November 28   2015, Saturday
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Dr KK AggarwalDr KK Aggarwal Weekend effect in obstetric care

An observational study of more than 1.3 million deliveries by William L. Palmer, from the Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London has suggested that obstetric outcomes and infants born on a weekend are worse than for those with weekday admissions and births. The study is published in BMJ.

Babies born at the weekend had an increased risk of being stillborn or dying in hospital within the first seven days. Women who were admitted and babies born at weekends also had higher puerperal infection rates, neonatal injuries and three day neonatal emergency readmissions.

The outcomes for 1,332,835 deliveries and 1,349,599 births between April 1, 2010, and March 31, 2012 were examined to investigate the possible association between day of delivery and the quality and safety of obstetric care. Seven quality and safety indicators were specifically examined: perineal tear, puerperal infection, and 3-day emergency readmission for mothers, and in-hospital perinatal mortality, injury to neonate, selected neonatal infections, and 3-day emergency readmissions for newborns. Significant associations were found in four of the indicators, all of which were consistent with a lower standard of care for women admitted and babies born at weekends. The largest effects were seen in perinatal mortality (adjusted odds ratio [AOR], 1.07; 95% confidence interval [CI], 1.02 - 1.13), puerperal infections (aOR, 1.06; 95% CI, 1.01 - 1.11), injury to neonate (aOR, 1.06; 95% CI, 1.02 - 1.09), and 3-day neonatal readmissions (aOR, 1.04; 95% CI, 1.00 - 1.08). Of note, the perinatal mortality rate was 7.3 per 1000 babies delivered on weekends, which is 0.9 per 1000 higher than that observed for weekdays. This translates to 770 newborn deaths above what could be expected if performance were consistent across days of the week. (Medscape)
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
Novel platelet RNA test finds cancer in single drop of blood

A blood-based platelet RNA test that uses the equivalent of one drop of blood can identify patients with cancer, differentiate between cancer types, and even pick out mutant biomarkers. According to the study published online November 9 in the journal Cancer Cell, RNA from "tumor-educated" platelets containing tumor-associated biomolecules could distinguish cancer patients from healthy individuals with an accuracy of 96%. The test could also differentiate six primary tumor types with an accuracy of 71%, and identify specific breast and lung cancer mutant biomarkers. The test complements other liquid biopsy tests that detect portions of tumor cell somatic mutant DNA shed into the circulation or released when tumor cells die, which could allow tumors to be detected, measured, and tracked… (Medscape)

Health ministry to amend D&C Rules to exempt academic research from DCGI go-ahead

The Union health ministry will soon amend the Drugs and Cosmetics Rules, 1945 for providing exemption in the case of clinical trials undertaken in the medical institutions or hospitals for academic research. Once the amendment is done, these institutions and hospitals do not have to take the now mandatory prior permission from the Drugs Controller General of India (DCGI). The Drugs Technical Advisory Board (DTAB), the highest authority under the Union health ministry on technical matters, in its 70th meeting held on August 18, 2015, has given its approval for a proposal by the ministry in this regard. It was proposed in the DTAB meeting that a provision may be provided under the Drugs and Cosmetics Rules, 1945 that permission for clinical trial purely for academic research may be approved by the Institutional Ethics Committees. The approval of DCGI should be mandatory only when the new drug is being evaluated or a new use for an existing drug is being tried out under certain conditions … (Pharmabiz - Ramesh Shankar)
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Specialty Updates
• Central sleep apnea and Cheyne Stokes respiration are linked to increased odds of atrial fibrillation, particularly in men aged 76 years and older, suggested a prospective cohort study published online in the American Journal of Respiratory and Critical Care Medicine.

• Taking progesterone supplements during the first 12 weeks of pregnancy does little to help women with a history of unexplained, recurrent miscarriages, suggested the 5-year PROMISE (progesterone in miscarriage treatment) trial published in the New England Journal of Medicine.

• Serum immunoglobulin E (sIgE) levels are of limited use for predicting food allergy in children with mild to moderate atopic dermatitis, suggested new research published online in Pediatrics.

• Reducing pain intensity as the primary goal of treatment for chronic pain could be counterproductive. Experts say, in a commentary published in the New England Journal of Medicine, that focus on the pain score has led to overprescribing of opioids, escalating dosing levels, and increased risks for patients. They also stated that treatment should focus on helping patients improve their ability to function at work and at home.

• In the first US safety trial of a new form of immunotherapy for type 1 diabetes, patients experienced no serious adverse reactions after receiving infusions of as many as 2.6 billion cells that had been specially selected to protect the body's ability to produce insulin. The findings have been published online in Science Translational Medicine.

• Overweight and obesity throughout adulthood, and especially elevated weight in early adulthood, were associated with increased risk of sudden cardiac death in a 32-year study published in JACC: Clinical Electrophysiology.

• Researchers are using a powerful imaging tool to locate hard-to-find epileptic foci. Glutamate chemical exchange saturation transfer (GluCEST) is a high-resolution MRI technique that measures how much glutamate is in the hippocampus and according to a study published in Science Translational Medicine is more sensitive than currently available imaging methods to detect the area in the hippocampus that contains the epileptic network.

• The higher the levels of urinary potassium excretion, the lower the risk for renal dysfunction and cardiovascular complications in patients with type 2 diabetes and normal renal function at baseline. The results of this study are published in the Clinical Journal of the American Society of Nephrology.
How to remove negative thoughts

Darkness is absence of light and similarly negative thoughts are absence of positive thoughts. The answer to negative thoughts is to bring positive thoughts back. Ideal mind is devils workshop and will always think negative. Here are some ways by which you can do so.

• Think differently as taught by Adi Shankaracharya. Once Menaka approached Arjuna with lust and said that she wanted to have a son like him with him. Arjuna said that why wait for 25 years consider me as you son from today.
• Think opposite as taught by Patanjali. For example, if you are thinking of stealing, then silently start thinking of charity.
• Think positive as taught by Buddha. Make a list of positive actions to be done today as the first thing in the morning and concentrate on that list. Divert your mind to the pending work. This is a type of behavioral therapy.

Legal Quote

V. N. Shrikhande vs Anita Sena Fernandes on 20 October, 2010

”If the complaint is per se barred by time and the complainant does not seek condonation of delay under Section 24A(2), the consumer forums will have no option but to dismiss the same.”
Digital IMA
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Capital Loss can be setoff only against Capital Gains and not under any other head. Further any long-term loss can’t be set off against short-term gains.

(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

Balloon Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) is one of the most common procedures performed during US hospital stays. According to a report published last year by the Agency for Healthcare Research and Quality, PTCA accounted for 3.6% of all operating room procedures performed in 2011, ranked behind only cesarean section, circumcision, and knee arthroplasty. It is interesting to note, then, that in 1976, when German cardiologist Andreas Roland Grüntzig first presented the idea as a poster at the annual meeting of the American Heart Association, world-renowned catheterization specialist Dr Spencer King said, "It'll never work." Grüntzig, who had spent years developing the concept and initial device in his kitchen, was undeterred. Croatian cardiac surgeon Marco Turina, MD, is noted to have said that Grüntzig "had the 'sacred fire,' as the French call it. It was what he thought about constantly. I have never seen somebody so centered on a single idea like Andreas was. Never in my life. Everyone was telling him his idea would never work, and had been tried before, and that he was going to fail, that there were pitfalls at every turn. But the idea was consuming him all the time." Grüntzig returned to the American Heart Association 1 year later in 1977 and presented his first four cases of angioplasties in humans from the podium. When he finished, the audience of his colleagues rose as one and gave him a standing ovation. (Source: Medscape)
WHO launches toolkit to help countries respond to sexual violence

WHO has called for the elimination of all forms of violence against women and girls to ensure their health, well-being and human rights. Together with the UN Office on Drugs and Crime, the WHO is launching a toolkit to help countries strengthen the medico-legal response to sexual violence. This initiative is also supported by UN Action against Sexual Violence in Conflict. The toolkit will be used by people working in health, social services, forensic medicine and lab services, police, the legal system (including judges and lawyers), and those coordinating these sectors. It includes recommendations on conducting forensic medical examinations, documenting events and responses, conducting an initial investigation, and ethical standards that must be upheld… ……… (WHO)
Chemists to go on indefinite strike from mid-December

Members of the All India Organisation of Chemists and Druggists (AIOCD) will go on an indefinite strike from mid-December as the government has failed to stop the online sale of drugs through various e-pharmacies, an AIOCD official said on Thursday. The decision came after the association had given one month's time to the government to ban the online sale of drugs, which according to the association, is completely illegal and a violation of the Drugs and Cosmetics Act, 1940… (Deccan Herald – IANS)
New scientific statement calls for further research in PCOS

In its new ‘scientific statement on the diagnostic criteria, epidemiology, pathophysiology and molecular genetics of polycystic ovary syndrome’ published in Endocr Rev. 2015;36:487-525, the US Endocrine Society recommends that the many aspects of PCOS, including its etiology are generally poorly understood and there is a need for further research to better delineate its characteristics, outcomes, and genetic underpinnings. "And because PCOS causes [SUCH] diverse symptoms that can vary among individual women, the definition and even the name 'PCOS' have been subject to debate." The Society recommends that a diagnosis of PCOS be made if adult women have 2 of the following 3 cardinal features of the syndrome: (Medscape)

• Excess androgen production.
• Anovulation.
• The formulation of cysts containing immature eggs in the ovaries (polycystic ovaries).
Conduction block an 'insufficient' indicator of pulmonary vein isolation

Results of a single-center study reported in JACC: Clinical Electrophysiology suggest that entrance and exit block may not be as good at gauging the procedural success of catheter-based radiofrequency (RF) ablation for atrial fibrillation (afib) as thought, perhaps explaining why so many cases recur. Among 30 afib patients getting pulmonary vein isolation (PVI), 62% of their pulmonary vein pairs showed entrance block of electrical impulses from the atria to the ventricles early, when the ablation scar was incomplete and still had visible gaps measuring more than 10 mm long. Only in 38% of pairs did entrance block develop after completion of the anatomical barrier to the pulmonary vein. (Medpage Today)
Three Bills related to health and pharma sectors, the Drugs and Cosmetics (Amendment) Bill, 2015; the HIV Bill; and the Mental Health Care Bill, have found a place in the tentative list of government legislative and financial businesses expected to be taken up during the winter  session of the parliament which will conclude on December 23… …(Pharmabiz – Ramesh Shankar).
China performs its first successful womb transplant

A 22-year-old woman successfully received a womb donated by her mother after doctors performed their first uterus transplant in China, giving hope to women struggling with infertility. But the 14-hour-long procedure drew mixed reactions from public. A robot assisted in removing the mother's uterus before doctors transplanted it into the daughter's body, said Chen Biliang, director with gynaecology and obstetrics department of Xijing Hospital in Xi'an, where the surgery was performed. Thirty-eight surgeons took part in the operation for which doctors prepared for two years, practicing it on goats, which are believed to share similar wombs with humans. After the daughter recovers, doctors will transfer frozen fertilised embryos into the new womb, allowing her to carry her biological child. The embryos were created by the daughter and her husband using in-vitro fertilisation prior to the transplant… (ET Healthworld)
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
IMA Live Webcast

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Central India Unit of the UNESCO Chair in Bioethics,
Haifa and IMA UNESCO Chair in Bioethics,

December 11, 2015, 9:00A.M
PGIMER - RML Hospital, New Delhi

For Registration for 16 IMA Nominee
Phone: 9811841351
Dr. R.P Beniwal
Types of noodles: Noodles always do not mean maida

• Wheat: Most of the world production is consumed by humans in the form of breads and other baked products, pasta, wheat noodles, bulgur (tiny pasta) and couscous (form of pre-cooked wheat).

• Rice: Primarily consumed as a cooked whole grain, although raw rice is also ground into flour that is used in various products (noodles, rice milk).

• Kutu or buckwheat: Non-cereal grain crop that is taxonomically unrelated to wheat, despite a name that suggests otherwise. The seed is used to make a dark flour (crepes, small pancakes, bagels, breads, breakfast cereals, and noodles
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
A cold day in December

An eye witness account from New York City, on a cold day in December, some years ago: A little boy, about 10–years–old, was standing before a shoe store on the roadway, barefooted, peering through the window, and shivering with cold. A lady approached the young boy and said, ‘My, but you're in such deep thought staring in that window!’ ‘I was asking God to give me a pair of shoes,’ was the boy’s reply.

The lady took him by the hand, went into the store, and asked the clerk to get half a dozen pairs of socks for the boy. She then asked if he could give her a basin of water and a towel. He quickly brought them to her. She took the little fellow to the back part of the store and, removing her gloves, knelt down, washed his little feet, and dried them with the towel. By this time, the clerk had returned with the socks. Placing a pair upon the boy's feet, she purchased him a pair of shoes. She tied up the remaining pairs of socks and gave them to him. She patted him on the head and said, ‘No doubt, you will be more comfortable now.’ As she turned to go, the astonished kid caught her by the hand, and looking up into her face, with tears in his eyes, asked her: ‘Are you God’s wife?’
eMedi Quiz
Which one of them is not true about celiac disease?

1. Celiac disease is a large bowel disorder
2. It is characterized by mucosal inflammation, villous atrophy, and crypt hyperplasia, which occur upon exposure to dietary gluten and which demonstrate improvement after withdrawal of gluten from the diet.
3. Several categories of celiac disease have emerged (asymptomatic, silent [i.e., asymptomatic and no evident malabsorption or other disease manifestations], potential [i.e., positive celiac-specific serology with normal histology]).
4. The natural history of these various forms of celiac disease is incompletely understood.
5. The log-term risk of complications in patients who are asymptomatic is unclear. Such patients may also be least likely to comply with a gluten-free diet.

Yesterday’s Mind Teaser: A 60-year-old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:

1. Thymoma
2. Lung cancer.
3. Hodgkin's lymphoma.
4. Superior vena caval obstruction.

Answer for Yesterday’s Mind Teaser:. 4. Superior vena caval obstruction.

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr.K.V.Sarma, Dr.B.R.Bhatnagar, Dr Kailash Chandra Sharma, Dr Avtar Krishan

Answer for 25th November Mind Teaser :. 4. Peri-articular calcification

Answers received from: Dr.K.V.Sarma, Daivadheenam Jella, Dr.Bitaan Sen & Dr.Jayashree Sen. Dr Avtar Krishan
No man can ever be satisfied with 4 things in life.

• Mobile
• Automobile
• TV
• Wife

Because there is always a better model in neighborhood…
Readers column
Dear Sir, emedinews is really very informative: Dr Sneha
Press Release
How cold weather affects your blood sugar levels?

The slight nip in the weather might come as a sign of relief from the scorching summer heat, but people living with diabetes should approach it with caution. It is believed that the peak of both the winter and summer months can cause severe fluctuations in a diabetic’s blood sugar levels. Most importantly, the weather transformation can impact their body functioning, and the how body produces and uses insulin.

Raising awareness about the issue, 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, “There exists a lack of awareness of how the winter months can affect our blood glucose levels. When the temperature drops, the body requires an increased amount of insulin to function effectively. It is not uncommon that diabetics experience a sudden drop in their insulin requirements when the chilly winters give way to the spring. The exact reason behind this is not known, but this change has continuously been associated with an increased delivery of glucose and insulin to peripheral tissues. People also tend to be more stressed during the winter months and are prone to depression. As a reaction to this stress, the blood sugar levels of diabetics often go up. The cold weather can make your blood thicker and aggravate shifts in blood sugar levels. It is therefore advised that all diabetics consult their consulting doctors before the onset of the winter for any change in their medication and also ensure that they stay warm and consume a healthy diet."

Follow certain tips to manage diabetes this winter:

Take precaution against the cold and flu: A cold and flu infection can prove to be harmful if proper precautionary measures are not taken. It is important for diabetics to get a flu vaccine after consulting their doctor. It is also important that proper hand hygiene is maintained, the body is given adequate rest, and a healthy diet is consumed.

Stay warm to stay protected: It is important to keep oneself warm to avoid the adverse effects of the chilly winters. Make sure you wear enough layers of clothes to keep your body warm and dry. In addition to this, one must cover his/her feet properly especially if the individual has blood circulation related problems. It is also important to keep a check on your blood glucose levels.

Consume a healthy diet: People have a tendency to indulge in high-calorie food during the winter months. The reason for this is the onset of the festive and wedding season as well as winter depression. It is extremely important that diabetics watch what they eat and consume ample amounts of fresh fruits and vegetables. Fruits with high sugar content should be avoided. Alcohol consumption also tends to go up during these months, and a strict watch is a must to ensure good health.

Get physical exercise: Shorter days and longer nights shouldn’t be your excuse for not working out this winter season. For diabetic patients, it is essential that you exercise daily. One can go out for a walk to the nearby shopping center or a park. Medical experts advise that in case you join a gym, you should always consult your doctor as to what kind of exercises you can do.