October 6   2015, Tuesday
Dr KK AggarwalDr KK Aggarwal
Govt. proposes a new Bill to regulate health-related services

The government has proposed a new bill concerning delivery of health related services in the country, including allied services covering therapeutic, diagnostic, curative, preventive and rehabilitative. This new bill is called The Allied and Healthcare Professional’s Central Council Bill, 2015

The objective of this bill is to regulate the professional conduct of allied and healthcare professionals, prepare and maintain a national live register, prescribe minimum standards of education, provide for a scheme of reciprocity for the purpose of recognition of foreign qualifications, ensure compliance of various statutory provisions under this Act and also provides for a uniform entry exam for admission to allied and healthcare educational institutions for undergraduate, postgraduate and doctoral courses.

All these functions would be carried out by a Central Council to be constituted as provided under this Bill, which would be headed by the Secretary to the Dept. of Health & Family Welfare. Regulatory bodies like the Medical Council of India (MCI), Indian Nursing Council (INC), Pharmacy Council of India (PCI), Atomic Energy Regulatory Board (AERB), Rehabilitation Council of India (RCI), National Board of Examination (NBE), National Institute of Open Schooling (NIOS)/ Indira Gandhi National Open University (IGNOU), University Grant’s Commission (UGC) will be represented in the central council, among other members as designated in the Bill.

An executive committee to be constituted from the members of the Central Council has been proposed to generally supervise the working of the council.

However, this Bill also gives powers to the central government to supersede the central council and has described the situations under which it can do so.

Similar to the Central Council, all state governments are required to set up state councils. And, any existing paramedical council e.g. Delhi Council for Physiotherapy & Occupational therapy would be subsumed under this Bill and renamed/restructured as “State Allied & Health Care Professionals Council”.

To maintain the minimum standards of education, courses etc. this new Bill has provision for permission to establish new allied and healthcare college, any new course of study etc. as well as recognition or de-recognition of existing allied and health care institutions.

A very important provision of this Bill is a central repository of live register. “The State Councils shall maintain a live register and enter names in it of allied and healthcare professionals in the manner determined by the Rules by the Central Government in this regards. No person shall be entitled to practice under this Act unless his name is entered in the State register of the appropriate regulator in the State where the professional is providing the services.”

The Bill has also laid down penalties for violation of the provision of this Act in the form of imprisonment (up to 1 year) or fine (up to Rs 5 lakh rupees). If a person who is not registered and is practicing as an allied and health care professional is liable for imprisonment (up to 6 month) or fine (up to 1 lakh) or both.

The Act gives powers to the Central Government as follows:
  • “The Central Government may, from time to time, issue such directions to the Central Council as in the opinion of said Government are conducive for the fulfilment of the objects of this Act and in the discharge of its functions, that Central Council shall be bound to carry out any such directions.”
  • The Central Government may, by notification, make Rules to carry out the provisions of this Act.
  • The Central Council may, subject to the control of the Central Government by notification in the gazette, make Rules for carrying out the purposes of this Act.
  • The Central Government, after consultation with the Council and after giving, by notification in the Official Gazette, not less than three months’ notice of its intention so to do, may, by a like notification, add to or otherwise amend the Schedule for the purposes of this Act and thereupon the said Schedule shall be deemed to be amended accordingly.”
Note: IMA views will be published in due course.
Breaking news
Transient transfer of food allergies via platelet transfusion

A recent case report highlights the possibility of acquiring food allergies following transfusion of a blood product such as platelets. The allergy is transient and is due to food-specific immunoglobulin E (IgE) in the blood product. An allergic reaction to a food can occur in an allergic recipient after receiving a blood product that contains intact allergen consumed by the donor. (Ching JC, et al. Peanut and fish allergy due to platelet transfusion in a child. CMAJ. 2015 Sep;187(12):905-7)
Dr Good Dr Bad
Situation: A patient with hypertension had non–responding cough.

Dr. Bad: Take an X–ray.

Dr. Good: Stop ACE inhibitors.

Lesson: The commonest cause of cough in a patient with high blood pressure is the intake of ACE inhibitors.

(Copyright IJCP)
Is your Thesis World Class?

IHJ Announces the Best Thesis Award in Cardiology

Indian Heart Journal is proud to announce its newest initiatives, the "Cardiology Best Thesis" Award for the best doctoral dissertation in Cardiological Sciences.

The inaugural event will be held in 2016. The whole process of the award will involve screening of thesis received from all over the country followed by rigorous examination of the selected candidates (on their thesis) followed by a finals (involving 10 students). Top three contenders will receive a certificate recognizing their merit, chance to publish in the national journal, Indian Heart Journal and also an unbelievable surprise award.

Prof Sundeep Mishra, Hony. Editor, Indian Heart Journal
Specialty Updates
  • A new study, published in the International Journal of Behavioral Nutrition and Physical Activity, suggests that by replacing 1 hour of sitting each day with walking, we can decrease our chance of early death by 12-14%.
  • Long-term use of inhaled corticosteroids to treat asthma could lead to a reduced rate of growth in development for infants given the medication during their first 2 years of life, suggests new research presented at the 54th Annual European Society for Paediatric Endocrinology Meeting.
  • In a unique initiative to identify risk factors associated with poor heart health among Indian women, the Saffolalife Study 2015 has revealed that more than 60% of urban India females in the 30 - 45 age group are at risk of being affected by cardiovascular diseases (CVDs). The study revealed that 89% of women at risk of CVDs in Mumbai fall in the overweight/obese category.
  • Cigarette smoking is a risk factor for developing multiple sclerosis (MS) among first-degree relatives of confirmed MS patients, suggested an ongoing study presented at the American Neurological Association's annual meeting.
  • Inflammatory features present at baseline among patients with hand osteoarthritis (OA) were associated with the subsequent development of joint erosions, reported a new study published online in Arthritis & Rheumatology.
  • Losing weight improved ovulation rates in overweight and obese women with infertility due to polycystic ovary syndrome (PCOS), reported a clinical trial published in the Journal of Clinical Endocrinology & Metabolism.
  • New research has identified molecular marker for killer cells and suggests that by studying these immune cells from patients' blood, one can predict the course of infections. The findings are published in the journal Nature Communications.
  • Laser speckle flowgraphy may offer a noninvasive method of assessing ocular blood flow in patients with central retinal vein occlusion (CRVO), suggested a prospective study published in the October issue of Retina.
  • New research, published in PLOS One, suggested a link between the chemical serotonin that helps transmit signals in the brain and genetic mutations present in a subset of individuals with autism spectrum disorder.
  • An opinion paper from a multinational coalition on obstetrics and gynecology states that because exposure to toxic chemicals can have detrimental effects on maternal and child health, clinicians need to be more aware of environmental hazards that their patients may face. The joint statement is published in the International Journal of Gynecology and Obstetrics.
Significance of Lighting a Lamp in Any Worship
Deepajyothi parabrahma
Deepa Jyotir Janaardanah
Deepo harati paapaani
Sandhyaa deepa namostute

I prostrate to the dawn/dusk lamp; whose light is the Knowledge Principle (the Supreme Lord), which removes the darkness of ignorance and by which all can be achieved in life.

Light symbolizes knowledge, and darkness, ignorance. Knowledge removes ignorance just as light removes darkness. The purpose of any ritual is to remove internal darkness and attain some knowledge.

Vedic literature recommends lighting a lamp daily as a part of puja ritual. Some do it once at dawn, others twice a day – at dawn and dusk ; while some let the lamp light continuously (akhanda deepa). No auspicious functions can commence without lighting of the lamp and the same is to be maintained right through the occasion.

Knowledge is a lasting inner wealth by which all outer achievement can be accomplished. By lighting the lamp we bow down to knowledge as the greatest of all forms of wealth. Knowledge about the self is the greatest wealth. It goes around achieving inner happiness by burning the negativity of mind full of lust and ego.

The traditional oil lamp defines this spiritual significance. The oil or ghee symbolizes our vasanas (lust) and negative tendencies (the wick & the ego). When lit by spiritual knowledge, the vasanas get slowly exhausted and the ego too finally perishes. The flame of a lamp always burns upwards signifying that only that knowledge should be acquired that takes us towards higher ideals.
Legal Quote
Martin F. D’Souza Vs. Mohd. Ishfaq, AIR 2009 SC 2049

“Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightway liable for medical negligence by applying the doctrine of res ipsa loquitur. No sensible professional would intentionally commit an act or omission which would result in harm or injury to the patient since the professional reputation of the professional would be at stake. A single failure may cost him dear in his lapse.”
TB Fact
Inhalation of Mycobacterium tuberculosis and deposition in the lungs leads to one of four possible outcomes:
  • Immediate clearance of the organism
  • Primary disease (rapid progression to active disease)
  • Latent infection (with or without subsequent reactivation disease)
  • Reactivation disease (onset of active disease many years following a period of latent infection)
Controlling your Cash Flow
Periodic fixed expenses

Most people lose control over cash flow because they have no system to handle periodic known expenses of a substantial nature. Good examples of this type of expense might be a large real estate tax bill due every March, an income tax payment due by 15th September or a life insurance premium due in December. What people frequently do is remember the bill a month before it is due and start scrimping, but it is too late! So, what happens then? In the ensuing months, they start running behind on bills or they simply do not make the planned payment at all. Interest charges are then added, and their attitude starts to decline. The solution is to schedule these larger payments and start saving for them on a monthly basis. For example, for a small additional amount, an automatic bank deduction can be made regularly to cover these expenses as and when they are due.

(Source: IJCP)
Industry News
There has to be just one boss in any start up, says Narayana Murthy

In a telephonic interview, NR Narayana Murthy said that there is a trend that startups these days start with many cofounders. There has to be one boss in every company and not two bosses in a company. Infosys started up in 1981 with seven cofounders, NR Narayana Murthy, K Dinesh, Nandan Nilekani, Ashok Arora, SD Shibulal, Kris Gopalakrishnan and NS Raghavan. (The Economic Times- Indulekha Aravind)

Technical education should cover start-ups

Speaking at a workshop on “Mission Make In India- synergy with technical education system”, the Vice Chancellor of Thiruvanthapuram-based Abdul Kalam Technological University, K.P. Issac said that engineering course students should undergo hybrid learning where education is not just restricted to four walls of the classroom but also towards start-up units. Also, there is need for a paradigm shift in the teaching process in technical education to prepare the young graduates for the needs of the present Industrial age. The workshop was organised by National Institute of Technology, Karnataka at Surathkal on Saturday. (The Hindu)

STPI to sponsor over 100 start-ups for CeBIT show

New Delhi: To promote domestic start-up companies, state-run Software Technology Parks of India (STPI) will sponsor over 100 such new age IT firms during the three-day CeBit India exhibition, which is scheduled to begin from October 29 in Bengaluru. "We are collaborating with CeBit to promote start-ups. Omkar Rai, the STPI Director General said that last year they had sponsored 127 start-up companies and are hopeful to have the same number this year too. (The Economic Times- PTI)

Terms you must know for a Startup Conversation

As an initiative to spread awareness among startups and increase startup education in the country, Thetechportal.in will bring out a series of articles to explain few terms that every person in the startup world should know! (Thetechportal.in - Pawas Jain)
Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
Inspirational Story
The Law of the Garbage Truck

One day I hopped in a taxi and we took off for the airport. We were driving in the right lane when suddenly a car jumped out of a parking space right in front of us. My taxi driver slammed on his brakes, skidded, and missed the other car by just inches! The driver of the other car whipped his head around and started yelling at us. My taxi driver just smiled and waved at the guy. And I mean he was really friendly. So I asked, 'Why did you just do that? This guy almost ruined your car and sent us to the hospital!'

This is when my taxi driver taught me what I now call 'The Law of the Garbage Truck.'

He explained that many people are like garbage trucks. They run around full of garbage, full of frustration, full of anger, and full of disappointment. As their garbage piles up, they need a place to dump it and sometimes they'll dump it on you. Don't take it personally. Just smile, wave, wish them well, and move on. Don't take their garbage and spread it to other people at work, at home, or on the streets.

The bottom line is that successful people do not let garbage trucks take over their day. Life's too short to wake up in the morning with regrets, so..... 'Love the people who treat you right. Forgive the ones who don't.'

Life is ten percent what you make it and ninety percent how you take it.
A woman customer called the Canon help desk with a problem with her printer.

Tech support: Are you running it under windows?

Customer: "No, my desk is next to the door, but that is a good point. The man sitting in the cubicle next to me is under a window, and his printer is working fine."
Achieving Privacy and confidentiality in day to day practice- an ethical dilemma

Pragya Sharma
Lecturer, Dept. of Clinical Psychology
Smita N Deshpande
Head, Dept. of Psychiatry,
De-addiction Services
PGIMER- Dr. Ram Manohar Lohia
Hospital, New Delhi

Doctors in busy settings face an ethical dilemma. Maintenance of confidentiality and privacy becomes problematic due to the use of shared rooms. At times, the patient hesitates to share medical information due to this fact. More funds and better infrastructure may not always be possible. What is your preferred solution in such circumstances?

a) Ignore the issue as sharing information is culturally acceptable in India

b) Acknowledge overcrowding, try to make the patient comfortable within the shared setting

c) Extend work hours, push back appointments to ensure one patient per room at a time

d) Whisper/ talk in low voices

Do write in with your views and solutions.

Here are the responses received
  • I will go for a) Ignore the issue, as sharing information is culturally acceptable in India unless someone specifically asks for not sharing a small part of information. Saranya Devanathan, Psychiatrist
  • I think we cannot see 2 or 3 patients in one room. The patient’s right of privacy cannot be compromised for any reason. Each patient should be interviewed in a single room, and the patient and the family members should also be seen separately at least once and as and when needed. Infrastructural issues cannot be the excuse for inefficient treatment. Prof. Anil Agarwal, Psychiatrist
  • Lack of infrastructure is not an excuse for not observing privacy and confidentiality Patients should be seen alone as well as with family members. Prof. Satish Malik
  • Explain that the other person too is a doctor like me and assure that she would maintain confidentiality. Sudhakar Bhat, Psychiatrist
  • It is very difficult to provide a separate place and extending work hours may not be possible for doctors. They can talk in low voices and make the patient as comfortable as possible. If the issue really demands confidentiality like HIV or any other which patient is not at all confident to discuss in overcrowded situations, then extra time can be given after the crowding hours. Respecting the privacy of the patient is very important. Triptish Bhatia, Principal Investigator, GRIP-NIH, USA Project, Dept. of Psychiatry, Dr Ram Manohar Lohia Hospital, New Delhi
  • Firstly, we can have cabins or space with glass partitions, which prevent the sound from reaching other places. Secondly, if we are to be economical then probably the patients, of course depending upon their problem and certainly alongside giving him assurance and confidence about confidentiality, can be asked to record their voices in their phones and then ear phones can be used as a medium to listen to the voice recorded by the patient. These ear phones shall be inserted/worn by both - the patient as well as the client so that they are on the same track of conversation. But, this can be done only at the time of case history taking. If the client is educated, he can write and the doctor can ask and clarify. Enquiry questionnaires could be used. Structuring the room accordingly can help. I don't know how much do we support online counselling and case history taking. However, people (doctors and patients) who are ready for the online case history-taking, shall be taken separately by doctors at say a particular day and they must be given facility and services of the same with helpers available around in a particular room Or can be done in a booth placed to be able to communicate with the doctors in any given area within the compound. Parul
  • Lack of rooms is a fact in mental health care. But mental health service cannot and should not be stopped due to this fact only. Privacy is definitely an important issue but when infrastructure is not adequate then also treatment means a lot. When any country does not have adequate infrastructure then decision should be taken according to what is available in nearby surrounding. So treatment comes first as per hierarchy of decision criteria. So the clinician should explore the possibility of privacy if possible. S/he may evaluate himself/herself, the nature of information forthcoming during the interview and take decision accordingly whether to ensure privacy or not. However privacy of any nature should be given due respect. But this suggestion is for setting where rooms are not available in adequate number. So the clinician may also ask the patient and family about their comfort level. However it has been observed that people do not care that much in a hospital outpatient department as they have their mind made up for such crowded places. And again people feel a kind of security being stranger in the crowd. If there are not too many patients then privacy must be secured for the patient. But during a rush this issue should be dealt by considering the nature of the problem and the sensitivity of the patient and the family. Ranjita Thakur
  • Having interned at Sion Hospital in Dept of psychiatry department, this dilemma was an everyday problem. However, practitioner skills made huge difference. Doctors who were able to successfully get history and provide details at the same time respecting confidentiality showed the following:
    • Apologize to the patient for the overcrowding but saying at the same time that all these people require a doctor so we have to work with this.
    • Telling that other professionals in this room are competent and caring doctors and will not make fun of (most men who were hesitant came with premature ejaculation issues); instead can actually assist in solving the problem.
    • Allowing them to speak softly if it is a sensitive detail.
Therefore if we really want to keep patient’s interest at the fore, a way can always be found to do so. Sadaf Vidha
Breaking news
Seeking Comments/Feedback from stakeholders
on “The Allied and Healthcare Professional’s Central Council Bill, 2015” (Last date for sending comments is 25th October, 2015)

A draft “THE ALLIED AND HEALTHCARE PROFESSIONAL’S CENTRAL COUNCIL BILL, 2015” is placed under public domain seeking valuable comments from the public.

Comments may be furnished through Feedback on dirahs-mohfw@gov.in by 25- 10-2015.
Situation: Doctor, this patient has developed acute renal failure.

Reaction: Oh my God, I forgot that he was on furosemide. I gave him the full dose of amikacin.

Lesson: Make sure, before calculating the dose of aminoglycoside (amikacin) that furosemide and other loop diuretics, which enhance its nephrotoxicity are not being given.
IMA Digital TV
MCI clears joint medical test proposal, ball in govt court

Mohua Chatterjee, TNN | Oct 5, 2015

The Narendra Modi government seems keen to push for a common entrance test for medical colleges across the country. An earlier effort to implement such a system had failed in 2013. The Medical Council of India (MCI), at its general body meeting on October 1, approved a joint proposal of the health ministry and the MCI to have a unitary 'Common Entrance Test' to be held by a designated authority for admission to MBBS and post-graduate medical courses, sources said.

MCI sources said the joint proposal was unanimously adopted by the GBM and it was for the ministry now to take the matter further. Sources also said MCI was in favour of an amendment to the Medical Council of India Act, 1956 to ensure proper implementation of the new system. Government sources, however, said even an "executive order" would be good enough to implement the change. Asked about the GBM, secretary in-charge of MCI Dr Reena Nayyar said, "The matter was placed before the general body though nothing can be said till the minutes are finalised."

In fact, top ministry sources told TOI that health minister J P Nadda is considering this matter very "seriously" and is taking precautions to ensure that it does not fall through this time as it did in 2013. So far, "all signals are positive" in this direction, said a top government source. With Vyapam and other scams blighting entrance tests, both MCI and the government feel a common entrance test would be the best way to benefit students and get rid of corruption in the system. The move to have a common entrance test for medical students across the country was first initiated in 2009, when MCI was headed by Dr Ketan Desai.

The Supreme Court had, in June 2013, ruled the MCI's notification for holding common entrance tests for MBBS, BDS and post-graduate medical courses as invalid. A three-judge bench by a 2:1 verdict held that the notification was against the Constitution. The majority verdict by the then Chief Justice of India Altamas Kabir and Justice Vikramajit Sen said MCI was not empowered to prescribe all India medical entrance tests.

The bench said the MCI notification was in violation of Articles 19, 25, 26, 29 and 30 of the Constitution. Justice A R Dave had dissented from the view. The court's decision had come on 115 petitions challenging the MCI notification on NEET for admission to MBBS and post-graduate medical courses conducted in colleges across the country.

(Note: eMedinews first reported this news in its editorial earlier)
Government of India
Ministry of Health and Family Welfare
Public notice

This Ministry is examining a proposal of Medical Council of India for amendment in the Clause 8(3)(1) of "Establishment of Medical College Regulations, 1999. The existing provision of Clause 8(3)(1)(d) and the proposed provision are as follows:


8(3)(1)(d) If it is observed that any institute is found to have employed a teacher with faked / forged documents and have submitted the Declaration Form of such a teacher, such an institute will not be considered for renewal of permission / recognition for award of M.B.B.S. degree / processing the applications for postgraduate courses for two Academic Years — i.e. that Academic Year and the next Academic Year also. (Colleges which are found to have employed teachers with faked/forged documents).

However, the office of the Council shall ensure that such inspections are not carried out at least 3 days before upto 3 days after important religious and festival holidays declared by the Central/State Govt.


If it is observed that any institute is found employed a teacher with fake faked / forged documents; multiple appearances in the assessments in the same academic year in different institute and non disclosure thereto either in the declaration form or during the assessment of the colleges or has disclosed wrong information in declaration form; is found doing private practice during duty hours and not stating this fact in declaration form submitted at the time of assessment, such an institute will not be considered for issue of LOP and for renewal of permission/recognition for award of M.B.B.S. degree /processing the applications for postgraduate courses for two Academic Years — i.e. that Academic year and the next Academic Year also.

However, the office of the Council shall ensure that such inspections are not carried out atleast 2 days before and 2 days after important religious and festival holidays declared by the Central/State Govt.

General Public is hereby requested to send suggestions/feedback in respect of proposed formulation. Suggestions may be furnished to ali.rizvi@nic.in by 30.09.2015.
Ali R. Rizvi, Joint Secretary, Medical Education
Safety Alerts List of Drugs, Medical Devices and Cosmetics declared as Not of Standard Quality/Spurious/Adulterated/Misbranded for the Month of August 2015

Deaths due to rabies high in India

Chennai: Another World Rabies Day has passed by with statistics being espoused about the number of deaths caused by rabies. The fact is that India accounts for 20,000 of the 45,000 deaths due to rabies every year. With over 95 per cent of the time rabies virus being transmitted through dog bites, the focus must be on the animal too. Doctors say the high number of deaths is due to the low proportion of vaccinated dogs. According to data provided by the Public Health Foundation of India in its Rabies Control Initiative in Tamil Nadu, 2010, the State has around 4,238 dogs per lakh population. “People do not realise that a bite by a pet can also cause rabies. The virus attacks the nervous system and reaches the brain. When a pet licks an open wound, it could transmit the virus even if it has been vaccinated. The risk is higher as not all dogs are vaccinated. We found in our survey that people want free vaccines and don’t want to take up animal birth control,” says S. Elango, president of the State branch of the Indian Public Health Association….(Source: The Hindu, October 3, 2015)
ICMR initiated efforts to set up a satellite TV for pc centre of the National Institute of Immunohaematology in Maharashtra’s Chandrapur district, the place genetic blood issues are on the rise. The objective of the centre can be to perform analysis on haemoglobinopathies that are a type of genetic defect that outcomes in irregular construction of one of many globin chains of the haemoglobin molecule. Common haemoglobinopathies embrace sickle-cell anaemia, which is an inherited blood disorder. (ANI)
Some observational studies have also shown links between heart health and higher intakes of certain vitamins — specifically, vitamins C and E, beta carotene, and three B vitamins (folic acid, B6, and B12). Guidelines from the American Heart Association state that supplements of the vitamins listed above should not be taken to prevent heart disease. Not only do they not help, there's even some suggestion that taking vitamin E supplements may slightly raise the risk of heart failure and hemorrhagic (bleeding) strokes.
GP Tip: Always write the numeric 0 before the decimal

Never write as .3. Always write 0.3. There are chances the .3 tablet may be misunderstood as 3 mg.
The Bureau of Labor Statistics reports that hospitals are hazardous to the health of their employees. In 2011, work-related injuries affected 157.5 of every 10,000 fulltime healthcare workers, exceeding the rate for both the construction and manufacturing industries at 147.4 and 111.8 per 10,000 employees, respectively. Overexertion and activities such as lifting, bending, or reaching cause 48% of injuries in healthcare workers. (Medpage)
The CDC has welcome the announcement by the World Health Organization (WHO) of new Early Release HIV Treatment and Pre-Exposure Prophylaxis (PrEP) guidelines that will significantly increase the number of people eligible for life-saving anti-retroviral treatment (ART) and expand access to a powerful tool for preventing HIV among those at greatest risk.
According to a joint WHO-UNICEF report, malaria death rates have plunged by 60% since 2000, translating into 6.2 million lives saved, the vast majority of them children. The report – “Achieving the malaria MDG target” – shows that the malaria MDG target to “have halted and begun to reverse the incidence” of malaria by 2015, has been met “convincingly”, with new malaria cases dropping by 37% in 15 years.
All of the following muscles are grouped together as muscles of mastication except:

1. Buccinator.
2. Masseter.
3. Temporalis.
4. Pterygoids.

Yesterday’s Mind Teaser: All of the following are examples of traction epiphysis, except:

1. Mastoid process.
2. Tubercles of humerus.
3. Trochanters of femur.
4. Condyles of tibia.

Answer for Yesterday’s Mind Teaser: 4. Condyles of tibia.

Answers received from: Dr K R Gandhi, Dr Pravin H Patel, Dr Rajesh S Joshi, Dr Avtar Krishan, Dr Poonam Chablani.

Answer for 4th October Mind Teaser: 2. Iliohypogastric

Correct Answers received from: Dr Kamal, Dr Krishna, Dr Sanjeev, Dr Kavya.
  • Manage your stress especially pressures of deadlines and petty arguments.
  • The biggest stress is an ongoing sense of extreme anxiety. This can be managed by deep breathing, meditation, yoga and by mindful approach to living.
  • Get a good night’s sleep. The most common reason for poor sleep is difficulty in falling asleep and staying asleep. Many drugs are used to treat insomnia, which can also impair memory.
  • If you need a sleeping medicine, it should be used in the lowest dose for the shortest period of time.
  • Get up at the same time in the morning.
  • If you smoke, quit.
  • If you do not drink, do not start.
  • Alcohol makes it difficult to perform short term memory tasks such as memorizing list. Alcohol induces vitamin B1 deficiency, which can cause dementia.
  • Protect your brain from injury as repeated minor head trauma can cause brain damage. Wear seat belt when riding in motor vehicle. Wear helmet while driving or riding motorcycle.
Over 120 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Satara

Readers column
The article on "Normal Aging Changes" is very good except that the changes have been described as though the individual has all his teeth in place. Also, there is no mention of teeth changes and as you know the process of aging gets faster because an individual will not be able to chew food properly due to changes in his dentomuscular structures and this will disturb digestion and result in malnutrition and the situation deteriorates day by day....At least a line on Age changes in teeth would have helped people appreciate the importance of maintaining Oral health (as controlling diabetes requires change in their food habits more than anything else). Thank you Sir, Dr J Rao
Press Release
Increasing suicides in India are a testimony to the faulty mental health policies of the country

According to recent reports, over 50 million people suffer from mental illness like depression, suicidal ideation and anxiety in India Over 7,000 people end up committing suicide because of lack of adequate counseling and other medical assistance

The Indian constitution grants us seven fundamental rights, out of which the most basic one is the ‘Right to Life’. The taboo in the society, which often exists when it comes to mental illnesses like anxiety and depression, has become a deterrent to this very basic right. The increasing number of suicide cases making the headlines has caused severe uproar in the medical fraternity and government for better facilities to mental health patients, however despite deliberations, no conclusion has come to light yet.

India is right on the top of the list in regards to the maximum cases of suicides recorded every year across Southeast Asia. The average suicide rate in India is 10.9 for every lakh people and the majority of people who commit suicide are below 44 years of age, said a World Health Organisation (WHO) report.

Suicidal ideation and behavior are among the most serious and common psychiatric emergencies. Patients at imminent risk for suicide require immediate psychiatric services and must be monitored continuously until they are in a safe situation. After a suicide attempt, psychotherapy may prevent subsequent attempts.

Speaking on the issue, Padma Shri Awardee, Dr A Marthanda Pillai – National President IMA & Dr K K Aggarwal – Honorary Secretary General IMA and President HCFI in a joint statement said, “Suicide cases are not only prevalent amongst the general population, teenagers, youngsters and adults alike, but they are also found to be common within the medical fraternity. Medical professionals, both students and doctors are also found to end their lives because of increased stress, depression and anxiety issues. As World Mental Health Day is nearing, we would like to highlight that an inadequate support system is the major cause behind the increased suicide rates in our country. The need of the hour is for the Government to focus on building comprehensive mental health counseling facilities. The Mental Health Bill that was introduced in last year in October is yet to be implemented and also needs some more discussions with the medical association.

On examining carefully mental health patients from across professions, it has been found that the highest rate of suicide is found amongst the medical fraternity. And further elaborating, it is the physicians, pathologists and anesthetists who take their own lives most commonly. Additionally, female doctor suicides significantly outnumber male doctor suicides.

The primary reasons being the stress and strain one has go through in order to be a doctor and carry on in the medical profession. Doctors also given the easy access to medication, often misuse this to take their own lives.

In a country with such high rates of mental health patients, it is imperative that necessary steps are taken to reduce the number of deaths. Adequate counseling services must be provided and awareness raised that it is okay to find oneself in a difficult situation but there are other ways of dealing with stress than taking ones life.

We live in the 21st century and it is essential that parents realize that they must not force their children to become a doctor before being sure of their caliber and interest. Additionally there is no harm or shame in admitting one’s state of mind and help must be sought. A healthy state of mind
Digital IMA