April 28  2015, Tuesday
editorial
Another case of one crore compensation
National Consumer Disputes Redressal Commission: Consumer Case No. 104 Of 2002:

Dr (Mrs) Indu Sharma, Complainant(s) vs Indraprastha Apollo Hospital
Dr KK Aggarwal Course of events

The patient was hospitalized in OP-1 hospital (Indraprastha Apollo Hospitals) after midnight due to rupture of membranes on 10.6.1999. On the same morning, Dr Sohini Verma (OP-3) advised IV fluid with 1 ampule of Syntocinon (Oxytocin) to speed up the delivery. According to the patient, she was administered the maximum dose of oxytocin and there was a fall in the fetal heart rate, which was 80/min during the midnight of 11/12-6-1999.

She underwent emergency caesarean section (LSCS) and delivered a female baby at 3.36 am, birth weight 3.7 kg. The baby did not cry immediately after birth and it took almost 5 minutes.

The baby was kept on ventilator in NICU. The condition of baby deteriorated further, till 29.6.1999. The baby was unable to suck milk. The patient was discharged on 16.6.1999, while the baby was discharged from OP-1, on 30.6.1999. The patient had taken treatment from OP-3 for infertility and thereafter, spontaneously she conceived after 4 ½ years.

After 2 ½ months, from 23.08.1999, the baby was admitted to Holy Family Hospital with complaints of loose motions and strong clonic seizures from 23.8.1999. CT scan showed severe brain atrophy which could lead to severe mental retardation. The complainant observed that at age of 1 year 8 months, the baby’s milestones were delayed; episodes of seizures persisted. Also, the baby was unable to hold her neck and unable to suck milk.

From 21.09.1999 to 03.12.2002, the child was treated at AIIMS. The Disability Board of AIIMS, New Delhi certified the baby as ‘95% disability’.

The baby survived for 12 years with disabilities and with mental retardation and died on 15.1.2012.

Allegations
• No senior doctor available at the time of admission to the hospital; patient examined by resident doctor.

• Oxytocin administered in maximum dose, following which the fetal heart rate began to drop (80/min), but none attended the patient immediately.

• OP-3 failed to perform LSCS within 12-18 hours after membrane rupture and was abnormally delayed for about 27 hours.

• Excessive dose of oxytocin led to fetal distress and cerebral anoxia-palsy.

• Further CT scan and x-ray reports of the baby were declared as normal by the OP; but, in the opinion of doctors in the US and brother of the patient (a pediatric surgeon in USA) the severe atrophy of baby’s brain cortex was due to birth asphyxia and that the child might remain severally mentally retarded for as long as she lives.

• OPs made number of corrections /interpolations on the case sheets; the neonatal record was also tempered with.

• The Complainant never received the CTG graphs from the OP.

• The OP-3 failed to take proper care during delivery, which resulted in birth of an asphyxiated baby.

The complainant filed a complaint in the NCDRC alleging medical negligence on the part of the treating doctors and the hospital where she delivered her baby. And sought a total compensation of Rs.2.5 crores plus Rs.5 lacs for the mental agony and Rs.25,000/- as costs of litigation.

The commission examined three separate affidavits of evidence by Dr Sohini Verma, Senior Consultant and Gynaecologist, (OP-3), the Neonatologist, Dr Saroja Balan working at OP-hospital, and the Medical Superintendent, Mr. Singhal of OP-1 including that of the two witnesses from hospital, one of the sister In-charge Retnamma K. Nair and the other of Dr Poornima Dhar, the Anesthetist.

OP-3 was allowed to argue and assist the counsel for OP. The counsel argued that as the complaint was filed after delay of 264 days, it was barred by limitation. According to OP-3, oxytocin was given only for 17 hours and not for more than 24 hours; total 66 units of oxytocin was given by controlled infusion pump with proper monitoring. The delay in LSCS was due to non-cooperative attitude of patient. The FHR was normal throughout. OP-3 denied that during the last two hours of the progress of the labour, in question, no uterine activity and FHR recording were mentioned in the nursing chart. The CTG records were handed over to the complainant at the time of discharge, along with other documents.

The counsel asked for the complaint to be dismissed as there was no negligence on the part of OP-1 and/or OP-3.

Observations of the Commission
• On 03.03.2003, the Complainant filed an application for Condonation of 264 days delay in filing the complaint. The Commission disregarded the defense of the OP that the complaint was time barred as the delay of 264 days in filing the complaint had been condoned on 16.12.2011. Also the cause of action remains continuous till the patient or the complainant comes to know about the real injury.

• The Complainant has not produced any medical expert evidence, and has not produced any witnesses from Holy Family Hospital and AIIMS where the baby was treated after discharge from OP-1. Initially on 27.03.2006 complainant filed one application for referring the case to the medical expert of AIIMS to take medical expert opinion but she withdrew the said application. The Complainant relied upon the medical textbooks, the research articles.

• The OPs produced three expert opinions from doctors in own hospital, namely Prof (Dr.) Kamal Buckshee, Senior Consultant with Department of Obstetrics & Gynaecology of OP-1 Hospital, Dr. (Mrs.) Urmil Sharma and Dr.(Mrs.) Harmeet Malhotra, all have examined the treatment papers, opined that the treatment given to the patient was correct, and that there was no deficiency or negligence on the part of the treating doctors.

• 'There was delay in performing LSCS by OP-3; waiting period should not have been more than 24 hours and FHR should be carefully monitored.

• The child was consulted at several hospitals like Holy Family Hospital, New Delhi from 29.091999 to 08.09.1999 and took treatment at AIIMS from 29.09.1999 to 2003 for cerebral palsy and brain atrophy.

• The Commission did not accept the defense of OP-3 that it was induction failure and instead stated that OP-3 decided emergency LSCS because of fetal distress/non-reassuring fetal heart rate, and not induction failure. The Commission also did accept the contention of OP-3 that the baby was born with pre-existing (prenatal) neurological disability in the absence of any signs of foetal hypoxia or birth asphyxia

• The medical records of the baby were produced after a decade i.e. on 20.11.2014.

• All investigations (blood and urine test, USG, colour Doppler, CTG) done in antenatal period were normal. Triple marker test was not done as there was no previous family history of any genetic disorder.

• Repeat USG was not done at the time of admission to recheck a loop of cord around neck seen in previous USG done 12 days back. Pelvic adequacy by clinical pelvimetry was not checked for including adequacy of fluid even when the patient was leaking profusely. The FHS recorded was 146/minute, therefore the condition of foetus was good prior to delivery.

• In the instant case, the resident and nurses failed to appreciate the signs of distress on the foetal heart monitor, and they failed to inform the attending OP-3 of the non-reassuring heart tracings.

• OP-3 did not follow the standard of care for a hospital to quickly deliver a baby by emergency C-section when necessary. “Standard of care allow obstetricians two options to ensure that the continuation of labour is safe for the baby. One option is to perform a test to make sure that the baby is not acidotic. (If a baby is acidotic, it means inadequate gas exchange is taking place and the baby is being deprived of oxygen.) If that test is not performed, the Oxytocin must be stopped. However, if stopping the Oxytocin did not improve the heart tracing, the standard of care required C-section delivery since vaginal delivery was not imminent. Even if the foetal acidosis test is not familiar to some obstetricians, all obstetricians are familiar with the necessity of calling a stat C-section when a fetal heart tracing does not improve despite resuscitative measures. A good trial on fetal resuscitation would require randomization based on fetal distress diagnosed using the “gold standard” of fetal scalp blood pH < 7.2, testing the methods used for resuscitation, and accounting for the variables.”

• In this case, the long labour process brought about by poor and negligent medical management caused the birth of asphyxiated child with cerebral palsy and seizures. The birth record voluminously speaks about the asphyxia.

• The medical records showed many cutting, erasing marks, pin holes; some handwritten insertions, over writings and discrepancies in the doctor’s and sister’s chart, which showed that the records were apparently manipulated and fabricated.

• The OPs were obliged to explain how the baby’s cerebral palsy occurred if the required treatment had been given. In the absence of such exculpatory evidence, the invocation of the maxim res ipsa loquitur, is justifiable in this case.

• The records of the patients should be maintained by doctors and hospitals. “It is wise to remember that “Poor records mean poor defense, no records mean no defense”.

• The Commission rejected the contention of the OP that the delay in cesarean section was due to the reluctance on the part of the patient stating that “it was the bounden duty of the doctor to decide, the correct line of treatment; doctor wouldn’t just blindly obey the wishes of the patient…”

• The Commission also rejected the expert opinions produced by OP-3 from the three experts of OP-1 hospital, as they had given their opinion on the basis of tampered medical records, they were from same hospital and more chances of interested witnesses.

• It is the responsibility of the medical team to closely monitor the heart tracings so that they know when the baby becomes distressed.

• The say of OP that the patient was informed about emergency LSCS which was rejected by the patient or by her husband. The OP did not take written consent or signature of the complainant or her husband about refusal of C-section. The progress sheet clearly shows some insertion made by OP/staff to show that patient was informed. Thus, the entry was also tampered one.

Conclusions of the Commission
• The patient had pregnancy after 4 ½ years of infertility making it a precious pregnancy.

• Corporate hospitals and Specialists must perform at a higher level than other hospitals/GPs as they represent themselves as possessing highest standard facilities and care, superior skills and additional training.

• The records clearly showed fetal distress indicated by hypertonic contractions and fall in FHR below 120/min and OP-3 failed to take proper decision for emergency C-section making it an act of omission, thus negligence.

• The medical records of the mother and baby are tampered at many places.

• The substandard care administered to the patient during labour resulted in poor outcome despite using modern technology of CTG. Inability to interpret the CTG trace, i.e., poor pattern recognition, failure to correlate to the pathophysiology that caused the CTG changes, not taking into consideration the clinical situation that may suggest fetal distress and delay in taking appropriate action due to poor communication and team work were reasons for the poor outcome.

• Taking into account the sufferings of mother and child for 12 years, treatment and other expenses, the metal agony and trauma to the parents who suffered loss of their baby and thereon the quantum of interest on such amount, the Commission allowed a lump sum award of compensation of Rs. One crore by relying upon the judgments of Hon’ble Apex Court for award of compensation.

• The Commission further imposed punitive costs of Rs.10 lacs on OP-1 as OP had not issued entire medical record to the patient, indulged in the unethical medical practices and professional misconduct like tampering of medical records. It was the duty of the hospital to preserve the CTG tracings. Thus OP did not follow the standard of medical practice, not maintained medical records.

Final judgement
The commission found the OPs guilty of medical negligence and fixed total compensation of Rs. One Crore; out of which OP-1 will pay Rs.80 lacs and OP-3 will pay Rs.20 lacs to the patient/complaint within 90 days from the date of receipt of this order. The insurance company shall indemnify the respective OPs, as per law. Rs.10 lacs was imposed as punitive cost which OP-1 shall deposit in the Consumer Legal Aid Account, NCDRC within 90 days from the date of receipt of this order. If the order is not compiled within 90 days, the OPs are liable to pay interest @ 9% per annum, till its realisation.

Fits or Epilepsy
  1. Seizure is a sudden change in behavior that is the consequence of brain dysfunction.
  2. Approximately 0.5–1% of population has epilepsy.
  3. ome seizures are provoked i.e. that occur in the metabolic derangement, drug or alcohol withdrawal and in situations like acute paralysis or acute encephalitis. Such patients are not considered to have epilepsy because these seizures would not recur in the absence of the provocation.
  4. Less than 50% of epilepsy cases will have an identifiable cause such as head trauma, brain tumor, paralysis, infection, brain malformation etc.
  5. Having one seizure does not always mean that the patient would always get a seizure.
  6. One episode of seizure may not require treatment.
  7. Hospitalization is required in the first seizure only if it is associated with prolonged post seizure altered level of consciousness.
  8. Patients with unprovoked seizure may not be allowed to drive for some time.
  9. In children, seizure can occur with high grade fever.
  10. In adults, the first episode of seizure may be due to worms in the brain. In such a situation, it may be necessary to do an MRI test.
  11. A patient with seizure can get married, live a normal life and produce children.
  12. It is a misnomer that during a fit you need to make the person smell a shoe.
  13. During epilepsy, never put the fingers inside the mouth of the patient as you could be bitten. Use a spoon instead to prevent tongue bite.
  14. A patient with epilepsy fall will have stiffness in the body; on the contrary, patient with cardiac loss of consciousness will fall loose.
  15. A seizure that lasts for more than 5–10 minutes requires specialized attention.
IMA,IJCP,HCFI
eMedipics IMA,IJCP,HCFI
Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association and the Ministry of Earth Sciences, Govt. of India
News
  • Sometimes the side effects of treatment, which include erectile dysfunction and incontinence, are worse than the disease. That's because some prostate cancers found using today's high-tech diagnostic techniques would never have caused any health problems or shortened life. That's one reason many doctors are advising men not to have a routine blood test for prostate-specific antigen (PSA) to detect early prostate cancer.
  • A new study suggests that removal of the ovaries is associated with a 62% reduction in deaths from breast cancer among breast cancer patients with the BRCA1 gene mutation. The study is published online April 23 in JAMA Oncology.
  • The effects of transrectal unltrasonography (TRUS)-guided biopsy on erectile function have most likely been underestimated, suggests new research published online in BJU International. Researchers suggested that though prostate biopsy is known as a low-risk procedure in an ambulatory office setting in most aspects, there may be side-effects that impair quality of life.
  • Smokers are at increased risk of anastomotic leak after left colectomy, and surgeons should consider postponing elective cases until the patient stops smoking, suggests new research published online in the American Journal of Surgery.
  • A new optical technology called multiphoton microscopy (MPM) could allow for noninvasive, painless, and rapid diagnosis of basal cell carcinomas (BCCs) in the clinic, suggests a small pilot study published online April 24 in JAMA Dermatology.
  • “…post-surgical fungal endophthalmitis occurring 2 to 3 weeks after the surgery is a clear possibility and it is important for all ophthalmologists to be aware of this and to treat it carefully. Such care should have been the highest order in the chronic diabetic patient. The opposite party no.2 has, therefore failed in treating the Complainant from 4th July, 1997 when the Complainant informed him of hazy and blurred vision."(National Consumer Disputes Redressal Commission, New Delhi, Original Petition No.36 of 1998)
  • Court has to be careful not to impute negligence simply because something has gone wrong. (National Consumer Disputes Redressal Commission, New Delhi, Original Petition No. 280 of 1992)
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Dr KK Spiritual Blog
Facts about Soul and the Spirit
  • Energy is the raw material of the universe.
  • Information is the organization of energy into reproducible patterns.
  • Consciousness is living information and energy (living energized information)
  • Consciousness is, therefore, intelligence.
  • Intelligence is information and energy that has self–referral or the ability to learn through experiences and the ability to reinterpret and influence one’s own information and energy states.
  • Consciousness is live, advanced, software–driven energized information.
Nearest example: Advanced computer software which can type, correct, interpret, edit and store spoken or read information.
Cardiology eMedinewS
  • Although the severity of hypertension or magnitude of cardiovascular risk do not affect the relative risk reduction of major cardiovascular events with antihypertensive therapy, the absolute benefit of antihypertensive therapy is greater in patients with more severe hypertension or greater overall cardiovascular risk. (Contributed by Dr Ravi Kasliwal)
  • Vascular calcifications in the hand radiographs of rheumatoid arthritis (RA) patients are associated with more than 40% increased risk of all-cause mortality, and these radiographic vascular calcifications may be markers of cardiovascular disease (CVD) risk, suggests a multicenter Veterans Affairs study published online in Rheumatology.
Pediatrics eMedinewS
  • A protein in animal and human breast milk - called epidermal growth factor (EGF) – holds off necrotizing enterocolitis (NEC) in preterm babies. The findings are published in Mucosal Immunology.
  • DNA methylation in paternal sperm may contribute to the risk of children's developing autism, suggests a new study published online in the International Journal of Epidemiology.
Zoonosis Update
Cats are responsible for transmission of an extensive array of bacterial, fungal and parasitic zoonotic pathogens. The route of transmission can be through the saliva (e.g., bites or contaminated scratches), feces, respiratory secretions, direct contact, or by the cat acting as a vehicle and source of tick or flea exposure.
Events
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Inspirational Story
A Most Important Lesson

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions, until I read the last one: "What is the first name of the woman who cleans the school?"

Surely, this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark–haired and in her 50s, but how would I know her name? I handed in my paper, leaving the last question blank. Just before class ended, one student asked if the last question would count toward our quiz grade.

"Absolutely," said the professor. "In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say ‘hello’." "I’ve never forgotten that lesson. I also learned her name was Dorothy.

Moral: Every person no matter who it is should be considered equal… something that we all forget so easily. To value a person regardless of their status is the highest noble work.
Wellness Blog
5 Ways to Use less Salt
  1. Use spices and other flavor enhancers such as spices, dried and fresh herbs, garlic and ginger, citrus, vinegars and wine. Flavors can be black pepper, cinnamon and turmeric to fresh basil, chili peppers, and lemon juice.
  2. Use the right healthy fats — from roasted nuts and avocados to olive, canola, soybean and other oils.
  3. Searing and sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the taste of fish and chicken. If you do steam or microwave food, perk up these dishes with a finishing drizzle of flavorful oil and a squeeze of citrus.
  4. Get your whole grains from sources other than bread. White bread contains salt, not just for flavor but to ensure that the dough rises properly.
  5. Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. (Harvard)
Make Sure
Situation: A patient with acute chest pain died before reaching the hospital.

Reaction: Oh my God! Why was water–soluble aspirin not given?

Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.
Dr Good Dr Bad
Situation: A pregnant lady died.

Dr Bad: Declare her dead.

Dr Good: Deliver the infant within 5 minutes.

Lesson: "Five minute rule": the best outcome with regards to neonatal neurological outcome is most likely when delivery occurs within 5 min of maternal cardiac arrest.

(Copyright IJCP)
eMedi Quiz
The primary role of chaperones is to help in:

1.Protein synthesis.
2.Protein degradation.
3.Protein denaturation.
4. Protein folding.

Yesterday’s Mind Teaser: In all of the following conditions neuraxial blockade is absolutely contraindicated, except:

1. Patient refusal.
2. Coagulopathy
3. Severe hypovolemia.
4. Pre-existing neurological deficits.

Answer for yesterday’s Mind Teaser: 1. Patient refusal.

Correct Answers received from: Dr Shangarpawar, Ganga Kundeti, Dr G Madhusudhan, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan, Dr Jainendra Upadhyay.

Answer for 26th April Mind Teaser: 1. Mapleson A

Correct Answers received: Dr Poonam Chablani, Dr K Raju.
eMedinewS Humor
Coffee Dilemma

A man and his wife were having an argument about who should brew the coffee each morning.

The wife said, "You should do it, because you get up first, and then we don’t have to wait as long to get our coffee".

The husband said, "You are in charge of the cooking around here and you should do it, because that is your job, and I can just wait for my coffee."

Wife replies, "No you should do it, and besides it is in the Bible that the man should do the coffee." Husband replies, "I can’t believe that, show me."

So she fetched the Bible, and opened the New Testament and shows him at the top of several pages, that it indeed says: "HEBREWS"
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Quote of the Day
Determine what specific goal you want to achieve. Then dedicate yourself to its attainment with unswerving singleness of purpose, the trenchant zeal of a crusader. Paul J. Meyer
Rabies News (Dr A K Gupta)
How is RIG life saving?

Administration of anti–rabies vaccine stimulates production of neutralizing antibodies by the patient’s immune system. Protective levels of antibodies (more than 0.5 IU/ml of serum) are seen 7 to 14 days after the initial dose of vaccine (window period). Moreover when the bites are on the head, neck, face & hands, the incubation period will be shorter.

Thus the patients are vulnerable to develop rabies during this window period of 7 to 14 days. RIGs are readymade anti–rabies antibodies and provide passive immunity to rabies.
IJCP Book of Medical Records
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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
Debate
The Dental Council of India is proposing a three-year bridge course in MBBS for BDS graduates in a bid to enable them to provide both medical and oral health care in rural areas.
There is shortage of medical professionals in rural areas.
Is there no shortage of dentists in the country?
A good number of BDS graduates come out every year. These graduates have already been trained in many aspects of treatment during their five-year course. With a further three-year MBBS course these graduates can meet the requirement of medical professionals in rural areas.
India is facing a severe shortage of dentists. The World Statistics 2012, released on Wednesday by the World Health Organization (WHO), says India has less than 1 dentist (0.8) per 10,000 population. In absolute numbers, there are only 93,332 dentists.
The Medical Council of India might have opposition (for the bridge course) as we will be entering in their domain
It is true. Not only MCI but IMA will also oppose. What about a six months course in dentistry after MBBS by MCI and every MBBS doctors to also become a dentist.
DCI has proposed changes in the curriculum for the BDS and MDS courses that were awaiting approval of the Government. The new BDS course with nine subjects would cover aspects namely basic and advanced life support mechanisms. In the third year of the new BDS course, subjects related to forensic medicine will be studied.
Tomorrow physiotherapists will come and say we will come out with one year bridge course in dentistry or modern medicine.
Government is thinking at the instance of the Dental Council, that in order to provide medical services in 300 MP villages where there is no doctor, dentists will be given one year's special training and then post them there to provide medical services.
This proposal in illegal because it is in contravention of the IMC Act, 1956. (M C Gupta)
To me these seem to be irrational suggestions. If such moves come, IMA will oppose them.

IMA Members Speak

Recently there have been a number of physical attacks on doctors particularly in UP, Haryana etc.IMA must come forward and meet PM and HM to tackle this menace nationwide by bringing a new Act or amendments to the existing Criminal Procedure Code exclusively for the protection and safety of medical community all over the country. (Dr. Jaya Prakash Reddy, Former Hony Secretary, IMA Nilagiri branch, Nalgonda, Telangana state)

IMA Response: IMA has approached the Parliamentary committee on health and is drafting a private bill for submission to the government. We also have raised our concern in the recently held meeting of World Medical Association. Forward any suggestions for the bill.

Dear Dr K K Aggarwal: You are probably aware of the very unfortunate incident at the Gala Dinner organized by Delhi Ophthalmological Society during Annual Conference on 11th April 2015 at Pusa Maidan. Mika Singh was invited to entertain the gathering. His sudden and unwarranted slapping of Dr. Shrikant, a third year resident at Ambedkar Hospital, resulted in the evening ending in turmoil and has caused great anguish to all our members. Physical assault has no justification in civil society. An FIR was lodged on Sunday 12th April. We call upon IMA not to invite Sh. Mika Singh for performing at any function. Dr. CYRUS M SHROFF / Dr. M. VANATHI / President - DOS /Secretary - DOS

IMA Response: IMA has already taken the same stand. We should not only boycott his function and but also all his CDs.

..............................................................................................
  • Doctors who are interested to go to Nepal and render their services are requested to contact Dr. Honnegowda, President, M- 9448273255 /9448118299 and Dr. S. T. Yavagal, Hon. State Secretary, M-9845005350. Karnataka
  • Dear Watveji, Raju, Colleagues, Please see the line of action initiated by IMA (published in eMedinewS dated 26th April, 2015). It will be worthwhile to join hands with IMA at this moment of a huge tragedy. A copy of this is marked to IMA President Dr Marthanda Pilliai and Secy Gen Dr KK Aggarwal to enable easy correspondence and liaison. Hope you would do the needful. Prof Roy Abraham Kallivayalil, Secretary General, World Psychiatric Association
For 1000 Patients: List of drugs required for relief camp Nepal Tragedy
T. Diclofenac Paracetamol- (20,000)
T. Ibuprofen Paracetamol –(20,000)
T. Cefadroxyl 500mg –(10,000)
Cap Amoxicillin 500mg-(10,000)
T. Ranitidine –(20,000)
T. Paracetamol 500 mg-(25,000)
Syr. Ibugesic Paracetamol –(5,000 bottles)
Syr. Cefadroxyl (5,000 bottles)
T. Diominic DCA-(20,000)
T. Chloroquene (5000)
Vein flow (VF) No.20 (100), NO.22 (100)
I V set – (200)
Inj DNS 500ml (500 units)
Inj Dextrose 5% (500 units)
Inj RL (500 Units)
Inj NS (1000 units)
POP- 4 & 6 (300 each)
Bandages 4 & 6 (500 each)
Betadine solution 5% 500 ml- 10 bottles
Adhesive Plaster (6 spools)
Betadine Ointment (10 jars)
Dressing material- gause piece cloth – (20 packets)
Sterilium (10 bottles)
Cotton rolls (3 dozen rolls)
Disposable Syringe 5 ml & 10 ml with needles (1000 each)

Emergency kit

Inj Noradrenaline (10)
Inj Atropine (10)
Inj Diclofenac (10)
Inj Tetanus toxoid (100)
Inj Hydrocortisol
Inj Deriphylline (10)
Inj Avil (10)
Inj Coramin (10)
Inj Adrenalin (10)
Inj Dopamine (10)
Inj Dobutamine (10)
Inj Lasix (10)
Inj Xylocaine 2% (10 bulbs)
Laryngoscope
Ambu Bag                                     1 set per camp
Endotracheal tube of all sizes
Folleys catheter all sizes (50)
Urobag (50)
Gloves (sterile & disposable) (1000 pairs all sizes)
The Declaration of Helsinki (DoH)
The Declaration of Helsinki (DoH) is the WMA's best-known policy statement. The first version was adopted in 1964 and has been amended seven times since, most recently at the General Assembly in October 2013. The current (2013) version is the only official one; all previous versions have been replaced and should not be used or cited except for historical purposes. The WMA thanks all those who submitted comments and suggestions for the most recent (2012-2013) revision of the DoH. The new version is published on the website of the Journal of American Medical Association (JAMA).

Cycle rally launched by the Kerala chapter of the Indian Medical Association (IMA)

Kannur: The cycle rally launched by the Kerala chapter of the Indian Medical Association (IMA) to campaign for sensitising the public to safe sound levels will reach here on April 27. The all-Kerala cycle rally, being held in association with the Indian Cycle Embassy, will be received at a function at the Chamber Hall here at 3 p.m. on Monday under the auspices of the Kannur chapter of the IMA. Former Minister K. Sudhakaran will inaugurate the function. District Collector P. Bala Kiran will flag off the rally from Kannur to Thalassery, the organisers said. The rally is being held as part of the campaign, National Initiative for Safe Sound. The cycle rally had been flagged off by Chief Minister Oommen Chandy in the capital city on April 16. The awareness rally will conclude in Kozhikode on April 28. (The Hindu)

No permission to Ayurvedic doctors in UP to practise allopathy

Uttar Pradesh government on Tuesday ruled out giving permission to Ayurvedic doctors to practice allopathy and give medicines and treatment to patients like MBBS doctors. "The government cannot allow Bachelor of Ayurvedic Medicine and Surgery (BAMS) doctors to do the work of MBBS doctors and provide allopathic treatment. It's not possible... If such a thing is done, there will be no need for MBBS studies," Parliamentary Affairs Minister Mohammad Azam Khan said in the state Assembly. He was replying to an adjournment notice given by some Congress members who asked the government to grant permission to BAMS doctors to provide allopathic treatment like MBBS doctors. Khan, however, said the government could consider the matter if associations of BAMS and MBBS doctors arrived at any conclusion on this issue and informed the authorities. (Jagran)
Additional list of doctors who have offered help for Nepal Tragedy
Dr .S.Yadukul
9986510681
Dr Alka
9235797797
Dr Arvind Jain
9425154004
Dr Binu Lal Singh
9443152889
Dr Jyoti Malik
9811226648
Dr Kalyan Singh
kalyansingh41@gmail.com
Dr Manish Sharma
9466678311
Dr N.K.Sharma
9811763276
Dr Narotham
9440979283
Dr Param Hans Mishra
9313622552
Dr Pawan Gupta
9813193071
Dr Prem Punhani
9896707788
Dr Raman Kr Verma
9431293996
Dr Ravi
9235797797
Dr Ravi Wankhedkar
8275008761
Dr S.D Rao
9826060629
Dr Samir Ranjan Bhowmik
9734718060
Dr Satender Tanwar
7676067600
Dr Satish Sangwan
9910308937
Dr Sharma
9848146869
Dr Subash Aggarwal
9810128494
Dr Upendra
9825115538
Dr. Anil Kumar
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Assault on doctors
Several studies indicate that violence often takes place during times of high activity and interaction with patients, such as at meal times and during visiting hours and patient transportation. Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a health care worker attempts to set limits on eating, drinking, or tobacco or alcohol use.
Why should we donate blood?
  • Blood is a precious human resource that is only available from voluntary donors.
  • Blood cannot be made in any lab in the world.
  • Every 3 seconds someone needs blood. We think that someone else will donate the blood that is needed, as a result, only less than 5% of qualified donors actually donate the blood.
  • The common your blood group, more and more people are going to need it. So don’t say that my blood group is too common.
  • Persons above 18years of age and over 50kgs in weight can donate blood once in 3 months. There is no upper limit age for blood donation.
  • Less than 10% of blood is taken out at time of blood donation. This blood is replaced by your body in 24-48 hours.
  • Every donor is given a medical check-up prior to donation to see if he is medically fit for donation
  • Even if you are taking any medication, still you may be able to donate the blood.
  • No special diet, rest or medicine is required after blood donation.
  • The donor cannot contract any infectious disease by donating blood. There is a clear procedure for taking blood from each donor. At no time will a donor come in contact with any piece of equipment or material that has had contact with someone else’s blood or body fluids.
  • Only 20 min are required for blood donation.
  • It gives you inner satisfaction, experience it!!!
From Dr Aruna Gulhane and Dr Neha Agrawal President/ Honorary Secretary IMA Paratwada Maharashtra
Sonal Namaste
Hand hygiene is as important in the community as in the hospital.
Experts warn of malaria's adverse impact on reproductive health
The Economic Times: By PTI | 26 Apr, 2015, 12.35PM IST

NEW DELHI: Malaria can have a serious impact on reproductive health, experts said on the occasion of World Malaria Day today as they pointed out that, although rare, the disease can hamper semen quality in males and increase miscarriage risks in women.

When a man suffers from high-grade fever during malaria, he may develop severe azoospermia (no measurable level of sperm in semen), necrozoospermia (sperm in semen is either dead or immobile) or oligospermia (low sperm count), experts said.

However, in most of the cases, recovery occurs once the person is cured of malaria. Thus, success rates are comparatively low among couples who try to conceive around the period when the male partner is affected with malaria or has just recovered from the disease.

"Not many are aware that a parasitic disease like malaria can affect the reproductive health of both men and women. We sometimes see that quinine and chloroquine, the anti-malarial alkaloids that are used to treat the disease, impact the quality of sperm and blood levels of some reproductive hormones in males.

"In some cases, they also hamper the egg quality in females. Malaria also increases miscarriage risks. However, more research needs to be done to ascertain the exact effects of malaria on male and female infertility," said Dr Kaberi Banerjee, a leading IVF and infertility specialist.

Dr KK Aggarwal, Secretary General of Indian Medical Association (IMA), said, "The vulnerable group when it comes to malaria are children, pregnant women and the elderly. Malaria in pregnancy can cause a low birth weight infant, abortions and premature delivery and should not be ignored and treated early.

"An unexpected abortion of this nature can cause long-term infertility in patients."

Being diagnosed with malaria during pregnancy can harm both the mother and the unborn foetus. It can cause severe parasitic infection and anaemia in the foetus thus becoming a major cause of maternal mortality.

The disease can also cause premature birth or low weight, which leads to increased risk of neonatal mortality, he added.
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IMA to send a team to Nepal
Indian Medical Association along with Heart Care Foundation of India will be sending a team of specialist surgeons to conduct a week long OPD in Kathmandu.

Giving details, Padmashri Awardee, Prof (Dr.) A. Marthanda Pillai, National President and Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General & Dr. Chetan Patel, Chairman, IMA Disaster Management Cell, IMA jointly said that team will consist of Orthopedic Surgeons, Plastic surgeons and surgeons who will be conducting free OPD and select cases for surgeries.

Surgeries which can be undertaken at Kathmandu will be done there and those which require to be done in India, patients will be brought to India in various hospitals to get the surgeries done.

IMA aims to help atleast 100 cases requiring complex sophisticated surgeries.

IMA is in touch with I.G Police of Kathmandu who will be giving full assistance for local hospitality and security.

The delegation will carry drugs and some surgical instruments. IMA is also in touch with Kathmandu administration to provide infrastructure for conducting surgeries.