December 9   2015, Wednesday
emedinexus emedinexus
Dr KK AggarwalDr KK Aggarwal Another win for medical profession

MCI Vs. Dr. Meenakshi Gautam & Anr. - CONT. APP. (C) No.17/2015

The aforesaid appeal has been filed on behalf of the MCI against the judgement dated 02.09.2015 passed by the Hon'ble Single Judge of the Hon'ble Delhi High Court in CONT. CAS. (C) No.137/2012 titled Dr. Meenakshi Gautam Vs. UOI & Anr.

The captioned appeal had was listed before the Hon'ble Division Bench of the Hon'ble Delhi High Court on 04.12.2015, when after hearing the submission on behalf of the parties, the Hon'ble Division Bench was pleased to stay the directions as contained in paras 36 to 44 of the judgement dated 02.09.2015 passed by the Hon'ble Single Judge in CONT. CAS. (C) No.137/2012.

The copy of the order dated 04.12.2015 passed in CONT. APP. (C) No.17/2015 will be published as soon as the same is available.
Dear Colleague

You are aware that huge damage has been done in Tamil Nadu and Pondicherry especially in and around Chennai due to the heavy rain and floods. Though the number of people who died are less, property worth lakhs of rupees is damaged.

As a member of medical fraternity, an elite group of society, we have to rise to the occasion and look after the medical needs. Epidemics need to be prevented and the curative treatment for the needy is essential.

You are requested to kindly contribute liberality to the “IMA President Disaster Relief Fund” at the Headquarters through a Demand Draft drawn in favor of “INDIAN MEDICAL ASSOCIATION, HQ’S” payable at New Delhi. You can also contribute in the form of medicines (samples), clothes and utensils.

You are requested to make a list of volunteer doctors who are interested to serve the affected area with a short notice and inform IMA HQ, Disaster Management Cell at and

A manual has been released by Indian Medical Association on How to Deal with Flood. Those who are interested to get a copy of the manual may contact the IMA HQ Disaster Management Cell.

A coordinating and monitoring cell has been set up at IMA HQ, New Delhi.

Please note that all donations made by you towards this fund are exempted from Income Tax under Section 80G of Income Tax Rules.

Dr A Marthanda Pillai                                           Dr KK Aggarwal                                                  Dr Chetan N Patel
President                                                                Hon Sec General                                                         Chairman
IMA HQ                                                                           IMA HQ                                                             IMA HQ DMC
Dr Arun Gupta, Consultant Pediatrician has been elected the President of the Delhi Medical council. Dr NP Singh, Consultant Nephrologist at Max Super-speciality Hospital, Vaishali has been elected has the vice president.
An inter-ministerial meeting was held today with representatives of Health, Law, Home, Consumer ministeries. The demands of IMA were agreed to in principle. Further modalities are being worked out.
Breaking News
FDA clears chewable methylphenidate for ADHD

The US Food and Drug Administration (FDA) has approved a chewable tablet form of extended-release methylphenidate (QuilliChew ER, Pfizer Inc), 20, 30 and 40 mg, for attention-deficit/hyperactivity disorder (ADHD) in children aged 6 years and older. The tablets will be scored to permit dose to be individualized. It is to be taken once daily in the morning with or without food. The recommended starting dose is 20 mg daily, with the dosage increased or decreased weekly in increments of 10, 15, or 20 mg per day. Maximum daily dose is 60 mg. (Medscape)

Health ministry to set up testing lab for infectious diseases in Dehradun

The Union health ministry plans to establish a modern state of the art dedicated lab of National Centre for Disease Control (NCDC) for the first time to enhance testing facilities for detecting infectious diseases such as Ebola in the country. The lab has been planned to set up in Dehradun. This could not come at a more opportune time where there is a great need of regular screening of migrant populations reaching India to detect possibilities of outbreak of viral infections such as Ebola and swine flu. (Pharmabiz - Shardul Nautiyal)
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Specialty Updates
• Lead author Tina Hoang, MSPH, Northern California Institute for Research and Education, San Francisco, and senior author Kristine Yaffe, MD, University of California, San Francisco, found that young adults aged approximately 25 years who watched television for 3 hours or more a day demonstrated poorer performance on several measures of executive function and processing speed 25 years later compared with those watching less.

• Use of bariatric surgery early in the course of type 2 diabetes might offer a better chance for remission, even at body mass indexes down to 30 kg/m2, a new analysis suggests. The findings were presented December 1 here at the World Diabetes Congress 2015.

• Women whose BMI increased by at least four units after a first pregnancy were more likely to experience infant mortality or stillbirth in a second pregnancy than women whose weight remained stable, reported Sven Cnattingius, MD, of Karolinska University Hospital in Stockholm, Sweden, and Eduardo Villamor, MD, of the University of Michigan in Ann Arbor in The Lancet.

• Antibiotic exposure during the third trimester of pregnancy is associated with excess risk of wheezing in early childhood, according to findings of an Italian birth cohort study published online December 3 in the European Respiratory Journal.

• Secondary analysis of the Efficacy and Economics of Exercise Maintenance Post-Cardiac Rehabilitation (ECO-PCR) study found that spending large amounts of time participating in sedentary behaviors, such as watching TV and checking the computer, by patients with CAD can worsen various cardiometabolic markers, even if the patients also spend time exercising.

• Michael Eisenberg, MD, assistant professor of urology and director of male reproductive medicine and surgery at Stanford University School of Medicine in California, and colleagues write in their study in Fertility and Sterility that men with infertility have a higher risk for a variety of other chronic medical conditions, including diabetes, heart disease, alcohol abuse, and drug abuse.

• Children with complex medical conditions including those with low body mass index (BMI), may be at increased risk of developing low bone mineral density (BMD) while on long-term warfarin therapy, report Dr. Leonardo Brandao and colleagues from The Hospital for Sick Children at the University of Toronto in Osteoporosis International, online November 16.

• Texting triggers a new type of brain waveform. According to William Tatum, DO, of the Mayo Clinic in Jacksonville, Fla at the American Epilepsy Society meeting, active text messaging actually creates an electrophysiologic potential that's unique to some type of personal electronic device.
Mindfulness meditation

• Sit on a straight-backed chair or cross-legged on the floor.
• Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.
• Once you've narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations and ideas.
• Embrace and consider each thought or sensation without judging it good or bad. If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
Legal Quote
Indraprastha Medical Corp. Ltd. vs State NCT of Delhi & Ors. Crl. M.C. No. 827/2010 on 2 August, 2010

“If there is a deliberate or negligent act of the Doctor working in the Corporation/Hospital, it is the liability of the Doctor and not of the Corporation for criminal negligence despite the fact that due to the act of the Doctor of treating patients the Corporation was getting some revenue.”
Medical Breakthroughs that were initially ridiculed or rejected
Cancer immunotherapy

Immunotherapy is now regarded as a revolution in cancer treatment, but when immunologist James Allison first put forth his interest in research in T cells, he was discouraged by his mentors. At that time, it was believed that the immune system had no role in cancer. He finally developed an antibody that he felt was ready for pharmaceutical development. But Allison was turned away by biotech companies. They were skeptical of immunology and immune therapy. But he continued in his pioneering work. Drugs based on his initial ideas are now set to become among the most clinically and commercially successful cancer drugs on the market; he has also won a number of awards for his work, including last year's Lasker Award, often considered a shortlist for the Nobel Prize. (Medscape)
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IMA White Paper on Live Surgeries


1. LSE: A live surgery event or LSE is defined as any surgical procedure conducted in real time and observed for educational purposes.

2. IMA endorses the use of LSEs as a technique for dissemination of surgical knowledge, provided that the LSE is organised within the IMA predefined regulatory framework. The overriding principle is that patient safety must take priority over all other considerations in the conduct of live surgery.

3. LOC: LSEs must be organised under the auspices of a specifically identified local organising committee (LOC)

(To be contd.)
IMA Satyagraha
IMA Poll
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
New York City is the first city in the US with salt warning on restaurant menus

A tiny salt shaker symbol that warns certain meals are high in sodium will appear on menus in chain restaurants in New York City, the first city in the United States to take the step in an effort to combat heart disease and stroke. Any menu item containing more than 2,300 milligrams (0.08 oz) of sodium, the daily limit many nutritionists recommend and which equals about one teaspoon of salt, must display the emblem of a salt shaker in a black triangle. The measure unanimously approved by the New York City Board of Health in September applies only to restaurants with at least 15 establishments across the US, and concession stands at some movie theaters and sports stadiums. (Reuters)
PHFI to scale up ‘Diabetes Capacity Program’ in India

The Public Health Foundation of India (PHFI), a premier think-tank and research institute in South Asia, has reaffirmed its commitment to scale up its ‘Diabetes Capacity Program’ in India, and further taking it to various countries in the South Asia region to expand professional capacity of specialized and primary care physicians in India and South Asia. Presently PHFI runs 4 courses in the field of diabetes management namely – Certificate Course in Evidence Based Diabetes Management, Certificate Course in Gestational Diabetes Mellitus, Advanced Certificate Course in Prevention and Management of Diabetes and Cardiovascular Disease (ACMDC), Diabetic Retinopathy Course. The courses are executive on-the-job training programs that develops core competencies of doctors (general physicians and specialists) to enhance their skills for practicing evidence based management various types of Diabetes and its associated complications. (Pharmabiz)
Ixazomib in first oral triplet for multiple myeloma

The newly approved ixazomib (Ninlaro, Millennium/Takeda) is the first available oral proteasome inhibitor and offers patients with multiple myeloma the option of taking an all-oral treatment regimen. Data from the ongoing phase 3 TOURMALINE-MM trial were presented at the American Society of Hematology (ASH) 57th Annual Meeting. The trial was conducted in 26 countries and included 722 patients with relapsed and/or refractory multiple myeloma. Results showed that a triplet combination with ixazomib, lenalidomide and dexamethasone significantly improved progression-free survival (PFS) when compared with the doublet of lenalidomide and dexamethasone. Median PFS was 20.6 months with the triplet vs 14.7 months in the control group (hazard ratio [HR], 0.742; P = .012)… (Medscape)
The Biggest Medical Stories of 2015 as rated by Medscape readers

Other major stories for readers in 2015 were the repeal of Medicare's sustainable growth rate formula for setting physician reimbursement (13%), the release of final rules for the federal government's program to promote meaningful use of electronic health records (5%), and an HIV outbreak in Indiana (2%). (Medscape)
Digital India scheme to focus on health sector

After banking, the next focus area of the Digital India programme is healthcare, said Arvind Gupta, head of the Digital India Foundation. Speaking on the sidelines of the 46th Union Conference on Lung Diseases here, he said, “Technology is a good intermediary. There is a gap of 1.5-2 million doctors in India, so we need technology to bring medicine to every Indian. India has seen the highest growth of Internet penetration. And there is a demand-supply gap when it comes to medical care, which can be reduced through technology… (The Indian Express- Abantika Ghosh)
Can’t avoid anger: Take aspirin

Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute heart attack. Episodes of anger are capable of triggering the onset of acute heart attack and aspirin can reduce this risk. People who cannot control their anger should ask their doctors to consider taking aspirin.

The Onset Anger Scale identified 39 patients with episodes of anger in the 2 hours before the onset of heart attack. The relative risk of heart attack in the 2 hours after an episode of anger was 23. Regular users of aspirin had a significantly lower relative risk (1.4) than nonusers (2.9). Anger in response to stress is also of particular importance for the development of premature heart attack in young men. An episode of anger may also trigger an acute heart attack in the next 2 hours.
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
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Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

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

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse- a doctor- as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

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

Responses received

Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar
Inspirational Story
A simple gesture

A little boy selling magazines for school walked up to a house that people rarely visited. The house was very old and run down and the owner hardly ever came out. When he did come out he would not say hello to neighbors or passersby but simply just glare at them.

The boy knocked on the door and waited, sweating from fear of the old man. The boy's parents told him to stay away from the house, a lot of the other neighborhood children were told the same from their parents.

As he was ready to walk away, the door slowly opened. "What do you want?" the old man said. The little boy was very afraid but he had a quota to meet for school with selling the magazines.

"Uh, sir, I uh am selling these magazines and uh I was wondering if you would like to buy one." The old man just stared at the boy. The boy could see inside the old man's house and saw that he had dog figurines on the fireplace mantle. "Do you collect dogs?" the little boy asked. "Yes, I have many collectibles in my house, they are my family here, they are all I have." The boy then felt sorry for the man, as it seemed that he was a very lonely soul. "Well, I do have a magazine here for collectors, it is perfect for you, I also have one about dogs since you like dogs so much." The old man was ready to close the door on the boy and said, "No boy, I don't need any magazines of any kind, now goodbye."

The little boy was sad that he was not going to make his quota with the sale. He was also sad for the old man being so alone in the big house that he owned. The boy went home and then had an idea. He had a little dog figure that he got some years ago from an aunt. The figurine did not mean nearly as much to him since he had a real live dog and a large family. The boy headed back down to the old man's house with the figurine. He knocked on the door again and this time the old man came right to the door. "Boy, I thought I told you no magazines."

"No, sir I know that, I wanted to bring you a gift." The boy handed him the figurine and the old man's face lit up. "It is a Golden Retriever, I have one at home, this one is for you." The old man was simply stunned; no one had ever given him such a gift and shown him so much kindness. "Boy, you have a big heart, why are you doing this?" The boy smiled at the man and said, "Because you like dogs."

From that day on the old man started coming out of the house and acknowledging people. He and the boy became friends; the boy even brought his dog to see the man weekly.

This simple gesture changed both of their lives forever.
The muscarinic signs can be remembered by the mnemonic, Fill in the blank


Salivation, Lacrimation, …, Defecation, GI symptoms, Emesis, Bronchorrhea, Bronchospasm, Bradycardia

Yesterday’s Mind Teaser: Low serum iron, low total iron binding capacity (transferrin), a normal to increased serum ferritin concentration; what is the diagnosis?

1. Anemia of inflammation
2. Iron deficiency anemia
3. Wrong report
4. Folic acid deficiency

Answer for Yesterday’s Mind Teaser: Anemia of inflammation

Answers received from: Dr Jainendra Upadhyay, Dr Bitaan Sen & Dr Jayashree Sen, Dr Poonam Chablani, Dr Avtar Krishan, Dr Arvind Jain Diwakar.

Answer for 7th December Mind Teaser: 4. All of the above

Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr BR Bhatnagar.
Funny definitions

Inflation: Cutting money in half without damaging the paper.
Readers column
Dear Sir, Reading emedinews is very informative. Regards: Dr Jyoti
Press Release
With the rising air pollution levels in the city, here’s how you can avoid being exposed to unhealthy air

According to World Health Organization, Delhi has become the most polluted city in the world. This is a cause of grave concern because air pollution has been linked to various life-threatening diseases including respiratory disorders, heart attacks, and strokes.

Given the crucial role played by the air we breathe on our overall health and well-being, it is crucial that awareness is raised about necessary prevention measures as well as the need to reduce the increasing environmental burden due to our everyday actions.

In order to reduce one’s exposure to unhealthy air, it is important that each one of us finds out the Air Quality Index (AQI)of the areas where we reside. If the AQI for ozone, particle pollution, carbon monoxide, or sulfur dioxide is found to be high, then steps must be taken to protect oneself from its hazardous effects.

This can be done through a reduction in the everyday prolonged and heavy exertion. Prolonged exertion defines any outdoor activity that a person does intermittently for several hours, and that makes them breathe slightly harder than normal. A good example of this is working in the yard for part of a day. When air quality is unhealthy, you can protect your health by reducing how much time you spend on this type of activity. Heavy exertion on the other hand means intense outdoor activities that cause you to breathe hard. When air quality is unhealthy, you can protect your health by reducing how much time you spend on this type of activity, or by substituting a less intense activity—for example, go for a walk instead of a jog.

Speaking about this, Padma Shri Awardee, Dr. A Marthanda Pillai – National President IMA and Padma Shri Awardee Dr. K K Aggarwal, President HCFI and Honorary Secretary General IMA said, “It is important that people are aware of the air they breathe and the harmful effects it can have on their health. It is thus recommended that each one of us wear masks when out in the open, reduce our outdoor activity level if we experience any unusual coughing, chest discomfort, wheezing, breathing difficulty, or unusual fatigue or when the AQI levels are high in the region. It is also a great point of concern for all of us in the medical fraternity to see how the pollution levels in Delhi continue to increase and it is essential that awareness is raised, and necessary steps are taken to reverse this trend. Car-pooling must be encouraged, people must be encouraged to plant more trees, and environmental preservation is a must. We must realize that the air we are breathing today is a major cause of all lifestyle diseases. High-risk patients must take extra care."

If the Air Quality Index (AQI) of ozone, PM 2.5/10, CO is between 0-50 then one must not worry and they are said to be in the safe zone. The air that they are breathing is said to be healthy and not dangerous for their health. For such patients, outdoor activities are recommended.

If the levels are between 51 – 100 then unusually sensitive people are advised to consider reducing their prolonged or heavy exertion. Everyone else is still considered to be in the safe zone and need not worry. If the levels are between 101- 150 then it should be considered as a warning sign for sensitive groups, which include patients with lung diseases such as asthma, young children and the elderly. They should reduce their outdoor exertion levels and ensure to get outdoor exercises during the early hours of the morning when the air is at its freshest form.
AQI levels between 151- 200 are overall considered unhealthy for all and dangerous for the sensitive groups of people. Here all individuals are advised to reduce prolonged and heavy exertion. Sensitive groups are on the other hand advised to avoid completely any prolonged or heavy exertion.

AQI levels between 201 – 300 are considered extremely unhealthy and heart and lung disease patients, the young and elderly are advised not to engage in any outdoor physical activity and all those not in the danger zone are advised to reduce outdoor exertion to the minimal given the harmful particles in the air which can aggravate diseases such as asthma.