April 4  2015, Saturday
editorial
ESMR in patients with refractory angina
Dr KK AggarwalThe incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms of angina in patients with RA.

This study performed a prospective cohort study to examine the efficacy of ESMR application in patients with RA despite optimal medical therapy, not suitable for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiving d ESMR the effect of on cardiac perfusion was assessed.

There were 43 patients in the case group and 29 patients in the control group. The mean age of the patients was 70 ± 9.5 years in the case group and 71 ± 5.3 years in the control group. Other characteristics (diabetes, coronary artery bypass graft, percutaneus coronary intervention, baseline CCS class score) were similar in both groups. There was a significant improvement in CCS class score (1.33 ± 0.57 in cases and 1.92 ± 0.69 in controls; p = 0.0002), nitroglycerin consumption (20% in case cases, and 44.8% in controls; P < 0.03) and hospitalization rate significantly reduced (13.9% in case cases, and 37.9% in controls; P < 0.03). The patients who received ESMR, there was a significantly improvement in myocardial perfusion after 6 months with a 33% relative reduction of summed stress score (SSS) (p = 0.002).

The study showed beneficial effects of ESMR therapy on cardiac symptoms, myocardial perfusion and reduced hospitalization in patients with refractory angina. The current study supports a role for ESMR as a non-invasive therapeutic option for patients with RA.

Reference: Alunni G, Marra S, Meynet I, et al. The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina. Cardiovasc Revasc Med. 2015 Jan-Feb;16(1):6-11
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eMedipics IMA,IJCP,HCFI
On the occasion of the World Health Day, Heart Care Foundation of India & the Indian Medical Association roll out awareness programs on food safety
News
  • A short daytime nap could significantly boost brain power, suggests a new study from Saarland University in Germany. The study is published in the journal Neurobiology of Learning and Memory. Researchers noted that a sleep of around 45-60 minutes could improve learning and memory by fivefold.
  • A study published in the March issue of Arthritis Care & Research has shown that distraction seems to be the greatest risk factor for new-onset acute low back pain (LBP). Study authors noted that onset was most likely between 7:00 am and noon, that the risk was substantially increased by a number of modifiable physical and psychosocial triggers, and that people >60 years of age were less at risk from heavy loads than younger participants.
  • New research presented at the 249th National Meeting & Exposition of the American Chemical Society suggests that taking vitamin D supplements may slow or reverse the progression of low-grade prostate tumors, without the need for surgery or radiation therapy.
  • Intravenous (IV) cosyntropin therapy in the treatment of postdural puncture headache shows efficacy that is similar to that of, but is slower to take effect than, the current gold standard treatment, an epidural blood patch, suggests a new study presented at the American Academy of Pain Medicine (AAPM) 31st Annual Meeting.
  • Exposure to the sun during adulthood might cause more nonmelanoma skin cancer than exposure during childhood, suggests a new study presented at the American Academy of Dermatology 73rd Annual Meeting.
IMA,IJCP,HCFI
Dr KK Spiritual Blog
How to Be Happy and Healthy

A disciple once asked Lord Buddha, "After meditating for years, I have not been able to gain anything." Then Lord Buddha asked, "Did you lose anything?" The disciple said, "Yes, I lost my anger, desires, expectations and ego." Buddha smiled and said, "That is your gain by meditating."

To be happy, one must learn to let go the following:
  • One should let go of desires. In Amarnath Yatra, Lord Shiva firstly let go of the Bull, which represents the sexual desires. In Hanuman’s Lanka yatra, desires are represented by Samhiki, a creature who used to catch birds by their shadows. Hanuman killed the desires. So, it is possible to kill your desires. Again in Ramayana, desires are linked to Rajsik mind and in mythology, Meghnath represents the Rajsik mind. Meghnath was killed by Lakshman, the determined mind. Therefore, one should let go of the desires by killing them by focused concentration of the mind on the desires.
  • Let go of expectations. In Amarnath Yatra, the second thing which Lord Shiva discarded was the moon, which in mythology symbolizes letting go of expectations.
  • Let go of your ego. In mythology, ego represents Kansa in Krishna era and Ravana in the era of Rama. Both were killed by Krishna and Rama respectively, who symbolize the consciousness. Ego can never be killed by the mind and can only be killed by the consciousness (conscious-based decisions). Ego is also represented by Sheshnag and both Lord Shiva and Lord Vishnu have a Sheshnag each with mouth directed downwards indicating the importance of controlling one’s ego. One should let go of his or her ego but also remember never to hurt somebody’s ego. Hurting somebody’s ego in terms of allegations of sexual misconduct, financial corruption or abusing one’s caste is never forgotten and carries serious implications. In Hanuman’s Lanka Yatra, ego is represented by Sursa; Hanuman managed her by humility and not by counter ego. On Nag Panchami, we worship Nag, the ego, by folded hands and by offering milk.
  • Let go of your inaction. One should learn to live in the present. In Hanuman’s Lanka Yatra, Hanuman first meets Menak Mountain, which indicates destination to rest. One should never do that and willfully divert his or her mind towards action.
  • Let go of your attachments. Let go of your attachments to your close relatives and the worldly desires. In Amarnath Yatra, Lord Shiva first leaves Bull (desires), moon (expectations), sheshnag (ego) and then he gives up Ganesha and worldly desires (five elements). In mythology, this is practiced as detached attachment and in Bhagavad Gita is equated to Lotus. In Islam, detached attachment is practiced in the form of Bakra Eid.
  • Let go of your habit of criticizing, complaining and condemning people. One should always practice non-violent communication and speak which is truth, necessary and kind. One should not criticize, condemn or complain about people, situation and events. Wayne Dyer said, “The highest form of ignorance is when you reject something you do not know anything about.”
  • Most of us often condemn people without knowing their capabilities and label them as unmatchable to us. One should also let go of the habit of gossiping as it is a form of violent communication.
  • Let go of your habit of blaming others: One should learn to take the responsibilities and people believe in team work. Good leader is the one who learns to be responsible in life.
  • Let go of your need to be always right: It is a form of ego. Remember, in arguments either you can win arguments or relationships. Always try to win relationship and not arguments.
  • Let go of your need to control situations, events and people: Learn to accept people as they are. The world is won by those who let this habit go.
  • Let go of your habit and the need to impress others: This is also a type of ego where we always seek appreciation.
  • Give up your belief that you cannot do it: Remember ‘IMPOSSIBLE’ is ‘I M POSSIBLE’. A belief is not an idea held by the mind but it is an idea that holds the mind. (Elli Roselle).
  • Give up your resistance to change: Remember change is the only constant which will happen and always welcome it. Joseph Campbell once said that one should follow one’s bliss and will open doors to your where there are only walls.
  • Let go of your fear and all negative thoughts: Remember, the mind is a superb instrument if used rightly. It becomes very destructive if used badly. (Eckhart Tolle).
  • Let go of your habit of giving excuses.
  • Let go of always being in the past.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
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Cardiology eMedinewS
  • The risk of future atrial fibrillation (AF) decreases with increasing cardiorespiratory fitness (CRF)—up to a point, suggests a new analysis of a large cohort of middle-aged men. The benefit was seen within an optimal range of fitness, but the risk increased in the most highly trained men, those considered "the fittest of the fit." The findings are published online in Heart Rhythm.
  • Five years after patients with left main coronary stenosis either underwent PCI with a sirolimus-eluting stent or had CABG, there was no difference in major adverse cardiac or cerebrovascular events (MACCE) in the two groups, reported the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease (PRECOMBAT) trial. The findings were presented at the American College of Cardiology 2015 Scientific Sessions.
Pediatrics eMedinewS
  • A recent study published in the Journal of the American Academy of Child and Adolescent Psychiatry revealed that following military parents' return from combat deployment, their children show increased visits for mental healthcare, physical injury, and child maltreatment consults, compared to children whose parents have not been deployed.
  • Training parents to engage in treatment of their children with attention-deficit/hyperactivity disorder (ADHD) symptoms improves the collaborative care model and the outcomes in all three key measures tested — hyperactivity/impulsivity, social skills, and oppositionality — suggests new research published online March 23 in Pediatrics.
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Make Sure
Situation: A patient with dengue died.

Reaction: Oh my God, why was he not given adequate fluids?

Lesson: Make Sure that all patients with dengue are given fluids to correct intravascular dehydration.
Dr Good Dr Bad
Situation: A patient who had Mediclaim for the last seven years came for executive checkup.

Dr. Bad: You will have to pay from your pocket.

Dr. Good: You can claim it from Mediclaim.

Lesson: In addition to cumulative bonus, the insured shall be entitled for a reimbursement of the cost of medical checkup once at the end of block of every four underwriting years provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount of 1% of the total amount of the average sum insured during the block of four claim free underwriting years.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
Inspirational Story
Two Types of People

There are two types of people in this world. The first is internally-motivated; they set goals for themselves and push themselves towards their goals on their own. These groups of people are usually those who do not believe in religions.

The second group is one that is externally-motivated; they rely on external motivation - religion, the promise of reward etc. These groups of people are usually those who firmly believe in religion.

Working with the different group requires a slightly different approach to the task. When working with the latter group, all you have to do is reward him or her with something. Praise him or her. When working with the former group, put him in comparison with another person who is weaker than him or her. He or she would do the rest.

There are many cases of talents & potential being wasted, just because they did not develop it further. I heard of this student whose mother allowed him to go out with his friends only once a year. Of course, he’s a GPA-4 student. But he has close-to-zero social lifestyle, and any talents he might have would be lost. Perhaps he is good at drawing? Playing piano?

So depending on which group you belong to, you can do different things to self-motivate yourself. For the former group, start comparing yourself with weaker peers (but don’t get too big-headed). For the latter group, start writing down the praises that others gave you.

Remember, your brain is a powerful thing. You definitely have a talent. If you’ve discovered it, don’t waste it. Motivate yourself to develop it further. For those of you, who haven’t discovered it, don’t be discouraged. You will find it one day.
Quote of the Day
A total commitment is paramount to reaching the ultimate in performance. Tom Flores
Reader Response
Dear Sir, very informative news. Regards: Dr Kartik
Wellness Blog
Why is my nose bleeding?

Nosebleed is a common problem, occurring in up to 60 percent of the general population and is often because of a respiratory illness or dry conditions. Nasal drying is common in the hot summer months because of the extreme temperature and dry air due to use of air conditioners.

Here are some typical reasons for nosebleeds:
  • Nasal allergies
  • Blowing your nose too hard or trying to remove something from inside the nose
  • A result of "popping" the ear
  • Nasal exposure to chemicals
  • Frequent sneezing or having an upper respiratory infection
  • Use of nasal spray or a blood–thinning drug, such as aspirin
  • Inhaling air that is extremely dry or cold
  • Having recent surgery on the nose or elsewhere on the face
  • Breaking the nose or a similar injury
  • Uncontrolled blood pressure
Bleeding can be controlled by direct pressure i.e. compression of the nostrils rasping the alae distally so all mucosal surfaces are opposed. Direct pressure should be applied continuously for at least 5 minutes, and for up to 20 minutes. The patient should be encouraged not to check for active bleeding. Patients who are properly instructed may control their bleeding while the evaluation gets underway.

Other maneuvers include bending forward at the waist while sitting up (to avoid swallowing blood), placing a plug of cotton wool or gauze into the bleeding nostril (sometimes coated with antibiotic ointment), expectorating out blood that accumulates in the pharynx and a cold compress applied to the bridge of the nose.

These maneuvers also should be taught to high–risk patients for use at home. Many ENT specialists recommend initial treatment with two puffs of oxymetazoline to hasten hemostasis.
eMedi Quiz
In a patient with a tumor in superior mediastinum compressing the superior vena cava, all the following veins would serve as alternate pathways for the blood to return to the right atrium, except:

1. Lateral thoracic vein.
2. Internal thoracic vein.
3. Hemiazygos vein.
4. Vertebral venous plexus.

Yesterday’s Mind Teaser: B-oxidation of odd-chain fatty acids produces:

1. Succinyl CoA.
2. Propionyl CoA.
3. Acetyl CoA.
4. Malonyl CoA.

Answer for yesterday’s Mind Teaser: 2. Propionyl CoA.

Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr G Madhusudhan, Viswanatha Sarma, Daivadheenam Jella.

Answer for 2nd April Mind Teaser: 3. Leaves extension at elbow joint intact.

Correct Answers receives: Viswanatha Sarma, Daivadheenam Jella, Dr Prabodh K Gupta, Dr Poonam Chablani, Raju Kuppusamy, Dr G Madhusudhan, Dr Avtar Krishan, Dr Jainendra Upadhyay, Raju Kuppusamy.
Rabies News (Dr A K Gupta)
Are there any dietary restrictions during intradermal rabies vaccination (IDRV)?

There are no dietary restrictions during IDRV. However, alcohol may be avoided as it may affect the immune response.
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
Request to send comments on the Concept Note on National e-Health Authority (Govt of India)
Ministry of Health and Family Welfare proposes to set up National e-Health Authority (NeHA) responsible for development of an Integrated Health Information System in India. The said Authority is proposed to be created through an Act of Parliament. The roles of the proposed Authority are as under:
  • To guide adoption of eHealth solutions.
  • To facilitate implementation of eHealth by integrating and harmonizing the standards.
  • To facilitate on orderly evolution of state-wide and nationwide HER system.
  • To act as an enforcement agency with suitable mandate and powers.
A copy Concept Note on establishment of NeHA, is available click here (http://emedinews.in/ima/e-health.pdf). The same is also available on the Ministry’s website: www.mohfw.gov.in

We would like to request you to offer comments on the concept Note on NeHA positively by 20.4.2015 to enable hear Ministry to take further necessary action.

Dr A Marthanda Pillai                     Dr K K Aggarwal
National President IMA             Honorary Secretary General
Sonal Namaste
CDC guidelines advise use of a plain (nonantimicrobial) soap with water for routine hand washing.
Facts about Tuberculosis (TB)
What is ‘DOTS’ and what are its advantages?
  • DOTS or ‘Directly Observed Treatment Short course’ is the most efficient and cost-effective WHO recommended strategy for TB control.
  • Under DOTS patient is administered supervised treatment by a trained DOT (Directly Observed Treatment) provider, which ensures that the patient completes the full course of medicine to get cured and prevent further spread.
DOTS ensures that the patient is given
  • the right drugs
  • in the right doses
  • for the right duration of treatment
Alcohol Awareness Month 2015
Alcohol Awareness Month 2015

April is Alcohol Awareness Month.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) encourages the public to dedicate this month to understanding how excessive drinking can affect health and to evaluating their own drinking habits.

Many adults drink moderately and responsibly without complications, and there are indications from research that some can derive modest health benefits. At the same time, alcohol-related problems – which result from drinking too much, too fast, or too often – are among the most significant public health issues.

For example, an estimated 16.6 million Americans have alcohol use disorder – a medical term describing a range of mild, moderate, and severe alcohol problems. In addition, research shows that binge drinking is not uncommon among adults.

Nearly one quarter of people age 18 and older report that they consumed five or more alcoholic drinks on the same occasion on at least one day in the past month. Importantly, this consumption pattern is also prevalent among adolescents ages 12-17, with about 6 percent of them reporting drinking in this way.

Do antibiotics raise diabetes risk via gut microbiota?

People who take multiple courses of antibiotics may face an increased risk of developing both type 1 and type 2 diabetes, potentially through alterations in gut microbiota.

Researchers led by Ben Boursi, at the department of gastroenterology at the University of Pennsylvania, Philadelphia, has shown that the risk of diabetes was increased by up to 37%, depending on the type of antibiotic and the number of courses prescribed. The study was published online ahead of print March 24 in the European Journal of Endocrinology. The More Courses of Antibiotics, the Greater the Risk

Studies both in animal models and humans have shown an association between changes in gut microbiota in response to antibiotic exposure and obesity, insulin resistance, and diabetes.

Germ-free mice are lean and, by fecal transplantation, we can transmit obesity to them. Low dose of penicillin may induce obesity in mice models.

Treatment with two to five courses of antibiotics was linked to an increased risk of diabetes with penicillin, cephalosporins, macrolides, and quinolones, at adjusted odds ratios (ORs) ranging from 1.08 for penicillin to 1.15 for quinolones. The highest risk for diabetes was seen among people who received more than five courses of quinolones.

An increased risk of diabetes was also seen in patients who took more than five courses of tetracyclines.

Eur J Endocrinol. 2015. Published online March 24, 2015. Abstract

(Medscape Cardiology)
Delhi government plans law to rein in private hospitals
Durgesh Nandan Jha, TNN | Apr 3, 2015, 12.38 AM IST

New Delhi: The Delhi government aims to make private clinics and hospitals in the city accountable by implementing the Clinical Establishments Act, a Central law under which the maximum cost of medical procedures would be laid out and services standardized.

The law, passed by Parliament in 2010 and notified two years later, provides for registration of all health facilities, clinics and pathology labs, even if it is run by a single doctor. It also stipulates the minimum requirements for facilities and manpower.

"The existing law, Delhi Nursing Home Registration Act, 1953, is outdated. It lacks the teeth to curb large scale corruption that plagues the medical sector today," said Delhi health minister Satyender Jain, confirming the move.

As health is a state subject, it was up to individual state governments to enact the Clinical Establishments (Registration and Regulation) Act. Arunachal Pradesh, Himachal Pradesh, Mizoram and Sikkim have so far opted to implement the law. It's also in force in all Union territories.

The Sheila Dikshit government had considered enacting the law but a senior health department official said it was stalled by doctors' associations.

According to an official in the Delhi health department, there was opposition to the clinical establishments Act from the Indian Medical Association and the Delhi Medical Association.

"The Act permits health authorities to conduct inspections and penalize or cancel licences of hospitals that are found to be fleecing patients, either by prescribing needless tests and procedures, or overcharging. The owners of clinics and hospitals are obviously perturbed," said a senior official in the directorate of health services.

He added that once enacted, the law would help in standardizing services and charges. "Today, if someone complains to us about a particular hospital charging Rs 2 lakh for a particular surgery which is being done at half the cost in other hospitals, we cannot do anything. But under the new law, government can put a cap on maximum charges for various services," the official explained.

Dr Kameshwar Prasad, professor and head of neurology at AIIMS, said that stricter regulatory mechanism is needed to check corruption in the medical sector. "Lab tests and imaging, procedures such as angioplasty, knee replacement and caesarean section must be audited. The government should appoint monitoring committees for random checks of patient data to identify instances where needless tests or procedures have been prescribed. That would put fear in the minds of errant doctors and hospitals," Dr Prasad said.

A recent survey carried out by TOI had revealed that most diagnostic labs in the city did not have quality equipment or adequate number of trained staff, and were operating out of congested localities.

It also revealed that most imaging centres did not follow the Atomic Energy Regulatory Board's guidelines on design and location parameters for setting up X-ray or ultrasound machines. The cost of tests such as MRI also varies from one centre to the other.

A recent Supreme Court Judgment has asked a pathological lab from residential area to shift on the following grounds:
A recent Supreme Court Judgment has asked a pathological lab from residential area to shift on the following grounds
Master Plan: MPD 2021: 15.5 PERMISSIBLE AND NON-PERMISSIBLE USES:

Any trade or activity involving any kind of obnoxious, hazardous, inflammable, non-compatible and polluting substance or process shall not be permitted (in residential areas).

Process: “A systematic series of mechanized or chemical operation that are performed in order to produce something." Lab comes under it “hazardous substance” under Section 2 (e) of the Environment (Protection) Act, 1986: “(e) "hazardous substance" means any substance or preparation which, by reason of its chemical or physico-chemical properties or handling, is liable to cause harm to human beings, other living creatures, plant, micro-organism, property or the environment;”

DPCC on pathological labs

DPCC on 4.8.2008: "...........chemical substances emitted from the Pathological Lab will be obnoxious, non-compatible, polluting" and therefore, the same are not permissible under Clause 15.5 of the MPD 2021.

Mixed Land Use Regulations of Government of India All parking arrangements will be made by you within the plot in question. AND the applicant will ensure that no nuisance or hardship is created for the local residents…

Clearance required for Noise Pollution

The Air (Prevention and Control of Pollution) Act, 1981 Noise was included in the definition of air pollutant in Air (Prevention and Control of Pollution) Act in 1987. Thus, the provisions of the Air Act, became applicable in respect of noise pollution, also. The Environment (Protection) Act, 1986. Although there is no specific provision to deal with noise pollution, the Act confers powers on Government of India to take measures to deal with various types of pollution including noise pollution.”

Noise Pollution (V) in RE5 at paras 11, 103 and 104 wherein it was held that noise generated up to unpleasant or obnoxious levels violates the rights of the people to a peaceful, comfortable and pollution-free life guaranteed by Article 21 of the Constitution of India.

Water act 25 clearance required

"....consent was not obtained by the respondent-owners from DPCC under Section 25 of the Water (Prevention and Control of Pollution) Act which states that no person shall without the previous consent of DPCC establish or take any steps to establish any industry, operation or process or any treatment and disposal system or any extension or addition thereto which is likely to discharge sewage or trade effluent into a stream or well or sewer or land. It is mandatory under the said provision to first obtain consent from DPCC and admittedly such consent has neither been obtained by the respondent-owners nor granted by the respondent No.5, DPCC, nor has the same been placed before the learned single Judge or the Division Bench or this Court."

Section 25(1) in The Water (Prevention and Control of Pollution) Act, 1974: (1) Subject to the provisions of this section, no person shall, without the previous consent of the State Board,— (a) establish or take any steps to establish any industry, operation or process, or any treatment and disposal system or any extension or addition thereto, which is likely to discharge sewage or trade effluent into a stream or well or sewer or on land (such discharge being hereafter in this section referred to as discharge of sewage); or (b) bring into use any new or altered outlet for the discharge of sewage; or (c) begin to make any new discharge of sewage: Provided that a person in the process of taking any steps to establish any industry, operation or process immediately before the commencement of the Water (Prevention and Control of Pollution) Amendment Act, 1988, for which no consent was necessary prior to such commencement, may continue to do so for a period of three months from such commencement or, if he has made an application for such consent, within the said period of three months, till the disposal of such application.

Beware of Generator and heavy equipments

"The running of the Pathological Lab for which the generator sets and other heavy equipments have been installed not only create sound pollution and air pollution but also the same is in contravention of the Water, Air and the Environment Protection Acts referred to supra."

On 18-5-1995, Justice R.C. Lahoti (as the former Chief Justice of India then was) in the case of ANZ Grindlays Bank v. Commr., MCD echoed similar words and referred to decision of this Court, observing that the word “environment” is of broad spectrum which brings within its ambit hygienic atmosphere and ecological balance. It is, therefore, not only the duty of the State but also the duty of every citizen to maintain hygienic environment. There is constitutional imperative on the State Government and the municipalities, not only to ensure and safeguard proper environment but also an imperative duty to take adequate measures to promote, protect and improve both the man-made and the natural environment. Dealing with the municipal laws providing for power of demolition, it was observed that while interpreting municipal legislation framed in public interest, a strict constitutional approach must be adopted. A perusal of the master plan shows that the public purpose behind it is based on historic facts guided by expert opinion.”

Public Peace

"The running the Pathological Lab by the respondent-owners air, sound pollution is created rampantly on account of which the public resident health and peaceful has been adversely affected. Therefore, public interest is affected and there is violation of rule of law."

Traffic Nuisance

"The provision for Mixed Use under the MPD 2001 clearly states that the area/street for Mixed Use activity should be identified by conducting a study of the impact on the traffic in that area/street in which such Mixed Use activity is likely to take place and also evaluate the environmental needs and impact on municipal services of the area if Mixed Use is allowed.

Conclusions

In the present case, no report or document of evaluation or study conducted by the MCD has been brought to the notice of the courts below or this Court to establish and prove that the concerned building is an appropriate premises to allow a non-residential or Mixed Use activity in residential premises. The Mixed Use Regulations under MPD 2001 further states that if after the above said evaluation and study it is found that the Mixed Use activity in the street/area is feasible, then such activity shall be allowed only on the ground floor of the premises to the extent of 25% of the area or 50sqm, whichever is less and that such establishment can be run by the resident of the dwelling unit only. In the present case, the Pathological Lab is being run on the basement, ground floor, first floor and the mezzanine floor and the respondent-owners of the Pathological Lab are not the residents of the concerned building, thus it is a clear violation of the provisions for Mixed Use of residential remises under the Master Plan 2001. The Master Plan 2001also provides that activities such as running of a nursing home should not be allowed, whereas in the Regularisation Certificate, it is clearly stated that permission is being granted for running of a nursing home. The relevant paras of the said plan are extracted hereunder:................"

"The running of this large Pathological Lab has lead to emission of hazardous substances and in that process human beings, plants, micro organisms, and other living creatures’ are being exposed to harmful physico-chemical properties. Not only this, they also create pollution which contaminates water on account of the discharge of chemical properties used in the process of running the Pathological Lab, causing nuisance and harm to public health and safety of the residents of the area. This fact is certified by the DPCC in its report dated 4.8.2008."

”The usage of such generator sets has led to the damage of the building and cracks have been found in the building structure. The explanation sought to be given by the respondent-owners is that the aforesaid generator sets were installed in the set-back area as the appellant has not permitted to install the same on the terrace of the building. The objection of the appellant installing the same in the terrace is that he has purchased the said area and the appellant is living on the second floor and therefore, if the generator sets are installed on the terrace, it would be completely impossible for him to live on the second floor of the premises due to the sound and air pollution caused by the generator sets. It would not only affect the appellant and his family but also the other neighbouring residents of the locality."
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Under the wagon

A farm boy accidentally overturned his wagonload of wheat on the road. The farmer that lived nearby came to investigate.
"Hey, Willis," he called out, "forget your troubles for a while and come and have dinner with us. Then I’ll help you overturn the wagon."
"That’s very nice of you," Willis answered, "but I don’t think Dad would like me to."
"Aw, come on, son!" the farmer insisted.
"Well, OK," the boy finally agreed, "but Dad won’t like it."
After a hearty dinner, Willis thanked the host. "I feel a lot better now, but I know Dad’s going to be real upset."
"Don’t be silly!" said the neighbor. "By the way, where is he?"
"Under the wagon," replied Willis.
On the occasion of the World Health Day, Heart Care Foundation of India & the Indian Medical Association roll out awareness programs on food safety
Announce a series of public health activities in association with the Delhi Medical Association, NDMC and Indian Oil

World Health Day is just around the corner and this year’s global awareness theme is ‘food safety’. In line with this, Heart Care Foundation of India & the Indian Medical Association today announced a serius of public health activities that they will be conducting on April 7, 2015 in association with the Delhi Medical Association, NDMC, Lions Clubs International District 321 A1 and Indian Oil.

Addressing the Press Conference, Padma Shri Awardee Dr A Marthanda Pillai, National President, Indian Medical Association said, “This year we are focusing on awareness about food induced anaphylaxis which means a serious allergic reaction following the ingestion of a food that is generally rapid in onset and might at times progress to death. There has been a rising incidence of patients getting admitted to hospitals due to this condition and it is essential that awareness is raised among the public. We are extremely thankful to our partnerts - Heart Care Foundation of India, NDMC, DMA and Indian Oil for joining us in this initiative.”

Food allergy affects 8% of children less than five years of age and up to 4 percent of the general population. Any food can cause anaphylaxis in a susceptible individual with some of the high risk foods being peanuts, tree nuts, sea food, shellfish, fish and sesame. The risk factors for food-induced anaphylaxis include concomitant asthma, allergies to certain high-risk foods, extreme sensitivity, and a history of previous food-induced anaphylaxis of any severity. Deaths most often occur in individuals who have had only mild previous reactions. The onset of symptoms can be accelerated by several influencers such as the consumption of alcohol, quantity of food consumed. Early administration of epinephrine can help save lives.

Adding to this, Padma Shri Awardee Dr K K Aggarwal, President of Heart Care Foundation of India and the Honorary Secretary General of Indian Medical Association said, “Food allergy is evolving to be a very common problem affecting people of all age groups. Thus, on this World Health Day, we at Heart Care Foundation of India & Indian Medical Association have planned to organize a series of public health activities including hands only CPR training, seminar on food safety, a health parade amongst others to help raise awareness amongst the people. My message to the public is simple, if you suspect a food has caused a reaction, avoid that food, talk with your doctor and have it investigated. If you know you have a food allergy, then always avoid that specific food trigger. Always have your emergency medication close by as accidents do happen.”

A health education program at Rahagiri Connaught place on 5th April will precedd the WHO day celebrations.

A variant of food-induced anaphylaxis is food-dependent exercise-induced anaphylaxis (FDEIAn), which refers to an IgE-mediated food-induced anaphylactic reaction that develops only when exercise is undertaken within a few hours of ingesting a food. Most FDEIAn only develops if a certain food, such as wheat, seafood, or nuts, is eaten in association with exercise/exertion.

Infants with food protein-induced enterocolitis, a form of non IgE-mediated food allergy, often presents with chronic illness, characterized by diarrhea, vomiting, and failure to thrive. These symptoms improve once the culprit food is identified and removed from the diet.

Dr Ajay Lekhi, President, Delhi Medical Association said, “The most common form of food-induced anaphylaxis is caused by the ingestion of a food to which the patient has immunoglobulin E (IgE)-mediated allergy. Symptoms typically appear within a few seconds to two hours after food ingestion and arise from massive mediator release from mast cells and basophils. IgE-mediated food-induced anaphylaxis accounts for the vast majority of reactions in older children and adults. Thus, it is very important for people to get themselves checked for any allergies that they might be susceptible to.”

Commenting on the association Dr PK Sharma, MHO, NDMC said, “We are glad to be associated with Heart Care Foundation of India in this awareness raising program which will help save lives of many. It is our duty to educate masses about various aspects of food allergy and ways in which they can be prevented.”

Other dignitaries who were present at the occasion were Padma Shri Awardee Dr Rajesh Kumar Grover and Dr R N Tandon.