February 24  2015, Tuesday
editorial
Medical Profession and Corrupt Practices
Dr A M Pillai and Dr K K Aggarwal This has reference to a news published in TOI about the corrupt practices in medical profession. IMA does not support its members if found in violation of any of the MCI ethics regulations analyzed below
Dr KK Aggarwal
Doctors with conscience speak out
Rema Nagarajan,TNN | Feb 22, 2015, 06.24 AM IST
 
In order to benefit the hospital and meet its commercial needs, one has to do things like keeping patients in the hospital longer than necessary, and doing unnecessary investigations and procedures (including angioplasty) since there was pressure from the management of the hospital.  My conscience began pricking and I left the hospital- Dr Gautam Mistry, Kolkata, cardiologist who left a corporate hospital after seven years.
These are violations of MCI act. The concerned doctor should bring it to the knowledge of the state council.
1. Regulation 1.7 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, reads as follows:  “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.”
2. MCI 3.1.2:  Consulting pathologists /radiologists or asking for any other diagnostic Lab investigation should be done judiciously and not in a routine manner.
3. MCI : 2.3 Prognosis: The physician should neither exaggerate nor minimize the gravity of a patient’s condition. He should ensure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.
4. MCI 3.1 Unnecessary consultations
Unnecessary consultations should be avoided. b. 3.1.1 However in case of serious illness and in doubtful or difficult conditions, the physician should request consultation, but under any circumstances such consultation should be justifiable and in the interest of the patient only and not for any other consideration.
A reference for angioplasty can earn a doctor Rs 30,000-40,000 - Dr Rajendra Malose, general practitioner, Nashik

Recently, a young doctor who joined our department told me, "Sir, every month there is a meeting with the CEO. He asks me questions because instead of having a 40% conversion rate for OPD-operative as per the target, my conversion rate is just 10-15%. (Conversion rate means out of all patients seen by the doctor, how many are advised to undergo surgery or procedures. Rational doctors try to keep this rate low, but profit-driven hospitals try to maximise number of surgeries and procedures, even if they are unnecessary). He tells me that such low conversion rate will not do, and that unless I increase it, I will have to leave the hospital." This young doctor will certainly surrender one day. To survive professionally, he will start doing 20-25% of additional procedures that are not required by medical logic. What choice does he have?"... And each corporate hospital has such targets! There is no getting out of it. – Super specialist from a metro
MCI Ethics Regulation: 6.4 Rebates and Commission:
6.4.1 A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment.

6.4.2 Provisions of para 6.4.1 shall apply with equal force to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study / work. Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision

In the last Central Council meeting of IMA held in Ahmadabad it was decided that IMA is against giving any targets weather in government or in private sector to its members.
Pharma companies are giving foreign tours and junkets to doctors. It happens under the pretext of medical study. Unfortunately, some doctors eagerly wait for the pharma company invitation for foreign tours- Dr HV Sardesai, physician Pune.
MCI regulation 6.8 covers it
Code of conduct for doctors in their relationship with pharmaceutical and allied health sector industry.

6.8.1 In dealing with Pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:-

a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives. 

b) Travel facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship , cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc as a delegate.

c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.

MCI has taken actions

MCI takes action on 15 doctors of Madhya Pradesh for sponsored foreign visits: Ashish Gaur, TNN | Feb 23, 2015

INDORE: In one of the major action on the medicos of the state, the Medical Council of India (MCI) has cracked its whip on 15 such doctors who went for pharma company sponsored foreign visits.

A MCI letter states that names of 15 doctors should be suspended. These doctors were found guilty of misconduct under the Clause 6.81-B of MCI Ethics Regulations by the Ethics Committee.

Suspension recommendation of the names have come after approval from the executive committee of the council.

Apparently, the MCI has taken the decision on the basis of a complaint which was lodged in 2012 against 15 doctors of the state and Intas Pharma for visiting UK in a sponsored trip.

The MCI has also ordered the DCGI & DGHS to take appropriate action against Intas Pharma, Ahmedabad.

The names of the doctors mentioned in the order include Dr Atul Sahai, Dr Shweta Sahai, Dr Narottam Vaishya of Gwalior, Dr Shrikant Rege, Dr Mahendra Chauhan, Dr Vrishali Nadkarni, Dr Vinod Nadkarni, Dr Dhanraj Panjwani, Dr Rajesh Mulay, Dr Swati Mulay, Dr Atul Tapadia and Dr Jaishree Tapadia of Indore, Dr Alok Agrawal, Dr Harsha Saxena and Dr Prachi Saxena of Jabalpur. In Panjwani's case tickets were booked but it is not clear who paid for it.
Corporate hospitals only want doctors who can help them earn more money. As a result doctors who practise ethically cannot last there. I know of a hospital where if a patient is charged Rs 1.5 lakh, the doctor gets a mere Rs 15,000. 90% of the income goes to the corporate coffers. Corporate hospitals can advertise while individual doctors are not allowed- Dr Sanjay Gupte, gynaecologist, Pune, ex-national president of the Federation of Obstetric and Gynaecological Societies of India (FOGSI)
Corporate organisations also  cannot advertise under MCI ethics regulation 6.1 
6.1 Advertising:
6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical. 
But under MCI ethics 7.12 one can advertise when'  7.12 An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees
These are just a few of the shocking revelations by 78 doctors from small towns to every one of the megacities who are critical of the growing commercialization of medical care. The doctors range from general practitioners to super specialists in corporate hospitals. These interviews that expose the corruption in private healthcare have been put together by SATHI (Support for Advocacy and Training to Health Initiatives), an NGO, to highlight the lack of regulation of the sector.

A report based on these interviews titled, "Voices of Conscience from the Medical Profession: Revealing testimonies by rational doctors about the reality of private medical practice in India" has been put together by Dr Arun Gadre, a doctor and writer with 20 years' experience of working as a gynecologist in rural Maharashtra, and Dr Abhay Shukla, convenor of SATHI who did his MBBS and MD from AIIMS. 
These should have been exposed under MCI ethics regulation 1.7 reproduces again: 1. Regulation 1.7 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, reads as follows:  “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.”
The report will be released at the All India Institute of Medical Sciences (AIIMS) on February 26, in a function to be attended by AIIMS director Dr MC Mishra, senior gastrointestinal surgeon Dr Samiran Nundy of Sir Ganga Ram Hospital, and several of the doctors from across the country who have spoken out in the report.
The report is an English translation of the recently published Marathi report “Kaifiyat – pramanik doctoranchi”, which is being widely read in Maharashtra and is already into its second edition. An enlarged version of this report is soon to be published as a book.
MCI should sumoto take action on all the cases mentioned and exposed in this book
"These 'whistleblower' doctors have exposed, perhaps for the first time on such a scale and in so many dimensions, the realities of the private medical sector today such as frequent irrational procedures and surgeries, the distorting influence of corporate and multi-specialty hospitals on ethics of the medical profession, and the growing grip of pharmaceutical companies on private medical practice. With testimonies by rational doctors from across India, this report can be an eye-opener for ordinary citizens as well as doctors, and could strengthen social support for much-needed moves to effectively regulate the private medical sector in India," explained Dr Shukla
As above
According to him, the government is trying to dilute the Clinical Establishments Act of 2010 on the grounds that outdated laws have to be changed. " The rules were passed in 2012 and the standards are yet to be formulated because of which it has not been implemented. Even before its implementation you are saying it is outdated. There is a strong lobby of the corporate health sector and the Indian Medical Association, the biggest lobby of doctors in India, that are trying to completely eliminate any kind of regulation. It is total jungle raj now. This is the larger policy environment in which we are releasing the report," said Dr Shukla.
IMA is in the committee for the formation of rules of CEA and is working with the government in this respect. IMA is only against some of the rules which are not in the interest of community.
Public health activists have stressed the need to urgently step up regulation of the private health sector rather than dilute whatever little regulation exists. "Doctors have their lobbying groups like the IMA, which will speak of their interests. Society needs to speak up and lobby for the interests of the patients," said Dr Shukla.
IMA always stand with strict application of above MCI regulations
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Heart Care Foundation of India launches its key project – Sameer Malik Heart Care Foundation Fund – in Varanasi
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News Around the Globe
  • Central government recently included drug mephedrone or meow as psychotropic substance under the Narcotics, Drugs and Psychotropic Substances (NDPS) Act, 1985, deeming it illegal.
  • The US Food and Drug Administration (FDA) has approved the VenaSeal closure system, the first device to permanently treat varicose veins by sealing them with an adhesive agent.
  • A systematic appraisal of published case reports supports a causal link between smoking marijuana and cerebrovascular events, suggests new research published online in Stroke.
  • New research suggests that the skin damage caused by UV rays does not stop once you get out of the sun. The potentially cancer-causing damage from the ultraviolet radiation from sunlight or tanning beds occurs up to three to four hours after exposure due to chemical changes involving the pigment melanin. The research is published in the journal Science.
  • A new randomized clinical trial suggests that aflibercept, bevacizumab, and ranibizumab all improve vision in eyes with center-involved diabetic macular edema. Aflibercept appears to be more effective in patients with worse levels of initial visual acuity. The findings are published online in the New England Journal of Medicine.
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Make Sure
Situation:A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy. Gingival hyperplasia is a known side effect of amlodipine.
Dr Good Dr Bad
Situation:A patient was found to have high triglycerides
Dr. Bad: Stop fat intake.
Dr. Good: Reduce refined carbohydrates.
Lesson: Triglyceride are refined carbohydrates dependent and not fat.
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Dr KK Aggarwal: Avoid chocolate for heartburn By Dr K K Aggarwal http://youtu.be/NMIK16PyBrY?a via @YouTube

Dr Deepak Chopra:If you can see it then it is not real. Reality is the invisible seer without which there is no seeing http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
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
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
IMA NEWS
Handle Swine Flu ‘Smartly’
Swine Flu’s killing power is more ‘phony’ than real

Handle Swine Flu ‘Smartly’

MediToAll" New Delhi, January18: As the danger of swine flu is more ‘phony’ than real, a smart phone could be a handy tool to more effectively handle swine flu.

Indian Medical Association has advised doctors not to see mild swine flu patients. In a press conference today, Dr. K.K. Aggarwal said, ‘telephone consultation is enough for such patients. Rushing them to hospitals without symptom of progressive breathlessness only complicate the matter by spreading infections far and wide. Doctors can use smart phones like iphone, Skype etc to see such mild swine flu patients and advice.’ He said, ‘IMA headquarters has sent this advisory to its all about 2 and half lakh members throughout India not to see patients with mild swine flu like symptoms.’

Terming panic about swine flu absolutely unnecessary, Dr. Aggarwal said, ‘No one dies of swine flu. It is pneumonia that kills if not tackled in time. In a thousand swine flu infected people only three develop pneumonia, so the stampede towards hospitals and clinics with mild symptoms is useless. In fact, normal flu has more power to kill than swine flu. ’

Dr. Aggarwal further said, ‘The government should move to streamline the ‘language’ that is being spoken by doctors and media. The best strategy to stem the unnecessary panic is government should formulate a ‘swine flu language’ and direct media and doctors to use it uniformly. It is diversity of language that is creating panic. IMA has sent its

‘language’ to all its members and has directed them not to exceed it while speaking.’ Given the ‘killing’ made by health providers and testing laboratories to fill their coffers taking advantage of the scare, Dr. Aggarwal called for rationalization of investigations, admissions and treatment. He also stressed that the government should fix the investigation cost with no variables and should also subsidize it. The government should also release advisory regarding when not to investigate and when not to admit.

He appealed for following the triad of respiratory hygiene, cough etiquette and hand hygiene for prevention of infection. According to him, the mean incubation period for flu is 1.5 to 3 days and the virus shedding begins the day prior to symptom onset and often persists for five to seven days or longer in immunocompetent individuals. Even longer periods of shedding may occur in children, elderly adults, patients with chronic illnesses, and immunocompromised hosts.

It is important to protect people from getting infections from each other.As mild flu does not require any investigations and treatment doctors should avoid calling them in the clinics. Instead they should encourage phone consults..

Dr Aggarwal said that respiratory transmission occurs mainly by droplets disseminated by unprotected coughs and sneezes and prevention lies in implementing respiratory hygiene, cough etiquette, and hand hygiene.Respiratory hygiene and cough etiquette applies to all patients and accompanying family or friends who have signs of respiratory illness such as cough, congestion, nasal discharge or increased volumes of respiratory secretions.

Maintain a distance of 3-6 feet from a person who is coughing or sneezing , cover coughs and sneezes with disposable tissues and wash hands if get spoiled with respiratory secretions, added Dr Aggarwal. Never cough in the hands or cloth handkerchief, instead use tissue paper or cough on the sides of your sleeves, warned Dr Aggarwal.

Frequent hand hygiene should be performed, including before and after every patient contact, contact with potentially infectious material, and before putting on and after taking off personal protective equipment, including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol–based hand rubs. If hands are visibly soiled, they should be washed with soap and water. In clinics all doctors should provide face masks to patients with signs and / or symptoms of respiratory infection and provide them space and encourage patients with respiratory symptoms to sit as far away from others as possible
MCI NEWS
MCI takes action on 15 doctors of Madhya Pradesh for sponsored foreign visits

Ashish Gaur,TNN | Feb 23, 2015, 05.08 AM IST

 INDORE: In one of the major action on the medicos of the state, the Medical Council of India (MCI) has cracked its whip on 15 such doctors who went for pharma company sponsored foreign visits.

 A MCI letter states that names of 15 doctors should be suspended. These doctors were found guilty of misconduct under the Clause 6.81-B of MCI Ethics Regulations by the Ethics Committee.  Suspension recommendation of the names have come after approval from the executive committee of the council.

 Apprarently, the MCI has taken the decision on the basis of a complaint which was lodged in 2012 against 15 doctors of the state and Intas Pharma for visiting UK in a sponsored trip.  The MCI has also ordered the Drug Controller General of India and Director General of Health Services to take appropriate action against Intas Pharma, Ahmedabad.  The names of the doctors mentioned in the order include Dr Atul Sahai, Dr Shweta Sahai, Dr Narottam Vaishya of Gwalior, Dr Shrikant Rege, Dr Mahendra Chauhan, Dr Vrishali Nadkarni, Dr Vinod Nadkarni, Dr Dhanraj Panjwani, Dr Rajesh Mulay, Dr Swati Mulay, Dr Atul Tapadia and Dr Jaishree Tapadia of Indore, Dr Alok Agrawal, Dr Harsha Saxena and Dr Prachi Saxena of Jabalpur. In Panjwani's case tickets were booked but it is not clear who paid for it.
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The Vedic meaning of Mahamritunjaya Mantra and the Gayatri Mantra

Any activity should always engage the 3 H model of Heart, the Head, and the Hand. The same has been advocated by the western scholars of today. The concept involves that while doing any work one should ask the head for choices and then refer these choices to the heart to choose one and finally order the hands to carry out that action.

In his book ‘The Seven Spiritual Laws of Success’, Deepak Chopra also talks about this. He writes that conscious–based decisions are the best decisions. Before taking any decision he recommends asking the body for the signals of comfort or discomfort and if the signals of discomfort are perceived, then one should not carry out that action.

All the above concepts come from our ancient Vedic knowledge. The two main mantras of our times are the Mahamritunjaya Mantra and the Gayatri Mantra.

The Mahamritunjaya Mantra is from the Rig–Veda and needs initiation for attaining any Siddhi. This is the greatest reliever from all evils and reads as under: Aum Trayambakam Yajamahe, Sugandhim Pushtivardhanam; Urva Rukamiva Bandhanan, Mrityor Mokshiye Mamritat. It means we worship Shiva – The Three–Eyed Lord; who is fragrant and nourishes all beings; May he protect us (bandhanana) from all big (urva) diseases (aarookam). May he liberate us (mokshiye) from death (mrityor), For the sake of immortality (mamritat, amrit); as the cucumber is automatically liberated, from its bondage from the creeper when it fully ripens.

The meaning of the mantra is the importance of the third eye and the benefits of its opening. The two eyes are at the level of the physical body. The third eye means the eyes of the mind and the eyes of the soul. It also indicates that in difficulty one should look inward from the eyes of the mind and ask for the choices. Like the cucumber, one should chose the good ones and drop the bad choices (Jo acha lage use upna lo, jo bura lage use jane do).

The mantra for the conscious–based decision comes from Gayatri mantra: Om Bhur Bhuvaha Suvaha Thath Savithur Varenyam Bhargo Devasya Dheemahi Dhiyo Yonaha Prachodayath. It means we meditate on the glory of the Creator; who has created the Universe; who is worthy of Worship; who is the embodiment of Knowledge and Light; who is the remover of all Sin and Ignorance; may He enlighten our Intellect.

It talks about the importance of conscious–based decisions and its directions to the intellect to choose the right and not the convenient actions.

The Gayatri is the Vedic prayer to illuminate the intellect. Gayatri is considered as Vedasara –– "the essence of the Vedas." Veda means knowledge, and this prayer fosters and sharpens the knowledge–yielding faculty. As a matter of fact, the four mahavakyas or ‘core–declarations’ enshrined in the four Vedas are implied in this Gayatri mantra.

Choosing the right decision from the consciousness was later defined by Buddha. He taught that before any action ask yourself the following four questions and if the answer to any of the question is no, not to indulge in that actions. These four questions are: is it the truth, is it necessary, will the actions bring happiness to you and to the others.
Inspirational Story
Believe in Yourself

Believe in yourself and you can achieve, things you never thought possible, Believe in yourself and you can discover talents new, that lie away hidden

Believe in yourself and you can reach, new heights that you thought unscalable, Believe in yourself and you can solve, problems that defy any solution

Believe in yourself and you can conquer, any situation, however difficult, Believe in yourself and you can make, the most complicated things seem simple

Believe in yourself and you can learn, the skills of gaining knowledge from experience, Believe in yourself and you can enjoy, the beauty in nature’s abundance

Believe in yourself and you can perceive, new depths your senses can apprehend, Believe in yourself and you can perform way beyond your expectations

Believe in your goal and work towards it with determination and dedication, Believe in yourself and output enhance by contributing to a given situation

Believe in yourself and you’ll feel blessed, as God's very own special creation. .
Quote of the Day
True genius sees with the eyes of a child and thinks with the brain of a genie. Puzant Kevork Thomajan
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Reader Response
  1. Dear Dr Aggarwal , I always like to read besides other news your spiritual Blog .today spiritual blog is just too good . Regards : Usha Gupta
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Different Phases of a man

After engagement: Superman
After Marriage: Gentleman
After 10 years: Watchman
After 20 years: Doberman
eMedi Quiz
A 40 year old male had undergone splenectomy 20 years ago. Peripheral blood smear examination would show the presence of:

1. Dohle bodies
2. Hypersegmented neutrophils.
3. Spherocytes.
4. Howell–Jolly bodies.

Yesterday’s Mind Teaser: A 7 year old girl from Bihar presented with three epidodes of massive hematemesis and melena. There is no history of jaundice. On examination, she had a large spleen, non-palpable liver and mild ascites. Portal vein was not visualized on ultrasonography. Liver function tests were normal and endoscopy reveled esophageal varices. The most likely diagnosis is:

1. Kala azar with portal hypertension.
2. Portal hypertension of unknown etiology.
3. Chronic liver disease with portal hypertension.
4. Portal hypertension due to extrahepatic obstruction.

Answer for yesterday’s Mind Teaser:: : 4. Portal hypertension due to extrahepatic obstruction.
Correct Answers received from: : Dr KV Sarma, Dr Avtar Krishan, Daivadheenam Jella, Dr Avtar Krishan, Dr.B.R.Bhatnagar, Daivadheenam Jella, Dr.K.Raju, Dr Gopal Shinde, Dr Gopal Shinde, DR JAINENDRA UPADHYAY, Dr Poonam Chablani, Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy,
Answer for 23rd Feb Mind Teaser:4. Claustridium perfringens infection.
Correct Answers receives: Daivadheenam Jella, Dr. Mahesh, Dr Avtar Krishan,
Cardiology eMedinewS
  • The use of fondaparinux is associated with a lower risk of in-hospital bleeding and mortality in comparison with low–molecular–weight heparin (LMWH) in patients with non–ST–segment elevation MI (NSTEMI), suggest the results of large Swedish registry published in the Journal of the American Medical Association.
  • Performance of PCI via the transradial route is independently associated with reduced risk of major acute coronary events (MACE), 30–day mortality, and major bleeding outcomes across all age groups, compared with transfemoral procedures, reported an analysis based on a large cohort of patients in the UK. The results are published in Catheterization and Cardiovascular Interventions.
Pediatrics eMedinewS
  • Proteins present in saliva might assist early diagnosis of autism spectrum disorders (ASDs), allowing for more prompt intervention, suggests a pilot proteomic study conducted in six children with ASD and six typically developing children. The study is published online in the journal Autism Research.
  • A series of studies being presented at the American Academy of Allergy, Asthma & Immunology's Annual Meeting suggest that an infant's immune system development and susceptibility to asthma and allergies may be influenced by a number of factors that shape their gut bacteria, such as gestational age at birth, breastfeeding and delivery by Cesarean section.
Rabies News (Dr A K Gupta)
What are the common side effects of intra–dermal rabies vaccination?

Cell culture vaccines have proved to be remarkably safe and free of significant adverse events. However, mild symptoms of pain, erythema, irritation or swelling at the intradermal injection sites occur in 3–92% of patients. The most frequent symptom is local irritation in 7–64% of vaccines. Generalized symptoms reported by 3–14% of recipients include headache, fever and influenza–like illness. Transient macular, papular and urticarial rashes are occasionally seen. All these adverse effects are mild, transient and self limiting and rarely call for the use of antihistamines and analgesics.
Medicolegal
Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Advertisement relating to pre–natal determination of sex is punishable


Prohibition of advertisement relating to pre–natal determination of sex and punishment for contravention
  • No person, organization, genetic counseling center or genetic laboratory or genetic clinic shall issue or cause to be issued any advertisement in any manner regarding facilities of the pre–natal determination of sex available at such center, laboratory, clinic or any other place.
  • No person or organization shall publish or caused to be published any advertisement in any manner regarding facilities of the pre–natal determination of sex available at such genetic counseling center, genetic laboratory, genetic clinic or any other place.
  • Any person who contravenes the provisions of sub–section (1) or sub–section (2) shall be punishable with imprisonment for a term which may extend to three years and with fine which may extend to ten thousand rupees.
  • For the purpose of this section, "advertisement" includes any notice, circular, label, wrapper or other document and also includes any visible representations made by means of light, sound, smoke or gas.
Press Release of the Day
Too much salt damages blood vessels and cause high BP

Eating a high-salt diet for several years is associated with markers of blood vessel damage like high uric acid and presence of albumin in the urine.  People with any of these markers of blood vessel damage, who eat a high-salt diet are more likely to develop high blood pressure, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA. 

The study published in the American Heart Association journal
Circulation analyzed the association between sodium consumption and blood levels of uric acid and albumin in the urine — both markers of medicine. Higher sodium intake was associated with increasing levels of uric acid and albumin over time.  The higher the levels of these markers, the greater the risk of developing hypertension if dietary salt intake was high. Compared with participants eating the least amount of sodium (2.2 grams a day), those eating the most (6.2 grams mg/d) were 21 percent more likely to develop high blood pressure. Those who had high uric acid levels and ate the most salt were 32 percent more likely to develop high blood pressure while those with high urine albumin levels and highest salt intake were 86 percent more likely to develop high blood pressure. A high–salt diet is believed to be responsible for 20 percent to 40 percent of all cases of high blood pressure.
PCPNDT Act defines some definitions
The PCPNDT (PROHIBITION OF SEX–SECTION) ACT, 1994 ACT NO. 57 OF 1994 20th September, 1994

Definition: 2. 

(c) "Genetic Counseling Centre" means an institute, hospital, nursing home or any place, by whatever name called, which provides for genetic counseling to patients;

(d) "Genetic Clinic" means a clinic, institute, hospital, nursing home or any place, by whatever name called, which is used for conducting pre-natal diagnostic procedures. Explanation– For the purposes of this clause, ‘Genetic Clinic’ includes a vehicle, where ultrasound machine or imaging machine or scanner or other equipment capable of determining sex of the foetus or a portable equipment which has the potential for detection of sex during pregnancy or selection of sex before conception, is used.

(e) "Genetic Laboratory" means a laboratory and includes a place where facilities are provided for conducting analysis or tests of samples received from Genetic Clinic for pre-natal diagnostic test. Explanation– For the purposes of this clause, ‘Genetic Laboratory’ includes a place where ultrasound machine or imaging machine or scanner or other equipment capable of determining sex of the fetus or a portable equipment which has the potential for detection of sex during pregnancy or selection of sex before conception, is used.

(f) "Gynecologist" means a person who possesses a post– graduate qualification in gynaecology and obstetrics;

(g) "Medical geneticist" includes a person who possesses a degree or diploma in genetic science in the fields of sex selection and pre–natal diagnostic techniques or has experience of not less than two years in any of these field after obtaining—

(i) any one of the medical qualifications recognised under the Indian Medical Council Act, 1956 (102 of 1956); or

(ii) A post–graduate degree in biological sciences;

(h) "Pediatrician" means a person who possesses a post– graduate qualification in pediatrics;

(i) "pre–natal diagnostic procedures" means all gynaecological or obstetrical or medical procedures such as ultrasonography, foetoscopy, taking or removing samples of amniotic fluid, chorionic villi, embryo blood or any other tissue or fluid of a man, or of a woman before or after conception, for being sent to a Genetic Laboratory or Genetic Clinic for conducting any type of analysis or pre-natal diagnostic tests for selection of sex before or after conception;

(j) "pre–natal diagnostic techniques" includes all pre–natal diagnostic procedures and prenatal diagnostic tests;

 (k) "pre–natal diagnostic test" means ultrasonography or any test or analysis of amniotic fluid, chorionic villi, blood or any tissue or fluid of a pregnant woman or conceptus conducted to detect genetic or metabolic disorders or chromosomal abnormalities or congenital anomalies or haemoglobinopathies or sex–linked diseases;

 (m) "registered medical practitioner" means a medical practitioner who possesses any recognized medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956, (102 of 1956.) and whose name has been entered in a State Medical Register;

 (p) “Sonologist or imaging specialist” means a person who possesses any one of the medical qualifications recognized under the Indian Medical Council Act, 1956 (102 of 1956) or who possesses a postgraduate qualification in ultrasonography or imaging techniques or radiology;

Definition

The PCPNDT Act 57 of 1994 under definition 2(p), the Act define a definition of Sonologist or Imaging Specialist as any person who possessive any one of the medical qualification  recognized under the Indian Medical Counci

Act 1956.

The word any of the medical qualification recognized include MBBS, Postgraduate diplomas and other postgraduate degrees.

An MBBS, recognized under the Indian Medical Council Act therefore by definition is also a Sonologist or Imaging Specialist.

The Act further goes ahead “or who possess a postgraduate qualification in Ultrasonography or Imaging techniques or Radiology".

People have been misinterpreting this as a Postgraduate qualification recognized under the Indian Medical Council Act. Any Postgraduate qualification would automatically come under the definition of Sonography or Imaging Specialist in the first para of Section 2(p) before the word “or”.

All over the world, Ultras sounds, CT Scan, MRI and echocardiography are done by Technicians and non-MBBS people. All the technical Ultrasound application specialist do Sonography and Echocardiology. Infect most of the training is done by them to the new modern medicine doctors.
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PCI often done at low–volume centers

About 25% of all percutaneous coronary interventions (PCI) in the US are performed at low–volume centers that do 200 or fewer procedures per year; 49% are done at centers that do no more than 400 such procedures annually, Gregory Dehmer, MD, of Scott & White Healthcare in Temple, Texas, and colleagues reported in the Journal of the American College of Cardiology. They also found that on–site cardiac surgery wasn’t available at 83% of centers that did 200 or fewer PCIs annually. The 2011 PCI guidelines stated that facilities doing 200 or fewer PCIs per year need to take a closer look at whether they should continue doing such procedures.