January 17 2015, Saturday
WMA urges immediate release of jailed Iranian cleric
(15.01.2015) The World Medical Association has written to Iran’s leader, Ayatollah Sayed ‘Ali Khamenei, to urge for the immediate release of the jailed Iranian cleric Sayed Hossein Kazemeyni Boroujerdi, who is serving an 11 year prison sentence.
WMA President Dr. Xavier Deau said that Kazemeyni Boroujerdi was in urgent need of medical treatment and should be released as a prisoner of conscience.
In his letter, Dr. Deau writes: ‘According to Amnesty International and the Boroujerdi Civil Rights Group, Mr. Kazemeini Boroujerdi suffers from a number of illnesses, including diabetes, asthma, Parkinson’s disease, kidney and heart problems and severe pain in his legs and waist. He has also reportedly gone partly blind in one of his eyes. His health conditions have apparently worsened and he collapses frequently. ‘Amnesty International considers that he is a prisoner of conscience, for advocating the separation of religion and state. He has been under increased pressure to write and sign “confessions” which he refused.
‘We are extremely concerned by this situation that reveal flagrant violations of medical ethics principles and human rights standards. The right of everyone to the enjoyment of the highest attainable standard of physical and mental health is a fundamental element of human rights enshrined in article 14 of the International Covenant on Economic, Social and Cultural rights that the Islamic Republic of Iran has ratified in 1976.

‘We are calling, through you, on the Iranian authorities to ensure as a matter of urgency that Mr. Kazemeini Boroujerdi is protected from torture and other ill-treatment, further that he is granted any medical attention he may require, outside the prison if necessary, as recommended by the prison clinic. Furthermore, being a prisoner of conscience, we respectfully submit to release him immediately and unconditionally.’
Can Blood Pressure Be Higher In One Arm?
Dr KK Aggarwal A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have your doctor check your both arms for blood pressure and whichever is higher, use that arm for future blood pressure readings.
Health Check Up and CPR 10 Camp at G B S S School, No-2, Ambedkar Nagar on 19th December 2014
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He who closes his ears to the views of others shows little confidence in the integrity of his own views. William Congreve
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The Department of Health and Family Welfare, Government of India, expresses its sincere gratitude to the very large number of persons/organization/Associations/Companies and other to have gone through the proposed amendments to the Drugs & cosmetics Act, 1940 and forwarding their detailed comments about amendment to the aforesaid Act. Some of the suggestions have also been received for changes in the Drugs & Cosmetics Rules, 1945. A few requests have also been received for extending the last date for submission of comments on the proposed amendments to the Act. It is notices that the request for extension for time range from three days to over a month. Keeping in view the interest of all stakeholders and encouraged by the their response, it has been decided to extend the time for submission of the proposed amendments to the Drugs and Cosmetic Act, 1940 upto 1200 hrs on 19.01.2015.

2. It may be appreciated that no further extension will be possible keeping in view the fact that Bill is proposed to be introduced in the Budget Session of Parliament.

(K. L. Sharma)
Joint Secretary (R)
Email: kl.sharma58@nic.in

After detailed discussions with all stakeholders, the Department has since placed the proposed amendments to the Drugs & Cosmetics Act, 1940 on the website of the Ministry and has separately also written to all stakeholders to forward their comments/views/suggestions on the proposed amendments to the Ministry latest by 12.01.2015. The Amendment Bill will, thereafter, be processed for obtaining the approval of the competent authority before introduction of the proposed amendment Bill in the Parliament in the Budget Session.

2. The amendment to the Drugs & Cosmetics Act is required to be accompanied by suitable changes in the Drugs & Cosmetics Rules, 1945 to enable creation of the requisite eco-system which while ensuring the quality, safety, efficacy and effectiveness of all medical products, will also help the industry to flourish and meet the unmet requirement of the humanity for newer medical products. With this in view, the Government has sought the comments/suggestions/views of all stakeholders by 27.01.2015 on the changes in these rules. The Department, after comprehensive review of the existing rules, proposes to draw up different sets of rules for dealing with (i) drugs; (ii) medical devices; and (iii) cosmetics.

3. Accordingly, the comments/view/suggestions for amending the Drugs & Cosmetics Rules, 1945 may be forwarded on the following e-mail address:

In respect of Drugs and Cosmetics: dcrules-mohfw@gov.in
In respect of Medical Devices: mdevices-mohfw@gov.in

Action against
4G. (1) Where the Central Licensing Authority is satisfied that the Ethics Committee is not able to discharge its functions and responsibility under this Act,
Ethics Committee
the Central Licensing Authority shall suspend or cancel its registration granted under section 4E.
(2) On the suspension or cancellation of the registration of the Ethics Committee under sub-section (1), the Central Licensing Authority shall review the approval granted by the Ethics Committee for continuance or otherwise of the clinical trial in such manner as may be prescribed.
(3) If the registration of the Ethics Committee is cancelled under sub-section (1), every member of such Committee shall be disqualified to be a member of any other Ethics Committee for a period of two years.
Inspection by Drugs Control Officer.
4H.(1)The Drugs Control Officer or any other officer authorised by the Central Licensing Authority shall have the power to enter with or without prior notice into any premises related to clinical trial to inspect the facilities, record, data, documents, books, drugs including investigational new drugs, notified category of medical devices and cosmetics. (2)The officer empowered under sub -section (1)shall have the power to seek clarifications, information and record regarding clinical trial or matters relating thereto.
Disclosure of name, address, etc. of persons involved in clinical trials
4-I. Every person, sponsor, clinical research organisation or any other organisation or investigator conducting a clinical trial or his agent, as the case may be, shall, if so required, disclose to the Drugs Control Officer or any other officer authorised by the Central Licensing Authority, the names, addresses and other particulars of the persons involved in conducting clinical trials and participants in the clinical trial.
Maintenance of record and furnishing information
4J. Every person, sponsor, clinical research organisation or any other organisation or investigator conducting a clinical trial or his agent holding a permission under this Chapter shall keep and maintain such data, record, registers and other documents as may be prescribed and shall furnish such information as may be required by the Central Licensing Authority or any officer authorised by it in this behalf
Penalty for conducting clinical trial of any drug or investigational new drug or any notified category of medical device or investigational medical device without permission.
person on his behalf, conducts clinical trial of,- (i) any new drug or investigational new drug, in contravention of section 4A and the rules made there under, shall be punishable with imprisonment which may extend to three years or fine which may extend to five lakh rupees or both; (ii) any notified category of new medical device and investigational new medical device, in contravention of section 4A and the rules made there under, shall be punishable with imprisonment which may extend to two years or fine of three lakh rupees or both.
Penalty for repeat offence.
4L. Whoever, having been convicted under section 4K, is again convicted under that section, shall be punishable with imprisonment for a term which shall not be less than three years but which may extend to five years and shall also be liable to fine which shall not be less than fifteen lakh rupees.
Penalty for conducting clinical trial of cosmetics without permission.
4M. Whoever, himself or by any other person on his behalf, conducts clinical trials with cosmetics in contravention of section 4A shall be punishable with imprisonment for a term which may extend to one year or fine which shall not be less than two lakh rupees.
Penalty for repeated offence regarding cosmetics clinical trials
4N. Whoever having been convicted under section 4M, is again convicted under that section, shall be punishable with imprisonment for a term which shall not be less than two years and shall also be liable to fine which shall not be less than three lakh rupees.
Penalty for violation of conditions of permission
4-O. Whoever, himself or by any other person on his behalf, conducts clinical trials with any new drug or investigational new drug or notified category of new medical device and investigational new medical device or new cosmetics in contravention of the conditions of permission issued under section 4A and rules made there under,-

(a)which causes adverse affects on the body of participants shall be punishable with imprisonment for a term which may extend to one year or fine which may extend to three lakh rupees or both;

(b) which does not cause any adverse affect on the body of participant shall be liable for a penalty, which shall not be less than fifty thousand rupees but which may extend to two lakh rupees, to be imposed by the Central Licencing Authority.
Penalty for repeated offence for conditions of permission
4P. Whoever, having been convicted of an offence,-
(a)under clause (a) of section 4-O, is again convicted of an offence under that section, shall be punished with imprisonment for a term which shall not be less than one year and fine which shall not be less than five lakh rupees; and
(b)under clause (b) of section 4-O, is again adjudged to have contravened the conditions specified therein shall be liable for a penalty, which shall not be less than two lakh rupees and which may extend to three lakh rupees to be imposed by the Central Licensing Authority.
Penalty for failure to provide compensation
4Q. Whoever is responsible to provide compensation for clinical trial related to injury, disability or death under section 4C fails to do so, shall be punishable with imprisonment which may extend to one year and fine which may not be less than twice the amount of the compensation.
Penalty for contravention of any provision of this chapter
4R. Whoever initiates or conducts clinical trial of any new drug, or investigational new drug, or notified category of new medical device and investigational new medical device, or new cosmetic, in contravention of any provisions under this Chapter, except the provisions of section s4Ato 4-I,both inclusive, and the rules made under this Act shall be liable for penalty which shall not be less than fifty thousand rupees to be imposed by the Central Licensing Authority.
Confiscation of stock, medical device or cosmetics.
4S. Where any person has been convicted for contravention of any provision of this Chapter or any rule made under this Act, the stock of the new drug, investigational new drug, notified category of new medical device and investigational new medical device or new cosmetic in respect of which the contravention has been made and implement, machinery, vehicle, vessel or other conveyances used in or for the purposes of conducting such clinical trial shall be liable to be confiscated.
Cognizance of offence
4T. (1)No prosecution under this Chapter shall be instituted, except on a complaint made by,-
(a) a Drugs Control Officer or any other officer duly authorised in this behalf by the Drugs Controller General India; or
(b) a Gazetted officer of the Central Government authorised by that Government by an order made in this behalf; or
(c) the person aggrieved; or
(d) any recognised consumer association.
(2)Nothing contained in this Chapter shall be deemed to prevent any person from being prosecuted under any other law for the time being in force for any act or commission which constitute an offence under this Chapter.
Power of Central Government to make rules.
4U. The Central Government may, after consultation with the Drugs Technical Advisory Board or the Medical Devices Technical Advisory Board, as the case may be, and after previous publication, by notification, make rules to provide for,-
eMedinewS Humor
Dog Washing

A young boy, about eight years old, was at the corner Mom & Pop grocery picking out a pretty good size box of laundry detergent. The grocer walked over, and, trying to be friendly, asked the boy if he had a lot of laundry to do.

"Oh, no laundry," the boy said, "I'm going to wash my dog."

"But you shouldn't use this to wash your dog. It's very powerful and if you wash your dog in this, he'll get sick. In fact, it might even kill him."

But the boy was not to be stopped and carried the detergent to the counter and paid for it, even as the grocer still tried to talk him out of washing his dog.

About a week later the boy was back in the store to buy some candy. The grocer asked the boy how his dog was doing.

"Oh, he died," the boy said.

The grocer, trying not to be an I-told-you-so, said he was sorry the dog died but added, "I tried to tell you not to use that detergent on your dog."

"Well," the boy replied, "I don't think it was the detergent that killed him."

"Oh? What was it then?"

"I think it was the spin cycle!"
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues

h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -

Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health

Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
Make Sure
Situation: A patient on ACE inhibitor developed angioedema.

Reaction: Oh my God! Why was ACE inhibitor continued?

Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately if swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).
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The Year in Medicine 2014: News That Made a Difference
10. ACA Subsidies Under Fire

In November the US Supreme Court agreed to settle whether people who bought health insurance through the federally funded exchanges can receive tax credit subsidies. Because of what has been described as an error in wording in the Affordable Care Act, only subsidies for insurance purchased on state-funded exchanges are spelled out. In various lower-court cases, subsidy defenders have argued that the legislation intended to include federal exchanges, while ACA critics contend that providing the subsidies in these exchanges was "an invalid implementation" of the law. Analysts estimate that 5 million people could be affected if the Supreme Court says the subsidies cannot be provided in the states that did not set up their own health insurance exchanges. If the Supreme Court strikes down the subsidies, some legal scholars say it would deal a potentially lethal blow to the law. (Source: Medscape)
News around the Globe
  • Older women who are satisfied with their lives have higher bone density than their unsatisfied peers, suggests a new study published in Psychosomatic Medicine.
  • Just a little bit of exercise, such as 20 min walking a day, is extremely beneficial, irrespective of whether people are overweight/obese or not, suggests a new study published online January 14 in the American Journal of Clinical Nutrition.
  • An analysis published online January 12 in JAMA Neurology has reported a mortality rate of 32% at 2 years after carotid artery stenting, thus raising concerns about the risk-benefit of this procedure, especially in older patients.
  • A prognostic 28-gene signature could predict which patients with stage I or II melanoma are at high risk for metastasis, and could alter the clinical management of these patients, points a confirmatory study published in Clinical Cancer Research.
  • Laparoscopic implantation of an artificial urinary sphincter (AUS) using the da Vinci robot is feasible and offers the surgeon advantages in terms of dexterity and visibility, report urologists from Lille University Hospital, France in European Urology.
Dr KK Spiritual Blog
Ganesha: Oh My God!

We sing His appraisal, we worship His deity, we believe in His powers blindfolded and yet distance Him from us by pining to see what lies deep within us. God, to which the world bows down has in fact been reincarnated into an issue of communal dispute, a reason for violence and an agenda to be banked upon for mere votes. Brahma, Vishnu, Shiva or be it Allah, Wahe Guru or Jesus, all personify the beauty of the unpolluted soul within us which is deep-rooted and blanketed by earthly desires.

While mythological studies knit stories of the Almighty’s existence, the fact remains that human being is bestowed with the untainted potential of recognizing heavenly facets in his own self. Ganesha, the son of Shiva and Parvati is likewise the name given to the harmonious Aacharan or characteristic disposition of man. Remembered and ritually worshipped before starting a new venture, the entity of Ganesha has in store the facets of a complete man. The magnanimous head of the Ganesha, which is that of an elephant, represents wisdom, intelligence and a healthy mind capable of making sound decisions. Not in vain is it said that ‘think before you speak’, which implies Ganesha’s huge head, that is identified with the need for a thoughtful and retrospective attitude. The big ears of this elephant-deity instills among the earthly man the patient channel of lending ears to the echo produced by others’ deeds and speech. It is said that half the dispute is resolved when an ear is lend most patiently. The Ganapati’s extremely small mouth characteristically represents the need for a limited dialogue and the vanity of chattering. Over-expression through words triggers unsought problems many a times which otherwise could be avoided by a tight lip.

Ganesha also represents the guru of stress-affected individuals. Shiva’s most promising son, Ganesha, by virtue of his small eyes, highlights the need of a focused outlook in life. Such an outlook not only redefines and foresees the right goals, but also relieves one from the stress-manifested episodes from the various chapters of life. The long trunk identifies with the power of discrimination. The sensitivity of Ganesha’s long nose has the strength to uproot a tree and the competency of picking up a pin from the ground. Such should be the approach of an individual who should be capable enough to perceive the good and the bad for himself besides the undaunted strength of overcoming all odds. The tusks and the small teeth of Ganesha should however, be recollected with the loss and gains in the life of a man. Man similarly ought to engrave his mental stature in such a manner that the ups and downs may not deter him from his honest endeavor and the balance of inevitable bliss and sorrow is maintained to add spice in the earthly existences. This stable healthy mental stature is only possible if the physical, social, spiritual and environmental requirements of the body are fulfilled. For the needful, individuals need to be bestowed upon a complete mental and physical health.

Further the big tummy of Ganapati Deva preaches the need for retaining information. Acquiring knowledge, utilizing it and retaining it for years to come, becomes the crux of ‘big-belly commandment’.

The Char-Bhuja Dhari Ganesha, further represents strength by virtue of the four hands in which the Lord entraps his attachments, desires and greed. Two of the arms of Ganesha, which hold rope, symbolize control over the attachments. The laddoo or sweet in the other two shows command over the desires and earthly delusion. The mouse sitting near the feet of Ganesha represents greed and gluttony upon which the Almighty rides, propagating a control over the evils.

Ganesha’s physical traits are an assembly of the characteristics most required in an individual of substance. Disposition incarnated with the goodness of such features will result in success in life and will positively procure an ailment-free survival.

Specifically for executives, Ganesha’s characteristic principles may be incorporated in a time-table format which will help in the dawn of a conformable work-atmosphere along with congenial relationship between the management and the union of workers. Deciding the first day of the week to hear all grievance and woes of the workers, the second for thinking and planning strategies to work upon and finally setting targets to be achieved may utilize three days of the week very constructively. Further, a day devoted to evaluating losses and gains (Ganesha’s teeth principle) may help additionally in business management. Retaining the information and filing all the pending work can affirmatively call upon the fifth day of the week, which works entirely on the principle of Ganesha’s tummy, which is massive by the virtue of holding tremendous loads of information.

Contemplation, discrimination and judging the good and the bad for the entire unit may take another day, leaving the Sunday for self-retrospection through meditation and yoga. One should strive and adopt Ganpati’s principles of life management rather than worshipping him with vanity. Life has much in store besides bothering about unnecessary qualms. Giving into a disciplined attitude may assuredly dawn upon a peaceful life. Heaven is where you are, it’s only a matter of perception which makes life as difficult as hell.
Inspirational Story
Self Motivation

My profession is running a dance school for the past 17 years. In doing so, I have learned many things about children; one being that self motivation is really not an inherited character. It is a learned behavior.

In the corporate world that we live in now where it's a race to keep up, some of our children are losing their battle before it ever begins. At times, I feel like my job requires more than just a dance instructor. I encounter children who cannot even fathom the thought of self motivation.

Why? Because their parents are probably too busy in their own corporate climb up the ladder that they've forgotten to notice their own offspring. They've forgotten that it's just as necessary to teach their own children how to be successful and to succeed -- how to be creative and to create.
In my own effort to be successful at what I do, there is one point I push every day that I walk into my studio: "You only get what you give". It may not look like much right off the bat, but if you look at the words really careful and read between the lines, it really says a lot. I have one other quote that I use in teaching expression: "You are like a paint brush on canvas. You "the dancer" are the paint brush and your canvas is the stage."
Rabies News (Dr A K Gupta)
Why do some people fear the vaccine?

In the past, rabies vaccine was a sheep brain derived Nerve Tissue Vaccine (NTV) and was associated with considerable side effects. Large volumes and a number of injections were required. So, rabies vaccine acquired the dubious reputation of a dangerous vaccination.
However, these fears are no longer justified with modern rabies vaccines that are very safe.
Cardiology eMedinewS
  • Visit-to-visit variation in systolic blood pressure (BP) and mean heart rate (HR) are both independently related to cognitive dysfunction and decline in patients at high cardiovascular risk, and together their predictive effects are additive, suggests new research published online January 12 in Hypertension.
  • A new study has identified genetic mutations that cause the heart condition dilated cardiomyopathy (DCM), paving the way for more accurate diagnosis. By sequencing the gene encoding the muscle protein titin, scientists have identified which variations are linked to disease, providing information that will help in screening of high-risk patients. The findings are published in Science Translational Medicine.
Pediatrics eMedinewS
  • Researchers at UT Southwestern Medical Center have identified hyaluronon (HA) as a critical substance made by the body that protects against premature births caused by infection. The findings are published in the Journal of Clinical Investigation.
  • Researchers from the Centre for Plant Biotechnology and Genomics (CBGP-UPM-INIA) along with the Allergy Department of the Hospital Infantil Universitario Niño Jesús of Madrid have shown that most of the children allergic to wheat that received a new oral immunotherapy treatment were able to eat 100 grams of wheat bread without side effects. The report is published in the Journal of Investigational Allergology and Clinical Immunology.
Wellness Blog
Air Quality a Temporary Trigger for MI

Heavy air pollution can trigger acute heart attack in the hours after exposure.

Every 10 µg/m3 increase in small particulate matter and nitrogen dioxide temporarily boosts heart attack risk by 1.2% and 1.1%, respectively, as per a report in the BMJ. The chances of suffering an attack increase by 1.3% in the six hours after coming in contact with high levels of vehicle-related pollutants.

The increased risk is seen up to six hours after exposure to typical traffic-related pollutants. The take home message is that breathing in large amounts of traffic fumes can trigger a heart attack within six hours following exposure.
eMedi Quiz
Beta-oxidation of odd-chain fatty acids produces:

1.Succinyl CoA.
2.Propionyl CoA.
3.Acetyl CoA.
4.Malonyl CoA.
Yesterday’s Mind Teaser: Injury to radial nerve in lower part of spiral groove:
1. Spares nerve supply to extensor carpi radialis longus.
2. Results in paralysis of anconeus muscle.
3. Leaves extension at elbow joint intact.
4. Weakens pronation movement.

Answer for yesterday’s Mind Teaser: 3. Leaves extension at elbow joint intact.

Correct Answers received from: Raju Kuppusamy, Dr K V Sarma, Dr Avtar Krishan.
Answer for 15th Jan Mind Teaser: 1. Transitional.
Correct Answers receives: Dr K V Sarma, Dr Rakesh Sharma Nohar, Dr Avtar Krishan.
Dr Good Dr Bad
IJCP Book of Medical Records
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If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one 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 https://www.youtube.com/watch?v=rjOel0aaqt0
Press Release of the Day
Eat less to remember more

"Eat less to remember more" is the prescription of the day for the elderly, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association.

A study published in Proceedings of the National Academy of Sciences, by Dr. Agnes Floel, assistant professor of Neurology at the University of Munster, has shown that memory and thinking skills improved among healthy, overweight elderly subjects who cut their calorie intake by 30 percent over a three-month period.

Calorie restriction boosts memory and cognition by reducing insulin resistance and inflammation, which may be linked to age-related cognitive decline.

Improvements in memory could be especially important, because memory losses are an early indication of Alzheimer's disease and its precursor, mild cognitive impairment.

The 49 men and women in the study had a mean age of 60.5 years and a body mass index of 28. Those in the calorie-restriction group were not told what to eat but were advised to cut portions and not to eat less than 1,200 calories daily.

The calorie restrictors lost an average of five pounds, with those who most closely adhered to the dietary recommendations losing an average of eight pounds. This subset with the largest weight loss also showed the biggest improvements in memory performance.
Reader Response
Dear Sir Very informative news. Regards: Dr Kranti