December 29   2015, Tuesday
Dr KK AggarwalDr SS Aggarwal Updates in Medicine

• Children with epilepsy should have a plan in place at school for how best to respond to medical emergencies. The American Academy of Pediatrics (AAP) has released guidance suggesting prescribing providers, families, and schools collaborate develop such plans detailing the use of seizure rescue medications. The recommendations are published online December 28 in Pediatrics.

• For patients with gram-negative bloodstream infections (BSI) who present with a beta-lactam allergy, treatment with a beta-lactam (BL) antibiotic from an alternative class carries a lower risk of clinical failure than treatment with a non-beta-lactam (NBL) antibiotic, according to a new study reported online December 11 in the Journal of Allergy and Clinical Immunology.

• Administration of oral ivermectin to whole communities can significantly decrease the prevalence of scabies and impetigo. In the study published in the December 10 issue of the New England Journal of Medicine, the prevalence of scabies from baseline to 12 months went from 36.6% to 18.8% in the standard care group and from 41.7% to 15.8% in the permethrin group. The greatest reduction was noted in the ivermectin group, which went from 32.1% to 1.9%. The severity of scabies at baseline was similar across all three groups.

• As per a study from published online December 28 in the journal Pediatrics, the prevalence of asthma in the US are leveling off and possibly declining, but not among the poor. The overall prevalence of childhood asthma doubled from 1980 (3.6%) to 1995 (7.5%), increased at a slower rate from 2001 (8.7%) to 2009 (9.7%), and dipped in 2010 (9.3%). The 1980s saw no or little disparity in asthma prevalence between black and white children, but asthma prevalence doubled for black children by 2010.

• Michael M. Ward, MD, of the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the NIH in Bethesda, Md., and colleagues report in the journal Arthritis & Rheumatology that only about one-fourth of patients with non-radiographic axial spondyloarthritis (axSpA) progressed to ankylosing spondylitis (AS) through more than a decade of follow-up. At the end of a mean of 10.6 years of follow-up, 26% patients progressed to AS. In addition, at 5, 10, and 15 years, the probabilities of remaining as non-radiographic axSpA were 93.6%, 82.7%, and 73.6%, respectively.
Breaking News

Centre to adopt IoT to speed up e-governance to make efficient reporting under PvPI, HvPI and MvPI

The central government is keen to adopt the internet of things (IoT) embedded with electronics, software, sensors and communication network connectivity that will bring in a major transformation in the Indian healthcare sector. In the areas of Pharmacovigilance Programme of India (PvPI) for assuring drug safety, Haemovigilance Programme of India (HvPI) to assure patient safety in blood transfusion and Materio-Vigilance Programme of India (MvPI) for safety of medical devices, the use of IoT with cloud-based apps will bring in efficiency and transparency in real-time. The ministry of health and family welfare is already working on evidence-based policy decisions. So long all drug safety data was based on approvals of EU and USFDA. “But now we are working to create the Indian patient data base. The ministry has already moved towards dispensing clinical trial approvals for medical devices not manufactured in the country if they are cleared from ICH countries. It is aggressively working to establish advanced labs and look at IoT which could speed up reports,” said KL Sharma, joint secretary (regulation), department of health and family welfare, government of India…(Pharmabiz - Nandita Vijay)

Horror movies can actually curdle your blood, says a new study

A new study from Leiden University Medical Center in The Netherlands found that watching a horror movie caused a spike in blood coagulation factor VIII. In the study, blood drawn before and after watching a scary movie showed a statistically significant 11.1 IU/dL increase in factor VIII vs an educational film but without evidence of thrombin induction, essential for clot formation (not so scary that it might cause a heart attack or stroke). The change in the coagulation parameter correlated with a visual analog scale (VAS) assessment showing that viewers found the horror movie more frightening than the educational one. The study published in the BMJ provides unprecedented scientific support for the oft-held view that horror movies can have a "bloodcurdling" effect on people who watch them… (Medpage Today)
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Specialty Updates
• If people at risk of rheumatoid arthritis consume more omega-3 fatty acids, found in fish and fish-oil supplements, they can probably decrease their chance of developing the disease, suggested new research published in Rheumatology.

• Outcomes for patients who undergo weight-loss surgery may be influenced by vitamin D levels, suggested a new study published in the journal Obesity Science & Practice.

• Patients with Chronic Obstructive Pulmonary Disease (COPD) and other chronic respiratory disorders who received music therapy besides standard rehabilitation saw an improvement in symptoms, psychological well-being and quality of life compared to patients receiving rehabilitation alone, reported a new study published in Respiratory Medicine.

• A new study directly links common variants of the genes -- ABCA7 and MA4A6A -- to atrophy in cortical and hippocampal regions of the brain, which are associated with memory and other key functions.

• Combining ursodeoxycholic acid (UDCA) with the cholesterol-lowering drug bezafibrate may improve liver biochemistry and the prognosis of primary biliary cirrhosis (PBC) among patients who do not respond sufficiently to UDCA monotherapy, suggested a meta-analysis published in the journal Drug Design, Development and Therapy.

• Data from the largest study ever of pulmonary hypertension shows that oral medication Selexipag led to a 40% reduction in hospitalizations and worsening symptoms among patients with pulmonary hypertension. The findings were published in the December 24 issue of the New England Journal of Medicine.

• A new study, published in the Proceedings of the National Academy of Sciences, suggests that many drugs already approved by the FDA for other purposes have antibiotic potential, and, because they have multiple targets, it would be harder for bacteria to become resistant to them.

• Azithromycin is less effective than doxycycline in treating chlamydia when treatment compliance is high, suggested a randomized trial published in the December 24 issue of the New England Journal of Medicine.

• Electronic toys for infants that produce lights, words and songs seem to be associated with decreased quantity and quality of language compared to playing with books or traditional toys such as a wooden puzzle, a shape-sorter and a set of rubber blocks, reported an article published online in JAMA Pediatrics.

• Screening male kidney transplant candidates for prostate cancer may be more harmful than protective because it does not appear to prolong their survival but may interfere with the transplant process, suggests a new study published in the Journal of the American Society of Nephrology (JASN).
Why do we Offer Food to God in Every Pooja?

We follow a ritual of offering ‘bhog’ to the deity we worship. The ritual also involves sprinkling water all around the place where we sit down to eat food. Many people have advocated that the sprinkling of water is related to preventing ants and insects from approaching the food. But in spiritual language there is a deeper meaning to these rituals.

Bhagwad Gita and Yoga Shastras categorize food into three types corresponding to their properties termed as gunas. Depending upon satoguna, rajoguna and tamoguna, the food items are categorized as satwik, rajsik or tamsik. Satwik foods provide calmness, purity and promote longevity, intelligence, strength, health, happiness and delight. Fruits, vegetables, leaves, grains, cereals, milk, honey, etc. are examples of satwik food. These items can be consumed as they are. One can also live on satwik food for life. Rajsik food items possess attributes of negativity, passion and restlessness. Hot, spicy and salty food items with pungent, sour and salt taste promote rajas qualities. Tamsik foods have attributes of inducing sleep, ignorance, dullness and inertia. The examples of tamsik food are meat, onions, garlic, left–over food, etc.

Only satwik food is offered to God. Rajsik and tamsik food is never offered as Bhog. The only persons who were offered tamsik and rajsik food in Ramayana are Ahi Ravana and Kumbhkaran. Both of them were of an evil nature. Kumbhkaran signified tamas and Ahi Ravana, rajas or aggression. Tamsik and rajsik food can be converted into satwik by slow heating, sprouting or keeping them in water overnight. The examples are sprouted wheat and chana (chickpeas), etc.

A mixture of honey, milk, ghee, curd and sugar is called panchamrut and is a routine offering to the God. All the five components have satwik properties and their consumption promotes health. In Ayurveda, there is a saying that any food item, which grows under the ground, is tamsik in nature and one, which comes from the top of the tree or plant like leaves, flower and fruits are satwik in nature. Satwik food is usually fresh, seasonal and locally grown.

Human beings are made up of body, mind and soul and soul is equated to consciousness or God. Whatever offered to external God if is offered to the internal God or consciousness leads to inner happiness. The ritual, therefore, of offering food to God before eating forces us to either eat only satwik food or to include a substantial portion of satwik food in our meals. It helps a person convert his meal into a pure satwik one or at least adding satwik items.

Sprinkling water around the plate is considered an act of purification.

Many people confuse bhog with chadhava or offerings to the deity. While bhog is shared with God, chadhava is the offering of your illness or negative thoughts to the God and you go back with prasada of inner happiness. Many people counter the above argument by saying that alcohol is offered to Bhairon, viewed as a demon God, which means alcohol, is good for health. I personally feel that alcohol is offered to Bhairon not as a bhog but as an offering which means that people who are addicted to alcohol go to Bhairon and give their share of alcohol to him so they can de–addict themselves.
Legal Quote
Martin F. D'Souza vs Mohd. Ishfaq, 3541 of 2002, dated 17.02.2009

” It must be remembered that sometimes despite their best efforts the treatment of a doctor fails. For instance, sometimes despite the best effort of a surgeon, the patient dies. That does not mean that the doctor or the surgeon must be held to be guilty of medical negligence, unless there is some strong evidence to suggest that he is. ”
The switch from trivalent to bivalent oral polio vaccine

18th December, 2015

Role of CDL Kasauli

• Govt. of India will not accept any tOPV from 1st March 2016 onward, therefore all testing of tOPV to be completed and report submitted by middle of Feb, 2016 for GoI supply

• No batch testing of tOPV after March 2016 even for private market.

• All tOPV to be destroyed and no tOPV should be stored after the switch date.

• Testing for bOPV should be fast tracked to ensure timely supplies immediately after switch.
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The Year in Medicine 2015: News That Made a Difference
Prenatal test identifies cancer in pregnant women

Noninvasive prenatal testing (NIPT), which identifies abnormalities in the fetus, can also identify cancer in pregnant women before they experience any symptoms. A review of three case reports was published online in JAMA Oncology. NIPT analyzes cell-free DNA present in maternal plasma. In pregnant women, the plasma contains fetal DNA, which is analysed for abnormalities in the fetus, but in women who also have cancer, the plasma also contains cancer DNA, explained lead author Joris Robert Vermeesch, PhD, of the Center for Human Genetics, in Leuven, Belgium. The findings could potentially change clinical practice… (Medscape)
Smoking rates falling, but number of women smokers rising in India
Cigarette consumption in India is falling steadily even as the number of women smokers is rising, making it home to the second largest number of female smokers after the United States. As per the latest data given by the Ministry of Health in Parliament, cigarette consumption in 2014-15 was 93.2 billion sticks - 10 billion less than in 2012-13. Production fell from 117 billion sticks to 105.3 billion in the same period. 'Smoking Prevalence and Cigarette Consumption in 187 Countries - 1980-2012', a global tobacco study conducted by the Institute for Health Metrics and Evaluation at the University of Washington and released last year showed that the number of women smokers in India went up from 5.3 million in 1980 to 12.7 million in 2012. Incidentally, unlike most countries where cigarettes constitute over 90% of tobacco consumption, in India, it is just about 11%. Hence, while the decline is a positive development, its impact on burden of diseases caused by tobacco remains limited as consumption is dominated by chewing tobacco, followed by bidis… (ET Healthworld - Atul Thakur & Rema Nagarajan)
Govt plans to fix price of stents
The government is moving ahead with its plan to cap prices of coronary or cardiac stents and is expected to take a final decision by the end of January after approval from a core committee on essential medicines. Once the approval comes through, maximum retail price (MRP) of bare metal stents is likely to be capped at around Rs 20,000, whereas that of drug-eluting stents may be fixed at Rs 28,000. Currently, bare metal stents are priced in the range of Rs 12,000 to Rs 20,000 in the local market while drug-eluting stents cost anywhere between Rs 23,000 and Rs 120,000, depending on the product specifications. (ET Healthworld - Sushmi Dey)
Indian women more prone to miscarriages
A study conducted in five cities of India and published in The Journal of Obstetrics and Gynecology of India reported that Indian women seem more likely than other ethnicities to miscarry their first pregnancy or suffer recurrent miscarriages. In the study, 32% of the participants had suffered spontaneous miscarriage. Miscarriage or spontaneous abortion without medical means to terminate a pregnancy, has so far been presumed to be 10% across the globe. Recurrent spontaneous abortions were as high as 7.46% compared to the figure of 0.8-1.4% of all pregnancies globally… (ET Healthworld)
EMA, HMA adopt 5-year common strategy to improve human and animal health
The European Medicines Agency (EMA) Management Board and the Heads of Medicines Agencies (HMA) have adopted a common strategy to 2020 for the European medicines regulatory network. This is the first time that a single strategy for the whole network has been developed. It outlines common challenges and opportunities and sets out joint key priorities and a high-level roadmap to achieve these over the next five years. The strategy also supports the strategic priorities of the European Commission and the European Union (EU) agenda on human and animal health. The European medicines regulatory network is unique in the global regulatory environment. It includes all national medicines regulatory authorities for both human and veterinary medicines from EU Member States and the European Economic Area (EEA), and EMA… (Pharmabiz)
IPC Code to know

IPC 312

Causing miscarriage: Whoever voluntarily causes a woman with child to miscarry, shall, if such miscarriage be not caused in good faith for the purpose of saving the life of the woman, be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both; and, if the woman be quick with child, shall be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine.
5 points order of Nainital High Court
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IMA NATCON - 2015, 76th Annual Meeting of Central Council of Indian Medical Association at New Delhi
Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

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

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse– a doctor– as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):

Responses received

• Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar

• As regards Bioethical issues as deliberated above, may I suggest to keep discussion anonymous, important material for discussion are clinical facts and not the identification of the patient. This way perhaps we may not breach the confidentiality issues. Dr VJ Mahhadik
About thyroid gland

• Low functioning thyroid is a new epidemic of the society affecting more than 3% of people. If thyroid function is low, it causes weight gain, loss of energy, cold intolerance and menstrual irregularities in women.

• All people who are aged 50 and above should have their thyroid profile (TSH test) done to look for thyroid deficiency.

• In younger people, or in cases of infertility, menstrual irregularity, pregnancy, weight gain, one should check for thyroid deficiency.

• Iodized salt should be used to prevent thyroid deficiency.

• Non–iodized salt is only used in two conditions: firstly in patient with thyroid inflammation and secondly, while doing Jalneti in naturopathy, a yoga–related nasal wash technique.

• Even mild thyroid deficiency in pregnancy can affect the growth of fetus; hence, dose requirement of thyroid medicine is much higher in pregnancy than in non–pregnancy.

• In the elderly, the dose of thyroid medicine to be started is always low as compared to one in the adults.

• If thyroid deficiency is untreated, osteoporosis (thickening of bone) and/or atrial fibrillation (irregular and fast heart rate) may result. Osteoporosis can cause recurrent fractures and atrial fibrillation may cause brain paralysis.

• In Allopathic medicine, thyroid deficiency is treated by synthetic T4 hormone replacement. In TFSP, thyroid extracts are available, which contain both T4 and T3 potential drugs.

• In Ayurveda, thyroid stimulant drugs are available but they are effective only if some amount of thyroid gland is available.

• As per Ayurveda, eating soya and drinking water from copper vessel is good for thyroid.
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
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Inspirational Story
Helping Yourself

Well my story starts 3 years ago. I was working in a retail store; I like to talk to everybody and know what’s going on in their lives. I remember this one girl who started working there a few months after me. I remember always seeing her. I don’t know why but for a weird reason we would never talk. We would just see each other and smile. She would always smile in a really happy way until one day when we got to work in the same department again. She smiled as if she was the happiest girl in the world. I went up to her and asked "What’s wrong with you?" She answered "Why?" I said, "I could feel you’re very sad and you’re always trying to hide it."

Her mouth just dropped as if I had discovered her deepest secret, so we started talking. She told me why she was feeling like that and why she was trying to hide it. Time went by and we became good friends. She’d always tell me I had changed her life in so many ways. I could not imagine. I would just smile, not really understanding what she meant by that. Today this girl is one of my best friends. I really don’t know what I would do without her. She has been there for me in every possible way a friend could be. I guess what I’m trying to say is you never know when you’re helping yourself. I helped this girl never knowing that at the same time I was helping myself by finding a truthful friend.

So the next time you see a stranger and they look like they need someone who will listen to them, listen to what they have to say. You never know, you might just end up helping yourself.
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.
Yesterday’s Mind Teaser: Which one of the following is a recognized x-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Answer for Yesterday’s Mind Teaser: 3. Bone erosions.

Answers received from: Dr Avtar Krishan, Daivadheenam Jella, Dr Raghvendra Chakurkar, Dr. Shaliwahan Pattanshetti, Dr Kailash Chandra Sharma, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.B.R.Bhatnagar

Answer for 27th December Mind Teaser:2. Interstitial lung disease.

Answers received from:Dr Kailash Chandra Sharma, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.B.R.Bhatnagar
Readers column
Positive Attitude write up is very good. Dr Maninder
A Horoscope for the Workplace After lunching at the Algonquin Hotel, Robert walked through the lobby, out the front door, and said to the uniformed man on the sidewalk, "My good man, would you please get me a taxi?"

The man immediately took offense and replied indignantly, "I’m not a doorman! I happen to be a rear admiral in the United States Navy."

Robert instantly quipped: "All right then, get me a battleship."
Press Release
Day 2 of IMA’s 76th annual Central Council meet graced by dignitaries such as Dr. Jitendra Singh, Sh Hansraj Gangaram Ajir, Sh JP Nadda and Dr. Mahesh Sharma

Leaders address and debate under one single roof, the essential healthcare issues being faced by both doctors and the public in our country

Dr S.S Agarwal takes over as the new President of the Indian Medical Association for the year Dec 2015-2016

New Delhi December 28, 2015: The second day of the NATCON 2015, the Indian Medical Association’s annual Central Council meeting organized by the Delhi Medical Association saw the presence of country leaders including Dr Jitendra Singh - Hon’ble Minister of Atomic Energy, Space & PMO GOI, Sh Hansraj Gangaram Ahir - Hon’ble Minister of State for Chemicals & Fertilisers, GOI, Sh J P Nadda – Hon’ble Minister of Health and Family Welfare, GOI and Dr Mahesh Sharma - Minister of State for Culture, Tourism & Civil Aviation.

Together with the 1000 Central Council members of IMA, they deliberated and addressed issues affecting the Indian medical community including the increased cases of violence against doctors, un-warranted media trials, redundant laws that need urgent amendments and the commercialization of the medical practice by its inclusion under the consumer protection act.

Dr. S S Agarwal was sworn in as the new IMA National President for the period of Dec 2015 – Dec 2016 as Dr. A Marthanda Pillai stepped down after the completion of his term. Dr. KK Aggarwal will continue to serve as the Honorary Secretary General of the IMA for the upcoming year.

Taking his oath as the new IMA National President, Dr. S.S. Agarwal said, “It is indeed a proud moment for me to take on the post of the IMA National President. I understand the immense responsibility that this comes with, and I assure each and every one of you that I will over the next one year work with uttermost dedication and honesty and work towards strengthening the Indian medical fraternity of our country.”

Congratulating Dr. S.S. Agarwal on his new role, Padma Shri Awardee Dr. A. Marthanda Pillai, Past President IMA and Padma Shri Awardee Dr KK Aggarwal continuing Honorary Secretary General of IMA in a joint statement said, "We congratulate Dr. SS Agarwal on his new role as the National President of IMA for the upcoming year and hope that together we can work towards ending the increasing cases of violence against doctors and bring back the nobility of the profession as was there in the earlier days.

In his statement, Dr Jitendra Singh - Hon’ble Minister of Atomic Energy, Space & PMO GOI said, "I congratulate team IMA for the work it is doing towards addressing the critical healthcare issues of our country".

Adding to this, Sh Hansraj Gangaram Ahir - Hon’ble Minister of State for Chemicals & Fertilisers, GOI said, "The nature of work being done by the IMA is commendable, and I wish the new team all the best for the coming term".

Addressing the audience, Sh J P Nadda – Hon’ble Minister of Health and Family Welfare, GOI said, “We condemn the increasing cases of violence against doctors in India and are working together with the iMA to find ways to reduce these.“

Commenting on the nobility of the medical profession, Dr. Mahesh Sharma - Minister of State for Culture, Tourism & Civil Aviation said, "Doctors work tirelessly towards saving lives, and each one of us must respect the profession. Cases of medical negligence must be handled by the court of law and violence should be eliminated from the equation." Other notable speakers who interacted with the doctors included Sh. B.S. Bassi – Commissioner of Police Delhi, Mr. Nalin Kohli – political influencer and media personality and Dr. Ved Prakash Mishra, Chief Advisor, DMIMS.