January 6 2016, Wednesday



Air quality and health

• Air pollution is a major environmental risk to health.

• By reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma.

• The lower the levels of air pollution, the better the cardiovascular and respiratory health of the population will be, both long- and short-term.

• Ambient (outdoor air pollution) in both cities and rural areas was estimated to cause 3.7 million premature deaths worldwide in 2012.

• Some 88% of those premature deaths occurred in low- and middle-income countries, and the greatest number in the WHO Western Pacific and South-East Asia regions.

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Guest editorial


Dear Leaders,

It is extremely disturbing that the West Bengal government is going forward with a program of training quacks to practice modern medicine and prescribe modern medical drugs. It is a very extreme situation, when IMA is objecting to BSc Community Health course and AYUSH, West Bengal government is going forward with the worst of the solutions to give health care to the poor people of the state.

To crown this situation Nobel laureate Amartya Sen is supporting quacks training program. It is unfortunate that an economist Nobel laureate should venture to give a solution for a public health issue particularly regarding man-power deployment. IMA would have appreciated if he had given a solution to the financial aspect of health care and health care accessibility and affordability.

Training Quacks Will Help In Rural Healthcare, Says AmartyaSen (Source: NDTV)

Kolkata: With the healthcare system not up to the mark in rural areas, Nobel laureate economist AmartyaSen today said training of quacks might help in tackling the situation.

"The healthcare infrastructure required in rural areas is non-existent. If the government feels that the existing infrastructure cannot be improved, then in that case, people whom we call quacks, if they are trained, then it can be beneficial," MrSen said on the sidelines of an event.

The eminent economist and philosopher, however, stressed the need to train the quacks.

"However, it is essential that these quacks possess some kind of medical knowledge, and are given training before they can be allowed to render their services," he said.

The IMA West Bengal branch has to strongly oppose this move of the government of West Bengal for the following reasons
1. Sub centers are the corner-stones of disease prevention activities and implementation of national health programs and not primarily meant to provide curative service except home remedies. The staff pattern in the sub centre consists of one male and one female multi-purpose health worker (JPHN/JHI/ANMs). The job description of these staffs include family welfare services, immunization, awareness, household visits, data collection regarding disease prevalence, and coordinating other national disease control programs. These staffs currently work under the supervision of a medical officer posted in PHC. For this purpose there is no need for a ‘trained quack’ and posting them at Sub Centre will be a wrong human resource management.

2. The policy proposal on this is not based on ground reality and is conceptually wrong. At Sub Centre level, more suitable workforce will be an ASHA worker with basic primary education and training. Entrusting the quacks to manage very sensitive areas like child health within the health system may even worsen the situation. To leave the health of children and adolescents in the hands of ill-equipped personals is detrimental and may nullify the results of years of hard work that the country has put into reducing child mortality and morbidity

I request the IMA West Bengal to get all the details on this issue and post it in Team IMA so that members can know the gravity of the issue. Our theatre of activity has to shift to West Bengal and I am sure that whole national IMA will be with you in this fight. If this attempt is not countered effectively, then we will not be able to fight against BSc Community Health or AYUSH

The central government has time and again came out with acts and rues to contain and eliminate quacks from the health care scenario. Knowing fully well that the quacks should be doing more damage to public health rather than sandwich health delivery. Instead of taking legal action against quacks, legitimizing them is a great harm to public health. The basic qualification of quacks practicing in rural areas is an unknown factor. They may even not be having plus two education. Those who are without at least plus two, how can they be trained in basic health care including pharmacology and medicine. It is also not an easy job even to find out those who have at least up to plus education.

“The Mamata Banerjee government in West Bengal in November had announced training of quacks operating in rural areas acknowledging them as 'village health workers'. In a notification issued by the state family and health department in November, it was announced that a standard operating procedure (SOP) for these village health workers will be prepared in consultation with clinical pharmacologists, physicians, surgeons and administrators.”

It is the general concept of health delivery in our country that the MBBS doctor will be the team leader in the PHC and under him nurses, para-medics, health workers, field staffs and others work. Even the small list of drugs which can be issued by field staffs are supervised by the doctor.

As mentioned earlier, the job of Health worker in PHC which is mainly preventive in terms of immunization, hygiene, sanitation, nutrition, awareness regarding healthy living, chlorination of water etc. The established system of utilizing ASHA workers who have minimum general education who are motivated persons from the same community and who has capacity to deliver at least part of the responsibility of ANMs will be a better choice rather than empowering quacks. Already quacks are doing great harm to public health. Increasing their legitimacy and giving them half-baked knowledge of modern medicine will empower them to do more harm. They cannot be part of our health delivery system and they cannot be brought under any regulation since they are already enjoying lot of autonomy in their own realms. They are already designating themselves as doctors and practicing and they don’t need West Bengal government’s permission to continue to do so. West Bengal will be opening a Pandora’s Box and complete chaos in health delivery and the opportunity to return back to a systematic approach to health delivery will be lost forever.

Instead of promoting this ‘quackery’, government should seriously plan attracting doctors to the rural areas and strengthen public health. National sample survey, 2014 has shown that 40% of our population depend on single man clinic and small rural hospitals for their health needs. It is observed that these small and medium level hospitals are closing down due to financial non viability. IMA demands the government to support these hospitals financially through a program of ‘aided hospitals’.

To attract modern medicine practitioners to serve in rural areas, IMA suggests the following
1. Government to identify difficult areas (primary health centres where doctors are not available for more than 3 years)

2. To develop a package to attract doctors to these areas by offering higher salary, accommodation preferably at headquarters with transportation, weightage for PG admission for those serving in difficult rural areas (upto 30% weightage), admission of children to central schools

3. To post minimum of three MBBS Doctors in PHCs instead of the present system of posting one MBBS Doctor

4. To utilise the service of private practitioners in the locality on a retainership / contract basis

5. To utilise the services of foreign degree holders (Russia/China Indian graduates) as trainees under the supervision of PHC doctors up to three years or till they get registered

6. Population covered by PHC to be revised from existing 30,000 to 20,000 whereas presently up to 1.5 lakhs population is covered by one PHC

7. To get orientation of rural health problems, and to motivate them to work in rural areas at least three to six months should be spend by both undergraduates and post graduates in rural set up, under graduates to get training in PHC during their Community medicine posting and also as part of vertical integration at clinical postings. The post graduates can work at least 3 to 6 months in CHCs along with or under the supervision of specialists. The period for preparation of thesis for this can be reduced to 6 months

IMA West Bengal has already lost time in strongly reacting to the situation. The support of the whole medical fraternity in West Bengal including specialist’s organisations and nursing home organisations, medicos, postgraduates, house surgeons should be sought and a plan of action culminating in various forms of protest should be drawn.

Dr A Marthanda Pillai
Immediate Past President,
Indian Medical Association.





First Guidelines for Chronic Pulmonary Aspergillosis released

The first–ever guidelines on chronic pulmonary aspergillosis (CPA) from the European Respiratory Society and the European Society of Clinical Microbiology and Infectious Diseases have been published in theDecember issue of European Respiratory Journal. Some of the recommendations are:

  • Diagnosis requires 3 or more months of one or more cavities with or without a fungal ball or nodules on thoracic imaging, direct evidence ofAspergillusinfection from microscopy or biopsy culture or an immunological response toAspergillusspp., and exclusion of alternative diagnoses.
  • Almost 90% of patients have raisedAspergillusantibody (precipitins).
  • Surgically excise simple aspergilloma if technically possible, preferably using video-assisted thoracic surgery.
  • Treat chronic cavitary pulmonary aspergillosis with long-term oral antifungal therapy, with careful monitoring of azole serum concentrations, drug interactions and possible toxicities.
  • Hemoptysis may reflect therapeutic failure and/or antifungal resistance. It may respond to tranexamic acid and bronchial artery embolization but rarely requires surgical resection.
  • Treat singleAspergillusnodules with antifungal therapy only if not fully resected.
  • Patients with multiple nodules may benefit from antifungal treatment and require careful monitoring.


DHR invites concept research proposals under ‘Grant–in–aid scheme for inter–sectoral convergence’

The Dept. of Health Research (DHR) has invited concept research proposals from eligible institutions under the ‘grant–in–aid scheme for inter–sectoral convergence and coordination for promotion and guidance on health research’. This scheme was launched in 2014 to promote and co–ordinate basic, applied and clinical research in the country. (Pharmabiz – Ramesh Shankar)




  • The US Food and Drug Administration (FDA) has reclassified surgical mesh for transvaginal repair of pelvic organ prolapse (POP) from a moderate–risk device (class ll) to a high–risk one (class lll) and gave manufacturers 30 months to prove that their products are safe and effective.
  • Higher monthly doses of vitamin D may not improve the function of lower extremities, instead they may increase the risk of falls in senior patients, suggests new research published online in JAMA Internal Medicine.
  • Abbreviated dosing of the monoclonal antibody palivizumab adequately protected infants at risk for respiratory syncytial virus (RSV) hospitalization in a real–world setting, suggested findings from a new study reported in a research letter published online December 28 in JAMA Pediatrics.
  • Levels of fecal calprotectin, a biomarker of intestinal inflammation, vary in patients with inflammatory bowel disease (IBD), suggests new research published online in the Scandinavian Journal of Gastroenterology.
  • Doctors are more likely to give smokers antibiotics for an infection, a habit that may promote antibiotic resistance, suggests a new study published online in the American Journal of Preventive Medicine. Researchers noted that smokers were 20% to 30% more likely than non-smokers to get an antibiotic prescription.
  • Patients with gout are at significantly increased risk for atrial fibrillation (Afib), reported a population–based study published online in Rheumatology.
  • Neuromuscular electrical stimulation (NMES) transiently improves exercise capacity in patients with severe COPD, suggests new research published online in The Lancet Respiratory Medicine.
  • A new study, published in the journal Cancer Research, suggests that high sugar intake can increase the risk of breast cancer and hasten spread of the disease to the lungs.
  • Developmental delays in young children were not found to be linked to infertility treatments that their mothers had undergone in comparison with children born to women who did not undergo those treatments, suggested a population–based study published in JAMA Pediatrics.
  • Prosthetic replacement of the ocular surface ecosystem (PROSE) continues to offer benefits several years after patients have been fitted with the scleral lenses, suggested a new review of data published online in the British Journal of Ophthalmology.


Why do We Burn Camphor in Any Pooja?

No aarti is performed without camphor. Camphor burns itself out completely, when lit, without leaving a trace. Camphor representsour inherent tendencies or vasanas.When lit by the fire of knowledge about the self, the vasanas burn themselves out completely, not leaving a trace of ego. Ego is responsible for a sense of individuality that keeps us separate from the Lord or consciousness. In addition, camphor when burns, emits a pleasant perfume. This signifies that as we burn our ego, we can only spread love and nothing else.



Nizam Institute of Medical Sciences Vs. Prasanth S. Dhananka and Ors, SC/4119 of 1999 and 3126 of 2000, 14.05.2009

the Court has to strike a balance between the inflated and unreasonable demands of a victim and the equally untenable claim of the opposite party saying that nothing is payable. Sympathy for the victim does not, and should not, come in the way of making a correct assessment, but if a case is made out, the Court must not be chary of awarding adequate compensation.




Two new states in the US legalize medical marijuana

Lawmakers in Georgia and Texas legalized medical marijuana in 2015. A total of 25 states and the District of Columbia now allow marijuana use in some form or at least have decriminalized possession of it. In February US Surgeon General Vivek Murthy, MD, said that medical marijuana can help some patients. Murthy said that preliminary data shows that marijuana can be helpful for certain medical conditions and symptoms and the data should be used to drive policymaking. Marijuana is still illegal at the federal level. Meanwhile in October, the American Academy of Family Physicians (AAFP) voted to support decriminalizing the possession of marijuana for personal use but stopped short of supporting legalization... (Medscape)


1. IMA Rare Blood Group Online Blood Bank Directory:
2.IMA Online TB Notification initiative: ima–
3.IMA Online Events Reporting initiative: http://www.ima––side–bar.php?scid=228
4. Proforma for Hypertension Screening: http://module.ima–
5. IMA Online Sentinel Events Reporting Initiative:
6. IMA Disease Notification:
12. IMA Slide Share: http://www.ima––way–page.php?scid=287
13. I Pledge My Organ: http://module.ima–
14. IMA Weekly Live: http://www.ima–
17. IMA ART: http://ima–
18. IMA Satyagraha: http://ima–
19. IMA Daily Webcast: http://ima–
20. CC Slides: http://www.ima––side–bar.php?scid=417
21. NATCON Photos: IMA Natcon 2015 – Day 2 – Camera 1, IMA Natcon 2015 – Day 2 – Camera 2,





Simulation training may improve interventional cardiology skills

A pilot study of 18 cardiology fellows in Germany showed that those randomized to receive about 8 hours of mentored virtual–reality (VR) simulator training had a 5.8–point increase from baseline on a graded "skills score" after performing a catheter intervention on a heart-flow model, whereas those randomized to 4.5 hours of lectures had a 6.7–point decrease in skills score (P=0.003 for group comparison). The findings published online December 16, 2015 in the Journal of Interventional Cardiology suggest that simulation training may increase the performance of fellows relatively new to interventional cardiology.


First Genetic disease identification center launched in Kerala

KIMS Hospital, Thiruvanthapuram, Kerala on Monday announced the launch of the first genetic disease identification centre in collaboration with Medgenome, India. The mission was to help patients and families with various genetic conditions through expert counselling and state of the art genetic testing facilities while maintaining complete confidentiality. According to the chairman, KIMS Healthcare Group, MI Sahadulla, this new partnership envisages genetic counselling and testing for rare and common genetic, hereditary diseases that includes various types of cancers, cardiovascular, neurological and gastro-intestinal diseases (ET Healthworld)


US complacent on infectious disease threats
The United States has to do more to boost its ability to prevent and control infectious disease outbreaks, according to the third annual report from Trust for America’s Health and the Robert Wood Johnson Foundation. The Report on the infectious disease preparedness of the US states that more than half of states (28) received a score of five or fewer of 10 key indicators related to preventing, detecting, diagnosing, and responding to outbreaks. Seven states (Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon, and Utah) tied for the lowest score, at three of 10, whereas Delaware, Kentucky, Maine, New York, and Virginia tied for the top spot, achieving a score of eight of 10 (Medscape)


US Labs score poorly on cardiac perfusion test radiation

Andrew J. Einstein, MD, PhD, of Columbia University Medical Center/New York–Presbyterian Hospital in New York City, and colleagues report online inJAMA Internal Medicine that most American laboratories are doing myocardial perfusion imaging in ways that expose patients to substantially more radiation than necessary. Compared with 32.6% of facilities in 64 other countries, only about 14% of facilities in the US met the quality benchmarkof exposing patients to a median of no more than 9 mSv for the procedure (Medpage Today)


World's largest database for cancer drug discovery goes 3D

Scientists have revolutionized the world's largest database for cancer drug discovery by adding 3D structures of faulty proteins and maps of cancer's communication networks, paving the way for more effective treatments. The new version of canSAR database uses artificial intelligence to identify nooks and crannies on the surface of faulty cancer-causing molecules, as a key step in designing new drugs to block them. The growing database now holds the 3D structures of almost three million cavities on the surface of nearly 110,000 molecules. The findings were published in the journal Nucleic Acid Research… (ET Healthworld)




WP(C) No.8706/2015 titled Indian Medical Association Vs. Union of India & Anr (NCERT) Delhi High Court, New Delhi

Click here to read the proposed changes



Parents dilemma in choosing sex of their intersex child

Smita N Deshpande
Head, Dept. of Psychiatry, Deaddiction Services
PGIMER–Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

A and Shave one child. The second, born three months ago, had indeterminate sexual genitalia. He doctor opines that the child will need one operation so that sex is clear. The operation can be done in the future once the child grows up and decides which sex s/he wants to belong to. They are worried because they feel that growing up with a confusing sexual identity will not be good for the child. Moreover the other sibling may face stigma. Finally the child does not even need to know about the operation. As their doctor what should you advise?

  1. What would you do, as a parent?
  2. Is such a surgery necessary at all? Can the child not go through life with indeterminate sex if s/he wants?
  3. What other social issues would such a child face?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):



Avoid chocolate for heartburn

People with heartburn should avoid chocolate as it can worsen heartburn. They should also avoid other reflux–inducing foods (fatty foods, peppermint and excessive alcohol, which may reduce lower esophageal sphincter pressure). A number of beverages have a very acidic pH and can exacerbate symptoms. These include colas, red wine and orange juice (pH 2.5 to 3.9). Promotion of salivation by either chewing gum or use of oral lozenges may also be helpful in mild heartburn. Salivation neutralizes refluxed acid, thereby increasing the rate of esophageal acid clearance.
Restriction of alcohol use and elimination of smoking; smoking is deleterious in part because it diminishes salivation.


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Where there is a will there is a way

A 72yearold male came to Sameer Malik Heart Care Foundation Fund to get financial assistance for his heart condition. He had heart failure, which required biventricular pacing device to help him relieve his symptoms and live a better quality of life. The private sector gave him an estimate of Rs. 7.50 lakhs. At AIIMS, the estimate was lowered to Rs. 2.25 lakhs for a reasonable device. He approached Prime Ministers Fund and was sanctioned an amount of Rs. 50000/ but the due six months passed as he could not raise further funds. Because of the large sum of money required, most of the family members refused to help him. When he approached us, he had also sold his only buffalo for Rs 30000/. When we first met him, he was an enthusiastic elderly person and said, "Mein jeena chahta hoon" (I want to live) and these words impressed me immensely. From Sameer Malik Heart Care Foundation Fund, we sanctioned an amount of Rs. 1 lakh towards his surgery and then talked to his family members and convinced them that when we are helping him all of them should also help. His brotherinlaw called us next day and said that he has arranged the balance amount of Rs 90000/. Ultimately, a total amount of Rs 2.25 lakh was collected and deposited with AIIMS and his rightful surgery was done.

The message is very clear "where there is a will there is a way." He showed us his will to live by selling his only buffalo and that paved the way for his successful surgery.



A vitreous aspirate has been collected in an emergency at 9 pm what advice you like to give to the staff on duty regarding the overnight storage of the sample.
1. The sample should be kept at 4C.
2. The sample should be incubated at 37C.
3. The sample should be refrigerated deep freezer.
4. The sample should be refrigerated for the initial 3 hours and then incubated at 37C.

Yesterdays Mind Teaser: A 60–year–old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:
1. Thymoma
2. Lung cancer.
3. Hodgkin’s lymphoma.
4. Superior vena caval obstruction.

Answer for Yesterdays Mind Teaser: DrKRaju, DrKVSarma, Daivadheenam Jella.
Answers received from: 4. Superior vena caval obstruction.
Answer for 4th January Mind Teaser: 3. Bone erosions.
Answers received from: Dr Jainendra Upadhyay, Dr.K.Raju, Dr Avtar Krishan.



Congratulations… really a great teamwork under your leadership…… Happy 2016 to everybody:
Dr Ujjwal Kumar Sengupta, Hony Jt Fin Secy, Kolkata



One day, a houseworkchallenged husband decided to wash his sweatshirt. Seconds after he stepped into the laundry room, he shouted to his wife, "What setting do I use on the washing machine?" "It depends," she replied. "What does it say on your shirt?" He yelled back, "Texas A & M."



IMA not in favor of NHRCs decision to publicly hear medical negligence cases

As per media reports the National Human Rights Commission (NHRC) will be publically hearing and addressing medical negligence cases against both the government and private hospitals during a two–day grievance redressal forum being held at the Tata Institute of Social Sciences campus in Mumbai fromJanuary 6–7, 2016.

The Indian Medical Association feels that creating an additional forum for patients to complain without any clear–cut rules or guidelines in place will only add to the ongoing cases of violence against doctors in the society.

NHRC is scheduled to hear around 125 complaints filed against erring hospitals from four states – Maharashtra, Gujarat, Goa and Rajasthan. This includes as many as 55 cases of medical negligence from Maharashtra, 30 each from Gujarat and Rajasthan, and 10 from Goa.

At present, patients who have grievances against private hospitals go either to the medical council or the consumer court or the police.

Sharing IMAs viewpoint,Dr. S.S Agarwal National President and Padma Shri Awardee Dr. KK Aggarwal Honorary Secretary General IMA and President HCFIin a joint statement said, IMA feels that the right way is to go about doing this is to file complaints with the State Medical Council. It is the duty of the State Medical Council to then decide the case on basis of its merit and refer it to the consumer court for compensation if any deficiency of service is found; refer it to criminal court if they find any violation of Indian Penal Code or refer it to NHRC if they find any violation of human rights. If none of the above is found then the case should be closed on priority to avoid any unnecessary harassment of the doctor.

It is not right to subject a medical doctor to investigation and harassment simultaneously by the police, consumer court, NHRC court and the ethics committee of medical council.

IMA has written to the Prime Minister of India to amend the MCI act and give more powers to the medical council.

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