March 3  2015, Tuesday
editorial
Cough Hygiene
Dr KK Aggarwal
  • When you cough or sneeze, you tend to expel out respiratory waste which can be droplets (larger than 5 micron) or airborne droplets less than 5 micron; both have a different implications.
  • Droplets remain suspended in the air only for a limited period. A distance of less than 3 feet is usually required for human to human transmission of droplet-borne respiratory organisms. In flu, this distance can be up to 6 feet. The sources of droplet infections are patients with meningitis, influenza, rubella etc.
  • No precaution needs to be taken by a person who is 6–10 feet away from the patient but if a person is sitting or working even 3–6 feet distance the non-coughing person should wear simple mask.
  • In contrast, airborne droplet nuclei carrying respiratory secretion smaller than 5 micron remain suspended in the air for an extended period and can cause infections to people who are standing even more than 10 feet away. The examples of airborne droplet nuclei infections are TB, measles, chickenpox and SARS.
  • These patients should be placed in an isolation room; all healthcare personnel looking after these patients must use a safe N95 mask.
  • Usually, in houses with their windows open, there is a constant exchange of air which prevents spread of infections but in AC setups with no air exchange, the infections can spread from one person to another.
  • When sitting in an air-conditioned atmosphere, the AC setting should be such that the same air is not circulated and fresh air is allowed to exchange. Split ACs, therefore, are more dangerous than the window ACs.
  • In an office with split AC, if one of many employees is suffering from any of the droplet nuclei, disease can transmit infection to others. Therefore, patients with confirmed TV, measles, chickenpox and SARS should not be allowed to work in areas with split AC.
eMedipics

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Congratulations! Sunil Kumar Saggar, Chief Executive Officer of Jaipur Golden Hospital, Delhi was admitted to the Degree of Science (Honoris Causa) by Chancellor Shri Gopal Das Neeraj Padma Bhushan Awardee in recognition of his contribution in the field of Hospital Administration.
News
  • Depending on drug class, some antipsychotics may be associated with cortical gray matter deficits in schizophrenia, whereas others may be neuroprotective, suggests new research published online in Biological Psychiatry.
  • In patients with rheumatoid arthritis (RA), higher body mass index (BMI) is associated with poorer response to a second-line biologic drug after failure of a first tumor necrosis factor-alpha (TNF-alpha) blocker, suggest new findings published online in Joint Bone Spine.
  • In the acute phase of oral anticoagulation-associated intracerebral hemorrhage, two factors may protect against hematoma enlargement: getting the international normalized ratio (INR) below 1.3 and getting the systolic blood pressure (BP) below 160 mm Hg within 4 hours, revealed a new study published in JAMA.
  • A new study presented at the American Glaucoma Society 2015 Annual Meeting reported that in patients with open-angle glaucoma, the experimental drug latanoprostene bunod improves ocular perfusion pressure more than the beta-blocker timolol maleate, and fewer doses are required.
  • Insomnia is associated with an increased risk of premature death and persistent insomnia poses a greater risk than intermittent insomnia, suggests a new study published in the American Journal of Medicine.
Dr KK Spiritual Blog
What is charity?

Some time back after returning from a free health check-up camp, I met a professor of Cardiology from Lucknow and started boasting that I saw 100 patients free today. He said do not get excited. Charity is a positive, but still not the absolute positive, unless it is done without any motive or done secretly. He said that you were honored on the stage; you got blessings from the patients and people talked about you in positive sense. It was an investment in the long run and not an absolute charity. When you serve, never be honored on the stage by the people to whom you are serving. If you get that then it is like give and take. The purpose of life should be to help others without any expectations.

Understanding helping others

When you help others, it should not end up in harming somebody else even though your help is unconditional. If you are promoting no.2 by superseding another who deserves the senior position, this is not regarded as helping as the person to whom you are helping will give you one blessing but the person to whom you have harmed will give you 10 curses. Ultimately you end up with minus 8 points. Helping other means that it should give happiness to you, to the person/s you have helped and also to those whom you have not helped.

Helping always pays

The difference between American and Indian models is that Indians always think of now and do not invest in future. Americans always plan for the future. When we help somebody, we want that the same person should help you when you are in need. But charity does not believe in this. Your job is to help others and negate your negative past karmas. You never know, may be decades later you get a help from a person to whom you helped decades earlier. Help should never be linked to returns.
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Cardiology eMedinewS
  • Following placement of an implantable cardioverter-defibrillator (ICD), men and women differ in how soon they resume their social lives, suggests new research. Study authors noted that women struggled more initially when they got their ICD but recovered faster in terms of their social health when compared to men. The report is published online in Circulation: Cardiovascular Quality and Outcomes.
  • Spending more than two hours a day in front of a screen increases the probability of high blood pressure by 30% in children, and doing no daily physical activity or doing less than an hour a day increases this risk by 50%, suggests a European study published in the International Journal of Cardiology.
Pediatrics eMedinewS
  • A study published in the journal Pediatric Blood & Cancer shows that pediatric cancer patients who receive antibiotics within 60 minutes of reporting fever and showing neutropenia, go on to have decreased intensive care consultation rate and lower mortality compared with patients who receive antibiotics outside the 60-minute window.
  • The TEDDY study, conducted among Swedish children, reveals that by measuring the presence of autoantibodies in the blood, it is possible to detect whether the immune system has begun to break down the body's own insulin cells and predict the development of type 1 diabetes. The study reported that autoantibodies often appear during the first few years of life. The findings are published in the journal Diabetologia.
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Make Sure
Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, came for follow up.

Reaction: Oh my God! Why didn’t you put him on antioxidants?

Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

What is the declaration of Oslo in abortion?
  • In 1970 the World Medical Association (WMA) drew up a statement on Therapeutic Abortion known as the Declaration of Oslo.
  • The first moral principal imposed upon the doctor is respect for human life as expressed in a clause of the Declaration of Geneva: ‘I will maintain the utmost respect for human life from the time of conception’.
  • Circumstances, which bring the vital interests of a mother into conflict with the vital interests of her unborn child create a dilemma and raise the question whether or not the pregnancy should be deliberately terminated.
  • Diversity of response to this situation results from the diversity of attitudes towards the life of the unborn child. This is a matter of individual conviction and conscience, which must be respected.
  • If the doctor considers that his convictions do not allow him to advise or perform an abortion, he may withdraw while ensuring the continuity of (medical) care by a qualified colleague.
  • This statement, while it is endorsed by the General Assembly of the World Medical Association, is not to be regarded as binding on any individual member association unless it is adopted by that member association.
Dr Good Dr Bad
Situation: A patient with chronic kidney disease (CKD) needed a diuretic.

Dr. Bad: Take once-daily dose.

Dr. Good: Take thrice-daily dose.

Lesson: Diuretics are to be given every 6–8 hours in CKD.

(Copyright IJCP)
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eMedi Quiz
Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionization of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.

2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.

3. Presence of food enhances the absorption of hydrochlorothiazide.

4. Anitimalarial drug halofantrine is more extensively absorbed if taken with food.

Yesterday’s Mind Teaser: All of the following statements regarding bioavailability 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.

Answer for yesterday’s Mind Teaser: 3. Low oral bioavailability always and necessarily mean poor absorption, Dr KV Sarma.

Correct Answers received from: Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 1st March Mind Teaser: 2.Sensory organs are not involved.

Correct Answers receives: Dr Poonam Chablani, Dr Jainendra Upadhyay.

 

Rabies News (Dr A K Gupta)
Can rabies vaccine be given to a child with chickenpox or measles?

As rabies is 100% fatal, there is no contraindication for antirabies vaccination. Rabies vaccine can be given to a child with chicken pox or measles and it is effective. If possible administration of measles vaccine should be postponed by a fortnight after the completion of antirabies immunization.
CPR 10
Total CPR since 1st November 2012 – 101090 trained
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
IMA NEWS
TROPICON 2015
Dear All, The Annual Meeting of Tropical Neurology Subsection of Indian Academy of Neurology (TROPICON 2015) is being held at India Habitat Center, Silver Oak Hall, New Delhi from 11-12 April 2015. The Scientific Program promises an exciting discussion and interchange of views based on the theme "Infection & Immunity: A Tropical Tempest of Challenges". The website http://www.tropicon2015.com/ gives further details. Since the topics include common neurological ailments which most physicians see every day, IMA will be sending 100 doctors to attend the conference. They will not have to pay any registration fee.

For registration contact Dr Padma Srivastava, Prof, Head Unit III Neurology AIIMS, New Delhi @ vasanthapadma123@gmail.com.

With Kind regards
Dr K K Aggarwal
Bill to protect elderly suffering from dementia introduced in LS
Sushmi Dey | 28 February 2015, TOI: New Delhi: Even as India reaps a demographic dividend for its larger share of working age population, the government appears to be worried about the graying millions and the disease burden associated with it.

Cutting across party lines, parliamentarians discussed the Senior Citizen (Prevention of Geriatric Dementia Care) Bill in the Lok Sabha on Friday. The private member bill, introduced by Biju Janata Dal member Bhartruhari Mahtab, aims to protect the elderly population of the country by providing specialized care to people suffering from dementia and provision for geriatric care facilities.

India has a significant population of senior citizens, which is growing rapidly day by day. Most of this population suffers from geriatric disorders. Experts say Alzheimer's disease and other forms of dementia are among the most common disorders in the elderly.

At present, over four million people in India are suffering from dementia. With this number expected to reach around seven million by 2030, the government has to recognize that diseases of the elderly is going to be a very important public health problem in India.

Worldwide, the cost associated with dementia was estimated at around $604 billion in 2010, according to the latest report by Alzheimer's Disease International. This include costs related to informal care, social care and medical care

For the Asia Pacific region, it is estimated at $185 billion. However, the report points out that these numbers are likely to increase as the number of people with dementia is growing tremendously in emerging economies like India, China and Indonesia.

"We claim that we are a young nation and there are often discussions about protecting the rights of a child but unfortunately very few discussions are around the growing and aged population. Whereas, facts show diseases like dementia are increasing rapidly," Mahtab said.

While India lacks provisions for proper care and protection of rights of senior citizens, the bill seeks policy directives to set up geriatric care units and day-care centres in all districts for senior citizens. Besides, it also proposes promotion of geriatric medicine education and training in geriatric care. The bill also proposes action against children who show disregard or abandon their parents suffering from dementia.

Experts say dementia needs to be treated differently from other mental diseases. It is more of a societal problem and values need to be inculcated in the family from the very beginning, Mahtab said.

"Developing an integrated care pathway also provides an opportunity to develop a policy framework which provides support and action at all stages of the disease," suggests the report by Alzheimer's Disease International.

The economic and social impact of dementia has led countries at the forefront of global ageing such as Australia, countries in Western Europe, Republic of Korea and Japan to initiate national programmes and strategies to contend with the increasing numbers of people with dementia.
Universal healthcare still far from reality
Mar 01, 2015 - SHASHI BHUSHAN | Asian Age: Reacting to the Union Budget, medical experts said on Saturday that a total allocation of Rs 33,150 crore for health will not make universal healthcare a reality.

The Union Budget presented by finance minister Arun Jaitley received a mixed response from the medical sector. Increase in exemption limit in health insurance was well-received by the health sector.

Joint replacement surgeon at the city’s Apollo Hospital, Dr Rajeev K. Sharma, said, “The most notable part of the Budget announcements on healthcare is, of course, on the health insurance front. We have seen people lose their savings, become indebted and bankrupt to meet healthcare exigencies in the family and we, as healthcare providers, strongly believe that penetration of health insurance should increase in India. Increasing of the tax exemption for health insurance is a welcome measure.”

The chairman and managing director, Radiant Life Care, which manages BLK Super Speciality Hospital in Delhi and Nanavati Hospital in Mumbai, Dr Abhay Soi, said the increase in tax exemption limit for health insurance will encourage more and more people to take up health insurance.

Head of medical services, HealthCare at Home (HCAH), Dr Gaurav Thukral, claimed that increasing the exemption limit would be particularly encouraging for the middle class as it reduces out-of-pocket health expenditure.

The medical fraternity had been hoping that the Union Budget would increased by at least 2.5 per cent, with a separate budget being allocated for disease outbreaks, rare diseases, rural posting of doctors, and free emergency care treatment for all.

Medical experts whole heartedly welcomed Mr Jaitley announcement to increasing the health insurance exemption limit to Rs 25,000 from Rs 15,000. For senior citizens, the limit will be increased to Rs 30,000 from the existing Rs 20,000, while for very senior citizens of the age of 80 years or more, who are not covered by health insurance, deduction of Rs 30,000 towards expenditure incurred on their treatment will be allowed. Healthcare professionals felt that this will help the middle-class in particular.

However, pointing out the shortcomings in the Budget, the Indian Medical Association, a body of over two lakhs doctors across the country, said that rise in service tax to 14 per cent is not in the interest of the common man.

“No provisions have been made in the Budget for free drugs, investigations or emergency care,” the association said. A total allocation of Rs 33,150 crore for health will not make universal healthcare a reality in the country, IMA general secretary Dr K.K. Aggarwal said. “A separate Budget being allocated for disease outbreaks, rare diseases, rural postings of doctors, and free emergency care treatment for all. We had also been demanding health be given ‘infrastructure status’,” he added. Echoing the IMA concern, Dr Thukral said that it was disappointing to see no major announcements on expanding the reach of public healthcare in India. Health experts welcomed the announcement of new AIIMS-like institutes, saying that they will improve the healthcare facilities across the country. Dr Soi said that the decision to set-up AIIMS in J&K, Punjab, Himachal Pradesh and Assam shows government’s commitment to take quality health care services to people’s doorsteps.

Delhi Medical Association President, Dr Anil Goyal, said that setting up five new AIIMS-like institutions in the country is a welcome step, but added that reduction in the health budget and increased in service tax from 12 to 14 percent splinters the expectation to get more from the Finance Minister.

Health experts also appreciated Mr Jaitley’s announcement to include ‘Yoga’ as charitable activity, which is applicable for exemption under the income tax act, which will promote Yoga in the country, separate budget for age related disability and construction of six crore new toilets.
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Inspirational Story
Emotional management

When someone is doing something or is about to do something, in a way we don’t want it to be done and when we are not able to accept it, we become angry.

However, when someone is doing something or is about to do something, in a way we don’t want it to be done – and we are able to accept it – we remain tolerant.

When someone has something which we don’t have, or someone is able to produce the results which we are not able to produce – and we are not able to accept it – we become jealous. When someone has something which we don’t have, or someone is able to produce the results which we are not able to produce and we are able to accept it – we get inspired.

Then emotional equation is quite simple.

Something + Acceptance = Positive Emotion

Something + Non Acceptance = Negative Emotion

So, it is not ‘something’ or ‘someone’ who makes us feel positive or negative, but it is our ‘acceptance’ or ‘non acceptance’ of something or someone, which makes us feel positive or negative.

It isn’t the world but the quality of our response to the world that determines the quality of our emotions. Next time we feel disturbed with a negative emotion, instead of asking who or what is disturbing us, we should examine who or what we are resisting (not accepting) that is causing this disturbance in us. If we replace resistance (non-acceptance) with acceptance, the negative emotion will turn into a positive one.

Emotional management begins by stopping to blame that ‘something’ or ‘someone’ and starting to take the responsibility to respond life with ‘acceptance’
Wellness Blog
OTC drug does not mean it can be taken without a doctor’s advice

An over–the–counter (OTC) antacid is often used to relieve mild cases of heartburn or acid reflux. Though they are available without a doctor’s prescription they should be taken only under a doctor’s advice.

As per American Academy of Family Physicians
  • There are different types of antacids that work in different ways.
  • Talk to the doctor before taking an antacid.
  • To manage an ulcer, an antacid may need to be taken along with an antibiotic.
  • If one needs more calcium to help strengthen bones, one should prefer an antacid that contains calcium carbonate.
  • In some, antacids may have minor side effects such as nausea, headache, diarrhea or constipation.
  • Read the label carefully to make sure that one is not allergic to any of the ingredients.
  • People with kidney disease may not be able to take all types of antacids.
  • An antacid may interact with other medications.
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Reader Response
  1. Sir, Thanks for updates I am getting regularly. It will be more useful if we can get Hindi version of message specially those which need to be circulated to public. Thanks: Dr. (Major) Chandan, Secretary, IMA Dhanbad
  2. Regarding de recognition of medical colleges by MCI. Dear sir/madam,There is no doubt that de recognition of a medical college midway through a course causes lot of hardship to the students. But regularizing a college without fulfilling MCI requirements is not the solution. That way standard of medical education will come down. Stern action should be taken against the management of colleges who fail to maintain the norms specified by MCI. Mere de recognition is not sufficient.-Dr. S. C. Parakh. Hyderabad.
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A man driving home late at night in his Volkswagen beetle car was stopped by policemen on patrol. The police asked the man to produce his car document. When they could not fault the document, the next question to the man was: "My friend, do you realize that you committed a criminal offence by driving alone in this car at late night?"

The man became angry and responded: "How could you say that? God the father, the son and holy spirit, Prophet Elijah and Angels Micheal and Gabriel are all with me in the car."

The policeman replied: "You mean, all these people are in this small car? I charge you for overloading!"
IMA strongly disapprove the cut in the budgetary allocation for health
Indian Medical Association strongly feels that the policy directions and budgetary provisions including promoting private health insurance are strongly biased in favor of the rich; and the poor still is left with not much choice for health care. Making primary health care completely free is the only way to improve the health situation in the country.

Indian Medical Association complimented the Central Government for the proposal for giving University status for National Institute of Speech and Hearing and initiating 6 AIIMS like institutions. IMA noted that there is better allocation for indirect health related issues particularly like sanitation, water supply, education. housing and setting up of six crores of sanitary toilets, mid-day meal scheme ete. lMA views with satisfaction the increased allocation for women and child welfare. Increase in taxation on cigarettes as well as a gutka and other tobacco products is a welcome move

At the same time, IMA is dissatisfied that there has been a dip of 5.7% in budgetary allocation for health, said Dr Pillai at Thiruvananthapuram. The draft health policy itself has suggested increasing health spending to 2.5% of GDP, while IMA has demanded a 5% allocation- he reminded.

It is believed that an important factor contributing to India's poor health status is it's low level of public spending on health. According to WHO statistics, India rank 166th among 191 countries as for as public health spending is concerned. Public spending as percentage of GDP in India has stagnated in the past two decades varying from 0.9% to 1.2%1 of GDP.

A robust and efficient public health delivery system should be in place to reduce the out of pocket expenditure on health, which is about 70%. The prohibitive cost of health care is pushing 4% of our population below the poverty line every year. The policy of too much dependency on health insurance emulating the American model can be catastrophic, making health care less and less affordable and accessible. Increasing allocation of more funds by government is the only way to make public health delivery more efficient, affordable and accessible.

Dr A Marthanda Pillai pointed out that the existing national disease control programs cover only 15% diseases. lMA demands that life style diseases, mental health, health problems of the elderly, cancer and trauma related health issues should all be included under the central government funded programs and expanded across the country

Small and medium private hospitals do play a significant role in making health accessible and affordable even in remote rural areas. To sustain these institutions, a concept of 'aided hospitals' just like aided schools should be envisaged and funds should be earmarked for this.

Family doctor system and three-tier health delivery system has to be reinforced and sustained. Services of Doctors working in rural areas in the private sector should be utilized to man the primary health centres where chronically there is absence of Doctors on a retainership basis. Funds should be earmarked for this.

75% of health expense is on account of drugs, There is no provision in the budget to make drugs cheaper. Quality drugs should be distributed through a public distribution system and 0.5% of GDP should be set apart for this. No fund has been set part for ensuring quality of drugs. Number of quality control institutions should be increased.

IMA welcomes the concept of Make in India, but this should be extended to the health sector by setting apart 20% or budgetary provision for production of biomedical equipment and devices and set-up medical research. parks across the country in the line with the technoparks.
Dr A Marthanda Pillai and Dr K K Aggarwal