November 26   2015, Thursday
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Pharmacy Practice Regulations, 2015

According to Regulation 2(b) of the Pharmacy Practice Regulations, 2015, ‘Practice of Pharmacy’ means: –

i. Interpretation, evaluation and implementation of medical orders; dispensing of prescriptions, drug orders ;

ii. Participation in drug and device selection, drug administration, drug regimen reviews and drug or drug related research,

iii. Provisions of patient counseling and the provision of those acts or services necessary to provide pharmaceutical care in all areas of patient care including primary care; and

iv. Responsibility for Compounding and labeling of drugs and devices (except labeling by a manufacturer, repacker or distributor of non-prescription drugs and commercially packaged legend drugs and devices) proper and safe storage of drugs and devices and maintenance of proper records for them.

According to Regulation 2(h) of the Pharmacy Practice Regulations, 2015, ‘Pharmacy Practitioner’ means an individual (Community Pharmacist/ Hospital Pharmacist/ Clinical Pharmacist/ Drug information Pharmacist) currently licensed, registered or otherwise authorized under the Act to counsel or otherwise and administer drugs in the course of professional practice.

According to Regulation 2(i) of the Pharmacy Practice Regulations, 2015, Registered Pharmacist means a person whose name is for the time being entered in the register of the State in which he is for the time being residing or carrying on his profession or business of pharmacy under the Pharmacy Act, 1948.

According to Regulation 2(j) of the Pharmacy Practice Regulations, 2015, ‘prescription’ means a written or electronic direction from a Registered Medical Practitioner or other properly licensed practitioners such as Dentist, Veterinarian, etc. to a Pharmacist to compound and dispense a specific type and quantity of preparation or prefabricated drug to a patient.

According to Regulation 3.3 of the Pharmacy Practice Regulations, 2015, ‘Displaying name of owner and registered pharmacist’:

(a) Name of the owner of pharmacy business shall be displayed at or near the main entrance of each premises in which the business is carried on.

(b) Name of the registered pharmacist along with his registration number and qualification along with his/her photograph shall be displayed adjacent to the area where dispensing is carried on in the pharmacy. Registered pharmacist shall also comply with a dress code of being dressed formally and wearing clean white overall (coat/apron)with a badge displaying the name and registration number.

(c) Registered pharmacists shall display as suffix to their names only recognized pharmacy qualification / degrees or such certificates/diplomas and memberships / honours which confer professional knowledge or recognizes any exemplary qualification/achievements.

According to Regulation 4.1 ‘Character of registered pharmacist’:

(a) The prime object of the pharmacy profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who- so-ever chooses his profession, assumes the obligation to conduct himself in accordance with its ideals. A registered pharmacist should be an upright man, instructed in the art of medicines. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and in all the actions of his life.

(b) A person having qualification in any other system of pharmacy is not allowed to practice modern system of pharmacy in any form.

(c) A registered pharmacist shall uphold the dignity and honour of his profession.
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 OKs Fluad, first seasonal influenza vaccine with an adjuvant

The US Food and Drug Administration (FDA) has approved a new seasonal influenza vaccine designed to provoke a stronger immune response in the elderly. Fluad (Novartis Vaccines and Diagnostics Limited) is the first seasonal influenza vaccine that contains an adjuvant, a substance that enhances or directs the immune response of the vaccinated person. The adjuvant is an oil-in-water emulsion of squalene oil, a naturally occurring substance in humans, animals, and plants that is highly purified for making vaccines. The new vaccine is trivalent, produced from three influenza strains: two subtypes A and the other type B. It is indicated specifically for people aged 65 years and older… (Medscape)

India's first MRI machine to be out in market by 2018

The department of IT's R&D laboratory SAMEER will soon bring out India's first MRI machine in the market by 2018. SAMEER is an R&D Laboratory set-up in 1960s for research, design and development of products in the field of RF and microwave systems. In a recent presentation to the Telecom Minister Ravi Shankar Prasad, Director-General SAMEER said the R&D laboratory was already in advance stages of product development of the machine which would enable use of imaging in medical diagnosis. Headquartered in IIT Powai, SAMEER also focuses on interdisciplinary research initiative addressing broader spectrum of electronics areas like optoelectronics, Digital signal processing, Navigational aids, radars, atmospheric remote sensing systems and Linear& accelerators… …(ET Healthworld)
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Specialty Updates
• About 1 in 10 children as young as 3 years of age may have suicidal thoughts or suggestive behaviors, and these linger into middle childhood for 3 of 4 children, especially for those with depression or externalizing disorders, suggests new research published in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

• Practical, day-to-day obstacles, including the weather, transportation problems, or finances, can play a major role in decreasing participation in an exercise program for patients with heart failure (HF), which may subsequently result in worsening cardiac outcomes, suggests new research published online in Circulation: Heart Failure.

• The anti-inflammatory biologic drug anakinra can safely and effectively treat the skin disorder hidradenitis suppurativa (HS), reported a small randomized controlled, double-blind trial published online November 18 in JAMA Dermatology.

• Four weeks of triple or quadruple combination therapy using new drugs for hepatitis C virus (HCV) results in only limited cure rates in patients with early-stage liver fibrosis, reported a study published online November 23 in the Annals of Internal Medicine.

• Persons who have had bronchiolitis in early childhood have an increased risk of asthma at the age of 28-31 years and a weaker health-related quality of life than their peers, suggested a new study published in Respiratory Medicine, Pediatric Pulmonology, Acta Paediatrica, and Pediatric Allergy and Immunology.

• Higher fasting plasma glucose (FPG) levels are associated with a higher burden of brain white matter hyperintensities (WMH), particularly in the frontal lobes, suggests a new study presented at the XXII World Congress of Neurology (WCN).

• Walnuts significantly improve diet quality, endothelial function, and cholesterol without negatively affecting blood pressure or glucose levels, reported a new study published in BMJ Open Diabetes Research & Care.

• Women with a certain type of lung nodule visible on lung cancer screening CT exams face a higher risk of lung cancer than men with similar nodules, suggests a new study scheduled to be presented at the annual meeting of the Radiological Society of North America (RSNA).
Vedic Fasting

Fasting and starvation are two different terms commonly confused with each other. Starvation means not eating or drinking altogether, while fasting means control and restrain of five sensory and five motor senses. During fasting one may continue eating or drinking but under discipline. Vedic fasting or spiritual fasting is mentioned in Karam Kanda in Yajurveda. Every fast in our mythology has a scientific basis and rituals are added so that the common man can follow it.

Legal Quote

In Jacob Mathew vs State of Punjab and Anr: 5th day of August 2005: 334/2005/SCI/ 144-145 of 2004

”Negligence which is neither gross nor of a higher degree may provide a ground for action in civil law but cannot form the basis for prosecution. ”
Digital IMA
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Income Heads

Income is classified into following five types.

• Salaries
• Income from house property
• Profits and gains from business or profession
• Capital gains
• Income from other sources

(Source: IJCP)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Medical advances that were initially ridiculed or rejected

Antiseptic Handwashing

Ignaz Semmelweis may be the best known example of a physician ridiculed for an idea that is now accepted as common sense. A Hungarian physician working in the maternity ward in Vienna in the mid-19th century, Semmelweis noted that puerperal fever was contagious—students and physicians were performing autopsies and then contaminating new mothers in the maternity ward with what Semmelweis, working prior to the germ theory of disease, termed "cadaverous particles."

Semmelweis advocated that doctors in obstetric clinics disinfect their hands following autopsies; at the clinic in which Semmelweis's hand-washing policy was implemented, the puerperal fever mortality rates dropped 90%, from 18.3% to less than 2%, in fewer than 6 months.

Despite Semmelweis's demonstration of the value of antiseptic techniques, by and large his ideas were rejected by the medical community, with a few notable exceptions. Semmelweis had believed that antiseptic hand washings would be widely adopted and save thousands of lives; when they were not, Semmelweis began publishing a series of vitriolic "open letters" against his critics. Increasingly isolated and unpredictable, Semmelweis was admitted against his will to a Viennese insane asylum, where he was severely beaten; –he died after 2 weeks.

(Source: Medscape)
Govt mulls 26-week maternity leave

The government is considering a proposal to increase the maternity leave for working women from the existing 12 weeks to 26 weeks. The proposal also talks of providing 12 weeks of maternity leave to commissioning mothers - who use surrogates to bear a child - as well as for working women adopting a baby. As per Maternity Benefit Act, 1961, a working woman, at present, is entitled to 12 weeks of maternity leave out of which six weeks are before the… expected date of delivery... –(ET Healthworld
India's vaccination programme to reach 90% within 3 years

Union Health Minister J P Nadda said that the vaccination program under 'Mission Indradhanush' will reach a coverage of almost ninety per cent in next three years. 'Mission Indradhanush', launched by Nadda in 2014, aims to immunise children against seven vaccine preventable diseases. "We came out with an ambitious program called Mission Indradhanush. Every year we used to increase our immunisation program by 1%. We thought if we go at this speed then we won't be able to reach the goal till 2050. In one year time we will be able to cover 5% and within three years we will be reaching from 65% to 90% of coverage," he said. The minister said four more vaccines will be added in the 'Mission Indradhanush' program……… (Economic Times)
CDC urges alert in wake of new H7N9 avian flu case in China

The Centers for Disease Control (CDC) has raised a travel advisory for China's Guangdong Province to the level of "alert" after receiving reports of a new H7N9 avian flu case there. Under the CDC's three-level travel advisory, it uses "watch," "alert" and "warning," in that order, to advise travelers planning to go there. The CDC confirmed the new case in Dapu County, Guangdong Province from the Chinese health authorities, but said the source of the infection is still under investigation. It is the first H7N9 case in Guangdong since the start of autumn. … …(Focus
Children will bear the brunt of climate change: UNICEF

More than half a billion children live in areas with extremely high flood occurrence and 160 million in high drought severity zones, leaving them highly exposed to the impacts of climate change, UNICEF said in a report released ahead of the 21st United Nations climate change conference, known as COP21. UNICEF Executive Director Anthony Lake said, “Today’s children are the least responsible for climate change, but they, and their children, are the ones who will live with its consequences. And, as is so often the case, disadvantaged communities face the gravest threat.”

Climate change means more droughts, floods, heatwaves and other severe weather conditions. These events can cause death and devastation, and can also contribute to the increased spread of major killers of children, such as malnutrition, malaria and diarrhea. This can create a vicious circle: A child deprived of adequate water and sanitation before a crisis will be more affected by a flood, drought, or severe storm, less likely to recover quickly, and at even greater risk when faced with a subsequent crisis…… … (UNICEF)
Routine follow-up blood tests not helpful in children with celiac disease

A study from The Netherlands published in the Journal of Pediatrics reports that routine blood tests to assess anemia, thyroid dysfunction, and nutritional deficiencies are not helpful during follow-up for most children with celiac disease. Many healthcare practitioners routinely check the indices of iron deficiencies, calcium, folate, and vitamin B12 levels including thyroid dysfunction. Dr. Margaretha Maria Susanna Wessels from Leiden University Medical Center said, Doctors do not need to perform standard tests, but personalize it for each child. I would recommend it at diagnosis, and if on a gluten-free diet (GFD) only in case of complaints such as fatigue, growth problems”. … …(Medscape)
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
Facts about exercise

• Exercise for 80 minutes a day and brisk exercise 80 minutes a week.
• The speed of walking should be at least 80 steps per minute.
• Do resistance or weight-bearing exercises twice in a week.
• Avoid doing strenuous exercises for the first time in life after the age of 40.
• According to Ayurveda, one should exercise to his or her body type.
• Diabetics who exercise should not exercise if blood sugar is lower than 90.
• In conditions of smog, avoid walking early in the morning till sunlight appears.
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):

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
IMA Digital TV
Inspirational Story
Is your hut burning?

The only survivor of a shipwreck was washed up on a small, uninhabited island. He prayed feverishly for God to rescue him, and every day he scanned the horizon for help, but none seemed forthcoming. Exhausted, he eventually managed to build a little hut out of driftwood to protect him from the elements, and to store his few possessions. But then one day, after scavenging for food, he arrived home to find his little hut in flames, the smoke rolling up to the sky. The worst had happened; everything was lost. He was stunned with grief and anger. "God, how could you do this to me!" he cried. Early the next day, however, he was awakened by the sound of a ship that was approaching the island. It had come to rescue him. "How did you know I was here?" asked the weary man of his rescuers. "We saw your smoke signal," they replied.

It is easy to get discouraged when things are going bad. But we shouldn't lose heart, because God is at work in our lives, even in the midst of pain and suffering. Remember, next time your little hut is burning to the ground----it just may be a smoke signal that summons the grace of God.
eMedi Quiz
Which one of the following is a recognized x-ray feature of rheumatoid arthritis?
1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: 2. Interstitial lung disease.

Answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay, Dr Kailash Chandra Sharma, DR SARMA P S, Dr Shangarpawar, Dr.B.R.Bhatnagar

Answer for 24th November Mind Teaser : 4. Progesterone therapy

Answers received from: Dr Jainendra Upadhyay, Dr Shangarpawar, Dr.B.R.Bhatnagar
This lady was talking in to an envelope. I asked her what she was doing, she said ‘sending voice mail’.
Readers column
A good effort to keep the medical fraternity informed. The legal corner is very useful.
Dr Mahalingeshwara Prasad S
Press Release
An Anti-Obesity Day awareness initiative

Obesity has continuously been undermined as a factor of deteriorating public health in India

India is the third most obese country in the world with more than 30 million people suffering from moderate to severe obesity

According to a report, around 11 percent of adolescents and 20 percent of adults are overweight and have a body mass index higher than 25 kg/m2 to 30 kg/m2

Over 30% of the Indian population including children is found to be suffering from Potbelly abdominal obesity. The incidence of metabolic syndrome, characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high blood sugar is at an all-time high in the country and continues to rise. The reason for this is the unhealthy lifestyle choices made my majority of the population including consumption of a diet, which predominantly has high trans fat, sugar and cholesterol levels, long hours spent working in closed spaces with minimal physical exercise and dependence on evils such as alcohol and cigarettes.

In fact, nowadays seeing the surge in preventable deaths annually, obesity is being considered as a new killer disease. It makes the young vulnerable to long-term chronic diseases like cardiovascular issues, diabetes and blood pressure fluctuations. Obesity is not only prevalent in youngsters or adults but is also plaguing the children. Children often become overweight due to innumerable factors like lack of physical activity, unhealthy eating habits, increasing reliance on convenience foods and hormonal issues.

However, weight problems are also linked to medical heredity complications. Thus, if obesity runs in the family, one must ensure that adequate prevention measures are taken to prevent it from becoming a part of their offspring's life as well.

Speaking about the growing problem, Padma Shri Awardee Dr. A Marthanda Pillai –National President IMA and Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General, IMA and President, HCFI said, “Very few people are aware of the fact that obesity can be prevented and managed if one's weight and eating habits are monitored properly. As the first step in this direction, all individuals should adopt a healthy eating pattern, which includes cutting down on the consumption of processed and convenience food items, as they boost the deposition of bad cholesterol in the body. A balanced diet should consist of items of all five colors and associated vitamins and minerals to help condition the human body to perform better and build a shield against diseases. Secondly, watching the portion size of each meal is crucial. Eating small portions in regular intervals will help you in balancing the energy intake and output. In addition to this, one should always plan an exercise routine, being physically active helps our body to function flexibly and avoid joint pains and bone fractures."

Few tips to keep in mind maintain a healthy lifestyle:

• Follow a healthy eating plan. Make healthy food choices, keep your calorie needs and your family's calorie needs in mind, and focus on the balance of energy IN and energy OUT.

• Focus on portion size. Watch the portion sizes in fast food and other restaurants. The portions often served are enough for two or three people. Children's portion sizes should be smaller than those for adults. Cutting back on portion size will help you balance energy IN and energy OUT.

• Be active. Make personal and family time active. Find activities that everyone will enjoy. For example, go for a brisk walk, bike or rollerblade, or train together for a walk or run.

• Reduce screen time. Limit the use of TVs, computers, DVDs, and video games because they limit the time for physical activity. Health experts recommend 2 hours or less a day of screen time that does not work- or homework-related.

• Keep track of your weight, body mass index, and waist circumference. Also, keep track of your children's growth.

• Ensure that your abdominal circumference is lower than 80 cm/90cm (women and men)

• Keep fasting sugar lower than 80 mg% and blood pressure lower than 80 mm Hg.

• Keep heart rate lower than 80 per minute and bad LDL cholesterol lower than 80 mg%.

• Do not consume more than 80 grams of caloric solid or liquid food at once.

• Observe carbohydrate fast 80 days a year.

• Consume at least 80 fruits and vegetables servings in a week.

As they say, you reap what you sow, and hence, to be able to live a disease free lifestyle, one should give up all the addictions this anti-obesity day, which may put them in a danger of suffering from life-threatening diseases in the future.