January 26 2015, Monday
eMedinewS and IMA Congrates and Salutes all Padma Awardee Doctors of the year 2015

Padma Bhushan

  • Dr. Ambrish Mithal (Medicine), Delhi
  • Dr. Ashok Seth (Medicine), Delhi

Padma Shri

  • Prof. Alka Kriplani (Medicine), Delhi
  • Dr. Harsh Kumar (Medicine), Delhi
  • Dr. Manjula Anagani (Medicine), Telangana
  • Dr. Rajesh Kotecha (Medicine), Rajasthan
  • Dr.Tejas Patel (Medicine), Gujarat
  • Dr. Narendra Prasad (Medicine), Bihar
  • Prof. Yog Raj Sharma (Medicine), Delhi
  • Dr. Nikhil Tandon (Medicine), Delhi
  • Dr.Hargovind Laxmishanker Trivedi (Medicine), Gujarat
  • Prof. (Dr.) Yogesh Kumar Chawla (Medicine), Chandigarh
  • Dr. Sarungbam Bimola Kumari Devi (Medicine), Manipur
  • Dr. Randeep Guleria (Medicine), Delhi
  • Dr. K. P. Haridas (Medicine),
  • Kerala Smt. Jayakumari Chikkala (Medicine), Delhi
  • Dr. Dattatreyudu Nori (NRI/PIO) (Medicine), USA
  • Dr. Raghu Rama Pillarisetti (NRI/PIO) (Medicine), USA
  • Dr. Saumitra Rawat (NRI/PIO) (Medicine), UK
  • Dr. Gyan Chaturvedi (Literature and Education), Madhya Pradesh

     

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IMA IAP FOGSI Initiative
Adolescent Clinics

All 1700 branches are requested to open weekly adolescent clinic and focus on mental, reproductive & life style health. Adolescence covers 22% of the population and is the period of rapid physical growth, sexual and psychological changes..

Reproductive Health
· Many adolescent boys and girls are sexually active but lack information and skill for self-protection (low level of information on Family Planning, low contraception use)
· They have simple but wide pervading crucial reproductive health needs- menstrual hygiene, contraception (including emergency contraception) safety from STI and HIV
· Adolescent sexuality: leads to adolescent pregnancy, unsafe abortion, RTI, STI/HIV and social problems
· Adolescent pregnancy, the risk of ADVERSE outcome (IMR, MMR LBW babies) again is higher
· Median age at marriage for girls in rural areas is alarmingly low at 14.5 years.
· Adolescent pregnancy is Common (50% of women in India had a child before reaching the age of 20. (Indian Paediatrics, January 2004).
· One out of ten children in India is sexually abused at any given point of time.
· 25% of the patients attending government STI clinics are younger than 18 years old (Ramasubban- 1995).
· Maternal Mortality elated to pregnancy and childbirth are an important cause of mortality for girls aged 15-19 worldwide, accounting for 70,000 deaths each year. Girls who give birth before the age of 15 are five times more likely to die in childbirth than women in their twenties.

Mental Health
· Psychological problems also arise like emotional disturbances, depression, low self esteem and anxiety over inadequate or excessive secondary sexual development, Acne etc.

Life Style Health
· Habits and behavior picked up during adolescence (risk taking behavior, substance abuse, eating habits, conflict resolution) have lifelong impact.
· 70% of the mortality in adulthood is linked to these habits picked up during adolescence
· Adolescence is the last chance to correct the growth lag and malnutrition.
· Prevailing malnutrition, anemia, stunting and lack of immunization have adverse impact on MMR, IMR, morbidity and have intergenerational effects.
· Stunted adolescent getting married giving rise to a low birth baby, that too female, again unable to develop or develop in to a stunted female and the cycle keeps on repeating
· A large number of adolescents are still unimmunized.
editorial
eMedinewS wishes all its readers Happy Republic Day
Dr KK Aggarwal Harvard’s 4 simple ways to boost your energy
  1. Pace yourself. If you’re a go–getter, you probably like to keep going — but don’t risk overtaxing yourself. You can pace yourself and still get things done. For example, instead of burning through all your "battery life" in two hours, spread it out among morning tasks, afternoon tasks, and evening activities — with rest and meals in between.
  2. Take a walk or a nap. There’s nothing more satisfying than a short power nap when you’re pooped out. However, if you have trouble sleeping at night, know that napping can make insomnia worse. If that’s the case for you, get moving instead. Get up and walk around the block, or just get up and move around. If you are not an insomniac, though, enjoy that 20– to 30–minute power nap.
  3. Skip most supplements. You may have heard about energy–boosting or "anti–aging" supplements. There is no evidence they work.
    • Helps in tissue characterization
    • Helps in prediction of outcome in tetralogy of Fallot
    • Useful in shunt calculation
    • Helps in detection of pediatric cardiac tumors, amyloidosis, acute onset of LV dysfunction, hypertrophic cardiomyopathy, myocarditis, cardiomyopathies, arrythmogenic RV dysplasia and restrictive cardiomyopathy.
  4. Fuel up wisely. A sugary roll from the bakery delivers plenty of calories, but your body tends to metabolize them faster, and then you can end up with sinking blood sugar and fatigue. You’ll maintain a steadier energy level by eating lean protein and unrefined carbohydrates. Try low–fat yogurt with a sprinkling of nuts, raisins, and honey. Your body will take in the carb–fiber–protein mix more gradually. Don’t skip meals, either. Your body needs a certain number of calories to get through the day’s work. It’s better to space your meals out so your body gets the nourishment it needs all through the day.
eMedipics IMA,IJCP,HCFI
Health Check Up and CPR 10 Camp at G B S. S. School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014
The Year in Medicine 2014: News That Made a Difference
Cynicism Linked to Dementia

A high level of cynical distrust — for example, believing that no one cares much what happens to you and that it's safer not to trust anybody — is associated with a higher risk for dementia, and the association is not entirely explained by depressive symptoms, a new study shows. "The findings of this study propose that psychosocial and behavioral risk factors may be modifiable targets for prevention of dementia," researchers at the University of Eastern Finland, Kuopio, conclude. "It may thus be possible to improve life quality by attempting to change people's attitudes to a more positive direction." The study was published online May 28 in Neurology.(Source: Medscape)
Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh by God! Why was additional insulin given?
Lesson: Make sure that the insulin dose is correctly calculated. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.
IMA,IJCP,HCFI
Quote of the Day

For I don’t care too much for money, for money can’t buy me love. The Beatles
News on Maps
CPR 10

Total CPR since 1st November 2012 – 101090 trained

IMA Facebook Likes
Click here
 27791 likes
Twitter of the Day

Dr KK Aggarwal: Inhaling diesel exhaust Fumes causes heart attack or stroke http://bit.ly/15QdVeB #Health

Dr Deepak Chopra: The most positive action we can take about the past is to change our perception of it http://bit.ly/15QdVeB #Health
Rabies News (Dr A K Gupta)

Can the IM and ID routes of vaccination be used interchangeably??

It is recommended by many internationally reputed experts that the phenomenon of mixing of IM and ID schedules is not to be practiced and must be avoided as far as possible.
eMedinewS Humor

Under the wagon

A farm boy accidentally overturned his wagonload of wheat on the road. The farmer that lived nearby came to investigate.

"Hey, Willis," he called out, "forget your troubles for a while and come and have dinner with us. Then I’ll help you overturn the wagon."

"That’s very nice of you," Willis answered, "but I don’t think Dad would like me to."

"Aw, come on, son!" the farmer insisted.

"Well, OK," the boy finally agreed, "but Dad won’t like it."

After a hearty dinner, Willis thanked the host. "I feel a lot better now, but I know Dad’s going to be real upset."

"Don’t be silly!" said the neighbor. "By the way, where is he?" "Under the wagon," replied Willis.
IMA NEWS
Launch of IMA Rise and Shine Web Lecture Series
 
Date of webcast
8th February 2015
Time of webcast
11:00 AM - 11.30 AM
Mode
Live webcast http://www.ima-india.org/ima/
Opening remarks:
Dr K K Aggarwal, Honorary Secretary General, IMA - 2 minutes
Introduction of President IMA and Chairman Apollo Hospitals Group
Dr. Anupam Sibal, Group Medical Director, Apollo Hospitals - 3 minutes
Presidential Address
Dr. Marthanda Pillai, National President – IMA - 7 minutes
Leadership Qualities: My personal Journey and Healthcare challenges
Dr. Prathap C Reddy, Chairman Apollo Hospitals Group - 15 minutes
Concluding Remarks and Thanks
Dr. K K Aggarwal - 3 minutes

IMA, IAP, NNF & FOGSI Initiative
 
  • No child ( 0 to 5 years ) should die of diarrhea and pneumonia. At present 2 lacs children die of diarrhea and 3 lacs from pneumonia every year, which is not acceptable to the medical profession. For every Neo-natal death public should make public outcry.
  • No child should die just because preventive and infrastructure facilities are not available for treating diarrhea and pneumonia.
  • To reduce infant mortality rate to 20 per 1000 from the present 40 per thousand.
  • Every Branch of IMA to have a Women Wing for educating adolescent girls.
  • Every Branch of IMA to have adolescent weekly clinics.
  • Every IMA member to sensitize adolescents about life style, reproductive and mental health.
  • IMA to focus on Delhi as a model to achieve zero death with diarrhea and pneumonia in 0-5 years of age.
IMA welcomes President elect of WORLD MEDICAL ASSOCIATION Sir Michael Marmot who is visiting Gujarat during 14-15 February 2015.

Dear ALL

IMA welcomes President elect of WORLD MEDICAL ASSOCIATION Sir Michael Marmot who is visiting Gujarat during 14-15 February 2015.

He has agreed to visit a remote tribal area of North Gujarat (Banaskantha District of Gujarat) where IMA's flagship AAO GAON CHALE programme was vibrantly launched in 2004 in presence of the then President of IMA Dr. Ketan Desai.

This is a great honour to have Michael with IMA at the place where IMA launched the dream project.

Padma Shri Awardee
Prof Dr A Marthanda Pillai, NP

Padma Shri Awardee
Prof Dr K K Aggarwal, HSG

Dr. Jitendra B. Patel (IPNP)
Important Websites
THE DRUGS AND COSMETICS (AMENDMENT) BILL, 2015
Amendment of section 24
29. In section 24 of the principal Act, for the words “drug or cosmetic” at both places, the words “drug, cosmetic or notified category of medical device” shall be substituted
Substitution of new section for section 25.
30. For section 25 of the principal Act, the following section shall be substituted, namely:-
Report of Government Analyst
“25. (1) The report of the Government Analyst in respect of sample of drug, cosmetic and notified category of medical device shall be the conclusive evidence of facts stated therein, unless challenged in such manner as may be prescribed.
 
(2) The procedure for further action on the report of the Government Analyst shall be such as may be prescribed.”.
Amendment of section 26
31. In section 26 of the principal Act, for the words “drug or cosmetic”, the words “drug, cosmetic or notified category of medical device” shall be substituted;
Amendment of section 26A
32. In section 26A of the principal Act,- (a) for the words “this Chapter”, the words, letter and figures “Chapter IIA and Chapter IV” shall be substituted; (b) for the words “drug or cosmetic at both the place where they occur”, the words “drug, cosmetic or notified category of medical device” shall be substituted.
Amendment of section 26B.
33. In section 26B of the principal Act, for the word “drug” at both the places where it occur, the words “drug or notified category of medical device” shall be substituted.
Amendment of section 27
34. In section 27 of the principal Act,-
 
(i) in the opening portion, for the words “for distribution,”, the words “for distribution or for market,” shall be substituted;
 
(ii) in clause (a), in the second proviso,-
 
(a) for the word “relative”, the words “legal heir” shall be substituted;
 
(a) manufacture for sale, distribution or marketing, sell, stock, exhibit, offer for sale or distribute any,
 
(b) the “Explanation” shall be omitted.
 
(iii) for clause (d), the following clauses shall be substituted, namely:-
 
“(d) any drug deemed to be misbranded under section 17, shall be liable for penalty which may extend to two lakh rupees to be imposed by the Central Licensing Authority or State Licensing Authority, as the case may be, in such manner as may be prescribed.
 
(e) any drug, other than a drug referred to in clause (a) or clause (b) or clause (c) or clause (d), in contravention of the any other provision of this Chapter or any rule made under the Act, shall be liable for penalty which may extend to five lakh rupees to be imposed by the Central Licensing Authority or State Licensing Authority, as the case may be, in such manner as may be prescribed.”
Media
IMA,IJCP,HCFI
Dr KK Spiritual Blog
There is a ritual and tradition of offering food to God before eating

This is a Vedic reminder to oneself that one should eat only those foods that are offered to God. Each time you offer food to God, it is a reminder to you to change your decision and choices. For example, alcohol, tobacco, onion, garlic, radish, etc. are not offered to God. If they are part of your food, there are chances that you will not consume these food items, if you observe this ritual.

Cheating is permitted out of 21 meals in a week. Over a period of time people have stopped following this ritual and now eat some foods, which cannot be offered to God in all their 21 meals. This is the reason why the incidence of lifestyle diseases is increasing in the community.
Inspirational Story
Addiction to Worry

Carole started counseling with me because she was depressed. She had been ill with chronic fatigue syndrome for a long time and believed her depression was due to this. In the course of our work together, she became aware that her depression was actually coming from her negative thinking – Carole was a constant worrier. Many words out of her mouth centered on her concerns that something bad might happen. "What if I never get well?" "What if my husband gets sick?" "What if I run out of money?" (Carole and her husband ran a very successful business and there was no indication that it would not go on being successful). "What if my son gets into drugs?" "What if my kids don’t get into good colleges?" "What if someone breaks into the house?"

Her worry was not only causing her depression, but was also contributing to her illness, if not actually causing it. Her worry caused so much stress in her body that her immune system could not do its job of keeping her well. Yet even the awareness that her worry was causing her depression and possibly even her illness did not stop Carole from worrying. She was addicted to it. She was unconsciously addicted to the sense of control that worry gave her.

I understood this well because I come from a long line of worriers. My grandmother’s whole life was about worrying. She lived with us as I was growing up and I don’t remember ever seeing her without a look of worry on her face. Same is with my mother – constant worry. Of course, I picked up on it and also became a worrier. However, unlike my mother and grandmother, who worried daily until the day they died, I decided I didn’t want to live that way. The turning point came for me the day my husband and I were going to the beach and I started to worry that the house would burn down and my children would die. I became so upset from the worry that we had to turn around and come home. I knew then that I had to do something about it.

As I started to examine the cause of worry, I realized that worriers believe that worry will stop bad things from happening. My mother worried her whole life and none of the bad things she worried about ever happened. She concluded that nothing bad happened because she worried! She really believed that she could control things with her worry. My father, however, never worried about anything, and nothing bad ever happened to him either. My mother believed that nothing bad happened to my father because of her worry! She really believed until the day she died (from heart problems that may have been due to her constant worry) that if she stopped worrying, everything would fall apart. My father is still alive at 92, even without her worrying about him!

It is not easy to stop worrying when you have been practicing worrying for most of your life. In order for me to stop worrying, I needed to recognize that the belief that worry has control over outcomes is a complete illusion. I needed to see that, not only is worry a waste of time, but that it can have grave negative consequences on health and well–being. Once I understood this, I was able to notice the stomach clenching that occurred whenever I worried and stop the thought that was causing the stress.

Carole is in the process of learning this. She sees that her worry makes her feel very anxious and depressed. She sees that when she doesn’t worry, she is not nearly as fatigued as when she allows her addiction to worry to take over. She sees that when she stays in the moment rather than projecting into the future, she feels much better. The key for Carole in stopping worrying is in accepting that worry does not give her control.

Giving up the illusion of control that worry gives us is not easy for anyone who worries. Yet there is an interesting paradox regarding worry. I have found that when I am in the present moment, I have a much better chance of making choices that support my highest good than when I’m stuck thinking about the future. Rather than giving us control, worry prevents us from being present enough to make loving choices for ourselves and others. Worrying actually ends up giving us less control rather than more!
Dr Good Dr Bad
IMA,IJCP,HCFI
Wellness Blog
Fever
 

Fever does not mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs. • Hyperthermia may not respond to anti–fever drugs. • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.
Medicolegal
IMA,IJCP,HCFI
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues

h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -
WhistleblowerDumped/videoshow/4468283.cms

Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health
https://www.youtube.com/watch?v=6Ktz5-iUINE

Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
https://www.youtube.com/watch?v=TGEGauzE0kg
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
https://www.youtube.com/watch?v=Mc3kKDXKWvs

Kishan, SM Heart Care Foundation Fund,
Post CHD Repair
https://www.youtube.com/watch?v=OTEG7toVkAQ

Deepak, SM Heart Care Foundation Fund,
CHD TOF https://www.youtube.com/watch?v=rjOel0aaqt0
eMedi Quiz
The Protein Efficiency Ratio (PER) is defined as:

1. The gain in weight of young animals per unit weight of protein-consumed.
2. The product of digestibility coefficient and biological value.
3. The percentage of protein absorbed into the blood.
4. The percentage of nitrogen absorbed from the protein absorbed from the diet.

Yesterday’s Mind Teaser: The following statements about meningococcal meningitis are true, except:

1. The source of infection is mainly clinical cases.
2. The disease is more common in dry and cold months of the year.
3. Chemoprophylaxis of close contacts of cases is recommended.
4. The vaccine is not effective in children below 2 years of age.

Answer for yesterday’s Mind Teaser: 1. The source of infection is mainly clinical cases.
Correct Answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay, Dr Chandresh Jardosh.
Answer for 24th Jan Mind Teaser: 3. Third quartile.
Correct Answers receives: Dr. Avtar Krishan, Dr. Poonam Chablani, Dr Abbas Vakil.
IJCP Book of Medical Records
IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one day.
United States’ “threats” to India’s domestic policies on Intellectual Property Right (IPR).

· Western world” is building “continuous pressure” on India to amend many sections of the Patent Act of 1970, particularly 3(d), which would qualify global pharmaceutical companies to market new drugs without making any genuine innovation, thus escalating profit. The GDP growth of US and EU is largely dependent on the knowledge-based economy. While 35% of US GDP growth comes from IPR related industry, 39% of EU’s growth is IPR dependent.

· Section 3(d) says that “mere discovery of a new form of a known substance which does not result in the enhancement of the known efficacy of that substance” will not be eligible for fresh patents

· In its annual report (2014 Special 301 Report) to underscore trade barriers to US companies due to IPR related laws, the US Trade Representative (USTR) has expressed its concerns about the existence of 3(d). “The United States is concerned that Section 3(d), as interpreted, may have the effect of limiting the patentability of potentially beneficial innovations.
Other issues

· Policy amendments in “compulsory licensing” especially while granting permission to NATCO for manufacturing cancer drugs which was being sold by BAYER of Germany “at exorbitant prices” in the country.

· Illegitimate demand of data exclusivity on pharmaceuticals” whereby the Drug Regulatory Authority of India will be prohibited to disclose trial results to the Indian generic companies.

· Protection” for products like Darjeeling tea, Basmati rice, textile goods and several other agricultural products which have its origin in India.
IMA in the News
IMA releases white paper on Crimean-Congo Hemorrhagic Fever

New Delhi: The Indian Medical Association (IMA) today sought to inform the public about preventive measures to counter Crimean-Congo Haemorrhagic Fever (CCHF) after tests confirmed that a patient who recently died at AIIMS here had contracted the disease.

The white paper compiled by Dr KK Aggarwal, the IMA Secretary General, explains what the disease is and what preventive measures should be taken to check it. The advisory came after tests at National Institute of Virology (NIV) at Pune confirmed that the patient, who was referred to AIIMS from a hospital in Jodhpur, had succumbed to CCHF.

As per the white paper, CCHF is a severe, potentially fatal disease in humans caused by tick-borne virus (Nairovirus) and mainly occurs in Africa, Asia, Eastern Europe and Middle East.

CCHF was first confirmed in a nosocomial (originating in a hospital) outbreak in 2011 in Gujarat. Another outbreak occurred in July, 2013, in Karyana village of Amreli district in Gujarat, IMA said.

"There is no vaccine available for either people or animals. Preventions that one can take include reducing the risk of human-to-human transmission in the community, avoiding close physical contact with CCHF-infected people, wearing gloves and protective equipment while taking care of ill people, washing hands regularly after caring or visiting ill people," stated the white paper.

Health workers caring for patients with suspected or confirmed CCHF, or those handling specimens from them, should implement standard infection-control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

Transmission of CCHF in humans occurs through tick bites, contact with a patient with CCHF during the acute stage of infection or contact with blood or tissue from infected livestock.

"Human-to-human transmission can occur resulting from close contact with the blood, secretions organs or other bodily fluids of infected persons. The four distinct phases of the disease are incubation, pre-haemorrhagic, hemorrhagic and convalescence," it added.

The incubation period that follows a tick bite is usually short and lasts for between three to seven days. The pre- hemorrhagic period is characterized by the sudden onset of fever, headache, myalgia, and dizziness. Additional symptoms of diarrhea, nausea and vomiting are also seen in some cases.

"Nearly three days later, hemorrhagic manifestations from petechiae, large haematomas and frank bleeding (vaginal, gastrointestinal, nose, urinary, and respiratory tracts) usually follows.

"The convalescence period begins in survivors about 10 to 20 days after onset of the illness," the white paper says.

The disease is diagnosed by ELISA and immunofluorescence assays from about seven days after its onset.

Treatment of CCHF is mainly supportive. Ribavirin is effective, to be given for 10 days (30 mg/kg as an initial loading dose, then 15 mg/kg every six hours for four days, and then 7.5 mg/kg every eight hours for six days).

Meanwhile, the report said that a study on Vector Borne and Zoonotic diseases looked at the prevalence of CCHFV among bovine, sheep and goat populations from 15 districts of Gujarat and found antibodies in all the 15 districts surveyed; with positivity of 12.09 per cent in bovine, 41.21 per cent in sheep and 33.62 per cent in goats.

"Anti-CCHF virus (CCHFV) immunoglobulin G (IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals," the white paper said.
PEDICON 2015
Severe asthma – Guidelines and beyond Dr. Krishan Chugh, Gurgaon
  • Severe asthma may be classified into Chronic Severe Persistent Asthma, Problematic Chronic Severe Persistent Asthma and Acute Severe Asthma and Problematic Acute Severe Asthma.
  • Chronic severe persistent asthma presents with symptoms daily, frequent exacerbations, frequent nocturnal asthma symptoms, limitation of physical activities, FEV1 or PEF = 60% predicted, PEF or FEV1 variability > 30%.
  • In such case, avoid triggers and treat acute episodes with high dose ICS+LABA+ LRTA, theophylline. Oral steroids may be added if required.
  • Problematic Severe Chronic Asthma represents asthma which requires treatment with guidelines suggested medications for GINA steps 4-5 asthma, (high dose ICS and LABA or leukotriene modifier/theophylline) for the previous year to prevent it from becoming uncontrolled or which remains uncontrolled.
  • Uncontrolled asthma is called so if at least one of the following exists: Poor symptom control, frequent severe exacerbations, serious exacerbations, airflow limitation.
  • Nightmare asthma involves persistent obstruction (>3 mths); Brittle – type I (swings in PEFR); Recurrent severe > 1 admission in PICU, > 2 hospital admissions, > 2 oral steroids/yr; Brittle type 2 – attack in spite of good control; Persistent airflow limitation; and patient on alternate day steroids.
  • Assessment of airway pathology – Non-invasive modalities are sputum cytology, exhaled nitric oxide, PFT, and steroid responsiveness. Invasive methods include CECT Chest, and Bronchoscopy – BAL; endobronchial biopsy.
  • Management options for severe asthma include steroids, omalizumab, immunomodulatory agents, gold salts, macrolides and Ig infusions.
  • Computed tomography of chest should be done in children and adults with severe asthma without specific indications for chest HRCT based on history.
  • In children with severe asthma, treatment should be guided by clinical criteria alone rather than by clinical criteria and sputum eosinophil counts.
  • FeNo should not be used to guide therapy in adults or children with severe asthma.
  • In both adults and children with severe allergic asthma, a therapeutic trial of omalizumab is recommended.
  • Methotrexate should not be used.
  • Macrolide antibiotics are not suggested in both adults and children with severe asthma.
  • Antifungal agents are not recommended for the management of asthma in adults and children with severe asthma without ABPA, irrespective of sensitization to fungi.
  • The difference between exacerbations of asthma and loss of baseline control is summarized in the table.
Exacerbation
Loss of baseline control
Abrupt decrease in peak flow, little diurnal variation
Marked diurnal viariability, baseline relatively stable
Usually viral
Usually related to adverse environmental exposures (e.g.,allergen)
Very difficult to prevent
Usually easily abolished by higher dose ICS
  • Advantages of noninvasive ventilation (NIV):
    • Decreases need for intubation
    • Improves alveolar ventilation
    • Improves gas exchange
    • Relieves dyspnea
    • Decreases work of breathing/resting of fatigued muscles
    • Decreases length of hospital stay
    • Decreases mortality.
  • In children admitted to the PICU, only 5% to 10% require mechanical ventilation.
Urinary Tract Infection in Children - Guidelines for management

Dr. Anand S. Vasudev, New Delhi
  • Urinary tract infections (UTIs) are common bacterial infections in children (second only to RTI). The diagnosis is often missed as symptoms are nonspecific.
  • Scarring of Kidneys is in 15% of UTI cases. It may cause permanent damage, reduced renal function, hypertension, complications in pregnancy and ESRD.
  • Clinical features of UTI in a young child may include recurrent fever, diarrhea, vomiting, poor weight gain and abdominal pain. In older children the classical symptoms include fever, dysuria, dribbling, urgency, frequency, flank pain, enuresis, pyuria, and hematuria. In neonates, UTI may be a part of septicemia.
  • In order to diagnose UTI, assess the degree of toxicity, dehydration, blood pressure (Proper Cuff size), history of bowel and bladder habits, CBC, KFT, CRP, ESR, blood culture and sensitivity in infants and sick child, and urine examination.
  • Urine examination is the most important investigation. A urine bag is not recommended since it can give high false positive results.
  • Initial empiric therapy pending culture report can include oral Cotrimoxazole , Cephalexin, Amoxyclav, Cefexime, for a period of 7-10 days.
  • Cases of complicated UTI (high fever, toxicity, vomiting, renal angle, high creatinine) in neonates may be treated as for sepsis with parentral antibiotics Amoxyclav, Aminoglycosides/3rd generation Cephalosporins. Duration of therapy should be 10-14 days.
  • Short 3 days course may be tried in adolescent with cystitis.
  • Imaging in UTI includes Renal Bladder Ultrasonography for kidney size, location, hydronephrosis, bladder anomalies, and post void residue; Micturating/Voiding cystourethrogram (MCUG/VCUG); DMSA Scan for renal parenchymal infection and scarring.
  • The imaging modalities suggested in children below 1 year (either sex) include RBUS, VCUG, and DMSA; and in those aged 1-5 years include RBUS, DMSA scan ( if abnormal then VCUG)
  • For children aged >5 years, RBUS should be done (If abnormal then VCUG, DMSA).
  • For cases of recurrent UTI, RBUS, DMSA, and VCUG should be done.
  • The American Academy of Pediatrics recommends RBUS for 1st febrile UTI in all children 2 – 24 months of age. VCUG is not recommended routinely after first UTI. It should be done only if RBUS shows hydronephrosis, scarring, high grade VUR, and obstructive uropathy.
  • Predisposing factors for recurrent UTI include the following:
    • Girls
    • Obstructive uropathy
    • Severe VUR (Grade III – V)
    • Voiding dysfunction
    • Constipation
    • Tight Phimosis, vulval synechiae
    • Neurogenic bladder.
  • Prevention of recurrent UTI involves increased fluid intake, precautions in cleaning the perineal area in girls, avoiding constipation, circumcision in boys with high grade reflux, avoiding tub bath.
  • Management for recurrent febrile UTI with VUR and in infants while awaiting imaging studies includes Trimethoprim 2 mg/kg (cotrimoxazole), Cephlexin 10 mg/kg, or Nitrofurantoin 1mg/kg (not below 3 mo age).
AICOG 2015
Robotic Surgery in Gynaecology

Dr Peter Barton-Smith, Singapore

Robotics has 3 advantages: Improved vision (3D/x10 magnification), improved precision (fine wristed instruments) and improved ergonomics (less trauma to the surgeon). Robotics in gynecology have made it easier for the surgeon, more women have access to MIS and better results especially in complex cases. The only major stumbling block is the cost of robotics

Empowering women in a resurgent India

S Srinivasan, Chennai

The mood of the nation is upbeat in the Resurgent India! The era of uncertainties and policy paralyses in the functioning of the Govt. at the centre appears to have ended. The new government at the centre is demonstrating its political will in implementing many of the promised programs. Many new schemes have been announced particularly involving welfare of women.

The women themselves have to get empowered based on such programs. There is an urban- rural divide and empowerment of women must take into account such divide and address issues relating to its own group. Women have been subjugated to lot of atrocities and have to unleash their power resorting to all legal means and social considerations. Urban women have their own problems and requirements depending upon whether they belong to the elite, middle income group, or the weaker sections of society. So is the case with rural women depending upon whether they are rich or poor. Alcoholism in men leads to domestic violence and ruins the family taking a heavy toll on the children. Sexual assaults at work places and rapes, which are growing must stop.

Women should be empowered to meet these challenges. They must make use of the Govt.’s initiative to bring the women as the power agent in all walks of life.

Case in point is the new Companies Act, which now allows women to enter board rooms of Companies with statutory backing. Corporate social responsibility has been cast on companies earning substantial turnover and profit to contribute a portion of the profits to schemes enunciated towards welfare of particularly women. All these are only the beginning towards a larger goal of the Govt. in the emancipation and empowerment of women. But there is a long way to go.

Let’s together make it happen to fulfill the dreams of a Resurgent India.

Dr Luis Cabero

Barcelona

Millennium development goals after 2015
  • We have not had good success in MDGs in the last 15 years. Now we have begun another period in MDG post 2015.
  • Goals 4 (Reduce child mortality) and 5 (improve maternal health) are closely related to obstetrics and gynecology. MDGs have brought into focus the need to eliminate extreme poverty.
  • Incorporation of MDGs into national strategies cannot be achieved without a committed participation of various players: Govt., civil society, private sector and international agencies. They have not taken into consideration the causes of poverty and issues such as inequality and people participation in decisions that affect them.
  • Gender inequality persists and women continue to face discrimination in education, work. There has been progress and maternal deaths have come down but there is still lot to be done. Urgent action is needed to expand proven interventions to improve reproductive and maternal health
  • The disproportionate impact of poverty on women and girls is not a result of accident but a result of systematic discrimination.
  • Reasons for failure: Failure of the developed application of at least 0.7 of its budget to developed cooperation, policies implemented in the least developed/developing countries are not tested and the UN itself has proved not only in effective in addressing similar objectives
  • The current dismal progress towards the MDGs is attributable in large part to the widespread failure by the international community tore cognize and then act on the discrimination against girls
  • The Maternal MDG, the most off track goal is also the one that depends on improving status of women. Women’s rights must be put at the center of efforts
IJCP’s ejournals
  • Indian Journal of Clinical Practice
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  • Asian Journal of Diabetology
  • Asian Journal of Critical Care
  • Asian Journal of Clinical Cardiology
  • Asian Journal of Obs & Gyne
  • Asian Journal of Paediatric Practice
  • Asian Journal of Ear Nose and Throat
IMA wants ESIC to continue medical education
BINDU SHAJAN PERAPPADAN: The Indian Medical Association (IMA) has come to the rescue of students studying in various medical colleges that come under the Employment State Insurance Corporation (ESIC). The Corporation had recently announced that it will be exiting the field of medical education. This will put at stake the educational future of students and job security of the faculty at these institutions across the country.

In a letter written to President Pranab Mukerjee, Prime Minister Narendra Modi, the Medical Council of India and the Heath Ministry, IMA office-bearer Dr. K. K. Aggarwal noted: “A total of 1,200 undergraduate medical students (MBBS, BDS and nursing) and 200 post-graduate students have commenced their study through the All India Examination [AIPMT] in the ESIC colleges…Also more than 200 faculties were also recruited, now the Corporation’s exit seems to be without considering the fate and future of the students and faculty members,” he added.

The Association has noted that the move has stalled all progress of development like construction, faculty appointment, promotions and opening of new post-graduate programmes. “The fate and future of the students pursuing their studies in these colleges are at stake. Further there is no clarity on what would happen to the more than 200 faculty members,” said Dr. Aggarwal.

Earlier, in accordance with Section 59B, ESIC started the work of opening medical, dental and nursing colleges and massive infrastructure was built for hospitals and colleges through investment of thousands of crores of rupees at different locations in the country.

While colleges at Bangalore (Karnataka), Kolkata, Gulbarga (Karnataka), Delhi were started and are still running, colleges at Faridabad (Haryana), Mandi (Himachal), Paripally (Kerala) and Channai (T.N.) are ready for operation.

“In case these colleges are shut, this will also lead to reduction of 1,000 medical graduation seats, 50 dental seats and about 100 post-graduate seats in the country annually, which is detrimental to the current national health policy of increasing the doctor-patient ratio,” noted IMA in its letter.

Appealing to the Government to direct ESIC to reconsider its move, the IMA has noted: “To initiate handing over all the ESIC-run medical, dental, paramedical and nursing institutions with all its required infrastructure to the Govt. of India/ State governments with the condition that the standard as per MCI/ DCI/ Nursing Council, terms and conditions of the employment of faculty members would remain same as at present and under which they were taken in the aforesaid colleges. All the current educational/ developmental activities must continue till handing over is completed.”
Reader Response
Dear Sir, Very Informative news. Regards: Dr Jayant
Press Release of the Day
Maintain a good health by sleeping 7 to 9 hours

Health is not mere absence of disease but a state of physical, mental, social, spiritual, environmental and financial well being, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association. He said that children should be given exposure to all aspects of health including financial health and spiritual health.

Quoting a study, Dr. Aggarwal said that internationally now it has been shown that seven to nine hours of sleep is necessary to achieve optimal health. Taking into consideration the New Year parties, which the children attend, he appealed to the students to take at least seven to nine hours of sleep which can be remembered by the formula: 8 hours for oneself (sleep and hygiene), 8 hours of studies and 8 hours for the social life and family.

Dr. Aggarwal said that childhood obesity is the new epidemic of the society and can only be controlled by the right education in school children.

He asked the children to refrain from fast food as it is not good for health and have such food provided that it is natural during the New Year party time. It’s unnatural fast food which is called junk food which is a combination of maida and cheese, with or without sugar, which is harmful.

Dr. Aggarwal said teachers, parents and doctors should be the role model to the society and should do what they preach.