June 9  2015, Tuesday
eMedinewS
editorial
All about tea
Dr KK AggarwalWhen we speak of tea, it is commonly assumed to be black tea with milk and sugar. However, the word ‘Tea’ means any herb. This means even hot Tulsi water is Tulsi tea or hot mint water is Mint tea. Many herbs can be converted into tea such as jasmine tea, lemon tea, lemon grass tea, masala tea, sounf tea etc.

When the leaves are boiled in water and reduced to 50%, it is called Kadha (decoction). Black tea without milk and sugar is much healthier than black tea with milk and sugar.

Classical tea without sugar and milk has an astringent taste. But according to Ayurveda, this is good for health as it reduces Kapha imbalance. When sugar and milk are added, both of which have sweet taste, they neutralize the weight-reducing and kapha–relieving properties of the black tea. Therefore, milk or sugar should not be added to tea. For the purpose of taste, one can add Gur or jaggery or artificial plant sweetener Stevia.

Black tea is also a mild diuretic and increases urination as it contains caffeine, which is also a stimulant. This is the reason why tea is used when there is a need to stay awake. In this regard, coffee is stronger than tea. When taken in moderation, black tea is good for the heart and general health. If one has to choose tea then jasmine, lemon and lemongrass teas are better.

In Ayurveda, different teas have been prescribed for different personalities. Therefore, you can get vata–pacifying tea, pitta–pacifying tea and kapha–pacifying tea.
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IMA Tirupathi students wing inauguration
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News
  • Almost half of patients with primary Sjogren's syndrome who are positive for anticyclic citrullinated protein antibodies (ACPA) develop rheumatoid arthritis over time but only in the presence of elevated acute phase reactants, suggests a longitudinal study published in RMD Open: Rheumatic and Musculoskeletal Diseases.
  • Nearly half of type 2 diabetes patients on glucagon-like peptide-1 (GLP-1) receptor agonists stopped taking them in the first year, primarily due to gastrointestinal problems, suggested new research presented at the American Diabetes Association (ADA) annual meeting.
  • Eating less late at night may help curb the concentration and alertness deficits that accompany sleep deprivation, suggests a new study scheduled to be presented at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies LLC.
  • A systematic review looking into the increased risk of death for people admitted to intensive care shows that the chance of dying is increased two-fold in people who become delirious, and that about a third of admissions will develop the brain dysfunction. The findings have been published in The BMJ.
  • Tumors with a specific type of DNA repair defect had a high likelihood of responding to treatment with the immune checkpoint inhibitor pembrolizumab, suggested a small study presented at the American Society of Clinical Oncology meeting. Researchers noted that more than 60% of colorectal cancers associated with mismatch repair (MMR) deficiency responded to the immune-system inducer; however, no patient without the repair deficiency responded to pembrolizumab.
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Dr KK Spiritual Blog
Do not give health advice unless you are an expert

Once a foreigner visited India and when he returned back, somebody asked him to tell three things about India. He said – All time is tea time, all behave like doctors and every street wall can be used as a urinal. Out of these three, the second one is very important and must be understood by all of us. In India, every person behaves like a doctor and is ready to give an advice.

In the West, when a person is sick, nobody is supposed to visit him or her except for close relatives, but in India, not visiting a sick person is considered bad manners.

Everybody who visits, comes with an advice: an advice to change the doctor, hospital or the pathy. They start giving examples of their experiences and try to influence the patient and the family. Neem Hakeem Khatraye Jaan is an old saying. No two patients are same and no two diseases behave in the same direction.

Changing medicines or pathy can be dangerous. When you go to another doctor for a second opinion, by default he or she has to disagree with the previous doctor, even if they do not need to. If they cannot find anything wrong in the prescription of the previous doctor, they will change the brand of the drugs or do minor modifications in the medicine.

In judicial practice, when you seek a review of judgment, you always file review petition in front of the same judge. Why can’t the same thing apply to medical science? If you are not satisfied with a doctor, go back to him and ask him to review you again as a fresh case.

Also in judicial system, if you are not satisfied with the judgment, you do not go to single judge bench but a double judge bench. Same thing should happen in medical science. If you are not happy with one doctor, never go to another single doctor but ask for a joint opinion with two specialists.
Cardiology eMedinewS
  • Type 1 diabetes patients younger than 40 may be candidates for statin use, as recommended after age 40, suggest researchers at the American Diabetes Association meeting. Researchers noted that the 10-year cardiovascular risk was about 5% for type 1 diabetes patients aged 30 to 39 and about 13% in those aged 40 to 44.
  • The use of sulfonylureas in patients with type 2 diabetes mellitus does not increase the risk of all-cause or cardiovascular mortality, suggests a new meta-analysis presented at the American Diabetes Association (ADA) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Recent long-term survivors of childhood cancer have died less often from treatment-related causes, driving an overall reduction in late mortality and suggesting a beneficial effect of less-intense therapy, suggests new research presented at the American Society of Clinical Oncology meeting.
  • Lower levels of youth drinking and binge drinking seem to be associated with more stringent policies on alcohol, suggested a longitudinal study that combined data from Youth Risk Behavior Surveys with an independent examination of state-level alcohol policies. The findings were published in Pediatrics.
Make Sure
Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.
Dr Good Dr Bad
Situation: A patient developed asthma within a year of menopause.
Dr. Bad: It is not asthma.
Dr. Good: It is associated with menopause.
Lesson: The onset of asthma within a year of menopause is a separate asthma phenotype.

(Copyright IJCP)
Inspirational Story
Life and Love’s Unending Journey

Love should always remain hopeful and positive in the difficult journey that follows along lives "bumpy detours and highways". Love should never lead dreamers astray, left to stumble and stammer along the "narrow muddy paths" of unfulfilled love, nor leave them alone to pass the dark and shadowy graveyards on the "lonely boulevards" of broken hearts, strewn with unkept promises and shattered dreams of "what was to be".

Love should always be alert and avoid the uncompromising gray sidewalk of the "two way street" of opposite direction and conflict and seek the sunny "one way street" of like attraction, goals, aims, purposes and desires.

So always drive on the "high road" on life’s golden carpet down the "yellow brick road" to love and life’s grand "promenades" and elegant "thoroughfares," leaving together to follow and smell the sweet scents and fragrances that waif and rise to greet and linger in the air.
eMedinewS Humor
Health Professionals in Heaven

Three nurses died and went to Heaven. They were met at the Pearly Gates by St. Peter, who questioned them.

"What did you do back on Earth?" he asked the first nurse. "Why do you think you should be allowed into Heaven?"

She told him, "I was a nurse at an inner city hospital. I worked to bring healing and peace to many sufferers, especially poor children."

"Very noble. You may enter." And he ushered her through the gates. He asked the same questions to the next nurse.

"I was a missionary nurse in the Amazon. For many years I worked with a small group of doctors and nurses to help people in numerous tribes, healing them and telling them of God’s love." The second nurse replied.

"Excellent!" said St. Peter. And he ushered her through the gates as well. Finally he posed his questions to the third nurse. She hesitated, then explained, "I was just a nurse at an HMO."

St. Peter considered her answer for a moment, then told her, "Well, you can enter, too."

"Wow!" the nurse exclaimed in relief. "I almost thought you weren't going to let me in."

"Oh, you can certainly come in," St. Peter told her, "but you can only stay for three days."
Events
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eMedi Quiz
An increase in which of the following parameters will shift the O2 dissociation curve to the left.

1. Temperature.
2. Partial pressure of CO2
3. 2,3 DPG concentration.
4. Oxygen affinity of haemoglobin.

Yesterday’s Mind Teaser: The parameters of sensitivity and specificity are used for assessing:

1. Criterion validity.
2. Construct validity.
3. Discriminant validity.
4. Content validity.

Answer for yesterday’s Mind Teaser: 1. Criterion validity.
Correct Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Raju Kuppusamy, Tukaram Pagad, Daivadheenam Jella, Dr G Madhusudhan, Dr K C Sharma, Dr Avtar Krishan.
Answer for 7th June Mind Teaser: 4. X-ray diffraction
Correct Answers received: Dr K C Sharma, Dr Avtar Krishan, Tukaram Pagad, Dr Jainendra Upadhyay.
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
Do rat bite cases require rabies vaccination?

In India, most rodents, rats, squirrel, rabbits, birds and bats have been found to be free of rabies. However, post exposure prophylaxis is recommended following exposure to mongoose. Rat bite cases do not require rabies vaccination but this is a right opportunity to start pre–exposure vaccination.
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
Medical Negligence and Consumer Protection Act
Justice NV Ramana

It is a great pleasure for me to be in the midst of distinguished and eminent doctors, engaged in the practice of medicine.  I am also honored to share the dais along with Hon’ble Justice DK Jain, President, National Consumer Disputes Redressal Commission and Hon’ble Smt M Sreesha, Member, National Consumer Disputes Redressal Commission and Padma Shri Awardees Dr A Marthanda Pillai, Dr KK Aggarwal and Dr K Shyam Sundar, President IMA Telangana.

Hon’ble Justice DK Jain is a humble and simple person with a human touch.  He is respected by one and all in judicial circles.  When I went to Delhi as Chief Justice of Delhi High Court, he was the first person to welcome me.  He made me feel at home and comfortable to work in Delhi High Court as the Chief Justice.  I have utmost respect and regard towards him.  His judgments give an erudite, scholarly reading and reflect a balance approach to the issues involved.  He has molded the law to benefit the deserving sections of the society.

Smt M Sreesha is a committed individual and a good human being. She worked as a Member of the District Forum and State Commission before her appointment as Member of the National Commission.  She has rendered several orders in consumer-related cases and I can say that she is an authority on the law relating to medical negligence.

As there are eminent speakers on the dais, who are masters on the subject, I do not want to delve on the issues relating to medical negligence.

Good health is very important for a nation’s future.  It makes an important contribution to economic growth.  Unless the health of the masses is good, no country can prosper. Doctors play an important and significant role in keeping the health of the country. Medicine is a science of art and healing.

Indian doctors are known for their charitable attitude, dedication, hard work and personal touch.  That is the reason why they are in demand all over the world.  A doctor meets a man at birth and also sees him at the end of his life.  The reputation of a doctor is determined by his professionalism, attitude towards patients, commitment, competency and his theoretical and practical skills in his profession. Trust is fundamental to the relationship of doctor and patient.  The vulnerability of patients and their need for care force them to trust a doctor.

Rapid development in medicine in the last century as revolutionized the field of medical practice. With this, the medical profession in India is at cross roads facing many ethical and legal challenges. The fact which cannot be ignored is increasing dissatisfaction on part of the patient who are expecting more and more from the doctors leading to increasing litigation,  The patients are expecting that the service provided by the doctors should be free from any fault, imperfection, shortcoming or inadequacy in quality.  Doctors, who are dealing with the precious life of human being, should be vigilant and should take utmost care in treating them.  The glory of the medical profession has come down to an extent where people are claiming damages against it equating it to any other profession.

Man is the only animal who believed in keeping order in his work.  This is one of the reasons why he invented the concept of law since no man is perfect in his work and a person who is skilled can also commit mistakes during his practice, which lead­ to minor or major injury to the patient.  The Supreme Court, in Indian Medical Association vs VP Shantha, bought the service rendered by the doctor to his patient within the definition of service as defined in section 2(1)(o) of the Consumer Protection Act.

The test to be applied for considering a case of medical negligence is a principal laid down in Bolam’s case.  The said principle states that “a man need not possess the highest expert skill but it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising the particular act”.

In Jacob Mathew’s case, the Supreme Court explained the meaning of negligence in medical profession and discussed the difference between the concept of negligence in civil and criminal law and held at that the negligence in civil law may not be necessarily be negligence in criminal law and the element of mens rea must be shown to establish the criminal liability.  In Martin F D’Souza’s case, the Supreme Court sought to protect the doctors from unnecessary harassment and laid down the guidelines to be followed by the consumer forum as well as police officials when they receive complaints of medical negligence.

The law does not aim to punish all acts of a doctor that causes injury to a patient.  It is only concerned with negligent acts.  Negligence is a branch of law of torts.  Then what is negligence?  Negligence is the breach of a legal duty to take care.  A doctor vows certain duties to the patient who consults him for his illness.  A deficiency in his service results in negligence, which is termed as medical negligence.  It is important to punish a guilty doctor but it is equally important to protect a doctor who acted in a good faith from harassment.  It is essential to note that protection of patients’ rights shall not be at the cost of professional integrity and autonomy.  There is definitely a need for striking a delicate balance.  From the times of Lord Denning till today it has been the consistent view of the courts that a charge of professional negligence against a medical professional stood on a different footing from a charge of negligence against the driver of a motor car.  The burden of proof is correspondingly greater on a person who alleges negligence against a doctor.

It is imperative that the present day medical practitioners need to have some awareness on the medicolegal issues.  Ignorance of law in its implications will be detrimental to the doctor even though he treats the patient in good faith.  All the actions that are done in good faith may not stand the legal scrutiny.  I hope this conference will proactively deliberate on several issues which are helpful in discharging your professional skills with utmost caution and satisfaction.

I believe that doctors are role models for the general public not only in the matters of health but also on the moral issues.  It is the constitutional right of every person to receive proper and timely health care and it is also the responsibility of doctors and hospital management to provide proper service with utmost care.  I hope this noble profession will be instrumental in giving the constitutional right to the citizen with cost-effective treatment, with state-of-the art technologies and with higher medical expertise and skill, which make the people of this country healthy.

Before I conclude, I would like to thank the IMA President, Secretary, office bearers and all members, in particular, Dr N Apparao National leader, IMA who has organized this meeting and for giving me an opportunity to be part of this conference.

I would like to conclude by quoting the words of Douglas Adams. I quote, “To give real service you must add something which cannot be bought or measured with money and that is sincerity and integrity.”  I unquote.
Jai Hind
Mega Press Conference on Doctor’s Day
In every State to be addressed by National President, Hony. Secretary General, State President & State Secretary

To,

The Presidents & Hony. Secretaries
All state Branches of IMA

Dear Colleagues,

This time IMA shall be observing Doctor’s Day (on 1st July) with a difference.  For the first time in the history of IMA, we want to organize a Press Conference (12 Noon to 1 PM) on 1st July, 2015 in every State to be addressed by National President, Hony. Secretary General, State President  & State Secretary.

All the Press Conferences will be conducted on the same theme ( which will be forwarded to you in due course of time).  Kindly book the date and venue for the Press Conference and also compile a list of health reporters. Please send the same list to IMA HQs so that we can also send them the invite.

Dr. Neeraj Gupta from  IMA HQ has been appointed as Coordinator for the mega Press Confernece event and he will be in touch  with you and will guide you how to e-Connect the Press Conference with National President & Hony. Secretary General.

Please make all efforts to conduct the above said Press Conference, as this is the only way we can show the strength of IMA at a national level.

Press Conference should also have photo opportunity highlighting “IMA Swachh Bharat Swasth Bharat”.  Please also make arrangements for some cleaning materials like brooms etc. at the venue of the Press Conference.

You are required to pass on this message to your Local Branch Presidents and Secretaries also.  You may also request them to compile the list of health reportes in their city and send it to IMA HQs so that a combined Press Release can also be sent to City Reporters.

For any further query, please do not hesitate to contact the undersigned.

With kind regards,

Yours sincerely,

Dr A Marthanda Pillai          Dr K K Aggarwal
Dr Dang's Lab gets extension for operating from the same premises (D-1, Hauz Khas) for another two months. (Till 29th August)
5 truths about protecting your eyes
Myth: It's best not to wear glasses or contact lenses all the time. Taking a break from them allows your eyes to rest.

Fact: If you need glasses or contacts for distance or reading, use them. Not wearing your glasses will strain your eyes and tire them out instead of resting them. However, it will not worsen your vision or lead to eye disease.

Harvard News Letter
Media
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Wellness Blog
Carbohydrates as substitute to saturated fats not the answer

More than 20 prospective studies have addressed components of diet and the risk of heart disease.

The type of fat consumed appears to be more important than the amount of total fat.

Trans fatty acids increase risk of heart disease while polyunsaturated and monounsaturated fats decrease risk.

There is a controversy about whether it is optimal to substitute saturated fats with carbohydrates. An increase in carbohydrate tends to reduce the level of good high density lipoprotein (HDL) cholesterol in addition to total and low density lipoprotein (LDL) cholesterol. Thus, the reduction in heart disease risk may be less than predicted by the reduction of saturated fat alone.

Observational studies have consistently shown that individuals consuming diets high in vegetables and fruits, which are rich in antioxidant vitamins, had a reduced risk of heart disease.

Results of a number of randomized trials are now available and show largely no significant clinical benefits of antioxidant vitamins on heart disease.

Supplemental vitamin C, E, and beta carotene cannot be recommended in the primary prevention of CHD.

Taking supplements without clinical benefits could, in theory, increase the risk if individuals mistakenly avoid therapeutic lifestyle changes or drug therapies with proven benefits.
Quote of the Day
Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending. Carl Bard
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Reader Response
Dear Sir, the views of IMA not in favor of exit exam are absolutely right. If needed IMA must file petition in court. Sunil Buchke
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Press Release
More rampant in females, around 70% of Belgaum’s population is Vitamin D deficient

Indian Medical Association trains over 450 doctors in the city on the urgent need to raise awareness about Vitamin D deficiency under its Rise & Shine campaign

A CME was organized in Belgaum today by the Indian Medical Association to discuss the growing concern on the rise of Vitamin D deficiency cases amongst the Indian population. Lately, studies have revealed that in addition to the known skeletal effects of Vitamin D deficiency, it can also have serious long-term impact on a person’s health making them vulnerable to diseases such as heart attacks, cognitive disorders, diabetes and cancer. The CME was an initiative under IMA’s Rise and Shine campaign and was attended by 450 doctors.

The IMA Rise and Shine campaign is a National movement initiated by the Indian Medical Association under an unconditional educational grant from leading pharmaceutical company USV. It is aimed at sensitizing its 2.5 lakh members across 30 states and 1700 branches over the next two years about the need to raise awareness of Vitamin D deficiency. The campaign also aims to provide essential soft skills training to all doctors on topics such as public speaking, managing patient records online, adapting to the new mobile app culture, how to break the news of death to a patient's family.

Speaking on the occasion, Dr. A Marthanda Pillai – National President and Dr KK Aggarwal – Honorary Secretary General of the Indian Medical Association in a joint statement said, “Lately deficiency of Vitamin D has been identified as a risk factor for various cardiovascular ailments such as ischemic heart disease, congestive heart failure, heart attacks and strokes. People with low circulating 25-hydroxyvitamin D (25(OH)D) have a higher incidence of high blood pressure and diabetes, conditions which are associated with cardiovascular diseases. It is advisable for such patients that apart from maintaining a regular healthy regime comprising of regular exercise, consumption of healthy food and quitting smoking, they should consume dairy products daily and spend at least 30 minutes in the sun every day. For the next two years, the IMA Rise & Shine campaign will raise awareness about Vitamin D deficiency and address the skill gap that exists in the healthcare sector."

Addressing the issue of Vitamin D deficiency Dr Vikrant Ghatnatti, Consultant Endocrinologist, Ghatnatti Endocrine Centre, Belgaum, Karnataka added, “8 out of 10 patients who come to me for consultation and 60-70% of the hospital’s OPD patients are found to be suffering from Vitamin D deficiency. An essential component of strong bones, Vitamin D deficiency can lead to various orthopedic problems in patients. In addition to this, it can also make them more vulnerable to non-skeletal diseases such as heart attacks and diabetes. Though it can happen to everyone, it is most common across females belonging to all age groups. The reason for this is the sun-shy behavior of women who mostly stay indoors and avoid the sun. The best way to prevent this deficiency is to undertake fortification of milk and encourage people to spend more time in the sun.”

Adding to this, Dr Ambrish Mithal, Chairman, Metabolic Disorders & Endocrinology, Medanta – The Medicity and Dr Prakash Subrao Phonde, President, Belgaum branch, Indian Medical Association in a joint statement said, “Vitamin D deficiency is rapidly gaining an epidemic status, yet it is the most under-diagnosed and undertreated nutritional deficiency in India and the World. Vitamin D, which can be synthesized in the body by sun exposure, is essential to maintain calcium homeostasis in the body for good bone health and for overall disease prevention. Supplementation is required when adequate levels are not met from natural sources. We must raise awareness about this and we must do it now. For we are at a higher risk than ever before.”

The IMA Rise and Shine campaign in addition to conducting CMEs and soft skill training workshops across 128 cities also includes a National daily SMS campaign for doctors, awareness through an active Facebook page, regular State and National Body meetings and public sensitization events.