February 2  2015, Monday
editorial
Congrats: Bhanu Pratap Sharma New Health Secretary
Dr KK AggarwalHealth secretary Lov Verma, a 1978 batch IAS of UP cadre, has been in the health ministry for the last two years, will now be the secretary department of empowerment of persons with disabilities.

DoPT's establishment officer and special secretary Bhanu Pratap Sharma has been appointed as new health secretary. Sharma is a 1981 batch Bihar cadre IAS officer. Sharma was a joint secretary in the health ministry (from October 2001 to January 2007). He is an MBA from XLRI, Jamshedpur.
eMedipics
IMA,IJCP,HCFI
Health Check Up and CPR 10 Camp at G B S.S. School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014
News Around the Globe
  • Weight gain as well as weight loss are associated with an increased rate of fractures in postmenopausal women, suggests a new study, thus challenging the existing paradigm that weight gain protects against fractures in this population. The study is published online in the BMJ.
  • First results from a human trial of an Ebola vaccine, being developed by the U.S. National Institutes of Health (NIH) against the Zaire strain of Ebola, show it is safe and generates an immune response, but larger trials are needed to determine the efficacy and if a booster is required. The data is published online January 28 in the New England Journal of Medicine.
  • Patients with inflammatory bowel disease manifest specific alterations in the enteric virome that are not explained by decreases in bacterial diversity, suggests new research published online in Cell.
  • Patients aged 65 and older appear just as likely as younger patients to benefit from surgery to correct problems with cochlear implants, points a new study published online in JAMA Otolaryngology Head and Neck Surgery.
  • Adherence to diabetes drugs falls after a diagnosis of cancer, suggests a new study published online January 28 in Diabetologia. Drop-offs in compliance with diabetes medication might negatively affect survival, reported the authors.
Dr KK Spiritual Blog
Music as a Drug

Our body is the largest pharmaceutical group in the world and has the capacity to heal each and every disease. The very fact that there is a receptor for every drug in the body means that the body has the capacity to produce that drug. Music is one such modality, which can heal by initiating various chains of chemical reactions in the body.
  • Chanting vowels produces interleukin 2 in the body, which works like a painkiller.
  • Chanting nasal consonants produces tranquilizers in the body.
  • Sounds like LUM are associated with fear, VUM with attachments, RUM with doubt, YUM with love, HUM with truthfulness and AUM with non-judgmental.
  • Various chemicals can be produced in the body by chanting of various vowels and consonants.
  • Nasal consonants are vibrant sounds and produce vibrations of the autonomic plexus causing balance between sympathetic and parasympathetic states. More the nasal consonants in music, the more will be its relaxing healing power.
  • Listening to overtone chanting in music can also heal people in the vicinity of the music.
  • Recitation of music can also increase or decrease respiratory rate of the singer. Lyrics which reduce respiratory rate will lead to parasympathetic healing activity. The respiratory rate of a listener too can increase and decrease if he is absorbed in the song.
  • Listening to a song word by word and by understanding its meaning can also change the biochemistry of the listener. A song can create an excitement or a feeling of depression.
  • A song can also work like intent by speaking in the form of prayers. Group prayers can have powerful affects and convert intent into reality through the concept of spontaneous fulfillment of desire.
  • Music is often linked with dance, both classical and western, which provides additional healing.
  • Gestures, mudras, bhavs and emotions associated with songs produce parasympathetic state in both the singer and the listener.
IMA,IJCP,HCFI
Cardiology eMedinewS
  • Younger adults with elevated systolic blood pressure have a higher risk for cardiovascular disease and coronary heart disease than those with normal blood pressure, suggests a large long-term study of younger adults published online in the Journal of the American College of Cardiology. The risk was higher for women.
  • Medtronic plc has revealed new one-year clinical data showing that transcatheter aortic valve replacement (TAVR) with the self-expanding CoreValve System offers advantages in survival and safety compared to surgical aortic valve replacement (SAVR) in high risk aortic stenosis patients who have previously undergone coronary artery bypass grafting (CABG) surgery. The findings were presented at the 2015 Annual Meeting of The Society of Thoracic Surgeons (STS).
Pediatrics eMedinewS
  • A new study finds that girls who frequently drink sugar-sweetened beverages are likely to start menstruation earlier than those who do not consume sugary drinks, potentially putting them at higher risk of breast cancer. The study is published in the journal Human Reproduction.
  • Neonatal intestinal disorders that prevent infants from getting the nutrients they need may be caused by defects in the lysosomal system that occur before weaning, suggests a new Northwestern Medicine study published in PLOS Genetics.
Make Sure
Situation: An elderly patient with unstable angina presented with URTI and tested positive for C. pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis. Seroepidemiological studies have shown a strong association between C. pneumoniae infection and atherosclerosis in patients with cardiovascular disease.
Event
IMA,IJCP,HCFI
Medicolegal
Can I distribute leaflets to public regarding my professional activity?

No. In a decision taken by Delhi Medical Council dated February 15, 2001, DMC/14/2/2001, the Council observed “Dr. RSV was soliciting patients through distributing unsolicited leaflets as is evident from the complaint and deposition of Mr M M P. As such, Dr. RSV has not complied with MCI Code of Medical Ethics, which states as follows: “MCI: 6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical.”

A warning was issued to Dr. RSV to refrain from such activity in future.
Dr Good Dr Bad
Situation: A re–sterilized defibrillator was re–implanted in a patient.
Dr Bad: This is unethical.
Dr Good: With consent it’s ok.
Lesson: Defibrillators that still have significant battery life can be successfully removed from patients who no longer need them and re–implanted in other patients. A total of 21 implantable cardioverter defibrillators (ICDs) and 19 cardiac resynchronization therapy defibrillators (CRT–Ds) were removed from US patients and re–implanted in Indian patients, resulting in a 35% successful shock rate and no instances of infectious complication (Pavru BB, et al. Preliminary experience regarding re–use of explanted, resterilized defibrilators Abstract 18350 presented at the American Heart Association Meeting 2010)

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
IMA,IJCP,HCFI
eMedinewS Humor
Broken window

There was a knock at the door. It was a small boy, about six years old. Something of his had found its way into my garage, he said, and he wanted it back. Upon opening the garage door, I noticed two additions: a baseball and a broken window sporting a baseball–sized hole. "How do you suppose this ball got in here?" I asked the boy.

Taking one look at the ball, one look at the window, and one look at me, the boy exclaimed, "Wow! I must have thrown it right through that hole!"
Twitter of the Day
Dr KK Aggarwal: Be cautious in giving painkiller to patients with high cholesterol http://bit.ly/15QdVeB #Health

Dr Deepak Chopra: No matter what happened in the past, we all have the right and the capacity to be happy and loved http://bit.ly/15QdVeB #Health
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
How to approach a case of irregularities in treatment schedule, e.g., if patients missed the doses as per the due dates, i.e. dose schedule is broken?

First three doses of modern rabies vaccine must be very timely and for the fourth and fifth, one or two days of variation is permissible.
Video of the Day
Press Release of the Day
Tips on family history of high cholesterol

Premature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Screening lipid analysis therefore is recommended for first-degree relatives of patients with MI (particularly if premature). Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

Approximately 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk.

First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews; and third-degree relatives refers to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL "bad cholesterol") levels, and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels one must do universal screening at age 16.

The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.
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
Inspirational Story

Be a Good Friend

One day, when I was a freshman in high school, I saw that a kid from my class was walking home from school. His name was Kyle. It looked like he was carrying all of his books. I thought to myself, "Why would anyone bring home all his books on a Friday? He must really be a nerd."

I had quite a weekend planned (parties and a football game with my friends tomorrow afternoon) so I shrugged my shoulders and went on. As I was walking, I saw a bunch of kids running toward him. They ran at him, knocking all his books out of his arms and tripping him so he landed in the dirt. His glasses went flying, and I saw them land in the grass about ten feet from him. He looked up and I saw this terrible sadness in his eyes

My heart went out to him. So, I jogged over to him as he crawled around looking for his glasses, and I saw a tear in his eye. As I handed him his glasses, I said, "Those guys are jerks. They really should get lives." He looked at me and said, "Hey thanks!" There was a big smile on his face. It was one of those smiles that showed real gratitude.

I helped him to pick up his books, and asked him where he lived. As it turned out, he lived near me, so I asked him why I had never seen him before. He said he had gone to private school until now. I had never hung out with a private school kid before. We talked all the way home, and I carried some of his books. He turned out to be a pretty cool kid.

I asked him if he wanted to play a little football with my friends, he said yes. We hung out all weekend and the more I got to know Kyle, the more I liked him, and my friends thought the same of him. Monday morning came and there was Kyle with the huge stack of books again. I stopped him and said, "Boy, you are gonna really build some serious muscles with this pile of books everyday!"

He just laughed and handed me half the books. Over the next four years, Kyle and I became best friends. When we were seniors we began to think about college. Kyle decided on Georgetown and I was going to Duke. I knew that we would always be friends, that the miles would never be a problem. He was going to be a doctor and I was going for business on a football scholarship.

Kyle was valedictorian of our class. I teased him all the time about being a nerd. He had to prepare a speech for graduation. I was so glad it wasn’t me having to get up there and speak. Graduation day, I saw Kyle. He looked great. He was one of those guys who really found himself during high school.

He filled out and actually looked good in glasses. He had more dates than I had and all the girls loved him. Boy, sometimes I was jealous! Today was one of those days. I could see that he was nervous about his speech. So, I smacked him on the back and said, "Hey, big guy, you’ll be great!" He looked at me with one of those looks (the really grateful one) and smiled. "Thanks!" he said. As he started his speech, he cleared his throat, and began:

"Graduation is a time to thank those who helped you make it through those tough years. Your parents, your teachers, your siblings, maybe a coach…but mostly your friends… I am here to tell all of you that being a friend to someone is the best gift you can give them. I am going to tell you a story."

I just looked at my friend with disbelief as he told the story of the first day we met. He had planned to kill himself over the weekend. He talked of how he had cleaned out his locker so his mom wouldn’t have to do it later and was carrying his stuff home.

He looked hard at me and gave me a little smile. "Thankfully, I was saved. My friend saved me from doing the unspeakable." I heard the gasp go through the crowd as this handsome, popular boy told us all about his weakest moment.

I saw his Mom and dad looking at me and smiling that same grateful smile. Not until that moment did I realize its depth.

Never underestimate the power of your actions. With one small gesture you can change a person’s life…for better or for worse. God puts us all in each other’s lives to impact one another in some way.

Wellness Blog

Give BP drugs at night

Blood pressure drugs should be taken at night.

Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours.

Controlling early morning blood pressure can reduce cardiovascular mortality.

According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure, taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events.

The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP–lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening.

A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping.

For each 5 mmHg decrease in mean sleep–time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow–up.

Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

eMedi Quiz

A 70 year old male patient presented with history of chest pain and was diagnosed to have coronary artery disease. During routine evaluation, an ultrasound of the abdomen showed presence of gallbladder stones. There was no past history of biliary colic or jaundice. What is the best treatment advice for such a patient for his gallbladder stones?

1. Open cholecystectomy.
2. Laparoscopic cholecystectomy.
3. No surgery for gallbladder stones.
4. ERCP and removal of gallbladder stones.

Yesterday’s Mind Teaser: The correct sequence of cell cycle is:

1. G0-G1-S-G2-M.
2 .G0-G1-G2-S-M.
3 .G0-M-G2-S-G1.
4 .G0-G1-S-M-G2.

Answer for yesterday’s Mind Teaser: 1. G0-G1-S-G2-M.
Correct Answers received from: Dr KV Sarma, Dr Avtar Krishan, Daivadheenam Jella.
Answer for 31st Jan Mind Teaser: 2. Presence of U waves.
Correct Answers receives: Daivadheenam Jella, Dr KV Sarma, Dr Avtar Krishan.
IMA NEWS
TPA and health insurance sector

Shri. T. S. Vijayan
Chairman IRDA
Insurance Regulatory and Development Authority of India
3rd Floor, Parisrama Bhavan, Basheer Bagh Hyderabad 500 004
Telangana State (INDIA )
(040) 23381100 / Fax: (040) 6682 3334

Delhi Office: Insurance Regulatory and Development Authority of India, Gate No. 3 , Jeevan Tara Building, First Floor , Sansad Marg, New Delhi-110001. Ph: (011) – 2374 7648, Fax: (011) 2374 7650

Dear Sir

Subject: TPA and health insurance sector

Kindly look into the following matters which are injurious to the health of community
1. Insistence on 24 hours admission: The duration should be decided by the team of doctors and not the policy. Shorter the duration less will be the chances of hospital acquired infection and readmission rates. Infect there should be bonus if the admission is short and re admission rates are lower.
2. No insistence on IV Line for admission: most of the time the cash facilities are denied if the doctors have not used IV lines. Doctors are forced sometimes to give IV drugs which is against the WHO policy of safe syringe practices. On the other hands bonus should be given for not using UV lines and switching early from IV to oral therapy.
3. Preventing delay in post discharge processing which at times can be upto 6 hours. This unnecessary occupies the bed and more chances of hospital acquired infections.
4. Not appointing non allopath doctors to process claims and raising technical questions. It ends up in injustice to the community
5. Making sure that no agencies mushroom for getting TPA empanelment. This has staerted happening. Make sure that there is no brokerage, commission and fees etc. by agents in the process of empanelment.
6. Approve all government approved Nursing Homes for cash less empanelment.
7. Process of Preferred Network (PN) Hospital is also a sort of brokerage being charged by TPAs as people who are offering more discounts / cut backs are given empanelment. This is also against medical council of India rules
8. GIPSA rates were pushed by four insurance companies without going into the costing and needs revision.
9. GIPSA rates, have not been revised since 2010 despite escalation on account of increased salaries of staff / nurses and all other establishment charges
10. GIPSA mechanism is not bothered about the quality as they apply the principle of L-1 rates. GIPSA makes the system non competitive and is highly subsidized in favour of TPA. GIPSA is not a declared policy and driven by controller i.e. Insurance business. We must follow L-1 rates while matching apple to apple.
11. TPA companies do not make payment even after sanctioning or reduce the payment.
12. TPA companies have not been able to put the grievance Redressal system so far
13. Premiums have been revised by 40% but the payments have not been enhanced.
14. TPA does not take into account difference in provisional and final diagnosis. Based on tests if the final diagnose is different with provisional diagnosis claims are denied altogether even if there is enough supportive documents are there. This indirectly forces hospitals and doctors to manipulate records which is unethical and illegal.

With Kind Regards

Dr A Marthanda Pillai
Recipient of Padma Shri
National President, Indian Medical Association

Dr K K Aggarwal
Recipient of Padma Shri, Dr B C Roy National Award and National Science Communication Award
Honorary Secretary General, Indian Medical Association


The insurance claim should not insist on intra venous line for admission: IMA

In a letter written to the Shri. T. S. Vijayan, Chairman Insurance Regulatory and Development Authority of India, Indian Medical Association has asked the IRDA to intervene in many aspects as the current policies are injurious to the health of community.

Writing to the regulatory body, Recipient of Padma Shri Dr A Marthanda Pillai, National President and Recipient of Padma Shri, Dr B C Roy National Award and National Science Communication Award
Dr K K Aggarwal, Honorary Secretary General, Indian Medical Association said that " insurance claims often insist on 24 hours admission. " The duration should be decided by the team of doctors and not the policy. Shorter the duration less will be the chances of hospital acquired infection and readmission rates. Infect there should be bonus if the admission is short and re admission rates are lower."

The insurance claim should not insist on intra venous line for admission. Most of the time the cash facilities are denied if the doctors have not used IV lines. Doctors are forced sometimes to give IV drugs which is against the WHO policy of safe syringe practices. On the other hands bonus should be given for not using UV lines and switching early from IV to oral therapy.

IRDA must prevent delay in post discharge processing which at times can be upto 6 hours. This unnecessary occupies the bed and more chances of hospital acquired infections.

IRDA should not appoint non allopath doctors to process claims and raising technical questions. It ends up in injustice to the community

IRDA must make sure that no agencies mushroom for getting TPA empanelment. This has staerted happening. Make sure that there is no brokerage, commission and fees etc. by agents in the process of empanelment.

IRDA must approve all government approved Nursing Homes for cash less empanelment.

Process of Preferred Network (PN) Hospital is also a sort of brokerage being charged by TPAs as people who are offering more discounts / cut backs are given empanelment. This is also against medical council of India rules IRDA must revise GIPSA rates. These were pushed by four insurance companies without going into the costing and needs revision. They have not been revised since 2010 despite escalation on account of increased salaries of staff / nurses and all other establishment charges. Also GIPSA mechanism is not bothered about the quality as they apply the principle of L-1 rates. GIPSA makes the system non competitive and is highly subsidized in favour of TPA. GIPSA is not a declared policy and driven by controller i.e. Insurance business. We must follow L-1 rates while matching apple to apple.

TPA companies also need to be tightened up. They do not make payment even after sanctioning or reduce the payment. They have not been able to put the grievance Redressal system so far. Also TPA does not take into account difference in provisional and final diagnosis. Based on tests if the final diagnose is different with provisional diagnosis claims are denied altogether even if there is enough supportive documents are there. This indirectly forces hospitals and doctors to manipulate records which is unethical and illegal.

Finally the claim payments need to be enhanced as the premiums have been revised by 40%
IMA White Paper Stop Child sexual abuse
IMA White Paper Stop Child sexual abuse Protection of Children from Sexual Offences (POCSO) Act,

• Child means any one below the age of 18 years.
• The act applies to all cases of sexual assault to a child.
• Any sexual activity with a child (boy or girl) is a crime.
• The act defines sexual offences against children and prescribes the punishment for the same
• Sexual offences can be penetrative sexual assault (Sec. 3), sexual assault (non-penetrative – Sec. 7), sexual harassment (Sec. 11), and use of a child for pornography (Sec. 13)
• A person commits Penetrative Sexual Assault of a child below 18 years if he inserts his penis or any other object into the vagina, anus, urethra or any part of the body of the child, or causes any other person to do so to the child, or applies his mouth to any such part of the body of the child.
• Penetrative sexual assault of a child below 18 years is punishable with imprisonment of a minimum of seven years, up to imprisonment for life.
• If a person touches the penis, vagina, anus, breast or any other part of the body of a child below 18 years of age with sexual intent, or causes any other person to do so, or causes the child to do so to him or any other person, he is said to commit (non-penetrative) Sexual Assault.
• Sexual assault of a child below 18 years is punishable with imprisonment for three to five years.
• Sexual assault and penetrative sexual assault of a child below eighteen years of age are considered to be aggravated when committed by a person in a position of trust or authority such as police/army/security personnel, public servants or family member, persons in management or staff of educational, medical or religious institution or persons in management or staff of jail, remand home, protection home, observation home, or any other place of custody or care and protection.
• Aggravated penetrative sexual assault of a child below 18 years is punishable with imprisonment of a minimum of ten years, up to imprisonment for life.
• Aggravated sexual assault of a child below 18 years is punishable with imprisonment for five to seven years.
• A person commits sexual harassment when, with sexual intent, in respect of child below 18 years of age, he utters a word or makes a sound or a gesture exhibits a part of his body or any other object or makes the child exhibit a part of his body, or shows an object or any form of media to the child for pornographic purposes, or repeatedly follows the child or watches him directly or through digital, electronic or other means, or threatens to use any part of the body of the child or the involvement of the child in a sexual act in any form of media, or entices the child for pornographic purposes or gives the child gratification for this.
• Sexual harassment of a child below 18 years of age is punishable with imprisonment of three years.
• A person commits the offence of pornography if he uses a child below 18 years of age in any form of media for sexual gratification. This includes the representation of the sexual organs of the child, images showing the child in real or simulated sexual acts, or the indecent or obscene representation of the child.
• Use of a child below 18 years of age for pornographic purposes is punishable with imprisonment of five years.
 
Offense Section Definition Punishment:
Imprisonment
Penetrative Sexual 3 A person commits Penetrative Sexual Assault of a child if he inserts his penis or any other object into the vagina, anus, urethra or any part of the body of the child, or causes any other person to do so to the child, or applies his mouth to any such part of the body of the child. 7 years to life
Sexual Assault (Non penetrative) 7 If a person touches the penis, vagina, anus, breast or any other part of the body of a child below 18 years of age with sexual intent, or causes any other person to do so, or causes the child to do so to him or any other person, he is said to commit (non-penetrative) Sexual Assault. 3-5 years
Aggravated Sexual assault (penetrative and non penetrative)   Sexual assault and penetrative sexual assault of a child are considered to be aggravated when committed by a person in a position of trust or authority such as police/army/security personnel, public servants or family member, persons in management or staff of educational, medical or religious institution or persons in management or staff of jail, remand home, protection home, observation home, or any other place of custody or care and protection. Penetrative: 10 years to life and non penetrative: 5-7 years
Sexual harassment 11 A person commits sexual harassment when, with sexual intent, in respect of child below 18 years of age, he utters a word or makes a sound or a gesture exhibits a part of his body or any other object or makes the child exhibit a part of his body, or shows an object or any form of media to the child for pornographic purposes, or repeatedly follows the child or watches him directly or through digital, electronic or other means, or threatens to use any part of the body of the child or the involvement of the child in a sexual act in any form of media, or entices the child for pornographic purposes or gives the child gratification for this. 3 years
Use of a child for pornography 13 A person commits the offence of pornography if he uses a child below 18 years of age in any form of media for sexual gratification. This includes the representation of the sexual organs of the child, images showing the child in real or simulated sexual acts, or the indecent or obscene representation of the child. 5 years
What every doctor must know

• Every case of sexual assault is a medical emergency.

• Child sexual abuse has lifelong consequences on the physical and mental health of the child. The impact of the abuse will depend on the duration and frequency of the exposure to abuse, the age of the child and the support network available.

• No medical facility, public or private, can deny emergency medical care and medical examination to a victim of suspected sexual assault.

• Treatment has to be provided free of cost by government as well as private medical facilities.

• Not providing free emergency medical care or medical examination to a child who has been or is suspected of having been sexually assaulted can result in imprisonment for one year or fine or both for the doctor (Section 357C CrPC).

• Not reporting a case of sexual assault or suspected sexual assault of a child can result in imprisonment of six months, or fine or both for the doctor (Section 19[1] ). The report has to be made to the nearest police station or Special Juvenile Police Unit

• Medical examination of a child with sexual assault must be conducted in the presence of the parent or guardian of the child or some other person in whom the child has trust and confidence. If there is no such person available, the head of the medical institution must nominate a woman to be present during the examination.

• Medical examination of a victim with sexual assault must be conducted, in the case of a female child, by a female doctor.

• FIR or permission from a magistrate, police or any other authority cannot be demanded by any medical facility or centre for providing emergency medical care to a child who has been or who may have been sexually assaulted.

• In a case of sexual assault informed consent must be taken from the child above 12 years of age, or, where the child is below 12 years of age, the child’s parent/ guardian, before medically examining the child. In case consent is not given, informed refusal must be documented by the doctor.

• Lack of medical evidence DOES NOT mean no sexual offence was committed. Evidence may have been lost due to healing of older injuries, use of condom by the offender, and post-assault activities such as washing, douching, urination and defecation.

• Doctors must protect children from sexual assault and its consequences. They should teach parents about safe, unsafe and uncomfortable touch and how to keep their children safe.

• Doctors must teach children how to protect themselves from sexual assault.

• Doctors must provide appropriate care and treatment to the survivor of sexual assault.

• Doctors should give social, psychological and legal guidance to the sexual assault survivor and the family.

• In a case of sexual assault doctors should help the process of justice delivery by conducting accurate and complete forensic medical examination and be willing to testify in court.

• Forensic examination needs to be conducted within 96 hours and requires evidence collection such as blood, semen, sperm, hair etc. linking to perpetrator.

• With timely medical care and mental health support, a child who is a survivor of sexual abuse can resume a normal and healthy life.

• Doctors should prominently display the Childline number (1098) in their clinics and hospitals. Any case of known or suspected child abuse or neglect can be reported to this number.

• It is the duty of the doctor to prevent the occurrence of child sexual abuse by teaching parents how to talk to their children about safe, unsafe and uncomfortable touch, and teaching children about personal safety.
Launch of IMA Rise and Shine Web Lecture Series
Date of webcast
8th February 2015
Time of webcast
11:00 AM - 11.30 AM
Mode
Live webcast http://www.ima-india.org/ima/
Opening remarks:
Dr K K Aggarwal, Honorary Secretary General, IMA - 2 minutes
Introduction of President IMA and Chairman Apollo Hospitals Group
Dr. Anupam Sibal, Group Medical Director, Apollo Hospitals - 3 minutes
Presidential Address
Dr. Marthanda Pillai, National President – IMA - 7 minutes
Leadership Qualities: My personal Journey and Healthcare challenges
Dr. Prathap C Reddy, Chairman Apollo Hospitals Group - 15 minutes
Concluding Remarks and Thanks
Dr. K K Aggarwal - 3 minutes
NABH Update
NABH Accreditation Program for AYUSH (Ayurveda, Homeopathy, Unani, Siddha and Yoga & Naturopathy) Hospitals is run in association with Department of AYUSH, Ministry of Health & Family Welfare. It consists of two kinds of standards - Accreditation Standards and Structural Standards.

10 Worst Medical Treatment Dangers 2015

Dirty Endoscopes and Surgical Instruments

When disinfection and sterilization of instruments aren't performed properly, pathogens can be spread to subsequent patients. Although the incidence is low, the consequences of reprocessing failures can be severe. The initial cleaning of the device at the procedure room is a crucial reprocessing step that is sometimes inconsistently performed. If organic soils and other contaminants are not removed first, successful disinfection or sterilization may not be possible.

Medscape Family Physician Lifestyle Report 2015

Do male or female physicians burnout more?

National surveys have reported a burnout rate of 60% in female physicians, which is higher than that of their male peers. The Medscape report supports these findings. More female family physicians (56%) reported burnout than males (47%). Of interest, both female and male family physicians had lower burnout rates this year than in the 2013 survey (60% of women and 52% of men). This is in opposition to the finding of higher burnout rates for physicians overall in our survey. Some studies suggest that burnout in men may differ from that in women; in men it tends to be characterized by depersonalization, whereas women describe emotional exhaustion.

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IMA & UNICEF PLEDGE
Child Sexual Abuse: Prevention & Response
Definition: CSA refers to the involvement of a child in any sexual activity that:-
  • the child does not understand;
  • the child is unable to give informed consent to;
  • the child is not developmentally prepared for and cannot give consent; and
  • violates the laws or norms of society
    (1999 WHO Consultation in Child Abuse Prevention, Chapter 7)
Under the Protection of Children from Sexual Offences (POCSO) Act 2012, any sexual activity with a child below 18 years, whether boy or girl, is a crime. As defined by the Act, sexual offences include penetrative sexual assault (Sec. 3), sexual assault (i.e. non-penetrative – Sec. 7), sexual harassment (Sec. 11), and use of a child for pornography (Sec. 13) Dr DS Bhullar

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Reader Response

Thanks for sharing and creating awareness. Regards: Yash Sharma

Congrates Alka madam and others for getting the prestigious Padma Shri award: Dr KS Chhabra, Raipur

Excellent and complete IMA news letter.My heartiest congratulations sir.It really needs somuch time,tithe and energy to gather sooooomuch of informations.Hats off to you. Really feel proud to have such legends as our leaders.Looking forward to have more and more and more.-DR.SHAILA MILTON PHILIP, BILASPUR,C.G.


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The Year in Medicine 2014: News That Made a Difference
3D Printing

Three-dimensional (3D) printing is beginning to reshape medical practice, but its implications for healthcare may be complex, according to an opinion article published online December 2 in JAMA. Although questions remain about how best to use the technology, experts agree that 3D printing is already changing patient care. These printers are being used to print bladders, and kidneys and other organs are in the works as well; these have great potential in that rejection risk is reduced because the tissue can be made from the patient's own cells. From prosthetics to teeth to heart valves, 3D printing is bringing made-to-order, custom solutions into operating rooms and physicians' offices. (Source: Medscape)
About the Editor
Padma Shri, National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)