March 6  2015, Friday
Suggestions for Medical Emblem Received So Far
IMA,IJCP,HCFI
editorial
Wish you all a Happy, Safe & Colorful Holi
Dr KK AggarwalIMA Online New Initiatives

Dear Colleague


Here are a few online initiatives of IMA. Kindly circulate amongst your members and ask them to report online.

Dr AM Pillai and Dr KK Aggarwal
  • IMA Rare Blood Group Online Blood Bank Directory: IMA has started an online voluntary rare group blood bank, where a list of all rare blood groups will be displayed. Kindly appeal to all people with rare blood groups, especially the Bombay blood group to enter their names, addresses, email and mobile numbers on the IMA website. People with rare blood groups can often be given blood, when needed, only from people with the same blood group. And in life-threatening situations, a website directory will come handy to save lives. Online Reporting: http://www.ima-india.org/ima/left-side-bar.php?scid=216
  • IMA Sentinel Event reporting on its website: IMA is committed to patient safety. The modern system of medicine is full of omissions and commissions leading to adverse events, a good number of which are preventable. We seek your co-operation in compiling and analyzing them and doing root cause analysis (RCA) which is very basic to prevent errors and good medical practice. Each IMA member is requested to report on the website (confidential) in the enclosed format. The member’s personal identity is not sought along with place of working. Data to be sought is only to be used for the specific purpose mentioned. On Line Reporting: http://www.ima-india.org/ima/left-side-bar.php?scid=228
  • Pro-forma for hypertension screening from India: 17th May is "World Hypertension Day". IMA wants to screen as many patients as possible all over the country till 17th May 2015 and create awareness. Kindly enroll as many on the website link. Online Reporting: http://module.ima-india.org/Default.aspx
  • IMA Online TB Notification initiative: Not notifying TB is a violation of IMC Act under Section 5.2 and 7.14. Regulation 5.2: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself.
Regulation 7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except
  • in a court of law under orders of the Presiding Judge;
  • in circumstances where there is a serious and identified risk to a specific person and / or community; and
  • Notifiable diseases.
In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately. Online reporting for consultants engaged in IMA-GFATM-RNTCP Project: http://www.ima-india.org/ima/left-side-bar.php?scid=226
eMedipics IMA,IJCP,HCFI
CPR Training, Chinmaya Vidyalaya at Vasant Vihar, Delhi 4th February 2014
News
  • Use of the hormone-suppressing drug goserelin during chemotherapy for breast cancer protects ovarian function and might help avoid treatment-related infertility, suggest the results from a study published online March 4 in the New England Journal of Medicine.
  • The combination of methylphenidate (multiple brands) and the antidepressant citalopram (multiple brands) may speed up the rate of response in elderly patients with depression, suggests new research published online in the American Journal of Psychiatry.
  • Statin therapy seems to increase the risk for type 2 diabetes by 46%, even after adjustment for confounding factors, suggests a large new population-based study published online March 4 in Diabetologia.
  • Trabecular micro-bypass stents reduce intraocular pressure in glaucoma patients just as well as the prostaglandin analog travoprost, suggested a new study presented recently at the American Glaucoma Society 2015 Annual Meeting.
  • Compared with no premedication or a placebo, lorazepam premedication failed to improve patients' overall satisfaction with the perioperative experience, and prolonged recovery, reported the randomized multicenter PremedX trial published in the March 3 issue of JAMA. Thus, routinely giving a sedative before anesthesia to patients undergoing elective surgery seems unnecessary.
Dr KK Spiritual Blog
Holi beyond Colors

The story behind the festival, Holi, starts with Holika, the sister of Hiranakashyap, the father of Prahalad.

Hiranakashyap had declared himself as GOD and wanted his son Prahalad to worship him and not Vishnu. When Prahalad refused to do the same, he was made to sit with Holika in an open fire. Holika had been granted a boon that she would not be burned even if she was on live fire. When she was made to sit with Prahalad on the live fire, the opposite happened. She lost her life and got burned but Prahalad came out alive from the fire.

The above story has a deep spiritual meaning. Hiranakashyap represents the "ego" which when takes control makes one forget about their own consciousness and makes one think of themselves as the supreme power. The same symbolic representation is seen with Ravana in Ramayana and Kansa in Mahabharata.

Prahalad symbolizes a person with self realization or the son of God or one’s consciousness or one’s true self. The consciousness cannot be burned, cut, dried or made wet by anything. It is imperishable and everlasting.

All those people who have acquired self realization utilizing any of the pathway (Bhakti, Karma and Gnana) are in a state of GOD acquaintance and nothing can destroy them.

The obstacles to the pathway of self-realization are mentioned as "attachment, anger, desire, greed and ego". When all these negative factors overpower any individual, it leads one away from self realization or away from God.

Holika represents the sum total of the negative forces in the body that can kill you if not controlled in time.

Getting attached to any of the 5 senses can end in a vicious cycle and one can get burnt in this ‘chakravyuha’ of attachments. If you are truthful, and have attained a state of one–point contemplation on a known truth, all the negative forces will stay away. All such negative forces if repressed within the body can burn you out over a period of time and that is one of the reasons why all negative emotions should never be suppressed or repressed.

The practice of burning Holi a day before the festival symbolizes burning of all your negative thoughts or emotions embedded in the mind and neutralize all the poison arising due to the negative feelings. As soon as negativity is removed from the mind, spiritual vision or the knowledge of the consciousness is attained. Once this is done, only positive thoughts remain, which is celebrated as sharing and loving each other, the next day.

Sharing love is the biggest thing one can do in removing all the above mentioned 5 obstacles to self–realization. Spreading love reduces anger as well as desires, detaches one from various attachments, reduces greed and brings humility in a person. By burning one’s ego and other negative qualities, we can also burn the ill feeling amongst each other and make everybody a friend.

During Holi, the practice therefore, is to visit and meet not only your friends but also those people with whom you are not friendly. The festival therefore, is an opportunity to spread brotherhood and happiness in the society.

WHO defines health as not mere absence of disease but a state of physical, mental, spiritual, social and environmental well-being. Holi, therefore, is a classic example of a custom to create and enhance "social health" amongst the general society.

The habit of throwing water on each other also has a deep spiritual meaning. It basically means removing dirt from each other. Dirt here does not means bodily dirt but mental dirt, which once removed leads to spiritual cleanliness.

The whole meaning is not to play Holi superficially or meet each other at a superficial level but to get rid of the negativity at the level of the mind as well. There is no point in celebrating Holi and meeting people unless you remove your negative thoughts about them from the mind.

When you lovingly smear ‘gulal’ (colored powder) on others, they reciprocate with doubled love and affection. Similarly, always think of good things about people. Express your positive thoughts about these friends loudly – not only in front of them but also in their absence. Don’t you think your heart will throb with pleasure when they reciprocate?
IMA,IJCP,HCFI
Cardiology eMedinewS
  • Older patients who survive an in-hospital cardiac arrest and subsequently receive an implantable cardioverter defibrillator (ICD) have a significantly reduced risk of death over a 3 year period compared with those who do not receive an ICD, reported a new study published online in American Heart Journal.
  • High- and low-intensity workouts are associated with similar weight loss and reductions in waist circumference, but only high-intensity workouts improve 2-hour glucose tolerance, suggests a study published in the March 3 issue of the Annals of Internal Medicine. High-intensity workouts are also associated with the greatest reduction in risk for cardiovascular mortality.
Pediatrics eMedinewS
  • Physicians follow "best practice" guidelines when prescribing antipsychotics to children and adolescents only about half the time, with failure to monitor cholesterol and blood sugar levels their main misstep, suggests new research published online March 2 in Pediatrics.
  • Screening for five growth parameters may help detect celiac disease (CD) with good accuracy in both boys and girls because growth falters in most children with CD, suggests an article published online in JAMA Pediatrics.
Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/70 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored. It is an impending sign that the patient is going into shock.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

Bolam Vs. Friern Hospital Management Committee 1957

Test for establishing medical negligence
  • The doctor is required to exercise the ordinary skill of a competent doctor in his field. He must exercise this skill in accordance with a reasonable body of medical opinion skilled in the area of medicine.
  • According to the Bolam test, negligence is the genus of which rashness is the species.
  • The latest trend of prosecution of the doctors, the term criminal negligence has come to light, which means recklessly acting without reasonable caution, hurting another person at risk of injury or death by negligence.
  • This applies to a medical practitioner when he shows gross negligence in his treatment, leading to severe injury or even death. He should not be held liable criminally for the patient’s death unless his negligence shows such regard for the life and safety of the patient as to amount to a crime.
  • The most important criterion is the degree of negligence required to prosecute them under the charge of criminal negligence, which should be gross or even high degree.
  • The jurisprudential concept of negligence differs in civil and criminal law. Negligence which is neither gross nor of a high degree may provide a ground for action in civil law but cannot form the basis for prosecution in criminal law.
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)
IJCP Book of Medical Records
IJCP’s ejournals
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
Can all available anti-rabies vaccines be used by intradermal route?

Not all vaccines produced in India at present are fit for intradermal usage. The following vaccines have been approved by DCGI for use by intradermal route.
  • Purified chick embryo cell vaccine (PCEC) – Rabipur and Vaxirab–N.
  • PVRV (Purified verocell rabies vaccine) – Verorab–vial of 0.5 ml,
  • PVRV – Abhayrab – vial of 0.5 ml., Human Biological Institute
  • PVRV – Indirab, vial of 0.5 ml/1.0 ml. Bharath Biotech, Hyderabad.
PDEV (Vaxirab) and HDCV (Rabivax) are approved for IM use only and not for IDRV.

Rabies vaccines formulated with an adjuvant should not be administered intradermally.
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,IJCP,HCFI
IMA NEWS
Dear Colleagues,

One of the UN’s specialist groups which looks at the control of narcotic agents will shortly be considering whether to schedule Ketamine as a controlled drug. Ketamine is an anesthetic agent, a simple-to-use substitute to the inhalable narcotics that are nowadays being used in surgery. In many poor countries Ketamine is the only alternative that is available for narcosis.

Unfortunately Ketamine is also being misused as a narcotic for non medical purposes: as an illicit “recreational” drug or component of those. Some countries have therefore proposed a change to its scheduling, presumably believing that this will reduce the illicit use.

We know from experience with other anesthetics, especially pain medication that the scheduling of drugs effectively prevents their use and that patients in poor countries and especially rural settings are then unable to receive treatment with those drugs. This is likely to further worsen the absence of adequate anaesthesia and pain relief in many health care settings globally. Even in countries which normally have access to a wide variety of other drugs Ketamine has a place as a fast acting and very powerful agent, sometimes used before other drugs or in some emergency settings.

The World Medical Association has addressed this problem already in its „Resolution on the Access to Adequate Pain Treatment“. With Ketamine the problem now seems to be likely to be repeated.

Within the UN System scheduling Ketamine as a controlled drug is NOT a WHO decision. It is the Economic and Social Commission of the United Nation taking this advice on the recommendation of the UN Commission on Narcotic Drugs in Vienna. While WHO has very strongly advised against scheduling of Ketamine there is a real concern that the commission in Vienna may disregard the advice

It is crucial to tell the members of the committee, who come from 53 Nations, that scheduling Ketamine as a controlled drug is a very bad idea and will harm many people especially in poor countries, as they will not get the necessary anesthesia for essential surgery,

The British Medical Association has already written to the Chief Medical Officer of England, Dame Sally Davies. The session of the UN dealing with this issue will be on Friday, March 13th, 2015!

Dr. Willem Scholten, former head of controlled Substances has put together a repository of further documents and information on Ketamine and the attempt to schedule it.

With kind regards

Dr. Otmar Kloiber
Secretary General, WMA
Draft: Standards and application format for accreditation of ethics committee, investigator and clinical trial site
An Expert Committee under the Chairmanship of Prof. Ranjit Roy Chaudhury was constituted by the Ministry of Health & Family Welfare to formulate policy and guidelines for approval of new drugs, clinical trials and banning of drugs. One of the recommendations of the committee was that clinical trials should be conducted only at accredited sites by accredited investigator with the oversight of accredited Ethics Committees.

The Ministry of Health and Family Welfare while agreeing to the recommendation, decided to assign the job of accreditation to Quality Council of India.

The Accreditation Standards and format for application for Accreditation prepared by Quality Council of India are being uploaded herewith for comments / suggestions of stakeholders. The comments / suggestions, if any, may be forwarded to the office of DCG(I), Room No. 111, FDA Bhawan, Kotla Road, New Delhi-110002 by post or by fax at 011-23236973 or by email to dci@nic.in within 30 days for further consideration.

Available at: http://cdsco.nic.in/forms/list.aspx?lid=2074&Id=23
WMA would like to inform you that the deadline for the WHPA collaborative practice award is extended to 15th March 2015.
The aim of the award is to actively encourage health professionals to work in collaboration and recognise an outstanding interprofessional team that has improved patients’ health and promote a collaborative approach to healthcare.

Please see attached the call for nomination including selection criteria and how to apply.

The World Health Professions Alliance brings together the global organizations representing the world’s dentists, nurses, pharmacists, physical therapists and physicians. http://www.whpa.org

If you have any questions pleaae contact julia.seyer@wma.net or whpa@wma.net.

With best regards,

Julia
Have a safe Holi, says IMA
BINDU SHAJAN PERAPPADAN

The India Medical Association (IMA) has released a set of guidelines to make Holi safe. IMA honorary secretary general Dr. K.K. Aggarwal said that water-filled balloons cause the maximum head and eye injuries during the festival.

Patients with cough and fever are also cautioned to be careful during the season. “They should be careful during Holi celebrations as swine flu can infect others who are in the vicinity of 3 feet from the patient. Because of untimely rain and lowering of temperature, the effect of swine flu will continue for a few more days. We would advise persons with swine flu to completely avoid gatherings,” said Dr. Aggarwal.

Use natural colours

Green Holi colours contain malachite green, which can be dangerous to the eyes. Most Holi colours may contain artificial colours or dyes or lead. These chemicals are harmful to the body and skin. Shiny colours may contain ground glass or mica, which again are harmful.

It is safer to use haldi/turmeric and flower-based colours to play Holi. People are advised to avoid eating adulterated sweets, bhang and alcohol.
Media
IMA,IJCP,HCFI
IMA in Social Media
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Twitter @IndianMedAssn 812 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/
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www.indianmedicalassociation.info
IMA Videos
Wellness Blog
Poor hygiene habits may lead to typhoid fever

Typhoid fever is caused by a bacteria Salmonella typhi and is transmitted through the ingestion of food or drink contaminated by the feces or urine of infected people.

Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Though the cases occur all through the year, the number is higher during the summer and rainy seasons.

Symptoms usually develop 1 to 3 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhea and enlarged spleen and liver. A healthy carrier state may follow acute illness.

Typhoid fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food.

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid.
  • Typhoid does not affect animals and therefore transmission occurs only from human to human.
  • Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water.
  • Careful food preparation and washing of hands are crucial to preventing typhoid.
  • Typhoid fever in most cases is not fatal.
  • Prompt treatment of the disease with antibiotics reduces the case–fatality rate to approximately 1%.
  • When untreated, typhoid fever may persist for 3 weeks to a month.
  • Resistance to common antibiotics is now common.
  • Typhoid that is resistant to common antibiotics is known as multidrug-resistant typhoid (MDR typhoid).
  • Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia.
  • Azithromycin is a new drug for drug–resistant typhoid.
  • Typhoid vaccine taken every three years is the best preventive approach.
Inspirational Story
Hospital window

Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room’s only window. The other man had to spend all his time flat on his back. The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation.

Every afternoon when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and color of the world outside. The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every color and a fine view of the city skyline could be seen in the distance. As the man by the window described all this in exquisite detail, the man on the other side of the room would close his eyes and imagine the picturesque scene.

One warm afternoon the man by the window described a parade passing by. Although the other man couldn’t hear the band – he could see it. In his mind’s eye as the gentleman by the window portrayed it with descriptive words. Days and weeks passed.

One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away. As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone.

Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside. He strained to slowly turn to look out the window beside the bed. It faced a blank wall. The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window. The nurse responded that the man was blind and could not even see the wall.

She said, "Perhaps he just wanted to encourage you."
IMA Humor
Cab Drivers

Two cab drivers met. "Hey," asked one, "why did you paint one side of your cab red and the other side blue?"

"Well," the other responded, "when I get into an accident, you should see how all the witnesses contradict each other.
Quote of the Day
Nothing ever comes to one that is worth having, except as a result of hard work. Booker T. Washington
Reader Response
  • We appreciate your messages. Thanks & Regards. Dr GN Patnaik
  • Congratulations Sir this is a great victory (Major Relief for IMA In Income Tax Case). The judgment not only helps IMA HQ but all state and local branches will get relief from this judgment. Long LIve IMA . Thanking You, Dr. Shivkumar. S. Utture
News on Maps
eMedi Quiz
Holgene's phenomenon is seen due to which component

a. Benzylpenicilloyl
b. Procaine
c. Crystalline
d. Benzathine penicillin

Yesterday’s Mind Teaser: Brocq's phenomenon is analogous to which clinical sign in psoriasis?

a. Olfleck's phenomenon
b. Auspitz sign
c. Salmon patch
d. Candle wax scales

Answer for yesterday’s Mind Teaser: b. Auspitz sign

Correct Answers received from: Dr Shangarpawar, Daivadheenam Jella, Dr Avtar Krishan, Virendra Kharpate, Dr Poonam Chablani, Dr K Raju, Dr KV Sarma.

Answer for 4th March Mind Teaser: c.5

Correct Answers receives: Dr Virendra Kharpate, Dr Shangarpawar, Dr Poonam Chablani, Dr Avtar Krishan, Dr KV Sarma, Raju Kuppusamy.
Spread the message of Holi: Communicate to remove mental impurities
Holi is a festival of love and joy and should be used as a medium of communication to remove the mental dirt and impurities and cleanse the mind.

Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA and President Heart Care Foundation of India said that Holi festival should not end up with quarrels, violence or eve teasing.

Unsafe Holi
  • Green and bluish green chemicals contain malachite green, which can be toxic to the eyes. Auramine, methyl violet, rhodamine and orange II are all phototoxic colours and can damage the skin.
  • Mica in Holi colours can damage the skin.
  • Instead of chemical dyes, one should use floral dyes. Flowers like Marigold, China rose, Butterfly Pea, Flame of the Forest etc. are used for the extraction of colours.
  • ‘Bhang’ or cannabis can precipitate acute abnormal mental behavior and psychosis. In the susceptible individuals, it can increase the heart rate and blood pressure. Pre treatment with a beta blocker can take away the bad effects of bhang.
  • Alcohol can impair judgment and increase chances of accidents.
  • Balloons can cause blunt injuries to the eyes and precipitate head injuries.
  • Beware of date rape drugs. Do not play Holi with strangers.
  • Do not throw colour at sensitive parts of the body, such as eyes. If colour enters the eye, immediately wash it with a lot of water. If irritation persists, medical aid should be sought immediately.
Some tips
  • Use dental caps to protect teeth from staining.
  • Use sunglasses to keep eyes safe from the harmful chemicals of the colours.
  • Wear old and ragged clothes that may be discarded.
  • Wear full-sleeved T-shirts or shirts and leggings that fully cover the legs.
  • Wear socks.
  • Brightly coloured and dark coloured clothes should be preferred.
  • Keep your eyes and lips tightly closed, when colour is being applied on you.
  • Apply a thick layer of any oil on your body and hair till they glisten to make the skin slippery. This will help wash off colours easily later on.
  • While washing off the colour, use lukewarm water and keep eyes and lips tightly closed.
  • While traveling, keep the car windows tightly shut.
  • Use a hat, cap to protect the hair from being coloured with hard-to rinse dyes/colours.
  • If you venture out on the streets, avoid mob frenzy.
  • Do not bump into the frenzied group of mob if you take to streets. Cross the road to the sidewalk across or simply stay at a safe distance.
  • Discourage children to play Holi with eggs, mud or gutter water.
  • Avoid use of abir as it has flakes of mica.
  • Stop children from forcibly applying colour on a hesitant neighbor.
  • Don’t walk alone on the streets on the day of Holi.
  • Use only natural colour and water.
  • Keep a big bucket of clean water handy for your children, so that they do not resort to gutter water and other unclean sources.