November 27   2015, Friday
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Dr KK AggarwalDr KK Aggarwal Physician leaders call for health to be protected in climate change agreement

A sustainable global agreement on climate change with a strong emphasis on the protection and improvement of health has been called for by the World Medical Association on the eve of the climate change summit in Paris. WMA leaders, headed by Past President Dr. Xavier Deau, will be attending next week's summit to press for a clear recognition in the final agreement of the threat to health from the world’s rising temperatures. Dr. Deau said: ‘For too long the alarming impact of climate change on health has been ignored by the world’s leaders despite repeated warnings from physicians across the globe. Yet we know that our patients' health is already being harmed by changes to the climate. ‘We know, for instance, that extreme weather events such as droughts and floods will lead to deaths and increased illnesses, changing the patterns of infectious diseases such as dengue and malaria. Warnings have also been given about increasing water shortages and water-borne diseases, and in a world where health inequality is profound, these changes will only make matters worse. It is vital for a comprehensive agreement to include a fair mechanism to address climate change loss and damage in all its forms around the world including through the appropriate valuation of health. 'The Paris agreement must take into account the social determinants of health, as climate change threatens many of them, from clean air, food and water security, to safe shelter and secure livelihoods. It must also include provision for fostering the transition to clean and renewable energy.’
Amit Sharma and Nilesh Aggarwal

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
Govt. identifies adverse drug reaction monitoring center

The department of pharmacology, Kasturba Medical College has been designated as adverse drug reaction monitoring centre by the Union ministry of health and family welfare under the National Pharmacovigilance Programme to report adverse drug reactions (ADRs). Dr K L Bairy, professor, department of pharmacology, is the coordinator of the centre. Its primary role is to create awareness about adverse drug reactions (ADRs). This joint effort is to promote patient safety. Counterfeiting, antimicrobial resistance are the pharmacovigilance challenges which need to be addressed. Submission of an ADR report does not have any legal implications. Both patients and healthcare professionals can provide information. Call 1800-180-3024 (9am-5.30pm weekdays).… (ET Healthworld)

Chikungunya virus can cause fatal encephalitis

A study published online November 25 in the journal Neurology has found that the mosquito-borne virus Chikungunya can lead to severe encephalitis and even death, especially in young babies and older adults. Thought the study reviewed cases of Chikungunya that occurred during an outbreak on Reunion Island off the coast of Madagascar in 2005 to 2006, the findings have implications for many other countries, including those in Europe and North America, say the authors of the study. Lead author Patrick Gérardin, MD, from Central University Hospital in Saint Pierre, Reunion Island said, “Before the 2005 to 2006 epidemic on La Réunion, Chikungunya infection was believed to be a nonfatal benign illness, and chikungunya-associated [CENTRAL NERVOUS SYSTEM] disease was thought to be a nonspecific complication of a systemic disease. But we have shown that beyond the well-described arthralgia/arthritis, this virus can be life-threatening and cause fatalities, and also long-term disabilities (lifelong in infants) such as cerebral palsy, neurocognitive delays and learning difficulties, and postinfective dementia in older adults."… (Medscape)
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Specialty Updates
• A new study suggests that older adults who take more steps, either by walking or jogging, score better on memory tasks than their sedentary peers. The findings are published in the Journal of the International Neuropsychological Society.

• Testosterone replacement therapy taken for up to 5 years is not associated with an increase in the risk of developing high-grade prostate cancer in older men, reported a study with more than 50,000 men with prostate cancer. The results are published in the December issue of the Journal of Urology.

• A higher resting heart rate is associated with a higher risk for all-cause and cardiovascular mortality, even in those without traditional risk factors for cardiovascular disease, suggested a meta-analysis published online November 23 in CMAJ.

• Inner city children with asthma had fewer exacerbations when pretreated prior to the start of school, suggested a randomized clinical trial, published in The Journal of Allergy and Clinical Immunology.

• Long-term exposure to air pollution was a risk factor for cardiovascular disease, and the risk was especially great among women with type 2 diabetes, reported a new analysis of data from the Nurses Health Study (NHS) published in the Journal of the American Heart Association.

• In regions where malaria is endemic, HIV patients on antiretroviral therapy (ART) should not stop taking cotrimoxazole even after their immune status improves, suggests a new study published online in the journal AIDS.

• Six months of hydroxyurea (HU) treatment yields significant reductions in albuminuria in patients with sickle cell disease (SCD), suggests new research published online in the Journal of the American Society of Nephrology.

• For patients with diabetic macular edema, long-term response to vascular endothelial growth-factor (VEGF) inhibitors can be predicted after just three injections, suggested a post hoc analysis of data from Protocol I of the Diabetic Retinopathy Clinical Research Network ( Presenting the findings at the American Academy of Ophthalmology 2015 Annual Meeting, researchers stated that those who did not respond to three monthly anti-VEGF injections were destined to remain relatively unresponsive at 3 years.
Why do we not offer onions to God?

Anything that grows under the ground is not offered to God. According to Vedic science, anything which is grown under the ground is Tamasik in nature and produces sluggishness, heaviness and extreme aggressiveness. Not only onion, all food products grown under the ground are not offered to God and are not supposed to be eaten during spiritual fasts. People who are spiritually-oriented like monks, rishis, munis avoid underground food altogether. Some people try to convert Tamasik food into Satvik food by slow heating them or by sprouting them or by soaking them in water. This is one reason why boiled potato is eaten during Vrat.

Legal Quote

V. N. Shrikhande vs Anita Sena Fernandes on 20 October, 2010

”… the consumer forums do not have the jurisdiction to entertain a complaint if the same is not filed within 2 years from the date on which the cause of action has arisen. This power is required to be exercised after giving opportunity of hearing to the complainant, who can seek condonation of delay under Section 24A(2) by showing that there was sufficient cause for not filing the complaint within the period prescribed under Section 24A(1).”
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Income Heads and Special Setoff Conditions

• Section 70 allows setoff of loss from one head to be adjusted with income from same head. Section 71 allows setoff of loss from one head to be adjusted with income from another head. The excess losses can be carried forward to eight years.
• Loss incurred during a particular financial year can be adjusted against any other head but carried forward losses can be adjusted only against income from the same head in future.
• If there is a failure to adjust carried forward loss in a subsequent year(s) with income, it can’t be setoff at a later date.

(Source: IJCP)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Medical advances that were initially ridiculed or rejected

Newborn Incubators

Incubators are standard equipment in neonatal intensive care units and have become so common that, in many ways, they are emblematic of the care given to premature babies in their first hours and weeks of life. In the United States, however, for the first decades of their use, the only place infant incubators could be found was at amusement parks and "sideshows" alongside tattooed ladies and sword swallowers.

First pioneered by French obstetrician Stéphane Étienne Tarnier, infant incubators were initially used and refined throughout Europe in the late 19th century. Martin Arthur Couney, who studied under one of Tarnier's assistants, first witnessed an infant incubator at the Berlin Exposition and decided to import them to the United States. After they were largely rejected by the US medical establishment, Couney established a bank of incubators at Luna Park on Coney Island in New York. From 1903 to the early 1940s, Couney charged visitors 25 cents to view the premies on display, money that was used to pay for the babies' medical care so that parents did not have to. It has been estimated that Couney treated about 8000 children and saved the lives of 6500 babies during his 4 decades on the Coney Island boardwalk. In 1939, New York Hospital opened the first official training and research center for premature babies—36 years after Couney debuted his baby incubator in Luna Park. Couney died in 1950 in relative obscurity; however, the widespread adoption of infant incubators is a testament to his courage (and showmanship).

(Source: Medscape)
Severe injuries in kids are red flag for abuse

Severe injuries, especially head injuries, in children ages 5 and younger are more likely to be the result of child abuse than accidental injury, according to the latest population-based study on child abuse, which examined data from a trauma registry network in the UK published online Nov. 23 in the Emergency Medicine Journal. The risk of serious physical abuse is highest among infants under the age of 1. Among children with abuse-related injuries, 98% were younger than 5, and 76% were less than a year old. Abuse-related injuries were more severe and more likely to involve the head/brain than accidental injuries. Boys accounted for 59% of abuse victims and 89% of those treated for injuries caused by fights or accidents.……… (Medpage Today)
Sartans are blockers of angiotensin II type 1 receptors (e.g. AT1R) but it should be noted that they also bind to other receptors (e.g. PPARγ peroxisome proliferator-activated receptor gamma). Two examples of sartans are candesartan and telmisartan. Sartans have demonstrable neuroprotective and anti-inflammatory properties in animal models of stroke, although evidence from human trials is inconclusive at present… (Bath and Krishnan, 2014).ip; (Focus Taiwan.t
Based on current evidence, clinicians should include body weight, along with other established variables when dosing Vitamin K Antagonists. Most important, obese and morbidly obese patients may require a 30% to 50% increase with the initial dosing of VKA.
Doctors, NGOs build pressure on Centre to declare cigarette butts as toxic waste

Doctors and non-governmental organisations (NGOs) have come together to build pressure on the Central government, so that it declares cigarette and bidi butts as toxic waste. NGO Doctors for You has filed a petition regarding the same with the National Green Tribunal (NGT), saying a filter of a single cigarette contains over 4,000 harmful chemicals. It stated that over 100 billion cigarette butts are discarded in India every year, which contain harmful, cancer-causing chemicals. The NGT has now asked the Union ministry of environment and forests (MoEF), ministry of health and family welfare and the central pollution control board (CPCB) to file their response on the harm caused by cigarette or bidi butts and chewing tobacco to the environment…… … (DNA)
2 out of 5 kids have unhealthy BMI

A survey by EduSports has found that two out of five schoolgoing kids do not have a healthy body mass index (BMI) and 50% of our children lack adequate lower body strength, reports the Times of India dated November 26. More than 1.48 lakh students from across 87 cities and 26 states over the academic year 2014-15 were included in the survey. Students were tested on sprint capacity, flexibility, upper body strength, abdominal strength and BMI. Some schools were found to offer three or more physical education periods per week while most offer just two. The study found that students from schools which offer more than three periods are fitter and healthier…… … (Times of India - Manash Pratim Gohain)
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
IMA Live Webcast

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Central India Unit of the Unesco Chair in Bioehtics, Hafia and
IMA UNESCO Chair in Bioethics,
December 11, 2015, 9:00A.M
For Resgitration for 16 IMA Nominee


Phone: 9811841351

Dr. R.P Beniwal
Treatment of acute leg cramps

Patients with an acute leg cramp should forcefully stretch the affected muscle, as an example by active dorsiflexion of the foot with the knee extended, when the cramp is in the calf. Some patients may also find relief from passive stretching by getting out of bed and standing with the foot flat on the floor then pressing downward firmly, although active dorsiflexion of the foot may be more effective. Other measures that may offer relief from the acute cramp include:

• Walking or leg jiggling followed by leg elevation
• A hot shower with the stream directed at the cramp area of the body, usually for five minutes, or a warm tub bath
• Ice massage
Bioethical issues in medical practice
Perils of Cosmetic Surgery

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

Young people today are extremely health and appearance conscious. Not only do they follow strict dietary regimens, they religiously take care of their appearance. Repeated surgery for changing the shape of their nose, chin or stomach is frequent. You as a family physician are approached by one such young woman, who has a normal shape and weight but wants liposuction. What should your primary advice/counselling center on?

a) Healthy lifestyle choices
b) Being comfortable with their natural appearance, whatever it may be
c) Perils of cosmetic surgery
d) Involving their family

Any other suggestions and solutions? Do write in!

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

Response received

Perils of cosmetic surgery should be explained to her and when completely satisfied, liposuction should be got done. This will not only change her outlook and appearance but also will be helpful in controlling hypertension, diabetes, PCOD, sterility and various conditions related to cardiovascular system. Dr BR Bhatnagar
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Inspirational Story
Weakness or Strength?

Sometimes our biggest weakness can become our biggest strength. Take, for example, the story of one 10-year-old boy who decided to study Judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese Judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move. “Sensei,” the boy finally said, “Shouldn’t I be learning more moves?” “This is the only move you know, but this is the only move you’ll ever need to know,” the sensei replied. Not quite understanding, but believing in his teacher, the boy kept training.

Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time-out. He was about to stop the match when the sensei intervened. “No,” the sensei insisted, “Let him continue.”

Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion. On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind. “Sensei, how did I win the tournament with only one move?” “You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grip your left arm.”

The boy’s biggest weakness had become his biggest strength.
eMedi Quiz
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.

Yesterday’s Mind Teaser: Which one of the following is a recognized x-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Answer for Yesterday’s Mind Teaser: 4. Peri-articular calcification.

Answers received from: Dr.K.V.Sarma, Daivadheenam Jella, Dr.Bitaan Sen & Dr.Jayashree Sen. Dr Avtar Krishan

Answer for 25th November Mind Teaser :. 2. Interstitial lung disease

Answers received from: Daivadheenam Jella, Dr Jainendra Upadhyay, Dr Kailash Chandra Sharma, DR SARMA P S, Dr Shangarpawar, Dr.B.R.Bhatnagar
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Press Release
Breathlessness occurring for the first time during the winter months’ individuals above the age of 40 should be assumed to be cardiac asthma

New Delhi, 26th November 2015: The winter months though awaited by many, bring with them a host of medical issues especially for young children, women and the elderly. It is important that awareness is raised about important prevention measures and warning signs to ensure good health during this period. Cardiac Asthma is one such hidden ailment, which often does, undetected and can prove to be life threatening.

Speaking about the issue, Padma Shri Awardee Dr A MarthandaPillai –National President IMA and Padma Shri Awardee Dr KK Aggarwal, Honorary Secretary General, IMA and President, HCFI said, “It is important to remember that any breathlessness after the age of 40, appearing for the first time in the winters, should be assumed to be cardiac asthma unless proved otherwise. Such patients should immediately have their blood pressure check-up done and if its high, immediate medical attention must be sought. A first-onset of breathlessness can also be an indication of angina or heart attack. However, winter asthma or acute exacerbation of winter COPD (chronic bronchitis) is more common”.

While asthma is a reversible airway obstruction, COPD is irreversible. Sudden exposure to cold, humidity and pollution when the atmosphere levels are low can precipitate asthma in susceptible individuals. It is thus advised that the dosage of asthma medicines should be increased during the winters. An attack of asthma occurs due to inflammation, narrowing and collection of fluid in the windpipe. Medicines need to be administered to widen the windpipe and reduce the inflammation.

An easy way to detect the severity of the asthma attack is to ask the patient to speak full sentences. If the patient can easily speak in full sentences, then the asthma attack is said to be mild. If they are only able to speak in broken sentences then, the asthma attack is moderate, and if the person is able to speak only words then the asthma attack is severe. A Severe attack of asthma requires immediate hospitalization.

The need of asthma medicines can be intermittent and/or permanent. The ‘Formula of ‘2T' becomes handy in such situations. A person who consumes more than two canisters of inhalers in a year or consumes asthma medicines more than twice in the night time in a month or more than twice in a day in a week, then he or she needs continuous asthma and anti-inflammatory medicines. Inhalers are the best choices.

Some of the other common health problems people may face during the winter months include:

1. Heart Attacks and Strokes: It is a known fact that the number of deaths due to heart attacks, cardiac arrests, and strokes increase during the winters. There are several reasons for this; firstly the reduction in the daylight hours affects the hormonal balance of the body and causes Vitamin D deficiency a common trigger for heart attacks. Additionally, cold temperatures cause the heart arteries to condense thereby restricting the blood and oxygen flow to the heart. This often causes a rise in the blood pressure.

2. Seasonal Affective Depression: This condition is characterized by experiencing episodes of depression every year, but only during the winter. What the exact cause of this is still unknown but it is believed that a low body temperature, scarcity of sunlight and hormone fluctuations play an important role. Winter depression causes an increase in stress levels and hypertension. People suffering from winter depression are also seen indulging in high sugar, trans fat and sodium comfort food, which can be extremely dangerous for the diabetic and hypertensive population. The temperature drop also increases the chances of blood clot formation, since blood platelets are more active and stickier during this time.

4. Vitamin D Deficiency: Indians are at an increased risk of vitamin D deficiency, especially during the winter month given that they spend most of their time in indoor spaces. Vitamin D is essential for good bone health, a strong immune system, and a healthy heart. It also helps prevent deadly diseases such as cancer. It is extremely important that all Indians ensure that they spend time out in the sun on a daily basis in the winter months. Supplementation is also advised to avoid health complications.

5. Influenza: Seasonal Flu is very common during the winter and has the potential to be life-threatening especially for high-risk individuals. It is thus recommended that the flu shot should be taken in consultation with one's physician.