November 25   2015, Wednesday
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EDITORIAL
Dr KK AggarwalDr KK Aggarwal NCERT to change the objectionable clauses in Social Science Textbook for Class 7, Social and Political Life-II

Sub: WP(C) No.8706/2015 titled “Indian Medical Association vs. Union of India & Anr (NCERT)” pending before Hon'ble Delhi High Court, New Delhi.

The captioned matter was listed today before Hon’ble Mr Justice Rajiv Shakdhar. The Ld. counsel for NCERT handed over the proposed changes recommended by the Complaints Committee set up by NCERT, in the Chapter-2 of Text Book “Social & Political Life-II” prescribed for the students of Class-VII, in compliance with the order dated 11.09.2015 by Hon’ble Court.

The copy of the proposed changes are attached herewith. We are directed to take instructions from IMA on the said changes and now the matter is re-notified for 14.12.2015 to apprise the Hon’ble Court about the stand of IMA on the proposed changes made by NCERT. Kindly do the needful.
Thanks and regards,
Contact Details:
Rahul Gupta & Associates

Social Science Textbook for Class 7, Social and Political Life-II Chapter-2: Role of the Government in Health Report of the changes (pages 22, 23, 24, 26, 29 and 122)

Page 22: (storyboard)
Last paragraph, last line: “ He prescribed…. Replace “lots of” with some,

Page 23: (Last panel in the storyboard)
Existing
Revised
My hospital was nice, but they gave me too many medicine and the whole thing cost more than Rs. 3,500/-
My hospital was nice, but they gave me many medicines and the whole thing cost quite a lot
That much! My treatment cost just Rs. 150/-
Oh! My treatment did not cost much
Page 24: (Change the sequence of the questions in the left column)

1. Where do you go when you are ill? Are there any problems that you face? Write a paragraph based on your experience

2. What problems did Aman face in the government hospital? How do you think the hospital can work in a better manner? Discuss

3. Why did Ranjan have to spend so much money? Give reasons.

4. What problems do we face in private hospitals? Discuss.

Page 26: Delete the following word in the paragraph beginning with “In India…..

“As these services are run for profit”
Existing
Revised
“In order to earn more money, these private services encourage practices that are incorrect. At times cheaper methods, though available, are not used. For example, it is common to find doctor5s prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicine can suffice” (45 words)
Some private services indulge in unethical or unfair practices to earn more money. At times inexpensive alternatives, though available, may not be used. For example, some medical practitioners are found to prescribe superfluous medicines, injections or saline when simple medications may suffice (42 words)
The following box and the question are to be included in the left column on page 26.
The Medical Council of India’s code of Medical Ethics states: “Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.”

How can healthcare be made more affordable? Discuss.
Page 29: Replace the existing table with a new table
Facility
Affordability
Availability
Quality
Private
     
Public
     
Glossary: Include the following terms:
Ethics: Moral principles that influence a person’s behavior
Generic names: These are Chemical names of the drugs. They help in identifying the ingredients. They are globally recognized. For example, acetyl salicylic acid is the generic name of Aspirin

Page 122: (References): Include the following:
• Medical Council of India,
http://mciindia.org/Rules-and-Regulation/Ethics%20Regulations-2002.pdf

• Supreme court of India, Paschim Banga Khet Mazdoor Samity & Ors. Vs State of West Bengal and Anr. (Hakim Seikh case, date of judgement: 6 May, 1996,
http://judis.nic.in/supremecourt/imgs1.aspx?fiename=15597)

• World Health Organization, Essential medicine and health products,
http://www.who.int/medicines/services/inn/en
EMEDINEXUS STATEMENT
Amit Sharma and Nilesh Aggarwal 

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
FDA warns intravascular device coatings may peel

Hydrophilic and/or hydrophobic coatings on intravascular medical devices may come off, potentially causing serious injuries to patients, the US Food and Drug Administration (FDA) warned in a safety communication. According to the FDA, many factors may cause the lubricious coatings to separate from these devices, including difficulty of the procedure and the patient's anatomy, user's technique or using the wrong device for the procedure, improper preconditioning of the device and improper storage conditions, and issues with device design or manufacturing processes. Since the beginning of 2010, 11 recalls from various manufacturers have been associated with these coatings peeling or flaking off intravascular medical devices. Most of these recalls were associated with guidewires, but other types of devices have been recalled, including sheaths, retrieval devices, and embolization device delivery wires used in the vasculature, according to the FDA... (Medscape)

ACOG recommendations for obese pregnant women

Integrating diet and exercise strategies into an obese pregnant woman's prenatal and postpartum care may help to improve maternal and fetal health outcomes, according to new recommendations released by the American College of Obstetricians and Gynecologists (ACOG). Diet and exercise should be at the forefront of all prenatal and postnatal care. Diet and exercise recommendations should be given throughout the pregnancy to help a woman maintain the Institute of Medicine (IOM) guidelines for weight gain, and after the pregnancy, behavioral interventions for diet and exercise may be used to help women lose postpartum weight. These recommendations are published in the journal Obstetrics & Gynecology… (Medpage Today)
Dr Good Dr Bad
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Specialty Updates
• A young woman surviving a heart attack or stroke still faces long-term risks of death and illness, suggested an article published in JAMA Internal Medicine.

• New research has revealed that certain platelet-derived growth factors are significant for the liver's regeneration processes. Researchers noted that platelets can encourage the regrowth of liver tissue in patients who have had parts of their liver removed surgically. The findings are published in the journal Hepatology.

• Stimulant medication for attention deficit hyperactivity disorder (ADHD) may have a negative effect on a child's ability to get to sleep and results in overall less sleep time, suggested a small meta-analysis published in Pediatrics.

• Proton pump inhibitors (PPIs), commonly used for heartburn and gastric distress, should be prescribed at the lowest dose possible and for the shortest length of time due to potential side effects, suggested a review published in the Canadian Medical Association Journal.

• In women with gestational diabetes mellitus (GDM), breastfeeding reduced the risk of progressing to type 2 diabetes, reported a large prospective cohort study published in Annals of Internal Medicine.

• New research suggests that persistent inflammation affects the brain in ways that are connected with stubborn symptoms of depression, such as anhedonia, the inability to experience pleasure. The findings are published online in Molecular Psychiatry.

• The combination of cobimetinib and vemurafenib has been shown to extend the lives of previously untreated patients with advanced skin cancer to nearly two years (22.3 months), amounting to an improvement of nearly five months more than vemurafenib alone, suggested new data from the coBRIM study presented at the Society for Melanoma Research (SMR) annual meeting.

• An experimental drug, ALS-008176, an oral nucleoside analogue, reduced viral load, hastened viral clearance, and reduced clinical disease severity in healthy adults inoculated with respiratory syncytial virus (RSV), reported a randomized, double-blind, placebo-controlled clinical trial published in the New England Journal of Medicine.
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eSpiritual
How to remove negative thoughts

Darkness is absence of light and similarly negative thoughts are absence of positive thoughts. The answer to negative thoughts is to bring positive thoughts back. Ideal mind is devils workshop and will always think negative.

Here are the ways
• Think differently as taught by Adi Shankaracharya. Once Menaka approached Arjuna with lust and said that she wanted to have a son like him with him. Arjuna said that why wait for 25 years consider me as you son from today.

• Think opposite as taught by Patanjali. For example if you are thinking of stealing, then silently start thinking of charity.

• Think positive as taught by Buddha. Make a list of positive action to be done today as the first thing in the morning and concentrate on that list. Divert your mind to the pending works. It’s a type of behavioral therapy.
Legal Quote
Samira Kohli vs. Prabha Manchanda Dr. & ANR. 1(2008)CPJ 56 (SC

”The ’adequate information’ to be furnished by the doctor (or a member of his team) who treats the patient, should enable the patient to make a balanced judgment as to whether he should submit himself to the particular treatment as to whether he should submit himself to the particular treatment or not .”
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Medicofinance
Computation of Gains
• An item with capital gain may end up as capital loss after the application of indexation, which not only eliminate tax for that item but also end up reducing tax from another item that has gains.
• Take lesser of the two in each item.
• Total up losses and gains for each class.

(Source: IJCP)
Media
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eMEDIPICS
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Centre launches drive to eradicate hepatitis B

The health ministry in collaboration with UNICEF on Monday launched a media campaign with the resolve to make India Hepatitis B Virus-free by the next decade. The government also launched the Hepatitis B vaccine programme in Maharashtra after the successful trial of the vaccine in other Indian states including Goa, Gujarat and Karnataka among a few others. Speaking at the launch, union Health Minister J.P. Nadda said ”Society is the main element that can help us in tackling a dreaded disease like Hepatitis. We will ensure that with the end of hepatitis, all others preventable diseases see an end.” The country is estimated to have around 40 million HBV carriers. Of the 2.6 crore (26 million) infants born annually in India, approximately 10 lakh (one million) run a life time risk of developing chronic HBV infections… (The Pioneer – IANS)
MRP may be mandatory for medical devices

According to official sources, price regulation on cardiac stents and implants is expected to be discussed when the department of pharmaceuticals meets medical device manufacturers and health ministry officials on Monday. The sources say that important packaging and labelling changes-including declaring the maximum retail price (MRP), as well as the per unit price on the pack-could be made mandatory to start with. Nearly 80% of the high-end devices, including cardiac stents and implants, are mainly import driven, while the domestic industry manufactures disposables and medical supplies…… (ET Healthworld)
Ortho implants may become 50% cheaper

Prices of exorbitantly-priced orthopaedic implants are expected to come down by 40-50%, with a government body suggesting-for the first time ever-price caps to make them more affordable for patients. At present, there are no controls on steeply-priced medical devices like cardiac stents and orthopaedic implants, giving rise to fleecing of consumers. Hip and knee surgeries are out of reach for over 80% of affected patients thanks to the steep cost of implants. cc cost between Rs 80,000 to Rs 1 lakh, while hip implants range from Rs 70,000 to Rs 1.5 lakh… …(ETHealthworld- Rupali Mukherjee)
Boston Heart Diagnostics, has introduced and is promoting direct to consumers "the first and only at-home saliva laboratory developed test," which it says will help identify people who are likely to experience side effects from taking a statin. Is it ethical
An altered sense of humor — including a switch away from complicated, subtle comedy towards more obvious simple jokes and laughing at inappropriate situations — could be an early sign of dementia, a new study suggests.– [Camilla Clark, MD, University College London, United Kingdom]
eWellness
Donating blood reduces chances of heart attack

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.
Bioethical issues in medical practice
Perils of Cosmetic Surgery

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

Young people today are extremely health and appearance conscious. Not only do they follow strict dietary regimens, they religiously take care of their appearance. Repeated surgery for changing the shape of their nose, chin or stomach is frequent. You as a family physician are approached by one such young woman, who has a normal shape and weight but wants liposuction. What should your primary advice/counselling center on?

a) Healthy lifestyle choices
b) Being comfortable with their natural appearance, whatever it may be
c) Perils of cosmetic surgery
d) Involving their family

Any other suggestions and solutions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013): http://www.eubios.info/

Response received

Perils of cosmetic surgery should be explained to her and when completely satisfied, liposuction should be got done. This will not only change her outlook and appearance but also will be helpful in controlling hypertension, diabetes, PCOD, sterility and various conditions related to cardiovascular system. Dr BR Bhatnagar
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Inspirational Story
The perfectionist sculptor

A gentleman once visited a temple under construction where he saw a sculptor making an idol of God. Suddenly he noticed a similar idol lying nearby. Surprised, he asked the sculptor, “Do you need two statues of the same idol?”

“No,” said the sculptor without looking up, “We need only one, but the first one got damaged at the last stage.” The gentleman examined the idol and found no apparent damage. “Where is the damage?” he asked. “There is a scratch on the nose of the idol.” said the sculptor, still busy with his work. “Where are you going to install the idol?” The sculptor replied that it would be installed on a pillar twenty feet high. “If the idol is that far, who is going to know that there is a scratch on the nose?” the gentleman asked. The sculptor stopped his work, looked up at the gentleman, smiled and said, “I know it and God knows it!”

Moral: The desire to excel should be exclusive of the fact whether someone appreciates it or not. Excellence is a drive from inside, not outside. Excel at a task today – not necessarily for someone else to notice but for your own satisfaction.
eMedi Quiz
High resolution computed tomography of the chest is the ideal modality for evaluating:
1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.


Yesterday’s Mind Teaser: All of the following conditions may predispose to pulmonary embolism except:

1. Protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy.

Answer for Yesterday’s Mind Teaser: 4. Progesterone therapy.

Answers received from: Dr Poonam Chablani, Dr KV Sarma, Dr.B.R.Bhatnagar, Dr jayendra Shah, Dr Avtar Krishan, Dr Shangarpawar,

Answer for 23rd November Mind Teaser: :. 1. The sample should be kept at 4°C.

Answers received from: Dr Jainendra Upadhyay, Dr.K.V.Sarma, Dr Kailash Chandra Sharma, Dr.B.R.Bhatnagar, Daivadheenam Jella, Dr Avtar Krishan,
Humor
Teacher: Billy, stop making ugly faces at other students!

Billy: Why, ma’am!

Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!

Billy: Well, I can see you didn’t listen then!
Readers column
Dear Sir, very informative news. Regards: Dr Shravan
Press Release
Winter induced health problems in women

New Delhi, 24th November 2015: With winters finally here, most of us find ourselves getting unusually lethargic, we resort to comfort food as a way of keeping our body warm, find it difficult to get out of the coziness of our homes and end up exercising less. Several people also become victims of winter depression and end up eating and sleeping more. All these can cause a spike in the number of complications suffered by people with existing lifestyle diseases namely hypertension, diabetes, obesity and heart disease. This holds particularly true for women, who are more prone to winter induced diseases.

Speaking about this, Padma Shri Awardee, Dr. K K Aggarwal – President HCFI and Honorary Secretary General IMA said, “Winter brings with it a host of medical problems specially for women. It is a known fact that hospital admissions during the winter months go up drastically. The reasons for this include the increased incidence of Vitamin D deficiency due to the tendency of people to spend most of their hours indoors, winter induced depression and obesity, as well as a 50% added risk of heart attacks and strokes. It is important that awareness is raised and adequate prevention measures taken by women in the high risk category.”

Some of the common health problems women might face during the winter months include:

1. Heart Attacks and Strokes: Heart disease kills more women than any other disease in our country including breast and cervical cancer. Stroke and heart disease-related hospitalizations and deaths rise by more than 50 percent during the winter months. It is important that women with pre-existing lifestyle diseases, or those at high risk of heart disease should consult their doctors at the onset of the winters for a revised dosage of medicines. They should also consume a healthy diet comprising of ample fruits and vegetables. Smoking, a diet comprising of red meat and alcohol consumption should be avoided. Regular aerobic exercise at warmer hours is highly recommended.

2. Seasonal Affective Depression: This condition is characterized by experiencing episodes of depression every year, but only during the winter. What the exact cause of this is still unknown but it is believed that a low body temperature, scarcity of sunlight and hormone fluctuations play an important role. Women are more prone to winter depression than men and have a tendency to indulge in high calorie comfort food to beat the winter blues. This can be extremely dangerous for people suffering from obesity, heart disease and hypertension. It is important that a person consumes a healthy diet and gets adequate exercise to avoid complications.

3. Hypothermia: Hypothermia is a condition characterized by an abnormally low body temperature and can occur in cold weather. The reason for this is when the temperatures dip; our body looses heat faster than it can create. The condition is usually hidden with no evident symptoms. If a person’s body temperature drops below 95 degrees Fahrenheit, one needs to seek emergency medical care immediately in order to avoid death. It is thus recommended that during extremely cold days, everyone must stay warmly clad specially children and the elderly.

4. Vitamin D Deficiency: Indians are at an increased risk of vitamin D deficiency, especially during the winter month given that they spend most of their time in indoor spaces. Women especially housewives often do not step out in the winter months to avoid the cold weather. This deprives them of Vitamin D, which is synthesized from the rays of the sun. Vitamin D is essential for good bone health, a strong immune system, and a healthy heart. It also helps prevent deadly diseases such as cancer. It is extremely important that all women ensure that they spend time out in the sun on a daily basis in the winter months. Supplementation is also advised to avoid health complications.

5. Influenza: Seasonal Flu is very common during the winter and has the potential to be life threatening specially for high-risk individuals. It is thus recommended that the flu shot should be taken in consultation with ones physician.
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