March 24 2015, Tuesday
editorial
3 dietary changes to help lower cholesterol levels
Dr KK Aggarwal For every 10% drop in your cholesterol level, your heart attack risk falls by 20% to 30%.
  • Choose healthy fats. Avoid saturated fats, which increase unhealthy LDL levels, and steer clear of trans fats, which both raise LDL and lower protective HDL. Instead, substitute healthier unsaturated fats found in fish, nuts, and vegetable oils.
  • Go with whole grains. Whole–grain breads, pastas, and cereals help prevent a blood sugar roller coaster and make you feel full longer. Many of these foods contain fiber, which can help lower LDL levels.
  • Make other healthy choices. Eat more fruits and vegetables. Ideally, substitute these for processed foods and sweets. Choose fat–free milk instead of whole milk. Opt for low–fat yogurt and pick brands that are not loaded with sugar. (Harvard Newsletter)
eMedipics IMA,IJCP,HCFI
World TB Day 2015 CME at IMA 22–3–2015
News
  • New National Comprehensive Cancer Network (NCCN) guidelines for bladder cancer recommend maintenance BCG Bacillus Calmette–Guérin for patients who receive induction BCG for nonmuscle invasive bladder cancer. The guidelines were presented at the NCCN 20th Annual Conference.
  • Natamycin treatment of mycotic corneal ulcers improves vision–related quality of life, compared with voriconazole treatment, suggest the results from the Mycotic Ulcer Treatment Trial I (MUTT I) published online in JAMA Ophthalmology.
  • Girls whose mothers smoked while pregnant entered puberty at a younger age, suggested a new Australian study. Since early menstruation is linked to higher risk of uterine, endometrial and breast cancers later in life, the study authors pointed that maternal smoking could predispose daughters for health problems even before they’re born. The findings are published online in Human Reproduction.
  • A new study finds a relationship between vitamin D and depression in otherwise healthy young women. The findings were published recently in Psychiatry Research.
  • The 13-valent polysaccharide conjugate vaccine protects older people against some strains of pneumococcus, suggests new research. However, the vaccine had no effect on the risk of catching community–acquired pneumonia from any cause. The findings are published in the March 19 issue of the New England Journal of Medicine.
Dr KK Spiritual Blog
On 4th Navratri be happy in all situations

Kushmanda is worshipped on the fourth day of Navratri.

SHE shines brightly with a laughing face. Out of eight hands (Ashtabhuja) in her four arms, she carries weapons like bow, arrow, discus and mace.
In other three hands, she holds a lotus, a beaded rosary and a Kamandalu. In remaining hand, she carries a jar of nectar.

SHE rides on Lion. Rosary represents her power to bless her devotees with Ashtasiddhi (eight types of studies or wisdom sources) and Navanidhi (nine types of wealth). In Ayurveda, SHE represents the control over the air element.

In Yoga Shastra, SHE represents the heart or Anhata Chakra with the Bija sound YAM.

Spiritual mantra on the 4th Navratri

One should continuously (beaded rosary) control the air (anahata plexus) within us by using our sharp intelligence (sword) and balancing the mind (Trishul) by focusing on one point (arrow and bow), practicing detached attachment (lotus), accepting things as they are (Kamandalu), keep smiling in both acceptable and difficult situations (smiling face) and killing the negative energies by using discus (power) when needed.
IMA,IJCP,HCFI
Cardiology eMedinewS
  • A randomized trial of patients with atrial fibrillation undergoing mitral-valve surgery confirmed the 1-year safety and efficacy of concomitant surgical ablation of the arrhythmia, but patients who had the ablation did not benefit clinically, and had a 2.5-fold higher rate of pacemaker implantation. The results were presented at the American College of Cardiology (ACC) 2015 Scientific Sessions.
  • Smoking is associated with worse clinical outcomes, especially MI, following coronary revascularization, thus suggesting that there is no "smoker’s paradox" when smoking status is accounted for across time, reported the SYNTAX trial. The findings were published in the March 24 issue of the Journal of the American College of Cardiology.
Pediatrics eMedinewS
  • A new study identified factors, such as high blood pressure, protein loss from the kidneys, and anemia that might predict chronic kidney disease worsening but that could be treated to ideally change the course of the disease. The study is published in the American Journal of Kidney Diseases.
  • Children with more symmetrical hands have speedier mental responses than others, suggests a study published in Developmental Psychology. Researchers noted that children with balanced physical proportion on their left and right hands were able to react more quickly in mental tests.
IMA,IJCP,HCFI
Make Sure
Situation: A patient with prosthetic heart valves (bioprosthetic) developed infective endocarditis.
Reaction: Oh my God! Why was he not given infective endocarditis prophylaxis?
Lesson: Make sure that all patients with prosthetic heart valves (bioprosthetic or homograft) are given infective endocarditis prophylaxis.
Media
IMA,IJCP,HCFI
Events
IMA,IJCP,HCFI
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

What is the concept of Brain stem death?

Medullary neurons are most resistant to anoxia; if they are dead, then higher centers are also dead

There are three distinct schools of thought to diagnose death: (i) French school that is similar to Harvard (ii) English school that is similar to Harvard (iii) Austor–German school that includes Harvard criteria and bilateral serial angiography of internal carotid and vertebral arty criteria. A negative angiogram for more than 15 minutes proves death.(iv) Absence of brainstem reflexes: (a) dilated and fixed pupil (b) absent corneal reflexes (c) absent Doll’s head phenomenon (d) absent cilospinal reflexes (e) absent gag reflex (f) absent vestibular response to caloric stimulation (g) absent tonic neck reflex (v) EEG not mandatory (vi) Spinal reflex not important (vii) All the findings above remain unchanged for at least 12 hours. Brainstem death can be pronounced only if the pathological processes responsible for above are deemed irreparable with presently available means.

The basic teaching of the American school was not the brain, but the brainstem death, after which there is the point of no return that should be equated as death. There were several reasons for this equation:
  • Medullary neurons are most resistant to anoxia, if they are dead then higher centers are also dead.
  • Brainstem is responsible for the vital functions because it is the seat of respiratory and circulatory center.
  • Brainstem is necessary for proper functioning of the cortex as all sensory and motor nerves pass through this gateway.
  • Immediately after an individual is put on respirator and other life support systems, a systemic examination is done to exclude the possibility of brainstem death. If Minnesota criteria are fulfilled, life support systems should be withdrawn and the person is to be declared dead.
Dr Good Dr Bad
Situation: A senior citizen with an insurance of one lakh came for admission. 
Dr. Bad: You should opt for Rs. 1000 room. 
Dr. Good: Take any room you want.
Lesson: The 1% room rent clause is not applicable to senior citizens.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
eMedi Quiz
The following separation technique depends on the molecular size of the protein:

1. Chromatography on a carboxymethyl (CM) cellulose column.
2. Iso-electric focusing.
3. Gelfiltration chromatography.
4. Chromatography on a diethylaminoethly (DEAE) cellulose column.

Yesterday’s Mind Teaser: An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1. Glyceraldehyde–3–phosphate dehydrogenase.
2. Phosphoglucomutase.
3. Lactate dehydrogenase.
4. Glucokinase.


Answer for yesterday’s Mind Teaser: 1.Glyceraldehyde-3-phosphate dehydrogenase.

Correct Answers received from: Dr B R Bhatnagar, Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr KV Sarma.

Answer for 22nd March Mind Teaser:4. Progesterone therapy

Correct Answers receives:Dr Jainendra Upadhyay, Dr Sharad SJ, Dr Shangarpawar, Dr Avtar Krishan, Daivadheenam Jella, Dr Poonam Chablani, Dr Prabodh K Gupta
Rabies News (Dr A K Gupta)
What are monoclonal antibodies?

Monoclonal antibodies (mAb) are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.
IMA,IJCP,HCFI
Reader Response
  1. Dear sir Good morning. Information regarding droplet infection and droplet nuclei infection was new. Brahmin food is good to know... continue your good work. Regards. Dr KD Tiwari.
  2. Dear Sir, A very good initiative by IMA. There is a mistake in the slogan sent by Shubham Sethy of Hi–Tech Medical College & Hospital, Bhubaneswar, Odisha, given below: "DOTS Ko Hum Apnayenge TB Mukt Susth Bharat Banayenge."It should be "DOTS Ko Hum Apnayenge TB Mukt Swasth Bharat Banayenge."Thanks and Best Wishes: Dr G Sampath, CC member, Hyderabad
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
Sonal Namaste
Hand sanitizers are not as effective when hands are visibly dirty or greasy.
Facts about Tuberculosis (TB)
Are there any side effects of anti-TB treatment
  • Very few people develop side–effects to anti–TB drugs.
  • Most of these side–effects are minor and include vomiting, nausea, loss of appetite, joint pain, orange/red urine and skin rash. These can be easily managed with simple medicines and without stopping the anti–TB drugs. 
  • In some very rare cases, serious side effects like deafness and jaundice may develop which may require temporary withdrawal of some of the anti-TB drugs.
Caution against MHC Bill
The Mental Health Care (MHC) Bill planned to be enacted by Parliament will ruin the mental health sector in the country, says Roy Abraham Kallivayalil, Secretary General of the World Psychiatry Association.

According to Dr. Kallivayalil, the MHC Bill proposes to bring the General Hospital Psychiatry Units (GHPUs) under its purview. The general hospitals mostly treat people with depression, anxiety, phobias, sexual dysfunctions, adjustment and stress disorders, etc, before any disability sets in. "If we are trying to put these everyday life events into legal framework, people will not seek treatment and some of them may even commit suicide, ultimately leaving the Bill a disaster," he said.

Dr. Kallivayalil said the GHPU attached to teaching hospitals, general hospitals, and to some major private hospitals was the biggest revolution in psychiatry in the last 50 years. It has de-stigmatised psychiatric treatment by bringing mental health care from the confines of the mental hospitals to the doorsteps of the common man. Moreover, the MHC Bill is modelled on certain Western Bills. Various clauses in the Bill like ‘nominated representatives’ and ‘advance directives’ are completely alien to the Indian family ethos, he alleged.
Lalita Kumari vs Govt. of U.P. & Ors on 12 November, 2013
Bench: P Sathasivam, B.S. Chauhan, Ranjana Prakash Desai, Ranjan Gogoi, S.A. Bobde

 http://indiankanoon.org/doc/10239019/

 OPERATIVE PARA NO. 110:

“110) Therefore, in view of various counter claims regarding registration or non-registration, what is necessary is only that the information given to the police must disclose the commission of a cognizable offence. In such a situation, registration of an FIR is mandatory. However, if no cognizable offence is made out in the information given, then the FIR need not be registered immediately and perhaps the police can conduct a sort of preliminary verification or inquiry for the limited purpose of ascertaining as to whether a cognizable offence has been committed. But, if the information given clearly mentions the commission of a cognizable offence, there is no other option but to register an FIR forthwith. Other considerations are not relevant at the stage of registration of FIR, such as, whether the information is falsely given, whether the information is genuine, whether the information is credible etc. These are the issues that have to be verified during the investigation of the FIR. At the stage of registration of FIR, what is to be seen is merely whether the information given ex facie discloses the commission of a cognizable offence. If, after investigation, the information given is found to be false, there is always an option to prosecute the complainant for filing a false FIR.

Conclusion/Directions:

 111) In view of the aforesaid discussion, we hold:

i) Registration of FIR is mandatory under Section 154 of the Code, if the information discloses commission of a cognizable offence and no preliminary inquiry is permissible in such a situation.

ii) If the information received does not disclose a cognizable offence but indicates the necessity for an inquiry, a preliminary inquiry may be conducted only to ascertain whether cognizable offence is disclosed or not.

iii) If the inquiry discloses the commission of a cognizable offence, the FIR must be registered. In cases where preliminary inquiry ends in closing the complaint, a copy of the entry of such closure must be supplied to the first informant forthwith and not later than one week. It must disclose reasons in brief for closing the complaint and not proceeding further.

iv) The police officer cannot avoid his duty of registering offence if cognizable offence is disclosed. Action must be taken against erring officers who do not register the FIR if information received by him discloses a cognizable offence.

v) The scope of preliminary inquiry is not to verify the veracity or otherwise of the information received but only to ascertain whether the information reveals any cognizable offence.

vi) As to what type and in which cases preliminary inquiry is to be conducted will depend on the facts and circumstances of each case. The category of cases in which preliminary inquiry may be made are as under:

a) Matrimonial disputes/ family disputes
b) Commercial offences
c) Medical negligence cases
d) Corruption cases
e) Cases where there is abnormal delay/laches in initiating criminal prosecution, for example, over 3 months delay in reporting the matter without satisfactorily explaining the reasons for delay.

The aforesaid are only illustrations and not exhaustive of all conditions which may warrant preliminary inquiry.

vii) While ensuring and protecting the rights of the accused and the complainant, a preliminary inquiry should be made time bound and in any case it should not exceed 7 days. The fact of such delay and the causes of it must be reflected in the General Diary entry.

viii) Since the General Diary/Station Diary/Daily Diary is the record of all information received in a police station, we direct that all information relating to cognizable offences, whether resulting in registration of FIR or leading to an inquiry, must be mandatorily and meticulously reflected in the said Diary and the decision to conduct a preliminary inquiry must also be reflected, as mentioned above.” MC Gupta
Every pharmacist must abide by code of medical ethics: IMA
Coming down heavily on pharmacists in the city, the Indian Medical Association (IMA) has maintained that “not only doctors but pharmacists also have a role in ethical dispensing of prescription medicines”.

“Safe and effective use of medicines is a complementary effort,” maintained the association. 

The IMA maintained that the Medical Council of India Code of Medical Ethics has some provisions that are of relevance to the pharmacists.

“The pharmacists should be familiar with these and try to comply with them. Regulation 5.3 states that physicians should recognise and promote the practice of pharmacy and should seek their cooperation wherever required,” noted the release.

Listing out the rules, the IMA noted that a doctor’s prescription should also make clear if he/she has himself or herself dispensed any medicine to the patient.

“Besides this, pharmacists should know that a registered medical practitioner shall not issue certificates of efficiency in modern medicine to any unqualified or non-medical person but he/she can issue such certificates to dispensers only after proper training,” said IMA office bearer Dr. K.K. Aggarwal.

The rule book also notes that no physician, as per Regulation 6.3, can run an open shop for sale of medicine for dispensing prescriptions prescribed by other doctors or for sale of medical or surgical appliances.

Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.

“A pharmacist should be aware that it is improper for a doctor to affix his/her signboard at a pharmacist’s shop and that every prescription should carry the registration number of the prescribing doctor. The pharmacist should check every prescription he/she comes across while dispensing medicines,” said IMA.

Stating that these are only some of the major rules, the IMA maintained that it is the duty of pharmacist also to know and follow the rules. “Ignorance is no excuse,” said Dr. Aggarwal.
‘Air pollution, malnutrition responsible for persistent TB’
Air pollution, malnutrition, overcrowding and poor living conditions are responsible for continuing tuberculosis problems in the country, noted the Indian Medical Association. It stated that to put off the chance of transmission and prevent the spreading of the disease, it is essential to reach all TB cases for treatment and cure.

“This will also prevent the emergence of drug-resistance TB,” noted a release issued by the Indian Medical Association.

Awareness movement

Several celebrities from across the city joined the TB awareness movement initiated by the IMA in association with the Central TB Division under the Directorate General of Health Services. They collectively signed and released the message ‘TB Harega Desh Jeetega’ and ‘Swachh Bharat Swasthya Bharat TB Mukt Bharat’.

Speaking on the occasion, Dr. K.K. Aggarwal IMA office bearer said: “Today, one fourth of all global TB cases occur in India every year. In 2013, twenty lakh TB cases occurred in India. The prevalence of the disease in India is 211 per lakh population, which amounts to 26 lakh annually. The incidence of TB per lakh population is 171. Deaths due to TB occur in 19 per lakh population. In total, 2.4 lakh people die of TB in India every year.”

No more a stigma

Dr. Jagdish Prasad, director general of health services, Ministry of Health and Family Welfare, said that no one should ignore any cough of more than two weeks in duration.

He further said that TB is no more a stigma. All contacts of TB patients should be checked, as they may be infectious before it clinically manifests as TB.

Today, one fourth of all global TB cases occur in India every year. In 2013, twenty lakh TB cases occurred in our country. The prevalence of the disease is 211 per lakh population, which amounts to 26 lakh annually
Stop attacks on doctors, hospitals: Indian Medical Association
CHENNAI: Doctors in the state should be offered protection considering the increase in the number of attacks on hospitals and doctors, said the president of the Indian Medical Association (IMA) Tamil Nadu branch, Dr R V S Surendran.

 "For quite some time in Tamil Nadu, doctors and hospitals have become the targets of anti–social elements. In the past two months alone, there have been 20 such incidents. And in most of the cases, it is not even the relatives of the patient who are involved in the attack," he said. Anti-social elements gain mileage out of the emotional, physical and financial strength that relatives are in, following a hospital death and induce violence into the situation, said National President of IMA, Marthanda Pillai.

"It is sheer foolishness to blame the doctors and hospital for all deaths that occur in hospitals. One can never assure 100% success rate in all the medical procedures that are performed in a hospital," the doctor added.

Dr Surendran pointed out that doctors and hospital staff were under tremendous pressure due to repeated attacks on hospitals and it was causing them severe mental agony and trauma.

"Inspite of the best treatment, sometimes the natural course of the body takes charge and patients die. If every death is viewed as a case of medical negligence, then there would be no end to such attacks," he said.

He also pointed out that friends and associates of the patient’s relatives brought in communal groups, political outfits and other fringe elements to threaten doctors.

Members of the IMA have decided to make ’attacks on doctors’ a major topic of discussion at their central working committee meeting which is to be held next month.
Inspirational Story
A Young Sad Lady

The old Master instructed the unhappy young lady to put a handful of salt in a glass of water and then to drink it. "How does it taste?" the Master asked. "Very bad" said the lady.

The Master then asked the young lady to take another handful of salt and put it in the lake. The two walked in silence to the nearby lake and when the apprentice swirled his handful of salt into the lake, the old man said, "Now drink from the lake."

As the water dripped down the young lady’s chin, the Master asked, "How does it taste?" "Good!" remarked the apprentice. "Do you taste the salt?" asked the Master. "No," said the young lady.

The Master said, "The pain of life is pure salt; no more, no less. The amount of pain in life remains the same, exactly the same. But the amount we taste the ’pain’ depends on the container we put it into. So when you are in pain, the only thing you can do is to enlarge your sense of things… Stop being a glass. Become a lake!"
Quote of the Day
Life begets life. Energy becomes energy. It is by spending oneself that one becomes rich. Sarah Bernhardt
Wellness Blog
Waist circumference a better indicator of mortality

A high body mass index (BMI) appears to be protective in certain populations.

Abdominal obesity –– measured using waist circumference ––was a better predictor of 5–year mortality among French survivors of an acute myocardial infarction (MI) than was BMI, according to a study presented by Tabassome Simon, MD, of HA′pital Saint Antoine in Paris.

Looking at BMI, there was an increased risk of dying for those with the lowest body mass (less than 22 kg/m2) and those with the highest (35 kg/m2 and higher), but not for those in the middle of those two groups, which included individuals who were overweight and mildly obese.

Within each category of BMI, however, increased waist circumference was associated with an elevated risk of dying within the follow–up period. After adjusting for BMI in a multivariate analysis, waist circumference in the upper quartile was associated with a 44% greater risk of dying through 5 years.
IMA in Social Media
https://www.facebook.com/ima.national 28138 likes
https://www.facebook.com/imsaindia 45354 likes
https://www.facebook.com/imayoungdoctorswing 952 likes
Twitter @IndianMedAssn 833 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
IMA Videos
News on Maps
IMA Humor
A friend recently explained why he refuses to get to married. He says the wedding rings look like miniature handcuffs.
Press Release of the Day
"I have notified TB patient today, have you ?" – IMA

In a workshop conducted by IMA, attended by 100 General Practitioners, IMA appealed to all its members to ask oneself at the end of the day “Have I notified a TB patient today?”.

Conducting the Workshop, Padma shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA said that IMA’s Slogan for this year :– I have notified TB Patient today, have you :– Do it today”.

Not notifying TB patient is not only a public hazard but also a violation of MCI Act and can lead to suspension of license of a doctor.

The faculty who conducted the workshop included Dr. Dinesh Negi, Dr.Sukhendu Roy, Dr. Parag Bajpai, Dr. Manisha Bidyae, Dr. B.M.Das, and Dr. Rajeshwar Rao.

Dr Aggarwal further said that it is not only important to notify TB patients, but equally important is to follow the patient till he/she is cured.

Most symptoms will disappear within a few weeks of treatment and there is a tendency for patients to stop treatment. Incomplete treatment can end up of drug resistance case which may not only be lethal to the patient, but also be a health hazard to the community.

IMA lauded the initiative by Shri Amitabh Bachhan who openly said that he had suffered from abdominal TB in the past.

The experts said that all pregnant ladies and lactating mothers suffering from TB should be given full treatment. Every patient of HIV should be followed for possible development of TB in the future.

IMA released two slogans:
  • If an elderly patient develops Diabetes – think of TB
  •  If a Middle aged person develops TB – think of diabetes..
MCD Teachers Trained

MCD teachers were also trained in respiratory hygiene & cough etiquettes. Over 100 MCD teachers were sensitized by Indian Medical Association to prevent the spread of Swine Flu and TB. Conducting the workshop Dr.Aggarwal said that both Swine Flu and TB have cough but if the cough lasts for more than two weeks TB should be ruled out.