013 and was a component of the first interferon-free regimen. (59) However, its price tag, $84,000 per year, has been controversial. (60-64) The price of a second Gilead drug, ledipasvir/sofosbuvir (Harvoni), which was approved in the United States in October, (65) is even higher, at $94,000 annually, which is causing pharmacy benefits managers and other stakeholders to hope that new drugs from AbbVie and others will be less expensive (Source: Medscape)
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Rabies News (Dr A K Gupta)
What is "furious form" of rabies in animals?
The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid anim al roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.
eMedinewS Humor
One day theres a couple of kids in a psychology class. The teacher stands up and says to the class “stand up if u think you’re stupid!” after about 5 minutes Little Johnny stood up and the teacher says “do you think you’re stupid Johnny?”
To which Little Johnny replies “No miss i just hate to see you standing there all by yourself!!!
Penalty for repeat of offence
13A. Whoever having been convicted of an offence,-
(i) under clause (a) of section 13 is again convicted of an offence under that clause, shall be punishable with imprisonment for a term which shall not be less than seven years but which may extend to ten years and shall also be liable to fine which shall not be less than five lakh rupees:
(ii) under clause (b) of section 13 is again convicted of an offence under that clause, shall be punishable with imprisonment for a term which shall not be less than five years but which may extend to seven years and shall also be liable to fine which shall not be less than two lakh rupees:
Provided that the court may, for any adequate and special reason to be recorded in the judgment, impose a sentence of imprisonment for a term of less than five years and of fine of less than two lakh rupees;
(iii) under clause (c) of section 13 is again convicted of an offence under that clause shall be punishable with imprisonment for a term which shall not be less than ten years but which may extend to imprisonment for life and shall also be liable to fine which shall not be less than five lakh rupees;
(iv) under clause (d) and clause (e) of section 13 again contravene the provisions of section 9 or any other provision of this Chapter or any rule made under the Act, shall be liable for penalty which may extend to seven lakh rupees to be imposed by the Central Licensing Authority in such manner as may be prescribed;
(v) under clause (f) or clause (g) or clause (h) of section 13 again contravene the provisions of section 9C or any other provision of this Chapter or any rule made under the Act, shall be liable for penalty which may extend to three lakh rupees to be imposed by the Central Licensing Authority in such manner as may be prescribed;
(vi) under clause (k) of section 13 again convicted under that clause, shall be punishable with imprisonment which shall not be less than three year and shall also be liable to fine which shall not be less than one lakh rupees.”.
Amend ment of section 17B.
20. In section 17B of the principal Act, after clause (e), the following shall be inserted, namely:- “(f) if it does not contain active ingredient.”.
Substit ution of new section for section 18
21. For section 18 of the principal Act, the following section shall be substituted, namely:-
Prohibi tion of manufa cture and sale of drugs and cosmeti cs
“18. (1) Save as otherwise provided in sub-section (3), no person shall himself or by any other person on his behalf,-
(a) manufacture for sale, distribution or marketing, sell, stock, exhibit, offer for sale or distribute any,
(i) drug which is not of a standard quality, is misbranded, adulterated or spurious;
(ii) cosmetic which is not of a standard quality, or is misbranded, adulterated or spurious;
(iii) proprietary medicine, unless there is displayed in the prescribed manner on the label or container thereof the true formula or list of active ingredients contained in it together with the quantities thereof;
(iv) drug which by means of any statement, design or device accompanying it or by any other means, purports or claims to prevent, cure or mitigate any such disease or ailment, or to have any such other effect as may be prescribed;
(v) cosmetic containing any ingredient which may render it unsafe or harmful for use under the directions indicated or recommended;
(vi) drug or cosmetic in contravention of any of the provisions of this Chapter or any rule made there under;
(b) sell, or stock or exhibit or offer for sale, or distribute any drug or cosmetic which has been imported or manufactured in contravention of any of the provisions of this Act or any rule made there under;
(c) manufacture for sale or for distribution or for market, or sell, or stock or exhibit or offer for sale, or distribute any drug or cosmetic,
except under and in accordance with a licence issued under this Chapter by the State Licensing Authority:
Provided that nothing in this section shall apply to the manufacture of small quantities of any drug for the purposes of examination, test or analysis:
Provided further that the Central Government may, after consultation with the Board, by notification, permit, subject to any conditions specified in the notification, the manufacture for sale, or for distribution, sale, stocking or exhibiting or offering for sale or distribution of any drug or class of drugs not being of standard quality
(2) The licence for the manufacture for sale or distribution or marketing of any new drug shall be issued by the Central Licensing Authority in such manner as may be prescribed
(3) Notwithstanding anything contained in sub-section (1), on and from the commencement of the Drugs and Cosmetics (Amendment) Act, 2014, the Central Licensing Authority shall have exclusive power to issue a licence in respect of manufacture for sale or for distribution or for marketing of drugs specified in the Third Schedule in such manner as may be prescribed;
(4) The Central Government, after consultation with the Board, and after previous publication, by notification, may amend the Third Schedule.
Dr KK Spiritual Blog
Do what you do to God
  1. There are two types of people who believe in Dvaita or Advaita philosophy.
  2. People who believe in Dvaita philosophy, for them God and human being are different.
  3. The people who believe in Advaita philosophy believe that God is within them.
  4. In Hinduism, the first group believes in Sanatan Dharma and does Moorti pooja (idol worship) and the second Arya Samaj, which does not believe in Moorti pooja.
  5. In both situations, medically the message is one.
  6. If God is different than you, then you try to be like Him and if God is in within you, then you are Him.
  7. In both situations, we should deal with our body the same way as we deal with God.
  8. Anything which is not offered to God should not be offered to our body such as cigarettes, drugs etc or such things should be consumed in less quantity (onion, garlic, radish etc.).
  9. We never worship God with hydrogenated oil; we always worship him either with oil or with Desi Ghee. The message is we should not consume trans fats.
  10. "Bhagwan ko bhog lagate hain" and we never feed God. The message is, we should eat less.
  11. Amongst all Gods, only Lord Shiva is said to consume Bhang and Alcohol that too only in his incarnation of Bhairon, which indicates that both alcohol and bhang can be consumed in some quantity only in special situations meaning that they cannot be consumed without medical supervision.
  12. Anything grown under the ground is not offered to God, thus, these items should not be eaten or eaten in moderation.
  13. We never offer white salt and white rice to God. They are also bad for human beings.
  14. Gur, shakkar, brown rice and puffed rice are offered to God. They can be consumed by human beings.
News around the Globe
  • A drug commonly used to treat attention-deficit/hyperactivity disorder (ADHD) may be safe and effective in treating binge eating disorder (BED), suggests new research published online in JAMA Psychiatry.
  • A nonpharmacologic intervention that involves daylight control and cognitive stimulation can significantly reduce the common problem of delirium in the intensive care unit (ICU), suggests new research presented at the Society of Critical Care Medicine 44th Critical Care Congress.
  • Some patients with keratinocyte carcinoma (KC) who remain free of subsequent tumors for two years tend to be at low risk and may not need routine follow-up screening, suggests new research published online in JAMA Dermatology.
  • A self-expanding polyurethane foam may help soldiers, as well as civilians, with severe abdominal hemorrhage survive long enough to reach a hospital and undergo surgery, reports preliminary research presented at the Eastern Association for the Surgery of Trauma (EAST) annual meeting.
  • Socially disadvantaged HIV-infected women who start highly active retroviral therapy (HAART) for the first time during pregnancy may be at higher risk for detectable virus at delivery than their better-off peers?, suggests a study published in the January 20 issue of the Annals of Internal Medicine.
Dr Good Dr Bad
Wellness Blog
Alcohol: Benefits Vs Risk
  • There is consensus that non drinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications. People tend to consume more alcohol in winter and near the New Year.
  • Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.
  • The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.
  • For young to middle–aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).
  • Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.
  • Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.
  • Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 grams per day. Medically safe limits are 10 grams in one hour, 20 grams in a day and 70 grams in a week. (50% for the women).
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues
h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -
Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health
Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
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 https://www.youtube.com/watch?v=rjOel0aaqt0
IJCP’s ejournals
  • Indian Journal of Clinical Practice
  • Indian Journal of Multidisciplinary Dentistry
  • Asian Journal of Diabetology
  • Asian Journal of Critical Care
  • Asian Journal of Clinical Cardiology
  • Asian Journal of Obs & Gyne
  • Asian Journal of Paediatric Practice
  • Asian Journal of Ear Nose and Throat
IMA Rare Blood Group Online Blood Bank Directory

IMA has started an online voluntary rare group blood bank, where a list of all rare blood groups will be displayed.

IMA has appealed to all people with rare blood groups, especially the Bombay blood group to pass on their name, address, email and mobile numbers so that the same can be uploaded on the IMA website.

People with rare blood groups can often be given a blood, when needed, only from people with the same blood group. And in life threatening such a website will c0me handy to save lives.

What is a rare blood group?

A: A rare blood is the one that, on the basis of the blood group characteristics, which is found in a frequency of 1: 1000 random samples in a given population.

From blood transfusion point of view, a rare blood is the one with red cells lacking a high-frequency blood group antigen.

Besides, a blood that lacks multiple common antigens may also be considered as a rare since such donor's blood may be useful for the transfusion recipient who has developed multiple antibodies to corresponding antigen.

Are rare blood groups present all over the world?

No. Rare nature of a blood type may vary from one country to another and therefore a blood type rare in one country may not be considered rare in another.

Which is the commonest rare blood group in India?

Bombay blood group.

Bombay (Oh) phenotype. Bombay hh.

Why it is called Bombay blood group?

The Bombay phenotype is found almost exclusively in individuals from India, with an incidence of 1/10,000.

What is lacking in Bombay blood group?

In the Bombay phenotype, fucosyl transferase, which conveys H antigen specificity, is lacking. Since the H antigen is the building block for the A and B antigens, neither A nor B can be produced, even in the presence of their respective transferase enzymes. Thus, red cells of the Bombay phenotype lack A, B and H antigens. These individuals naturally produce anti-A, anti-B, and broad thermal range anti-H antibodies, and they can only be transfused with blood from other individuals of the Bombay phenotype (usually a relative, although autologous blood can be obtained by apheresis prior to a surgical procedure or risk a severe hemolytic transfusion reaction.

Can Bombay blood group patients donate blood?

They are universal (ABO) donors.

How will one detect Bombay blood group?

Tests would show them to be O, unless further tests were performed. Cross matching of blood from an individual with this phenotype will show hemolysis with all group O screening cells and panel cells, alerting the blood bank to the need for further investigation. If an individual with the Bombay phenotype needs blood in an acute emergency and blood from a Bombay phenotype donor is not available what are the options?
  • Look at IMA website for potential donor in that city
  • Get blood tests done of all your relatives one of them may be Bombay Blood Group.
  • Use artificial blood could be used instead.
  • Autologous blood can be obtained by apheresis prior to a surgical procedure
What are other rare blood groups?
  • - D -/- D -
  • In(a+b-)
  • Co(a-b-)
  • A host of weaker variants of A, B and H antigens
  • I-i-
  • CdE/CdE (ryry)
  • Mg
What about AB negative blood group?

AB negative overall, though different parts of the world have different instances of blood type. In the US, AB negative is extremely rare, but not in Asia. Still, overall, it is the rarest, unless you consider the Bombay a group. (Compiled by Prof Dr K K Aggarwal, Padma Shri Awardee, Honorary Secretary General IMA 1014-16)
Trimethoprim- sulfamethoxazole and sudden death
Quality Care in PICU – Error free PICU in India

Dr Krishnan Chugh, Fortis Memorial Research Institute, Gurgaon
  • Quality care - The degree to which health services increase the odds of desired health outcomes and are consistent with current professional knowledge.
  • Quality indicators:
    • Structural indicators - Nurse-patient ratio; Space per patient
    • Outcome indicators - All cause mortality; Sepsis-specific mortality
    • Process indicators - Time to administration of the first dose of antibiotic in septic shock.
  • The Quality Indicators in a PICU are as follows:
    • Appropriate policies should be followed for transfer or referral of patients to or from the PICU
    • Laboratory services and imaging services are provided as per the requirements of the patients in PICU
    • Documented policies and procedures should guide nursing care, appropriate pain management
    • Policies and procedures must define rational use of blood and blood products
    • Documented policies and procedures should guide appropriate rehabilitative services, nutritional therapy and research activities
    • Documented policies and procedures must guide the end of life care
    • Documented policies and procedures guide the storage of medication
    • Near misses, medication errors and adverse drug events must be reported and analyzed
    • The organization should have a Hospital Infection Control (HIC) program
    • Actions are taken by the organization to prevent and control healthcare-associated infections (HAI) in patients
    • Biomedical waste (BMW) is handled in an appropriate and safe manner
    • The PICU conducts proper monitoring and analysis of important Quality indicators
    • Length of stay is therefore used to assess quality of care and resource utilization
    • Readmission to the ICU within 24 hours of transfer during a single hospital stay is an indicator of post-ICU care. A zero readmission rate reflects more defensive approach by ICU team causing risk of nosocomial infection, iatrogenic complications, and nonavailability of bed for the deserving paitents. A higher readmission rate suggests premature decision to shift out.
  • Medication error could occur due to wrong prescription, dosing and due to communication gap (verbal or written).

Medication error rate = (no. of error/no. of bed days) x 1,000
  • Common ICU errors are associated with treatment, procedure, ordering or carrying out medication orders, reporting or communication, and failures to take precautions or follow protocols.

Adverse events/error rate = (no. of error/no. of bed days) x 1,000
  • Errors occur because of the following reasons:
    • Poor communication with staff and co-workers, errors during handover
    • Difficult working conditions (noisy, distractions)
    • High turnover of patients and providers
    • Multiple care providers - integration of different care plans difficult.
  • Commandments for Quality care:
    • Always simultaneously evaluate history of disease and treatment in the past as it may affect current management
    • Individualization specific to disease may be necessary in priortizing sequence of interventions
    • Do not give oral orders in nonemergent situations
    • Always give specific written orders
    • Use separate port for each inotrope and ensure that each port is labeled with a color-coded sticker
    • Ensure proper labeling of all medications in PICU o Do not over-rule the protocols made for procedures
    • Never give sedation without being prepared for resuscitation
    • Never be over confident o Always assess the patient as a whole.

Aniruddha Chatterjee, New Delhi.

1. How important is DHA for growing children?

DHA plays numerous important biophysical roles in brain structure and function, and has the potential to influence neurocognitive development and subsequent performance.

2. Where does the DHA supplemented in foods such as infant formula come from?

The DHA added to infant formula are sourced from algal and fungal oils or fish oil.

3. Is the current rate of breastfeeding in India sufficient enough to fulfil kids’ DHA requirements?

Annually about 26 million babies are delivered in India. According to National Family Health Survey-3 (NFHS-3) data, 20 million are not able to receive exclusive breastfeeding for the first six months and about 13 million do not get good timely and appropriate complementary feeding after six months along with continued breastfeeding.

4. What role does DHA have in visual development?

DHA serves as a key structural component of cell membranes and is found in high levels in the cells of the retina and the brain, comprising approximately 30-65% of the cell membrane fatty acids of the rods and cones in the retina.

5. What is the ideal DHA requirement for children 1-5 years of age?

A recommendation of DHA for infants and young children (6-24 months of age) ranges from 70-100 mg/day.

6. How does DHA improve cognition in kids?

Childhood is a period of brain growth and maturation. DHA is the principal omega-3 fatty acid in brain’s gray matter representing about 15% of all fatty acids in the human frontal cortex and is known to affect neurotransmitter pathways, synaptic transmission and signal transduction.

7. Is it safe to give DHA during pregnancy?

DHA can be given from the first trimester of pregnancy.

8. At what age can DHA supplementation be started?

DHA supplementation can be started even in neonates.
AICOG 2015
Dr Valluri Padmini, Secundrabad

What are the symptoms of PCOS?

The common symptoms of polycystic ovarian syndrome are irregular menstrual cycles, hirsutism and acne.

What is the role of insulin resistance in these symptoms?

Insulin resistance causes anovulation.

What are the various health risks associated with PCOS?

Hypertension, endometrial cancers are some of the important health risks associated with PCOS.

How do insulin sensitizers help in the management of PCOS?

Insulin resistance and hyperinsulinemia are important factors implicated in the development of PCOS. Hence, by reducing insulin resistance, insulin sensitizers help relieve symptoms.

What are the disadvantages of the available treatment options?

Acidity, weight gain…these are common adverse effects associated with the available treatment options.

What is the evidence supporting the role of myoinositol in PCOS?

Through patient coming to conceive with myoinositol.

Dr BS Madhuri

What are the symptoms of PCOS?

The common symptoms of polycystic ovarian syndrome are infertility, hirsutism, prolonged menstrual periods and cysts in the ovaries.

What is the role of insulin resistance in these symptoms?

Insulin resistance leads to hyperinsulinemia, which increases androgen levels, poor oocyte quality, absence of menses leads to PCOS.

What are the various health risks associated with PCOS?

Some of the important health risks associated with PCOS are diabetes, hypertension, endometrial cancers and lipid abnormalities.

How do insulin sensitizers help in the management of PCOS?
Insulin sensitizers reduce insulin resistance in PCOS.

What are the disadvantages of the available treatment options?

Gastrointestinal side effects, including nausea, multiple pregnancy are some disadvantages of the available treatment options.

In your opinion, what is the rationale of using myoinositol in PCOS?

Myoinositol is a natural insulin sensitizer.

What is the evidence supporting the role of myoinositol in PCOS?

Myoinositol improves ovarian function, metabolic and hormonal parameters in women with PCOS.

What are the advantages of the combination of myoinositol and folic acid help PCOS vis-à-vis metformin?

The advantages are: helps in ovulation in amenorrhea patients, better patient compliance, no multiple pregnancy.
Inspirational Story
Nature’s lessons

Why don’t you and your friend get together and play the game?

One of you say the name of any bird, animal, worm or plant and guess what you can learn from it. There usually is something so do not give up too easily. And if you stumped you can always ask the grown up to help you out. Take, for instance, ants. Are they not a model of hard work? How busily and tirelessly they ferret for food all day. They are excellent at team work too. It is wonderful to see six or seven of them haul away a tiny shred of coconut or grain of sugar.

And what about the crow? Most people don’t like crow but I think they are admirable. Do you know that they are nature's garbage disposers? Give them anything, even rotten food, and they will gratefully gobble it up. Another remarkable trait is that when one of them spies food, they generously call out to their fellows, even if it is just a mite, so go ahead and see what our animal friends have to teach us.
eMedi Quiz
Elements of primary health care include all of the following except:

1. Adequate supply of safe water and basic sanitation.
2. Providing essential drugs.
3. Sound referral system.
4. Health Education.

Yesterday’s Mind Teaser: A married middle aged female gives history of repeated abortions for the past 5 years. The given below is conceptions pre-natal karyogram. This karyogram suggests the following:

1. Klinefelter's syndrome.
2. Turner's syndrome.
3. Down's syndrome.
4. Patau's syndrome.

Answer for yesterday’s Mind Teaser: 3. Down's syndrome.

Correct Answers received from: Dr Avtar Krishan.

Answer for 21st Jan Mind Teaser: 4. Glycosylation.

Correct Answers receives: Daivadheenam Jella, Dr Avtar Krishan.
IJCP Book of Medical Records
IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one day.
Press Release of the Day
PEDICON 2015, the largest congregation of pediatrics in India, begins in the capital

The 52nd Annual National Conference of Indian Academy of Pediatrics aims to explore the latest developments in the field of pediatrics

The 52nd Annual Conference of Indian Academy of Pediatrics, PEDICON 2015, was inaugurated today in the presence of Hon'ble Secretary Health & Family Welfare, Shri. Lov Verma, the Chief Guest for the evening. With over 8,000 delegates expected, PEDICON is the largest conference on Pediatricians in India. In its 52nd edition, the conference is taking place from Jan 22 – 25 at the Samrat Ashok Hotel Complex in New Delhi.

Dr. Ajay Gambhir, Organizing Chairperson PEDICON 2015 and Dr Anupam Sachdev, the Organizing Secretary addressed the conference. Other dignitaries who graced the occasion with their presence included Dr. S. S. Kamath (President, IAP), Dr. Pramod Jog (President – Elect, IAP), Dr. Vijay N. Yewale (Immediate Past President, IAP), Dr. Pravin Mehta (Secretary General, IAP), Dr. Krishan Chugh (Org. Chairperson, IAP) and Dr. N. K. Anand (Reception Chairperson & Organizing Secretary). The inaugural ceremony also witnessed a dance recital by world-renowned Kathak dancer, Smt. Shobhna Narayan and by a troupe of extremely talented special children. The breathtaking act mesmerised the audience present at the ceremony.

The 4-day conference will see major issues discussed, such as the gaps that exist in healthcare implementation, the lack of interface between public and private players, child survival strategy in a tribal set up and decoding of the IAP growth chart coming to the forefront. To encourage young talent, 40 scholarships would be awarded to young pediatricians presenting the free papers.

Congratulating the Indian Academy of Pediatrics on successfully organising PEDICON 2015, Hon'ble Secretary, Health & Family, Shri. Lov Verma said, “Complete transformation of the health sector through research, latest technology and innovation is the aim of our government. Conferences like this contribute a lot in raising the bar of healthcare. Children are the future of the country and we are committed to ensure that their health is taken proper care of through rational health policies, healthy lifestyles and, most importantly, doctors who are skilled and updated with the latest advancements. We strongly need the support of bodies like Indian Academy of Pediatrics to fulfill our commitment.”

Speaking about PEDICON 2015, Dr. Ajay Gambhir, Organizing Chairperson of the conference said, “We are happy and proud to announce that over 8000 delegates are attending the conference, thus, making PEDICON the largest conference on Pediatrics in India. We have over 800 free paper presentations, 150 free paper oral presentations, 650 poster presentations and this year we have introduced E posters too.”

Adding to this, Dr Anupam Sachdev, Organizing Secretary, PEDICON 2015 said, “The conference is an excellent platform for knowledge sharing. A convention of such scale wherein doctors from all across the country have come together would surely help in bringing forward the latest technology and advancements happening in the arena of pediatrics. I thank Shri. Lov Verma ji for his support and presence today and hope that together we can bridge the gap between the functioning of the public and private sector towards providing better healthcare facilities for children.”

On the occasion, Dr. S. S. Kamath (President, IAP) said,” It is unfortunate that India has the highest new born mortality. What is more concerning is the fact that the health budget has come down and in the healthcare field, 30% goes in manpower development. Also, India is not getting much pediatricians in spite of increasing medical seats because people are choosing to go for specializations like radiology and other fields instead. Thus, PEDICON provides a good opportunity to bring together the leading healthcare experts in the field of pediatrics who can brainstorm about the future of healthcare and more specifically pediatric healthcare.”

According to Dr. Krishan Chugh (Organising Chairperson, IAP), "Quality development of every child is only possible when quality medical care is provided at every point in their lives, both when they are unwell and when they are healthy. While to some extent the private sector has succeeded in achieving this, it is only possible to attain International standards of medical care when there is a strong public private partnership. I really hope that we can in the coming future work towards building highly advanced children's hospitals based on this model."

Recognizing the importance of skill and educational training for doctors and the lack of available public sector programs for the same, a special focus was given to these in the pre-conference and inaugural sessions. As a pre-conference initiative, about 40 workshops on skill training were held at various reputed hospitals of Delhi NCR on subjects like primary immunodeficiencies for practicing pediatricians, computers in pediatric practice and the role of imaging & ultrasound in pediatric intensive care. On the inaugural day, 7 parallel Continuing Medical Education (CME) programs were held wherein National and International experts discussed topics like immunology of vaccines, status of adolescent health in India, social media and internet addiction and congenital diaphragmatic hernia among many others.

To know more please visit www.pedicon2015.com

About Indian Academy of Pediatrics (IAP):

The Indian Academy of Pediatrics was established in 1963, at Mumbai with a little more than 150 pediatricians as its members. In its Golden Jubilee year, 2013, there are over 23,000 members across the country. It has 26 State, and 303 District, and City level branches. The Academy has promoted different specialties in the field of Pediatrics through it various Chapters. IAP is the largest and most representative association of Pediatricians in India as compared with other organizations of medical specialties that are often fragmented and segmented. This indicates the unity that the association has been able to maintain among its members over the past 50 years.