[CONTENT]
December 7   2015, Monday
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EDITORIAL
Dr KK AggarwalDr KK Aggarwal Clinical Updates

• Findings from the largest analysis ever reported of the clinical course of untreated cavernomas in Lancet Neurology suggests that 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, but older age, female sex, and having multiple cavernomas are not independent predictors of poor outcomes.

• A slow walking speed was associated with a higher level of brain amyloid deposits in a population of older adults at a high risk of developing dementia in a new study in Neurology.

• White matter integrity should be considered a primary phenotype for linking genes to biological pathways that contribute to the development of schizophrenia and may represent a genetic vulnerability marker, reports a study in JAMA Psychiatry.

• After a year of treatment with the drug ranibizumab (Lucentis), some people with vision loss due to diabetes regain their confidence to drive and have vision good enough to do so, according to a new study in JAMA Ophthalmology.

• Using a combination of tenofovir disoproxil fumarate and emtricitabine before and after sex was 86% more effective than placebo in protecting men having unprotected anal sex with men against HIV-1 infection, according to new results published in the New England Journal of Medicine.

• More extensive colonization of skin by Staphylococcus aureus is associated with greater severity of atopic dermatitis, researchers from France report in Journal of Allergy and Clinical Immunology.
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
Supreme Court asks the Central Govt to educate children about dangers of alcohol & drugs

The Supreme Court on Friday asked the Centre to consider the suggestions by the NGO Bachpan Bachao Andolan to incorporate in curriculum the study material highlighting ill-effects of alcohol and drugs among children. The social justice bench of justices M B Lokur and U U Lalit asked Additional Solicitor General Pinky Anand to mull over the suggestion submitted by the NGO. The counsel appearing for the NGO told the apex court that "alarming" spurt in the use of drugs and among children in India and there was an urgent need to educate them on the issue… (Zeenews India)

AAP guidelines on apnea of prematurity

The American Academy of Pediatrics (AAP) has released guidelines on apnea of prematurity, published in the journal Pediatrics. These guidelines clarify the definition, epidemiology, treatment of apnea of prematurity including discharge recommendations for preterm infants who have recurrent apneic events. It is defined as sudden cessation of breathing that lasts for at least 20 seconds in an infant younger than 37 weeks; however, apnea of prematurity frequently also includes shorter pauses in airflow that are accompanied by bradycardia or oxygen desaturation. Most apneic episodes in preterm infants are mixed events "in which obstructed airflow results in a central apneic pause, or vice versa”… (Medscape)
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Specialty Updates
• A new study has found interesting links between specific chemicals in coffee and type 2 diabetes. Researchers noted that cafestol and caffeic acid increased insulin production in the presence of glucose. Cafestol also increased glucose uptake into muscle cells at a similar rate to current diabetes drugs. The findings are published in the Journal of Natural Products.

• Supplementation with the estrogen hormone estriol, found in high levels during pregnancy is associated with fewer relapses in patients with relapsing-remitting multiple sclerosis (RRMS), reported a randomized, placebo-controlled study published online in Lancet Neurology.

• Whole Genome Sequencing is a faster, cheaper and more effective way of diagnosing tuberculosis, suggests a new study published in the journal Lancet Respiratory Medicine.

• Researchers have developed the world's first commercially-available "smart dressing" for use in futuristic wound care applications. The smart dressing, called 'DermaTrax', contains sensors that monitor conditions in a patient's wound, including its temperature, moisture and pH.

• Feeling high levels of distress, fear and hostility just before undergoing medical procedures such as angioplasty may lead to a poor outcome, suggested a new study.

• A study finds that particles from burning coal are far worse for the health than other pollution sources. The study noted that particles from burning fossil fuels were associated with an increased risk of death from ischemic heart disease.

• Activating receptors in the brain for the body's hunger hormone increases food-related behaviors, such as gathering, storing and consuming food, suggested a new study published in The American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. The findings may have important implications for treating obesity.

• Graphene oxide could be used to make super strong dental fillings that don't corrode, suggested a new study published in Colloids and Surfaces B: Biointerfaces.
eSPIRITUAL
You look at people the same way as you are

Honest people look at everybody as honest and dishonest people regard everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel everybody is honest. If you take bribe then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.
Legal Quote
M/S. Spring Meadows Hospital & Anr vs Harjol Ahluwalia Through, K.S. on 25 March, 1998

A consultant could be negligent where he delegates the responsibility to his junior with the knowledge that the junior was incapable of performing of his duties properly.
Medical Breakthroughs that were initially ridiculed or rejected
Germs cause disease

Louis Pasteur was not the first to propose the germ theory of disease; but, he is forever linked with this critical leap forward in medical science because he was the first to conduct convincing experiments that demonstrated the underlying role of micro-organisms in disease, thus firmly overturning the concept of "spontaneous generation" as their cause. Less well known is the bitter and long-running resistance to Pasteur's ideas spearheaded by Pierre Béchamp, a successful French chemist and biologist. Béchamp, a contemporary of Pasteur's, believed that tiny organisms present in all things called "microzyma" were responsible for disease, as opposed to external bacteria that invaded healthy tissue. Though Béchamp was well known at the time of his public dispute with Pasteur, he died in relative obscurity and would be nothing more than a historical footnote had he not become the figurehead of a larger movement of germ theory denialists that continued throughout the 20th century. (Medscape)
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eIMA NEWS
IMA National Health Scheme (Contd.)

Duties of the Secretary: The secretary shall carry out the day to day function of the scheme and shall implement the decision taken by the managing committee. He/ she shall be in overall charge of the membership enrolment, collection and routine administration and besides other duties and function specified by the managing committee. Joint secretary shall help the secretary in all routine works and perform the duties of the secretary in his absence.

Duties of Treasurer: The Treasurer shall maintain day to day accounts of the scheme, submit the accounts for the approval of the managing committee. He shall submit a statement of audited account to the managing committee of the scheme, the Central Working committee and Central Council of IMA. He shall prepare a budget for the next year.

Duties of the state coordinators: State coordinators shall assist the secretary in membership enrolment, dues collection and claim disbursement in their respective States.

Duties of Vigilance officer: Before each Managing Committee the vigilance officer shall audit the accounts and submit the reports to the managing committee. The audited account of the scheme shall be presented to the Managing Committee, National Finance Committee, Central Working Committee and the Central council.

Accounts and Audit : (a). A separate Bank account shall be opened in any nationalized / Scheduled Bank in the name of the Scheme and shall be operated jointly by Hon. Secretary and Treasurer. (b) The financial year of the scheme shall be from 1st April to 31st March. (c).The Managing Committee shall approve account submitted by the office bearers duly audited by the chartered accountant of the scheme.

(To be contd.)
Media
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eMEDIPICS
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
All state capitals to have CGHS wellness centers soon

More than 900 healthcare organizations, including 558 hospitals, are empanelled under Central Government Health Scheme (CGHS and efforts are being made to ensure that more people are able to avail their services, the government said on Friday. Health and Family Welfare Minister JP Nadda told the Lok Sabha that the government has decided to set up at least one CGHS Wellness centre in all state capitals. CGHS is operational in 26 states. There are 949 healthcare organizations empanelled under CGHS as on November 30. Of these, there are 558 hospitals, 286 eye clinics and 105 dental centers and 165 diagnostic centers… (ET Healthworld)
HvPI registers over 3000 adverse transfusion reaction reports

The Haemovigilance Program of India (HvPI) has till date registered over 3000 adverse transfusion reaction reports. In addition to monitoring adverse transfusion reactions, HvPI will also help generate evidence based recommendations. HvPI was launched on December 10, 2012 by National Institute of Biologicals (NIB) to identify trends in adverse reactions and events, thereby to form transfusion policy, target areas for improvement in practice, stimulate research, raise awareness of transfusion hazards and give an early warning of new complications to improve safety of transfusion for patients. It covers 236 centers covering blood banks, medical colleges, government and private hospitals across the country… (Pharmabiz - Shardul Nautiyal)
Human tularemia cases rising in some states in the US

A surveillance report from the Centers for Disease Control and Prevention (CDC) states that during the last 2 decades in the United States, about 125 tularemia cases have been reported every year. The number of human tularemia cases increased substantially this year in Colorado, Nebraska, South Dakota and Wyoming. The report is published in the December 3 4 issue of in the Morbidity and Mortality Weekly Report. Tularemia is caused by Francisella tularensis, a gram-negative coccobacillus that infects humans and animals… (Medscape)
National Child Health Programme

Under the National Health Mission (NHM), the Government of India is implementing Rashtriya Bal Swasthya Karyakram (RBSK) since 2013, for screening of all the children from 0-18 years of age including school children for 4 Ds i.e. Defects at birth, Deficiencies, Diseases and Development delays including disability. (PIB).
90–90–90: UNAIDS Treatment target to end the AIDS epidemic

By 2020, 90% of all people living with HIV will know their HIV status.
By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

(UNAIDS)
India’s first dedicated society for therapeutic neurointerventions formed

A group of top neurosurgeons has come together to form India's first dedicated society for therapeutic neurointerventions, called Society of Therapeutic Neurointerventions to bring all the practicing and budding Neurointerventionists of the country on the same platform. Neurovascular intervention is a branch in which minimally invasive procedures of blood vessels of brain and spine are performed through endovascular (inside the blood vessel) route. The Society is holding its first annual conference from December 4-6 at Gurgaon… (ET Healthworld – IANS)
eWELLNESS
Repeated CT scans are risky to life

CT scan involves x–ray radiation and can be harmful to the body. Unless it is essential for any diagnostic procedure, one should not undergo repeated CT scans on annual basis for diagnosis of certain cancers. On the other hand, ultrasound and MRI are safe and carry no radiations. Experts have said that MRI and CT scan are not interchangeable diagnostic procedures. Contrast imaging which was earlier used with x–ray is now available for ultrasound and echocardiography. Thirty percent of patients do not have a good heart window of routine echocardiography. In these cases, using special ultrasound contrast can prevent angiography and other cath procedures.
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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
Protecting the privacy and confidentiality of patients

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

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse- a doctor- as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in! Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013): http://www.eubios.info/
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Inspirational Story
The Falcon & the Branch

Once there was a king who received a gift of two magnificent falcons. They were peregrine falcons, the most beautiful birds he had ever seen. He gave the precious birds to his head falconer to be trained. Months passed, and one day the head falconer informed the king that though one of the falcons was flying majestically, soaring high in the sky, the other bird had not moved from its branch since the day it had arrived.

The king summoned healers and sorcerers from all the land to tend to the falcon, but no one could make the bird fly. He presented the task to the member of his court, but the next day, the king saw through the palace window that the bird had still not moved from its perch.

Having tried everything else, the king thought to himself, “May be I need someone more familiar with the countryside to understand the nature of this problem.” So he cried out to his court, “Go and get a farmer.” In the morning, the king was thrilled to see the falcon soaring high above the palace gardens. He said to his court, “Bring me the doer of this miracle.”
The court quickly located the farmer, who came and stood before the king. The king asked him, “How did you make the falcon fly?” With his head bowed, the farmer said to the king, “It was very easy, your highness. I simply cut the branch where the bird was sitting.”

Moral: We are all made to fly — to realize our incredible potential as human beings. But at times we sit on our branches, clinging to the things that are familiar to us. The possibilities are endless, but for most of us, they remain undiscovered. We conform to the familiar, the comfortable, and the mundane. So for the most part, our lives are mediocre instead of exciting, thrilling and fulfilling. Let us learn to destroy the branch of fear we cling to and free ourselves to the glory of flight.
eMEDI QUIZ
Which of the following are true regarding anemia?

1. Hb <13.5 g/dL or hematocrit (HCT) <41.0% represents anemia in men
2. Hb <12.0 g/dL or <36.0%, respectively, represents anemia in women.
3. Differences may also exist between races, in older adults, and in athletes.
4. All of the above

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: 1. 1.5 to 3 days

Answers received from:Daivadheenam Jella, Dr Rajesh S Joshi, Dr Avtar Krishan, Dr Kailash Chandra Sharma, Dr.K.Raju,

Answer for 5th December Mind Teaser: 4. The amount of virus shed is greatest during the second week of illness.

Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.
Humor
The Anesthesiologist

Jill received a bill from the hospital for her recent surgery, and was astonished to see a $900 fee for the anesthesiologist. She called his office to demand an explanation. "Is this some kind of mistake?" Jill asked when she got the doctor on the phone. "No, not at all," the doctor said calmly.

"Well," said Jill, "that's awfully costly for knocking someone out." "Not at all," replied the doctor. "I knock you out for free. The 900 dollars is for bringing you back around."
Readers column
Dear Sir, You are giving fabulous information. Regards: Dr Piyush

Dear Sir,
I am thankful to the IMA Hq for intervening in election dispute of Punjab State IMA 2016 and we have reached amicably in a compromise.
I hereby withdraw my complaint in the tribunal.
Thanks & regards
Dr RL Taneja
IMA Ferozepur , Punjab
Press Release
Over 12000 children examined at Indian Medical Association and Johnson & Johnson’s ‘Healthy Baby’ camp at 5 cities in UP

The camp aimed at raising awareness of the urgent need to reduce under-5 mortality in the State

New Delhi, December6th, 2015: The UP branch of the Indian Medical Association in association with Johnson and Johnson successfully organized a ‘Healthy baby camp’ in five UP cities today. The camp that took place simultaneously at Agra, Moradabad, Kanpur, Ghaziabad and Meerut aimed at addressing and finding effective solutions the high prevalence of under-5 mortality in the region.

Free health check-ups were provided to over 12000 visiting children. Their parents were educated about the importance of breastfeeding, timely vaccinations, prevention of life-threatening disease such as malnutrition and diarrhea for a healthy future for their child. A panel of judges comprising of leading city pediatricians also judged and awarded the parents with the healthiest children.

It is unacceptable that over 13 lakh children die in India every year before their fifth birthday; out of these 7.48 lakh die before their first birthday itself. UP, Bihar, MP, and Rajasthan account for 50% if the total child deaths in the country. There is an urgent need to reverse this trend.

Commenting on the issue, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. K K Aggarwal, Honorary Secretary General IMA in a joint statement said, “Children are the future of our country, and we must do everything in our capacity to protect them. Through these camps taking place simultaneously in 5 cities in UP; our endeavor has been to educate parents about the importance of breastfeeding, maintaining sanitation and hygiene, ensuring proper medical care for the newborn and the proper disposal of waste. By doing so, we hope that we can help reduce the incidence of conditions such as asphyxia, pneumonia, diarrhea, malaria, measles, and malnutrition that are leading causes of infant death. Maternal mortality is another major issue that our country faces given that its rate is as high as 178 per 1000 live births at present. The Indian Medical Association aims to reduce this to 128 in the near future through various awareness driven initiatives”.

Adding to this, Dr. AP Singh – President and Dr. Anand Prakash – Secretary of the IMA UP branch said, “It is deplorable that in the 21st century, one in five children die in India before the age of five because of diarrhea and malnutrition-related illnesses. In addition to this, only 41% mothers initiate early breastfeeding. Through the ‘Healthy Baby' camp, our aim was to educate parents about ways in which they can ensure a healthy and long life for their child. We are happy to say we succeeded in educating the parents of over 12000 children in the State. We thank the team at Johnson and Johnson for supporting this cause.”

In their statement Dr. JN Tandon – President and Dr. Amod Shankar – Secretary of the IMA Agrabranch; Dr. Subash Aggarwal – President and Dr. PallavRastogi– Secretary of the IMA Ghaziabadbranch; Dr. ArtiChandani– President &Dr. ArchanaBhadori – Secretary of the IMA Kanpur branch; Dr. TanujSirohi– President and Dr. Shishir Jain – Secretary of the IMA Meerutbranch and Dr. Rajesh Singh – President &Dr. Mohd. Asad Khan – Secretary of the IMA Moradabad branch said that there exists large-scale ignorance about the importance of good nutrition, hygiene, and sanitation in the region. It is important that all doctors educate new mothers about key child health issues and ways to prevent them. We are extremely happy with the success of this camp and hope to organize more such events in the future.
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