May 22  2015, Friday
Food poisoning with rice dishes
Dr KK Aggarwal Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit
  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic-type food poisoning associated with B. cereus.
  • The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.
  • Cooked rice, subsequently at room temperature, can allow vegetative forms to multiply. The heat-stable toxin that is produced can survive brief heating such as stir frying.
  • Two distinct types of toxin–mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B. cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea and vomiting. Diarrhea also occurs in about one–third of individuals. Symptom onset is usually within one to five hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice–based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.
This World Health Day, the Indian Medical Association commits to making food safety a priority within its Swachh Bharat Swasth Bharat program
  • Healthy older adults who take cholesterol-lowering drugs may be cutting their risk of stroke, a new French study published in BMJ suggests. The study found that when people took statins or fibrates, their risk of stroke over almost a decade went down by about one-third.
  • Persistent symptoms characteristic of urinary tract infection (UTI) that do not improve with time or treatment could indicate bladder cancer, suggests a new study presented at the American Urological Association 2015 Annual Meeting.
  • Compared to other antithrombotic drugs, novel oral anticoagulants (NOACs) do not pose an extra risk of substantial intraocular bleeding, suggests new research published online in JAMA Ophthalmology.
  • Mindfulness-based cognitive therapy (MBCT) is superior to therapy focused on exercise and healthy eating in patients with treatment-resistant depression, suggests new research presented at the American Psychiatric Association (APA) 2015 Annual Meeting.
  • During the removal of personal protective equipment (PPE), the skin and clothing of healthcare workers can become contaminated, even when there are no lapses in the removal technique, according to new research presented at the Society for Healthcare Epidemiology of America Spring 2015 Conference. But, a dramatic reduction in the rate of contamination was observed after the implementation of an educational intervention.
Dr KK Spiritual Blog
Types of Memory

The easiest way to remember is to understand the concept of Suno, Samjho, Jano and Karo (hearing, listening, knowledge and wisdom). Hearing is the shortest lasting memory. We hear and we forget is the rule.

Once we listen and understand, the memory is longer lasting but the same memory become everlasting if we not only hear, understand and know but also incorporate the knowledge in our practice.

These principles have been used by marketing people in brand recall. I know many pharmaceuticals play a game and ask 100 doctors to enter into a competition in which they have to write the company’s brand a number of times in one minute and the one who writes the maximum number of times is given a prize. By practicing the brand name repeatedly, you create a permanent impact of their brand in the soul and it is unlikely that you will forget the brand and its recall value will increase each time you think about the molecule.

The same principle has been used by devotees of Rama and Shiva where they ask people to write the name of Rama repeatedly everyday and the devotees of Shiva ask people to write Om Namaha Shivai on a piece of paper for years together. By doing so you inculcate the teachings of Lord Rama and Shiva.

Many spiritual Gurus give a Mantra, which is also based on the same principle. A mantra is nothing but a positive affirmation which you have to follow every minute of your life throughout your life. Once you start doing it, a time will come when it will become a part of your sole consciousness and you will start living and behaving in a way as of your positive affirmation. For example, Brahma Kumaris say that always say a positive affirmation to yourself that I am a peaceful soul. After some time you will start behaving like a peaceful soul and you will lose agitation, anger and negative affirmations of life.
Cardiology eMedinewS
  • It's possible to get door-to-needle (DTN) time for tPA administration in acute ischemic stroke down to 60 minutes or less when using MRI in place of CT for decision-making as reported in the Journal of Neurology.
  • Percutaneous coronary intervention (PCI) patients have a high prevalence of obstructive sleep apnea (OSA) with nontypical presentations, according to a large multicenter international study. Among more than 1,300 patients who had successful PCI, the overall prevalence of OSA was 45%, according to Sofia Furlan, PhD, of the University of Sao Paulo School of Medicine in Brazil.
Pediatrics eMedinewS
  • The introduction of the 10-valent pneumococcal conjugate vaccine, PCV10, decreases the rates of clinical pneumonia even in unvaccinated children, suggests new research presented at the 33rd Annual Meeting of the European Society for Paediatric Infectious Diseases.
  • Childhood obesity is increasing, especially among lower socioeconomic classes, and parents may misperceive the extent of the problem, suggest two new studies, one published online May 18 in JAMA Pediatrics and the second in the June issue of Childhood Obesity.
Make Sure
Situation: A patient with chest pain with normal ECG died half an hour later.

Reaction: Oh my God! Why was acute MI not suspected?

Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.
Dr Good Dr Bad
Situation: A middle–aged patient was found to have central obesity.

Dr Bad: It is normal.

Dr Good: Rule out diabetes.

Lesson: As per results of a prospective cohort study (1989–2007) of 4,193 men and women 65 years of age and older in the Cardiovascular Health Study, among older adults, overall and central adiposity and weight gain during middle age and after the age of 65 years are associated with risk of diabetes (JAMA. 2010 Jun 23;303(24):2504-1).

(Copyright IJCP)
Inspirational Story
I Wanted to Change the World

When I was a young man, I wanted to change the world. I found it was difficult to change the world, so I tried to change my nation.

When I found I couldn’t change the nation, I began to focus on my town. I couldn’t change the town and as an older man, I tried to change my family.

Now, as an old man, I realize the only thing I can change is myself, and suddenly I realize that if long ago I had changed myself, I could have made an impact on my family. My family and I could have made an impact on our town. Their impact could have changed the nation and I could indeed have changed the world."

Great words for reflection if we rashly attempt to change something or someone else other than ourselves!
Wellness Blog
Apples during pregnancy and Asthma

Women who eat apples while pregnant may protect their child from developing asthma.

A study showed that children of moms who munched on more than 4 apples per week were 37 percent less likely to have a history of wheezing and 53 percent less likely to have doctor–confirmed asthma, compared to moms who ate one or no apples per week while pregnant. The effect may be due to apple's phytochemical content, such as flavonoids, which have been shown to have beneficial effects on adult lung function.

The study also found that eating fish during pregnancy may curb the risk of eczema in offspring. Children of mothers who ate fish once per week or more while pregnant had a 43 percent lower risk of eczema compared to children whose mothers avoided fish altogether.
eMedi Quiz
What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories.
E. There is no recommended amount of fat; you should strive to eat as little of it as possible

Yesterday’s Mind Teaser: When should you have your first colonoscopy to screen for colon cancer?

A. At age 35.
B. At age 40.
C. At age 45.
D. At age 50.
E. At age 55.

Answer for yesterday’s Mind Teaser: D. You should have your first colonoscopy at age 50.

Correct Answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr. G. Madhusudhan.

Answer for 20th May Mind Teaser: C. Lung cancer.

Correct Answers received: Dr Jainendra Upadhyay, Dr K V Sarma, Dr K Raju, Tukaram Pagad.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the 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
Rabies News (Dr A K Gupta)
What are the signs of rabies during the prodromal phase in animals?

Prodromal phase may last for 1–3 days and the animal may show only vague CNS signs, which intensify rapidly and death is virtually certain within 10 days after the initial onset of signs.
eIMA News
Physicians and Veterinarians must work together to combat health threats, says WMA leader
(21.05.2015) An integrated approach by physicians and veterinarians to combat different types of health threats has been called for by Dr. Xavier Deau, President of the World Medical Association.

Speaking at a One Health conference in Madrid organised by the WMA and the World Veterinary Association, in collaboration with the Spanish medical and veterinary associations, Dr. Deau said the world urgently needed such an approach to combat an increasing amount of antimicrobial resistance, but also the threat from re-emerging infections.

He said that human health, animal health, and the ecosystems were interlinked and it needed a coordinated, multidisciplinary approach to address risks that merged at the animal-human-ecosystems interface.

‘There is a commonly shared concern that as cross-border human, animal, food and seeds mobility increases, so does the threat of the spread of dangerous pathogens and infectious diseases. More education and more training for the next generation of experts are required. We also need a framework for information-sharing to detect and fill knowledge gaps, and to strengthen inter-disciplinary cooperation.’

Dr. Deau added: ‘Our key objectives should be to promote a cross-disciplinary and collaborative approach in order to improve human health and animal well-being. We need to foster scientific research on zoonosis and vector-borne infectious disease. We also must create synergies and facilitate the sharing of data between researchers. And it is important that new scientific findings should be disseminated and translated to anyone who might benefit from them.’
Reply received to notice - Gabbar is Back


Ref. No: NN/AND/120/2015-16
Date: 19th May, 2015

Asa Law Firm
3, Birbal Road, Ground & 1st Floor
Jangpura Extension
New Delhi-110011

Ref: Notice dated 12th April, 2015 (“Your Notice”) issued on behalf of your client Indian Medical Association (“Your Client”)

Dear Sir(s)

We write to you on behalf of our client, Viacom 18 Media Private Limited, a company incorporated under the provisions of the Companies Act, 1956 and having its registered office at Zion Bizworld. Subhash Road-A, Vile Parle (E), Mumbai 400 057. (Ph: 91 22 42581818; Fax 9122 42581890; Website; CIN: U92100MHI995PTC095508) (“Our Client”) with instructions to state as under:
  1. At the outset we state that Our Client is one of India’s top media & entertainment companies and operates several general entertainment channels such as MTV, Nick, Vh1, Colors, Sonic, Comedy Central, Nick Jr/Teen, Rishtey, MTV Indies and film business through Viacom18 Motion Pictures, that produces acquires and distributes cinematograph films.
  2. Our Client states that it has co-produced the captioned Film through its film division – Viacom18 Motion Pictures with Bhansali Productions Pvt Ltd and the Film theatrically released on 1st May 2015.
  3. Our Client is in the process of giving us detailed instructions to respond to Your Notice and we will revert upon receipt of the said instructions. In the meanwhile, Our Client denies all the allegations made against Our Client by Your Client in Your Notice and further states that nothing shall be deemed to be admitted by our Client for reason of non-traverse.

Yours sincerely
For Naik Naik & co.

CC: Viacom 18 Media Private Limited, Zion Bizworld, Subhash Road-A, Vile Parle (E), Mumbai 400057
New Service Tax Rate of 14% to Come into Effect From June 1, 2015
The new service tax rate of 14 per cent will come into effect from June 1, the Finance Ministry notified on Tuesday, in a move that will make eating out in restaurants, insurance and phone usage expensive, among many other things. The service tax is currently levied at the rate of 12.36 per cent including education cess.
In continuation of the operationalisation of IMA NABH initiative the following directives have been drafted. Kindly study them and send your suggestions.
Responsibility of IMA HBI
  1. Coordination with NABH.
  2. Coordination with IMA state branches and IMA HBI state chapters.
  3. Arranging faculty for the state level NABH Master trainer workshops and their travel.
  4. Selection, training and administration of IMA NABH consultants.
Responsibility of IMA State Branches/HBI State chapters implementing IMA HBI initiative
  1. Arrange awareness programmes for the hospitals.
  2. Form a cluster of 15 hospitals in a city / district.
  3. Assist in selection of IMA NABH consultants.
  4. Supervise the field activities of the consultants.
  5. Collect the IMA expenses amount from the hospitals and forward to IMA HBI
  6. Arranging all logistics for Master trainer workshops including local hospitality accommodation and transport for the faculty.
Dr R V Asokan                            Dr Raviwankhedkar
Chairman IMA HBI                      Secretary IMAHBI
Patients pay 300% to 700% more than cost of import for cardiac stents, reveals FDA study
A study by the Maharashtra Food and Drug Administration (FDA) has revealed that the maximum retail price of a cardiac stent is 300% to 700% more than the actual cost of import in Maharashtra.

20 May 2015, 8:55 AM IST ET Health World

Pune: A study by the Maharashtra Food and Drug Administration (FDA) has revealed that the maximum retail price of a cardiac stent is 300% to 700% more than the actual cost of import in Maharashtra.

The finding is based on the department's eight-month-long (September 2014 and May 2015) inquiry against major importing companies dealing in cardiac stents as well as distributors and hospitals in Mumbai, Pune and Nashik division.

The inquiries were specifically conducted to know the cost to the importing company and also cost to the distributors, hospitals and, finally, its cost to the patients. The FDA carried out similar studies in the past to highlight the need of price control.

The department has now sent a set of recommendations to the National Pharmaceutical Pricing Authority (NPPA), a government regulatory agency that controls the prices of pharmaceutical drugs in India, to bring it under control. The report stated that for one of the stents, which had a landing cost of Rs 25,000, the MRP was fixed at Rs 1.55 lakh.

The FDA has recommended that cardiac stents be brought under the national list of essential medicines under Drugs Price Control Order since they are life-saving.

"Cardiac stents which fall under medical devices category are 'drugs' as defined under Drugs and Cosmetics Act 1940 and therefore NPPA can very well issue directions. We have submitted a set of recommendations to NPPA. State FDA minister Girish Bapat is also going to take up this issue with the Union health ministry," said state FDA commissioner Harshadeep Kamble.

There have been complaints from the public and non governmental organizations regarding overpricing of cardiac stents. Based on the inputs, the vigilance branch of FDA Maharashtra conducted a detailed inquiry into this issue under joint commissioner (vigilance) Dnyaneshwar Phadtare. He was supported by M M Pawar, assistant commissioner, and drug inspector D C Shaikh from FDA's investigation bureau.

There is a possibility that the importing company, distributors and hospitals are making a profit while the patients suffer, Kamble said.

"As most of these are not available in the open market, patients can't check the price," said a distributor requesting anonymity.

Experts, however, also underline that having an MRP has not prevented profiteering in medicines as the MRP can be fixed on a higher level to accommodate commissions.

With inputs from Sumitra Deb Roy in Mumbai
Establishment of a Bioethics Unit
Dear Heads of Nodal Centres, Units, committee members of the International Network of the UNESCO Chair in Bioethics Haifa,

I am delighted to welcome the establishment of a Bioethics Unit of the International Network of the UNESCO Chair in Bioethics Haifa at Medical College of the well renowned Dr. D. Y. Patil Vidyapeeth University at Pune India. The Honourable Vice Chancellor Professor Razdan, Prof Dr Siddharth Dubhashi Director Academics and Professor of Surgery the Head of the Unit, Professor Dr. Praveen Arora Associate Professor of Forensic Medicine and the distinguished steering committee are congratulated on receiving the approval for the establishment of this unit by the UNESCO chair. This unit will be joining with the inaugurated

Nodal Bioethics Centre of the UNESCO Chair Maharashtra at the Maharashtra University of Health Sciences and its 40 medical College in Maharashtra State India. These Colleges are introducing the Integrated Bioethics curriculum based of the UNESCO Core Curriculum from June 2015. This initiative is led by Prof Dr Jamkar the Honourable Vice Chancellor and Prof Dr Rajderkar Pro Vice Chancellor and Head of the Nodal Centre.

The formal inauguration of the unit with a seminar on Bioethics in Medical Education will take place on the 30th May 2015.

Please join me in welcoming the New Bioethics Unit of the Dr. D. Y. Patil Vidyapeeth University Pune India to the Asian Pacific program and the International Bioethics Network of the UNESCO Chair.

Best Wishes, Russell D’Souza
Letter to Editor
This is in reference to the mail regarding incidents of assault on doctors. It is very difficult to get the no. of incidences as most of them are nor registered. Here with sending the information received from President, IMA Vadodara Branch.

Dr Chetan N Patel

This is for your perusal that although Gujarat has an act for prevention of assaults on doctors (Act 13 of 2012) rules notified in the gazette in December, 2012, the junior police force is not aware, as well as not keen to book culprits under the act.
  1. In December 2014, Medical Officer in ER of Sterling Hospital, Vadodara was assaulted. CCTV footage were given to Gotri Police. IMA Vadodara wrote to Commissioner of Police with a copy of Act and Rules. Undersigned personally met the PI of Gotri Police Station. Booked under IPC only.
  2. In January, a dentist at RC Gandhi Charitable hospital was assaulted. This video became viral on YouTube. Karelibagh Police was given the video and copy of act as well as rules. No steps taken.
  3. A meeting of Surgeons and ICU owners of Vadodara took place at Global Hospital. Inaction on part of the Police was discussed.

    IMA, Surgeons association etc should hold programmes to educate police and meet their state and district officers to get assurance from them that the act will be followed.
IMA in Social Media 28367 likes 45842 likes 1325 likes
Twitter @IndianMedAssn 966 followers
IMA Humor
The Coma

The woman’s husband had been slipping in and out of a coma for several months, yet she had stayed by his bedside every single day.

One day, when he came to, he motioned for her to come nearer. As she sat by him, he whispered, eyes full of tears, "You know what? You have been with me all through the bad times.

"When I got fired, you were there to support me."
"When my business failed, you were there."
"When I got shot, you were by my side."
"When we lost the house, you stayed right here."
When my health started failing, you were still by my side. You know what?"

"What dear?" She gently asked, smiling as her heart began to fill with warmth.

"I think you’re bad luck."
Quote of the Day
Don’t waste your life in doubts and fears: spend yourself on the work before you, well assured that the right performance of this hour’s duties will be the best preparation for the hours or ages that follow it. Ralph Waldo Emerson.
Reader Response
We know it early , Insurance company very often didnot reimburse and increasing the premium every year To counter this exploitation IMA has started its Medical Re-reimbursement Scheme as IMA National Health scheme. Join the scheme and escape from exploitation . Join IMA National Health Scheme Applicatin form and details given as attached file.
IMA Videos
Press Release
Best age to stop smoking is before 40

Cigarette smoking is a leading preventable cause of mortality. It kills more than 60 lakh people worldwide every year. More than 50% of regular smokers would invariably die from tobacco-related illnesses which includes heart attack, cancer or asthmatic lung diseases.

31st May is “World No Tobacco Day” and IMA will come out with a weeklong health education activities for the public, said Padma Shri Awardee Dr A Marthanda Pillai, National President Indian Medical Association (IMA) and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA.

Quitting smoking before the age of 40 is associated with larger decline in premature death than stopping it at a later date. Best age therefore to stop smoking is before 40.

However, stopping smoking even after the age of 50 is still associated with lower risk of death as compared to those who continue to smoke. Even in smokers aged 80 years or more, quitting smoking appears to reduce some mortality.

Cigarette smoking is responsible for more than 10% of all cardiac deaths.
News on Maps