October 26   2015, Monday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
Doctors for Social Responsibility: Fight against Nuclear Weapons

The terrible aftermath of the atomic bombings on Hiroshima and Nagasaki 70 years ago has not been forgotten even today. These bombings devastated these cities and killed several thousands of people and the horrifying after effects in the form of cancers, radiation injuries and suffering are still being studied today. After the bombings, the land became absolutely ravaged and there wasn’t anything left that could be used for sustenance further.

These bombings and the tremendous destruction that they left behind have changed the perception about nuclear bombs.

Lamenting the circumstances, way back then, doctors had warned the world against the devastating effects of nuclear weapons. And since then, doctors from across the world have stood steadfast and united against all kinds of nuclear tests and other such activities.

The recent WMA Declarations of Geneva, Helsinki and Tokyo have shed light on how doctors from all across the globe have stood up for humanity and social responsibility. As the nations are proceeding towards development, doctors are being encouraged to act on their responsibilities beyond curing their patients. Given the importance and status that doctors are accorded in our society, they are being called to serve the world for the cause of humanity. The WMA recognizes its duty towards working for elimination of nuclear weapons.

The WMA took the declaration forward by:
  • Agreeing that the world together should condemn the development, testing, production, stockpiling, transfer, deployment, threat and use of nuclear weapons
  • Requesting all the respective governments to refrain from the development, testing, production, stockpiling, transfer, deployment, threat and use of nuclear weapons and to work in good faith towards the elimination of nuclear weapons;
  • Advising all governments that even a limited nuclear war would bring about immense human suffering and substantial death toll together with catastrophic effects on the earth’s ecosystem, which could subsequently decrease the worlds food supply and would put a significant portion of the world’s population at risk of famine
  • Requesting that all National Medical Associations join the WMA in supporting this Declaration, use available educational resources to educate the general public and to urge their respective governments to work towards the elimination of nuclear weapons
  • Inviting all National Medical Associations to join the WMA in supporting this Declaration and to urge their respective governments to work to ban and eliminate nuclear weapons
The world needs a strong support system of doctors to ensure the universal slogan of peace across the globe.
Nuclear weapons are highly destructive in nature and pose an existential threat to humanity. If used, they can kill several millions of people and destroy the ability of the planet to sustain life.
It’s time we react before all is gone!
Breaking news
Major aspirin anti-cancer trial launches in UK

The world's largest ever clinical trial into whether taking aspirin every day for five years can stop or delay five common cancers from recurring was launched in Britain on Thursday. The Add-Aspirin phase III trial will recruit 11,000 patients who have recently had or are having treatment for bowel, breast, esophagus, prostate or stomach cancer. The trial will take place at more than 100 centres across the UK and will run for up to 12 years, according to Cancer Research UK, which is funding the study along with the National Institute for Health Research (NIHR).
The study will compare a group taking a 300mg daily dose of aspirin, a group taking 100mg every day and a group taking placebo. Up to 9,000 patients will be recruited in the UK while another 2,000 will take part in India where the trial is expected to open in 2016, a Cancer Research UK spokeswoman told AFP. Participants will self-administer tablets over the five-year period and will be actively followed up for another five years, according to the Medical Research Council Clinical Trials Unit at University College London (UCL), which will oversee the trial in the UK.

Dr. Fiona Reddington, Cancer Research UK's head of population research termed the trial to be a potentially game-changer for patients. Professor Ruth Langley, chief investigator at the Medical Research Council Clinical Trials Unit, said, “This trial aims to answer this question once and for all. If we find that aspirin does stop these cancers returning, it could change future treatment - providing a cheap and simple way to help stop cancer coming back and helping more people survive.” (Economic Times)
Dr Good Dr Bad
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Specialty Updates
• New research, scheduled to be presented at the American Academy of Pediatrics National Conference & Exhibition, suggests that maternal stress levels benefit from skin-to-skin contact after birth.

• Asthma patients can reduce their medication safely and save money; however, patients should do this only under professional guidance, suggests new research published in The Journal of Allergy and Clinical Immunology.

• Low-carb diets are more effective than low-fat diets in weight loss and reducing cardiovascular risk, suggests a new meta-analysis published in PLoS One.

• Women with early breast cancer had similar disease control and survival with accelerated partial breast irradiation (APBI) or whole-breast irradiation (WBI), reported a randomized trial published in The Lancet.

• Patients with acromioclavicular joint dislocation who opt for non-surgical treatment typically experience fewer complications and return to work sooner in comparison with those who undergo surgery, suggested new research published in the Journal of Orthopaedic Trauma.

• The oriental liver fluke, Opisthorchis viverrini, known to cause cancer, secretes a growth factor and drives wound healing and blood vessel growth, suggests new research by James Cook University scientists.

• A phage, called “CR5,” showed strong anti-microbial activity against the bacterium, Cronobacter sakazakii, a type of food-borne bacterium that often kills infants after infecting them via infant formula, reported new research published October 23 online in Applied and Environmental Microbiology.

• An updated practice bulletin from the American College of Obstetrics and Gynecology (ACOG), published in the November issue of Obstetrics & Gynecology, affirms the use of operative vaginal delivery as a way to avoid cesarean delivery and improve outcomes for mothers and babies.

• A history of bilateral salpingo-oophorectomy does not reduce the odds of death from cardiovascular disease among postmenopausal women with type 2 diabetes; however, there may be an association between oophorectomy and CVD in women aged 45 and younger, suggests a new study published online in Diabetes Care.

• People who fell below the lean-muscle-mass cutoff proposed by Dr Richard N Baumgartner et al (Am J Epidemiol.1998;147:755-763) and by the European Working Group on Sarcopenia in Older People (EWGSOP 1) (Age Ageing.2010;39:412-423) had a significant 2.3-fold greater risk of having a low-trauma fracture within 3 years, Andrea Trombetti, MD, from the Geneva University Hospitals and Faculty of Medicine, Switzerland, reported in an oral session at the recent American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting.
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Media
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eSPIRITUAL
Is the origin of ISO Certification from the Vedas?
Whatever you say or do means you are ISO certified.

In mythology, truthfulness means that you do what you think or say. ISO therefore is a Vedic stamp for truthfulness. You need ISO certification in Kalyug as majority being Kalyugis will not be doing what they say or think.

In traditional old business times, transactions were done on verbal assurances but today every one works on written agreements. The saying was "Prana Jaye per vachan na jaye".
Legal Quote
Jacob Mathew v. State of Punjab and Anr SC / 0457 / 2005: (2005) 6 SCC 1 (iii)

“To prosecute a medical professional for negligence under criminal law it must be shown that the accused did something or failed to do something which in the given facts and circumstances no medical professional in his ordinary senses and prudence would have done or failed to do. The hazard taken by the accused doctor should be of such a nature that the injury which resulted was most likely imminent.”
GP Tip: Rule of 40

First-onset acidity or first-onset asthma after the age of 40: Rule out heart attack or heart asthma

(Source: IJCP)
Medicofinance
Components of a Trust

• Author of the Trust (Settlor): A Person who settles the Trust or the author of the Trust.

• Trustee: The person who is appointed by the settler to administer the trust and who accepts the responsibility of acting as a trustee.

• Beneficiary: The person for whose benefits the trust is created is called the beneficiary.

• Trust Property: The subject matter of the trust is called the Trust Property viz. Immovable property,

• Bank balances, jewelry, investment, etc.

(Source: IJCP)
Industry News
A miniature medical device to measure five of your blood's vital signs: A tiny 3D-printed device has been created by researchers at the École Polytechnique Fédérale de Lausanne in Switzerland to keep track of five different substances - glucose, lactate and bilirubin in the blood, as well as checking the levels of the ions calcium and potassium - in your blood and pass on the results to a nearby tablet using Bluetooth. It uses a series of biosensors to do that, then takes the results and sends them wirelessly so that doctors and nurses can keep an eye on them. (Gizmodo.in)

A mobile app to diagnose and treat cancer: Doctors of Tata Memorial Hospital in Parel have developed a mobile phone application (app), based on the cancer staging manual developed by the American Joint Committee on Cancer (AJCC) to help cancer diagnosis and treatment. The app, titled TNM app, will help doctors, especially those in interior areas and poor nations, diagnose the severity of cancer immediately and standardize cancer medicine practice. (Times of India)

Fresher salaries peak as startups look for young talent: A study conducted in October this year by Hiree, an online hiring firm shows that salaries offered by start-ups in India have risen by as much as 42% over a year ago, thanks to a dearth of talent, especially at the entry level. While salaries of fresh recruits (with experience of up to three years) have increased 42%, those with experience of 3-5 years are up 40% over a year earlier. The rise for employees with experience of 5- 15 years has been 26-32%. (Business Standard- Anita Babu)

BSE favours compulsory market making for SMEs, start-ups: To boost liquidity in capital markets, top stock exchange BSE has suggested that market making be made compulsory for all stocks listed in SME segment as also scrips of start—ups to be listed on Hi—Tech platforms. Apart from stocks listed on SME and Hi—Tech platforms, market making be a must for main board companies having market capitalisation of less than Rs. 200 crore, it said. BSE has also suggested that market making be made compulsory for all corporate and government bonds. In a presentation to the Finance Ministry, the exchange has also suggested a number of other measures to shore—up liquidity in the capital markets. (The Hindu Business Line- PTI)
eWELLNESS
How safe are anti-obesity drugs?

Obesity is a major health problem. The long–term success rate is low of diet and physical activity. Therefore, antiobesity drugs are of great interest, especially when lifestyle modification has failed. As obesity is not an immediate life–threatening disease, these drugs are required to be safe.

Drugs developed so far have limited efficacies and considerable adverse effects affecting tolerability and safety. Therefore, most antiobesity drugs have been withdrawn

. • Fenfluramine and dexfenfluramine were withdrawn because of the potential damage to heart valves.

• Sibutramine was associated with an increase in major adverse cardiovascular events in the Sibutramine Cardiovascular Outcomes (SCOUT) trial and it was withdrawn from the market in 2010.

• Rimonabant was withdrawn because of significant psychiatric adverse effects.

• Orlistat was approved for long–term treatment of obesity, but many patients cannot tolerate its gastrointestinal side effects.

• Phentermine and diethylpropion can only be used for less than 12 weeks because the long–term safety of these drugs is unknown.

• Ephedrine and caffeine are natural substances but the effects on weight reduction are modest.

• Recently lorcaserin and topiramate plus phentermine have been approved for the treatment of obesity but long–term safety data are lacking. (Ther Adv in Drug Safe 2013;4(4):171–181)
eMEDIPICS
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Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
MTNL Perfect Health Mela 2015.

Pls click here for details
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Humor
Law of Bag/Box Occupancy: All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.
BIOETHICAL ISSUES IN MEDICAL PRACTICE
Defensive Medicine

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

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
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Breaking news
ICMR releases guidelines draft for celiac disease

ICMR has released draft guidelines on diagnosis and management of celiac disease in India. There are total of 48 statements covering various aspects of diagnosis and management of celiac diseases, divided into 9 sections. Each statement has been described and supported with most relevant evidence available.

ICMR has also asked for suggestions/comments on the guidelines by November 30, 2015. (ICMR)
MAKE SURE
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Indian Medical Association National Satyagraha for a Healthy India
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IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.
• Writing prescription drugs by unqualified people can be dangerous.
• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)
• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?
• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?
• Allow us to treat poor and rich equally.
• Non pelvic ultrasound providers should be out of PCPNDT Act.
• Unless caught doing sex determination, no criminal offence shall be registered.
• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.
• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.
• Money spent does not mean you will get a cure.
• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.
• How can we treat patients using outdated standard treatment guidelines made by government?
• How can government decide the charges of a clinical establishment?
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.

Answers received from: Dr.K.Raju, Dr.Bitaan Sen

Answer for 23rd October Mind Teaser: B. Once a year after either turning 21 or having sexual intercourse for the first time.

Correct Answers received from: Dr.K.Raju, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Jainendra Upadhyay,
An independent panel of advisers to the US Food and Drug Administration on Friday voted 10-4 in favor of approving AstraZeneca Plc's gout drug, lesinurad.
U.S. Food and Drug Administration approved Strensiq (asfotase alfa) as the first approved treatment for perinatal, infantile and juvenile-onset hypophosphatasia (HPP).
The American Association of Physicians of Indian Origin (AAPI) will hold its 10th Global Health Summit from Jan 1 to 3 in New Delhi with a focus on women's health and non-communicable diseases in India. A ground breaking launch of the first Trauma and Brain Injury Guidelines for India is also planned for Jan 2, according to AAPI president Dr Seema Jain. (Business Standard)
About 27% of deaths in India due to lack of medical attention

Nearly 27% of the total deaths in India happen with no medical attention at the time of death, according to the 2013 civil registration data released by the Census directorate. And, only 43% of the total deaths occur in institutions and only 3.9% of the rest under the care of a qualified allopathic doctor. As against the number of deaths, 71% of the total births happen in institutions and other births get care from physicians, nurses, mid-wives etc. Expert attribute this to high cost and inaccessibility to medical care in rural and hilly areas. (Times of India - Sivakumar B)
Hepatitis cases outnumber HIV in India

According to a report by the Union Health ministry, there are far more hepatitis infections than HIV. The National AIDS Control Organisation (NACO) found that voluntary and replacement blood donors had a higher level of hepatitis infections (both HBV and HCV) than HIV at the national level.

Five transfusion transmissible infections - HIV, Hepatitis B, Hepatitis C, syphilis and malaria were studied by NACO. Dr Arun Kumar Sharma, one of the authors of the report said, “Of the five TTIs, in 2012, Hepatitis B positivity was the highest (0.9 per cent), followed by Hepatitis C Virus (HCV) (0.45 per cent), syphilis (0.23 per cent), HIV (0.17 per cent) and malaria (0.03 per cent). All the TTIs showed a declining trend, except HCV, which showed a rising trend in the Eastern and Southern regions.” The findings are published in the World Journal of AIDS. Globally, the World Health Organisation (WHO) has recommended mandatory screening of all donated blood units for TTIs, including HIV, Hepatitis B, Hepatitis C and syphilis before use. (India Today – Neeru Chandra Sharma)
India is the only country where more girls die than boys in the under-five age group, according to a UN report. At 93, the country has the lowest sex ratio in under-5 mortality. This means 93 boys die before age five for 100 girls that die by that age. India is also among the countries with the largest surplus of men. Overall, men outnumber women in eastern Asia, southern Asia, Oceania, and western Asia, according to 'The World's Women 2015' report. (ET Bureau)
CDC releases combined summary of notifiable infectious, noninfectious diseases

Beginning with the Oct. 23, 2015, Supplements to Morbidity and Mortality Weekly Report (MMWR), CDC will publish the summaries of all notifiable conditions – infectious and noninfectious – at the same time. The reports being released are the Summary of Notifiable Infectious Diseases and Conditions — United States, 2013, and the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks — United States. Together, the reports are referred to as the Summary (Infectious and Noninfectious). Together, these two reports provide official statistics for all nationally notifiable conditions in the same MMWR volume. CDC Director Tom Frieden, M.D., M.P.H said, “Tracking and responding to infectious and noninfectious diseases is a major part of CDC’s mission to protect America’s health. These annual summaries let us take the nation’s pulse and see where we are succeeding and what we need to do better.” (CDC)
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Inspirational Story
Good alphabet given by Swami Sivananda

A………Adjust, adapt, accommodate
B………Be good, do good, be kind, be compassionate
C………Control anger by forgiveness and love
D………Do to others as you would wish them to do to you
E………Envy not others
F………Forget and forgive
G………Giving is the secret of abundance
H………Hate sin not the sinner
I………Industrious nature destroy evil tendencies
J………Jealousy is a cancer, therefore kill it
K………Keep company with the sages
L………Love the lord by seeing everyone in him
M………Morality is the great way to the eternal bliss
N………Never insult or backbite
O………Obedience is a greater virtue than reverence
P………Purity leads to God realization
Q………Quench the sensual craving
R………Return good for evil
S………Share what you have with others
T………Truthfulness is a fundamental virtue
U………Unite, cooperate, collaborate
V………Virtues are ornaments they adorn life
W………Wander not in sensual pleasure
X………Examine your heart and remove evil traits
Y………Yield not to temptation
Z………Zealously endeavor to be simple and ample
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Readers column
Excellent spiritual messages.. Dr.R. Kamat
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Press Release
IMA urges the government to withdraw plans to start a Bachelor of Science in Community Health

New Delhi, October 25, 2015: The Indian Medical Association strongly objects the Government move to start BSc Community Health course under the National Board, to man sub-centers and empowering them to prescribe medicines.

Speaking about this issue, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. K K Aggarwal, Honorary Secretary General and President HCFI in a joint statement said, “Sub centers are the cornerstones of disease prevention activities and implementation of national health programs and not primarily meant to provide curative service except home remedies. The staff pattern in the sub center consists of one male and one female multipurpose health worker (JPHN/JHI/ANMs). The job description of these staffs is family welfare services, immunization, awareness, household visits, data collection regarding disease prevalence, and coordinating other national disease control programs. These staffs currently work under the supervision of a medical officer posted in PHC. For this purpose there is no need for a more qualified workforce. Posting the proposed BSc (Community Heath) graduates in sub centers will be a wrong human resource management”.

At the Sub Centre level, a more suitable workforce would be an ASHA worker with basic primary education and training. So the concept of posting paramedics at sub centers will be a gross waste of human resources and will be counterproductive for the purpose they are meant. The policy proposal on this is not based on ground reality and is conceptually wrong. The deployment of over qualified staff at sub centers will only increase the attrition rate. Entrusting the newly proposed BSc (Community health) graduates to manage very sensitive areas like child health within the health system may even worsen the situation. To leave the health of children and adolescents in the hands of ill-equipped personals is detrimental and may nullify the results of years of hard work that the country has put into reducing child mortality and morbidity

Moreover, if the Government’s intention is to produce health workers to work in sub centers, then why should such courses be conducted by the National Board of Examination (NBE)? In fact the NBE conducts postgraduate courses and not even undergraduate courses in modern medicine. Allowing these graduates to be registered under Medical Council will set a wrong practice.

IMA therefore, urges the Government to desist from the move to start BSc (Community Health) course.
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