December 6   2015, Sunday
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EDITORIAL
Dr KK AggarwalDr KK Aggarwal Doctors around the globe tackle climate change and fossil fuels

Public health advocates from five continents will share success stories on energy choices that protect health and mitigate climate change and air pollution.

Taking place in Paris during the COP21 climate talks, the event is entitled “Health professionals in action for Healthy Energy and Climate”. It is organised by the Health and Environment Alliance (HEAL) in collaboration with the Conseil National de l'Ordre des Médecins (CNOM), the World Medical Association and the International Federation of Medical Students' Associations, which represent millions of doctors worldwide.

The French medical council, Conseil National de l'Ordre des Médecins (CNOM), has recently issued a newsletter on health and climate change to its 280,000 members. Its leaders are concerned about the risks to health from climate change and want to promote the positive effects that reducing emissions - from coal powered electricity generation, private cars in cities and fossil fuel use in heating and cooking - can have on health from cleaner air. Air quality in France is responsible for 43,000 premature deaths per year.

Dr Patrick Bouet, CNOM President says: “Climate change is above all a question of public health. Doctors are in the front-line in responding to the harm from climate turmoil. We have a privileged position and a moral duty to protect and promote the population's health. An imperative is to appeal to professional medical organizations to call on local politicians to limit emissions in our towns.”

The World Medical Association has shown consistently strong leadership in promoting the involvement of physicians in climate action since 2009. It supports the recent WHO Call to Action on climate and health, the Paris Platform for Healthy Energy and is an important partner in the “Our Climate, Our Health” campaign.

Dr Xavier Deau, Immediate Past President of the World Medical Association (WMA) says: “Thanks to the many physicians who are taking up their responsibility as leaders on climate action, health is moving up the agenda. But it is not yet in the central place that must be achieved. Governments should be hearing more from us on the health and humanitarian disaster that is looming and about the policies needed to protect and promote the health of all our patients.”

The International Federation of Medical Students' Associations (IFMSA) represents a group of young people who will feel the full impact of climate change. “We are calling for more ambition in the Paris agreement and national actions to address health co-benefits,” says Skander Essafi, IFMSA Liaison Officer for Public Health Issues. “The health sector organisations should divest from the fossil fuel industry - just as they did from the tobacco industry in previous years,”

Representatives from many powerful international and national medical bodies around the world are taking part in the meeting. Their healthy energy testimonies will be web-streamed and shared via social media. Genon Jensen, Executive Director of Health and Environment Alliance (HEAL) says: “The Health and Environment Alliance calls for the swift decarbonisation of our economies and energy systems to tackle climate change, reduce pollution and boost health. Energy choices are a key driver for better health and for dealing with the challenge of climate change. By sharing the convincing arguments on an equitable transition to cleaner forms of energy - in Paris and with national governments, in their clinics and hospitals when they go home - doctors can bring health closer to the top of the climate agenda.”
EMEDINEXUS STATEMENT
Amit Sharma and Nilesh Aggarwal

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
FDA approves Algovita spinal cord stimulator in chronic pain

The US Food and Drug Administration (FDA) has approved the Algovita Spinal Cord Stimulation System (Greatbatch Inc) to treat chronic pain. The device is indicated as an aid in the management of chronic, intractable pain of the trunk and/or limbs, including unilateral or bilateral pain associated with failed back surgery syndrome, intractable low back pain and leg pain… (Medscape)

Every 13th new cancer patient is an Indian

Replying to a question in Lok Sabha on Friday, Union Health Minister JP Nadda said that India shares 7.5% of the global cancer burden which implies that every 13th new cancer patient in the world is an Indian. This rise in the number of cancer cases may be attributed to larger number of ageing population, unhealthy lifestyles, use of tobacco and tobacco products, unhealthy diet, etc. The Central government supplements the efforts of the state government for improving healthcare, including prevention, diagnosis and treatment of cancer, he further said… (DNA – PTI)
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Specialty Updates
• The estimated number of adolescents dying of AIDS in the Asia Pacific region has more than doubled since 2005, experts said, warning of a "hidden epidemic". UNICEF has urged Asian countries to improve teenagers' access to testing. The 10 worst hit countries include India, Indonesia, Thailand, Myanmar, Vietnam, China, Cambodia, the Philippines, Papua New Guinea and Pakistan.

• People with cerebral cavernomas located in the brainstem and those who present with intracranial hemorrhage or new focal neurological deficits have the highest risk for later brain bleeds, suggests new research published in the journal Lancet Neurology. Researchers noted that older age, female sex, and having multiple cavernomas were not independent predictors of poor outcomes.

• Early weight loss in patients taking the newly approved injectable obesity drug liraglutide 3 mg predicts sustained weight loss with the drug, suggest findings from a post hoc analysis of two large randomized trials, presented at the International Diabetes Federation World Diabetes Congress.

• A new study published in the journal PLos One suggests that transcendental meditation stimulates genes that produce telomerase, an enzyme linked with reduced blood pressure and mortality. Transcendental meditation involves sitting comfortably and closing the eyes for 20 minutes, twice a day, to achieve a quality of rest in the mind and body.

• Both in-person and online education are effective in helping parents reduce breakfast-skipping and improve nutrition in children, suggested a new study published in the Journal of the Academy of Nutrition and Dietetics.

• Low levels of exposure to the metal cadmium may increase the risk of weaker bones and fractures in elderly men, suggests a Swedish study published in the Journal of Bone and Mineral Research.

• Early results from a Canadian study suggest that breastfeeding reduces the risk of mothers and their offspring developing diabetes. The findings were presented recently at the World Diabetes Congress

• A new study, published in the journal Biological Psychiatry, suggests that delta-9-tetrahydrocannabinol, the primary active constituent of cannabis, increases random neural activity, termed neural noise, in the brains of healthy human subjects. The findings suggest that increased neural noise may play a role in the psychosis-like effects of cannabis.
eSPIRITUAL
What is charity?

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

When you help others, it should not harm somebody else. Even if your help is unconditional, if you end up in promoting no.2 by superseding another deserving senior person is not a help as the person to whom you are helping will give you one blessing but the person to whom you have harmed will give you 10 curses. Ultimately you end up with minus 8 points. Helping other means that you should give happiness to you, to the persons you have helped and also to others to whom you have not helped. When we help somebody, we want that the same person should expect you by helping you when you are in need in a shorter run. But charity does not believe in that. Your job is to help others and negate your negative past karmas. You never know, may be decades later you get a help from a person to whom you helped decades earlier. Help should never be linked to returns.
Legal Quote
M/S. Spring Meadows Hospital & Anr vs Harjol Ahluwalia Through, K.S. on 25 March, 1998

"The true position is that an error of judgment may, or may not, be negligent; it depends on the nature of the error. If it is one that would not have been made by a reasonably competent professional man profession to have the standard and type of skill that the defendant holds himself out as having, and acting with ordinary care, then it is negligence. If, on the other hand, it is an error that such a man, acting with ordinary care, might have made, then it is not negligence."
Medical Breakthroughs that were initially ridiculed or rejected
Infectious proteins

Stanley Prusiner, a neurologist insisted that mad cow disease and Creutzfeldt-Jakob disease are caused by infectious proteins and not by viruses, bacteria, or fungi. He called these proteins "prions" in 1982. This generated much controversy especially among his colleagues, who were unwilling to accept that a mere protein, with its lack of genetic material, could transmit disease. Prusiner himself described this first publication as setting off a "firestorm," and he suffered a series of "very vicious" personal attacks in the press. But, he continued to publish, further characterizing prions and adding diseases to the list of those he believed were caused by infectious proteins. The first cases of the human form of mad cow disease were reported in Britain in 1996, more than a decade after he had initially described prions. Mad cow disease, or bovine spongiform encephalopathy, had previously been identified as a prion disease by Prusiner. In 1997, Prusiner was awarded the Nobel Prize for his discovery of prions. (Medscape)
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IMA National Health Scheme (Contd.)

Scrutinizing committee shall be nominated by the National President. The members of the committee shall be from different specialties including an anaesthetist to a maximum of 7 members. The chairman, Secretary, and treasurer shall also be the member of scrutinizing committee. The secretary shall be the convener of the committee. The scrutinizing committee shall scrutinize the claim as per the bye law and decide on the amount of reimbursement. In case of doubt / difference of opinion the matter shall be referred to the managing committee.

Election of office bearers
o All the office bearers shall be elected from the members of the scheme by the Central Council.
o The term of office of the office bearers shall be 3 years, but the Founder Secretary will be for 4 years so that both Chairman and Hon. Secretary will not change in the same year

Office: The office of the scheme will be at the place of the Hony. Secretary, at Thiruvananthapuram

Managing Committee: It shall meet at least thrice a year. The quorum of Managing committee shall not be less than four. If quorum is not sufficient then reconvene the meeting after 15minutes.

Function of the Managing Committee: The managing committee shall run the day to day functioning of the scheme. It shall receive the minutes, reports and accounts of the scheme and pass it. The Managing Committee shall receive the reports of the scrutinizing committee, empanelment committee and all other committees appointed. Management committee can decide regarding the policy of disbursement and /or investment of the funds and all other matters subject to ratification by the CWC and Central council.

Duties of the chairman: The chairman shall conduct all the meetings of the managing committee. In the absence of chairman, the vice chairman shall conduct the meeting.

(To be contd.)
Media
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
No immediate plans to use vaccines to treat dengue, says Health Minister

There are no immediate plans to use vaccination to treat dengue and the main focus to prevent the disease would continue to be cleanliness and medicines. Health Minister J P Nadda said in the Lok Sabha that there are also no plans as of now to cure swine flu using vaccines. For dengue and swine flu, medicines would continue to be used... (Economic Times)
Immunization in India

As per the HMIS data of 2014-15 (as on November 2015), full immunization coverage of the country is 85.7%. The Government of India has identified 201 high focus districts in 28 State/UTs where nearly 50% all unvaccinated or partially vaccinated children reside… (PIB)
The Biggest Medical Stories of 2015 as rated by Medscape readers

Thirty-nine percent of Medscape readers put the switch to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), diagnostic codes on October 1 ranked as the biggest medical news of 2015 as revealed in an online survey of Medscape readers… (Medscape)
A new research published online December 3 by Lancet Oncology, shows that the differences in the prices of novel cancer drugs between European countries and Australia and New Zealand range from more than 25% to almost 400%.
The FDA said Friday that SGLT2 (sodium-glucose cotransporter-2) inhibitors such as empagliflozin (Jardiance), dapagliflozin (Farxiga), and canagliflozin (Invokana) will need new warnings on the risks of ketoacidosis, urinary tract infections, and other serious illnesses.
Maharashtra extends free H1N1 vaccination program to include patients with HT and diabetes

Starting next week, Maharashtra will extend the free H1N1 vaccination program for patients with hypertension and diabetes. This year 898 people died of H1N1 in the state and of these, 384 (43%) people had at least one of ailments. Till now, the free injectable vaccines were available only for healthcare workers and pregnant women… (Times of India)
eWELLNESS
Cough Hygiene

• When you cough or sneeze, you tend to expel out respiratory waste, which can be droplets (larger than 5 micron) or airborne droplet less than 5 micron; both have different clinical implications.

• Droplets remain suspended in the air for a limited period only and exposure of less than 3 feet is usually required for human to human transmission of droplet-borne respiratory organisms. In flu, this can be up to 6 feet. The examples of droplet infections are meningitis, influenza, rubella (German measles) etc.

• No precaution needs to be taken by a person who is 6–10 feet away from the patient but if a person is sitting or working even 3–6 feet distance, the non-coughing person should wear a simple mask.

• Airborne droplet nuclei that carry respiratory secretion smaller than 5 micron can remain suspended in the air for extended period and can cause infections to people who are standing even more than 10 feet away. The example of airborne droplet nuclei infections are TB, measles, chickenpox and SARS.

• Patients with these disease require to be placed in an isolation room and all healthcare personnel who are looking after these patients must use a safe N95 mask.

• In normal house with windows opened, there is a constant exchange of air, which prevents spread of infections but in AC setups with no air exchange, the infections can spread from one person to another.

• When sitting in an air conditioned atmosphere, the setting of the AC should be such that the same air is not circulated and fresh air is allowed to exchange. Split ACs, therefore, are more dangerous than the window ACs.

• In an office with split AC, if one employee is suffering from any of the droplet nuclei, disease can transmit infection to others. Therefore, patients with confirmed TV, measles, chickenpox and SARS should not be allowed to work in split AC atmosphere.
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http://module.ima-india.org/ima/jima/2015/September/
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
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Bioethical issues in medical practice
Duty as a parent

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

Rina is mother to Chini, an 11 year old girl with mental retardation. Chini can barely look after herself. Her mother is constantly worried as to how she will look after herself when her periods start. At present Chini has barely learnt to bather herself, speak intelligible sentences and move around by herself. However Chini has no idea about her own disability and loves watching romantic scenes on TV. Rina is worried that in these insecure times, Chini may end up being abused or taken advantage of due to her lack of understating. They approach you as a doctor to provide a certificate so that the parents can ask for a hysterectomy. You tell them that this is against human rights and in fact, there is a court judgment against this practice but they keep insisting, because they see you both as a doctor as well as a friend. What should you do?

a) Go all out to help them for the operation because you feel that times are actually bad and chances of (possible) rape and pregnancy are high?
b) Go by the book and say there is nothing you can do?
c) Suggest alternative treatments?

Any other suggestions and solutions? Do write in!

Responses received

It is the responsibility of the mother to protect her from sexual abuses and subsequent pregnancy as she cannot take care of herself. The best course would be to get a certificate from psychologist that she is mentally unfit and cannot take care of herself. Then she should get her operated for tubectomy to save her from subsequent pregnancy and then get her treated by some psychologist for her mental illness. If she recovers and becomes mentally fit she may get her operated for reversal of procedure, reuniting the tubes. This will give her a chance of getting pregnant which is very important factor for any lady. Hysterectomy will be a permanent failure to get the child of her own, which becomes unethical. Dr BR Bhatnagar
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Inspirational Story
Emotional management

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

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

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

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

The emotional equation is quite simple.

Something + Acceptance = Positive Emotion

Something + Non Acceptance = Negative Emotion

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

It isn’t the world but the quality of our response to the world that determines the quality of our emotions. Next time we feel disturbed with a negative emotion, instead of asking who or what is disturbing us, we will examine who or what we are resisting (not accepting) that is causing this disturbance in us. If we replace resistance (non acceptance) with acceptance, the negative emotion will turn into a positive one. Emotional management begins by stopping to blame that ‘something’ or ‘someone’ and starting to take the responsibility to respond life with ‘acceptance’
eMEDIQUIZ
The estimated median incubation period for H1N1 flu is

1. 1.5 to 3 days
2. 3-7 days
3. 7-10 days
4. 14 days

Yesterday’s Mind Teaser: All are true except:

1. Similar to what has been observed with seasonal influenza, shedding of pandemic H1N1 influenza A is observed to begin the day prior to symptom onset and often to persist for 5 to 7 days or longer in immunocompetent individuals.
2. Even longer periods of shedding occur in children (especially young infants), elderly adults, patients with chronic illnesses, and immunocompromised hosts.
3. Delayed clearance of virus from the nasopharynx is observed in patients who developed acute respiratory distress syndrome or who had fatal disease.
4. The amount of virus shed is greatest during the second week of illness.

Answer for Yesterday’s Mind Teaser: 4. The amount of virus shed is greatest during the second week of illness.

Answers received from: Dr Avtar Krishan, Dr B R Bhatnagar, Dr K Raju, Daivadheenam Jella, Dr Kailash Chandra Sharma.

Answer for 4th December Mind Teaser: 9% cases

Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.
Humor
Seen on a famous beauty parlor in Bombay
Don’t whistle at the girl going out from here. She may be your grandmother!
Readers column
Dear Sir, Very Informative News. Regards: Dr Kapil
Press Release
Take necessary precautions to protect your child from Pneumonia this winter season

According to the reports, pneumonia and diarrhea cause one in five deaths in India

With over 43 million people suffering from pneumonia in the country, it is extremely important that awareness about disease prevention and detection is raised especially during the winter season. The reason for this is the similarity in the symptoms of pneumonia with those of flu, a chest infection or a persistent cough.

Pneumonia can be described as an acute respiratory infection or inflammation of the lungs caused by bacteria, virus, fungus or parasites, which causes the blood and oxygen flow to stop due to the deposition of fluid like substance in them. Coughing up phlegm, chest pain, a high temperature and quick breathing are all indicators of pneumonia. Generally if you or your child have the flu or heavy cold-like symptoms, which don't show signs of improvement, it is important to visit a doctor and get a chest x-ray to rule out pneumonia.

Recent reports of the World Health Organization (WHO) indicate that Streptococcus pneumonia is the prime cause of the hospitalization and death of many children below five years of age. As per WHO statistics, around 1, 20,000 deaths of children under five are caused due to pneumonia and a child dies every minute from pneumonia in India.

Creating awareness, Padma Shri Awardee Dr. A Marthanda Pillai –National President IMA and Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General, IMA and President, HCFI said, “Infants, neonates, premature babies aged 24-59 months with underdeveloped lungs, narrow airways, poor nutrition and immature immune system are at risk of contracting pneumonia. It is extremely important that awareness is raised amongst the masses of how unhygienic and unclean environments, malnutrition and lack of breastfeeding can increase the rate of mortality of children suffering from pneumonia. Several child deaths are preventable, and it is the duty of all doctors to educate new mothers about ways to keep their child healthy and the importance of timely vaccination".

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat can infect the lungs if they are inhaled. They may also spread via airborne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth.

Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors. Pneumonia caused by bacteria can be treated with antibiotics, but only one-third of children with pneumonia receive the antibiotics they need at present. It is important that during winter months, children are kept warm, exposed to adequate sunlight and are kept in well-ventilated rooms. It should also be ensured that they receive adequate nutrition and necessary vaccinations.

Pneumococcal Conjugate Vaccine (PCV) and Haemophilus influenza type b (Hib) are the two vaccines, which prevent pneumonia. However over 70% of children are not given these vaccinations due to the high-cost factor as well as a lack of awareness. It is important that a government led vaccination program for the pentavalent vaccine is implemented at a National level to help reduce the disease incidence.
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