January 3 2016, Sunday


Air pollution and the heart


· Air pollution, and specifically fine particulate matter, is associated with increased cardiovascular disease mortality.
· Air pollution has emerged as a potentially modifiable risk factor for the development of CVD.
· Whether air pollution is associated with episodes of AF was evaluated in a study of 176 patients with dual chamber implantable cardioverter-defibrillators that were capable of detecting episodes of AF. After follow-up of nearly two years, there were 328 episodes of AF lasting 30 seconds or more found in 49 patients.The potential impact of multiple parameters of air pollution, (measured hourly) on the development of AF was examined. The odds of AF increased significantly as the concentration of particulate matter increased in the two hours prior to the event. ( J Am Coll Cardiol 2013; 62:816. )
· Multiple observational studies have demonstrated an association between fine particulate air pollution (primarily from the use of fossil fuels in automobiles, power plants, and for heating purposes) and cardiovascular and cardiopulmonary mortality as well as an increased risk for the development of acute coronary syndromes
· The Women's Health Initiative Observational study database of more than 65,000 postmenopausal women without prior CVD was used to evaluate the relation between a woman's long term exposure to air pollutants and the risk for a first cardiovascular event.For each 10 mcg/m3 increase in pollution concentration, there were significant increases in the risk of any cardiovascular event (hazard ratio 1.24), death from CVD (hazard ratio 1.76), and of cerebrovascular events (hazard ratio 1.35). ( N Engl J Med 2007; 356:447. )
· Mortality data from nearly 450,000 patients in the American Cancer Society Cancer Prevention Study II data base were correlated to air pollution data, including average concentrations of ozone and fine particulate matter (≤2.5 micrometers in diameter [PM2.5]). In multivariate analysis PM2.5, but not ozone, concentration was significantly associated with the risk of death from cardiovascular causes (relative risk 1.2). (< N Engl J Med 2009; 360:1085. )
· Further support for the significance of air pollution comes from a study of death rates in Dublin, Ireland before and after a ban on coal sales that led to a 70 percent reduction in black smoke concentrations ( Lancet 2002; 360:1210. ). Adjusted cardiovascular deaths fell by 10.3 percent in the six years after the ban.
· Both the American Heart Association (2010) and the European Society of Cardiology (2015) have issued official statements discussing the association between long-term exposure to fine particulate air pollution and increased risk of developing cardiovascular disease ( Circulation 2010; 121:2331. Eur Heart J 2015; 36:83)
· In addition to long-term risk, short-term exposure to air pollutants (both ozone and fine particulate matter) has been associated with acute coronary ischemic events.’
· In a study of over 12,000 patients living in a defined geographic area, a short-term increase in fine ambient particulate matter positively correlated with an increase in acute ischemic coronary events ( Circulation 2006; 114:2443 )
· In a systematic review and meta-analysis of data from 34 studies, CO, NO2, SO2, and PM < 10 microns and less than 2.5 microns were all associated with an increased risk of myocardial infarction, with the overall population attributable risk ranging from 1 to 5 percent ( JAMA 2012; 307:713 )
· In a study of 772 patients with an acute MI, the risk of an MI was increased in the two hours after exposure to elevated levels of fine particles in the air (odds ratio 1.48 compared to low levels of fine particles); this effect lasted for up to 24 hours after exposure ( Circulation 2001; 103:2810. ).
· Possible mechanisms by which fine particulate air pollution may increase the risk of CVD include (Eur Heart J 2015; 36:83)
· An increase in mean resting arterial blood pressure through an increase in sympathetic tone and/or the modulation of basal systemic vascular tone ( Circulation 2002; 105:1534 )
· An increase in the likelihood of intravascular thrombosis through transient increases in plasma viscosity and impaired endothelial dysfunction ( Circulation 2002; 106:933 )
· The initiation and promotion of atherosclerosis (Circulation 2010; 121:2755)
· Multiple observational studies have demonstrated an association between fine particulate air pollution and distance from a major urban road or freeway and cardiovascular and cardiopulmonary mortality. However, there is conflicting evidence concerning whether air pollution is (J Thromb Haemost 2010; 8:669.), or is not ( J Thromb Haemost 2011; 9:672.), causally related to VTE development

(Source: uptodate)


Dear All

Team IMA with all humility thanks and salutes all past presidents, leaders, presidents and secretaries of state and local branches, all central council members and all the members for their unstinted, whole hearted support, encouragement and empowerment given to the team to fight for IMA and public health in the last 365 days.

Your advice and vigilant support helped us to move forward in the correct direction with confidence.

I specifically thank our Honorary Secretary General Dr KK Aggarwal for his staunch support. IMA has never seen an HSG like Dr KK before and he has set a benchmark, which is difficult for others to surpass. I join all of you to complement dear KK.

I wish the new President Dr SS Aggarwal and Dr KK Aggarwal all success.  A great team which will take IMA to newer heights.

Long live IMA! Jai Hind!

Dr A Marthanda Pillai
Immediate Past President IMA



Government issues Draft Guidelines for Kidney Donors 
The National Organ and Tissue Transplant Organisation (NOTTO) under the Ministry of Health & Family Welfare has issued draft guidelines for Allocation Criteria for Deceased Donor Kidney Transplant. The draft guidelines include issues such as: recipient registration, listing and scoring system in the waiting list, scoring system for making priority, allocation principles, allocation algorithm, including criteria for urgent listing, and inter-state issues. The draft also includes a list of the government and non-government hospitals in Delhi along with those in the neighboring area of the NCR (Gurgaon, Ghaziabad, Faridabad, Noida). The draft guidelines are posted on the website of NOTTO- for comments and suggestions, which may be sent to the Director, NOTTO at by 16th January 2016... (PIB)

Study supports waiting period for non cardiac surgery post stent implantation
Mary T. Hawn, MD, MPH, of California's Stanford University, and colleagues report in JAMA Surgery that noncardiac surgery soon after getting a stent carries higher risks for patients who were sickest when they received their stent -- those with myocardial infarction (MI) as the indication rather than a less serious blockage. The postoperative major adverse cardiovascular event (MACE) rate was 7.5% among patients who had received a stent due to MI vs 2.7% among those stented for unstable angina and 2.6% for those with indications other than acute coronary syndrome… (Medpage Today) 



• Progression of coronary artery calcification (CAC) appears to raise atrial fibrillation in a dose-dependent fashion, suggest new findings from the Multi-Ethnic Study of Atherosclerosis (MESA) published in Circulation: Cardiovascular Imaging. 
• Diabetes is a risk factor for surgical site infection, even after controlling for hyperglycemia, suggests a new systematic review published in the January issue of Infection Control and Hospital Epidemiology.
• An increasing number of emergency department patients are being given computed tomography (CT) scans, even those patients who are unlikely to benefit and are most likely to experience harm from the scan, suggest the results of a trends analysis published online December 28 in JAMA Internal Medicine. 
• Complication rates of percutaneous dilational tracheostomy (PDT) are low and similar with or without use of bronchoscopy, reported a retrospective cohort study published online December 30 in JAMA Otolaryngology Head & Neck Surgery.
• A new study, published online in the Journal of Child and Family Studies, suggests that addressing the parents' attitudes about fighting, involving them in violence prevention programs and tailoring programs to different racial/ethnic groups may improve the effectiveness of prevention programs for teen violence. 
• Chemodenervation using botulinum neurotoxin-A (BoNT-A) can prolong the life of hyaluronic acid fillers by reducing muscle activity in the treated area, suggested a study published in Plastic and Reconstructive Surgery.
• Patients with systemic lupus erythematosus (SLE) are at a higher risk of stroke than the general population irrespective of the type of stroke, and the relative risk is greatest among younger patients, suggested a meta-analysis published in RMD Open -- Rheumatic & Musculoskeletal Diseases. 
• Fennel vaginal cream improves the signs and symptoms of vaginal atrophy in postmenopausal women, suggests new research published online in Maturitas.



Spiritual Prescriptions: Prefer Meditation and Not MedicationMeditation and not medication should be the first line of treatment for most lifestyle disorders. The very fact that our body has a receptor for each and every drug means it has the capacity to produce that drug. God did not make these receptors for pharmacological agents or drugs. The key lies in achieving the undisturbed state of consciousness, which can be obtained by either controlling the disturbed state of mind or bypassing it by using the mantra.

The subject of spiritual medicine should be included in schools, colleges and medical sciences.

Confession and communication are two easy modules of controlling the disturbed state of mind. As darkness is absence of light, negative thoughts are absence of positive thoughts. To reduce negative thoughts, one should inculcate positive thoughts, actions and behaviors. One cannot hate a stranger. One can only hate a person whom he or she has loved. Hatred is therefore withdrawal of love, and it can only be removed by bringing the love back.

It has been shown that diseases like diabetes, high blood pressure, heart disease, paralysis, asthma and acid-peptic disease can be kept under control with meditation without or with minimal medicines



Indian Medical Association vs VP Shantha & Ors on 13 November, 1995, 1996 AIR 550, 1995 SCC (6) 651 

“In devising a rational approach to professional liability which must provide proper protection to the consumer while allowing for the factors mentioned above, the approach of the courts is to require that professional men should possess a certain minimum degree of competence and that they should exercise reasonable care in the discharge of their duties.”


1. IMA Rare Blood Group Online Blood Bank Directory:
2. IMA Online TB Notification initiative:
3. IMA Online Events Reporting initiative:
4. Proforma for Hypertension Screening:
5. IMA Online Sentinel Events Reporting Initiative:
6. IMA Disease Notification:
12. IMA Slide Share:
13. I Pledge My Organ:
14. IMA Weekly Live:
17. IMA ART:
18. IMA Satyagraha:
19. IMA Daily Webcast:
20. CC Slides:
21. NATCON Photos: IMA Natcon 2015 - Day 2 - Camera 1, IMA Natcon 2015 - Day 2 - Camera 2, 


Ministry of Health & Family Welfare Immunization Division - Minutes of meeting on tOPV to bOPV switching

A meeting to discuss tOPV to bOPV switch was held on 18th December 2015 at 3:30 p.m. under the chairpersonship of AS&MD (NHM) in Room No. 249-A, Nirman Bhawan, New Delhi. The meeting was attended by senior officials from Ministry, representatives from WHO-SEARO, WHO-India, UNICEF, CDSCO, CDL Kasauli, INCLEN, IMA and vaccine manufacturers…






Power morcellators come federal scrutiny
In September, the US Government Accountability Office (GAO) announced that it would launch an investigation into power morcellators. The controversial device shreds uterine fibroids for easy removal through laparoscopic incisions. Studies have long established that the use of power morcellators poses a high risk for spreading undiagnosed uterine cancer. In October, 12 members of Congress asked the GAO to find out why the FDA took so long to issue warnings. Last year in April, the FDA recommended that surgeons stop using power morcellators for fibroid removal... (Medscape)


Maintaining hand hygiene can curb 40% of ICU infections
Health experts have said about 40% infections in intensive care units (ICUs) can be avoided by maintaining hand hygiene, which is regarded as one of the most important elements of infection control activities. A large proportion of these hospital infections are easily preventable with by stepping up hygiene practices such as frequent hand-washing. Implementation and adherence to hand hygiene practices in a healthcare facility can prevent infections and limit the transmission of microorganisms… (ET Healthworld - Ranjana Diggikar)


IDMA urges DCGI not to make phase IV trial mandatory to justify irrational FDCs
The Indian Drug Manufacturers' Association (IDMA) has urged the DCGI not to make phase IV trial mandatory for justification of the irrational fixed dose combinations (FDCs) as the SMEs cannot afford the expenditure of phase IV trial which is around Rs. 60 lakhs per product. Recently, the DCGI had issued show cause notices to companies making FDCs considered irrational by Prof Kokate Committee. Based on the report by Professor Kokate Committee, the DCGI office has issued letters of NOCs for certain safe FDCs, and show cause notices on certain FDCs considered irrational. The manufacturers have been asked to give their response within 90 days and the manufacturers of certain FDCs were asked to justify the combination through phase IV trial… (Pharmabiz - Swati Rana)


Pollution on Day 1 of the odd-even experiment in Delhi
Air pollution reduced between 8am and 2pm before rising again, on Day 1 of the Delhi government’s odd-even experiment to check pollution in the national capital, even as experts said it is premature to jump to conclusions with just 10 hours’ data. Between 8am and 2pm, PM 2.5—particulate matter with diameter less than 2.5 microns—levels fell from 194 mcg/m3 to 188 mcg/m3, according to a report by the System of Air Quality and Weather Forecasting and Research (SAFAR), ministry of earth sciences. By 6pm, PM 2.5 levels were at 198 mcg/m3, which is considered very poor quality as the optimum level is 60 mcg/m3… (LiveMint – Nikita Mehta)


All about alcohol dose and terminologies used
Dr K K Aggarwal

What is a social dose (ideal dose)?

  • No level of alcohol consumption can reliably be regarded as safe for some people.
  • Who should not drink at all: Pregnant women, those with personal or strong family history of alcoholism, previous hemorrhagic stroke, hepatic or pancreatic disease and those who operate potentially dangerous equipment or machinery.
  • Alcohol should be restricted in: Active gastritis, esophagitis, premalignant GI lesions such as Barrett's esophagus, or a strong family history of breast cancer.
  • The ideal dose of alcohol is likely around 6 grams per day (one US drink every other day).  




Parent’s dilemma in choosing sex of their intersex child

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

A and S have one child. The second, born three months ago, had indeterminate sexual genitalia. He doctor opines that the child will need one operation so that sex is clear. The operation can be done in the future once the child grows up and decides which sex s/he wants to belong to. They are worried because they feel that growing up with a confusing sexual identity will not be good for the child. Moreover the other sibling may face stigma. Finally the child does not even need to know about the operation. As their doctor what should you advise?

  1. What would you do, as a parent?
  2. Is such a surgery necessary at all? Can the child not go through life with indeterminate sex if s/he wants?
  3. What other social issues would such a child face?

Any suggestions? Do write in!

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



Children and adolescents with congenital heart disease should avoid body piercing
Children and teenagers with congenital heart disease should be strongly discouraged from getting a tattoo or piercing their ears or other body parts, because it could lead to a potentially deadly infection of the heart called endocarditis. Infective endocarditis occurs when bacteria or fungi attach and begin to grow on the valves of the heart. If left untreated, it can lead to a fatal destruction of heart muscle. Body art in the form of tattoos and piercing has become increasingly popular among children and teenagers. But, most people remain unaware that they should talk to their doctor before tattooing or piercing their body. Most experts today strongly discourage all forms of body art. For those who cannot be dissuaded, the recommendation is to give antibiotics prior to tattooing or piercing, "with strong advice for prompt treatment of any signs of subsequent infection".


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 

Click here



Always remember those who serve
In the days when an ice cream sundae cost much less, a 10 year old boy entered a hotel coffee shop and sat at a table. A waitress put a glass of water in front of him. "How much is an ice cream sundae?" "Fifty cents," replied the waitress. The little boy pulled his hand out of his pocket and studied a number of coins in it. "How much is a dish of plain ice cream?" he inquired. Some people were now waiting for a table and the waitress was a bit impatient. "Thirty–five cents," she said brusquely. The little boy again counted the coins. "I’ll have the plain ice cream," he said. The waitress brought the ice cream, put the bill on the table and walked away. The boy finished the ice cream, paid the cashier and departed. When the waitress came back, she began wiping down the table and then swallowed hard at what she saw. There, placed neatly beside the empty dish, were two nickels and five pennies – Her Tip



High resolution computed tomography of the chest is the ideal modality for evaluating:
1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.

Yesterday’s Mind Teaser: The extent to which ionization of a drug takes place is dependent upon pKa of the drug and the pH of the solution in which the drug is dissolved. Which of the following statements is not correct?
1. pKa of a drug is the pH at which the drug is 50% ionized.
2. Small changes of pH near the pKa of a weak acidic drug will not affect its degree of ionisation.
3. Knowledge of pKa of a drug is useful in predicting its behaviour in various body fluids.
4. Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionised in plasma.

Answer for Yesterday’s Mind Teaser: 4. Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionised in plasma.
Answers received from: Dr.K.Raju, Dr Avtar Krishan.
Answer for 31st December Mind Teaser: 4. Progesterone therapy.
Answers received from: Dr Bitaan Sen & Dr Jayashree Sen, Dr Rajeev Ardey.



Dear Sir, Thanks for everything during NATCON 2015. A superb event full of useful sessions dipped in solution of affectionate hospitality and personalized care of each delegates and guest. It is a superb achievement for team IMA & the organizing committee of NATCON 2015. Special thanks to national President Dr A Marthanda Pillai, HSG Dr KK Aggarwal, Dr RN Tandon, Dr Monga, Dr Ajay Lekhi and the Organizing Committee chairman Dr Vinay Agarwal and his team besides IMA HQ staff. Wishing hearty congratulations to new President IMA Dr SS Agarwal and new National Vice presidents. Wishing very Happy New year 2016 to all IMA members and all doctors of India and abroad. Long live IMA, long live our unity. With best wishes and regards: Dr Ajoy K Singh National Chairman IMA AMS 2014-2015



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Team IMA will work hand in hand with the Central Government to solve various medical issues pertaining to the country

Addressing a Press Conference today Dr S S Agarwal, National President, IMA and Padma Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA said that the working group proposed by Shri J P Nadda, Hon’ble Union Minister of Health & Family Welfare is a welcome step and IMA will leave no stone unturned to take this opportunity to help the Government in solving issues ailing the society.

The aim of the working group will be to provide easily accessible, affordable, quality and safe healthcare to the community at large with special emphasis to rural and semi urban areas.

IMA, today is spread over 1700 local branches, 30 State Branches and has a membership of over 2.5 lakh doctors.  Through this infrastructure, the Govt. can reach anywhere in the country from remote areas including North-East, Deserts of Rajasthan and Gujarat, tribal areas of Jharkhand and Chattisgarh to the terror-hit areas of Kashmir and Naxalite areas of the country.

IMA is willing to provide its massive infrastructure to be incorporated in various National Health Programmes for providing healthcare delivery.

All IMA members can be incorporated and work hand in hand in the National Health Programmes jointly with the Government. Any National Health programme launched by the Government, should not only involve the Govt. but also incorporate the private sector.

IMA is willing to join hands with the Govt. and open the Adolescent Clinic pan India on the lines of National Health Programme. IMA is also offering its infrastructure to link these Adolescent Clinics with the non Clinical Awareness Programme.

IMA during the year, is also planning to come out with a standard management protocol and also prepare a White Paper on Self-Regulation of Doctors and allied industry.  The main aim of the IMA in the current year is to work to create trust between the government, doctors and patients.

IMA will also be working to frame guidelines and update the knowledge of its members in the field of Family Medicine and Legal Medicine.

IMA also wants to strengthen the Referral System in the country to enter into capacity building programmes for IMA members and start refresher courses on a regular basis.

IMA will also be focusing in the field of Geriatric Care in the current year.

IMA is for PP Models and will explore possibilities of a joint PP Project Models with the Government. IMA will also come out with a series of health education documentaries.

Quackery, today, is a real menace in the society and needs to be curbed at every level.  IMA is demanding a stringent Central Anti quackery Law in the country from the Government. The rising problem of MDR-TB, antibiotic resistance can be largely attributed to Anti Quackery in the country.

IMA wants major amendments in the Clinical Establishment Act and PC-PNDT Act.

IMA is against the Panchayati Raj.  The idea of the Clinical Establishment Act should be to provide minimum standards of care at every level for which single entry level NABH accreditation should be taken into account and implemented.

IMA and Central Ministry should sit together to find an answer for filling the MBBS and Specialist Posts in the rural areas.

Today, there is a lack of communication between the doctors in the private field with that of Govt. health programmes. Also, today, no private doctor is informed on a regular basis about the introduction of new drugs or banning of drugs etc. IMA can be the only Association which can bridge this gap and connect the national health programmes to the doctors. The standard of care should be the same though the magnitude of care may differ.  IMA is offering its services to the Govt. in building capacity of healthcare service at a national level.

IMA is for holistic treatment approach for the treatment of the patient.

IMA will promote the concept of wellness more than the concept of disease treatment and is not averse to combining the philosophy of Vedic medicine including Yoga and Mind-Body medicine in providing holistic health care.

IMA is the collective consciousness of over 2.5 lakh doctors and together with the Govt. can make a difference, which can create wonders in the healthcare delivery system in the country.

IMA is emphasizing the concept of Self-Regulation more than the Govt. coming out with regulations.

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