October 9   2015, Friday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
IMA White Paper on Crimean-Congo Hemorrhagic Fever

A few cases have been recorded in Gujarat.

What are hemorrhagic fevers?
  1. Dengue
  2. Yellow fever
  3. Ebola
  4. Marburg hemorrhagic fever: Rare and limited to countries in Central Africa
  5. Crimean-Congo hemorrhagic fever
What is Crimean-Congo hemorrhagic fever?

It is a severe, potentially fatal disease in humans caused by CCHF tick-borne virus (Nairovirus) of the Bunyaviridae family.

In which countries is the disease prevalent?

CCHF is seen in Africa, Asia, eastern Europe, and the Middle East.

Is it seen in India?
  • CCHF was first confirmed in a nosocomial outbreak in 2011 in Gujarat. Another notifiable outbreak occurred in July, 2013, in Karyana Village, Amreli district, Gujarat.
  • Anti-CCHF virus (CCHFV) immunoglobulin G (IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals.
  • A study published in Vector Borne Zoonotic Dis. 2104 looked at the prevalence of CCHFV among bovine, sheep, and goat populations from 15 districts of Gujarat State and found antibodies in all the 15 districts surveyed with positivity of 12.09%, 41.21%, and 33.62% in bovine, sheep, and goat respectively.
What is the mode of human transmission?
  • Transmission to humans occurs through tick bites, contact with a patient with CCHF during the acute stage of infection, or contact with blood or tissue from infected livestock.
  • Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.
What are the four distinct phases of the disease?

The typical course of CCHF has four distinct phases
  • Incubation
  • Pre-hemorrhagic
  • Hemorrhagic
  • Convalescence
What is the incubation period?

The incubation period that follows a tick bite is usually short (3 to 7 days).

What are the clinical symptoms?
  • The pre-hemorrhagic period is characterized by sudden onset of fever, headache, myalgia, and dizziness.
  • Additional symptoms of diarrhea, nausea, and vomiting are also seen in some cases.
  • Nearly three days later , hemorrhagic manifestations from petechiae, large hematomas, and frank bleeding (vaginal, gastrointestinal, nose, urinary, and respiratory tracts) usually follow.
  • The convalescence period begins in survivors about 10 to 20 days after onset of illness.
How serious is the disease?

The case fatality rates range from 3 to 30 percent.

What is the cause of death?
  • Disseminated intravascular coagulation
  • Vascular dysregulation
  • Higher serum levels of proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)
What are the ultrasound findings?

Ultrasound findings include liver and spleen enlargement, paraceliac abdominal enlargement of lymph nodes, gall bladder wall thickening, and intraperitoneal and pleural effusion. These become prominent on the third day of disease in some patients.

How is the diagnosis made?
  • Viral isolation in bio-safety level four laboratories
  • IgM and IgG antibodies are detectable by ELISA and immunofluorescence assays from about seven days after the onset of disease
  • Specific IgM antibodies decline to undetectable levels approximately four months after presentation.
What is the differential diagnosis?

All hemorrhagic fevers including dengue and Ebola. CCHF should be suspected in all cases of dengue-like illness with negative ebola or dengue test.

What is the treatment?
  • Treatment is mainly supportive.
  • Ribavirin is effective, to be given for 10 days (30 mg/kg as an initial loading dose, then 15 mg/kg every 6 hours x 4 days, and then 7.5 mg/kg every 8 hours x 6 days)
Is a vaccine available?

There is no vaccine available for either people or animals.

How can CCHF be prevented?
  • Reducing the risk of human-to-human transmission in the community
  • Avoid close physical contact with CCHF-infected people;
  • Wear gloves and protective equipment when taking care of ill people;
  • Wash hands regularly after caring for or visiting ill people.
  • Health-care workers caring for patients with suspected or confirmed CCHF, or handling specimens from them, should implement standard infection control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.
What is common in homorganic fevers?

Vascular dysregulation with severe intravascular leak. Clinically, it presents with low pulse pressure and responds to massive vascular resuscitation with fluids.

What is the clinical clue?

Dengue-like illness, pleural effusion on ultrasound, gall bladder thickening in ultrasound, negative dengue serology and signs of intravascular leak.
Breaking news
Combinations of antibiotics show promising results against some microbes

An NIH-funded team led by Dr Gautam Dantas at Washington University School of Medicine in St. Louis tested a multidrug approach against MRSA. The scientists carefully selected clinically approved drugs that work synergistically. They chose from 3 distinct subclasses of β-lactam compounds that target different aspects of the cell wall synthesis machinery in MRSA: meropenem, piperacillin, and tazobactam (ME/PI/TZ). Results of the study appeared online in Nature Chemical Biology on September 14, 2015. The scientists began with a MRSA strain that is highly resistant to 23 diverse antibiotics. The ME/PI/TZ trio was more effective against the strain than any of the drugs alone or in pairs. The triple combination also proved effective in the lab against a panel of strains taken from 72 other clinical cases of MRSA.
Dr Good Dr Bad
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Specialty Updates
  • The findings of a new study show that ovarian stimulation therapy with clomiphene is at least as effective as letrozole, with a lower though not statistically significant difference in the frequency of multiple births. “The conclusion for couples with unexplained infertility is that clomiphene still remains the first-line therapy,” concludes first author Dr. Michael P. Diamond of Georgia Regents University.
  • A recent study, published in JAMA Surgery, noted that the risk for self-harm emergencies increased after bariatric surgery.
  • Not being exposed to sunlight during adolescence could lower the age at onset of multiple sclerosis (MS), suggests a new study published online October 7 in Neurology. The results thus support a potential protective role of the sun in the pathogenesis of MS.
  • New research suggests that young women who are diagnosed with ovarian cancer now have the chance to conceive later in life with the help of ovarian transplants. The findings are published in the journal Human Reproduction.
  • Findings from a new population-based study suggest a twofold increased relative risk for central demyelinating diseases in patients with inflammatory bowel disease (IBD) who receive tumor necrosis factor (TNF) inhibitors. The findings are published online in JAMA Internal Medicine.
  • Among patients with osteoarthritis of the knee, women experienced greater sensitivity to various pain modalities -such as lower tolerance to heat, cold, and pressure - and greater widespread pain than men, reported a new study published in the Arthritis Care & Research.
  • Both current and past use of fluoroquinolone antibiotics may be associated with an increased risk for life-threatening aortic aneurysm and aortic dissection, suggests new research published in JAMA Internal Medicine.
  • Hormone therapy might be protective in postmenopausal women during a first myocardial infarction (MI), but could increase the risk, and severity of a second, suggests an observational Finnish study presented at the North American Menopause Society 2015 Annual Meeting.
  • New unconventional sources of data are changing the way pharmaceutical companies research and market their products, industry insiders reported here at the Health 2.0 Fall Conference 2015. One year of social media postings yields more information on adverse events than the entire US Food and Drug Administration (FDA) database, said Greg Powell, director of the GlaxoSmithKline global safety program.
  • Dr. Mirjam Curno and colleagues report in their analysis spanning several decades that included work done as recently as 2012 that women typically comprised about 11% of participants in trials investigating cures for HIV. Similarly, drug studies were only about 19% female and just 38% of vaccine trial subjects were women. Findings are published in the Journal of Acquired Immune Deficiency Syndromes.
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Media
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eSPIRITUAL
Leverage your strengths
  • Know your strengths.
  • According to a British study, only about one-third of people have a useful understanding of their strengths.
  • If something comes easily, you may take it for granted and not identify it as a strength.
  • If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
  • Strengths most closely linked to happiness are gratitude, hope, vitality, curiosity and love.
  • Strengths are so important that they are worth cultivating and applying in your daily life, even if they don’t come naturally to you.
Legal Quote
Jacob Mathew v. State of Punjab SC / 0457 / 2005: (2005) 6 SCC 1 (iv)

“Simply because a patient has not favourably responded to a treatment given by a physician or a surgery has failed, the doctor cannot be held liable per se by applying the doctrine of res ipsa loquitur.”
TB Fact
Among the approximately 5-10% of infected individuals who develop active disease, approximately half will do so within the first 2-3 years following infection.
Medicofinance
Lifecycle Investing
The concept of lifecycle investing has been developed taking into account the unique earning, saving and spending patterns of physicians across different specialties and age groups, and utilizes that understanding to build a customized financial plan focused squarely on the needs of each doctor client by a thorough assessment of their economic lifecycle and short- and long-term goals. The objective is to help doctors accumulate, preserve and enjoy the wealth that an extensive education and years of hard work have earned. In order to do so, there is a need for a balanced financial platform of practice structure optimization, risk management, portfolio design and asset protection identifying inefficiencies in their existing financial strategies and correct these shortcomings. A financial advisory team should be appointed which should invest the funds with a specific target date in mind, retirement.

(Source: IJCP)
Industry News
  • Assocham pitches for easing of IT norms for startups: Start-ups should be freed from certain restrictions placed under the income-tax law, such as the one on shareholding pattern, the chamber said in a pre-budget submission to Revenue Secretary Hasmukh Adhia. “Restrictions prescribed under Section 79 of the Income-Tax Act should not apply to the start-up ecosystem, where a change in the shareholding pattern is due to the infusion of funding by investors without a change in the management of the company run by the original founders,” it said. (The Hindu Business Line)
  • Beijing-based Apus Group’s $15 Mn Package for Indian Startups: Beijing-based Apus Group plans to invest $15 Mn (INR 100 crore) in Indian startups. In a statement, the company said, “The group will offer support to these companies via programmes focused on developing and building a positive ecosystem for their growth. These programmes will range from providing incubation to free Apus traffic.” (Inc42.com- Rahul Raj)
  • Micromax invests in price comparison app Scandid: Micromax Informatics has invested in Scandid, a price comparison and product discovery portal owned and operated by Pune-based WishPoint Tech Pvt Ltd. Scandid was launched in June 2012 and helps customers compare prices and discover discounts across top e-commerce and local retailers. (Techcircle.in- Anuradha Verma)
  • Digital startups are increasing their hiring activities despite jobs being lost to technologies: According to ‘Perspective 2025: Shaping the Digital Revolution’, a report by the National Association of Software and Services Companies (NASSCOM), the Indian Technology and Services industry will continue the pace of growth, and shall touch $200 to $250 billion revenues by 2020; and will swell to $350 billion revenue market by 2025. As per the report, around 260 million jobs would be replaced due to augmented technologies, in various sectors of IT and Services and as technology is getting better, the role of a human being is getting shorter and less important. (Trak.in- Mohul Ghosh)
eMEDIPICS
IMA,IJCP,HCFI
Dates of the annual flagship event of Heart Care Foundation of India, the 22nd Perfect Health Mela were announced at a press conference. The Mela will be held from 4-8th November at Talkatora Stadium, New Delhi. The theme this year is "Safe Water, Food, Earth & Air"
Inspirational Story
The Chinese farmer

There is a Chinese story of an old farmer who had an old horse for tilling his fields. One day the horse escaped into the hills and, when all the farmer’s neighbors sympathized with the old man over his bad luck, the farmer replied, ‘Bad luck? Good luck? Who knows?’ A week later the horse returned with a herd of wild horses from the hills and this time the neighbors congratulated the farmer on his good luck. His reply was, ‘Good luck? Bad luck? Who knows?’

Then, when the farmer’s son was attempted to tame one of the wild horses, he fell off its back and broke his leg. Everyone thought this very bad luck. Not the farmer, whose only reaction was, ‘Bad luck? Good luck? Who knows?’ Some weeks later the army marched into the village and conscripted every able–bodied youth they found there. When they saw the farmer’s son with his broken leg they let him off.

Now was that good luck? Bad luck? Who knows?
eWELLNESS
High HbA1c linked to hypoglycemia in diabetics with kidney failure

A retrospective study of patients with diabetes enrolled in a large hemodialysis program found an association between high baseline HbA1c and an increased risk for hypoglycemia hospitalization. Higher baseline HbA1c was also associated with greater variability in HbA1c levels. The investigators suspect that the greater risk of severe hypoglycemia associated with high HbA1c may derive from glucose variability during treatment for hyperglycemia. The study is published in Hemodialysis International.
Humor
Successful Marriage

A couple had been married for 45 years and had raised a brood of 11 children and were blessed with 22 grandchildren. When asked the secret for staying together all that time, the wife replies, "Many years ago we made a promise to each other: the first one to pack up and leave has to take all the kids."
Medicolegal
Achieving Privacy and confidentiality in day to day practice- an ethical dilemma

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

Doctors in busy settings face an ethical dilemma. Maintenance of confidentiality and privacy becomes problematic due to the use of shared rooms. At times, the patient hesitates to share medical information due to this fact. More funds and better infrastructure may not always be possible. What is your preferred solution in such circumstances?

a) Ignore the issue as sharing information is culturally acceptable in India

b) Acknowledge overcrowding, try to make the patient comfortable within the shared setting

c) Extend work hours, push back appointments to ensure one patient per room at a time

d) Whisper/ talk in low voices

Do write in with your views and solutions.

Here are the responses received
  • I will go for a) Ignore the issue, as sharing information is culturally acceptable in India unless someone specifically asks for not sharing a small part of information. Saranya Devanathan, Psychiatrist
  • I think we cannot see 2 or 3 patients in one room. The patient’s right of privacy cannot be compromised for any reason. Each patient should be interviewed in a single room, and the patient and the family members should also be seen separately at least once and as and when needed. Infrastructural issues cannot be the excuse for inefficient treatment. Prof. Anil Agarwal, Psychiatrist
  • Lack of infrastructure is not an excuse for not observing privacy and confidentiality Patients should be seen alone as well as with family members. Prof. Satish Malik
  • Explain that the other person too is a doctor like me and assure that she would maintain confidentiality. Sudhakar Bhat, Psychiatrist
  • It is very difficult to provide a separate place and extending work hours may not be possible for doctors. They can talk in low voices and make the patient as comfortable as possible. If the issue really demands confidentiality like HIV or any other which patient is not at all confident to discuss in overcrowded situations, then extra time can be given after the crowding hours. Respecting the privacy of the patient is very important. Triptish Bhatia, Principal Investigator, GRIP-NIH, USA Project, Dept. of Psychiatry, Dr Ram Manohar Lohia Hospital, New Delhi
  • Firstly, we can have cabins or space with glass partitions, which prevent the sound from reaching other places. Secondly, if we are to be economical then probably the patients, of course depending upon their problem and certainly alongside giving him assurance and confidence about confidentiality, can be asked to record their voices in their phones and then ear phones can be used as a medium to listen to the voice recorded by the patient. These ear phones shall be inserted/worn by both - the patient as well as the client so that they are on the same track of conversation. But, this can be done only at the time of case history taking. If the client is educated, he can write and the doctor can ask and clarify. Enquiry questionnaires could be used. Structuring the room accordingly can help. I don't know how much do we support online counselling and case history taking. However, people (doctors and patients) who are ready for the online case history-taking, shall be taken separately by doctors at say a particular day and they must be given facility and services of the same with helpers available around in a particular room Or can be done in a booth placed to be able to communicate with the doctors in any given area within the compound. Parul
  • Lack of rooms is a fact in mental health care. But mental health service cannot and should not be stopped due to this fact only. Privacy is definitely an important issue but when infrastructure is not adequate then also treatment means a lot. When any country does not have adequate infrastructure then decision should be taken according to what is available in nearby surrounding. So treatment comes first as per hierarchy of decision criteria. So the clinician should explore the possibility of privacy if possible. S/he may evaluate himself/herself, the nature of information forthcoming during the interview and take decision accordingly whether to ensure privacy or not. However privacy of any nature should be given due respect. But this suggestion is for setting where rooms are not available in adequate number. So the clinician may also ask the patient and family about their comfort level. However it has been observed that people do not care that much in a hospital outpatient department as they have their mind made up for such crowded places. And again people feel a kind of security being stranger in the crowd. If there are not too many patients then privacy must be secured for the patient. But during a rush this issue should be dealt by considering the nature of the problem and the sensitivity of the patient and the family. Ranjita Thakur
  • Having interned at Sion Hospital in Dept of psychiatry department, this dilemma was an everyday problem. However, practitioner skills made huge difference. Doctors who were able to successfully get history and provide details at the same time respecting confidentiality showed the following:
    • Apologize to the patient for the overcrowding but saying at the same time that all these people require a doctor so we have to work with this.
    • Telling that other professionals in this room are competent and caring doctors and will not make fun of (most men who were hesitant came with premature ejaculation issues); instead can actually assist in solving the problem.
    • Allowing them to speak softly if it is a sensitive detail.

      Therefore if we really want to keep patient’s interest at the fore, a way can always be found to do so. Sadaf Vidha
  • Acknowledge overcrowding, try to make the patient comfortable within the shared setting and talk in an audible voice/tone. At the same time, if the number of patients is very high, capital expenditure in infrastructure is required. Dr S Rastogi, Director
  • It is quite natural that the patient will not like to express his symptoms before anybody and the doctors may not find a place to listen to him exclusively. In this situation, if the patient is hesitating to tell his problem, the doctors should ask him to write it on a paper and the doctor should read it and give it back to him after reading. Dr BR Bhatnagar
Breaking news
Online clinical trial applications could be mandatory by October end

Central Drugs Standard Control Organisation (CDSCO) plans to go fully online for submission of applications for clinical trial registration in one month’s time. The trial run of an IT enabled system for online submission of clinical trial applications started in early September for the purpose of feedback/suggestions only, with physical submission of applications continuing as usual. Before making it mandatory, CDSCO has asked stakeholders to share their feedback and suggestions within a month’s time. Dr GN Singh, Drugs Controller General of (India) said, “Before going fully online, we have introduced the first phase of an IT enabled system for online submission of clinical trial applications as a trial run. And asked the industry to raise technical difficulties so that we can rectify issues before going fully online.”

In order to improve transparency, accountability and efficiency in processing of clinical trial applications and monitoring, CDSCO with the approval of Ministry of Health and Family Welfare, Government of India has taken the initiative to create an IT enabled system for online submission and processing of applications as well as monitoring of clinical trials in the country. The objective of the software is to simplify the application process and also to be user friendly… (Financial Express – Usha Sharma)
MAKE SURE
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IMA Digital TV
Updates
IMA Stress Detox & Leadership Meet

IMA is organizing a 2-day Detox Meeting of state/local branch presidents and secretaries at Om Shanti Retreat Centre, Pataudi Road, Near Manesar, Gurgaon on 10th and 11th October, 2015. This meet is being organized by IMA in association with Heart Care Foundation of India and Brahma Kumaris. The final program is as below.

Saturday 10th October 2015
 
12.00 noon to 2.00 PM
Allotment of Rooms to the delegates
4.00 PM to 4.30 PM
Address by National President & Hony. Secretary General
4.30 PM to 5.00 PM
Acquiring Leadership Qualities (BK)
5.00 PM to 5.30 PM
Detox Tea
5.30 PM to 6.30 PM
Inauguration
6.30 PM to 7.00 PM
Communication Skills (BK)
7.00 PM to 7.30 PM
IMA Satyagraha
7.30 PM to 8.30 PM
Detox Dinner
8.30 PM to 9.00 PM
Clinical Establishment Act (IMA)
9.00 PM to 11.00 PM
Spiritual Outing and Relaxation in Detox atmosphere (BK)


Sunday 11th October 2015
 
7.00 AM to 8.00 AM
Pranayam & Rajyog Meditation
8.00 AM to 9.00 AM
Detox Breakfast
9.00 AM to 9.30 AM
Acquiring Leadership Qualities (BK)
9.30 AM to 10.00 AM
Happy Group (BK)
10.00 AM to 10.30 AM
Violence against doctors
10.30 AM to 11.00 AM
Communication Skills (BK)
11.00 AM to 11.30 AM
Crosspathy
11.30 AM to 12.00 Noon
Doctor-Patient Relationship (BK)
12.00 Noon to 12.30 PM
Clinical Establishment Act (IMA)
12.30 PM to 1.00 PM
Detox of doctors (Dr KK)
1.00 PM to 2.00 PM
Detox Lunch
2.00 PM to 2.30 PM
Parasympathetic lifestyle
2.30 PM to 3.00 PM
Parasympathetic lifestyle
3.00 PM to 3.30 PM
Open House Discussion
3.30 PM to 4.00 PM
Open House Discussion & Resolutions
4.00 PM onwards
Prasadam & Valedictory Function
A 20-km green corridor transports liver in 20 min
The Gurgaon and Delhi traffic police coordinated to form a 20-km green corridor for transporting an organ from the Indira Gandhi International Airport to a private hospital in Gurgaon in about 20 minutes. The donor was a 40-year-old patient suffering from brain hemorrhage in Indore. The liver was transported via the Delhi-Gurgaon Expressway for a 56-year-old patient suffering from liver cirrhosis at Medanta - The Medicity Hospital in Gurgaon. She had been waiting for a liver transplant for the last six months. “All necessary precautions were taken by the traffic police so that the organ could safely reach the hospital. It was important for us that the liver reached on time and a life was saved,” Hawa Singh, ACP traffic (east), said. The 18-km stretch, which usually takes 45 minutes to an hour with traffic, was covered in 20 minutes. This is the third time this year that a green corridor has been created for the transportation of an organ. (Source: Isha Sahni, Hindustan Times)
Court orders framing of charges

A court here on Wednesday ordered framing of corruption charges in two separate cases against former union health minister Dr Anbumani Ramadoss and various others. Central Bureau of Investigation (CBI) special judge Ajay Kumar Jain found prima facie evidence against Ramadoss and others in two cases, relating to alleged favours being shown by Ramadoss, health minister in the UPA-I government, and other accused to the private Rohilkhand Medical College and Hospital (RMCH) in Uttar Pradesh’s Bareilly city and the Index Medical College Hospital and Research Centre (IMCHRC) in Madhya Pradesh’s Indore. According to the charge sheet, Dr Ramadoss abused his official position to grant permission to the Indore-based institution to admit students although it lacked adequate facilities. (Business Standard – IANS)
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Three AIIMS for Maharashtra, West Bengal and Andhra Pradesh approved

New Delhi: In a meeting chaired by Prime Minister Narendra Modi, the union cabinet on Wednesday approved the setting up of three new All India Institutes of Medical Sciences (AIIMS) in as many states. The new AIIMS would be set up at Nagpur in Maharashtra, Manglagiri in Andhra Pradesh and Kalyani in West Bengal under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), which involves financial implications of Rs.4,949 crore. "The proposed institutions shall have hospitals with a capacity of 960 beds. In addition, there shall be teaching, administrative and AYUSH blocks, auditoriums, nursing colleges, night shelters, hostels and residential facilities “… "These will augment quality medical education and also address shortfall of health care professionals in these regions. Large populations of Andhra Pradesh, Maharashtra (Vidarbha) and West Bengal along with people in adjoining states will benefit from the projects," said the statement. (IANS – New Indian Express.com)
Nearly 95 lakh toilets built in 1st year of Swachh Bharat

ANI | Oct 8, 2015,

New Delhi: Within one year of Swachh Bharat Mission's launch, about 95 lakh toilets have been constructed across the country against the target of 60 lakh toilets, said union minister for rural development and drinking water and sanitation Chaudhary Birender Singh here.

Singh said that the pace of construction of toilets in rural India has gathered momentum. He said, states like West Bengal, Karnataka, Rajasthan and Maharashtra have taken the lead in construction of individual household and community toilets and these states may achieve the target of Open-Defecation Free status in 2017 or 2018, well ahead of the target of 2nd October, 2019. The minister said the government is committed to drive a pan-India mass movement towards improved sanitation and this is possible only through collaborative efforts of the Indian citizens.

He said, his ministry has encouraged devolution of the responsibility of sanitation promotion, upgradation and management to Gram Panchayats by giving flexibility to the states. Swachh Bharat Mission was launched on October 2 last year, as one of the largest national campaigns to make the country open defecation free in five years. (TOI)
GP Tip: Remember your ABCs when reading chest films

A Airway (midline, patent)

B Bones (e.g., fractures, lytic lesions)

C Cardiac silhouette, size

D Diaphragm (e.g., flat or elevated hemidiaphragm)

E Edges (borders) of the heart (to rule out lingular and left middle lobe pneumonia or infiltrates)

F Fields (lung fields well inflated; no effusions, infiltrates or nodules noted)

G Gastric bubble (present, obscured, absent)

H Hilum (nodes, masses)

I Instrumentation (e.g., lines, tubes)
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eMEDI QUIZ
The right coronary artery supplies all of the following parts of the conducting system in the heart except:

1. SA node.
2. AV node.
3. AV bundle.
4. Right bundle branch.

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: 3. Loss of overhead abduction.

Answers received from: Dr Bharat Bhushan Aggarwal, Dr Avtar Krishan, Dr Bitaan Sen & Dr Jayashree Sen, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K Raju, Daivadheenam Jella.

Answer for 7th October Mind Teaser: 4. Genitofemoral

Correct Answers received from: Dr Kusum Gandhi, Dr B R Bhatnagar, Dr Pravar Passi, Priyanka Kesarwani, Dr Jainendra Upadhyay, Dr Bitaan Sen & Dr Jayashree Sen.
Readers column
Dear Sir, your webcasts are really very useful to the general practitioners. Is there any procedure to view the program later when we don't get the live webcast for various reasons of network and systems? Please make it possible for us to view it on YouTube or on our website. Thanking you, Dr V Amarender, President, IMA Bhongir, Dist. Nalgonda, Telangana.
Press Release
Heart Care Foundation of India to create health awareness this festive season through its annual flagship event – the MTNL 22nd Perfect Health Mela

Delhites will get their health dose the fun way by participating in various cultural events and health activities, which will be hosted during the five-day celebrations

Heart Care Foundation of India, a leading national non-profit organization committed to making India a healthier and disease-free nation is all set to open the doors to its annual flagship event – the 22nd Perfect Health Mela. A confluence of tradition and modernity, the main aim of the Mela is to create mass awareness about all aspects of health; using a consumer-driven model as the medium. In its 22nd edition, the Perfect Health Mela is being co-organized in association with the IMA, MTNL, Coke, LIC, NDMC & MCD and is scheduled to take place from 4- 8th November 2015 at the Talkatora Indoor Stadium in New Delhi. The theme of this year’s event is “Safe Water, food, earth and air”.

The Mela is designed to cater to people from all age groups and walks of life. Additionally, the Perfect Health Mela incorporates activities across categories such as health check up camps, entertainment programs, lifestyle exhibitions, workshops, and competitions.

Addressing a press conference, Padma Shri Awardee Dr. KK Aggarwal, President HCFI & Honorary General Secretary of IMA said, “Our main motive behind organizing the Perfect Health Mela is to educate people about numerous easy ways by which they can prevent themselves from contracting common lifestyle and environmental diseases. We prioritize inculcating easy precautionary measures and the most important steps an individual should follow in situations of an emergency such as when someone is suffering from a sudden cardiac arrest. As we all know the probability of such medical casualties can’t be eliminated completely, but they can be well managed if an individual knows what to do. We have enthused a number of cultural activities to keep up the interest of students; the idea behind is that the basic education on how to maintain a healthy lifestyle should be inculcated at an early age. We thank our sponsors and supporters for as always working with us closely towards making this event a success.”

The Perfect Health Mela was started in 1993 and is currently in the 22nd year marked by huge success and each year more people participating as it caters to people from all age groups and all walks of life. It showcases activities across categories such as health education seminars, check-ups, entertainment programs, lifestyle exhibitions, lectures, workshops, and competitions. The Mela is attended by over 200 organizations each year including those from the State and Central government, PSUs, and leading corporates.

Speaking about the event, Dr A B P Mishra Scientist NCSTC, DST said, “I congratulate Heart Care Foundation of India for keeping up the healthy legacy. I am proud to be associated with the event, and as they say, nothing is better than saving lives of the individuals and being at the service for the betterment of the society. This event approaches society as a whole and this is what makes it such a huge success.”

Health and sanitation are key contributors to the overall health of a Nation. A special focus will be laid this year on how to ensure the water you use, the food you consume, the air you inhale, the earth where you live, are all pure and healthy.

Adding to this, Dr P K Sharma, Medical Health Officer, NDMC & Dr N K Yadav, Director, MCD in a joint statement said, “We wholeheartedly support Heart Care Foundation of India’s out-of-the-box initiative to reinstate the value of preventive health measures. We encourage everyone to come and attend the event for all the health related queries solved in an easy way. The Perfect Health Mela is in line with our aim of making India a healthy and a disease-free country”.

For more information about the event, please visit www.perfecthealthmela.com. Entry to the Mela is free for all.
Digital IMA