April 26 2015, Sunday
Nepal earthquake: IMA writes to Nepal Medical Association
Dr KK Aggarwal A massive earthquake killed scores in Nepal and India on Saturday morning.
The massive 7.9 magnitude earthquake hit Nepal with devastating force less than 50 miles from the capital, Kathmandu causing tremors in northern India as well.

At least 970 people are known to have died. The quake struck an area between the capital, Kathmandu, and the city of Pokhara.

IMA appeals
  1. IMA has communicated to Nepal Medical Association for all help
  2. IMA members are requested to donate to the IMA disaster cell
  3. Those members who want to volunteer to visit the affected areas and help can give their names, email numbers and mobile numbers
  4. Members can also send suggestions
Dr AM Pillai and Dr KK Aggarwal
Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
  • Pets may lower blood pressure, reduce cholesterol and triglyceride levels, and improve feelings of loneliness, while increasing opportunities for exercise, outdoor activities and socialization. In a study of 28 patients with chronic age-related disabilities living in a nursing home, patients assigned to animal interaction ("pet therapy") had improved symptoms of depression and a significant decrease in blood pressure values as compared with the control patients (usual activities). (Arch Gerontol Geriatr Suppl. 2004;(9):407-12)
  • Physical activity isn't enough to overcome a bad diet when it comes to weight loss, argued a new opinion piece that said it was time to bust the myth. "It is time to wind back the harms caused by the junk food industry's public relations machinery," wrote Aseem Malhotra, MD, a clinical associate to the Academy of Medical Royal Colleges in London. "Members of the public are drowned by an unhelpful message about maintaining a 'healthy weight' through calorie counting, and many still wrongly believe that obesity is entirely due to lack of exercise." Malhotra, along with two co-authors, published the commentary on April 22 in the British Journal of Sports Medicine.
  • Two diabetes drugs, one approved and one investigational, show promise in treating fatty liver disease, according to new research presented here at the European Association for the Study of the Liver (EASL) International Liver Congress 2015. The glucagon-like peptide-1 analogue liraglutide (Victoza, Novo Nordisk) resolved nonalcoholic steatohepatitis in more than a third of patients in a phase 2 study. Post hoc findings from another phase 2 study of the investigational sodium-glucose cotransporter-2 inhibitor remogliflozin etabonate suggest benefit in nonalcoholic fatty liver disease.
  • Women younger than 75 years and men under 60 years can expect to live at least 15 more years after beginning treatment for osteoporosis, according to a new observational study published in February 7 in the Journal of Bone and Mineral Research.
  • Shortages of antibacterial drugs increased dramatically after 2007 and currently affect 26 drugs, nearly half of which are needed in treating multidrug-resistant infections, according to a new study. Farha Quadri, from the Department of Emergency Medicine, George Washington University, Washington, DC, and colleagues report their findings in an article published online April 23 in Clinical Infectious Diseases.
Zoonosis Update

A surveillance study of possible animal reservoirs of Campylobacter spp in Barbados identified that 61 of 130 pet dogs (47 percent) had Campylobacter spp isolated from fecal specimens. Direct zoonotic transmission of Campylobacter from contact with dogs and puppies (one of which resulted in neonatal sepsis) has been documented. Campylobacter enteritis presents after an incubation period of one to seven days as a syndrome most commonly characterized by prominent abdominal pain and profuse diarrhea that is often bloody. (Uptodate)
Dr KK Spiritual Blog
The lips of truth shall be recognized for ever, a lying tongue is but for a moment

This sutra from Bible has a very deep significance in day to day life. The truth is ever lasting and always ends up in internal happiness and self-realization and in the long run always gives you happiness and an all-win situation. On the contrary, a lying tongue will only give you a momentary pleasure but will lead to or create some difficulty later in life.

Spoken words cannot come back just as in the case of a released arrow from the bow. Once lost, one cannot get back their youth, virginity, or respect. Similarly, spoken bad words cannot be taken back and once spoken will create negative waves in the other persons (on whom they were spoken) mind which will persist as repressed thoughts or memory in the people’s mind for ever. Such bad memories will keep on coming back in the person’s mind causing damage to the personal relationships.

A spoken word is a karmic expression. For every karmic action there is an opposite and equal reaction. For every negative karmic expression one has to pay the debt either now or in future. The law of karma says that every debt has to be paid. It is always better to avoid negative language both in spoken words as well as in the mind. The yoga sutras of Patanjali describe thinking, speaking or doing anything wrong as having the same karmic significance. We should not only purify our self in actions and spoken words but also in the mind. If a person keeps negative thoughts in the mind sooner or later the same will be reflected to the outside world.

The momentary pleasure which one gets by "lying" has no spiritual significance as it only satisfies your ego sense or makes you attached to any of the five senses. The transient pleasure experienced by the body stimulates a chain of reactions, consisting of action, memory and desire leading to action again, which will only intensify the greed & attachments.

In the Mahabharata, Lord Krishna has given only two examples, which work as an exception to such a situation. Any truth which harms others may not be spoken and any lie which does not harm anyone but benefit a few may be spoken.

Truth is the opposite of doubt & it is always better to clear all the doubts from the mind as any repressed doubts can end up into causation of heart attack, paralysis and cancer.

Truth also means taking conscious-based decisions as the consciousness will never lie. While taking any decision, one should always ask oneself— Is it the truth? Is it necessary? Will it bring happiness to me and the people around?

Lord Krishna is also described as "Satchitanand", which only indicates qualities like truthfulness, conscious based decisions and internal happiness. The practice of truthfulness has to be practical over a period of time and made a part and parcel of your daily life. To start with a person may have bad experiences but in the long run truthfulness will always win.
Cardiology eMedinewS
  • An article published in the April 21 issue of the Annals of Internal Medicine suggests that if all 75- to 94-year-olds living in the US in 2014 received generic statins for 10 years for primary prevention of MIs and death from CHD, this would be cost-effective, but only when geriatric-specific side effects including functional limitations (muscle pain and weakness) and mild cognitive impairment were excluded.
  • Even after 60 years of age, quitting smoking for 5 years translates into a significant reduction in cardiovascular mortality when compared with individuals who continue to smoke, suggest the results from a meta-analysis published April 22 in the BMJ.
Pediatrics eMedinewS
  • In the Pre-POINT pilot study, five of six children who were at extremely high risk of developing type 1 diabetes and who received a high dose of oral insulin had a protective immune response, and the insulin did not cause hypoglycemia.
  • The European Medicines Agency's (EMA's) Coordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh) had endorsed restrictions on use of codeine-containing medicines when used for cough and cold in children. The CMDh said that use of codeine for cough and cold is now contraindicated in children younger than 12 years and is not recommended in children and adolescents aged 12 to 18 years who have breathing problems.
Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.

Reaction: Oh my God! Why was additional insulin given?

Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.
Dr Good Dr Bad
Situation: A diabetic patient was found unconscious.

Dr Bad: He has suffered a stroke.

Dr Good: First rule out hypoglycemia.

Lesson: In diabetics, sudden loss of consciousness is hypoglycemia unless proved otherwise.

(Copyright IJCP)
Wellness Blog
Work–related stress can kill

Job stress raises the risk of heart disease by disrupting the body’s internal systems.

The findings from a long–running study involving more than 10,000 British civil servants also suggest that stress–induced biological changes may play a more direct role than previously thought.

The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12–year period and found chronically stressed workers – people determined to be under severe pressure in the first two of the surveys – had a 68 percent higher risk of developing heart disease. The link was strongest among people under 50.

Stressed workers also eat unhealthy food, smoke, drink and skip exercise – all behaviors linked to heart disease.

In the study, stressed workers also had lowered heart rate variability – a sign of a poorly–functioning weak heart and higher than normal levels of cortisol, a "stress" hormone that provides a burst of energy for a fight–or–flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart.
Quote of the Day
Whether you believe you can do a thing or believe you can’t, you are right. Henry Ford
eMedi Quiz
A 25-year-old male is undergoing incision and drainage of abscess under general anesthesia with spontaneous respiration. The most efficient anesthetic circuit is:

1. Mapleson A.
2.Mapleson B.
3.Mapleson C.
4.Mapleson D.

Yesterday’s Mind Teaser: Epidermodysplasia veruniciformis is caused by which of the following HPV serotypes:


Answer for yesterday’s Mind Teaser: c.5

Correct Answers received from: Dr K Raju, Dr G Madhusudhan, Dr Avtar Krishan, Dr Poonam Chablani.

Answer for 24th April Mind Teaser: 2. Pre-oxygenation is mandatory

Correct Answers received: Daivadheenam Jella, Dr Shangarpawar, Dr Pandit Hantodkar, Dr Poonam Chablani, Dr KV Sarma, Dr K Raju, Dr Madhusudhan G
eMedinewS Humor
10 Guinness’ in 10 Minutes

An American walks into an Irish pub and says, "I’ll give anyone $100 if they can drink 10 Guinness’s in 10 minutes."

Most people just ignore the absurd bet and go back to their conversations. One guy even leaves the bar.

A little while later that guy comes back and asks the American, "Is that bet still on?"
"Sure," he says.

So the bartender lines 10 Guinness’ up on the bar the Irishman drinks them all in less than 10 minutes.

As the American hands over the money he asks, "Where did you go when you just left?" The Irishman answers, "I went next door to the other pub to see if I could do it."
Rabies News (Dr A K Gupta)
What are the signs of rabies in dogs/cats?
  • Any change in normal behavior suggesting either undue aggression or depression.
  • Running aimlessly and attacking others without provocation.
  • Becomes too drowsy and withdraws to a corner.
  • Change in voice/bark.
  • Excessive salivation.
  • Refusal to feed or eating objects like stone, paper, wood, metal pieces etc.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF
eIMA News
6 ways to ease neck pain
  1. Don’t stay in one position for too long.
  2. Make some ergonomic adjustments. Position your computer monitor at eye level so you can see it easily. Use the hands-free function on your phone or wear a headset. Prop your touch-screen tablet on a pillow so that it sits at a 45° angle, instead of lying flat on your lap.
  3. If you wear glasses, keep your prescription up to date.
  4. Don’t use too many pillows.
  5. Know your limits.
  6. Get a good night’s sleep. (Harvard News Letter)
AIMED joins IMA to accelerate India manufactured medical devices
Drug Today Online: Association of Indian Medical Device Industry (AIMED), representing Indian manufacturers of medical devices, has signed a memorandum of understanding (MoU) with Indian Medical Association (IMA) to promote ‘Cure in India’ initiative.

The initiative aims at driving medical tourism within India while simultaneously promoting ‘Buy Indian’ to promote India manufactured devices in healthcare sector along with Indian medical expertise.

Under the scheme of things, IMA will encourage medical fraternity to go ‘One Step Beyond Endorsement’ for India manufactured medical devices which would be approved by IMA based on stringent internationally accepted quality parameters.

As per the MoU, IMA and AIMED will establish joint mechanism to promote Indian medical device industry and under their ‘Cure in India’ initiative will give users and consumers access to ‘IMA preferred Brands of Safe Indian Medical Device’ that are affordable.

The move is likely to have a huge positive impact on ‘Make in India’ programme while giving a big shot to manufacturing of medical devices within the country and bring esteem to the Indian Industry & Nation thereby building Brand India.

Speaking to DTMT, Forum Coordinator of AIMED Rajiv Nath hoped that the MoU will give a big push to manufacturing and innovation in Indian medical device industry while promoting Indian healthcare sector as a whole.

“The initiative will also help reduce country’s huge import dependency in medical device sector while encouraging exports,” he added.

Dr KK Aggarwal, Honorary Secretary General of IMA, said the medical body is of the view that for those consumables and devices, which are manufactured in India and approved by appropriate authorities, no reimbursement should be given to foreign devices.

Under the joint mechanism, both associations will soon roll out promotional campaigns to achieve the objectives of this MoU.
BSNL: Gives possible anti-cancer advice
BSNL has announced unlimited FREE calling during night hours from 9 pm to 7 am from its LANDLINE PHONES to all landline phones and MOBILE PHONES of all service provider's network on all India basis from 1st May.

Cellular telephones are a source of radiofrequency radiation exposure. There are news that it is a potential risk factors for brain tumors, presumably due to exposure of the head of the user to radio frequency energy. Unlike mobile cellular phones, portable cellular phones include an antenna as part of the headset, theoretically increasing cranial exposure to RF energy. Other sources of radiofrequency radiation exposure include microwave and radar equipment and occupational exposures (sealers, plastic welders, amateur radio operators, medical personnel, and telecommunications workers). Exposures to RF energy are difficult to quantify.

Numerous epidemiologic studies have looked for a possible relationship between cellular telephone use and the development of brain tumors. A meta-analysis in J Clin Oncol 2009;27:5565 that included data from 22 case control series concluded that there was a slight increase in risk associated with cell phone use in those studies where investigators were blinded to whether the participant was a case or a control. The risk also appeared to be associated with an induction period of 10 years or longer. (Uptodate.com)

The WHO/International Agency for Research on Cancer (IARC) recently classified radiofrequency electromagnetic fields as possibly carcinogenic to humans (Group 2B) [IARC. IARC monographs on the evaluation of carcinogenic risks to humans. In: IARC monographs on the evaluation of carcinogenic risks to humans, IARC, Lyon Vol 102).
Sonal Namaste
Preventive measures for acute diarrhea among children in resource-limited settings include breastfeeding, consumption of safe food and water, adherence to hygienic practices, and vaccination against rotavirus infection.
Violence against doctors in India
Himmatrao Saluba Bawaskar: The Lancet

I read with interest the Editorial1 about the deterioration of the doctor–patient relationship in China. I believe the situation in India is worse than it is in China. Studying in private medical colleges has become very expensive. Admission is based on entrance examination, not on vocation, aptitude, or attitude of the student. How can one expect ethics and humanity in the medical profession? Moreover, to settle in big cities, where life is expensive, doctors might unwillingly practise unethically, such as advising expensive unnecessary radiology, endoscopic, or laboratory investigations.2 In government hospitals, doctors are overworked and under pressure from politicians who can interfere with medical admission, affecting doctors' self-esteem.

The main reasons for patients' relatives to become violent are unnecessary investigations, delay in attending patient, request of advance payments, or withholding a deceased body until settlement of final billing. Ultimately the medical trade now involved in this noble profession has resulted in doctors, patients, and relatives' unrest. Today, doctors are not recommending to their children to go to medical colleges, which is a real misery for the medical profession.

Another important issue is the involvement of drug companies in unethical trade including sponsoring doctors' tours abroad, conferences, and offering expensive gifts. 30 mg of tenecteplase, a thrombolytic drug used for acute myocardial infarction, costs 27?000 rupees (US$450) to patients (beneficiaries), which is the maximum retail price. However, the same drug costs only 21?000 rupees ($350) to the treating physician. Patients are used for research, but benefits are given to doctors. I declare no competing interests. (The Lancet Volume 384, No. 9947, p955–956, 13 September 2014)
One-year imprisonment in a case relating to the loss of vision
As per newspaper reports the chief judicial magistrate in Trichy on Wednesday sentenced three persons, including two doctors, to a one-year imprisonment in a case relating to the loss of vision to 66 people who underwent cataract surgeries at Joseph's Eye Hospital in Perambalur on July 29, 2008.

As many as 66 villagers from different villages in Perambalur and Villupuram districts, who participated in an eye surgery camp at the hospital, lost their vision. CJM M Sridhar found hospital managing director Dr Nelson Jesudasan, its chief administrative officer Christopher Thomas and Dr Ashok guilty in the case. The court directed the hospital to provide compensations, varying from Rs 2.28 lakh to Rs 5.75 lakh with 7.5 % interest, to the victims. The compensation was fixed according to the Workmen’s Compensation Act.

The CBI investigated the case following a Madras high court order. A CBI officer said ten victims had died and a victim had gone missing during the trial. Unsatisfied over the compensation to them and the punishment given to the culprits, the victims said they would file an appeal in the high court.

Surgeons Avvai, M Sowjanya and Thendral Ponnudurai were acquitted for lack of proof. Besides warning the acquitted doctors, the CJM directed the MCI to initiate disciplinary action against them. Lab assistant T Androse, the seventh accused, was also acquitted.

The court held the trio guilty of gross and culpable negligence endangering the personal safety of the victims. The CBI contended that the hospital neither followed the established sterile procedure while conducting the surgeries nor maintain the operation theatre properly at its Perambalur branch. The investigating agency filed a case naming seven persons as accused, including the director of the hospital and some of its doctors.
IMA in the News
Letter from IMA to IRDA

Mr. T. S. Vijayan
Chairman: Insurance Regulatory and Development Authority
Delhi Office – Gate No. 3
Jeevan Tara Building, First Floor
Sansad Marg, New Delhi – 110 001.

Dear Mr. Vijayan,

Greetings from Indian Medical Association!

Indian Medical Association (IMA) is a pan Indian voluntary organization of modern medicine doctors. It has a membership of 2.5 lakh doctors spread over 1700 branches in almost all the districts of India.

Many of our members have complaint that Insurance Companies does not cover cost of breast reconstruction surgery in a patient who has undergone the same.

The breast reconstruction surgeries, for these cases are not a cosmetic surgery but a part of breast cancer surgery. There is no reason why Insurance Companies should not cover the cost of such a surgery.

Indian Medical Association is willing to discuss this matter, if required, with the representatives of your Organization.

Kindly treat this matter as most urgent.

Thanking you & with regards,

Yours sincerely,

(Dr K K Aggarwal)
Padma Shri Awardee
National Science Communication &
Dr B C Roy National Awardee
Honorary Secretary General, IMA

Reply received from IRDA

Dr. K.K. Aggarwal,
Padma Shri Awardee,
National Science Communication &
Dr B C Roy National Awardee,
Honorary Secretary General, IMA

Sub:- Insurance Cover to Breast Reconstruction Surgery

Ref:- Your letter dated 31st March 2015

While appreciating the idea and the suggestion seeking Insurance Coverage to cover the cost of Breast Reconstruction Surgery, we wish to impress upon you that the Authority does not interfere into the designs of the products of the Insurance Companies unless these are in violation of the Insurance Act 1938, IRDA Act 1999, IRDA Health Insurance Regulations 2013 and circulars/guidelines issued by the Authority from time to time.

Generally, surgeries of this nature that are medically necessary are not excluded. However inclusion or exclusion of a particular cover (including the cover for any disability/for and surgery like the one mentioned) in a product depends on the design of that particular product. Similarly acceptance or rejections or accepting a risk with certain conditions depends on the underwriting policy of the Insurance Company. The product design is solely done by the Insurance Companies taking into account various factors like risk assumptions, claims experience etc.

In view of the above, your suggestion may, please, be taken forward with any of the Insurance Companies offering Heath Insurance. By marking a copy this letter, we are forwarding the copy of your letter dated 31st March 2015, to the General Insurance Council Mumbai, which is a representative body of all General Insurance Companies and stand alone Health Insurance Companies for their further looking into the matter.

Thanking you,
Yours sincerely,
Yegnapriya Bharath

Joint Director (Health) IRDAI, Hyderabad
Respected sir, On Sunday 19 4 2015, Dr RN Tandon & myself Dr Chandresh Jardosh gave a talk on Child Sexual abuse. Very successful program. Our talk was published in Times of India Ahmedabad edition on Wednesday 22/04/2015. Sincere thanks to IMA HQ, IMA Vadodara, and all for giving us an opportunity to talk
Inspirational Story

The cockroach theory for self development

At a restaurant, a cockroach suddenly flew from somewhere and sat on a lady.

She started screaming out of fear.

With a panic stricken face and trembling voice, she started jumping, with both her hands desperately trying to get rid of the cockroach.

Her reaction was contagious, as everyone in her group also got panicky.

The lady finally managed to push the cockroach away but …it landed on another lady in the group.

Now, it was the turn of the other lady in the group to continue the drama.

The waiter rushed forward to their rescue.

In the relay of throwing, the cockroach next fell upon the waiter.

The waiter stood firm, composed himself and observed the behavior of the cockroach on his shirt.

When he was confident enough, he grabbed it with his fingers and threw it out of the restaurant.

Sipping my coffee and watching the amusement, the antenna of my mind picked up a few thoughts and started wondering, was the cockroach responsible for their histrionic behavior?

If so, then why was the waiter not disturbed?

He handled it near to perfection, without any chaos.

It is not the cockroach, but the inability of the ladies to handle the disturbance caused by the cockroach that disturbed the ladies.

I realized that, it is not the shouting of my father or my boss or my wife that disturbs me, but it’s MY inability to handle the disturbances caused by their shouting that disturbs me.
It's not the traffic jams on the road that disturbs me, but MY inability to handle the disturbance caused by the traffic jam that disturbs me.

More than the problem, it’s MY reaction to the problem that creates chaos in my life.

Lessons learnt from the story:

I understood, I should not react in life. I should always respond.

The women reacted, whereas the waiter responded.

Reactions are always instinctive whereas responses are always well thought of, just and right to save a situation from going out of hands, to avoid cracks in relationship, to avoid taking decisions in anger, anxiety, stress or hurry. A beautiful way to understand…………………LIFE
IMA in Social Media
Reader Response
Dear Dr. Aggarwal, really great work is carried by eMedinewS. Dr. Bora KL, Dhule, Maharashtra
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Most uncontrolled asthmatics think they are controlled
Two-thirds of patients with uncontrolled asthma think their disease is well under control, said Padma Shri, Dr B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Asthmatics on proper medicines can not only lead a normal life but also reduce their future complications. Drugs include those medicines that keep the disease at bay as well as those that are used when a flare-up occurs. Uncontrolled asthmatics will invariably end up with right heart complications due to persistent lack of oxygenation in the blood.

Most asthmatics fail to perceive their level of disease control and with an uncontrolled state they often feel that their asthma is under control.

A study published in the Annals of Allergy, Asthma, and Immunology, examined 1,048 subjects with inadequate asthma control. When asked how they would rate their asthma control over the past 14 days, nearly 69 percent considered themselves to be completely or well controlled. Failure to perceive inadequate asthma control was more likely to be found in patients between the ages of 41 and 50 years.

In severe asthma, low blood oxygen levels might impair a person's ability to assess their own breathing difficulty.

Another reason is that the notion of asthma control seems poorly understood by asthmatic patients. Also, mild to moderate asthma limits the activities of a person and they over a period of time take that as their normal limits.