March 9  2015, Monday
editorial
WMA warns against making essential anaesthetic a controlled drug
Dr KK Aggarwal(06.03.2015) The World Medical Association is urging its 111 member associations to lobby their governments to oppose scheduling the anaesthetic agent Ketamine as a controlled drug.

The United Nations Commission on Narcotic Drugs is due to vote next Friday (March 13) on whether to schedule Ketamine because of concern about its use as an illicit recreational drug in many countries. But the WMA warns that if it is made a controlled drug, it would effectively prevent the drug’s use in many poor countries where it is the only alternative for short term pain relief in surgery.

Dr. Xavier Deau, President of the WMA, said: ‘We understand that the UN Commission on Narcotic Drugs is concerned about Ketamine’s use as a recreational drug. However the action it is proposing would make the drug unavailable and increase the level of suffering for people in the most difficult of clinical circumstances.

‘We know from experience with other anaesthetics, especially pain medication, that the scheduling of drugs effectively prevents their use and that patients in poor countries and in rural settings are then unable to receive treatment with those drugs. So this is likely to further worsen the absence of drugs for anesthesia in many health care settings globally.’

The World Health Organisation has strongly advised against scheduling Ketamine. But the WMA is concerned the UN Commission may disregard this advice. It has now written to all its national medical association members urging them to contact their governments to oppose the change.

The WMA says that pain relief is an important component of health care and strongly advocates for such medications to be available. It recommends tackling the illicit use of Ketamine by tightening the control of the drug’s availability through the pharmaceutical industry and by applying and enforcing legislation on prescription of drugs.

The WMA is supported by the World Veterinary Association which is also opposed to the change. In its press release today Dr. René Carlson, President of WVA declared: ‘Ketamine is essential for veterinary use, because it is the only injectable anaesthetic that is safe and well tested in the full range of species that the veterinarian must treat. This includes both large and small domestic animals, children’s pets and laboratory animals, large, wild and zoo animals, as well as birds and reptiles. It is safely used by virtually every veterinary practice throughout the world. It has been used safely as prescription only medicine.

‘Scheduling of Ketamine would restrict its availability worldwide, which again would lead to harmful impact on animal health and welfare, as well on public health. It would have economic consequences for agricultural production; it would affect unified efforts of medical and veterinary professions to control a wide range of emerging and re-emerging zoonotic diseases on human-animal-environment interface. A number of such diseases (i.e. Ebola) may take the form of pandemics, especially the ones with their reservoir in wildlife; since veterinarians can administer ketamine by dart-gun injection, it contributes to professional safety when a dangerous animal needs to be approached. Without Ketamine there would be huge difficulties in managing many field programmes in epidemiology or conservation medicine e.g. blood sampling and radio-tracking collar attachment.’
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Dr A Marthanda Pillai, National President, IMA inaugurates the ‘IMA National Mental Health Initiative’ at Pushpagiri, Thiruvalla on March 3, 2015. Fr Thomas Parackal, Dr VC Velayudhan Pillai (Past National President), Dr Roy Abraham Kallivayalil (Secretary General, World Psychiatric Association), Dr KV Devadas and Fr Mathew Punakulam are also seen.
News
  • Adults and children must cut the amount of sugar they consume by as much as half and even more to lower risk of obesity and tooth decay, suggests the World Health Organization.
  • Long-term use of bisphosphonates is associated with a reduced risk of developing type 2 diabetes, suggests a new study published online in The Journal of Clinical Endocrinology & Metabolism.
  • A new, long-term study of a hepatitis E vaccine has found that it is 86.8% effective and the immunity may last for at least 4.5 years. The findings are published in the March 5 issue of the New England Journal of Medicine.
  • The investigational pituitary-hormone–related protein (PTHrP) analog abaloparatide significantly reduces fractures in high-risk postmenopausal women with osteoporosis, suggests a key phase 3 study presented at the annual meeting of the Endocrine Society, ENDO 2015.
  • Repeated intravitreal injections of ranibizumab for diabetic macular edema (DME) may lead to sustained elevation of intraocular pressure (IOP), suggest the results from the Diabetic Retinopathy Clinical Research Network, published online in JAMA Ophthalmology.
Dr KK Spiritual Blog
Alternative medicine and healing

The universe is made of five elements, namely air, space, fire, water and earth. Any imbalance of these five elements leads to natural disasters. The science which deals with balancing these five elements and using them as a therapeutic modality is Naturopathy. The five elements also constitute human body. These five elements in the body form three humors i.e. movement, metabolism and structure, which define the Vata, Pitta and Kapha functions of Ayurveda.

A vitiation of any of the three humors leads to diseases and balancing these three humours makes the basis of Ayurvedic healing.

These three humours define seven Dhatus – Rasa, Rakta, Mamsa, Medha, Asthi, Majja and Shukra (plasma, blood, muscles, adipose tissues, bone, bone marrow and vital force including semen and ova).

The science which deals with balance of these dhatus is again Ayurveda.

These seven dhatus make organs, organs have receptors. Various drugs act at these receptors. This forms the basis of the modern allopathic medicine. The science which deals with these organs is modern science or allopathy.

When the drugs act as receptors, the drugs can be allopathic, homeopathic tincture or Ayurvedic. All of them differ in their preparations. Ayurvedic drugs are from natural sources potentised by grinding and homeopathic drugs are alcohol extracts of various molecules, which may be plant in origin or biochemical in origin.

Homeopathic tinctures can also be titrated or potentised or triturated.

The drug molecules can be converted into more potentised form as mentioned above by grinding in Ayurveda, trituration in homeopathy and by using nanotechnology in modern medicine.

Matter can also be converted into non–matter, a technique used in classical homeopathy and bhasma therapy in Ayurveda. A similar technology is used for vaccine therapy in modern medicine.

In homeopathy, liquid and solid molecules are triturated or potentised repeatedly in succession till no more matter is traceable in the original solution. Once the matter is converted into non–matter it becomes a classical potentised homeopathy medicine. The same exercise is done by repeatedly heating; matter can be converted into potentised non–matter, a technique well–defined in Ayurveda.

In science of physics, matter is made of atoms; atoms break down into proton, neutron and electron. They breakdown into photons and they into quantum and quantum into energy and energy into waves and these waves arise out of nothing called consciousness or the potential.’

The science, which deals with balancing these waves and shunya or consciousness, is the science of yogic meditation.

The science, which deals with balancing at the level of quantum and energy, is the science of classical homeopathy and bhasma Ayurveda.

All the above make it very clear that most of these pathies act at different levels and therefore there is a ground for their merger.

The time has come for all the pathies to work together and carry out research together so that benefits of each can be availed of in treating the patients.
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Cardiology eMedinewS
  • A small study of older outpatients seen in a memory clinic revealed that those who were receiving antihypertensives and had a low daytime systolic blood pressure (<128 mm Hg) had a greater 9-month decline in cognition than their peers. The findings are published online in JAMA Internal Medicine.
  • A new study revealed that for patients with heterozygous familial hypercholesterolemia well treated with existing medical therapy, including high-intensity statins and ezetimibe, the addition of anacetrapib for 1 year further reduced LDL-cholesterol levels and other atherogenic lipoproteins. The study is published in The Lancet.
Pediatrics eMedinewS
  • Adolescents with a history of childhood trauma exhibit different neural responses to subjective anxiety and craving, suggests new research published online in Neuropsychopharmacology.
  • A low-cost antiseptic used to cleanse the cord after birth could help reduce infant death rates in developing countries by 12%, suggested a systematic review published in The Cochrane Library. Researchers noted that when chlorhexidine was used on babies born outside of a hospital, it reduces the number of newborn babies who died or suffer from infections.
Make Sure
Situation: A 42–year–old male developed acute heart attack after playing squash.
Reaction: Oh my God! Why did he not get a cardiac check up done yet?
Lesson: Make sure that after the age of 40 anybody going for anaerobic games should first get a cardiac clearance.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

World Medical Association Declaration Principle VIII–Continuing Medical Education
 
  • All Physicians are committed to lifelong learning.
  • These educational experiences are essential if the physician is to keep updates of developments in medicine and if the physician is to maintain the knowledge and skills necessary to provide high quality care; scientific advances are essential to an adequate health care of the people.
  • Medical schools, hospitals and professional societies share the responsibility for developing and making available to all physicians opportunities for continuing medical education.
  • The demand to provide medical care, prevent disease and give advice in health matters calls for the highest standards of undergraduate post graduate and continuing medical education.
  • Internationally standardize methods of assessing professional competence and performance should be developed and applied in medical care.
Dr Good Dr Bad
Situation: A patient with mediclaim policy required hospitalization for dental treatment.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Clause 4.7 excludes dental treatment/surgery unless requiring hospitalization.
(Copyright IJCP)
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Rabies News (Dr A K Gupta)

What are monoclonal antibodies?

Monoclonal antibodies are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
IMA- National Mental Health Initiative
March 7, 2015:There is no health without mental health. Recognising this, IMA has launched a 'National Mental Health Initiative'. This was formally inaugurated by Dr A Marthanda Pillai, National President IMA at a grand meeting held at Pushpagiri Medical College, Thiruvalla, Kerala on March 3, 2015. He said, the mental health sector in India is in a state of neglect and the investment of the Union and State governments in the mental health sector was grossly inadequate, considering its grave need in different parts of the country

Dr Roy Abraham Kallivayalil (Secretary General, World Psychiatric Association, Geneva) delivered the key-note address. Dr VC Velayudhan Pillai (Past National President, IMA), Fr Thomas Parackal, Dr KV Devadas (CWC Member), Fr Mathew Punakulam, Dr Fazal Mohammed and Dr Joice Geo also spoke on the occasion.

Dr Roy Abraham Kallivayalil
Chairman, IMA National Mental Health Initiative.
IMA to frame guidelines for swine flu and other outbreaks
AVITA KISHORE: With diseases like swine flu and dengue affecting the population across the country every year, the Indian Medical Association (IMA) is formulating a set of guidelines that will help the government prepare for disease outbreaks.

The guidelines will stress the need to standardise testing, vaccinations (if available), treatment and cost of medication for various disease outbreaks. According to K.K. Aggarwal, Secretary General, IMA, there is currently no government policy to deal with outbreaks and epidemics.

“Just like any natural disaster, dengue, swine flu and other outbreaks should also be treated as a national calamity and the government should have a policy on how to deal with them,” he said, adding that IMA would present its recommendations to the government soon.

IMA’s guidelines will insist that news and information about any outbreak should come only from a single source.

“Different doctors are giving out varied information, which is adding to the panic about swine flu. When there is only one source for information, it will be more regulated,” Dr. Aggarwal added.

In terms of the pricing, the cost of vaccines, medication, and hospitalisation for all outbreaks should be covered by the Central Government Health Scheme, the guidelines state.

Speaking of the swine flu vaccine, Dr. Aggarwal said that the government should have been prepared and apprised pharmaceutical companies of the potential demand several months earlier. “There are over 25 lakh healthcare workers in the country, but only several thousands of units of vaccine available,” he said.

“From the next year onwards, vaccine should be made available well ahead of time for all healthcare workers and the at-risk population – including people with pulmonary, cardiovascular, renal, hepatic, neurologic and haematological disorders; patients with diabetes; and pregnant women,” he said.

Need for standardised testing, vaccinations, treatment and cost of medication for various disease outbreaks
Sonal Namaste

Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings.

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Event
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Inspirational Story
The Wooden Bowl

A frail old man went to live with his son, daughter-in-law, and four-year old grandson. The old man's hands trembled, his eye- sight was blurred, and his step faltered.

The family all ate together at the table. But the elderly grandfather's shaky hands and failing sight made eating difficult. Peas rolled off his spoon onto the floor. When he grasped the glass, milk spilled on the tablecloth.

The son and daughter-in-law became irritated with the mess. We must do something about Grandfather," said the son. I've had enough of his spilled milk, noisy eating, and food on the floor. So the husband and wife set a small table in the corner. There, Grandfather ate alone while the rest of the family enjoyed dinner.

Since Grandfather had broken a dish or two, his food was served in a wooden bowl. When the family glanced in Grandfather's direction, sometime he had a tear in his eye as he sat alone. Still, the only words the couple had for him were sharp admonitions when he dropped a fork or spilled food. The four-year-old watched it all in silence.

One evening before supper, the father noticed his son playing with wood scraps on the floor. He asked the child sweetly, "What are you making?" Just as sweetly, the boy responded, "Oh, I am making a little bowl for you and Mama to eat your food in when I grow up." The four-year-old smiled and went back to work.

The words so struck the parents so that they were speechless. Then tears started to stream down their cheeks. Though no word was spoken, both knew what must be done.

That evening the husband took Grandfather's hand and gently led him back to the family table. For the remainder of his days he ate every meal with the family. And for some reason, neither husband nor wife seemed to care any longer when a fork was dropped, milk spilled, or the tablecloth soiled.

“What goes around comes around!”
Wellness Blog

Being a doctor is injurious to health

When I was President of Delhi Medical Association in 2005, we tried to honor doctors, who were 80 plus. We could not find many. The DMA also tried to honor doctors last year, who were 80 plus. Again they could not find many.

As per normal statistics, 8% of people should be above 60 years of age, which means 14 lakh people in Delhi would be above the age of 60, out of which 10% would be above the age of 80 amounting to 1.4 lakhs.

If we apply similar statistics to DMA members numbering 15000, we should have 1200 doctors above the age of 60 and 120 doctors above the a¬ge of 80.

The very fact that we do not have so many DMA doctors who are 80 plus, means that being a doctor is injurious to health.

Most people believe that doctors live longer as they know everything about health but this is not true. Doctors die 10 years earlier than non–doctors.

General public needs to follow and understand principles of prevention of lifestyle disorders but doctors need to strictly follow them.

I normally teach my GPs and my patients how to be free from lifestyle disorders till the age of 80 by narrating the Formula of 80 which is as under:
  • Keep your lower blood pressure, LDL bad cholesterol, fasting blood sugar, fasting heart rate, abdominal circumference all below 80.
  • For that you should walk 80 minutes a day and brisk walk 80 minutes a week where brisk walk means minimum 80 steps in a minute.
  • Eat less than 80 g of caloric solids and drink less than 80 ml of caloric liquid in one meal. Do not eat cereals 80 days in a year.
  • Take sunbath 80 days in a year to remove deficiency of vitamin D.
  • Avoid sitting in a noisy atmosphere of more than 80 db.
  • One should not take alcohol but if one takes, it should be less than 80 ml (whisky) a day and 80 g (240 ml) a week.
  • One should do 80 cycles of pranayama every day (slow and deep parasympathetic breathing) and spend 80 minutes a day in a non toxic mental environment with no condemnations, no criticisms, and no complaints. Instead during this period, give non–materialistic gifts and think different and positively.
  • Smoking and transfats should be zero so as to avoid any cardiac interventions which may end up with you spending 80,000 rupees.
  • In terms of diet, I normally recommend that one meal a day should be fruits, one vegetable and salad and third a regular meal. As far as possible, carbohydrates should not be taken in all the meals. Trans fats are bad for the heart and should be avoided at any cost.
All the above are true for general public but should be strictly followed by the medical community.
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A Nice Boy?

One night a teenage girl brought her new boyfriend home to meet her parents, and they were appalled by his appearance: leather jacket, motorcycle boots, tattoos and pierced nose.

Later, the parents pulled their daughter aside and confessed their concern. "Dear," said the mother diplomatically, "he doesn’t seem very nice."

"Oh please, Mom," replied the daughter, "if he wasn’t nice, why would he be doing 500 hours of community service?"
Quote of the Day

Money is like a sixth sense – and you can’t make use of the other five without it. William Somerset Maugham
Reader Response

Colorful Holi Greetings to Editor Dr K K Aggarwal, his team and readership! Prof M E Yeolekar, Mumbai.
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eMedi Quiz
Beel's phenomenon can be seen in the following conditions except

a. Hemiplegia
b. Ramsay hunt syndrome
c. Bell's palsy
d. Leprosy
Yesterday’s Mind Teaser: A self-practicing dermatologist needs
a. Videoconference
b. Mobile teledermatology
c. Store and forward teledermatology
d. A combination of store and forward, online discussion group, and author based second ipinion teledermatology
Answer for yesterday’s Mind Teaser: d. A combination of store and forward, online discussion group, and author based second ipinion teledermatology

Correct Answers received from: Dr. Amit Desai, Dr Avtar Krishan, Daivadheenam Jella. Dr.K.Raju, Dr Gopal Shinde, Daivadheenam Jella
Answer for 7th March Mind Teaser: a. Neutrophil
Correct Answers receives: Dr Shangarpawar, Dr. Bharat Bhushan Aggarwal, Daivadheenam Jella, Dr Prabodh K Gupta, Arvind Diwaker, Dr Avtar Krishan, Dr Shangarpawar, Dr KV Sarma.
Chocolate, not tea, good for the heart

Regular consumption of polyphenol–rich cocoa products like dark chocolate may be considered a part of dietary approaches to lower BP, provided there is no total gain in calorie intake, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Drug treatment is the basis of blood pressure control, and it should always be accompanied by lifestyle measures such as exercise and proper diet.

The recommendation is an occasional cup of cocoa but not chocolate milk, because it is high in sugar and fat.

According to a survey of medical literature by German researcher, Dr. Dirk Taubert from the University Hospital of Cologne, cocoa–rich products, not tea, help lower high blood pressure. They covered 10 studies on cocoa that included 173 participants and five tea studies with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP.

The average reduction was 4 to 5 mm HG in systolic pressure and 2 to 3 mm in diastolic pressure –– enough to reduce the risk of stroke by 20 percent and of coronary heart disease by 10 percent. No such reduction in blood pressure was noted in any of the tea trials, which lasted an average of four weeks. Tea and cocoa contain different kinds of polyphenols –– flavan–3–ols in tea, rocyanids in cocoa.