March 2  2015, Monday
Pain Management
Dr KK Aggarwal
  • Pain is a common occurrence in day to day life and should be managed well.
  • Remember the word ‘ICE’ which means putting ice pack on the injured painful area, ‘C’ stands for compression and ‘E’ stands for elevation.
  • The mantra, therefore, is to use cold compression and elevation for any injury.
  • Alternate hot and cold packs are used for chronic pain.
  • Painkillers should not be taken without a doctor’s advice.
  • If a painkiller has to be taken, it should be one tablet of paracetamol.
  • People who take alcohol should not consume paracetamol without asking their doctor.
  • In patients with kidney disease, even one tablet of painkiller can precipitate kidney failure.
  • In patients with acid peptic disease, one tablet of painkiller can precipitate gastric bleeding.
  • Instead of taking a painkiller, look for alternative methods to relieve pain.
  • Pain relieving ointments are better than oral painkillers.
  • In hospital setting, intravenous and intramuscular injectable painkillers are available.
  • Always tell your doctor that you are taking painkillers.
  • There are effective pain management therapies available in Homeopathy and Ayurveda.
  • Always contact your doctor if the pain is uneasy, unexplainable or appears for the first time in life.
21st MTNL Perfect Health Mela 2014
  • No change in Income Tax Slab.
  • Corporate Tax to be reduced from 30% to 25% over the next Four Years
  • Exemptions have been removed.
  • Exemptions and Incentives to Individual tax payers will continue.
  • GST to be implemented by April 1,2016.
  • Wealth Tax to be abolished and replaced with a super rich tax for those with Income of over Rs 1 Crore.
  • Service Tax Rate to be increased to 14%. A consolidated rate of Service tax is proposed, i.e, No Education and Senior Higher Education Cess.
  • Cess of 2% on Services for Swachh Bharat on certain taxable services.
  • Increase in limit of deduction of health insurance premium (Under Section 80D) to Rs. 25,000 from the present limit of Rs 15,000. For senior citizens, the limit will be Rs. 30,000. Very senior citizens (Above 80 years) can claim Rs. 30,000 deduction on account of medical expenses incurred.
  • Additional deduction of Rs. 25,000 for differently abled persons.
  • Government has aimed to increase the access to Insurance.
  • Basic Customs Duty reduced for 22 items (Customs duty on raw material and intermediaries to be reduced).
  • Excise Duty proposed at a consolidated rate of 12.50% , i.e, No Education and Senior Higher Education Cess.
  • Changes proposed in Excise Duty on Cigarettes.
  • Incentives to be provided for Leather Footwear to Leather manufacturers and to Companies like BATA.
  • Tax reduced for footwear above Rs 1,000/pair.
  • Tax-free infrastructure bonds for projects in railways and roads.
  • Foreign Exchange Management Act to allow for seizure of foreign properties and assets.
  • FEMA Act to be amended to incorporate Black Money Provisions
  • To Enact new law for Black Money. Stringent penalties and Jail for Black money holders and evaders.
  • To defer GAAR by 2 Years.
  • Yoga to be included as a Charitable Purpose.
  • Government to raise visa-on-arrival facilities to 150 countries in different stages from the present number of 43 countries.
  • AIIMS to be set up in J&K, Punjab, Tamil Nadu, Himachal Pradesh and Assam.
  • Investment in infrastructure to go up by Rs 70,000 crores.
  • Allocation of Rs 150 Crore for creating a World Class IT Hub in India.
  • Proposes 5 ultra mega power projects for 4,000 MW each.
  • Power Sector: Subsidy and tax exemptions for stranded Gas Assets.
  • Make in India policy for Defence Equipment: Allocation of Rs 246,727 crore for Defence.
  • Additional Allocation of Rs 1,000 crore to Nirbhaya Fund.
  • Govt to introduce Indian gold coin with Ashoka sign on it. A gold monetization scheme is proposed as India is the largest consumer of Gold in the world.
  • World Heritage Sites to be made more tourist friendly.
  • Aim for housing for all by 2022.
  • Aim to make India a cashless society by providing incentives for card transactions.
  • GDP growth for 2015-16 seen between 8-8.5%. Real GDP growth expected to accelerate to 7.4%
  • Objective to keep inflation below 6%
  • Budget Estimates:
Non-plan expenditure - Rs. 13,12,200
Plan expenditure - Rs. 4,65,277
Fiscal deficit - 3.9% of GDP
We will update you on any significant tax impact after deep analysis of the roadmap for Budget 2015.
Please feel free to write back to us for any clarification or further information that you may require.
You are most welcome to send us your queries by filling the Query Form on the below mentioned link:

CA Sakshi Kharabanda

India Live 2015
Bifurcation – Non LMCA: How do I do it?
Dr Samuel Mathew, Chennai
  • Single stent strategy with or without SB POBA appears to be the preferable choice.
  • Provisional or single stent strategy does not mean poor final result is acceptable.
  • Two stent strategy is very reasonable in appropriate cases and it does not mean poor long-term result.
  • Final kissing balloon dilatation would be preferable.
How would I treat?
  • Radial or femoral: Femoral preferable
  • Guide catheter 7F/8F would be my choice.
  • Protect all side branches (vessel diameter >2mm), especially if ostium of SB is diseased
  • Plaque modification if required (cutting balloon/Rota) if MB/SB - tubular, heavily calcified
  • SKS first choice with very small shift in the carina
  • IF angle is too acute and the shift of the carina is likely to be too long would prefer mini crush, cross over T/Culotte technique.
  • if SB is also large (>2-2.5 mm), both vessels have to be wired and keep the option for two stent strategy.
  • If SB is larger than the distal MB, stent into the SB first and then re-assess the MB subsequently.
Lifetime Achievement Award Session: TAVI: What have we learnt?
Dr Alan Cribier, France
  • After 13 years of experience and >200 000 cases performed worldwide, TAVI remains in a process of continuous learning.
  • TAVI is an exception example of translational research leading to an outstanding ‘learning to solution’ pathway.
  • Improved results and safety associated with simpler procedures explain the exponential expansion of TAVI.
  • Indications should expand soon to lower risk patients and should concern in the future the vast majority of patients with degenerative AS.
Pharmacoinvasive treatment: Is it the way forward in STEMI management?
Dr Thomas Alexander, Coimbatore
  • In India, 3.5 - 4.6 million patients with STEMI yearly
  • Pharmacoinvasive strategy: A strategy of routine or adjunctive PCI within 3-24 hours of thrombolysis.
  • Is PI approach better than standard lysis? Is PI as good as Primary PCI?
  • Early routine PCI after fibrinolysis in STEMI patients significantly reduced reinfarction and the combined endpoint death/reinfarction and recurrent ischemia at 1 month, with no significant increase in adverse bleeding events vs standard therapy (Eur Heart J. 2010 Sep;31(17):2156-69).
  • The 1-year outcome of patients treated with PHT compares favorably with that of patients treated with other modes of reperfusion therapy; this favorable trend persists after multivariate adjustment. Patients with PHT admitted very early have a very high 1-year survival rate Circulation. 2004 Oct 5;110(14):1909-15
  • STREM: Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding (N Engl J Med. 2013 Apr 11;368(15):1379-87).
    Pharmacoinvasive strategy is as good as primary PCI, widens the time window, logistically easier to accomplish especially during off hours, the aim is to lyse within 30 min of first medical contact followed by PCI within 3-24 hours. It is the ideal strategy in India as transportation times can be long and Cath labs are located in metros.
Tamilnadu STEMI Project: STEMI INDIA
  • Demonstrated the feasibility of developing a STEMI system of care combining the two proven strategies of primary PCI and the pharmaco-invasive strategy to manage patients with STEMI – ‘The STEMI INDIA Model’
  • Utilizing technology to diagnose STEMI has helped in starting reperfusion treatment early especially in rural and poorly served areas
  • Developing a STEMI system incorporating below poverty line insurance ensures equity by including the lower socioeconomic strata- a vulnerable and high risk population.
  • The dominant mode of re-perfusion in this country is not primary PCI and is unlikely to change in the foreseeable future
  • The implementation of the STEMI system of care has increased access to pharmacoinvasive treatment, especially in patients from rural areas who traditionally have standalone thrombolysis as the only treatment for STEMI. This has increased from 1% to 38%
  • For the first time we have demonstrated the effectiveness of the pharmacoinvasive strategy utilising streptokinase as the lytic agent.
  • Importantly, the safety of intervening within 24 hours and intervention after treatment with a cost effective non fibrin specific agent does not show increased bleeding complications
Deferred stenting
Dr Prabhu C Halkati, Karnataka
  • Coronary stenting is a Class IA indication in STEMI.
  • Stent apposition squeezes the endoluminal component of the coronary plaque and dislodges the residual superimposed thrombus distally.
  • The question remains...should we defer stenting in large thrombotic lesions once antegrade flow is observed or established after manual or mechanical thrombectomy.
  • The deferred PCI strategy involves an intention-to-stent 8 to 16 hours after initial coronary reperfusion to permit the beneficial effects of reperfusion and antithrombotic therapies.
  • Deferred completion of PCI in selected STEMI patients reduces no-reflow, distal embolization and intraprocedural thrombotic complications. It improves final coronary flow grade and myocardial blush grade. On longer term follow up, myocardial salvage as measured with cardiac MRI was significantly greater (DEFER-STEMI; J Am Coll Cardiol. 2014 May 27;63(20):2088-98).
  • Benefits of deferred stenting
    • Acute thrombotic plaques, especially in primary PCI are associated with a 30-40% rate of acute stent malapposition as shown in the IVUS.
    • Reducing thrombotic burden before stenting not only reduces embolic events but also allows for a better stent selection, which might translate into shorter lengths and larger diameters.
    • Patients with multivessel disease where surgical revasculariztion could be an option could have their stenting deferred and re-assessed by a multidisciplinary team.
    • Medical compliance could be carefully assessed and allow a better stent selection (BMS vs DES)
    • In about 10% of patients, the infarct-related coronary lesions might be treated medically without requiring a stent at all.
    • In STEMI cases, the repeated angiogram may allow treatment of the non culprit artery in patients with multivessel disease.
    • Delayed stenting allows for a proper statin loading before the stenting which has been associated with a reduction in the composite of death, MI, UA and repeat revascularization after PCI.
Dr KK Spiritual Blog
Be Positive, Be Different and Be Persistent
You should be not only positive, different but also persistent. In ten incarnations of Lord Vishnu, the first is a fish, which indicates to be different in life. The second incarnation is the tortoise, which indicates that you should be different but learn to withdraw when the need arises. The third is a boar which indicates persistence.
The mantra of a successful life is to be positively different and persistent and yet learn to withdraw when the situation arises.
Make Sure
Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.
Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS
What is abortion and miscarriage?
  • According to Webster’s Ninth New Collegiate Dictionary, "abortion is the expulsion of a non–viable fetus; a spontaneous expulsion of the fetus during the first 12 weeks of gestation."
  • Abortion is the spontaneous or artificially induced expulsion of an embryo or fetus. As used in legal context, it usually refers to induced abortion.
  • Miscarriage is the expulsion of the fetus before it is viable and especially between 12th and 28th weeks of pregnancy. The distinction between abortion, miscarriage, and premature labor is not recognized in law and all are referred to as abortion.
  • These are terms used to signify expulsion of the contents of a pregnant uterus during the 1st, 2nd and 3rd trimesters of pregnancy respectively.
  • A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. A miscarriage is medically referred to as a spontaneous abortion.
  • The World Health Organization defines this non survivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less.
Dr Good Dr Bad
Situation: A patient with COPD needed oxygen.
Dr. Bad: Use binasal cannula.
Dr. Good: Use Venturi mask.
Lesson: Venturi mask helps in washing out carbon dioxide
(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained

Inspirational Story
The Touchstone

When the great library of Alexandria burned, the story goes, one book was saved. But it was not a valuable book; and so a poor man, who could read a little, bought it for a few coppers.

The book wasn't very interesting, but between its pages there was something very interesting indeed. It was a thin strip of vellum on which was written the secret of the "Touchstone"!

The touchstone was a small pebble that could turn any common metal into pure gold. The writing explained that it was lying among thousands and thousands of other pebbles that looked exactly like it. But the secret was this: The real stone would feel warm, while ordinary pebbles are cold.

So the man sold his few belongings, bought some simple supplies, camped on the seashore, and began testing pebbles.

He knew that if he picked up ordinary pebbles and threw them down again because they were cold, he might pick up the same pebble hundreds of times.

So, when he felt one that was cold, he threw it into the sea. He spent a whole day doing this but none of them was the touchstone. Yet he went on and on this way. Pick up a pebble. Cold - throw it into the sea. Pick up another. Throw it into the sea.

The days stretched into weeks and the weeks into months. One day, however, about mid-afternoon, he picked up a pebble and it was warm. He threw it into the sea before he realized what he had done. He had formed such a strong habit of throwing each pebble into the sea that when the one he wanted came along, he still threw it away.

So it is with opportunity. Unless we are vigilant, it's easy to fail to recognize an opportunity when it is in hand and it's just as easy to throw it away.

Wellness Blog
A mix of exercise protocol is better

A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease.

Only aerobic exercise is also good as it reduces weight and inches off the waistlines. Jut weight lifting alone has very little benefit.

According to a study published in the journal American Journal of Cardiology, people in the weight–training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists.

Those who did both weight and aerobic training dropped about 4 pounds and 1 waistline inch. This group also saw a decrease in diastolic lower blood pressure and in a metabolic syndrome score.

Both the aerobic–only group and the combined–exercise group also lowered their levels of bad triglycerides.

Quote of the Day
The human is immortal; therefore he must die endlessly. For life is a creative idea; it can only find itself in changing forms. Rabindranath Tagore
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
eMedi Quiz

All of the following statements regarding bio availability of a drug are true except:

1. It is the proportion (fraction) of unchanged drug that reaches the systemic circulation.

2. Bioavailability of an orally administered drug can be calculated by comparing the Area Under Curve (0- ) after oral and intravenous (iv) administration.

3.Low oral bioavailability always and necessarily mean poor absorption.

4.Bioavailability can be determined from plasma concentration or urinary excretion data.

Yesterday’s Mind Teaser: All of the following are features of hallucinations, except:

1.It is independent of the will of the observer.

2.Sensory organs are not involved.

3.It is a vivid as that in a true sense perception.

4. It occurs in the absence of perceptual stimulus.

Answer for yesterday’s Mind Teaser: 2.Sensory organs are not involved.

Correct Answers received from: Dr Amit Desai, Dr Avtar Krishan.

Answer for 28th Feb Mind Teaser: 2. Griseofulvin.

Correct Answers receives: Dr Amit Desai, Dr Avtar Krishan, Daivadheenam Jella.

eMedinewS Humor
Where is God?

A couple had two little boys, ages 8 and 10, who were excessively mischievous. They were always getting into trouble and their parents knew that, if any mischief occurred in their town, their sons were probably involved. The boys’ mother heard that a clergyman in town had been successful in disciplining children,so she asked if he would speak with her boys.The clergyman agreed, but asked to see them individually. So the mother sent her 8–year–old in first that morning, with the older boy to see the clergyman in the afternoon. The clergyman, a huge man with a booming voice, sat the younger boy down and asked him sternly,"Where is God?"

The boy’s mouth dropped open, but he made no response,sitting there with his mouth hanging open, wide eyed. So the clergyman repeated the question in an even sterner tone, "Where is God!!?" Again the boy made no attempt to answer. So the clergyman raised his voice even more and shook his finger in the boy’s face and bellowed, "Where is God!?"

The boy screamed and bolted from the room, ran directly home and dove into his closet, slamming the door behind him.When his older brother found him in the closet, he asked, "What happened?" The younger brother, gasping for breath, replied, "We are in BIG trouble this time, dude. God is missing – and they think WE did it!"
Reader Response
  1. Respected Dr Martandapillai IMA Hqrs president and Sec General Dr KK Agarwalji thanks for messages and giving vast regular informations. to medical profession .to make it glory .your hard work is well felt. Dr A.Selvarajan IMA CWC Tamil Nadu Virudhunagar Long Live IMA: Dr.A.SELVARAJAN
Rabies News (Dr A K Gupta)
What is pre—exposure vaccination?

Pre—exposure (Prebite) vaccination means immunization before the bite.
Health Budget Highlights
Dr A M Pillai and Dr K K Aggarwal
  • The health budget saw a dip of 5.7 per cent with an outlay of Rs 33,152 crore. In the last fiscal it stood at Rs 35,163 crore.
  • AYUSH was allotted Rs 1,214 crore.
  • The department of health research under the health ministry got a hike of 9.2 per cent with Rs 1,018.17 crore allotted to it compared to last year's Rs.932 crore, whereas the department of health and family welfare got a hike of a mere two per cent as Rs 29,653 crore earmarked this year as compared to Rs 29,042 crore last fiscal.
  • The department of AIDS control also got a hike of just 7.4 per cent. It was allotted Rs 1,397 crore this fiscal compared to Rs 1,300 crore last year.
  • The government also proposed to set up six more AIIMS like institutes in the country ( Jammu and Kashmir, Punjab, Tamil Nadu, Himachal Pradesh and Assam) and one more in Bihar. With six more AIIMS-like institutes, the number of such super specialty institutes has gone up to 14 in the country.
  • Three new National Institute of Pharmaceuticals Education and Research in Maharashtra, Rajasthan and Chattisgarh
  • One Institute of Science and Education Research to be set up in Nagaland and Orissa each.
  • To upgrade the existing National Institute of Speech and Hearing to a University of Disability Studies and Rehabilitation
  • A National Skills Mission through the Skill Development and Entrepreneurship Ministry. The Mission will consolidate skill initiatives spread across several Ministries and allow us to standardize procedures and outcomes across our 31 Sector Skill Councils.
  • Investment in Sukanya Samriddhi Scheme will be eligible for deduction u/s 80C and any payment from the scheme shall not be liable to tax.
  • Increase the limit of deduction u/s 80D of the Income-tax Act from ` 15,000 to ` 25,000 on health insurance premium (in case of senior citizen from ` 20,000 to ` 30,000). It is also proposed to allow deduction of expenditure of similar amount in case of a very senior citizen not eligible to take health insurance.
  • To increase the limit of deduction in case of very senior citizens u/s 80DDB of the Income-tax Act on expenditure on account of specified diseases from ` 60,000 to ` 80,000.
  • To increase the limit of deduction u/s 80DD of the Income-tax Act in respect of maintenance, including medical treatment of a dependant who is a person with disability, from ` 50,000 to `75,000. To increase the limit of deduction from ` 1 lakh to `1.25 lakh in case of severe disability.
  • To increase the limit of deduction u/s 80U of the Income-tax Act in case of a person with disability, from ` 50,000 to ` 75,000. To increase the limit of deduction from ` 1 lakh to `1.25 lakh in case of severe disability.
  • To increase the limit of deduction u/s 80CCC of the Income-tax Act on account of contribution to a pension fund of LIC or IRDA approved insurer from ` 1 lakh to ` 1.5 lakh.
  • To increase the limit of deduction u/s 80CCD of the Income-tax Act on account of contribution by the employee to National Pension Scheme (NPS) from ` 1 lakh to ` 1.50 lakh. It is also proposed to provide a deduction of upto ` 50,000 over and above the limit of ` 1.50 lakh in respect of contributions made to NPS.
  • ‘Swachh Bharat’ : 50 lakh toilets already constructed in 2014-15. New target of building six crore toilets. 100% deduction for contributions, other than by way of CSR contributions, to the Swachh Bharat Kosh. A similar tax treatment is also proposed for the Clean Ganga Fund.
  • Clean Energy Cess from `100 to `200 per metric tonne of coal, etc. to finance clean environment initiatives.
  • Excise duty on sacks and bags of polymers of ethylene other than for industrial use is being increased from 12% to 15%.
  • Swachh Bharat Cess at a rate of 2% or less on all or certain services if need arises. This Cess will be effective from a date to be notified. Resources generated from this cess will be utilised for financing and promoting initiatives towards Swachh Bharat.
  • Custom duty exemption: Certain specified inputs for use in the manufacture of flexible medical video endoscopes from 5% to 2.5%.
  • Excise duty on cigarettes increased by 25% for cigarettes of length not exceeding 65 mm and by 15% for cigarettes of other lengths. Similar increases are proposed on cigars, cheroots and cigarillos
  • Attracting Investment to create Jobs: Increased FDI caps in defence, Insurance and Railway Infrastructure; rationalised the conditions for FDI in construction and medical devices sectors;
  • A large proportion of India’s population is without insurance of any kind - health, accidental or life. It is also going to be pension-less. To create a universal social security system for all Indians, specially the poor and the under-privileged.
  • Pradhan Mantri Suraksha Bima Yojna will cover accidental death risk of `2 lakh for a premium of just `12 per year.
  • Atal Pension Yojana: will provide a defined pension, depending on the contribution, and its period. To encourage people to join this scheme, the Government will contribute 50% of the beneficiaries’ premium limited to `1,000 each year, for five years, in the new accounts opened before 31st December, 2015.
  • Pradhan Mantri Jeevan Jyoti Bima Yojana: will cover both natural and accidental death risk of `2 lakhs. The premium will be `330 per year, or less than one rupee per day, for the age group 18-50.
  • There are unclaimed deposits of about `3,000 crore in the PPF, and approximately `6,000 crore in the EPF corpus. To create a Senior Citizen Welfare Fund. Corpus to be used to subsidize the premiums of vulnerable groups such as old age pensioners, BPL card-holders, small and marginal farmers and others.
  • Senior citizens in the country which is now approximately 10.5 crore, out of which over one crore are above the age of 80 years. 70% live in rural areas and a large number are in the BPL category. A sizeable percentage of them also suffer from age related disabilities. Ours is a society that venerates its elders. New scheme for providing Physical Aids and Assisted Living Devices for senior citizens, living below the poverty line is being launched.
  • Indirect health budgets ( 68,968 crore to the education sector including mid-day meals, 79,526 crore for rural development activities including MGNREGA, 22,407 crore for housing and urban development, `10,351 crore for women and child development, 4,173 crore for Water Resources and Namami Gange.)
  • Service tax to be levied on service by way of carrying out any processes as job work for production or manufacture of alcoholic liquor for human consumption.
  • Donation made to National Fund for Control of Drug Abuse (NFCDA) shall be eligible for 100% deduction under section 80G of the Income-tax Act.
  • All ambulance services provided to patients are being exempted from service tax
  • Life insurance service provided by way of Varishtha Pension Bima Yojna is being exempted from service tax
  • The service tax rate is being increased from 12% plus Education Cesses to 14%. The ‘Education Cess’ and ‘Secondary and Higher Education Cess’ shall be subsumed in the new service tax rate. The revised rate shall come into effect from a date to be notified.
  • Service tax to be levied on service by way of admission to entertainment event of concerts, non-recognized sporting events, pageants, music concerts and award functions, if the amount charged for admission is more than Rs 500.
  • An enabling provision is being made to exclude all services provided by the Government or local authority to a business entity from the Negative List. Once this amendment is given effect to, all service provided by the Government to business entities, unless specifically exempt, shall become taxable.
  • Service tax exemptions withdrawn: Departmentally run public telephone, guaranteed public telephone operating only local calls and service by way of making telephone calls from free telephone at airport and hospital where no bill is issued.
  • Custom Duty: Exempt artificial heart (left ventricular assist device) from Basic Customs Duty of 5% and CVD.
  • With respect to ESI, the employee should have the option of choosing either ESI or a Health Insurance product, recognized by the Insurance Regulatory Development Authority (IRDA).
  • The Finance Bill includes a proposal to amend the Income-tax Act to prohibit acceptance or payment of an advance of `20,000 or more in cash for purchase of immovable property.
  • Quoting of PAN is being made mandatory for any purchase or sale exceeding the value of `1 lakh.
  • Young entrepreneurs running business ventures or wanting to start new ones, they need latest technology. To facilitate technology inflow to small businesses at low costs, reduce the rate of income tax on royalty and fees for technical services from 25% to 10%.
  • To abolish the wealth tax and replace it with an additional surcharge of 2% on the super-rich with a taxable income of over `1 crore.
  • To track the wealth held by individuals and entities, the information regarding the assets which are currently required to be furnished in wealth-tax return will be captured in the income tax returns. This will ensure that the abolition of wealth tax does not lead to escape of any income from the tax net.
  • Income Tax Savings ( Deduction u/s 80C `1,50,000/ Deduction u/s 80CCD `50,000/ Deduction on account of interest / On house property loan (Self occupied property) `2,00,000/ Deduction u/s 80D on health insurance premium `25,000/ Exemption of transport allowance `19,200 = Total `4,44,200)
Major Relief to IMA in Income Tax Case
Dear Colleague
Sub: ITAT Order for the A/Y 2009-2010 ADIT (E) vs IMA
  1. The Income Tax case for A/Y2009-2010 was selected for scrutiny and the order was passed against IMA by the then AO on the basis that some of the receipts are arising out of commercial transactions with outsider who are non- member of the IMA.
  2. For the next A/Ys i.e. 2010-11,2011-12 all orders were passed on the same ground and huge demands were created against IMA. ( over five crores)
  3. The main controversy/ground was related to section 2(15) regarding nature of receipts from various endorsements and rent received.
  4. The IO case was that IMA case does not fall in the 2(15) "charitable purpose" but falls in the proviso under advancement of any other object of general public utility
    2(15) "charitable purpose" includes relief of the poor, education, medical relief, preservation of environment (including watersheds, forests and wildlife) and reservation of monuments or places or objects of artistic or historic interest,) and the advancement of any other object of general public utility: Provided that the advancement of any other object of general public utility shall not be a charitable purpose, if it involves the carrying on of any activity in the nature of trade, commerce or business, or any activity of rendering any service in relation to any trade, commerce or business, for a cess or fee or any other consideration, irrespective of the nature of use or application, or retention, of the income from such activity:) (Provided further that the first proviso shall not apply if the aggregate value of the receipts from the activities referred to therein is (twenty-five lakh rupees) or less in the previous year;)
  5. IMA appealed against the AO Order in The court of CIT (Appeals) and won. This order was challenged by IT Department in ITAT. The final order passed by ITAT is passed now in IMA's favour.
Main Points
  • " 7.3. In the facts of the present case since the Ld. Sr. DR inviting attention to only the agreement of Pepsico has canvassed that it cannot be related to any charitable activity as the other companies may be health related and pharmaceuticals companies we find on considering the copy of the specific agreement which is placed at pages 152 to 169 that the “endorsement ” refers to “Quaker Oats” and “Tropicana 100% fruit Juice and fortified drinks” as set out in page 152. Per se we find no conflict if the assessee in the advancement of its aims and objects to promoting by improving public health if on research and analysis it propounds that there are significant health benefits to the uses of Oats or drinking fruit based, fortified health drinks as opposed to aerted drinks having no health benefits."
  • " It is not the case of the Revenue that the endorsement of healthy nutrition is medically/scientifically incorrect. "
  • " The assessee as per the mandate of its objects and the methods set out in Clause IV(2); (3)(5) (6); (7) and (16) has endorsed products on the claims of health and nutritional benefit the grievance of the Revenue appears to be misplaced. The above is notwithstanding the material fact considering the judicial precedent as laid down by the Jurisdictional High Court in ITPO case (cited supra) namely that the dominant purpose of the activity was to mobilize funds for charitable purposes and not for endorsing the products. In the absence of any adverse finding in regard to the activities of the trust we find that the department’s case has no merits. "
  • " On considering the judicial precedent cited we find that the Hon’ble High Court took into consideration in the facts of the ITPO that prime land was made available to the assessee to facilitate its objects of providing space on rent etc. for promotion of trade wherein the assessee apart from selling tickets etc was also providing food & beverage outlets and providing for water, electricity etc in the facts of the present case admittedly financial support is also provided to the assessee trust whose activities have not been assailed to be contrary to the aims and objects and we find that mobilizing resources towards its aims and objects that too within the methods enshrined by the trust deed which are ploughed back by the society towards its aims & objects to our minds does not cause any grievance to the Revenue."
  • :It goes without saying that financial support from the Ministry of Health and Family Welfare to the assessee necessarily would be based on the functions performed by the said trust and would necessarily be monitored at each and every step and stage with adequate checks and balances and would not be allowed to be frittered away carelessly".
  • "Accordingly considering the judicial precedent cited and the arguments of the parties before the Bench and the peculiar facts and circumstances of the case which we have brought out in great detail in the earlier part of this order, we hold that the departmental grounds have no merit and deserve to be dismissed."
  • ".................."trade", "commerce" or "business" in Section 2(15), mean activity undertaken with a view to make or earn profit. Profit motive is determinative and a critical factor to discern whether an activity is business, trade or commerce."
  • " If the dominant and prime objective of the institution, which claims to have been established for charitable purposes, is profit making whether its activities are directly in the nature of trade, commerce or business or indirectly in the rendering of any service in relation to any trade, commerce or business, then it would not be entitled to claim its object to be a ‘charitable purpose’. On the flip side, where an institution is not driven primarily by a desire or motive to earn profits, but to do charity through the advancement of an object of general public utility, it cannot but be regarded as an institution established for charitable purposes.
  • " .....the expression "charitable purpose", as defined in Section 2(15)' cannot be construed literally and in absolute terms. It has to take colour and be considered in the context of Section 10(23C)(iv) of the said Act."
  • ". It is also clear that if the literal interpretation is given to the proviso to Section 2(15) of the said Act, then the proviso would be at risk of running fowl of the principle of equality enshrined in Article 14 of the Constitution India. In order to save the Constitutional validity of the proviso, the same would have to be read down and interpreted in the context of Section 10(23C)(iv) because, in our view, the context requires such an interpretation."
  • "The correct interpretation of the proviso to Section 2(15) of the said Act would be that it carves out an exception from the charitable purpose of advancement of any other object of general public utility and that exception is limited to activities in the nature of trade, commerce or business or any activity of rendering any service in relation to any trade, commerce or business for a cess or fee or any other consideration. In both the activities, in the nature of trade, commerce or business or the activity of rendering any service in relation to any trade, commerce or business, the dominant and the prime objective has to be seen. If the dominant and prime objective of the institution, which claims to have been established for charitable purposes, is profit making whether its activities are directly in the nature of trade, commerce or business or indirectly in the rendering of any service in relation to any trade, commerce or business, then it would not be entitled to claim its object to be a ‘charitable purpose’.
  • Section 10(23C)(iv) of the Income-tax Act, 1961 – Exemptions charitable funds/institutions – Notified fund or charitable institution:Notification No. S.O. 692, dated 23-9-2009 In exercise of the powers conferred by sub-section (iv) of clause (23C) of section 10 of the Income-tax Act, 1961 (43 of 1961) read with rule 2C of the Income-tax Rules, 1962, I, Chief Commissioner of Income-tax, Udaipur hereby notify the Help Society, New Purnima Guest House, Holy Chowk, Charbhuja, Rajsamand (Rajasthan) for the purpose of the said sub-clause for the assessment years 2008-09 onwards subject to the following conditions, namely :-

    (i) The assessee will apply its income, or accumulate for application, wholly and exclusively to the objects for which it is established;
    (ii) The assessee will not invest or deposit its fund (other than voluntary contributions received and maintained in the form of jewellery, furniture, etc.) for any period during the previous year relevant to the assessment years mentioned above otherwise than in any one or more of the forms or modes specified in sub-section (5) of section 11;
    (iii) This notification will not apply in relation to any income being profits and gains of business, unless the business is incidental to the attainment of the objectives of the assessee and separate books of account are maintained in respect of such business;
    (iv) The assessee will regularly file its return of income before the income–tax authority in accordance with the provisions of the Income-tax Act, 1961;
    (v) That in the event of dissolution its surplus and the assets will be given to a charitable organization with similar objectives;

    This notification is applicable only to the recipients of income on behalf of the assessee and not to any other receipt or income of such recipients. Taxability or, otherwise of the income of the assessee would be separately considered as per the provisions of the Income-tax Act, 1961.
    Take Home Points
  • As long as the dominant purpose of any activity of society is to mobilize funds and resources for the charitable purposes as mentioned in its aims and objects and these raised funds are ploughed back and used by the society only towards its aims and objects, the same is within the law and within the proviso of section 2(15). And are allowed.
  • Raising funds by sponsorships, endorsements, registration fee, entry to events ate are allowed to IMA and its branches as long as the proceeds and the excess of income over the expenditure is used only for the objects for which IMA was formed.
  • This order can be cited in the following A/Ys cases which are pending before different courts at different stage.

Regards Dr A Marthanda Pillai and Dr K K Aggarwal
24th March World TB day
Dear Colleague

Kindly observe in your state and Branch World TB Day.

Pass on health messages, organise press meets, senistisation of nurses, school principals, general practitioners, slogan competitions, patient education meets, involve celebrities etc. We are enclosing 36 approved health messages which you can use for dissemination.

Health Messages
  1. Swach Bharat, Swsathya Bharat, TB Mukt Bharat
  2. TB harega desh jeetega
  3. Two weeks cough can be TB. Consult a Doctor
  4. World cup lao, TB ko harao
  5. 2 hafte se jyada khansi, wajan ghatna, bukhaar aana, balgam mein khoon aane par turant doctor se salaah karein. Ye TB ho sakti hai
  6. Notify all TB cases in Nikshay at and make TB free India.
  7. Notify all TB cases in Nikshay at and make TB Mukt Bharat
  8. Standards for TB Care in India are available at
  9. Diagnose and treat TB every case as per the Standards for TB Care in India
  10. Kshay rog ka nidaan v ilaaj bhartiye kshay rog manakon ke anusaar hi karaye
  11. TB anywhere is TB everywhere.
  12. TB sab ko nahin hoti; par kisi ko bhi ho sakti hai
  13. TB isn’t just somebody else’s problem, it could be yours. Coughing for more than 2 weeks, test for TB
  14. 9 million new TB cases are detected every year globally
  15. 1.5 million people die every year from TB globally
  16. Do not ignore cough of more than 2 weeks, it may be TB.
  17. Serological tests for diagnosis of TB are banned and not recommended
  18. Follow the standard IMA Protocol for TB
  19. Not notifying TB is a violation of IMC Act under Section 5.2 and 7.14.
  20. 2 consecutive negative sputum samples for AFB at the end of treatment means TB is cured
  21. DOTs provides free treatment to TB patients and their confidentiality is maintained
  22. MDR TB means TB that is resistant to INH, Rifampicin.
  23. MDR TB requires treatment for 24-27 months
  24. "Reach the 3 Million: Reach, Treat, Cure Everyone"
  25. All diagnosed TB patients should be offered HIV counselling & Testing.
  26. TST and IGRA should not be used for diagnosing active TB.
  27. TB patients should be given dosages of the drugs depending upon body weight.
  28. Patients with pulmonary tuberculosis should be monitored by follow-up sputum microscopy at defined intervals.
  29. TB patients living with HIV should receive the same duration of TB treatment with daily regimen
  30. ART must be offered to all patients with HIV & TB at the earliest.
  31. People living with HIV should be screened for TB
  32. Ensure pura course for pakka ilaj
  33. Ensure all contacts of TB patients are screened for TB
  34. <6 yrs contacts of TB patients after excluding active TB, should get INH for 6 months
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Every arthritis is not same
Every arthritis is not the same. While osteoarthritis also called as green arthritis may require only painkillers and rehabilitation exercises, the red inflammation arthritis called rheumatoid arthritis if not treated aggressively and early can end up with serious deforming complications.

Any arthritis in young women of child-bearing age should not be ignored, especially if it is worse in the morning and improves by movement. Most of them will have high platelet count on blood examination. These patients require aggressive treatment with disease modifying drugs within days of the onset of symptoms and diagnosis. Approximately 1-2% of population may have this type of disease.

Osteoarthritis, on the other hand, is a disease of age 50+ and is due to wear and tear of various joints in the body and break down of the cartilage cushion in the joints. It mainly affects the weight bearing joints like the knees, hips, neck and lower back joints. Inflammation is not a major feature of osteoarthritis. The experts said that another form of joint disorder is due to gout which is never seen in people below 40 years of age and is almost never seen in young women before the onset of menopause unless there is a known underlying kidney disease and never seen in children.

The progression of osteoarthritis can be arrested with appropriate exercises, weight reduction and preventing posture and movement that worsen the disease.

Typical wear and tear of osteoarthritis is caused by sitting cross legged, doing padmasana, squatting, other non physiological postures, sitting on low level surface like floor and low chairs, doing push ups, going up and down on stairs, etc.

Most yoga postures should be done under medical supervision and should follow with a counter yoga exercise.

Most patients of serious arthritis end up with treatment with other systems of medicines or with quacks.
Dr A M Pillai and Dr K K Aggarwal.
UNICEF, IMA join hands to combat child abuse
Bindu Shajan Perappadan: The Hindu

The UNICEF and the Indian Medical Association have joined hands to strengthen the response of medical practitioners in identifying, reporting and treating cases of child sexual abuse (CSA).

CSA is a widespread phenomenon and can cause lifelong consequences on the physical and mental health of a child In India.

“Any sexual activity with a child is a crime,” said IMA office-bearer K.K. Aggarwal. Announcing the partnership on Wednesday, UNICEF India and the IMA said that they would equip medical practitioners with a detailed understanding of diverse facets of CSA, along with relevant legal provisions. Medical practitioners are often the first point of contact in a child sexual abuse case, and are required to take prompt action to ensure immediate and effective treatment.

The programme aims to build a nation-wide cadre of doctor-trainers who can later disseminate the knowledge at different levels.

Under the supervision of the IMA State branches, these doctor-trainers will take the training forward to the State and district levels. To assist these trainers, the UNICEF has provided support to the IMA for the preparation of a teaching manual, and key messages for doctors.

The focus will be to inform and implement 10-key action points about CSA that every doctor should know while handling cases of sexually-abused children. UNICEF India deputy representative, David McLoughlin, said, “Violence against children is often unseen, unheard and underreported. This partnership with the medical fraternity of the country will play a key role in strengthening the care for child survivors and bringing in new ideas and expertise to support our mission in generating awareness among medical and allied professionals.’’ “Medical professionals have a critical role in the prevention, detection and response to sexual offences against children,” said A. Marthanda Pillai, national president of the IMA.

Focus will be to implement 10-key action points about CSA that every doctor should know while handling cases of sexually-abused children