January 27 2015, Tuesday
Govt may negotiate price of drugs before market entry

Once pricing is linked with marketing approval for patented medicines, it is bound to impact multinational pharmaceutical companies.

NEW DELHI: The government may negotiate prices of patented medicines with their manufacturers before allowing pharmaceutical companies to launch them in India. The move, a first of its kind, is also likely to be applied on patented drugs that are already being sold in the country, an official source said.

An inter-ministerial committee, evaluating the mechanism to negotiate prices of patented medicines, has recently sought detailed information about such drugs from the National Pharmaceutical Pricing Authority (NPPA), which regulates prices of medicines in the country. This include data on number of patented medicines currently available in India, their market share, prices, disease burden, date of grant of patent and its expiry.

The move is significant because it is expected to bring down prices of many medicines mostly used in treatment of life threatening diseases such as cancer, HIV/AIDS and hepatitis C. Presently, patented medicines are outside the ambit of the National Pharmaceutical Pricing Policy, which mandates a price cap on 348 essential medicines.

However, the government is concerned about prices of such medicines mainly because of the high disease burden in these therapeutic categories. Besides, in the absence of generic competition, patented drugs continue to remain expensive.

So far, pricing of medicines and their marketing approval are not linked and are being looked at by two separate government departments. While NPPA, under the ministry of chemicals & fertilizers, regulates prices of medicines, the health ministry does quality control and gives marketing approval through Drugs Controller General of India (DCGI).

Once pricing is linked with marketing approval for patented medicines, it is bound to impact multinational pharmaceutical companies. Companies claim spending billions of dollars on research and development of innovative medicines. A patent period of 20 years allows such innovator companies a monopoly in the market, while the price of the drug remains high in the absence of generic competition.

The move also assumes significance in the light of the upcoming visit of the US President Barack Obama to India. According to sources, intellectual property rights (IPR), particularly in case of medicines, is going to be one of the topics on top of the agenda for talks between the two countries.

Of late, multinational companies such Novartis, Pfizer, Gilead, Bristol-Myers Squibb and Roche have been facing tough times in India seeking patent protection for some of their products. While the Supreme Court refused patent protection for Novartis' anti-cancer drug Glivec in April 2013, compulsory license was granted against Bayer's cancer drug Nexavar allowing generic drug makers to manufacture and sell the product against a royalty to the innovator firm. Recently, the Indian patent office rejected an application by Gilead seeking IPR protection for its blockbuster Hepatitis C drug Sovaldi.

Industry estimates show patented medicines currently constitute around 1% of the total Rs 87,000 crore domestic pharmaceutical market. However, this is gradually growing as companies are increasingly seeking patent protection in India. Government data shows as many as 970 pharmaceutical product patents were granted between 2007 and 2011, whereas the number has increased to around 1300 between 2011 and 2013.

Another committee, constituted earlier through a memorandum in February 2007, had suggested prices of patented drug be referenced to that of the UK, Canada, France, Australia and New Zealand. The price should then be adjusted by taking into account India's purchasing power parity, the committee recommended. However, the report was shelved in December 2013 with a view that market dynamics have changed over the years.

The new committee was set up in 2014 with representatives from various ministries including commerce, health and pharmaceuticals.
Non obstructive heart blockages not benign
Dr KK Aggarwal In a retrospective study of patients undergoing elective coronary angiography, non-obstructive coronary artery disease (heart blockages), compared with no apparent coronary artery disease ( no blockages), was associated with a significantly greater 1– year risk of heart attack and all– cause mortality.

After risk adjustment, there was no significant association between 1– or 2– vessel non-obstructive coronary artery disease ( blockages in one or two arteries) and mortality, but there were significant associations with mortality for 3– vessel non– obstructive coronary artery disease (blockages in all three arteries).

Veterans with evidence of non– obstructive CAD on elective coronary angiography had a 2– to 4.5– fold greater risk for heart attack compared with those with no evidence of blockages and 1– year heart attack risk was found to increase progressively by the extent of blockages, rather than increasing abruptly when blockages became obstructive.

The results of this study are published in Nov. 5 JAMA.

Never tell your patients "that your coronaries are fine and they have nothing to worry about," but one should say " "There is evidence of atherosclerosis and while there is no need to panic, we need to address it Remember there is nothing like ""mild coronary artery disease." Up to 1 in 4 Angiograms Show Minimal Plaque or blockages.

Non– obstructive blockages mans presence of atherosclerotic plaque revealed during coronary angioplasty or angiography that does not appear to obstruct blood flow or result in angina symptoms.

These non– obstructive lesions occur in between 10% and 25% of patients undergoing elective angiography, and their presence has historically been characterized as "insignificant" or "no significant blockages in the medical literature even though multiple studies have shown plaque ruptures leading to heart attack commonly come from non–obstructive plaques.
MCI Ethics Committee Reconstituted as Under
  1. Dr. Muzaffar Ahmad, Chairperson
  2. Dr. D. Santharam, Chennai
  3. Dr. Nanandkar Sudhir Digambar, Mumbai
  4. Dr. S.N. Chaudhary, Ranchi
  5. Dr. Nileshbhai V. Parekh, Gujrat
  6. Dr. K.P. Kushwaha, Gorakhpur (U.P.)
  7. Dr. Navin Dang, Delhi
  8. Dr. Sudipta Kumar Ray, Kolkata
  9. Dr. Satya Prakash Yadav, Gurgaon
  10. Dr. A M Jagadeesh, Karnataka
  11. Dr. Vinay Kumar Aggarwal, Delhi
  12. Dr. N. S. Sengar, Jhansi

Health Check Up and CPR 10 Camp at G B S S School, No-2, Ambedkar Nagar on 19th December 2014
Make Sure
Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on bimanual palpation.

Reaction: Oh my God! You should do cervical swabs and consider starting antibiotics.

Lesson: Make sure to remember that women with such symptoms may have endometritis, which requires prompt diagnosis.
It may respond to doxycycline and metronidazole.
Quote of the Day

This is my simple religion. There is no need for temples; no need for complicated philosophy. Our own brain, our own heart is our temple; the philosophy is kindness.

– Dalai Lama
News on Maps
CPR 10

Total CPR since 1st November 2012 ? 101090 trained

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Twitter of the Day

Dr KK Aggarwal: Stress may increase smoking habits http://bit.ly/ 15QdVeB #Health

Dr Deepak Chopra: Science is a creation of the mind in order to understand reality. The mind itself is an expression of consciousness http://bit.ly/15QdVeB #Health
Rabies News (Dr A K Gupta)

A patient received two doses of modern vaccine (on days 0 and 3) and the dog was well on days 5 and 7 (third injection due, but not given). However, the dog dies on any day between 8 and 15. What should be done?

In case, day 0 and 3 injections were given and the dose due on day 7 was postponed because the dog was kept under observation but the dog dies between 8 and 15 days, three doses of vaccine must be given as close to the original dates of the schedule and all five injections must be completed by day 28.
IJCP's ejournals
  • Indian Journal of Clinical Practice
  • Indian Journal of Multidisciplinary Dentistry
  • Asian Journal of Diabetology
  • Asian Journal of Critical Care
  • Asian Journal of Clinical Cardiology
  • Asian Journal of Obs & Gyne
  • Asian Journal of Paediatric Practice
  • Asian Journal of Ear Nose and Throat
Amendment of section 27A
35. In section 27A of the principal Act,
(a) in the opening portion, for the words for distribution " the words "for distribution, " or for market," shall be substituted;
(b) for clause (ii), the following clauses shall be substituted, namely:
"(ii) any cosmetic deemed to be misbranded under section 17C, shall be liable for penalty which may extend to fifty thousand rupees to be imposed by the State Licensing Authority in such manner as may be prescribed.
(iii) any cosmetic, other than a drug referred to in clause (i) or clause (ii), in contravention of the any other provision of this Chapter or any rule made under the Act, shall be liable for penalty which may extend to two lakh rupees to be imposed by the State Licensing Authority in such manner as may be prescribed."
Amendment of section 28.
36. In section 28 of the principal Act, for the words" may extend to one year or with fine which shall not be less than twenty thousand rupees or with both", the words "shall not be less than three years and shall also be liable to fine which shall not be less than three lakh rupees" shall be substituted.
Amendment of section 28A.
37. In section 28A of the principal Act, for the words "may extend to one year or with fine which shall not be less than twenty thousand rupees or with both", the words "may extend to three years or fine which may extend to rupees three lakh or both"shall be substituted
Amendment of section 28B.
38. In section 28B of the principal Act, for the words "may extend to three years and shall also be liable to fine which may extend to five thousand rupees", the words "shall not be less than three years and shall also be liable to fine which shall not be less than five lakh rupees" shall be substituted
Amendment of section 29
39. In section 29 of the principal Act,
(a) for the words "drug or cosmetic", the words "drug, cosmetic or notified category of medical device"shall be substituted;
(b) for the words "which may extend to five thousand rupees", the words "which shall not be less than fifty thousand rupees" shall be substituted
(b) for the words "which may extend to five thousand rupees", the words "which shall not be less than fifty thousand rupees" shall be substituted
(b) for the words "which may extend to five thousand rupees", the words "which shall not be less than fifty thousand rupees" shall be substituted
(b) for the words "which may extend to five thousand rupees", the words "which shall not be less than fifty thousand rupees" shall be substituted
(b) for the words "which may extend to five thousand rupees", the words "which shall not be less than fifty thousand rupees"shall be substituted
(b) for the words "which may extend to five thousand rupees", the words "which shall not be less than fifty thousand rupees" shall be substituted
Amendment ofsection 30
40. In section 30 of the principal Act,
(i) in sub– section (1), for clause (c), the following clauses shall be substituted, namely:–
"(c) under clause (d) and clause (e) of section 27, again make contravention under that clause, shall be liable for penalty which may extend to five lakh rupees to be imposed by the Central Licensing Authority or State Licensing Authority, as the case may be, in such manner as may be prescribed;
(d) under clause (i) and clause (ii) of section 27A, again make contravention under that clause, shall be liable for penalty which may extend to three lakh rupees to be imposed by the State Licensing Authority in such manner as may be prescribed."
(ii) in sub-section (1A), for the words "may extend to two years or with a fine which may extend to two thousand rupees", the words "shall not be less than three years and shall also be liable to fine which shall not be less than ten lakh rupees" shall be substituted;
(iii) in sub–section (2), for the words "may extend to two years, or with fine which shall not be less than ten thousand rupees or with both", the words "shall not be less than two years and shall also be liable to fine which shall not be less than one lakh rupees" shall be substituted
(iv) after sub– section (2), the following sub– section shall be inserted, namely:
"(3) Whoever having been convicted of an offence under section 28A or section 28B is again convicted of an offence 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 five lakh rupees."
Dr KK Spiritual Blog
Wahans (Vehicles) In Mythology

In mythological era, the negative tendency of a man is symbolized with the animal nature. Gods in Indian mythology are symbolized by living a positive behavior. Every God has been given a vehicle or Wahan. Both God and the Wahan symbolized how to live a positive life and how to control the animal tendencies.
Following are a few examples:
  1. Lord Ganesha rides a Mouse. Mouse in mythology is symbolized with greed and Ganesha with one who removes obstacles. The spiritual meaning behind both is – one should learn to control greed to tackle obstacles in life.
  2. Lord Shiva riding Nandi (Bull is symbolized with uncontrolled sexual desires) and the duo signifies that for learning meditation, one needs to control sexual desires first.
  3. Saraswati (the goddesses of knowledge) sitting on Swan symbolizes that to acquire knowledge one must learn to control the power of discrimination or Vivek. Swan can drink milk and leave water from a mixture of milk and water.
  4. Indra (the one who has a complete control over the intellect) riding on the elephant Airavat symbolizes that intellect (Indra) for its development requires control over Masti and madness (elephant).
  5. Durga (the perfect woman) riding a lion symbolizes that to become a perfect woman, one must learn to control her agitation or aggression (lion).
  6. Lakshmi (wealth) riding an owl symbolizes that to earn righteously, one must learn to control Owl like properties within us, which is not to get befooled.
  7. Lord Vishnu (the doer) riding eagle or Garuda (Eagles are opportunistic predators which means they eat almost anything they can find) means controlling your desires to eat the unbalanced food.
  8. Krishna riding five horses means one need to control our five senses.
  9. Kartikey rising on Peacock symbolizes that should learn to control one – s pride (vanity) or ego.
  10. The vehicle of Goddess Kali is a black goat. Agni rides Mesha – a ram. Kubera, the god of wealth, also has a ram as his vehicle. A ram is an uncastrated adult male sheep. Goat also signifies uncontrolled sexual desires but lesser than the bull.
  11. Yamraj rides a buffalo, which is known for its rampant destruction. Lord Yama or Yamraja is referred to as the God of death, twin brother, lord of justice, Dharma Raja. One can do justice only if one has a control over anger and aggressive behavior.

    In mythology, apart from Wahans, animals are also shown to be sacrificed, which means to kill that animal tendency within ourselves. For example, during exams, you need to kill your goat behavior, which is known to possess excessive sexual desires. You may need to control them throughout the year but during exams you need to kill them. In Kali Pooja, a buffalo is sacrificed, which again means that in extreme situations, you may need to kill your ego or anger.
Dr Good Dr Bad
eMedi Quiz
Acantholysis is characteristic of

1. Pemphigus vulgaris.
2. Pemphigoid.
3. Erythema multiforme.
4. Dermatitis hepetiformis.

Yesterday"s Mind Teaser: The Protein Efficiency Ratio (PER) is defined as:

1. The gain in weight of young animals per unit weight of protein–consumed.
2. The product of digestibility coefficient and biological value.
3. The percentage of protein absorbed into the blood.
4. The percentage of nitrogen absorbed from the protein absorbed from the diet.

Answer for yesterdays’ Mind Teaser: 1. The gain in weight of young animals per unit weight of protein–consumed.
Correct Answers received from: Dr.K.V.Sharma, Dr Chandresh Jardosh, Dr Avtar Krishan
Answer for 25th Jan Mind Teaser: 1. The source of infection is mainly clinical cases.
Correct Answers receives: Dr. Avtar Krishan, Dr. Poonam Chablani, Dr Abbas Vakil.
Inspirational Story
The value of sincerity of purpose

A story is told of a man who approached three workers who were doing the same job.

"What are you doing?" he asked each one of them separately and got different answers.

"I am cutting the stones" replied the first. "I am earning my livelihood," replied the second.

"I am building a mosque" replied the third. Each of the three workers saw himself linked to a different purpose.

Each one was to that extent, different from others, although all worked alike and were engaged in the same task.

Our two hands with which we work are in no sense different from the hands of any other person.

The value of what we do depends upon the quality of the inner purpose in our heart with which we do our work.
IMA in Social Media
https://www.facebook.com/ ima.national 27937 likes
https://www.facebook.com/ imsaindia 45928 likes
https://www.facebook.com/ imayoungdoctorswing 254 likes
Twitter @IndianMedAssn 738 followers
http://imahq.blogspot.com/ www.ima-ams.org
http://www.imacgpindia.com/ http://www.imacgponline.com/ http://www.ima-india.org/ima/ www.indianme dicalassociation.info
eMedinewS Humor

Computer Gender

Why computers should be considered masculine,
1. In order to get their attention, you have to turn them on.
2. They have a lot of data but are still clueless.
3. They are supposed to help you solve your problems, but half the time they ARE the problem.
4. As soon as you commit to one, you realize that, if you had waited a little longer, you could have had a better model.

Why computers should be considered feminine

1. No one but their creator understands their internal logic.
2. The native language they use to communicate with other computers is incomprehensible to everyone else.
3. Even your smallest mistakes are stored in long–term memory for later retrieval.
As soon as you make a commitment to one, you find yourself spending half your paycheck on accessories for it.
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
Reader Response
Dear Sir, Very Informative news. Regards: Dr Sagun
The Year in Medicine 2014: News That Made a Difference
Exercise and CVD Risk: Too Much of a Good Thing?

When it comes to exercise, there apparently can be too much of a good thing.
In one study published online May 14 in Heart, investigators report that men who exercised for more than 5 hours per week when they were 30 years old had a significantly higher risk of developing atrial fibrillation later in life compared with men who exercised less. In a second study, a separate group of researchers found that those who participated in daily "strenuous" physical activity had an increased risk of dying from cardiovascular causes. An editorial in the same issue notes that both studies are limited by the self-reported measurements of physical activity but still raise important clinical questions (Source: Medscape)
IMA in the NEWS
IMA sets up 1,700 clinics to counsel teenage girls

By Mayuri Phadnis, Pune Mirror | Jan 26, 2015, 02.30 AM IST The Indian Medical Association (IMA) will start 1,700 weekly clinics for adolescent girls across the country in an attempt to focus on their lifestyle and psychological problems.

"Adolescents these days suffer from a variety of issues, especially because of their changing lifestyle choices. We have asked all branches of IMA to have such weekly clinics. We also have a team working on standard protocol in this regard, such that we'll have a uniform literature to adhere to," said Dr KK Aggarwal, honorary secretary of the IMA.

About 22 per cent of India's population consists of adolescents, who are at an age in their lives when problems like emotional disturbances, depression, low self-esteem, etc, tend to wreak havoc on their psychological and physiological well-being. Rapid physical growth and sexual developments also occur at this age, leaving many teens confused and perplexed.

Shedding more light on these observations, Dr Neville Misquitta, a psychiatrist and consultant at Pathfinder Clinic in Magarpatta, said, "Adolescents mainly suffer anxiety and depression. Many of them are also addicted to narcotics. Their parents notice problems when academic performance suffers as a result of these issues and come to us. Watch out for warning signs like sleep problems, suicidal thoughts, drug usage, etc. And, instead of scolding them, professional help must be sought from medical healthcare workers."

Teenage pregnancy and spread of STDs are also on the rise. Half of India's female population has had a child before attaining the age of 20, according to Indian Paediatrics. The IMA added that girls, who give birth before the age of 15, are five times more likely to die in childbirth compared to women in their 20s. Moreover, problems like plycystic ovarian disease (PCOD) and irregular menstrual cycles are also commonplace these days.

"When girls start menstruating, they are shy of the changes happening in their bodies. These aspects need to be explained to them. parents also need counselling such that they are better equipped to handle these issues. They should talk to their children about the need to be careful with one's sexual urges. And, in case of accidental pregnancies, instead of finding faults with them, they need proper medical care. There might be vaginal infections that they may not share openly, but will come to light when examined by a trained professional," said Dr Shubhada Deoskar, city-based gynaecologist.

Dr Aggarwal further stated that habits picked up during this time tend to have a lifelong impact. "Addictions and eating disorders all start from here. This is the last chance to correct growth lag and malnutrition. Moreover, stunted adolescents give rise to undernourished babies and the cycle continues," he said.

Dr Amol Halbe, president of IMA’ s Pune branch, added, "We have been told to open the clinics, but we're waiting for final protocols and brochures and the official correspondence to arrive. We will then decide on an action plan for Pune."

Vital Statistics
70: Mortality percentage among adults linked to habits picked up during adolescence.
14.5: Median age for marriage in rural areas. Pregnancy usually follows soon after.
25: Percentage of patients under 18 years attending government– run clinics to educate them on STDs
70,000: Annual deaths worldwide related to pregnancy and childbirth among girls between ages 15 and 19.
No need to panic, says IMA
Tribune News Service: Chandigarh, January 25: Following one confirmed case of Congo fever resulting in the death of a 35-year-old male nurse at the AIIMS, New Delhi, two days ago, the Indian Medical Association (IMA) today issued a white paper to all its members (doctors) providing information on the virus. The white paper, compiled by Dr KK Aggarwal, IMA secretary general, stated that there was no need to panic as the disease was not new and its treatment was available. Two days ago, the National Institute of Virology in Pune confirmed that a male nurse died of extensive internal bleeding due to contagious Congo fever. The nurse from a private hospital in Jodhpur was among five members of the nursing staff who developed flu-like symptoms. The fever is common in Africa, Asia, Eastern Europe and the Middle East. In India, CCHF was first confirmed in a nosocomial outbreak in 2011 in Gujarat. About Crimean-Congo haemorrhagic fever It is a severe, potentially fatal disease in humans caused by CCHF tick-borne virus (Nairovirus) of the Bunyaviridae family. The virus is transmitted through tick bites, contact with a patient suffering from CCHF or contact with blood or tissue from the infected livestock.
IMA to open 1,700 adolescent clinics
NEW DELHI, The Indian Medical Association (IMA) will open 1,700 adolescent clinics in the country to educate the girl child on lifestyle and on reproductive and mental health. At present two lakh children die of diarrhoea and three lakh due to pneumonia every year, which is not acceptable to the medical profession, IMA secretary general K.K. Aggrawal said Saturday. "No child should die of diarrhoea and pneumonia," he said at the annual conference of the Indian Academy of Pediatrics. "Why report a rare congo fever death and not report a preventable neo– natal death?" asked Aggarwal to over 2,500 child specialists who gathered in the city. He said the IMA will open 1,700 adolescent clinics in the country. No child should die just because preventive and infrastructure facilities are not available for treating diarrhoea and pneumonia. For every neo-natal death, someone should be held accountable. The IMA will sensitise over 2.5 lakh doctors on the subject, he added.
ABC of hepatitis
Prof. NK Arora
  • Epidemiology of hepatitis A is changing in the country with improvement in economic state and environmental hygiene. There are geographic and population pockets where children require HAV vaccine to prevent severe disease in adulthood.
  • All jaundice children are not viral hepatitis. Typhoid, malaria and dengue can also have raised bilirubin and transaminases.
  • Gastroenterology – Approximately 1% of Indian population potentially have celiac disease. Pediatricians need to be aware of the diverse manifestations of celiac disease and investigate and diagnose appropriately.
Infectious diseases – Panel discussion
A significant panel discussion was conducted at PEDICON 2015 on Case Scenarios in Infectious Diseases, with eminent physicians including Dr. Digant D Shastri, Dr. Sanjay Ghorpade, and Dr. Kheya Ghosh Uttam constituting the panel with Dr. Jaydeep Choudhury as the moderator. Several cases of infectious diseases in neonates were discussed in the form of an interactive session where the common causative organisms, evaluation and management approach were discussed for the respective conditions.
Catheter Related Blood Stream Infections
Dr. Vikas Taneja, Gurgaon
  • A central line-associated blood stream infection (CLABSI) is a primary BSI in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream-related to an infection at another site. This is a simple definition for surveillance purpose only.
  • On the contrary, catheter-related blood stream infection (CRBSI) is a clinical definition, used when diagnosing and treating patients, and requires specific laboratory testing that identifies the catheter as the source of the BSI.
  • The types of catheters commonly used in a PICU include multiple lumen central lines, PICC, chemotherapy port, Quinton catheter, Swan Ganz catheter.
  • The source of microorganisms causing CRBSI is
    1. Touch contamination – inner aspect of catheter
    2. Skin colonization – outer aspect of catheter
    3. Hematogenous – from a distant site.
  • Risk factorsRisk factors include loss of skin integrity, severity of underlying illness, thrombogenicity, number of catheter lumens, repeated catheterizations, presence of septic focus elsewhere, catheter insertion with submaximal precautions, location of catheter: femoral high risk; internal jugular > risk than subclavian; lower extremities > risk than upper extremities, duration of placement.
  • Non-tunneled pose more risk than tunneled while tunneled pose greater risk than implantable. SI may be suspected in the presence of the following:
  • Local cellulites.
  • Bacteremia without source.
  • Clinically septic without source.
  • Non functioning catheter.
  • Positive tip culture.
  • Pus at insertion site.
  • Shivering during the use of catheter.
  • The 2011 CDC Guidelines for the Prevention of Intravascular Catheter– related Infections underline the following points:
  • Educate health care personnel regarding indications for catheter use, proper insertion and maintenance and infection control.
AICOG 2015

Algorithm for management of atonic PPH - HAEMOSTASIS
Dr S Arulkumaran, UK

H: Ask for help A: Assess vital parameters and blood loss and resuscitate E: Identify etiology + ecbolics+ ensure availabilit
H: Ask for help
A: Assess vital parameters and blood loss and resuscitate
E: Identify etiology + ecbolics+ ensure availability of blood
M: Massage uterus (bimanual compression)
O: Oxytocin infusion/prostaglandins – IV, PR, IMO: Oxytocin infusion/prostaglandins – IV, PR, IM, intramyometrial
S: Stabilize clotting, antishock garment, shift to OT
T: Tissue/Trauma/tone/thrombin>tamponade (balloon/uterine packing)
A: Apply compression sutures (B lynch/modified B lynch ± balloon ± suction
S: Systematic pelvic devascularization
I: Interventional radiology (uterine artery embolization / internal iliac artery ligation)
S: Subtotal/total abdominal hysterectomy
Hypertensive crisis
Dr Alokendu Chatterjee, Kolkata
  2. One-third of adults worldwide have high BP; high BP is responsible for 50% of all deaths from stroke and HT diseases (WHO 2012).
  3. HT crisis is uncontrolled HT characterized by SBP >180 or DBP >120. The signs and symptoms of HT crisis may be life-threatening.
  4. HT crisis includes HT urgency and HT emergency following severe and sudden increase in BP.
  5. HT urgency: SBP 180 and/or DBP 110, without end organ damage. Bp can be brought down safely within few hours with anti-HT drugs.
  6. HT emergency is a real crisis; acute persistent SBP >160-180 and/or DBP >110 with s/s of PE and eclampsia + end organ failure, which may be life threatening; BP needs to be aggressively and urgently managed as it carries an immediate risk to the mother and the baby.
  7. Symptoms: Intense headache, blurred vision, severe anxiety, altered consciousness
  8. Signs: Higher Glasgow coma scale, HT encephalopathy
  9. Diagnosis of HT emergency during pregnancy can be made by h/o use of anti-HT drugs, sudden rise of BP, eclamptic fits or confusion, ?urinary output, proteinuria, chest x-ray, ECG, Echo, fetal monitoring.
  10. A combination of immediate diagnosis of HT emergency + specific diagnostic tests+ decide order of treatment, lower BP prevents end organ damage and improves outcome.
  11. Avoid reducing BP too quickly or to below target level ? reduce intrauterine perfusion ? adverse impact on fetus
  12. Inform seniors and start fetal surveillance if fetus viable
  13. Mode of delivery: the most popular belief is cesarean section.
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.
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
Telangana Deputy Chief Minister Rajaiah Sacked
Hindu: Jan 25, 2015: Chief Minister K. Chandrasekhar Rao was miffed with the flak his government drew due to the increasing death toll following outbreak of swine flu.

The suspense over the fate of Telangana Deputy Chief Minister and Health Minister T. Rajaiah in the wake of serious charges of corruption in his department ended on Sunday when Chief Minister K. Chandrasekhar Rao sacked him and inducted Warangal MP Kadiam Srihari in his place.

In a series of fast-paced events, Mr. Rao sent his emissaries to Governor E.S.L. Narasimhan recommending the dropping of Dr. Rajaiah and this was followed by the swearing in of Mr. Srihari at the Raj Bhavan . The decisions ended four days of turmoil in the medical and health department which, on one hand, was faced with the challenge of tackling swine flu that claimed 22 lives and, on the other, grappled with charges of corruption in the purchase of 285 ambulances under the National Health Mission and the employment of doctors and paramedics on outsourcing basis.

The Chief Minister made other significant changes in the Cabinet after the swearing-in of Mr. Srihari around 2.40 PM. The latter was made the Deputy Chief Minister and given the portfolio of education, a post held by Mr. G. Jagdish Reddy, who was shifted to power.

Mr. C. Laxma Reddy was shifted from power to medical and health.

Earlier in the day, Mr. Rao reportedly discussed with his Cabinet colleagues Dr Rajiah’s charge that he was being subjected to "character assassination".

Later he drove back to his camp office where he decided to recommend Dr. Rajaiah’ s removal to Governor E.S.L. Narasimhan. He also summoned Mr. Srihari instantly.
Press Release of the Day
Top 10 Ways to Keep the Kidneys Healthy

We all want our kidneys to last for a lifetime. We all should show our love for kidneys by adopting 10-step program for protecting kidney health, 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.

One should begin with monitoring blood pressure and controlling weight and then move on to the rest of the kidney-healthy tips.
  1. Monitor blood pressure and cholesterol.
  2. Control weight.
  3. Don't overuse over–the–counter painkillers.
  4. Monitor blood glucose.
  5. Get an annual physical exam.
  6. Know if chronic kidney disease (CKD), diabetes or heart disease runs in your family. If so, you may be at risk.
  7. Don't smoke.
  8. Exercise regularly.
  9. Follow a healthy diet.
  10. Get tested for chronic kidney disease if you're at risk.