January 13 2016, Wednesday


World Medical Association (WMA) Course on Tuberculosis (TB) and Multi Drug Resistant TB - Dr KK Aggarwal

The WMA is running a free course on Tuberculosis (TB) and Multi Drug Resistant TB, developed in association with the New Jersey Medical School Global TB Institute, available online on the WMA website. Management of TB has become increasingly complex due to the disease’s increasing mutability and resistance to drugs used to combat it.

Use of second-line drugs and/or resectional surgery may be required in the management of drug-resistant TB. Drug resistance in the primary form is believed to occur in patients who have never received an anti-TB therapy. Secondary resistance relates to resistance developed during or post chemotherapy in patient previously with drug-susceptible TB. Multi drug resistant tuberculosis is defined as an isolate of M. tuberculosis, which is resistant to rifampin and isoniazid at least, in addition to other agents.

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eMEDI QUIZ - Fill in the blank

For most patients with group 1 pulmonary arterial hypertension who have class II or III symptoms, give ambrisentan and ………………………….rather than other combinations or single agent therapy.

Nifedipine retard
Oxygen therapy 



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Physicians’ key players to tobacco control, including curbing second hand smoke exposure

Secondhand smoke is a well-recognized health hazard. It can be defined as smoke that is exhaled by the person who smokes (mainstream smoke) or emitted from burning cigarettes, cigars or pipes (side stream smoke). Breathing in this smoke is called passive smoking. Mainstream smoke contains more than 4000 chemicals, including chemical irritants and about 70 carcinogens. Side stream is dangerous because while it has a composition similar to mainstream smoke, the concentration of toxins and carcinogens is often higher.

Sharing their thoughts, Dr. S.S Agarwal – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA and President HCFI in a joint statement said, “Secondhand smoke increases the risk for respiratory infections, asthma, COPD, lung cancer and heart disease. The longer the duration of exposure, the greater the level of harmful substances in the body. Children, in particular are vulnerable to the effects of exposure to second hand smoke. Homes and vehicles are the main places of exposure for children. For adults it is their work place or social environments. Creating a 100% smoke-free environment is the only way to provide protection from exposure to tobacco smoke. Second hand or passive smoking is a serious public health problem and needs to be tackled. All stakeholders – healthcare professionals, policy makers and public – need to be actively involved.”

Research indicates that secondhand smoke causes approximately 7,330 deaths from lung cancer and 33,950 deaths from heart disease each year in the United States. The effects of second hand smoke in relation to exposure time can be understood through the following:

  • Exposure for 5 min stiffens the aorta as much as smoking a cigarette
  • Exposure for 20-30 min causes excess blood clotting, and increases the build-up of plaques in blood vessels thereby increasing the risk of heart attack and stroke
  • Exposure for 2 hours increases the risk of arrhythmia and can trigger a fatal cardiac event or heart attack.

Article 8 of the WHO Framework Convention on Tobacco Control requires the adoption of effective measures to protect people from exposure to tobacco smoke in indoor workplaces, indoor public places, public transport and ‘as appropriate’ in ‘other public places’. Guidelines for implementation of WHO Framework Convention on Tobacco Control state that ‘no safe levels of exposure to second-hand smoke exist’ and ventilation, air exchange including use of designated smoking areas, do not protect against exposure to tobacco smoke.

According to the WHO, unless urgent action is taken, tobacco use and exposure to second-hand smoke (SHS) will cause over 8 million deaths by the year 2030. Tobacco could claim up to one billion lives globally in the 21st century. Physicians have a key role to play in tobacco control including control of second hand smoke exposure. As healthcare providers, they occupy a unique position in the society to educate people about dangers of tobacco use and exposure to second-hand smoke and support tobacco control efforts initiated by the government.

Not only physicians as individuals, but also medical associations too should take up leadership roles in such initiatives. Continuing educating on tobacco control for physicians therefore assumes significance. The World Medical Association (WMA) has made available a new online course for physicians to help them assess the health effects of second hand tobacco smoke on children's health. The School of Policy, Government and International Affairs at George Mason University in Arlington, Virginia, USA in collaboration with the WMA have developed the course. The course helps physicians to explore intervention methods and legislation to minimize tobacco smoke exposure for infants and children and understand the existing evidence. It is recommended that all physicians try to undertake this course.