May 9  2015, Saturday
editorial
Clot dissolving therapy or angioplasty in early acute heart attacks
Dr KK Aggarwal Outcomes are comparable between primary removal of clot in heart artery with stent angioplasty and clot dissolving drugs in patients with ST–elevation heart attacks who present early.

Results of STREAM study
  1. Best is stent angioplasty if it can be done within one hour of presentation to the hospital
  2. Those who present within three hours of chest pain and stent angiopslaty cannot be done in one hour there was no difference between the two treatments (stent angioplasty of clot dissolving drugs) in the primary composite end point of major adverse cardiovascular events at 30 days.
Comments: In most non busy cardiac centers, stent angioplasty lab needs to be informed and angiographer called for doing the procedure and that take time. In such cases, give clot dissolving drugs.
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
  • Patients with rheumatoid arthritis are at increased risk of a surprise heart attack, suggests new research presented at ICNC 12. Risk was increased even when patients had no symptoms and was independent of traditional cardiovascular risk factors such as smoking and diabetes.
  • A distinct set of bone metabolism biomarkers appears to be associated with more severe periodontal disease, suggests new research published online in The Journal of Clinical Endocrinology & Metabolism. Researchers noted that older men with more severe periodontitis had significantly higher levels of parathyroid hormone and lower vitamin D levels.
  • The American Society for Radiation Oncology (ASTRO) has released new evidence-based guidelines on external-beam radiotherapy for patients with locally advanced non–small cell lung cancer (NSCLC). The guideline is published in the May-June issue of Practical Radiation Oncology.
  • Two new antibiotics, the first broad-spectrum fluoroketolide antibiotic and a novel fluorocycline, could provide alternatives for the treatment of drug-resistant bacteria, suggest studies presented at the 25th European Congress of Clinical Microbiology and Infectious Diseases Hemoglobin A1c identifies three times more undiagnosed individuals as having prediabetes or diabetes than does fasting plasma glucose (FPG), suggests new research published online in Diabetes Care.
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Dr KK Spiritual Blog
Positive Attitudes

All those out there who feel you are at your wits’ end wondering how things don’t ever work out for you, can now relax and dwell on all those failures that life has taken you through and turn failure into success.
  1. Failure doesn’t mean you are a failure. But it does mean you haven’t succeeded yet.
  2. Failure doesn’t mean you have accomplished nothing. It does mean you have learned something.
  3. Failure doesn’t mean you have been a foolish. It does mean you had a lot of faith.
  4. Failure doesn’t mean you’ve been discouraged. It does mean you were willing to try.
  5. Failure doesn’t mean you don’t know what to do. It does mean you have to do it in a different way.
  6. Failure doesn’t mean you are inferior. It does mean you are not perfect.
  7. Failure doesn’t mean you have wasted your life. It does mean you have a reason to start afresh.
  8. Failure doesn’t mean you should give up. It does mean you must try harder.
  9. Failure doesn’t mean you’ll never make it. It does mean it will take a little longer.
  10. Failure doesn’t mean God has abandoned you. It does mean God has a better idea.
Cardiology eMedinewS
  • Patients taking one of the new oral anticoagulant drugs (NOACs) and who underwent recanalization therapy with thrombolysis, endovascular intervention, or both for an acute ischemic stroke did not have an excessive risk for intracerebral hemorrhage, reported a new study presented at the European Stroke Organisation (ESO) Conference 2015.
  • Researchers have developed a simple, thermometer-like device that could help doctors diagnose heart attacks with minimal materials and cost. The report appears in the journal Analytical Chemistry. The device detects troponin levels.
Pediatrics eMedinewS
  • Parents' influence on teens' drinking varies in girls and boys, suggests a new study published online in BMJ Open. While the drinking behaviors of both genders were mostly influenced by fathers, the behaviors of girls were also influenced by their mothers.
  • Premature birth reduces connectivity in brain regions linked to cognitive functioning, suggests new research published in the Proceedings of the National Academy of Sciences. This could explain why infants born preterm are at greater risk for neurodevelopmental disorders.
Make Sure
Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Lesson: Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.
Dr Good Dr Bad
Situation: An asymptomatic patient came with erectile dysfunction.
Dr Bad: You can start taking the drug Viagra.
Dr Good: Rule out CAD first.
Lesson: Patients with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of coronary or other vascular disease, should be screened for cardiovascular disease prior to initiating therapy for their sexual dysfunction, as there are potential cardiac risks associated with sexual activity in patients with heart disease.

(Copyright IJCP)
Inspirational Story
Planting Potatoes

When I was a boy growing up we had several gardens around our old house. The largest one of all was used just for growing potatoes.

I can still remember those potato planting days. The whole family helped. After my Dad had tilled the soil, my Mom, brothers and I went to work. It was my job to drop the little seed potatoes in the rows while my Mom dropped handfuls of fertilizer beside them. My brothers then covered them all with the freshly turned earth.

For months afterward I would glance over at the garden while I played outside and wonder what was going on underneath the ground. When the harvest time came I was amazed at the huge size of the potatoes my Dad pulled out of the soil. Those little seedlings had grown into bushels and bushels of sweet sustenance. They would be turned into meal after meal of baked potatoes, mashed potatoes, fried potatoes, and my personal favorite: potatoes slowed cooked in spaghetti sauce. They would keep the entire family well fed throughout the whole year. It truly was a miracle to behold.

Thinking back on those special times makes me wonder how many other seeds I have planted in this life that have grown unseen in the hearts and minds of others. How many times has God used some little thing that I said or did to grow something beautiful? How many times has Heaven used these little seedlings to provide another’s soul with sweet sustenance?

Every single day of our lives we step out into the garden of this world. Every single day we plant seeds that can grow into something wonderful. We may never see the growth that comes from the kind words or loving acts we share but God does. I hope then that you always tend the garden around you with care. I hope that you plant only goodness, peace, and compassion in the lives of everyone you meet. I hope that every day you help miracles to grow.
Wellness Blog
Aspirin for the primary prevention of cardiovascular disease and cancer

People above the age of 50 without excess bleeding risk should take low-dose daily aspirin (75 to 100 mg) as per the current recommendations.

Patients who are more concerned about the bleeding risks than the potential benefits (prevention of cardiovascular events and cancer) may reasonably choose to not take aspirin for primary prevention.

Meta –analyses of randomized trials have shown aspirin to reduce the risk of non-fatal myocardial infarction (Arch Intern Med 2012; 172:209) and long–term aspirin use reduces overall cancer risk (Lancet 2012;379:1602).

A meta–analysis addressing this combined outcome suggests that aspirin use in 1000 average risk patients at age 60 years would be expected to result, over a 10–year period, in six fewer deaths, 19 fewer non-fatal myocardial infarctions, 14 fewer cancers, and 16 more major bleeding events.
Events
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Quote of the Day
The will to win, the desire to succeed, the urge to reach your full potential... these are the keys that will unlock the door to personal excellence. Confucius
eMedinewS Humor
Organized Crime

No matter how much the government fights it, organized crime just seems to get more organized every day. The police pulled in a Mob kingpin recently and reminded him he had the right to make a phone call.

"Just fax the arrest report to my lawyer," the mobster said calmly.
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.

Correct Answers received from: Dr K Raju, Dr Jainendra Upadhyay, Dr Shangar Pawar, Nahar Kuldeep, Arvind Diwaker, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 7th May Mind Teaser: 4.Genitofemoral

Correct Answers received: Dr Poonam Chablani, Dr AK Jain, Diwaker, Daivadheenam Jella, Sri Rekha, Dr G Madhusudhan, Dr Avtar Krishan.
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
Human rabies can be very effectively prevented, and animal control is an important component in reducing the public health risk to humans. Dog rabies can be eliminated by well established control methods and routine dog rabies vaccination programs
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
ACP Highlights: Top Studies of 2014
  1. Prolonged cardiac monitoring in patients with cryptogenic stroke increased detection of atrial fibrillation, according to a randomized, controlled trial. The study did evaluate the effect of anticoagulation.
  2. Patients with idiopathic venous thromboembolism (VTE) or VTE associated with "weak risk factors" and had completed at least 3 months of anticoagulation therapy underwent ultrasonography and D-dimer testing. The hazard ratio for recurrent VTE in patients with positive D-dimer results who declined therapy was significantly increased compared with patients with positive D-dimer results who resumed therapy. The study was a prospective cohort trial and not randomized.
  3. The ACP recommended polysomnography in patients with unexplained daytime sleepiness.
  4. Two additional vaccines were added to the adult vaccine schedule: pneumococcal 13-valent conjugate and Haemophilus influenza type B.
  5. The US Preventive Services Task Force recommended annual screening for lung cancer with low-dose computed tomography in high-risk patients.
(Source: Medpage Today)
  • IMA today has written to Censor Board, Ministers of I&B, Home and Health Ministry, with a demand to ban the film ‘Gabbar is Back’ immediately. If the film is not banned and the actor producer do not apologize IMA will be forced to file a defamation suit against the producer, director and actor, both criminal as well as civil.
IMA comments and suggestions on Concept Note for National eHealth Authority of India
  1. The note mentions “legacy systems” and appears to maintain that such systems exist in India. This is open to interpretation. Legacy systems generally mean UNIX based systems. Such systems functioning in the healthcare provider domain do not exist in India. On the other hand, if “legacy systems” mean outdated systems using older technology, then the statement is fair since many DOS-based and FoxPro-based systems are still functioning in establishments of all types and sizes. We suggest that either the term “legacy systems” be clarified or replaced by the more appropriate term “outdated systems”.
  2. Several benefits of Electronic Health Record have been mentioned. However, the list is not exhaustive although fairly representative. Therefore, we suggest that the phrase “this list is indicative and not exhaustive” be added in the appropriate place.
  3. The mission states that NeHA will be responsible for “development of an Integrated Health Information System”. Under the core functions, NeHA is expected to prepare documents dealing with architecture. The subsequent section dealing with governance provides a list of people who will serve as committee members – Chairman, full-time members, part-time members, etc. There are no qualified people currently listed there that have the knowledge, experience and understanding to perform any kind of IT system development work. To undertake any such type of work, NeHA will need to have in place on a continuous basis a dedicated team of healthcare IT engineers. A healthcare IT engineer is someone who is either a health informatics professional or an IT engineer who has had at least six (6) months of full-time exposure to healthcare IT projects for products as either a project manager or module leader. For being a member of the authority, the healthcare IT engineer must have worked as a system architect for healthcare IT projects for products for a period of not less than five (5) years and must have been involved in at least three (3) different projects that involved working in clinical information system, telemedicine and mHealth domains. We suggest that either NeHA have a dedicated team as specified above or drop the development and architecture requirements and confine itself to governance instead of development.
  4. In Standing Consultative Committee: “The Committee shall be chaired by Chairman of NeHA and, besides its four members, shall have members who represent experts and stake-holder community. Concept Note- National eHealth Authority (NeHA) 16 Indicative membership positions of Standing Consultative Committee are: Ministry of Health & Family Welfare (4) {AS&DG(CGHS), AS&MD(NHM), DGHS, Mission Leader of Health MMP}, Principal Secretaries (Health)/ Mission Leaders from States(3), Expert Doctors by rotation (2), Private Healthcare providers by rotation (2), IT industry reps by rotation (2), Standards org rep (2), DeitY rep (1), DOT rep. (1), Independent Medical Practitioners by rotation (1), MCI Chairman or nominee (1), NASSCOM & NATHEALTH Presidents (2), FICCI President, ICMR DG or nominee (1), IRDA Chairman (1), Consumer Rights Activists (2 by rotation), WHO rep (1)."

    It does not mention the name of Indian Medical Association, which is the largest medical NGO of the world with a membership of over 2.5 lakhs. IMA also has a Hospital Board of India connecting over 10000 medical establishments owned by doctors. Two members of IMA should be in the standing consultative committee.
IMA Rise & Shine: Fight for your dignity
  1. Boycott all movies of Akshay Kumar and Sanjay Leela Bhansali: http://tinyurl.com/kzkg48o
  2. IMA asks doctors to boycott Mika functions: http://tinyurl.com/mqat9b3
  3. Doctors want censor's scissors for Bhansali's 'Gabbar Is Back': http://tinyurl.com/m85dftz
  4. Doctors demand laws against violence - Navbharat Times: http://tinyurl.com/kelvn4t
Doctors want censor's scissors for Bhansali's 'Gabbar Is Back'
Sushmi Dey, TNN | May 8, 2015, 03.10 AM IST

NEW DELHI: Sanjay Leela Bhansali's 'Gabbar is Back' has run into a controversy with the medical fraternity from across the country fuming that the film depicts a "derogatory" image of doctors and has the potential to even instigate violence against them.

Indian Medical Association (IMA), representing over 2,50,000 doctors from across the country, has written to Censor Board of Film Certification (CBFC) chairman Pahlaj Nihalani, Health Minister JP Nadda and the I&B ministry for removing certain scenes which show doctors in bad light.

In one of the scenes, the movie purportedly shows doctors providing medical treatment to a person who is had died even before being brought in.

Threatening to take to the streets, doctors have asked the government to ban the film till the scene is removed.

"The movie is a total instigation of the general public against the medical profession. With violence against doctors on the rise, such unjustified messages through the movie will only add fuel to the fire," IMA wrote in the letter sent to Nihalani and various government departments.

Doctors say the comment made on doctors is loud and in bad taste. "Such comments will harm the faith and trust that patients place on doctors in times of distress and this trust is very important in the doctor -patient relationship," IMA secretary general KK Aggarwal said.

Over 75% of doctors across the country have faced at least some form of violence, initial findings of an ongoing study recently revealed. Doctors are found facing maximum violence when providing emergency services, with as many as 48.8% of such incidents reported from incentive care units (ICUs) or after a patient has undergone surgery, the study said. Patients' kin are often found guilty of such actions. According to the findings, data of past five years show attendants of patients were involved in 68.33% of violent acts.

Some experts the actual situation is even worse as many do not report violence. Patients also complain about lack of transparency, sharing of information and overcharging by many private hospitals, some of the problems that Bhansali's film highlights.
Healthcare is a key policy priority for the government: Shripad Yesso Naik
By ET Bureau | 8 May, 2015, 05.48AM IST

NEW DELHI: Ensuring universal access to drugs and diagnostics is a key policy priority for the government, said Shripad Yesso Naik, union minister of state for health and family welfare, while launching ETHealthworld.com, an initiative of The Economic Times, on Wednesday.

Naik said the government is using a wide range of techniques, such as a central network of ambulances for timely emergency care, mobile medical units in tribal areas, boat clinics in the river islands of Assam and telemedicine in states such as Tripura and Odisha, to reach out to the unaddressed population besides use of m-health to build the capacity of frontline workers

"However, India is a country of diversities and there is no disagreement on the fact that there is need to optimally harness public resources, technologies and innovation to effectively manage the growing burden of diseases, bridge the crucial skill gap in the sector and reduce the cost of providing better access to affordable healthcare," the minister said.

KK Aggarwal, secretary general of the Indian Medical Association, said that at the very least, emergency healthcare services and primary health care services are a fundamental right of every Indian and it is the state's responsibility to provide these.

Health issues do not make it to the political agenda because no one loses an election in India over them and the middle class, an important electoral constituency, has chosen to exit the public health system, said Girindre Beeharry, India country director, Bill and Melinda Gates Foundation. Barring the last general elections, health didn't find much of a mention in the manifestos of most political parties, said KG Ananthakrishnan, managing director, MSD India.

Citing a recent Harvard School of Public Health study, Daljeet Singh, president, Fortis Healthcare, estimated India will lose more than $6 trillion to non-communicable diseases over the next 15 years.
Private doctors on strike today
TNN | May 8, 2015, 01.03 AM IST

LUCKNOW: Services at all pathologies, diagnostic centers, clinics, nursing homes and private hospitals in the city would not be available on Friday with private doctors body Indian Medical Association observing a 12 hours long strike to protest state's failure to save doctors from rowdy persons, including attendants.
After treating 800 patients in Nepal, IMA medical team returns
www.dnaindia.com: A 13-member team of doctors, associated with the Indian Medical Association, on Wednesday returned from its humanitarian expedition to quake-hit Nepal.
Letter to Editor
Dear Dr K K Aggarwal

This movie “Gabbar is Back” is the copy of Telugu version "Tagore" acted by Chiranjeevi a few years ago. In fact the IMA AP state never objected to this movie nor any protest to either Censor Board or government. To be frank, the image of corporate hospitals in AP is very low and bad inspite of introducing many new technologies in the medical treatment.

Everybody criticizes the corporate hospitals including governor of AP but every one still goes to these hospitals for treatment. Praising in front and enjoying all services of these hospitals and back stabbing with bitter criticism. It may be true there might be deficiencies on services and charges but not to the extent of treating a dead body. I am glad at least you have come forward with protest. The main weakness of our medical community is nobody comes forward and openly fight anything that is against medical community and at the same time there are many black sheep in our profession tarnishing the divine image of doctors.

With regards

Yours sincerely

Dr Jaya Prakash Reddy
Former Hony Secy, IMA Nilagiri,
Nalgonda - 508001, Telangana
Sonal Namaste
What should you do if you don’t have soap and clean, running water?

Washing hands with soap and water is the best way to reduce the number of microbes on them in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs.
Media
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IMA in Social Media
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Twitter @IndianMedAssn 944 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/
http://www.ima-india.org/ima/
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Reader Response
  • Dear Sir, only boycotting movie will not serve the purpose. IMA should fight it in the court of law. The way media is showing our profession in poor taste has led to staggering rise of violence. Against medical fraternity. Let's fight it out for once and all. Long live IMA. Dr Alok Kumar, IMA Chas, Jharkhand
  • Dear Sir, Only condemnation and boycott will not do. We must initiate legal action and a case of defamation against the producer as it defames the whole medical fraternity. We should worry about the cost as I am sure all doctors will come forward to bear the same. Immediately legal opinion should be taken in this regard. Thanks: Dr RD Dubey.
  • I have seen the movie. The hospital is owned by mafia gangster of Dubai. So the frauds shown in this movie are against gangsters entering into hospital business. Their aims and objectives are absolutely different from any normal doctor. I think there is no reason for us medical fraternity to over react. Dr Arun Gupta
  • Dear Sir, I have strong objection to this movie. Even the conversation between Doctors is foul and not acceptable. Such greedy talks never happen anywhere in the world. Thanks: Plz re circulate again & again & ask everyone to write comments to you so that you know how many have read it. Dr Ashok Mittal
  • I feel, I wasted my 40 years of life, it is painful, the cinema people, even media can enjoy rape & suicide, what more you expect from them. In previous days we used to resuscitate the patient by mouth to mouth breathing. Who counts those days, I was absent for family functions, Diwali, even death events of dear ones. This society is cunning. Do not accept any serious patient, send him to see the cinema hall and enjoy. Close your hospital & do other job. Sell mobile instrument you will earn more. Dr Venkat Kolpuke
  • Will IMA take legal action for derogatory remarks in film Gabbar is Back, else why such body, which cannot fight for our honor? Arvind
IMA Videos
News on Maps
Press Release
portrayal of the Medical Profession

Last week saw the National release of the much-awaited film ‘Gabbar is Back’ produced by none other Sanjay Leela Bansali and Viacom 18 Motion pictures. The star cast of the film includes Akshay Kumar and Shruti Hassan.

The director is Mr Krish and scriptwriter Mr A R Murugadoss.

The film has however come into controversy with the Indian Medical Association - one of the oldest National voluntary organizations representing doctors of modern medicine around the world having as its members 2.5 lakh doctors spread over 29 States and 1700 local branches.

Speaking on the issue, Padma Shri Awardees and the present National President - Dr A Marthanda Pillai and Honorary Secretary General of the IMA - Dr K K Aggarwal in a joint statement said, “The Indian Medical Association is in deep anguish about the way the medical profession has been projected in the Movie “Gabbar is Back. It’s portrayal is derogatory and unrealistic and we together stand against it.”

‘Gabbar is Back’ showcases doctors in a hospital setting carrying out the fraudulent act of providing medical treatment to a person who was already “dead” before arriving at the hospital. Akshay Kumar who plays the role of the doctor is shown to be aware of the patient’s death however he makes everyone at the hospital believe that he is critical but still alive.

With cases of violence against doctors on the rise, a totally unjustified message such as this one as shown in the movie will only add fuel to the fire and further provoke public outrage against the medical profession. The IMA wants the above-referred scene to be withdrawn from the movie immediately. Till such time that this is done, the movie should be boycotted and banned.

The video clipping of the scene has been sent by the IMA to its 2.5 lakh doctor members to create awareness about the issue and to request all of them to boycott the film.

The IMA feels that if the Censor Board, Ministry of Information & Broadcasting, Health Ministry or the Home Ministry do not take any immediate action against this, IMA will be forced to start a public protest against the movie.

One can view a snapshot of the movie by clicking the following link:http://tinyurl.com/kzkg480