Dr KK AggarwalDr KK Aggarwal IMA Satyagraha on 16th November: Ministry of health agrees to act on all five demands within six weeks

Happy and Healthy Dewali

National IMA has been perusing five community oriented demands for over a year. IMA had given a protest notice to Prime Minister, Union Health Minister, Minister for Consumer Affairs, Home Minister and Union Law Minister in reference to the Observation of a Protest Day/Satyagraha on November 16th.

IMA had also sent the copy of this letter to all the Members of Parliament on 1/11/2015.

IMA stated a successful signature campaign on eMediNexus, which is a doctors social network with a focus on medical content and the updation of knowledge of Indian doctors, and the same was signed by over 50,000 members of IMA. eMediNexus also organised an interactive webcast with Attorney General Mr Mukul Rohatgi along with the IMA on these issues.

This video has been uploaded on www.emedinexus.com and is also available on the emedinexus android app. You can go there to view the same. The first hour of the video is a discussion with IMA leaders and Dr Naresh Trehan and after the hours mark this panel is joined by the Attorney General Mukul Rohatgi. You can also leave your comments on the comments section of the video

The Attorney General suggested that for all the demands inter-ministerial coordination committee was required, involving the health, home, consumer, law ministries along with the MCI and IMA.

IMA was called for a discussion by the Union Health Minister on the 5 issues that were raised on 10/11/2015. A very detailed discussion on all issues were made. The meeting was also attended by the Union Health Secretary.

The Union Health Minister agreed on all the major issues and the solutions suggested by IMA. Most of these issues require amendment of existing Acts.

The Health Minister agreed and constituted a time bound committee consisting of the Additional Secretary Health, Joint Secretary Law, Joint Secretary Home, Joint Secretary Home and Joint Secretary Consumer Affairs. The committee will have three representatives of IMA (IMA insisted for the same) and one from MCI. The committee will study all the suggestions and amendments given by Indian Medical Association on all five issues and submit a report within six weeks (before the central council meet). The ministry will than expeditiously act on the suggestions and amendments.

IMA had discussions with senior leaders and all felt that it was the right step. In the history of IMA it has happened for the first time that a joint inter-ministerial committee has been formed by the government to look into the amendments and suggestions given by IMA.

The health Minister has also agreed to address the Central Council meeting in Delhi.

It’s a victory of Team IMA and shows the strength of our signature campaign and mass preparedness for the event.

Team IMA is grateful to the enthusiasm and commitment given by all members, state leaders and senior leaders and specially thank Mr. Mukul Rohatgi and eMediNexus for their timely help.

Taking into consideration of the above facts and sequences Team IMA is POSTPONING the protest from November 16th.

The enthusiasm and commitment given by all members, state leaders and senior leaders have given Team IMA the courage to make this deal.

Keep up the preparedness in case we have to go ahead with the protest.

With regards,
Dr A Marthanda Pillai and Dr K K Aggarwal
eMediNexus Statement
We are extremely happy to have been part of this campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
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World's first blood test for accurate prenatal testing developed
Scientists at Plymouth University have developed a non-invasive, low risk and accurate blood test that can detect foetal blood group, sex, and genetic conditions in unborn babies. "Although foetal blood grouping and sexing using maternal blood has been done for over a decade, this research proves a much more accurate and sensitive method of detecting foetal DNA," said lead corresponding author professor Neil Avent. The test developed can be carried out on mothers at risk of X-linked genetic recessive diseases including haemophilia and Duchenne muscular dystrophy and mothers at risk of haemolytic disease of the newborn. It can use the blood that is taken from the mother at the early stages of pregnancy, negating the need for multiple appointments. (Economic Times – IANS)

Normal-weight central obesity more deadly than just high BMI

Central obesity in normal-weight people places them at greater risk of death than does overall overweight or obesity in people without the excess abdominal fat. The startling findings were published online November 9, 2015, in Annals of Internal Medicine by Karine R Sahakyan, MD, PhD, of the Mayo Clinic, Rochester, Minnesota, and colleagues. Their analysis of an average 14 years' follow-up data from more than 15,000 participants in the Third National Health and Nutrition Examination Survey (1988–1994) reveals that people who had normal body mass indexes (BMIs 18.5–24.9 kg/m2) but who had central obesity (defined using World Health Organization criteria of waist/hip ratio 0.85 or greater in women and 0.90 or above in men) had worse long-term survival compared with participants with normal fat distribution, regardless of their BMI.
Dr Good Dr Bad
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Indian Medical Association National Satyagraha for a Healthy India
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Specialty Updates
• Drinking just a single energy drink may increase the risk for cardiovascular events among young, healthy adults, suggests a new study published in JAMA.

• Increasing intake of homemade meals may protect against the development of type 2 diabetes, reported a new study presented at the American Heart Association's Scientific Sessions 2015.

• Normal-weight people who carry fat around their midsections have a greater mortality risk than those who are overweight or obese but have normal fat distribution, suggested an article published in Annals of Internal Medicine.

• Loss of consciousness may be an indicator of a severe bleeding event and therefore a predictor of death or poor functional outcome a year later in patients with subarachnoid hemorrhage, reported an article published online in JAMA Neurology.

• A study presented at ASN Kidney Week 2015 reported that among patients on dialysis, nalbuphine, a type of κ-opioidagonist/μ-opioid antagonist, was safe and reduced itching intensity, and also improved sleep.

• Gonorrhoea resistance to cefixime was noted to decrease by nearly 70% between 2011 and 2013, suggesting a halt in the drift toward resistance. However, data from 2014 show the opposite and may indicate increases in resistance, reported a paper published recently in JAMA.

• Probiotic exposure during the first 27 days of an infant's life may be associated with reduced risk of islet autoimmunity among children at increased genetic risk for type 1 diabetes, reported an article published online by JAMA Pediatrics. However, further studies are needed before any recommendations for probiotics can be made.

• For older adults who experience a proximal fracture, the risk for premature death is significantly elevated, suggests new research presented at the American College of Rheumatology (ACR) 2015 Annual Meeting.

• Patients with schizophrenia whose symptoms do not respond to standard antipsychotic medications have better outcomes if they are switched to clozapine instead of another standard antipsychotic, suggests new research published in the American Journal of Psychiatry. These patients have fewer hospitalizations, stay on the new medication longer, and are less likely to need to use additional antipsychotics.

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What is the importance of Govardhan Pooja?

Mistakes of the Intellect are responsible for the disturbed state of mind. Even if the mind is under control, the intellect can disturb the mind. It is the discriminative faculty of the mind and can be very destructive. It is the main cause of ignorance. External desires and the uncontrolled five senses are responsible for it. Kama, Krodha, Lobha and Moha are the causative factors.

In mythology, Krishna won over the intellect– symbolized by King Indra, the one who controls the indriyas and the senses. Govardhan pooja is the example of winning over the intellect. The same can only be done by one point concentration on the object of concentration. Krishna raised the mountain (the problem) on one finger (one point determination) to save people from heavy rains (turmoil of thoughts). This denotes taking one point decision (one finger) whenever the mind is indecisive (Mountain) with multiple possibilities (rain). Only when the mind body and soul are purified after one month Yagna (first Navratri to Diwali), can one use his/her intellect to tale one point decisions.

Govardhan pooja can also be understood by the following story.

Once a disciple asked his Guru about the difference between a girlfriend and wife. The Guru asked him to go to the tomato field and pick up the largest and most colored tomato but put a condition that once he had crossed one line he could not return back. The disciple went and saw a large tomato in the first row. He went ahead and found a larger tomato in the next row. Thinking that the subsequent rows would have still larger tomatoes he went on further and further. In the seventh row he found a very large red tomato but in search of finding a still larger tomato he left it and went to next row only to find smaller and smaller tomatoes in the subsequent rows and ultimately came empty handed. The GURU said this is the example of search for a girlfriend.

Four days later the Guru asked the disciple to do the same exercise again. This time in the fifth row the disciple found a very large red tomato, got satisfied, plucked it and came back. When the guru asked why he did not search further, he said that that once he decided on that tomato his mental turmoil to search further stopped. It did not bother him anymore that a still larger tomato may have been ahead. The Guru said this is an example of the search for a wife.

Govardhan pooja means stopping your search at some point and being satisfied with what you get or learning to make a stop to all your desires at some point in your life.
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Digital IMA
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Legal Quote
Jacob Mathew vs State of Punjab and Anr: 5th day of August 2005: 334/2005/SCI/ 144-145 of 2004

“The standard of care has to be judged in the light of knowledge or equipment available at the time of the incident and not at the date of the trial.”
Developing an Investment Portfolio

Assets are generally held for either personal use or production of current or future income. Since assets held for personal use are a matter of individual discretion, the focus is on those assets held for the production of current income or for potential appreciation. The asset characteristics which matter are:

• Taxability upon deposit, on income and at withdrawal
• Safety
• Growth and inflation protection
• Yield
• Liquidity

Each of the asset categories can be evaluated according to these characteristics in order to decide what role each should play in the final investment portfolio.

(Source: IJCP)
Industry News
AskmeBazaar launches community for e-commerce merchants: E-commerce platform AskmeBazaar has started an online community to help sellers to interact and share insights on their experience doing business online. Under its 'Grow with Us' initiative, the company has launched a new portal, growwithus.askmebazaar.com and is also looking at engaging sellers on social media. "The community portal is a platform where sellers from across the country explain how they managed various aspects of commerce to grow their business online," AskmeBazaar CEO Kiran Murthi told PTI. (The Economic Times- PTI)

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How can startups build a better tomorrow with Bluemix: The Cloud is the latest vehicle driven by startups to remain competitive in today’s fast-paced business environment. Quick and easy deployment of technology, increased output and productivity, and better flexibility to course correct – these are just a few of the features of Cloud computing that companies leverage to remain nimble and responsive in today’s dynamic world. Bluemix is an implementation of IBM‘s Open Cloud Architecture based on Cloud Foundry, an open source Platform as a Service (PaaS). It provides access to a wide variety of services that can be incorporated into an application… (Yourstory)
IMA Satyagraha
IMA Satyagraha, suggested slogans

• Allow doctors to treat patients irrespective of patients’ income - If compensation is not capped, we can't do this.
• Writing prescription drugs by anyone other than with an MBBS degree is injurious to peoples’ health.
• Please allow Doctors to treat poor and rich equally.
• More patients will die if doctors are not provided protection during duty hours.
• Death does not mean negligence.
• Save single clinic and small establishments - Exclude them from Clinical Establishment Act
• PCPNDT Act needs graded punishments

View Video: https://www.youtube.com/watch?v=UV1zCH33BlU
IMA Digital TV
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50 million Indians have mental illness

Five percent of the population in India lives with a mental illness, which translates to over 50 million people. These numbers have a close bearing to the rate of suicides, cardiovascular health and several days of productivity lost. Nearly half of those with severe mental illness are not treated and of those with less severe problems, nearly 9 in 10 go uncared for. There are only 5,000 psychiatrists in India, which is just 10% of the number required. These statistics were highlighted at the 22nd national conference of Indian Association for Social Psychiatry held in Agra… (ET Healthworld – Deepak Lavania)
India’s first dedicated Medical Device Park
Chief Minister of Andhra Pradesh, Chandrababu Naidu has taken in-principle decision to develop a dedicated 200 acre industrial park for the manufacture of medical devices in his state. The decision was conveyed by Mr Naidu himself following an hour-long tripartite meeting between the CM and his senior officials, senior central government officials with the representatives of Indian medical device industry led by Forum Coordinator of Association of Indian Medical Device Manufacturers (AIMED) & Jt. Managing Director of Hindustan Syringes & Medical Devices, Rajiv Nath. The Indian medical device industry is worth over Rs 60,000 crore. And country's humungous import bill for this segment amounts to over Rs 23,000 crore (approximately USD 4 billion) while export amounts to only over Rs 7000 crore (USD 1.1 billion). India's import dependency on high-end medical devices is over 80 per cent and 60-70% for other devices. And this is where the dedicated medical device park would be of great value - reducing humongous import dependency, increasing export while generating wealth and employment within… (ET Healthworld)
NY docs must complete 4-hour CME to prescribe marijuana
New York state has launched its continuing medical education (CME) program for physicians who wish to recommend marijuana to their patients, and it appears to be one of the more stringent programs in the United States. The state's Compassionate Care Act, which legalized medical use of marijuana, was signed into law in June 2014. Physician training was established by the statute. The state announced availability of the course on October 20. Physicians who wish to certify that their patients should be allowed to use medical marijuana will be required to take a 4-hour continuing medical education course. It will cost them $250… (Medscape)
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A study by professional services firm Deloitte Instant has shown that messaging apps like Whatsapp and social networks are the first things that most consumers check on their smartphones in the morning. According to Deloitte’s Mobile Consumer Survey 2015, about 78% of respondents owning smartphones said they checked their phones within 15 minutes of waking up. About 52% of the respondents said they check their phones within 5 minutes before going to sleep every night. The survey analyzed mobile usage habits of over 2,000 Indian consumers as part of a global survey of 49,000 respondents across 30 countries… (Financial Express)
GP Tip
Lubricant for sutures

When suturing in a hairy area such as the scalp, use of a lubricant to smooth down the hair around the wound can keep the hair out of the way. (Source: IJCP)
Annakoot emphasizes the importance of eating mixed vegetables

Annakoot festival is observed on the day of Govardhan Pooja after Diwali. There are many mythological scientific descriptions for this pooja.

• On this day, there is a change in the season so is change in the availability of fruits and vegetables in the market. On the day of Annakoot, people cook all types of outgoing and incoming vegetables and eat them. It reminds people that this is the last day for eating these outgoing vegetables for health reasons.

• Annakoot emphasizes the importance of eating mixed vegetables. It is traditionally said that one should eat all seven colours and six tastes. Mixed vegetables provide all vitamins.

• Annakoot is observed after Diwali. During Diwali people eat a lot of heavy food with predominant sweet taste. On the day of Annakoot eating a diet predominant in green vegetables that are bitter in taste help undo the imbalance caused by heavy sugary food items during Diwali.

• In mythology it is also said that on this day, a mountain heap is created of all the cooked vegetables, eaten and distributed. It also indicates that from now onwards, one should eat only light food and distribute the leftovers.
Bioethical issues in medical practice
Rights and duties of a parent

Smita N Deshpande

Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

A girl suffering from intellectual disability, serious enough so that she could not take care of herself became pregnant at the care home. By the time the pregnancy was discovered she was pregnant for over four months. The girl was admitted to a government hospital and assessed for MTP. The girl insisted- from the point of view of her limited understanding of the matter- that she wanted to keep the child and bring it up herself. Doctors at the hospital where she was admitted after the pregnancy was discovered were of the opinion that she was intellectually unfit to look after herself, what to say of a child. What should the doctors do?

a) Carry out MTP regardless of the girl’s wishes

b) Allow the pregnancy to continue possibly to the future detriment of the unborn baby.

c) Any other recourse such as going to court – but what if the court orders continuance of the pregnancy? Who will look after the baby?

Do write in with views and your solutions!

Responses received

• The pregnancy should be allowed to be continued. Efforts should be made to find out the father. He should be compelled to take care of the child and in case he is unable to take care of, he should be prosecuted for rape and child be sent to some social organisation along with the mother. Dr BR Bhatnagar
Inspirational Story
Testing for Gossip

In ancient Greece, Socrates was reputed to hold knowledge in high esteem. One day an acquaintance met the great philosopher and said, "Do you know what I just heard about your friend?" "Hold on a minute", Socrates replied. "Before telling me anything I’d like you to pass a little test. It’s called the Triple Filter Test."

"Triple filter?" "That’s right", Socrates continued. "Before you talk to me about my friend, it might be a good idea to take a moment and filter what you're going to say. That’s why I call it the triple filter test. The first filter is Truth. Have you made absolutely sure that what you are about to tell me is true?" "No," the man said, "Actually I just heard about it and …"

"All right", said Socrates. "So you don’t really know if it’s true or not. Now let’s try the second filter, the filter of Goodness. Is what you are about to tell me about my friend something good?" "No, on the contrary."

"So", Socrates continued, "you want to tell me something bad about him, but you're not certain it’s true. You may still pass the test though, because there’s one filter left: the filter of Usefulness. Is what you want to tell me about my friend going to be useful to me?" "No, not really."

"Well", concluded Socrates, "if what you want to tell me is neither true nor good nor even useful, why tell it to me at all?" …
eMedi Quiz
A 20-year-old man complains of difficulty in reading the newspaper with his right eye. Three weeks after sustaining a gunshot injury to his left eye. The most likely diagnosis is:

1. Macular edema.
2. Sympathetic ophthalmia.
3. Optic nerve avulsion.
4. Delayed vitreous hemorrhage.

Yesterday’s Mind Teaser:  Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5' Capping.
3. 3' polyadenylation.
4. Glycosylation.

Answer for Yesterday’s Mind Teaser: 4. Glycosylation.

Answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr.K.V.Sarma, Dr Poonam Chablani, Dr.K.Raju, Dr Jainendra Upadhyay, Raghavendra Chakurkar, Daivadheenam Jella,

Answer for 10th November Mind Teaser: 2. Corticosteroid

Answers received from: Dr Avtar Krishan, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Jainendra Upadhyay
IMA Digital TV
Teacher: Billy, stop making ugly faces at other students!

Billy: Why, ma’am!

Teacher: Because when I was a child, my parents told me that if I kept making ugly faces my face would stay that way!

Billy: Well, I can see you didn’t listen then!
Readers column
Dear Sir, Thanks for the information. Regards: Dr Sneha
Press Release
Be safe and healthy this Diwali season

As one approaches the festivals of lights, they often forget the health risks that come with it. Necessary precautions are a must to enjoy the festive season to the fullest. 

Speaking about this, Padma Shri Awardee – Dr KK Aggarwal – President HCFI and Honorary Secretary General IMA said, “This Diwali, we must take a pledge to take necessary precautions to prevent environmental pollution and accidental injuries. We must also eliminate evils like smoking and drinking from our lives. With the rising incidence of lifestyle diseases it is important that everyone restricts the consumption of food containing high levels of trans fat, sodium and refined sugar. We must deal with stress through a holistic approach and to do away with anger and negativity from our lives. Most lifestyle diseases are preventable and manageable, only when necessary precautionary measures are taken. We must work towards beating obesity, heart disease, hypertension and diabetes.”

Here are a few tips for a healthy and safe Diwali

Candle Pollution: One should be careful of candle pollution. Candles made from beeswax or soy, although more expensive, are safer because they do not release potentially harmful pollutants.

However an occasional paraffin candle and its emissions do not harm but lighting many paraffin candles daily or lighting them frequently in an unventilated bathroom around a tub, may cause problems. Pollutants from burning candles can also cause respiratory irritation and allergy. The candles, which are made from petroleum, are a source of known human carcinogens and indoor pollution.

Diwali Sweets: White sugar in sweets can lead to uncontrolled diabetes and weight gain in individuals. Adulterated khoya can cause GI upset. Artificial coloring in sweets can cause cancer in long run. Eating chocolates can add to calories in blood sugar. The best item for Diwali is fruits and dry fruits.

Diwali Fire Hazards: Diwali should not lead to fire with resulted burns and loss to life. In case of burning the effected part should be put in the running water till burning disappears. Blisters should not be punctured, as they work like a natural dressing.

Eye injury- Particle of crackers can cause eye burn. Continuous water should be poured into the effected eye till the burning is over.

Safe dressing- if medicated bandage is not available, one can use a piece of cloth and iron it. It will work like a medicated bandage.

Diwali Pollution: The condition of patients with COPD (Adult Asthma) may worsen in Diwali festival and they should use wet clothes whenever they are exposed to smoke.