January 2 2016, Saturday


Revisiting the Year 2015 … IMA Achievements 

The year 2015 saw some notable achievements of the Indian Medical Association (IMA), many of the first-of-its-kind.  

• Formation of a working group: Health Ministry in collaboration with the IMA will form a first of its kind working group to address the major healthcare problems in the country. This was announced by the Union Health Minister J P Nadda during his address at NATCON 2015, the recently concluded annual Central Council meeting of IMA.

• Inter-ministerial meeting: An inter-ministerial committee was formed involving five ministries to look into the demands made by IMA: amendment of Clinical Establishment Act, PCPNDT Act, Capping of Compensation, issues against medical violence and the issue of Crosspathy practice by medical practitioners. The committee headed by Add. Secretary for health held its first meeting at Nirman Bhavan on 8th December 2015, where apart from IMA representatives, representatives of MCI, Joint Secretaries of departments of Health, home affairs, law ministry and consumer affairs ministry participated.

• IMA created a digital group called Team IMA, which makes daily communication between over 2500 Central Council Members possible. Since the beginning of 2015, over 2 lakh doctor members of the IMA are being sent daily updates on the organization and key health matters through the medium of text messages and emails.

• Introduction of IPV in universal immunization program: Injectable polio vaccine (IPV) was introduced in a phased manner in the in its universal immunization program (UIP) from November this year as a part of the WHO’s polio endgame strategy. In the first phase of IPV introduction, 17 high-risk states and four UTs were covered. From April, 2016 the trivalent polio vaccine (tOPV) that is currently administered will be replaced by the bivalent variety (bOPV) to reduce incidence of vaccine-derived polio virus.

• Digital IMA campaign: IMA started a weekly live webcast and webinar as part of Digital IMA campaign every Thursday from 3-4 pm on issues of common interest for doctors and patients to update and educate doctors from across the nation and to facilitate interaction with the IMA leadership.

• The amendment of the chapter in an NCERT textbook to remove the objectionable lines that were damaging to the health profession was a major win this year (WP(C) No.8706/2015 “Indian Medical Association vs. Union of India & Anr (NCERT)” in Delhi High Court, New Delhi).

• Exit exam: IMA strongly opposed the govt. proposal to hold an exit exam for all medical graduates passing out from Indian universities. IMA is of the view that if the standards of MBBS graduates are not to the mark, then the need of the hour is timely revision of curriculum and syllabi for MBBS course and introducing a system of accreditation for evaluating the standards of medical education.

• ART Bill: IMA has opposed the ART bill in its present format, which bans surrogacy to foreign couples and is also silent on laws for single parents and same sex couples. IMA has suggested amendments to the proposed Bill under governmental debate.

• Prescription of modern medicine drugs by other systems: The Centre clarified that non MBBS cannot prescribe drugs of modern medicine.

• BSc Community Health: IMA strongly opposed the introduction of the 3-year course and put forth the view that posting AYUSH doctors at PHC and sub centres will be injurious to public health.

• New Initiatives of IMA: The following new Initiatives were taken up by Team IMA: Clinton Health Access, The Union, Vector Borne Disease, Child Sexual Abuse by UNICEF, Digital Partnership, renewal of IMA-RNTCP Project from October 2015

• IMA One Voice: 30 press conferences in one day (238 press coverage, PR value 2, 28, 09756/-); 31 press insertions in one day (press inserts 420, PR value 5, 34, 99350); 33 location single day Mission clean India walk

• IMA Welcome the Girl Child Wing and IMA Aao Gaon Chalen Wing have been started

• IMA Rise and Shine: This project aims to enhance the knowledge of doctors on management skills and also provides updated knowledge about Vitamin D deficiency in our country under the guidance of IMA Course Director Dr Ambrish Mithal.

• I Pledge My Organ initiative: This initiative was started to spread awareness about organ donation in India. The Donor Card helps people to express their wish, to become an organ donor.

• and many others


Right to health is a human right: Himachal High Court 

In a landmark judgment, the Himachal Pradesh High Court Wednesday directed the central government to provide full medical benefits, including reimbursements of medical emergencies, to employees post-retirement. A Division Bench comprising Justices Rajiv Sharma and Sureshwar Thakur passed the orders while dismissing an appeal filed by the central government, challenging an order of the Central Administrative Tribunal (CAT) in favour of Shankar Lal Sharma who underwent heart surgery post-retirment and incurred an expenditure of Rs 1.80 lakh  – which the government declined to reimburse. In a 101-page order handed down by Justice Sharma, the court ruled that right to health is a human right and questioned as how could the government, a principal employer, abdicate the responsibility of taking care of the health of its retired employees… (Indian Express)


Slightly raised blood sugar may increase risk of kidney damage 

Norwegian researchers suggest that people whose blood sugar levels are in the borderline range - higher than normal, but not yet diabetic - might still have an increased risk of kidney problems. And, compared to individuals with normal blood glucose levels, those with prediabetes are more likely to have glomerular hyperfiltration and albuminuria. After a typical follow-up period of around five years, people with slightly abnormal blood sugar under either set of guidelines were more likely to have glomerular hyperfiltration, which is thought to contribute to kidney damage in diabetes. Participants who had slightly abnormal baseline fasting glucose test results were also more likely to have elevated levels of albumin in the urine, indicating early kidney damage. The study findings are published in the American Journal of Kidney Diseases.


Specialty Updates 

Noncardiac surgery soon after getting a stent carries higher risks for patients who were sickest when they received their stent -- those with myocardial infarction (MI) as the indication rather than a less serious blockage, reported a study published online December 30 in JAMA Surgery 

Topical mupirocin therapy, used to treat symptomatic chronic sinusitis (CRS), might lead to increased pathogenic bacteria, suggested new research published online in JAMA Otolaryngology - Head and Neck Surgery.

An intra-articular corticosteroid injection into the temporomandibular joint (TMJ) provides pain relief for some patients with juvenile idiopathic arthritis (JIA) whose orofacial symptoms haven't responded to other pain management strategies, reported a small pilot study published in Pediatric Rheumatology.

New research, published in the journal Immunology and Cell Biology, has discovered that exercising early in life can alter the microbial community for the better, promoting healthier brain and metabolic activity over the course of a lifetime.

Everolimus significantly improves progression-free survival in patients with advanced, nonfunctional neuroendocrine tumors (NETs) of the lung or gastrointestinal tract, reported the RADIANT-4 study published online in The Lancet.

A new study, published in BMC Nutrition, revealed that people who paid a lower price for an all-you-can-eat buffet experienced greater feelings of guilt and fullness after eating than those who paid a higher price, despite consuming the same amount of food.

Oral antibiotic therapy for meibomian gland dysfunction (MGD) is common practice, but the existing evidence is insufficient to conclude its effectiveness, reported an ophthalmic technology assessment by the American Academy of Ophthalmology published online in Ophthalmology.


A new study, published in the Journal of the American Society of Nephrology, suggests that the cytokine IL-17 A is protective and suppresses kidney damage in response to diabetes.


The Year in Medicine 2015: News That Made a Difference 

FDA approves first-of-kind device for treating obesity

In January the FDA approved a new device for treating obesity. The vBloc vagal blocking therapy is delivered via a rechargeable device implanted into the chest wall. It intermittently blocks the vagus nerve, reducing hunger and increasing feelings of satiety. The first-of-kind device, made by EnteroMedics, is for the treatment of obese adults who have tried and failed at least one supervised weight management program within the past 5 years. The concept came from the fact that patients who undergo surgical vagotomy to treat peptic ulcers experience temporary weight loss. The vBloc therapy is reversible and can be noninvasively adjusted or turned off when necessary. This year, the FDA also approved two minimally invasive gastric balloons for weight loss, the ReShape Dual Balloon (ReShape Medical) in July and the Orbera Intragastric Balloon System (Apollo Endosurgery) in August. (Medscape)


1. IMA Rare Blood Group Online Blood Bank Directory:

2.      IMA Online TB Notification initiative:

3.      IMA Online Events Reporting initiative:

 4.      Proforma for Hypertension Screening:

5.      IMA Online Sentinel Events Reporting Initiative:

6.      IMA Disease Notification:

7.      IMA RISE and SHINE:

12.  IMA Slide Share:

13.  I Pledge My Organ:

14.  IMA Weekly Live:

17.  IMA ART:

18.  IMA Satyagraha:

19.  IMA Daily Webcast:

20. CC Slides:

21. NATCON Photos: IMA Natcon 2015 - Day 2 - Camera 1, IMA Natcon 2015 - Day 2 - Camera 2


Some combinations of lifestyle factors more risky than others 

Ding Ding, PhD, from the Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, New South Wales, Australia, and colleagues report in an article published online December 8 in PLOS Medicine that levels of daily physical activity and sleep duration in combination with other lifestyle behaviors may influence longevity. The all-cause mortality risk for individuals with high scores on a health risk index that combines measures of smoking, alcohol use, dietary behavior, physical inactivity, sedentary behavior, and sleep duration was significantly higher than for those scoring lower on the combined measure. Highest risks were associated with certain combinations of behaviors, including those involving physical inactivity, prolonged sitting, and long sleep duration, as well as those involving smoking and high alcohol intake… (Medscape)


Nizam Institute of Medical Sciences Vs. Prasanth S. Dhananka and Ors, SC/4119 of 1999 and 3126 of 2000

“There may be cases which do not raise such complicated questions and the deficiency in service may be due to obvious faults which can be easily established such as removal of the wrong limb or the performance of an operation on the wrong patient or giving injection of a drug to which the patient is allergic without looking into the outpatient card containing the warning.”


IMA Satyagraha


IMA Poll


Centre’s 42-point to clear air in a year 

Amid reports of alarming level of air pollution in the capital, on Wednesday, the Centre issued a 42-point action plan to handle the situation and directed Delhi and three neighboring states of Haryana, Uttar Pradesh and Rajasthan to implement them in right earnest. While some of these points are supposed to be implemented immediately, the others will be taken care of in a staggered manner ranging from 30 days to one year. The directions include carrying out checks of the overloaded transport vehicles as it causes pollution, installing weighing machines immediately at entry points, ensuring no parking in non-designated areas, stringent action against bio-mass burning and immediate stoppage of unauthorized brick kilns, decongestion of pathways, taking steps for retrofitting of diesel vehicles with particulate filters, allowing only those diesel sets which meet prescribed standards, introduction of early alarm system for commuters related to traffic congestion on major routes, formulation of action plan for creation of green buffers along traffic corridors and ensure proper collection of horticulture waste … (ET Healthworld)


Cabinet may extend maternity leave to 26 weeks

The Union Cabinet may soon give its go ahead to labour ministry's proposal to extend maternity leave to 26 weeks from the existing 12 weeks. Even mothers who use surrogates to bear a child or women adopting a baby could also get 12 weeks of maternity leave, which will help more women to resume work… (ET Healthworld – Yogima Sharma)


ECRI's Top 10 Health Technology Hazards for 2016

1. Flexible endoscopes: Inadequate cleaning before disinfection can spread germs
2. Alarms: Missed alarms can have fatal consequences
3. Monitoring postoperative patients for opioid-induced respiratory depression: Failure to do so effectively can lead to brain injury or death
4. Monitoring patients in telemetry setting: Inadequate surveillance can put patients at risk
5. Operating room technology: Insufficient clinician training puts patients at risk
6. Healthcare IT configurations and facility workflow: Errors can arise when they don't support each other
7. Syringes: Unsafe injection practices can lead to possible patient exposure to pathogens
8. Gamma cameras: Mechanical failures can lead to injury or death
9. Intensive care ventilators: Failure to operate them properly can cause ventilator-induced lung injuries
10. USB ports: Misuse can cause medical device malfunction



All about alcohol dose and terminologies used

Dr K K Aggarwal 

What is moderate, heavy or binge drinking?

1. Moderate drinking: Women: <2 US drinks per day; men: <3 US drinks per day; people age ≥65: < 2 US drinks per day
2. NIAA: All women and men age ≥65: ≤1 US drink per day and men < age 65: ≤2 US drinks per day
3. Heavy drinking:  Women: >US 7 drinks per week or 3 drinks per occasion; men: >14 US drinks per week or 4 drinks per occasion
4. Binge drinking: Women: 4 or more US drinks in a row; men: 5 or more US drinks in a row (180 ml of 80 proof whisky in men and in women 90 ml of 80 proof whisky)
5. Liver safe dose: 10 gm of alcohol in one hour, 20 gm in a day and 70 gm in a week.

10 gm of alcohol is present in 30 ml of whisky, 50 ml of wine and one bottle of beer. One peg stays in the body for one hour, therefore, it is safe to drive only one hour after taking a peg. The rough formula is number of pegs taken should be equal to number of hours after which a person can drive. Alcohol and smoking together is more harmful.




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


Even children can have acidity

Children who have continuing recurrence of cough and croup could be suffering from stomach reflux problems.
Croup or ‘Kali Khansi’ as it is called in local parlance, is recognized by a loud cough that often sounds like the barking of a seal. It can cause rapid or difficult breathing, and sometimes wheezing. Croup is thought to be caused by a virus, but reflux acidity has been suggested as a possible trigger. In GERD, or gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway. It can trigger more swelling with any kind of viral or respiratory infection. Identifying children with GERD could help treat and improve recurring croup. It is unusual for a child to have three or more bouts of croup over a short period of time. These children need to be evaluated. The same is true for adults also. Patients with non responding asthma should be investigated for underlying acidity as the cause of acute asthma.


WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi 

Click here to read the proposed changes


IMA Live Webcast 

Click here


Inspirational Story

A True friend
Horror gripped the heart of the World War I soldier as he saw his lifelong friend fall in battle. Caught in a trench with continuous gunfire whizzing over his head, the soldier asked his lieutenant if he might go out into the "no man’s land" between the trenches to bring his fallen comrade back. "You can go," said the lieutenant, "but I don’t think it will be worth it. Your friend is probably dead and you may throw your life away." The lieutenant’s advice didn’t matter, and the soldier went anyway. Miraculously he managed to reach his friend, hoist him onto his shoulder and bring him back to their company’s trench. As the two of them tumbled in together to the bottom of the trench, the officer checked the wounded soldier, and then looked kindly at his friend.

"I told you it wouldn’t be worth it," he said. "Your friend is dead and you are mortally wounded." "It was worth it, though, sir," said the soldier. "What do you mean; worth it?" responded the Lieutenant. "Your friend is dead." "Yes, Sir" the private answered. "But it was worth it because when I got to him, he was still alive and I had the satisfaction of hearing him saying, "Jim…, I knew you’d come."

Many times in life, whether a thing is worth doing or not, really depends on how u looks at it. Take up all your courage and do something your heart tells you to do so that you may not regret not doing it later in your life. May each and every one of you be blessed with the company of true friends! A true friend is one who walks in, when the rest of the world walks out. War doesn’t determine who’s right. War only determines who’s left.


eMedi Quiz

The extent to which ionization of a drug takes place is dependent upon pKa of the drug and the pH of the solution in which the drug is dissolved. Which of the following statements is not correct?

1. pKa of a drug is the pH at which the drug is 50% ionized.
2. Small changes of pH near the pKa of a weak acidic drug will not affect its degree of ionisation.
3. Knowledge of pKa of a drug is useful in predicting its behaviour in various body fluids.
4. Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionised in plasma.

Yesterday’s Mind Teaser: All of the following conditions may predispose to pulmonary embolism except:

1. Protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy.

Answer for Yesterday’s Mind Teaser:. 4. Progesterone therapy.

Answers received from: Dr Poonam Chablani, Dr.B.R.Bhatnagar, Raghavendra Chakurkar, Dr.K.Raju

Answer for 30th December Mind Teaser: 1. The sample should be kept at 4°C.
Answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Poonam Chablani


Reader’s Column

Indeed an exceptionally good conference. It appears the collective glory of IMA has risen like a phoenix. The host team led by all-time great Dr Vinay Aggarwal and his trusted team of Dr Monga, DMA president Dr Ajay Lekhi, Dr Rakesh and scores of friends must have spent their many many productive hours in planning, executing and creating lively moments for all of us after spending plenty of finance. National president Dr Marthanda Pillai and our mercurial HSG Dr KK Aggarwal both of whom have given a new definition of work culture and ethos are even beyond any praise. Galaxy of IMA stalwarts like Ketan Desai, Dr N Appa Rao, Dr Arul Rhaj, Dr Viilyadhan Pillai, Dr Ajay Kumar, Dr Vijay Kumar and the incumbent president our next state neighbor president Dr SS Agarwal who is forever helpful, all of these big names have given a grand dimensions  to this year conference. Long live IMA. Satish Chugh 



A traffic slogan: Don’t let your kids drive if they are not old enough – or else they never will be


Press Release

Pledge to quit tabacco consuption this new year 

New Delhi January 1, 2016: The much awaited 2016 is here and everyone is in the process of deciding their new years resolutions. The need of the hour in our country is for everyone to vow to give up smoking and chewing tabacco.

According to recent reports, while the consumption of cigarettes in our country has fallen by 10% over the years, the number of women smokers has risen making India home to the second largest number of female smokers after the United States. This comes as a issue of great concern to the Indian medical fraternity.

Speaking about this, Dr. S.S Agarwal – National President and Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General of IMA in a joint statement said, “Smoking in women drastically effects their fertility, reproductive capability as well as the health of their children. It increases the chances of early incidence of heart disease, precipitates lung disorders and causes cancer. Each one of us must pledge this year to quit smoking and chewing tobacco for a healthy and long life.”

The Indian Medical Association too in the year 2016 dedicate itself to raising awareness amongst the public as well as the medical fraternity about the evils of tobacco use. Given the extremely stressful lives doctors live, a large section of the fraternity is found to smoke and drink. Awareness needs to be created about how they need to be healthy as well as educate their family and patients to abstain from tobacco use.

“Together we must work towards decreasing this number by an additional 20% in the coming year. The government must increase the taxes on tobacco products as well as run awareness campaigns to reduce consumption further. Each one of us also must set the right example for our children and families. Smoking in front of children is extremely dangerous for their health as well a risk factor for them developing the habit in the future,” Dr. KK Aggarwal added. According to the latest data on cigarette consumption given by the health ministry in Parliament, the consumption in 2014-15 was 93.2 billion sticks — 10 billion less than in 2012-13. The production of cigarettes too fell from 117 billion to 105.3 billion sticks in the same period.

Passive smoking is another major issue of concern in India. Innumerable people become victims to second hand smoke and develop life-threatening diseases. We must protect ourselves and those around us.