Dr KK AggarwalDr KK Aggarwal SPRINT to be in focus again in AHA annual meeting

Results of SPRINT (Systolic Blood Pressure Intervention Trial), the landmark trial by the National Institutes of Health, released earlier in September this year had suggested an almost 25% reduction in mortality and 30% reduction in a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, or cardiovascular death with a systolic target under 120 compared with less than 140 mm Hg for middle age and older adults.

The complete data would be presented at a special late-breaking clinical trial session on Monday, Nov. 9 at the American Heart Association (AHA) Scientific Sessions meeting in Orlando, Florida in the US, which begins today.

The SPRINT study, which began in the fall of 2009, includes more than 9,300 participants age 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States and Puerto Rico.

Much rests on the findings of the trial as this study is expected to provide useful information to physicians as well as impact development of evidence-based clinical guidelines. Frank Sellke, MD, chief of cardiothoracic medicine at Brown University's Rhode Island Hospital in Providence and the Conference co-chair agreed that the trial would be influential both because of its size (9,361 hypertensive patients 50 years of age or older) and sponsor (the National Heart, Lung, and Blood Institute). He said, "It may actually change some guidelines."

Answers to some important questions are awaited such as the total number of deaths and how big was the reduction in cardiovascular mortality to indicate how meaningful the findings were; How much did the softer endpoints of ACS and heart failure contribute to the primary composite endpoint; the possible impact of the trial being stopped early and the risk profile of the population, which will dictate generalizability and Possible reasons why the more intensive strategy worked in SPRINT but not in diabetes in the ACCORD trial
Breaking News
FDA approves new drug for HIV with fewer side effects
The US FDA has approved Genvoya — a fixed-dose combination tablet containing elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg and tenofovir alafenamide 10 mg for the treatment of HIV-1 infection in treatment-naive adults and children aged 12 and older weighing at least 35 kg and for adults whose HIV-1 is currently suppressed (HIV-1 RNA < 50 copies/mL) on a stable antiretroviral regimen. (Medscape)

Though the drug is currently not available in India, experts say approval in the US is a major breakthrough and may trigger trials for the medicine in India, which has the third highest number of HIV-infected people in the world. Currently, India has over 20 lakh people living with HIV, while there are around 1.5 lakh children infected with the virus. Though India
demonstrated an overall reduction of 57% in the annual new HIV infections among adults, it still witnesses around 1.2 lakh new infections and 1.5 lakh AIDS-related deaths every year … (Times of India – Sushmi Dey)

Surrogacy by foreigners initiated before Nov 4 not to be hit by ban

Mumbai: Cases of surrogacy already initiated or in progress will not be affected by the ban prohibiting foreigners from seeking surrogacy in India, announced an online statement put up by the Union ministry of health and family welfare on November 5. The statement also identified November 4 — the date on which the statement was drafted — as the cut-off to deny permissions, visa and other facilities to foreigners seeking surrogacy in India.

It also spelt out that overseas citizens of India (OCI) cannot seek surrogacy in the country. "No permission should be granted by the Foreigners Regional Registration Officers (FRROs)/Foreigners Registration Offices (FROs) to Overseas Citizens of India (OCI) cardholders to commission surrogacy in India," said the statement … Regarding cases already initiated, the Centre's statement said: "Such cases will be allowed to complete the processes already started to avoid medical complications. However, all such cases will approach the state health authorities for permission. The state health authorities will decide such cases on a case-to-case basis.'' It added: "The child/children born through surrogacy already commissioned on or before issue of this circular, exit permission will be decided by FRROs/FROs on a case-to-case basis." (Times of India - Malathy Iyer)
Indian Medical Association National Satyagraha for a Healthy India
IMA Digital TV
Specialty Updates
• Using clopidogrel with aspirin for over a year does not increase or decrease the risk of overall death in patients with CHD or who are at risk for developing the disease, and it does not change the risk of cancer death or of developing cancer, pointed the US FDA.

• Prenatal exposure to maternal cancer, whether the cancer is treated or not, had no ill effects on cognitive or cardiac function or on the general development of children in early childhood, reported a case-control study published in The New England Journal of Medicine. However, the study did show a higher risk for infants being born prematurely and its concomitant later effects.

• A small, proof-of-principle trial suggests that stimulating the prefrontal cortex in the brain may dampen food cravings and lead to weight loss. The findings were presented at Obesity Week 2015 and published in the November issue of Obesity.

• Women with high levels of abdominal fat in their first trimester are at increased risk for diabetes later in pregnancy, suggested a new study published in the journal Diabetes Care.

• The power of vitamin C could one day be used to fight colorectal cancer, suggested a new study published in Science. Researchers noted that in cell cultures and mice, high doses of vitamin C - equivalent to around 300 oranges - impaired the growth of KRAS and BRAF mutant colorectal tumors.

• Treatment with the selective estrogen receptor modulator raloxifene did not improve cognitive function compared with placebo in a small pilot study of older women with Alzheimer's disease (AD), published online November 4 in Neurology.

• NICE issues positive Final Appraisal Determination (FAD) recommending the use of ciclosporin 1 mg/mL eye drops emulsion in single-dose containers for the treatment of severe keratitis in adult patients with dry eye disease, which has not improved despite treatment with tear substitutes.

• Maternal bone density decreases after childbirth, but only among women who lactate for at least four months, suggested a PhD thesis at Sahlgrenska Academy, University of Gothenburg. The paper further stated that the lactation period is unrelated to vitamin D status.

• The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study showed that who ate a "sweets/fat" diet or a high-sugar (Southern) diet had high insulin levels, whereas having a "plant-based" or an "alcohol/salad" diet was associated with a lower risk of these outcomes.
More about Debts
Hindu scriptures have talked about three types of Hrin (debts): Dev Hrin, Pitra Hrin and Rishi Hrin.

God or the devtas gave us the consciousness, parents gave us our body and teachers gave us the knowledge or intellect. In Vedic language, our body is a mix of mind, body and soul which can be equated to three Hrins of mind (teachers), body (parents) and soul (Rishi & Gods). In computer language, this can be equated to operational software (God), application software (teachers) and computer hardware (parents).
IMA Digital TV
Legal Quote
Martin F. D'Souza vs Mohd. Ishfaq SCI: 3541 of 2002, dated 17.02.2009
“No prescription should ordinarily be given without actual examination. The tendency to give prescription over the telephone, except in an acute emergency, should be avoided.”
Benefits of Estate Planning

Controlled estate planning will also help you plan against ‘Improper disposition of assets’. This could result in the estate being disposed of in equal but inequitable shares among his children, even if their needs vary greatly. It may also be an improper disposition of assets to leave forty or fifty lakhs in life insurance to a 21-year-old child or to a spouse - without the benefit of a trust arrangements to prioritize for proper investment or to preclude wild spending.

(Source: IJCP)
Industry News

Twitter launches new ‘Make in India’ emoji: The Indian government on Wednesday became the first non-US based brand to have a Twitter emoji – #MakeInIndia – which aims to promote the country as a global manufacturing hub. “As a key highlight of this government campaign, an emoji of a black lion on an orange background, a version of the national programme’s official logo, will now appear next to the #MakeInIndia hashtag in any Tweet worldwide,” Twitter said in a release following Commerce and Industry Minister Nirmala Sitharaman’s visit to its headquarters in San Francisco. (Times of India – IANS)

Key hiring challenges for emerging companies: Findings from a survey of 100 startups highlight key areas of concern for emerging businesses in terms of hiring, and the link between scarcity of funds and human resource problems. 47% 80% 40% 53% respondents said many venture capitalists review the quality of their workforce to assess funding potential. 53% startups said they spend more than 60% of the standard market value to hire the best talent. 80% startups agreed that employer branding plays a critical role in attracting the right talent… (The Economic Times)

Digital business strategies will drive more than half of enterprise IT spending within next 24 months: International Data Corporation (IDC) has announced its worldwide information technology (IT) industry predictions for 2016 and beyond. In 2007, IDC identified the 3rd Platform – built on the technology pillars of mobile computing, cloud services, big data and analytics, and social networking – as the foundation for the IT industry's future innovation and growth. Since then, the rapid adoption of 3rd Platform technologies has moved into the "Innovation Stage" – an explosion of innovation and transformation on top of the 3rd Platform's foundation… (Firstpost)

Swachh Bharat cess on all services from 15 November: Hotel, mobile-phone bills and airline tickets will get more expensive with the finance ministry deciding to impose a Swachh Bharat cess on all services starting 15 November to fund Prime Minister Narendra Modi’s Clean India mission. The cess was announced in the 2015-16 budget by finance minister Arun Jaitley but its imposition was deferred to a later date. While the budget proposed a maximum two percentage point cess above already existing 14% service tax, the finance ministry on Friday imposed a cess of 0.5 percentage points, taking the service tax to 14.5%... (Livemint - Asit Ranjan Mishra)
Digital IMA
IMA Digital TV
IMA Digital TV
Indian Medical Association and UNESCO join hands to express their solidarity on the importance of Bioethics
Benefits of Estate Planning

Controlled estate planning will also help you plan against ‘Improper disposition of assets’. This could result in the estate being disposed of in equal but inequitable shares among his children, even if their needs vary greatly. It may also be an improper disposition of assets to leave forty or fifty lakhs in life insurance to a 21-year-old child or to a spouse - without the benefit of a trust arrangements to prioritize for proper investment or to preclude wild spending.

(Source: IJCP)
IMA Satyagraha
IMA Satyagraha, suggested slogans

• Allow doctors to treat patients irrespective of patients’ income - If compensation is not capped, we can't do this.

• Writing prescription drugs by anyone other than with an MBBS degree is injurious to peoples’ health.

• Please allow Doctors to treat poor and rich equally.

• More patients will die if doctors are not provided protection during duty hours.

• Death does not mean negligence.

• Save single clinic and small establishments - Exclude them from Clinical Establishment Act

• PCPNDT Act needs graded punishments
• Dear sir, excellent job such initiatives will motivate government doctors to join IMA: Dr Kiran Shankar Deoras

• It has come to my knowledge that MCI has debarred Dr. Gaurav Bansal and Dr VK Kohli for one year as they were found guilty of medical negligence and for employing BAMS practitioner. This is happening all over the country. Most hospitals and nursing homes employ BAMS practitioners who are unauthorized to practice modern allopathic medicine. Most cases of medical negligence by BAMS practitioners do not come to light, nevertheless such cases are huge in number. We have been asking medical establishments not to employ BAMS practitioner but to no avail. IMA need to carry out inspections and take strict action against such establishments. Dr VN Sharma

• The office bearers of BCWMA extend their full support to the 'Satyagrah for a Healthy India' and shall inform our members and request them to sign the petition. Dr Neelang S Shah.
China becomes the largest contributor of MBBS doctors to India
China is today the largest contributor of MBBS doctors to India followed by Russia, Ukraine and Nepal, according to data collated by the National Board of Examinations, which conducts Foreign Medical Graduate Examination (FMGE) screening tests… (ET Healthworld – Sushmi Dey)
A national nutrition strategy on the anvil
In a first of its kind initiative, the government will soon come out with national Nutrition Strategy and set up inter-ministerial group on health and nutrition data to identify the focus districts and finalize recommendations for monitoring and tracking progress of the nutrition strategy. "NITI Aayog has been tasked with preparing the draft Nutrition Strategy by the end of December 2015, in consultation with both the concerned ministries, sectoral experts, States and other relevant stakeholders," an official statement said. "It was decided that an Inter-Ministerial Group on Health and Nutrition Data will also be constituted, to identify the focus districts and finalize recommendations for monitoring and tracking progress of the nutrition strategy," it said. (ET Bureau - Yogima Seth Sharma)
US FDA issues new integrated summary of effectiveness to pharma industry
US FDA has issued an Integrated Summary of Effectiveness (ISE) to the pharmaceutical industry which is viewed by the industry to provide the much-needed support during submission of its New Drug Application (NDA) and Biologics License Application (BLA). According to the regulatory authority, the guidance provides a direction on the recommended content of the integrated summary of effectiveness (ISE) for inclusion in NDA or BLA. Although there are no regulations requiring an ISE for BLA submissions, applicants are encouraged to provide an ISE because it represents an opportunity to present a coherent analysis of the drug’s benefits. The recommendations to include ISE provides an integrated analysis that offers insights beyond those observable in individual clinical trials. However these norms are not applicable to medical devices regulated as biologics under the Public Health Service Act… The ISE is a comprehensive integrated analysis of the effectiveness of a study drug. Its objective is to describe the available information regarding effectiveness, delineate strengths and weaknesses, and highlight important missing information. Generally, analyses in the ISE are based primarily on the clinical effectiveness data included in the application, but it could also include other sources of information relevant to efficacy… (Pharmabiz - Nandita Vijay)
GP Tip
Deltoid versus forearm for PPD testing

The volar (flexor) surface of the forearm is traditionally used for purified protein derivative (PPD) testing. Patients have less pain when PPD is applied over the deltoid surface, which has fewer nerve fibers than the volar surface. (Source: IJCP)
OTC drug does not mean it can be taken without a doctor’s advice

An over–the–counter antacid is often used to relieve mild cases of heartburn or acid reflux. Though they are available without a doctor’s prescription they should be taken only under a doctor’s advice.

As per American Academy of Family Physicians
• Different types of antacids work in different ways.
• To manage an ulcer, an antacid may need to be taken in conjunction with an antibiotic.
• If one needs more calcium to help strengthen bones, prefer an antacid that contains calcium carbonate.
• Antacids may have minor side effects in some such as nausea, headache, diarrhea or constipation.
• Read the label carefully to make sure that you are not allergic to any of the ingredients.
• People with kidney disease may not be able to take all types of antacids.
• An antacid may interact with other medications. So, talk to the doctor before taking an antacid.
Bioethical issues in medical practice
Right to refuse treatment

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

In India, going on protest fasts is a recognized method of registering opposition to several public issues- from AFSPA to reservations and pensions. Indian law permits force feeding of protesters.

a) While correct in law, is this ethically proper?
b) What alternatives should the State follow, if force feeding is not permissible? Do write in with views and your solutions!
Inspirational Story
Lesson in Leadership

Excerpt from: "You Can’t Send a Duck to Eagle School" – by Mac Anderson

In 1982, Jan Carlson had just been named the CEO of Scandinavian Airlines. His company was in trouble. They had just been ranked by a consumer poll as the worst airline in the world. Last in service, last in dependability, and last in profits as a percentage of sales. Yet one year later, in the same poll, they were ranked number one in all three categories. What happened?

Carlson had decided to focus on what he thought was the most critical issue…serving the customer. He wanted to keep it simple: Identify every contact between the customer and the employee, and treat that contact as…"a moment of truth." He set out to let his people know the importance of that moment…the captain, the ticket agent, the baggage handler, the flight attendant. "Every moment, every contact," he said, "must be as pleasant, and as memorable as possible."

He figured that he had approximately 10 million customers each year, and on average each customer made contact with five of his people for approximately 15 seconds apiece. Therefore, in his mind, these 50 million contacts, 15 seconds at a time, would determine the fate of his company.

He set out to share his vision with his twenty thousand employees. He knew the key was to empower the front line. Let them make the decision and take action, because they were Scandinavian Airlines during those fifteen seconds. He now had twenty thousand people who were energized and ready to go because they were focused on one very important thing…making every moment count.

"A leader’s job is to look into the future and see the organization, not as it is, but as it should be." Jack Welch
Readers column
As usual the issue of emedinews was very informative and useful in practical sense. Dr J U Pathak. (Source: IJCP)


Will I live longer?
Patient: Doctor, if I give up wine, women, and song, will I live longer?
Doctor: Not really, it will just seem longer.
IMA Digital TV
Press Release
Indian Medical Association and UNESCO join hands to express their solidarity on the importance of Bioethics

Dr. A Marthanda Pillai – National President, Dr. KK Aggarwal – Honorary Secretary General and Dr. S.S Aggarwal, President Elect IMA appointed the first Indian Bio-ethics UNESCO Chairs

New Delhi, 7thNovember 2015: The healthcare industry in India and across the globe has seen a revolutionary shift over the past decade. Technological advancements have made possible the eradication of epidemics like polio and plague, which used to be the cause of death for millions. Diseases like cancer, which were considered incurable in the past, have now found successful treatments. The life expectancy of the population has gone up, and the quality of life has improved. However, with all of this has also come an increased consumerization of the medical field. The doctor – patient relationship has become extremely impersonal, and there has been a drastic rise in evils such as medical negligence and violence against doctors.

Addressing these new age problems and stressing the importance of a comprehensive bioethics charter, the Indian Medical Association, and UNESCO co-organized a debate at Heart Care Foundation of India's annual flagship event, the 22nd MTNL Perfect Health Mela today. Dr. Susan Vize, Advisor - UNESCO, Prof Kalra - Vice Chancellor, University of Health Sciences and Patron of the UNESCO Charter, IMA’s National President Dr. A Marthanda Pillai && Honorary Secretary General Dr. KK Aggarwal chaired the discussion.

Bioethics is the study of the typically controversial ethical issues emerging from new situations and possibilities brought about by advances in biology and medicine. It is also moral discernment as it relates to medical policy and practice. In his statement Shri Jagat Prakash Nadda, Union Minister of Health and Family Welfare said, “I congratulate the trinity of IMA, UNESCO, and Vice-Chancellor of healthcare universities in their endeavor to inculcate and propagate ethics in medical services. Every doctor in our country should be educated about the ethics of the profession right from the beginning.” Addressing the importance of ethics in medicine, Padma Shri Awardee Dr A. Marthanda Pillai – National President IMA and Padma Shri Awardee Dr. K K Aggarwal, Honorary Secretary General IMA and President- HCFI in a joint statement said, “Ethics play an extremely crucial role in defining a positive doctor-patient relationship and ensuring effective health care delivery. There is an urgent need to educate the medical fraternity of what they must and must not do to protect the nobility of the medical profession. In this regard, it is extremely important to formulate a bioethics charter and include medical ethics as a part of the regular MBBS curriculum. In addition to this, ethics must also be taught as a part of CME for established medical practitioners. Being aware of necessary principles of ethics can help doctors make the right decisions on how to act in complicated clinical situations and avoid any subsequent unpleasantness. An open and honest communication between doctors and their patients can help set necessary expectations and ensure proper treatment.” Adding to this, Dr. Susan Vize, Advisor, UNESCO said, “All medical practitioners must be aware of what is the right thing to do and the good way to be, what obligations do they have towards their patients and what constitutes a case of medical negligence and inappropriateness. By doing so, they are more likely to take the right decisions during high-stress situations and emergencies".

Addressing the gathering Dr. Princy Louis Palaty - Head, South-India Unit, UNESCO, Chair in Bioethics and National Bioethics Curriculum said, “Every practicing doctor must be ethical while delivering healthcare services to the society and not let lucrative and other negative instincts influence his/her decision. Educating the medical fraternity about ethics is the need of the hour, and we hope that through this collaborative joint venture we can steer the country towards ethically excellent healthcare.”

The discussion panel also constituted Dr Rusell D’souza - Head, Asia-Pacific Division, UNESCO, Dr Mary Mathew - National Chair, TTT program and Head, Karnataka Unit UNESCO and Dr Mohandas - National Chair, Technical Skill Head Kerala Unit. Eight Vice-Chancellors were also present including Prof. Dr. Raja Babu Panwar from Rajasthan University of Health Sciences, Prof. Dr. Raj Bahadur from Baba Farid University of Health Sciences, Prof. Dr. Ravi Kant from King George Medical University, Prof. Dr. MKC Nair from Kerala University of Health and Sciences, University of Health Sciences, Dr. O. P. Kalra from Pandit Bhagwat Dayal Sharma University of Health Sciences, Prof. (Dr.) Bhabatosh Biswas from Madhya Pradesh Medical University and Prof. Dr. D. P. Lokwani from West Bengal University of Health and Sciences.
eMedi Quiz
In a patient with a tumor in the superior medistinum compressing the superior vena cava, all the following veins would serve as alternate pathways for the blood to return to the right atrium, except:

1. Lateral thoracic vein.
2. Internal thoracic vein.
3. Hemiazygos vein.
4. Vertebral venous plexus.

Yesterday’s Mind Teaser: B-oxidation of odd-chain fatty acids produces:
1. Succinyl CoA.
2. Propionyl CoA.
3. Acetyl CoA.
4. Malonyl CoA.

Answer for Yesterday’s Mind Teaser: 2. Propionyl CoA.

Answer for 4th November Mind Teaser: 3. Leaves extension at elbow joint intact Answers received from: Dr KV Sarma, Dr Thakor Hitendrsinh G, YJ Vasavada, Dr K Raju, Dr Pankaj Agarwal.