October 29   2015, Thursday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
IMA condoles the sad demise of Prof Ranjit Roy Chaudhury, the force behind clinical trial regulations in India

IMA has expressed its condolences over the sudden demise of Padma Shri Awardee Prof Ranjit Roy Chaudhury. He passed away in Chennai on Tuesday, where he was there to deliver speech in a conference on Pharmacovigilance, organised at Sri Ramachandra University, Chennai.

His loss is a big blow to clinical research and the healthcare industry in India. Under his guidance, the country saw the introduction of new regulations and policies built on the principles of scientific research and a framework based on quality, ethics and patient safety.

He was the head of the Committee to Formulate Policy and Guidelines for Approval of New Drugs, Clinical Trials and Banning of Drugs formed under the ministry of health & family welfare.

He developed the "Delhi Model" of Rational Use of Medicines and took steps to provide almost 90 per cent of medicines prescribed by the government hospitals, free to the patients. He was the founder of Delhi Society for the Promotion of Rational Use of Medicines. He was also responsible for Task Force preparing the "Antibiotic Policy" of the Government of India.

He was the Founder President of Delhi Medical Council, and was a member of the expert committee of Indian Council of Medical Research. The Indian Society for Clinical Research (ISCR) also has expressed its condolences over his death.
Breaking news
USPSTF issues new guidelines for abnormal glucose screening

The US Preventive Services Task Force (USPSTF) has recommended screening for abnormal glucose as part of cardiovascular risk assessment in overweight or obese adults aged 40 to 70 years and referral of those identified with abnormal glucose to intensive behavioral interventions to promote a healthful diet and physical activity. The recommendation, given a "B" grade for moderate evidence of benefit, was published online October 26, 2015 in Annals of Internal Medicine. The recommendation earlier had been to screen only asymptomatic individuals with hypertension (blood pressure > 135/80 mm Hg). Fasting blood glucose, HbA1c, or an oral glucose tolerance test can be used as screening tests. Individuals with normal glucose values should be followed up at intervals of 3 years. The guidelines recommend that for individuals found to have either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), clinicians should "offer to refer…to intensive behavioral-counseling interventions to promote a healthful diet and physical activity." (Medscape)
Dr Good Dr Bad
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Specialty Updates
• Adolescents who used legitimately prescribed opioids before the 12th grade had an overall 33% greater risk for future opioid misuse, and this risk was greatest among those who had little to no drug experience or who strongly disapproved of marijuana use, reported a longitudinal cohort study published online October 26 in Pediatrics.

• New research has identified a molecule called growth differentiation factor 10 (GDF10) that signals brain tissue to form new connections following a stroke, thus suggesting that it may be possible to stimulate brain tissue to repair itself after a stroke. The findings were published in Nature Neurology.

• A point system can calculate the risk of subsequent diabetes for women who had gestational diabetes when they delivered a baby, suggests new research published in Acta Diabetologica. The score takes into account four factors - insulin treatment during pregnancy, family history of diabetes, body mass index (BMI) in early pregnancy, and lactation.

• Two new studies suggest that the medications used to treat acid reflux and heartburn could damage the kidneys, increasing the risk of chronic kidney disease. The studies are scheduled to be presented at the American Society of Nephrology Kidney Week 2015.

• Over-the-counter (OTC) weight-loss supplements commonly contain unlabeled and clinically significant levels of thyroid hormones, including thyroxine (T4) and triiodothyronine (T3), thereby posing potentially serious health risks to users unaware of the contents, suggests new research presented at the 2015 International Thyroid Congress and Annual Meeting of the American Thyroid Association (ITC/ATA).

• People who experience frequent blackouts and near-drowning incidences may be at increased risk of a heart disorder known as long QT syndrome, which can heighten the risk for sudden death, suggested new research presented at the South African Heart Association Annual Congress.

• In women who undergo in vitro fertilization (IVF), the risk for cancer is minimal, suggested a large study presented at the American Society for Reproductive Medicine 2015 Annual Meeting. Researchers stated that there is little to worry about regarding the risk of cancers and the drug treatments women undergo to have a baby with IVF.

• Antibiotic resistance continues to be high among ocular pathogens; nearly half of staphylococcal isolates are resistant to methicillin, and most of those isolates are also resistant to multiple other commonly used ophthalmic antibiotics, reported data from the prospective surveillance Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study published online in JAMA Ophthalmology.

• A study presented at the annual American College of Chest Physicians (CHEST 2015) meeting stated that the use of a wearable ventilator system in COPD patients with chronic respiratory insufficiency is associated with significant improvement in healthcare utilization and overall respiratory health status.

• A new and simpler surgical method for the treatment of intestinal perforation - laparoscopic lavage - is a poorer alternative for patients compared to the old method - primary resection, suggested a new study published in the Journal of the American Medical Association (JAMA).
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Media
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eSPIRITUAL
Mindfulness meditation
• Sit on a straight–backed chair or cross–legged on the floor.

• Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.

• Once you've narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas.

• Embrace and consider each thought or sensation without judging it good or bad. If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
Legal Quote
Dr. Suresh Gupta vs. Government of N.C.T. of Delhi and another AIR 2004 SC 4091 Appeal (crl.) 778 of 2004

“To convict, therefore, a doctor, the prosecution has to come out with a case of high degree of negligence on the part of the doctor. Mere lack of proper care, precaution and attention or inadvertence might create civil liability but not a criminal one.”
Medicofinance
Estate planning: Gifts

Gift is another good tool for estate planning during lifetime. A person can make a gift of any property (movable or immovable) during his lifetime. It can be made by discretion of a person in favor of anyone. Although in a case of gift of an immovable property, there is no exemption of stamp duty, but one can ensure the safe transfer of immovable property in favor of his heirs. It is also important to mention that there is no gift tax on gifts made to relatives as defined in Income Tax Act.

(Source: IJCP)
Industry News
Majority of companies plan to be 80% digital in next five years: As per a new study conducted by The Economist Intelligence Unit, two-thirds of companies have digitized roughly half of their operations or less but most plan to be 80% digital or more in five years. The study was based on a global survey of 444 executives from the healthcare, finance and telecommunications industries. (Firstpost)

India's first forex booking mobile app for exchange of foreign currency: Fxkart.com, the online aggregator of foreign exchange dealers, on Monday launched India's first forex booking mobile app for exchange of foreign currency. "The UAE-based Free Zone company, Fxkart.com, aims to change the way consumers buy/sell forex in India through the use of technology. The app is available on iOS and Play store platforms," Fxkart.com said. The company has its R&D (Research and Development) Centre at Bengaluru, and is currently reaching out to people at more than 650 locations across India. (Business Today- PTI)

Asia-Pacific emerging as a hotbed of startups for VC investors: The startup ecosystem in the emerging economies of Asia-Pacific is still at a nascent stage, but is rapidly evolving. Asia-Pacific region has overtaken Europe in terms of deal value and has emerged as hotbed for venture capital (VC) investors, who are attracted by the region’s growth prospects. As per the research report by Aranca, China and India, two key economies in the region, have grown at a substantial rate over the past decade and are fast becoming the hot destination for global venture capital investments. (Iamwire.com- Bhavna Singh)

Govt sets up panel to simplify I-T laws: The government on Tuesday set up a 10-member panel to simplify the over 50-year-old Income Tax Act, a move aimed at ensuring certainty in tax policy for ease of doing business. The panel, headed by retired Delhi high court judge R V Easwar, has also been tasked with identifying provisions and phrases in the I-T Act, which are leading to litigation due to different interpretations. The term of the committee is for one year and the first report is expected by January 2016. (Times of India)
Inspirational Story
The hedgehogs

It was the coldest winter ever. Many animals died because of the cold.

The hedgehogs, realizing the situation, decided to group together to keep warm. This way they covered and protected themselves; but the quills of each one wounded their closest companions.

After awhile, they decided to distance themselves one from the other and they began to die, alone and frozen. So they had to make a choice: either accept the quills of their companions or disappear from the Earth.

Wisely, they decided to go back to being together. They learned to live with the little wounds caused by the close relationship with their companions in order to receive the heat that came from the others. This way they were able to survive.

The best relationship is not the one that brings together perfect people, but when each individual learns to live with the imperfections of others and can admire the other person's good qualities.
eWELLNESS
Avoid Food Poisoning by thorough washing and proper cooking

Thorough washing and proper cooking of fruits and vegetables can eliminate most bacteria that cause food poisoning.

Food-borne illnesses or food poisoning usually occurs due to eating food that is contaminated with bacteria or their toxins. Virus and parasites can also be cause food poisoning. People have known for long that raw meat, poultry and eggs can also harbor diseases causing microbes. But in recent years most outbreaks of food borne illnesses have been due to fresh fruits and vegetables.

Food poisoning can cause abdominal pain, nausea, headache, fatigue, vomiting, diarrhea and dehydration. Symptoms may appear several hours to several days after eating tainted food. For example, Salmonella bacteria will cause illness 12 hours to 3 days after ingestion lasting about 4-7 days.

The most common way to treat food poisoning is to drink plenty of fluids. The sickness usually subsides within a few days.
eMEDIPICS
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Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
MTNL Perfect Health Mela 2015.

Pls click here for details
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eMEDI QUIZ
The parameters of sensitivity and specificity are used for assessing:

1. Criterion validity.
2. Construct validity.
3. Discriminant validity.
4. Content validity.

Yesterday’s Mind Teaser: The substances present in the gallbladder stones or the kidney stones can be best identified by the following technique:

1. Fluorescence spectroscopy.
2. Electron microscopy.
3. Nuclear magnetic resonance.
4. X-ray diffraction.

Answer for Yesterday’s Mind Teaser: 4. X-ray diffraction.

Answers received from: Raghavendra Chakurkar, Dr Poonam Chablani, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 27th October Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Raju Kuppusamy, Daivadheenam Jella, Dr Avtar Krishan.
Humor
While the doctor was talking to me, his nurse came in and said,
"Doctor, there is a man here who thinks he’s invisible."
The doctor said, "Tell him I can’t see him."
BIOETHICAL ISSUES IN MEDICAL PRACTICE
Defensive Medicine

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
New Delhi

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
 
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Breaking news
AAP new policy statements urge strong regulations of e-cigarettes

In a new policy statement, the American Academy of Pediatrics has strongly recommended that the minimum age be hiked to 21 years nationwide, not only for traditional tobacco products, but for e-cigarettes as well. The AAP recommendations are contained in three policy statements announced on Monday, Oct. 26 and published simultaneously in Pediatrics. The statements outline recommendations for public policy changes, clinical guidance for physicians to counsel families on reducing exposure and dependence on tobacco, and recommendations for the regulation of e-cigarettes. A companion technical report provides a review of the scientific evidence that supports the recommendations. The AAP has also urged the US Federal Food and Drug Administration (FDA) to regulate e-cigarettes and other electronic nicotine delivery systems the same as other tobacco products. This includes age restrictions, taxes, bans on advertising to youth, and bans on flavored products that are particularly attractive to youth. (AAP)
MAKE SURE
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Indian Medical Association National Satyagraha for a Healthy India
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IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.
• Writing prescription drugs by unqualified people can be dangerous.
• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)
• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?
• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?
• Allow us to treat poor and rich equally.
• Non pelvic ultrasound providers should be out of PCPNDT Act.
• Unless caught doing sex determination, no criminal offence shall be registered.
• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.
• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.
• Money spent does not mean you will get a cure.
• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.
• How can we treat patients using outdated standard treatment guidelines made by government?
• How can government decide the charges of a clinical establishment?
Despite precautionary measures, dengue still a big worry

Bathinda, October 27: Despite intensified dengue-control measures like the programme aiming at reduction of dengue larvae, education and communication (IEC) activities in vulnerable areas, the disease is still a cause of worry for the Health Department as the number of cases are increasing every day. Today, samples of 40 suspected patients were tested, of which 28 were found positive. This takes the total number of dengue patients in the city to an alarming 1,303. Over the past four days, samples of total 131 suspected patients have been checked of which 80 have been found to be down with dengue.

Officials of the Health Department have maintained that with the help of health activists and nursing college students, awareness was being created among people. Residents are being told not to ignore any kind of fever and get themselves checked, preferably at a government hospital.

Considering the spread of dengue in several cities across the country, this year’s ‘Perfect Health Mela’ in New Delhi will also focus on creating health awareness among the people about dengue and swine flu. Organised by the Heart Care Foundation of India (HCFI) and Ministry of Science and Technology, Earth Sciences, Textile and the Indian Medical Association, the event is scheduled to take place between November 4 and 8. The five-day event will include seminars, on-ground check-ups, entertainment programmes, lectures, workshops and competitions all centered around preventive health issues of swine flu and dengue. (Tribune News Service)
Blood disorder tests during pregnancy soon

Pregnant women and new-born children will soon be also screened for blood disorders such as anemia, thalassemia and sickle cell during routine checkups at the Community Health Centres and Primary Health Centres under the Health Ministry’s National Health Mission across the States. At present, pregnant women are screened for several blood tests, AIDS and high blood pressure and heart diseases among others. According to a senior health official, hemoglobinopathies comprising of thalassemias and anemia and various hemoglobin (Hb) variants continue to plague the health system in the country. Hence, urgent need has been felt to test the pregnant women in her trimester and newly-born babies for the genetic disorders as well, as per the guidelines “Prevention and control of hemoglobinopathies in India” recently prepared by the experts in the sector along with Health Ministry officials. As per the guidelines to be released shortly, the HPLC diagnostic machine, which is already available in many PHCs and CHCs, can be effectively used for the direct identification of hemoglobin variants with a high degree of precision in the quantification of major and minor, normal and abnormal, hemoglobin fractions… (The Pioneer - Archana Jyoti)
First trial to use umbilical cord stem cells to cure HIV

The world’s first clinical trial which aims to cure five HIV patients within three years using transplants of blood from umbilical cords is set to start in Spain. The project seeks to be the world’s first clinical trial of its kind by recreating the success of Timothy Ray Brown — the only living person ever to be completely cured of HIV, known as “the Berlin patient”. Plans for the clinical trial were announced last week at a hematology conference in Valencia by Spain’s National Organisation of Transplants (ONT)… (The Hindu)
Chocolate, pizza among most addictive foods

In a study from the University of Michigan and Columbia University investigating common addictive foods, chocolate topped the list of foods that are most addictive. It was followed by favourites such as ice cream, French fries, pizza and cookies, Tech Times reported. Cheese, bacon, pretzels, fried chicken, soda and cake also made it to the top 20 list. Processed foods have higher levels of glycemic load and fat compared to the non-processed ones and they are closely associated with eating disorders or behaviors that mimic addiction. (Times of India – PTI)
Climate deal more important for your health than you realize: WHO

A new global agreement to combat climate change, due to be reached in December in Paris, is more important for everyone's health than many people realize, a senior World Health Organisation (WHO) official said on Tuesday. Apart from the direct impact, disasters like heat waves and floods increase the risk of infectious diseases spreading, while air pollution in cities causes diseases such as lung cancer and strokes, said Maria Neira, the head of public health at WHO. An estimated 7 million people a year die as a result of air pollution, which is made worse by rising temperatures, especially in cities… The WHO sees climate change as the greatest threat to global health in the 21st century… (Daily News & Analysis)
Supreme Court directs Centre and states to scrap quotas in super-specialty medical courses

New Delhi: The Supreme Court on Tuesday directed the central government and all states to make sure that super-speciality medical courses are kept "unreserved, open and free" following complaints that some states were allowing only domiciled MBBS doctors to appear for entrance exams. The Supreme Court held that national interest requires doing away with all forms of reservation in institutions of higher education, and urged the Centre to take effective steps “objectively”… (Firstpost)
Can't ban firecracker bursting on Diwali, says Supreme Court

The Supreme Court categorically refused to ban people from bursting firecrackers during Diwali, saying it might be "dangerous" to infringe into the common man's right to enjoy his religious festivities. Refusing the plea made by three toddlers, who turned to the Supreme Court for relief against the air pollution caused by firecrackers during Diwali, a Bench led by Chief Justice H.L. Dattu said: "the court cannot stop people from bursting crackers in front of their homes." (The Hindu) )
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IMA Digital TV
GP Tip: Heeding a clue to possible dementia

Formal mental status testing is time-consuming and often unnecessary for general medical evaluations. If a patient with reasonable hearing acuity looks at his or her companion more than twice before answering when directly questioned during history taking, there is a strong likelihood of incipient dementia. (Source: IJCP)
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Readers column
Dear Sir, very informative news. Regards: Dr Pankaj
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Press Release
                                          A World Stroke Day feature

Timely action is of key essence while dealing with patients who have suffered a heart attack, sudden cardiac arrest or stroke

In India, around a third of the population suffers from degenerative diseases like ischemic heart issues, chronic obstructive pulmonary problems and stroke. These diseases also known as the leading killers were also accountable for 30 percent of all deaths in 2013. Stroke and heart disease are leading causes of death and disability in India. The estimated prevalence rate of stroke in the country ranges from 84-262 per 100,000 population in rural and 334-424 per 100,000 populations in urban areas. Approximately 40% of patients with stroke succumb to their illness.

Both heart attack and stroke are caused by interruptions in the normal flow of blood to the heart or brain, the organs that are the most essential to life. This happens when the cells present in the heart and brain don’t get enough access to the oxygen-rich blood and other nutrients. In such a case, these heart and brain cells begin to malfunction and die. This cell death can set off a series of harmful effects throughout the body resulting in familiar symptoms of a heart or brain emergency. However, one must remember is that heart attacks and strokes are not the same. While one affects the heart, the other damages the brain.

Speaking about the issue, Padma Shri Awardees Dr A Marthanda Pillai National President Indian Medical Association and Dr K K Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India said, “Stroke-like heart disease is a lifestyle induced ailment aggravated due to obesity, physical inactivity, regular heavy or binge drinking, smoking, hypertension, high cholesterol levels, diabetes, sleep apnea, family history and heart disease. Timely recognition of symptoms and seeking emergency help is key to saving lives. Just like in sudden cardiac arrest deaths every minute lost in performing hands-only CPR decreases the chances of a person's revival by 10%, every minute lost in getting medical attention increases chances of death and disability. India is facing a stroke and heart disease epidemic, and we must work towards amending our high-stress lifestyle to reverse this trend and save lives.”

The most common symptoms of heart attack include crushing chest pain and difficulty breathing. A heart attack might also cause cold sweats, racing heart, pain in the left arm, jaw stiffness, or shoulder pain. Additionally, many don't know that women often have different heart attack symptoms than men. For instance, instead of having chest pain during a heart attack, women may feel exhausted and fatigued or have indigestion and nausea.

The symptoms of stroke include sudden difficulty seeing, speaking, or walking, and feelings of weakness, numbness, dizziness, and confusion. Some people get a severe headache that’s immediate and strong, different from any kind they’ve ever had.

It is important to differentiate the conditions and seek immediate help when faced with such situations. One should never neglect the even the smallest symptoms. In the case of stroke, the F.A.S.T technique should be used to detect the conditions and save lives.

Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?
• If the answers to these questions are yes, then it is Time to call your doctor immediately.

Lifestyle changes are also a must. People often remain unaware of the consequences of their choices on their health. The risk of a stroke and heart disease in a smoker is double when compared to a non-smoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque build-up in the arteries of both he heart and brain. In addition to this, obesity puts a strain on the entire circulatory system. It can also make people more likely to have high cholesterol, high blood pressure and diabetes, all of which can increase stroke and heart disease risk. Alcohol use is also very dangerous. A healthy diet comprising of fruits, vegetables, and low trans fats is a must for the prevention of lifestyle diseases.
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