December 30   2015, Wednesday
Dr KK AggarwalDr KK Aggarwal Ministry of Health & Family Welfare Immunization Division

Minutes of the meeting for tOPV to bOPV switch

A meeting to discuss tOPV to bOPV switch was held on 18th December 2015 at 3:30 p.m. under the chairpersonship of AS&MD (NHM) in Room No. 249-A, Nirman Bhawan, New Delhi. The meeting was attended by senior officials from Ministry, representatives from WHO-SEARO, WHO-India, UNICEF, CDSCO, CDL Kasauli, INCLEN, IMA and vaccine manufacturers.

The meeting initiated with welcome note by AS&MD (NHM) highlighting the importance of each partner in tOPV to bOPV switch and requesting them to fully support the Govt. of India in the successful implementation of switch. A powerpoint presentation was made by DC (I) highlighting the timeline of switch and role of various stakeholders and validation of switch.

Key issues and discussion points

1) The country has decided 25th April, 2016 as National Switch Date. After the switch date only bOPV will be used, both in routine immunization as well as polio campaigns. No supplies of tOPV will be accepted after 1 st March 2016 in Government supply chain and after 1st April 2016 in private market. After switch date, remaining tOPV will be removed from cold chain and disposed as per National Switch Plan. National Validation Day has been decided as 9 th May, 2016.

2) After 16th July 2016, no facility (including vaccine manufacturers and testing labs) other than the designated essential facility for India - NIV Pune- to retain any Sabin type 2 containing material including tOPV.

3) Communication materials for the switch will be provided by MoHFW to stakeholders, so that uniform message is conveyed across the country.

4) Role of DCG(I) DCG(I)

• DCG(I) to communicate with vaccine manufacturers and drug controllers at Zonal and District level to ensure availability of bOPV two weeks prior to switch. It must be ensured that secondary packaging of bOPV is not opened before switch date.

• DCG(I) to cancel all licenses for manufacturing as well as import of tOPV for use after 25th April 2016.

• DCG(I) to issue necessary communication to prohibit the use/storage of tOPV and ensure destruction of existing stock of tOPV after the switch day.

• DCG(I) to issue necessary instructions to clearing and forwarding agencies so as to allow the supply of tOPV to dry up and to build up supply of bOPV in view of switch date. CDL, Kasauli

• Testing for bOPV to be fast tracked to ensure timely supplies in view of switch date.

• Testing of all tOPV intended for GoI supplies to be completed and report submitted by middle of Feb, 2016 as GoI will not accept any tOPV from 1 st March, 2016 onwards.

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

5) Role of IMA/IAP

• MoHFW to provide the communication material (pamphlet, joint appeal, SMS messages) on tOPV to bOPV switch to IMA/IAP for circulation to its members nation-wide.

• IMA/IAP, in their upcoming conferences, to reserve a session for GoI representatives to sensitize the participants about the switch.

• IMA/IAP to ensure participation and cooperation of its members in switch validation. For appropriate disposal of tOPV, IMA/IAP to also ensure that disposal of tOPV from private market is linked with that of public sector.

6) Role of vaccine manufacturers

• Manufacturers to ensure tOPV supply to GoI till Feb, 2016 as per committed supply timeline and quantity.

• No supplies of tOPV after 1st March 2016 to Government stores and after 1st April 2016 in private market.

• Manufacturers to ensure availability of bOPV from 10th April, 2016 i.e. two weeks before the switch date in open market.

• All remaining tOPV and type 2 polio bulks to be destroyed in consultation with DCG(I) as per laboratory containment GAP-III plan.

7) Role of NCCPE

• NCCPE with its additional charge of “National Switch Monitoring and Validation Committee” will validate the switch in the country. IMA/IAP and DCGI to provide complete support in switch validation. To conclude, AS&MD (NHM) emphasized on the importance of the switch and that there should be no laxity on the part of any stakeholder.
Breaking News

ACOG releases updated guidelines on prenatal obesity and exercise

Two new guidelines from the American College of Obstetrics and Gynecology (ACOG) emphasize the need for exercise during pregnancy and the post-postpartum period to prevent or correct maternal weight issues. Practice Bulletin Number 156, "Obesity in Pregnancy," and Committee Opinion Number 650, "Physical Activity and Exercise during Pregnancy and the Postpartum Period," appear in the December issue of Obstetrics & Gynecology. Together, the documents address the clinical management of overweight and obese women before and during pregnancy, and the need for women to exercise regularly to prevent or correct overweight or obesity.

Round-the-clock helpline for TB launched

The ministry of health and family welfare has launched a toll free number (1800-11-6666) where people can get counselling as well as treatment support for tuberculosis. Union health ministry recently announced the launch of the round-the-clock helpline. The dedicated toll free number with a call center will work round the clock to provide support for patient counselling and treatment support services. The call center will have trained personnel to provide feedback to patients and also link or refer patients with symptoms of TB to RNTCP centers. Callers can also give a missed call …. (ET Healthworld)
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Specialty Updates
• Anyone at high risk of a cardiovascular event should be offered blood pressure-lowering drugs, regardless of their blood pressure at the start of treatment, suggests new research published in The Lancet.

• A "watch-and-wait" approach in the treatment of rectal cancer has again been shown to be as oncologically safe as radical surgery among patients who achieve a complete clinical response to chemoradiotherapy, reported a new study published online in the Lancet Oncology. Researchers stated that it also allows many patients to avoid a permanent colostomy.

• The American Academy of Pediatrics (AAP) has released guidance suggesting prescribing providers, families, and schools collaborate develop plans detailing the use of seizure rescue medications that is particularly important for children with prescriptions for rescue medications. The recommendations are published online December 28 in Pediatrics.

• New research, published in the International Journal of Sport Nutrition and Exercise Metabolism, suggests that drinking a coffee before a run might help you keep going for longer. Researchers noted that athletes consuming 3-7 mg of caffeine through coffee saw an average improvement in endurance performance of 24%.

• A number of comorbidities, including circulatory and respiratory conditions, were associated with a significantly increased risk of mortality among patients with rheumatoid arthritis (RA), reported a large prospective cohort study published online in Arthritis Care & Research.

• Certain types of weight loss surgery may weaken bones, increasing the risk of fractures, reported a new study published online in the journal Medicine.

• A transurethral convective water vapor system may safely provide rapid benefit in patients with urinary symptoms due to benign prostatic hyperplasia (BPH), suggests a new study published online in The Journal of Urology.

• A new study revealed that graphic warnings on cigarette packets were more effective than text-only warnings in getting consumers to consider the dangers of smoking. The findings are published in the journal PLOS One.

• Researchers from the Institute for Research in Biomedicine in Switzerland, the KEMRI-Wellcome Trust Research Programme in Kenya, and the University of Oxford have discovered a new class of antibodies that can target different malaria parasites and also identified the target proteins as members of the RIFIN family.

• For adults with uncomplicated respiratory tract infections, delayed prescription strategies are associated with reduced antibiotic use compared with immediate prescriptions, according to the results of a randomized clinical trial published online December 21 in JAMA Internal Medicine. Delayed antibiotic prescription is a strategy that involves advising patients to take the prescription only if disease symptoms either worsen or fail to improve a few days after the clinician consultation.
Avoid Drunk or Drugged Driving

The dangers of drinking alcohol and driving are well known to all. But, it is also important to recognize that taking drugs and driving too can be as dangerous. Drugged driving or driving under the influence of any drug that acts on the brain can adversely affect your vision, reaction time, judgment and driving skills. This not only endangers your life but also of your co-passengers as well as others on the road.

Tips for safe driving

• All through the year, especially during the holiday season, take steps to make sure that you and everyone you celebrate with avoid driving under the influence of alcohol or other drugs.

• Always designate a non-drinking driver before any holiday party or celebration begins.
• Arrange for someone to pick you up
• Do not let a friend drive if you think that they are impaired. Take the car keys.
• Stay overnight at your friend’s place, if possible and drive back home in the morning.
Legal Quote
Indian Medical Association Vs. V.P. Shantha & Ors 1996 AIR 550, 1995 SCC (6) 651

“ … the occupations which are regarded as professions have four characteristics, viz., i) the nature of the work which is skilled and specialized and a substantial part is mental rather than manual; ii) commitment to moral principles which go beyond the general duty of honesty and a wider duty to community which may transcend the duty to a particular client or patient; iii) professional association which regulates admission and seeks to uphold the standards of the profession through professional codes on matters of conduct and ethics; and iv) high status in the community.”
The switch from trivalent to bivalent oral polio vaccine

18th December, 2015

Role of Vaccine Manufacturer /Distributors

• Ensure tOPV supply till Feb 2016 as per supply timeline and qty.
• No supplies of tOPV after 1st March 2016 in Government and after 1st April 2016 in private market.
• Ensure availability of bOPV in private market from 10th April 2016.
• Destruction of tOPV and type 2 polio bulk in consultation with DCGI.
The Year in Medicine 2015: News That Made a Difference
FDA says no to dirty endoscopes

The FDA ordered Custom Ultrasonics to recall all of its endoscope reprocessors. Persistent regulatory violations could increase the risk of transmitting infection. The recall is the agency's latest move to reduce the spread of antibiotic-resistant bacteria via dirty endoscopes, particularly duodenoscopes. Recently, no less than six outbreaks of multidrug-resistant bacteria, some deadly, have been linked to dudenoscopes, despite following the proper reprocessing instructions. The many small, hidden parts make the device very difficult to clean. Dirty endoscopes are placed no. 1 in the 2016 list of healthcare technology hazards identified by the nonprofit ECRI Institute… (Medscape)
Digital IMA
IMA Satyagraha
IMA Poll
Another feather added to Team IMA: Team IMA 2015-16 has taken over
• Dr SS Agarwal is the New President of IMA
• Central council had a live webcast for the whole duration
• Except for minor hiccups, there were no controversies
• Four union ministers in installation function apart from many Members of Parliament, Dr Anil Jain, Dr Sambit Patra, Ministers Sh J P Nadda, Shri Hans Raj Ahir, Dr Jitendra Singh, Dr Mahesh Sharma
• Delhi health minister, Shri Satyendra K Jain hosts a tea party
• Delhi police Commissioner B S Bassi addresses the gathering
• MCI education PG Chairman Dr V P Mishra addresses the gathering
• Media personality Nalin Kohli addresses the gathering
• WMA President 2015-16 blessings throughout CC (Dr Desai)
• Formed ASG Siddhartha Luthra addresses the gathering
• IMA lawyers interact
• Four agenda books
• All agenda ebooks
• Over 1000 people in installation
• Over 2000 delegates in NATCON
• Five star atmosphere
• Health Ministry Announces working group with IMA

Dr SS Agarwal
Dr A Marthanda Pillai
Dr K K Aggarwal
Dr Vinay Aggarwal
Dr Ajay Lekhi and Team IMA Delhi
MPs pledge support to make India TB-free
Parliamentarians across party lines came to demand and sustain high-level domestic commitment to end TB in India. The MPs from both Lok Sabha and Rajya Sabha pledged to drive political, administrative, and technical solutions to address specific barriers affecting TB prevention and care in India. "Parliamentarians Meet towards a TB-Free India" was organized to sensitize them on the TB situation in India and the urgent need for action. The meet was jointly organized by Central TB Division, Ministry of Health & Family Welfare (MoHFW), Government of India (GoI), The International Union against TB and Lung disease (CTB-The Union) and IAPPD in New Delhi… (ET healthworld)
DCI asks all dental colleges to set up public health dentistry departments
Dental Council of India (DCI) has asked the dental colleges in the country to mandatorily set up public health dentistry departments within a period of one year. There are around 310 dental colleges in the country. DCI has directed that the subject Master of Dental Surgery (MDS) in Public Health Dentistry personnel has to be taught. For this, both the examiners should be MDS in the same subject for the University Professional Examinations... (Pharmabiz - Shardul Nautiyal)
Indians more prone to cardiac arrest
Indians are three times more prone to cardiac arrest than Americans owing primarily to poor lifestyle, eating habits and genetic reasons. While Americans on an average suffer from cardiac arrest in their 50s, Indians get it in their 40s. The major reason being lifestyle and food consumption. Genetically also the disease is likely to be passed down Indian families three times more than American families… (Times of India)
Diabetes growing at alarming rate

Results of a survey conducted over the last three years show that that an overwhelming percentage of people had diabetes. The survey carried out by Metropolis Healthcare analyzed more than 10.21lakh blood sugar levels found that over 60% of men, 51% women and 28% children between the age group of 0-12 were diabetic… (ET Healthworld)
An outbreak of a new strain of 'super gonorrhea,' which began in Leeds in the UK and which is making the disease resistant to antibiotics, has led experts to warn about the risk of "untreatability." (ET Healthworld)
IPC Code to know

IPC 314

Death caused by act done with intent to cause miscarriage: Whoever, with intent to cause miscarriage of a woman with child, does any act which causes the death of such woman, shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine; [if act done without woman’s consent] and if the act is done without the consent of the woman, shall be punished either with imprisonment for life, or with the punishment above mentioned. Explanation: It is not essential to this offence that the offender should know that the act is likely to cause death.
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
Water Hygiene

Safe water is an essential commodity to prevent most water and food-borne diseases like diarrhea, typhoid and jaundice. These diseases are 100% preventable. All of them can be lethal if not prevented, diagnosed or treated in time.

Transmission of parasitic infections can also occur with contaminated water. Here are a few tips:

• Travelers should avoid consuming tap water.
• Avoid ice made from tap water.
• Avoid any food rinsed in tap water.
• Chlorination kills most bacterial and viral pathogens.
• Chlorination does not kill giardia cysts.
• Chlorination does not kill amoeba cysts.
• Chlorination does not kill cryptosporidium.
• Boiled water is safe.
• Treated water is safe.
• Bottled water is safe.
• Carbonated drinks, wine and drinks made with boiled water are safe.
• Freezing does not kill the organisms that cause diarrhea. Ice in drinks is not safe unless it has been made from adequately boiled or filtered water.
• Alcohol does not sterilize water or the ice. Mixed drinks may still be contaminated.
• Hot tea and coffee are the best alternatives to boiled water.
• Bottled drinks should be requested without ice and should be drunk from the bottle with a straw rather than with a glass.
• Boiling water for 3 minutes followed by cooling to room temperature will kill bacterial parasites.
• Adding two drops of 5% sodium hydrochloride (bleach) to quarter of water (1 liter) will kill most bacteria in 30 minutes.
• Adding five drops of tincture of iodine to a quarter of water (1 liter) will kill bacteria within 30 minutes.
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

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Inspirational Story
Be Positive

Father: "I want you to marry a girl of my choice." Son: "I will choose my own bride!"
Father: "But the girl is Bill Gate’s daughter." Son: "Well, in that case… ok"
The Father then approaches Bill Gates. "I have a husband for your daughter."
Bill Gates: "But my daughter is too young to marry!" Father: "But this young man is vice–president of the World Bank."
Bill Gates: "Ah, in that case… ok" Finally Father goes to see the president of the World Bank.
Father: "I have a young man to be recommended as your vice–president." President: "But I already have more vice–presidents than I need!"
Father: "But this young man is Bill Gate’s son–in–law." President: "Ah, in that case… ok"
This is how business is done!!

Moral: Even if you have nothing, you can get anything. But your attitude should be positive.
A vitreous aspirate has been collected in an emergency at 9 pm what advice you like to give to the staff on duty regarding the overnight storage of the sample.

1. The sample should be kept at 4°C.
2. The sample should be incubated at 37°C.
3. The sample should be refrigerated deep freezer.
4. The sample should be refrigerated for the initial 3 hours and then incubated at 37°C.

Yesterday’s Mind Teaser: A 60-year-old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:

1. Thymoma
2. Lung cancer.
3. Hodgkin's lymphoma.
4. Superior vena caval obstruction.

Answer for Yesterday’s Mind Teaser: 4. Superior vena caval obstruction.

Answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Poonam Chablani, Dr.K.V.Sarma, Raju Kuppusamy, Jayashree sen, Dr Jainendra Upadhyay

Answer for 28th December Mind Teaser: 3. Bone erosions.

Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan
Readers column
Dear Sir, Very Informative Newspaper. Regards: Dr Karan
A Horoscope for the Workplace After lunching at the Algonquin Hotel, Robert walked through the lobby, out the front door, and said to the uniformed man on the sidewalk, "My good man, would you please get me a taxi?"

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

Robert instantly quipped: "All right then, get me a battleship."
Press Release
Health Ministry and the Indian Medical Association to form a joint working group to discuss, deliberate and find solutions to the major Indian healthcare concerns

Shri JP Nadda announces the formation of the working committee during his address during IMA’s annual conference the NATCON 2015

Marking a historic moment for the Indian Medical Association, Shri JP Nadda - Hon’ble Minister of Health and Family Welfare, GOI announced that the health ministry with support of the Indian Medical Association will form a first of its kind working group to evaulaute and address the major healthcare problems in our country. He asked the IMA leaders for their expertise and help to fight the major health battles being faced by the Indian population during his address at IMA’s annual Central Council meeting the NATCON 2015.

Speaking about this achievement, Dr. S.S Agarwal – National President and Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General of IMA in a joint statement said, “Never in the history of the IMA has a joint committee of this nature been formed between the IMA and Government of India. We are extremely hopeful that together we will be able to find effective solutions to major healthcare issues being faced in our country. Some of these include the high prevalence of water and food borne diseases, increase in percentage of women smokers, epidemics nature of diseases such as dengue and swine flu as well as the incidence of lifestyle diseases in people as early as in their late twenties and thirties.”

In addition to this, Dr. Mahesh Sharma - Minister of State for Culture, Tourism & Civil Aviation also announced that he is in the process of setting up a Medical Tourism and Wellness Board of which the IMA will be a prominent member. They will together work towards strengthening and defining the in respect to medical tourism in India

Sh Hansraj Gangaram Ahir - Hon’ble Minister of State for Chemicals & Fertilisers GOI announced that he will be bringing three device parks in our country for local development of medical devices thereby reducing their costs drastically.

“This will be a great boon for the Indian consumer at large for now medical devices will become more affordable and accessible even to the lower strata of the society. We believe that access to healthcare is a basic fundamental right of each and every Indian citizen under article 21 of the Indian constitution and no person must die of disease just because they cannot afford treatment. We are hopeful that all these partnerships will help IMA achieve its aim of making India a healthier country”, added Dr. KK Aggarwal. The IMA Central Council meeting was attended by over 1000 and they together discussed over a two day period issues affecting the Indian medical community including the increased cases of violence against doctors, un-warranted media trials, redundant laws that need urgent amendments and the commercialization of the medical practice by its inclusion under the consumer protection act.

On the last day of the conference, Dr. S S Agarwal was sworn in as the new IMA National President for the period of Dec 2015 – Dec 2016 as Dr. A Marthanda Pillai stepped down after the completion of his term.