May 8  2015, Friday
editorial
Lowering BP No Help in Acute Stroke
Dr KK Aggarwal Use of antihypertensive drugs to lower systolic blood pressure by close to 13% as part of acute treatment of ischemic stroke did not reduce early mortality or disability compared with patients who did not receive antihypertensive therapy.

At 14 days after randomization, there were 683 events among patients who received early aggressive antihypertensive therapy versus 681 events in the control group and at 3 months, there were 500 additional events in the treatment arm versus 502 among controls, said Jiang He, MD, PhD, of Tulane University School of Public Health in New Orleans.

He reported the findings from China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) at the American Heart Association scientific sessions here and the results were simultaneously published online by the Journal of the American Medical Association. (MedPage)
IMA,IJCP,HCFI
eMedipics IMA,IJCP,HCFI
Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
News
  • Omega-3 fatty acid supplements appear to be effective for controlling joint pains and stiffness from aromatase inhibitors in women with early-stage breast cancer, but placebos made of soybean and corn oil are every bit as good, suggests a randomized controlled trial. The findings are published online in the Journal of Clinical Oncology.
  • New interferon (IFN)-free treatment regimens demonstrated a high rate of sustained virologic response among patients with chronic hepatitis C virus (HCV) infection, including those who had been previously treated or have compensated cirrhosis, suggest new data published online May 5 in JAMA.
  • Twice-daily application of sodium nitrite and citric acid creams cleared anogenital warts more effectively than placebo, suggests new research published in JAMA Dermatology.
  • People with type 2 diabetes who are obese and have dyslipidemia should be considered for screening for non-alcoholic fatty liver disease (NAFLD), suggests new research published online in Gut.
  • Corneal collagen crosslinking reduces the risk for ectasia in LASIK patients, suggests a new study presented at the American Society of Cataract and Refractive Surgery 2015 Symposium.
IMA,IJCP,HCFI
Dr KK Spiritual Blog
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.

Never judge people with you personal experience. I recall one of the doctors saying that every doctor takes and gives bribe because he was running an imaging centre and every doctor who approached him asked for a bribe. But he did not take into consideration the doctors who did not approach him.
Cardiology eMedinewS
  • An inverse, dose-response relationship exists between cardiorespiratory fitness (CRF) and development of atrial fibrillation in patients without known heart disease, especially in those who are obese, suggest findings from the Henry Ford Exercise Testing (FIT) Project. The results were published online in Circulation.
  • Adding more complex ablation to pulmonary vein isolation for persistent atrial fibrillation does not obliterate recurrences, suggested the STAR AF II trial published in the May 7 issue of the New England Journal of Medicine.
Pediatrics eMedinewS
  • Children whose mothers faced more psychosocial stressors during pregnancy have higher levels of cortisol in their hair and worse health, suggest new findings published online May 4 in Pediatrics.
  • Timely infant and maternal pertussis vaccination could reduce infant mortality from the disease, suggest the U.S. Centers for Disease Control and Prevention (CDC) in a report published online May 4 in Pediatrics.
Make Sure
Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.
Dr Good Dr Bad
Situation: A woman with rheumatoid arthritis became pregnant while taking Leflunomide.
Dr. Bad: You can continue to take it.
Dr. Good: Stop it immediately.
Lesson: In women with rheumatoid arthritis who become pregnant while taking leflunomide, healthy pregnancy outcomes usually occur, if the drug is discontinued at the earliest and a cholestyramine drug elimination procedure is done. (Arthritis Rheum 2010;62:1494)

(Copyright IJCP)
Inspirational Story
Let me put forward a story to you which I once read which should be borne on mind by every parent.

A little boy was playing ball when his father hurried out calling the secretary on the phone.

"Dad, do you have a minute to play ball with me?"

"Sorry son, I’m busy" was the response.

Years later, the father, now bald–headed and reclining in a chair in the lawn saw his son coming out to his car, keys twirling on his finger.

"Son, do you have a moment to have a cup of tea with me?" he asked.

"Sorry I’m busy," came the response.

A simple story and one which I am sure is not new to many of you in essence, but one which does call for some soul searching.

Of course, we have our busy schedules but it is important to make up for the time which you could not give your child when you were busy, with some quality time later.

But make sure that it happens before it is too late.
Wellness Blog
Smell check, scratch and sniff, a new test for Parkinson’s disease

Olfactory dysfunction presenting as odor detection, discrimination, and identification is a common finding in patients with early non vascular Parkinson’s disease.

As per a study of 2,267 men published in the Annals of Neurology, an impaired sense of smell could be an early indicator of Parkinson’s disease, occurring up to four years before motor skill problems appear.

In the study decreased odor identification was associated with older age, smoking, more coffee consumption, less frequent bowel movements, lower cognitive function and excessive daytime sleepiness, but even after adjusting for these factors, those with the lowest odor identification scores had a five time greater risk of developing Parkinson’s disease than those with the highest scores.

Nerve loss and the formation of Lewy bodies –– abnormal clumps of proteins inside nerve cells that are thought to be a marker of the disease –– are known to take place in the olfactory structures of patients with the disease.

An impaired sense of smell could also be caused by impaired sniffing, which may be another motor symptom of Parkinson’s.

Early indicators of Parkinson’s disease are olfactory abnormality, constipation and sleep disturbances.

Besides Parkinson’s disease, obesity, diabetes, hypertension, malnutrition, Alzheimer’s disease, multiple sclerosis and Korsakoff’s psychosis are all accompanied or signaled by smell disorders.
Events
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eMedinewS Humor
If a lion is chasing you

Teacher: If a lion is chasing you, what would you do?

Student: I’d climb a tree.

Teacher: if the lion climbs a tree?

Student: I will jump in the lake and swim.

Teacher: if the lion also jumps in the water and swims after you?

Student: Teacher, are you on my side or on the lion’s?
eMedi Quiz
All of the following features can be observed after the injury to axillary nerve except:

1. Loss of rounded contour of shoulder.
2. Loss of sensation along lateral side of upper arm.
3. Loss of overhead abduction.
4. Atrophy of deltoid muscle.

Yesterday’s Mind Teaser: Referred pain from ureteric colic is felt in the groin due to involvement of the following nerve:

1. Subcostal.
2. Iliohypogastric.
3. Ilioinguinal.
4. Genitofemoral

Answer for yesterday’s Mind Teaser: 4.Genitofemoral

Correct Answers received from: Dr Poonam Chablani, Dr A K Jain, Diwaker, Daivadheenam Jella, Sri Rekha, Dr G Madhusudhan, Dr Avtar Krishan.

Answer for 6th May Mind Teaser: Buccinator.

Correct Answers received: Daivadheenam Jella, Dr Shangar Pawar.
IMA,IJCP,HCFI
Quote of the Day
Permanence, perseverance and persistence in spite of all obstacles, discouragement, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak. Thomas Carlyle
Rabies News (Dr A K Gupta)
How should the animal causing the bite be handled?

It is important to establish whether the biting animal is healthy or diseased, bearing in mind that a rabid animal excretes the virus in its saliva not just throughout the illness but also several days before the appearance of the first signs. An unknown animal, which has disappeared, must be considered as rabid and full course of PEP must be given. Cats and dogs, which can be identified, must be kept under observation. The risk of rabies can be considered as slight if the animal shows no sign of disease after 5 days, and non–existent if the animal is still healthy on the 10th day (The European Standards recommend an observation period of 15 days).

All wild animals, and those domestic animals suspected of having rabies must be put down and the rabies diagnosis must be carried out in the laboratory.

If it is proven that the animal is not rabid, only then the anti–rabies treatment may be halted.
Reader Response
Dear Dr Aggarwal, thanks for your prompt reply and elaborate article on 20 points on asthma every doctor must know. Dr Jagdeep Chugh.
IJCP Book of Medical Records
IJCP’s ejournals
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
eIMA News
Boycott all movies of Akshay Kumar and Sanjay Leela Bhansali
Shri Arun Jaitley
Hon’ble Minster for Information and Broadcasting
Ministry of Information & Broadcasting
Soochna Bhawan, CGO Complex
Lodhi Road
New Delhi-110 003

Respected Sir,

Indian Medical Association (IMA) is a pan India voluntary organization of modern medicine doctors. It has a membership of 2.5 lakh doctors spread over 30 State/U.T. Branches and 1700 Local Branches.

IMA is anguished about the way medical profession is projected in the Movie “Gabbar is Back”. The clip of the movie can be seen by clicking http://module.ima-india.org/ima/video/Ban%20Gabbar%20is%20Back-%20IMA.aspx

In this movie medical profession is shown in a bad, derogatory and unrealistic manner. The movie shows the doctors in hospital in extremely poor light where they carry out a fraudulent act of providing medical treatment to a person who is already “dead” even before arrival. The Hero of the movie is still aware that the patient is dead and is carrying a death certificate but he approaches the hospital as if the patient is just dead.

The movie “Gabbar is back”, is directed by Mr. Krish and Produced by Mr.Sanjay Leela Bhansali, produced by Viacom 18 motion pictures, storey written by Mr. A R Murugadoss and the role played by Mr. Akshay Kumar. The movie is a total instigation of the general public against the image of the medical profession.

With Violence against Doctors on the rise and such type of unjustified message through the movie will only add fuel to the fire.

Even the role played by Mr. Akshay Kumar is illegal where his act is a loss of dignity of a dead body and fraud misrepresention of a dead person being "alive but critical".

IMA wants the above referred scene to be immediately withdrawn from the movie and till then this movie to be immediately censored and banned.

IMA today has sent the above clipping to its 2.5 lacs doctors who are member of our Association.

We urge you, if no action is taken by the Censor Board/Ministry of Information & Broadcasting/Health Ministry/Home Ministry, IMA will be forced to agitate & protest against the movie.

IMA has already made a call to its members to boycott all movies of Mr. Akshay Kumar & Mr. Sanjay Leela Bhansali.

IMA strongly register its objection and protest on the depiction of medical profession in a derogatory and unrealistic manner in a scene/sequence in film “Gabbar is back”.

With kind regards,

Yours sincerely,

Dr. A. Marthanda Pillai               Dr. K K Aggarwal
Padma Shri Awardee         Padma Shri, National Science National President            Communication & Dr B C Roy                                                 National Awardee
                                                Honorary Secretary General

Copy to:

Mr. Pahlaj Nihalani, Chairperson, Film Censor Board

Central Board of Film Certification, 91E, Bharat Bhavan,
White House Compound, Walkeshwar Road, Walkeshwar, Mumbai-400 006 (Mah.)

Shri Rajnath Singh Ji, Hon’ble Home Minister

Ministry of Home Affairs, North Block

Central Secretariat, New Delhi-110 001


Shri J.P. Nadda, Hon’ble Minister of Health & Family Welfare

Ministry of Health & Family Welfare, Govt. of India,

A-Wing, 346-A, Nirman Bhawan, New Delhi
ACP Highlights: Top Studies of 2014
  • A combination of sofosbuvir and ledipasvir, with or without oral ribavirin, led to a sustained viral response in hepatitis C patients.
  • Statins caused liver injury in 22 of 1,188 patients, with one fatal case. "Universal monitoring of liver test results in patients receiving statins does not appear to be warranted," concluded authors.
  • Chronic and recurrent diverticulitis is being treated less aggressively with antibiotics or surgical intervention, found a review of 80 articles between 2000 and 2013.
  • Proton pump inhibitors were not associated with community-acquired pneumonia, according to a retrospective cohort including the U.S., Canada, and the U.K.
  • Compared with warfarin, dabigatran had a more favorable benefit/harm trade-off and cost-effectiveness. Researchers used incident rates from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial, costs from Medicare payment schedules, and quality of life estimates. But the study "required assumptions that increased the uncertainty of its findings," authors noted.
(Source: Medpage Today)
Reining in of Quacks and Sale of Fake Drugs
Press Information Bureau

Government of India, Ministry of Health and Family Welfare

05-May-2015 13:31 IST:

The Indian Medical Council Act, 1956, prohibits a person other than a medical practitioner enrolled on a State Medical Register to practice medicine in the State. Punishment of imprisonment for a term which may extend to one year or with a fine which may extend to Rs.1,000/- or both is also prescribed.

For popularizing and promoting generic drugs in the country, the Government through its agency – BPPI has been publicizing through print media to generate awareness among general public about the advantages of generic medicines and availability of generic medicines from Jan Aushadhi Stores.

Further, under NHM up to 5% funding over and above the normal allocation of the States is also provided as an incentive for those States that implement policy and systems to provide free generic medicines to all in public health facilities.

The Medical Council of India (MCI) in its regulations namely the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 under Clause 1.5 has prescribed as under:

“Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.”

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today
AYUSH Practitioners Should Not Conduct Abortions: IMA to Govt
Wednesday, 06 May 2015 | PNS | New Delhi/Pioneer

The Indian Medical Association (IMA) and Federation of Obstetric and Gynaecological Societies of India (FOGSI) have objected to the Government’s move to allow AYUSH practitioners to conduct abortions, Union Health Minister JP Nadda informed the Rajya Sabha.

The Government had formulated a draft Bill to amend the Medical Termination of Pregnancy (MTP) Act, 1971, which will allow AYUSH practitioners, homeopaths and paramedical staff, excluding yoga and naturopathy, to administer medical methods of abortion with requisite training and certification.

According to IMA and FOGSI, MTP is to be done only by registered medical practitioners who are all trained qualified MBBS doctors, he said. Replying to another query, Nadda said the birth rate in India is greater than that of China and that the country’s population will cross China’s by 2028.
Nadda, however, said the population control measures taken by the Government are not ineffective. In yet another reply, he said India has extended a helping hand to countries with high polio ratio, like Afghanistan and Pakistan.
IMA against AYUSH practitioners performing abortion: Nadda
6 May 2015, New Delhi, Team MP

Millenium Post: In a shocking revelation, Union Health Minister JP Nadda on Tuesday said that the Indian Medical Association (IMA) has objected to the government’s move to allow AYUSH and non-MBBS medical practitioners the right to conduct abortions. It would have made available safe and quality abortion services to women, especially in rural areas.

Nadda, replying to a question in Rajya Sabha, said IMA and the Federation of Obstetric and Gynecological Societies of India (FOGSI) have raised objections to expand provider base to include AYUSH and other non-MBBS practitioners for conducting abortion services.

The government had formulated a draft bill to amend the Medical Termination of Pregnancy (MTP) Act, 1971, which will allow AYUSH practitioners, homeopaths and paramedical staff excluding yoga and naturopathy to administer medical methods of abortion on pregnant women with requisite training and certification.

According to IMA and FOGSI, MTP is to be done only by registered medical practitioners who are all trained qualified MBBS doctors, he said. “The government is of the view that expanding the provider base by way of including AYUSH practitioners will enhance the access and availability of safe abortion services to women without compromising on quality of services,” the minister told the Rajya Sabha.

Speaking on policies for promotion of AYUSH practices, the minister said the government has laid down the national policy on Indian Systems of Medicine and Homoeopathy-2002 which envisages overall growth and development of Ayurveda, Yoga and Naturopathy.

“Government has formulated programmes and operational measures for promotion of AYUSH medical practices through centrally-sponsored scheme of National AYUSH Mission (NAM) and various central sector schemes,” Nadda said.

The minister also informed for the Ministry of AYUSH, a total budgetary provision of Rs 1,214 crore has been earmarked for the current financial year 2015-16, of which Rs 1,008 crore are for plan and Rs 206 crore for non-plan outlay. Central sector schemes have been provided a provision of Rs 690 crore whereas Rs 318 crore has been kept for centrally sponsored schemes.
Bihar hospital superintendent suspended over ‘bhukamp’ stickers
Patna (IANS): The superintendent of Darbhanga Medical College Hospital (DMCH), Dr Shankar Jha, was suspended on Tuesday after stickers inscribed with the word “bhukamp” (earthquake) were found pasted on the foreheads of quake victims last month, officials said. Ignoring the Indian Medical Association’s support to Dr Jha and the demand for a judicial inquiry into the incident, the state government finally took action against him. Dr Jha had expressed regret over the incident and claimed that it happened without any order from any one.
IMA Rise & Shine: Thalassemia Day: IMA Patri
If both parents have Th trait: chances of Th major 1 in 4, Th minor 1 in 2, unaffected child 1 in 4. Dr Pillai Dr KK
IMA expresses concern over kidnapping of doctors
Press Trust of India | New Delhi May 6, 2015 Last Updated at 18:07 IST: Business Standard

Expressing concern over some recent incidents of kidnapping of doctors, Indian Medical Association (IMA) today said that it is preparing a draft bill proposing measures to prevent violence against medical practitioners and institutions for government's consideration.

Addressing a press conference here, IMA's National President A Marthanda Pillai and Secretary General K K Aggarwal said governments of 18 states have passed ordinances on Prevention of Violence and Damages or Loss of Property against violence on doctors and medical establishments.

"The time has now come for the central government to enact the same.... The IMA is preparing a draft bill for submission to Government of India to enact the same at the earliest," an IMA statement said.

R B Choudhury, a doctor from Gumla district in Jharkhand, was kidnapped from his clinic on April 30.

He was found dead on May 4.

Another doctor from Bihar, Pankaj Gupta was abducted along with his wife on May 1. The couple is still untraceable.

The IMA office bearers demanded Choudhury's case to be probed at the earliest and demanded the investigation to be handed over to the Crime Branch or CBI.

They also demanded Gupta's case to be solved immediately.

Doctors in Jharkhand and Bihar have gone on strike and have been staging several protests.

In its statement, IMA also said that it will be forced to go on a nationwide protest, if the above cases are not solved and the central act is not enacted by the government.

The Indian Medical Association HQ representing Medical Professionals across the country and its members are deeply concerned about the loss of human life and despair following the natural calamity that took place in Nepal. This is a very sad event and we being doctors desire to relieve the pains of the affected. Many IMA Members have volunteered their services. The Indian Medical Association HQs deputed teams of specialist Doctors/ Primary Care Physicians to treat the injured and save the life of affected.

The recent development and information received from our Team members, the emergency work is now over. There are very few patients & that too not related to earthquake in the hospital designated to us (to treat the patients up to 12-5-2015).

The situation of Law and Order is also bad. There is also a language problem. Looking to the above facts, IMA is not sending team further unless requested by Govt. of India or Nepal. The present teams will be returning
Team IMA Jharkhand
We had met Health Minister and Principal Secretary to CM on 05-05-2015 at 7:30pm. He has almost accepted all demands including compensation amount and security etc. They promised before the media about expediting the Medical Protection Bill which is long pending. Medical bill was on the verge of implementation.

Today total strike including govt. and non-govt hospital continues excluding post mortem and emergency services. Black ribbon continues. Urgent meeting is called at 12:00pm on 06-05-2015 to discuss further action.
After written assurance by the government of Jharkhand to fulfil all our demands. IMA Jharkhand has called off the strike. Normal services to resume from 7th May.
Sonal Namaste
How should you wash your hands?
  • Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  • Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air dry them.
Media
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IMA in Social Media
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Twitter @IndianMedAssn 942 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
IMA Videos
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Press Release
Screen Thalassemics before Marriage

International Thalassemia Day is on 8th May. Thalassemic minor should not marry another Thalassemic.

As many as 10,000 children, are born with Thalassemia major each year. An ICMR study on 12,000 school children revealed that 5.5 per cent of Delhiites are carriers of the gene.

Thalassemics need repeated blood transfusion and costly medicines throughout life and the cost of therapy ranges from Rs 50,000 to Rs 2 lakh per annum.

Padma Shri Awardee, Prof (Dr) A Marthanda Pillai, National President IMA and Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA said the disease can be prevented by screening Thalassemics before marriage or conception.

The disease has been largely controlled abroad and Thalassemics even enjoy marital life and have normal children.

Genetic counseling of couples

To be clinically useful, this screening information has to be coupled with an education program informing local physicians and the affected population about the disease, its manifestations, cause, and clinical course. If both parents have beta thalassemia trait, they can be told the following about the chances of an affected child: Child with severe disease (beta thalassemia major) – One chance in four; asymptomatic carrier (beta thalassemia trait) – One chance in two and unaffected child – One chance in four.