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January 5 2016, Tuesday

 
 
     
 
   
   

EDITORIAL

IMA not in favour of NHRC’s decision to publicly hear medical negligence cases

As per media reports the National Human Rights Commission (NHRC) will be publically hearing and addressing medical negligence cases against both the government and private hospitals during a two-day grievance redressal forum being held at the Tata Institute of Social Sciences campus in Mumbai from January 6-7, 2016.

The Indian Medical Association feels that creating an additional forum for patients to complain without any clear-cut rules or guidelines in place will only add to the ongoing cases of violence against doctors in the society.

NHRC is scheduled to hear around 125 complaints filed against erring hospitals from four states - Maharashtra, Gujarat, Goa and Rajasthan. This includes as many as 55 cases of medical negligence from Maharashtra, 30 each from Gujarat and Rajasthan, and 10 from Goa.

At present, patients who have grievances against private hospitals go either to the medical council or the consumer court or the police.

IMA feels that the right way is to go about doing this is to file complaints with the State Medical Council. It is the duty of the State Medical Council to then decide the case on basis of its merit and refer it to the consumer court for compensation if any deficiency of service is found; refer it to criminal court if they find any violation of Indian Penal Code or refer it to NHRC if they find any violation of human rights. If none of the above is found then the case should be closed on priority to avoid any unnecessary harassment of the doctor.

It is not correct to subject a medical doctor to investigation and harassment simultaneously by the police, consumer court, NHRC court and the ethics committee of medical council.
IMA has written to the Prime Minister of India to amend the MCI act and give more powers to the medical council.

 
 

BREAKING NEWS

 

DCGI directs all state drug controllers to act against online sale of drugs
The Drug Controller General of India (DCGI) has directed all the state/UT drugs controllers to strictly check online sale of drugs and take action against those who do so in violation of the Drugs and Cosmetics Act and Rules. According to Dr S Eswara Reddy, Joint Drugs Controller of India, serious concerns have been raised on issues impacting public health such as gross violation of the provisions under Drugs and Cosmetic Act and Rules, endangering human lives, rendering pharmacovigilance machinery ineffective, rendering drugs recall impossible, compromise of storage conditions, danger of online sale of controlled substances, encouragement of drug addiction among youth, etc... (Pharmabiz - Ramesh Shankar)

Woman delivers baby after ovarian tissue transplant
Isabelle Demeestere, of the Université Libre de Bruxelles in Belgium, and colleagues have reported the first-ever case report of a 27-year-old woman whose ovarian tissue was cryogenically preserved when she was 14 years of age, had a successful ovarian graft and finally, more than 2 years later, a spontaneous pregnancy and the birth of a healthy baby in the journal Human Reproduction… (Medpage Today)

 

 
IMA JIMA 

http://module.ima-india.org/ima/jima/2015/September/
 

SPECIALTY UPDATES 

  • Any disturbances to microbiota in early life could impact the risk of later-life disease, suggests a new review published in the journal Birth Defects Research Part C: Embryo Today.
  • Foods portrayed as healthy may lead to overeating and contribute to weight gain, suggests new research published in the Journal of the Association for Consumer Research. Researchers stated that if we perceive a certain food to be healthy, we are likely to consume more of it.
  • More than 90% of patients taking warfarin would not benefit, and could be harmed, from bridging anticoagulation, and should not receive heparin or other short-acting blood thinners during treatment interruptions before surgery, suggests new research published online in the journal Circulation: Cardiovascular Quality and Outcomes.
  • A new study, published in the Proceedings of the National Academy of Sciences, finds links between sleeping patterns, circadian rhythms, bipolar disorder and specific phenotypes.
  • A new study, published in the Journal of Parasitology, found pentadecane treatment to be effective against intracellular Leishmania amastigotes, with a growth inhibition of 77% after 48 hours of treatment at the 300 µM level. It was also noted to decrease the viability of Leishmania promastigotes and amastigotes up to 14% at 300 µM.
  • A new study shows that a novel whole-body PET/CT imaging-based method for defining appropriateness of breast cancer treatment is as accurate as the current standard-of-care and could reduce the need for invasive tissue sampling. The results, published in the journal Theranostics, suggest that the method might lead to more optimal treatment of individual patients.
  • For severe cases of neuropsychiatric systemic lupus erythematosus (SLE), the antiproliferative agent cyclophosphamide will likely remain a cornerstone of treatment, suggests new research published online in Lupus.
  • A new study, published in the journal PLos One, suggests that people who are less bothered by their tinnitus use different brain regions when processing emotional information. These patients were found to use more of the brain's frontal lobe, a region critical for attention, planning and impulse control, rather than the amygdala, commonly believed to play an important role in emotion processing.
  • A new review suggests that many of the triggers of migraine converge on a common pathway involving oxidative stress. The findings, published in Headache: The Journal of Head and Face Pain, further suggest that antioxidants might help prevent or preempt migraines.
  • Adding continuous progestin to estrogen may lower the risk of endometrial cancer in postmenopausal women, suggested a study published in the JNCI: Journal of the National Cancer Institute.
 

eSPIRITUAL

Following are the five types of people:

  • Nastik: Those who do not believe in God.
  • Astik: For whom God exists.
  • Those for believe that God also exists in them (I and the God are the same)
  • Tat Tvam Asi (God not only exists in me but also in you)
  • God is in everybody

People who believe that God exists are fearful people and they always fear God. People who see God in themselves, live a disciplined Satvik life and do not indulge in activities that are not God-friendly. People who believe that God is not only in them but also in you, treat every person the same way as they treat themselves. People for whom God is everywhere always work for the welfare of the society.

 

LEGAL QUOTE

Indian Medical Association vs VP Shantha & Ors on 13 November, 1995, 1996 AIR 550, 1995 SCC (6) 651 

“The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law require.”

 

 

THE YEAR IN MEDICINE 2015: NEWS THAT MADE A DIFFERENCE   

Obama administration fights antibiotic resistance
The White House released the first national plan to fight antibiotic resistance in March last year. The 2016 budget also doubled federal funding for antibiotic-resistance efforts to more than $1.2 billion. The National Action Plan for Combating Antibiotic-Resistant Bacteria coordinates federal agencies and sets goals for reducing antibiotic-resistant disease and inappropriate antibiotic use. The new action plan is organized around five main goals: preventing the spread of antibiotic resistance, strengthening surveillance efforts, advancing diagnostic testing, accelerating the development of new antibiotics, and improving global collaboration… (Medscape)

 

1. IMA Rare Blood Group Online Blood Bank Directory: ima-india.org/Rare
2. IMA Online TB Notification initiative: ima-india.org/tbnotify
3. IMA Online Events Reporting initiative: http://www.ima-india.org/ima/left-side-bar.php?scid=228
4. Proforma for Hypertension Screening: http://module.ima-india.org/
5. IMA Online Sentinel Events Reporting Initiative: ima-india.org/sentinel
6. IMA Disease Notification: http://disnotif.ima-india.org/
7. IMA RISE and SHINE: http://imariseandshine.com/
12. IMA Slide Share: http://www.ima-india.org/ima/free-way-page.php?scid=287
13. I Pledge My Organ: http://module.ima-india.org/ipmo/
14. IMA Weekly Live: http://www.ima-india.org/imalive/
17. IMA ART: http://ima-india.org/artbill
18. IMA Satyagraha: http://ima-india.org/satyagraha
19. IMA Daily Webcast: http://ima-india.org/ima/
20. CC Slides: http://www.ima-india.org/ima/left-side-bar.php?scid=417
21. NATCON Photos: IMA Natcon 2015 - Day 2 - Camera 1, IMA Natcon 2015 - Day 2 - Camera 2, 

 

IMA SATYAGRAHA

https://www.youtube.com/watch?v=UV1zCH33BlU

IMA POLL

http://www.ima-india.org/ima/ima-poll.php

 

1 in four of those tested have poor ‘lung health’
Lung-function tests being conducted by Maulana Azad Medical College (MAMC) during the odd-even run find that one of every four persons who took the tests in the past two days was found to have a 'compromised' lung function. Project head Dr Suneela Garg said most people who were tested had either obstructive or restrictive lung function, but they didn't perceive it as a disease. "Hopefully, after these tests, they will attend to the medical needs arising out of the situation. We are referring some patients to pulmonologists also. These tests will go on till January 15," she said… (ET Healthworld)

 

Random use makes even paracetamol unsafe
Even the safest of drugs can have side-effects on indiscriminate usage, Indian Medical Association (IMA) has warned. It cited example of paracetamol, a commonly self-prescribed painkiller and which has been linked to liver damage, heart attack and stroke in recent researches. Paracetamol is a schedule K drug, which means that the retailer does not need a license to sell it and people can buy it without prescription. Dr K K Aggarwal, secretary general of IMA, said many people take it only to reduce hangover after binge drinking. "Such careless and indiscriminate usage must be stopped. Alcohol and paracetamol if taken together in large quantity can prove lethal," he added. According to Dr Anoop Misra, leading endocrinologist and chairman, Fortis C-doc, an adult can take three to six tablets of paracetamol in a day. "However, dosage may vary for those with liver disease, or alcoholics. Also, in children, the safe limit is lower as compared to adults," he said… (ET Healthworld)

 

US complacent on infectious disease threats
The United States has to do more to boost its ability to prevent and control infectious disease outbreaks, according to the third annual report from Trust for America's Health and the Robert Wood Johnson Foundation. The Report on the infectious disease preparedness of the US states that more than half of states (28) received a score of five or fewer of 10 key indicators related to preventing, detecting, diagnosing, and responding to outbreaks. Seven states (Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon, and Utah) tied for the lowest score, at three of 10, whereas Delaware, Kentucky, Maine, New York, and Virginia tied for the top spot, achieving a score of eight of 10… (Medscape)

 

Safe Driving Limit
Two pegs in the 1st hour and one per every one hour after that will gave a blood alcohol concentration of 0.05 (g/100ml)

The blood-alcohol maximum-per-drink number

If you divide the number 3.8 by your body weight in pounds, you should obtain a number between 0.015 and 0.40. This is your personal "blood-alcohol maximum-per-drink" number. This is the maximum percentage alcohol that will be added to your blood with each "drink" you take. For the purposes of this calculation, a "drink" is a 12-ounce, 4% alcohol, bottle of beer, or a 4-ounce glass (a small wine glass) of 12% alcohol wine, or a one-ounce shot glass of 100 proof liquor (most bars’ mixed drinks have this amount of alcohol). (Microbrewery beer, malt liquor, pint bottles of beer, large (6 oz.) wine glasses, 20% alcohol ("fortified") wines, and very stiff or large mixed drinks should be counted as "1½" drinks.)

 

Is the iconic stethoscope dead?
A leading Indian-origin cardiologist declaring “the stethoscope is dead” giving rise to a debate on the role of the stethoscope, the quintessential trademark of the medical profession for over 200 years. The widespread use of echocardiograms and the development of pocket-size ultrasound devices are raising questions about why doctors and others continue to sling earphones and rubber tubing around their necks. Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital in New York said, “The stethoscope is dead.” Starting in 2012, Mount Sinai began giving its students hand-held ultrasound devices that are little bigger than a cellphone but can generate real-time images of the heart right at the bedside. Several other schools will join the experiment in the coming months, the report said … (Hindustan Times)

 

Despite being known as the medical hub of Central India, Nagpur has an infant mortality rate (IMR) double the centre and state government's standard norm in 2015. Total 1,772 infants (newborn to one year) died last year, of which 1,213 could not survive even for a week. Besides, 1,603 stillbirths were also recorded, which figure too is high. About 56,827 births were registered in 2015. IMR is calculated as infant deaths per 1,000 live births. Thus, city's IMR is 31.18 in 2015. The nation's standard norm of IMR is said to be 14… (ET Healthworld)

 
 
Media
eMediPics

IMA NATCON - 2015

 

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

 

BIOETHICAL ISSUES IN MEDICAL PRACTICE

Parent’s dilemma in choosing sex of their intersex child

Smita N Deshpande 
Head, Dept. of Psychiatry, De–addiction Services 
PGIMER-Dr. Ram Manohar Lohia Hospital 
Park Street, New Delhi 

A and S have one child. The second, born three months ago, had indeterminate sexual genitalia. He doctor opines that the child will need one operation so that sex is clear. The operation can be done in the future once the child grows up and decides which sex s/he wants to belong to. They are worried because they feel that growing up with a confusing sexual identity will not be good for the child. Moreover the other sibling may face stigma. Finally the child does not even need to know about the operation. As their doctor what should you advise?

  1. What would you do, as a parent?
  2. Is such a surgery necessary at all? Can the child not go through life with indeterminate sex if s/he wants?
  3. What other social issues would such a child face?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):  http://www.eubios.info/

 

eWELLNESS 

Elderly should Beware of Commonly Prescribed Group of Drugs
Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities. Two reports from Wake Forest University School of Medicine support findings that anticholinergic drugs used to treat acid reflux, Parkinson's disease and urinary incontinence may cause older people to lose their thinking skills more quickly than those who do not take the medicines.
Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells. Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities. For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older. Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine. Cholinesterase inhibitors, drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10% of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs.

 
 

IMA Live Webcast 

Click here

 

INSPIRATIONAL STORY

Happiness is a Voyage

We convince ourselves that life will be better once we are married, have a baby, then another. Then we get frustrated because our children are not old enough and that all will be well when they are older. Then we are frustrated because they reach adolescence and we must deal with them. Surely we’ll be happier when they grow out of the teen years. We tell ourselves our life will be better when our spouse gets his/her act together, when we have a nicer car, when we can take a vacation, when we finally retire. The truth is that there is no better time to be happy than right now. If not, then when? Your life will always be full of challenges. It is better to admit as much and to decide to be happy in spite of it all. For the longest time, it seemed that life was about to start. Real life…

But there was always some obstacle along the way, an ordeal to get through, some work to be finished, some time to be given, a bill to be paid... Then life would start. I finally came to understand that those obstacles were life. That point of view helped me see that there isn’t any road to happiness. Happiness is the road. So, enjoy every moment. Stop waiting for school to end, for a return to school, to lose ten pounds, to gain ten pounds, for work to begin, to get married, for Friday evening, for Sunday morning, waiting for a new car, for your mortgage to be paid off, for spring, for summer, for fall, for winter, for the first or the fifteenth of the month, for your song to be played on the radio, to die, to be reborn… before deciding to be happy.

Happiness is a voyage, not a destination. There is no better time to be happy than… NOW! Live and enjoy the moment

 

eMEDI QUIZ

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.

Yesterday’s Mind Teaser: Which one of the following is a recognized x-ray feature of rheumatoid arthritis?
1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Answer for Yesterday’s Mind Teaser:. 3. Bone erosions.
Answers received from: Dr Jainendra Upadhyay, Dr.K.V.Sarma, Dr Avtar Krishan
Answer for 3rd January Mind Teaser: 2. Interstitial lung diseas
Answers received from: Dr Jainendra Upadhyay, Dr.K.Raju, Dr Avtar Krishan

 

READER'S COLUMN
Dear Dr Marthanda Pillai, HSG Dr K K Agarwal, NP Dr S S Agarwal, exceptionally marvelous execution of the functioning of IMA. All the members are truly indebted for your focused vision in marching the IMA to unprecedented heights, really you made a difference sir. Congratulations is a small word, what a year of achievements IMA has sailed through. Your commitment and communication skills, 15 success points made IMA visible in all aspects. Understanding the way you dealt with multiple issues, Team IMA is proud to have such people to lead IMA. Young PGs should be mandatorily taught ethics in the last three months of their education. We look forward for greater achievements in the coming year ahead. Three cheers to NATCON 2015 for the wonderful hospitality, arrangements. Happy New Year to Team IMA. Dr E Prabhavathi, Dean CGP 2015

 

HUMOR

Masterpiece
One day a girl came home crying to her mom. The mom asked what was wrong.
The girl responded, "I’m not a creation, God made men first! I’m nothing!"
Then the mom said, "Oh baby that’s not true, God may have made men first, but there’s always a rough draft before the masterpiece."

 

PRESS RELEASE

Atrial Fibrillation is the new epidemic of the society

Atrial fibrillation, the most common heart rhythm disorder is said to be the new epidemic of the society. According to research, the number of Atrial Fibrillation patients is increasing in India. In fact in 2013 alone over 1.27 crore Indians suffered from Atrial Fibrillation, an increase by 40 lakhs from 2012 and 60 lakhs from 2011.

Atrial Fibrillation, which is the number one cause of paralysis in the elderly, is classified as new onset, paroxysman, persistent, long standing persistent or permanent. Its two most common causes in the elderly in India are uncontrolled high blood pressure and unmanaged heart blockages and in children is rheumatic heart disease. In India, the increasing incidence of potbelly obesity and chronic heavy alcohol use is directly linked to the increase in incidence of Atrial Fibrillation.

Speaking on the topic, Dr. S.S Agarwal – National President IMA and Padma Shri Awardee, Dr. KK Aggarwal – President HCFI and Honorary Secretary General IMA said, “Medically, all patients with Atrial Fibrillation need sequential echocardiography and permanent blood thinners unless contraindicated. In the absence of a reversal cause Atrial Fibrillation is always recurrent. If not treated Atrial Fibrillation can lead to paralysis, an increased heart rate linked low pumping action and distressing symptoms”.

Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance and a major cause of stroke and death. Over recent decades, the incidence of AF has increased dramatically, positioning AF as one of the epidemics of the new millennium globally. To tackle this growing problem, it is extremely important that the medical fraternity works towards:

Controlling rick factors so that Atrial Fibrillation does not occur

Make provisions for cost effective blood thinners to prevent stroke
Conducts training and increases availability of more ablation centers and physicians in the country
Cardiologists, neurologists and physicians need to work together to control Atrial Fibrillation

To prevent atrial fibrillation, it's important to live a heart-healthy lifestyle to reduce your risk of heart disease. A healthy lifestyle may include:

Eating a heart-healthy diet
Increasing your physical activity
Avoiding smoking
Maintaining a healthy weight
Limiting or avoiding caffeine and alcohol
Reducing stress, as intense stress and anger can cause heart rhythm problems
Using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat

 
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