Saturday 31 December 2016

Flu in children

Flu in children With the onset of winter, children become increasingly prone to influenza infections highlighting the importance of preventive measures and good hygiene practices. New Delhi, Dec 26, 2016: Influenza is a viral illness and it often manifests in a mild form in children. Influenza infections are most frequent in winter and children are especially susceptible to infection due to weaker immune system. The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestation of respiratory tract illness – sore throat, sough and nasal discharge. Flu symptoms in children are usually very similar to the symptoms of a cold, or upper respiratory tract infection. It might also cause nausea, vomiting and diarrhoea in occasional cases. Padma Shri Awardee Dr. K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Elect Indian Medical Association (IMA), adds “ Flu is highly contagious, particularly when kids stay in close vicinities like they do in school classrooms. The spread of influenza occurs when children inhale droplets that are coughed up or sneezed by an infected person, or when they come in direct contact with mucus or spit from someone who has the disease. The best way to avoid flu in children is to get a yearly vaccination. Parents should consult a physician for the same. ” Ear discharge, development into asthma and pneumonia are common complications in children. Complicated pneumonia may be severe and rapidly fatal, especially if the bacterium is Staph. However, it is not necessary that all the mentioned symptoms be present in all children, individual variations do occur. Moreover, the duration of fever can also last from a week to upto ten days. “During winter, flu should be considered in all children with fever; children with fever and acute onset of respiratory illness; children with fever and exhilaration of underlying chest condition; children with pneumonia and children with fever of more than 100, with severe cough or sore throat. In 95% of the cases, more than 39oC fever is present and about 77% of the cases present with cough and nasal discharge. The treatment is often symptomatic. Paracetamol should be given in recommended doses upto 48 hours and encourage your child to rest and drink lots of fluids, preferably warm fluids. One important point to remember is that flu is caused by a virus, so antibiotics won’t help and can even cause stomach upsets and diarrhoea.”, adds Dr. K.K Aggarwal.

Government of Karnataka, to Regulate/Prescribe the Rates Chargeable by Private Medical Establishments (and Professionals)

Government of Karnataka, to Regulate/Prescribe the Rates Chargeable by Private Medical Establishments (and Professionals) The Government of Karnataka​is is planning to introduce a bill (January 2017?) ​for price control ​in the private healthcare sector. Prices will be fixed for all medical procedures including that for the patients​ in the private wards. The government is unable to provide care to the citizens through their networks and it is​ ​the private healthcare providers​who are providing safe and quality healthcare to around 70 percent of the citizens. If this happens it will destroy the healthcare delivery system and the citizens of our state will have no access to the state of the art technology. If the GoK succeeds, other states will follow suit. Current Position Clinical Establishment Act: rule 9 (2) The clinical establishment shall charge the rates for each type of procedure and services within the range of rated determined and issued by the central government from time to tile in consultation with the state government Recommendations of inter-ministerial committee The committee recommends that the position of the rule 9 (2) of the CE rules can be considered to be changed to the extent that central government should specify the list of procedures and costing templates while actual determination of the range of rates could be left to the state governments who can take into consideration the relevant facts while deciding upon the range of rates for their respective states in consultation with relevant states holders including the Indian Medical Association. IMA Position 1. Challenge the rule 9 as ultra-wire as there is no provision of this in the parent act 2. No rates can be decided without involvement of Indian Medical Association 3. IMA is launching IMA costing department to decide templates and range of costing 4. Only in emergency and national calamities government has powers to regulate the rates under municipal acts not otherwise. Legal Position taken by AHPI and CAHO 1. The anticipated governmental action may arise in one of two ways—(a) legislative action, through the enactment of a fresh law, or the amendment of existing laws by the State Legislature; or (b) executive/administrative action, through the issuance of Rules/Regulations, or notifications/circulars, etc. under the existing laws or otherwise. 2. Legislative action by the State is subject to challenge on broadly the following parameters—(a) legislative incompetence [Whether the State Legislature has the right to legislate on that subject], and (b) other constitutional grounds, including violation of fundamental rights [right to equality and right to trade and profession etc.]. Administrative actions are subject to the same constitutional parameters, but can additionally be challenged on grounds that they do not derive authority from any statutory framework, or fall foul of the statutory framework from which they derive. 3. In particular, any legislative or administrative action to control or regulate rates applicable in private medical establishments (or charged by professionals) would predominantly be open to challenge on grounds that (a) the body taking action does not have the competence to do so, and (b) violation of the fundamental rights of medical practitioners/establishments, or other constitutional provisions. 4. In the absence of any details of the nature and mechanism of the anticipated action in Karnataka, the present Note restricts itself to a broad discussion on the feasibility of a challenge on grounds of violation of the right to practice any profession or carry on any occupation, trade or business, under Article 19(1)(g) read with Article 19(6) of the Constitution. The question centers around the power of the Government to control price of private enterprise. 5. At present, the statutory framework for private medical practice in Karnataka consists of (a) the Karnataka Medical Registration Act, 1961 and (b) the Karnataka Private Medical Establishments Act, 2007 (and Rules framed thereunder). These laws are enacted for (a) the registration of medical professionals and establishments, and (b) for regulation of the technical and professional standards to be followed in medical practice. 6. The existing framework in Karnataka requires private medical establishments and professionals to (a) conspicuously publish their charges, and (b) adhere to them. There is no restriction in the present framework on the quantum of rates/fee that may be charged by private establishments/professionals [See: Section 10, Karnataka Private Medical Establishments Act, 2007, and Section 15, Karnataka Medical Registration Act, 1961 read with the Code of Medical Ethics issued by the Medical Council of India in 2002]. 7. However, measures to regulate the quantum of rates chargeable by medical establishments/professionals do exist in territories outside the state of Karnataka. For example, the Clinical Establishments (Central Government) Rules, 2012, framed under the Clinical Establishments (Registration and Regulation) Act, 2010, mandate that all registered establishments (which includes individual doctors) in the territories to which the Act applies, shall charge for procedures/services within the range of rates determined and issued by the Central Government from time to time, in consultation with the State Governments [See: Rule 9(ii), Clinical Establishments (Central Government) Rules, 2012]. It is pertinent that the Act itself does not contain any provision related to the regulation of rates (and may therefore be subject to challenge on grounds of “excessive delegation”). 8. Under the Clinical Establishments (Registration and Regulation) Act, 2010, a National Council has been set up to oversee its implementation. A Sub-Committee to give recommendations on the range of charges was also formed, and appears to have submitted its report, but it is presently unclear what the status of implementation of this report is. 9. It is notable however that there is precedent to suggest that the State has no ability to introduce price control measures through Rules when the parent Act does not provide for the same. Notifications/Rules have been struck down in the past on grounds of "excessive delegation”. Whilst the constitutional validity of the Clinical Establishments (Registration and Regulation) Act, 2010 has been upheld by the Delhi High Court, the said Act and the Rules do not appear to have been tested before any court on the ground of excessive delegation (or even otherwise on the constitutionality of imposing rate regulation on private medical establishments/professionals). 10. It is worth cautioning that while there is no legal precedent specific to price regulation of medical establishments/professions, challenges to price/fee regulation in other fields have not met with considerable success in the past. The High Courts and Supreme Court have time and again upheld the competence of the Centre and States to regulate rates/fee as a “reasonable restriction” under Article 19(6) of the Constitution, if the same is found to be in greater public interest. 11. For example, the Supreme Court has categorically outlawed “commercialization” in the field of education, whilst holding the same to be predominantly “charitable” in nature. It has specifically prohibited the charging of “capitation fees” for admission into any educational institution (including private unaided educational institutions) and has upheld legislative/administrative action to fix and regulate the fees that may be charged. Such regulation has been held to be a “reasonable restriction” in “public interest” under Article 19(6) of the Constitution.Landmark judgments occupying this field include: a. TMA Pai Foundation v. State of Karnataka (2002) 8 SCC 481 b. Islamic Academy v. State of Karnataka (2003) 6 SCC 697 c. PA Inamdar v. State of Maharashtra (2005) 6 SCC 537 d. Modern Dental College v. State of Madhya Pradesh (2016) 7 SCC 353 12. By way of another example, in Deepak Theatre v. State of Punjab 1992 Supp (1) SCC 684, the Supreme Court upheld Rules framed under various State legislations, which empowered the government to fix rates for admission to cinema theatres. Whilst repelling the challenge made by theatre owners under Article 19(1)(g), and holding such regulation to be “reasonable” and in “public interest” in terms of Article 19(6) of the Constitution, the Supreme Court observed that: “Witnessing a motion picture has become an amusement to every person; a reliever to the weary and fatigue; a reveler to the pleasure seeker; an importer of education and enlightenment enlivening to news and current events; disseminator of scientific knowledge; perpetrator of cultural and spiritual heritage, to the teeming illiterate majority of population. Thus, cinemas have become tools to promote welfare of the people to secure and protect as effectively as it may a social order as per directives of the State Policy enjoined under Article 38 of the Constitution. Mass media, through motion picture has thus become the vehicle of coverage to disseminate cultural heritage, knowledge, etc. The passage of time made manifest this growing imperative and the consequential need to provide easy access to all sections of the society to seek admission into theatre as per his paying capacity. Though the right to fix rates of admission is a business incident, the appellant having created an interest in the general public therein, it has become necessary for the State to step in and regulate the activity of fixation of maximum rates of admission to different classes, as a welfare weal. Thereby fixation of rates of admission became a legitimate ancillary or incidental power in furtherance of the regulation under the Act.” 13. It is notable that the governmental responsibility to improve public health finds place in the Directive Principles of State Policy set out in the Constitution (Article 47). It is furthermore notable that the Supreme Court/High Courts have upheld the right to health as a part of the right to life under Article 21 of the Constitution, and have observed that improvement to public health is one of the “primary duties” of the State. There is also language in the Code of Ethics framed by MCI as well as the Oath taken by all medical professionals that will go a long way in establishing the public nature and interest in these services. [See: Mukhtiar Chand v. State of Punjab (1998) 7 SCC 79, Rajasthan Pradesh VS Sardarshahar v. Union of India (2010) 12 SCC 609, Delhi Medical Association v. Principal Secretary, Health 229 (2016) DLT 322]. 14. We should challenge the Rules framed under the Clinical Establishments Act, 2010, given the availability of other stronger legal grounds (including “excessive delegation”) for getting the provision related to rate regulation/price control struck off as ultra vires the parent Act. This will help us get audience in court, and will allow us to raise challenge based on Article 19(1)(g) of the Constitution as well. If and when the Karnataka legislation is passed, it may be easier to club the challenge (based on the language used in the statute/notification etc.) to this.

Dr KK Aggarwal takes oath as IMA’s National President

Dr KK Aggarwal takes oath as IMA’s National President Promises to represent the best interests of over 2.8 lakh registered IMA doctors from across the country New Delhi December 28, 2016: Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal was today sworn in as the 88th President of Indian Medical Association today. Dr RN Tandon will support him as the association’s Honorary Secretary General. The Indian Medical Association is the largest representative organisation of doctors of modern scientific medicine in the world with over 2.8 lakh-registered members, 1700 local and 30 state branches. The installation of IMA’s new Governing Body took place at its 77th Central Council Meeting – NATCON’16 in the presence of Dr Ketan Desai – President World Medical Association, Dr Jayshree Ben Mehta – President MCI & Mr AR Kohli – Former Governor of Mizoram. Taking his oath as the new IMA National President, Dr K.K Aggarwal said, “It fills me with utmost pride and joy to take on the post of the IMA National President. I vow to take my work forward with dedication, integrity and honesty. I look forward to working with Team Digital IMA. The real strength of IMA lies in its unity and a collective commitment to the betterment of the medical profession, and it is for this reason that the theme for the coming year will be ‘IMA One Voice. The four A’s of universal healthcare- “Available”, “Accessible”, “Affordable”, and “Accountable” will be the guiding determinants of this our policies for the year 2017. Our fight against the unfair nature of the PCPNDT and Clinical Establishment Act, increasing violence against doctors, the undemocratic NMC Act will continue.” Adding to this, Dr Tandon, said that, “IMA has witnessed historic wins over the past two years. I assume this position with the promise to stay committed to the aim of restoring the nobility of the profession and working towards the best interest of the medical fraternity as a whole. This year, IMA will embrace the Digital India initiative by our honorable Prime Minister, and will work paperless from the forthcoming term”. Congratulating the new team, Dr Ketan Desai, President of the World Medical Association added that, “Team IMA 2017’s vision of becoming a digitally superior, cashless and transparent organisation is commendable and heralds a promising future for the medical fraternity. I congratulate the new team and as the World Medical Association’s President, promise my commitment to highlighting the key success and issues faced by the Indian medical fraternity at a global forum.” Mr AR Kohli, Former Governor of Mizoram said, “The medical profession is a noble one, and we must respect those who tirelessly work to help us stay healthy and alive. I congratulate Dr KK Aggarwal and look forward to a more efficient medical fraternity under his able leadership.” In 2017 IMA will continue to fight for its demand of capping the compensation provided in medical negligence cases, undemocratic National Commission Bill and a ban on non-MBBS and non-BDS doctors prescribing modern medicine drugs. Some key initiatives that will be launched this year include a mandatory request for organ donation under the ‘Poochna mat bhoolo’ initiative, auditing of preventable mortality and ‘think before you ink’ campaign in context of encouraging blood donations. Finally, ‘Jiska koi nahi uska IMA’ resonates the ideology that IMA holds above all- the greatest good is in helping those in need. With this vision, IMA plans to make affordable, quality and specialized healthcare available to all. This shift in IMA’s ideology from ‘What IMA can do’ to ‘What IMA should do’ will help foster more holistic and community directed goals and visions as IMA strives to touch new heights this year.

Dr K K Aggarwal National President IMA

Dear Colleague Big Thank You I thank all my mentors and colleagues for the confidence shown in me. I am both happy and tense so the responsibility given to me is huge and the time is only one year. But with the help of you all I am sure Team Digital IMA will be able to deliver. Our mission for the year is IMA 1 Voice. Let us all take IMA to a great height. Dr K K Aggarwal Following are the links 1. Website link : http://kkaggarwal.com/Presidential-speech.php 2. Presidential-speech- https://youtu.be/dxo7_Oi_l0E 3. ebook - http://kkaggarwal.com/28speech/index.html 4. HSG ACTIVITY REPORT IMA: http://module.ima-india.org/Natcon2016/hsgreport/ 5. 'Medico-legal Insights -IMA Legal Success Stories & White Papers’ : http://module.ima-india.org/Natcon2016/success_story/ 6. ‘STOP NMC - AMEND IMC ACT IMA Satyagraha 2016’ : http://module.ima-india.org/Natcon2016/stopnmc/ 7. Dr. KK Aggarwal taking over as National President of IMA: https://www.facebook.com/drkkaggarwal/ 8. IMA Natcon 2016 - Sister Shivani Verma On Self Motivation: https://youtu.be/qoDA0qjg2k0 9. Dr K K Aggarwal takes over as the National President of The Indian Medical Association: https://youtu.be/8gSq5fAgmrg

‘Walk with Doc’: IMA’s new National President launches programme aimed at encouraging doctors to go for morning walks with their patients

‘Walk with Doc’: IMA’s new National President launches programme aimed at encouraging doctors to go for morning walks with their patients
Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal was sworn in as the 88th President of Indian Medical Association yesterday New Delhi, Dec 29, 2016: Indian Medical Association (IMA) represents over 2.7 lakhs doctors practicing modern medicine spread across its 31 State branches and 1700 local Chapters. In an innovative step, the association has launched a campaign urging its doctors to ask their patients to join them in their morning walk routine. The move is a step towards encouraging patients and doctors to indulge in a more active lifestyle. Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that, “Sedentary way of life is slowly but surely killing us. We advise our patients to remain active and exercise everyday but seldom do they heed our advices. By asking them to join their doctors for a morning walk can be an encouraging step in encouragement. I request all doctors to invite their patients for a walk along with them in the park. This will enable the collective benefit of the doctor as well as the patient. Moreover, it will help foster an open and friendly relationship between the doctors and their patients.” According to WHO, approximately 2 million deaths per year are attributed to physical inactivity, making it the leading cause of disease and disability worldwide. It is also the leading cause behind cardiovascular diseases especially, in the younger population. “Earlier the focus was on heavy exercises and intense routines like running or cardio. Now, owing to the increasingly sedentary way of living, especially in the corporate world; the focus has shifted to ‘being on the move’. You should always find opportunities to keep moving, make it a habit to not sit still for more than half hour at a time. While at work take a walk often or get up from your desk now and then. 30 minutes of physical activity is essential everyday”, added Dr R N Tandon Honorary Secretary General IMA. Following are some tips to remain active throughout the day: 1. When there is a choice, always choose stairs over escalators and lifts. 2. Walk to your workplace if it is within a short distance. 3. Get up from your desk every few hours for a quick walk. 4. While at a lunch/dinner buffet, sit far away from the serving table. This way you will have to walk every time you need a refill 5. Do regular chores around your house; it is a good way to keep moving. 6. Move while talking on the phone. 7. Park farther away at the shopping mall and walk the extra distance.

Final Clarification regarding PC&PNDT registration of a person having done MBBS & other PG Degrees

Final Clarification regarding PC&PNDT registration of a person having done MBBS & other PG Degrees Withdrawal of earlier circular with error dated 23rd December and circulation of corrected circular An e-circular dated 23rd December, 2016 was mailed to IMA members on the above said subject. This circular inadvertently carried a factual error. In a line in the e-circular as follows: “This affidavit needs to be submitted with the application for PNDT Registration. However, they may NOT be permitted to carry out ANC Ultrasound”, the word ‘NOT’ had been missed out, which completely altered the meaning of the sentence. The final and corrected version may kindly be noted. This circular was published in All IMA Google Groups and eIMA. The error and confusion caused is sincerely regretted. The corrected notification is as below. Corrected Circular Govt. of NCT of Delhi Office for the Chief District Medical Officer South East District Directorate of Health Services Govt. of NCT of Delhi Delhi govt. Dispensary building PVR Complex, Saket, New Delhi – 110 0017 Email: cdmosoutheast@gmail.com F.No.13(07)CDMO/SED/PNDT/Misc/Part II/2268 Date 19-9-16 To All Medical Directors/Medical Superintendent/Directors/Owners PNDT Registered Centres South East District Govt. of NCT of Delhi Sub: Clarification regarding registration of a person having done MBBS and other PG Degree Sir/Madam, A letter from SPO, PC & PNDT, Directorate Family Welfare, Govt. of NCT of Delhi dated 11/8/16 vide letter no. F9/7/1/PNDT/DFW/o3/Pt. File II/4943-53 has been enclosed for “Clarification regarding registration of a person having done MBBS and other PG Degrees”. Under the PNDT Act, it is hereby clarified that all the specialties other than MD/DNB in Radio/Obstetric should be allowed to undertake ultrasound & can use Ultrasound equipments/Echo Machines in their concerned specialized fields if the Ultrasound equipment / Echocardiology Machine is required in that specialized field. The concerned Doctors are strictly directed to: 1. Do Ultrasound/Echocardiography only in their own field of specialization. 2. Do not conduct any ANC Ultrasound (Submit affidavit) 3. Will be allowed to do USG/Echo cardiology only at the centre for which they have been registered under PNDT Act with PNDT Cell, South East District. They however need to be registered with the PNDT & submit a self explanatory affidavit specifying the use of Ultrasound would be for so & so purposes and not for ANC check-ups. This affidavit needs to be submitted with the application for PNDT Registration. However, they may NOT be permitted to carry out ANC Ultrasound. This is with prior approval of Competent Authority. Copy to: 1. PA to District Magistrate cum District Appropriate Authority SED 2. SPO, PNDT, DFW, Vikas Bhawan II, Civil Lines, Delhi 3. DNO, PNDT, PVR Complex, Saket, ND – 17 4. Office Copy PDF copy of the department circular is also attached herewith

IMA’s new governing body led by Dr KK Aggarwal as the National President & Dr RN Tandon as Hony. Secretary General HO pledges to work towards an affordable and ethical medical practice

IMA’s new governing body led by Dr KK Aggarwal as the National President & Dr RN Tandon as Hony. Secretary General HO pledges to work towards an affordable and ethical medical practice New Delhi, December 30, 2016: The new governing body of the Indian Medical Association – Team Digital IMA 2016-2017 was sworn in recently in Amritsar led by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, as it’s 88th National President. Dr RN Tandon will support him as the association’s Honorary Secretary General. Together they will represent the best interests of over 2.8 lakh registered IMA doctors from across the country The Indian Medical Association is the largest representative organisation of doctors of modern scientific medicine in the world with over 1700 local and 30 state branches. In 2017 IMA will continue to fight for its demand of capping the compensation provided in medical negligence cases, undemocratic National Commission Bill and a ban on non-MMBS and non-BDS doctors prescribing modern medicine drugs. They also stand united against the increasing violence against doctors and feel that a Central Act to protect doctors is the need of the hour. Awareness campaigns aimed at highlighting the unfair nature of the PCPNDT and Clinical Establishment Act will be launched. The real strength of IMA lies in its unity and a collective commitment to the betterment of the medical profession, and it is for this reason that the theme for the coming year will be ‘IMA One Voice. The four A’s of universal healthcare- “Available”, “Accessible”, “Affordable”, and “Accountable” will be the guiding determinants of the new team’s policies for the year 2017. Discussing the goals and visions of IMA for the forthcoming term, IMA’s National President Dr KK Aggarwal said, “I thank each one of you for entrusting me with this great responsibility and on behalf of the entire team I assure you transparent, efficient and effective governance. The year 2017 will be about embracing our Prime Minister’s vision of a cashless and digital economy. We will launch several training modules for doctors detailing ways in which they can ethically maximize their practice and work in the best interest of the public by going digital. We will ensure open communication between all IMA members and help them move towards a cashless practice. Several important programs aimed at providing affordable and quality healthcare will be launched. The best practices of the Indian Medical Sector will also be highlighted at a global stage through our representation in the World Medical Association and CMAAO.” Adding to this, Dr RN Tandon, the new Honorary Secretary General said, “We are committed to making 2017 a promising year for the medical fraternity and promise to work in the best interest of all IMA members and the general public. The medical profession is a noble one and we must all restore faith in it by being transparent and accountable”. Some new initiatives that will be launched in 2017 include: • Mandatory request for organ donation under the ‘ Poochna mat bhoolo' initiative. • For Vector Control, IMA will be launching the campaigns “Apkeghar me machhar to nahi” and “Katwaiga to nahi”. Community participation is a must for vector control. No house should be left unattended. The IMA campaign against mosquito breeding, especially Aedes, will be called ‘DENGwar’. • Hygiene: A large number of diseases can be controlled by teaching and practicing hygiene. The components will include personal, food, water, sleep, hand, sexual, pet, kitchen, cough, respiratory, and mobile hygiene. The campaign slogan will be “Kahinmeingandagi to nahifelaraha”. • “Aao School Chalen” will be a project dedicated to hygiene, vector control, and cardiac first aid(CPR). Thousands of lectures will be organized in schools at the same time on the same date acrossthe country. • IMA will start a Campaign 950 with the intention of bringing the female-to-male ratio back tonormal. • A Blood Donation Cell will create awareness about 100% voluntary blood donations. 1st July will be IMA Voluntary Blood Donation Day. Every state will have a Blood Donation Cell and chairmen of all states will meet regularly to promote blood donations in the country. • . With regard to the elderly and the oldest, IMA will start campaigns “Abhi to main jawanhoon” and “Forget me not”. • . To control non-communicable diseases, IMA supports high alcohol tax, 85% pictorial warning on tobacco packs and high tobacco taxes and introduction of sugar tax. The campaigns will be “White sugar is a slow poison”, “Move Move and Move” and “Glow Red Campaign”. • To help document and control preventable mortality, every preventable death will be duly audited. • The concept of ALERT- Acknowledge, Listen, explain, Revise and Thanks is being advocated as a routine practice in a clinical setting. Dr Anil Goel, Dr Vinod Khetrapal & Dr Ashwani Dalmia the new Joint Secretary were also present in the press meet

A year gone by: Much more needs to be done

A year gone by: Much more needs to be done

Dr K K Aggarwal
National President IMA
Today is the last day of the year 2016 and as we stand on the threshold of a new year, it’s usual to take stock of the year gone by and reflect upon what we have been able to achieve. It’s also a time when we look ahead to the New Year, full of hope and determination to further achieve our goals. My journey with the IMA has been more than two decades long. And, over these years, I have taken on progressing roles in the Association culminating in my role as the National President. It’s a role that brings with it huge responsibilities and challenges and as I embark on this new journey, I do so with your support and contributions. The strength of IMA lies in our unity and common commitment for the betterment of our profession, regarded perhaps the most noble of all professions. True to the theme ‘IMA 1 Voice’, I am sure that we can all speak as ‘one’ for the best interests of the medical community and also give it a global platform. IMA is the largest and a recognized association of professional doctors and one of the biggest medical NGOs in the world and is therefore a stakeholder in national health related issues and policies. Mattie Stepanek, an American poet and peace activist, who died at a young age of 13, said, “Unity is strength... when there is teamwork and collaboration, wonderful things can be achieved.” Let’s together take IMA to even greater heights... My best wishes to you for a healthy, happy and successful new year 2017…

Saturday 26 November 2016

An Anti-Obesity Day awareness initiative

An Anti-Obesity Day awareness initiative Type 2 diabetes mellitus is strongly associated with obesity. There is a significant correlation between type 2 diabetes mellitus and obesity, especially in older individuals. Awareness needs to be raised about these comorbidities and how they affect each other. New Delhi, November 24, 2106: India has the infamous distinction of being the Diabetes capital of the world and on the obesity front, India ranks third worldwide. Clearly, these two morbidities are plentiful in the Indian population. Several studies have aimed at evaluating this relationship. The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg. Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial. Padma Shri awardee Dr. K.K Aggarwal, President HCFI and National President Elect IMA adds, “More than 80 percent of cases of type 2 diabetes can be attributed to obesity. It is seen that there is a curvilinear relationship between BMI and the risk of type 2 diabetes. The lowest risk is associated with a BMI below 22 kg/m2. At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.” Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes. It is a matter of extreme concern as weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes. “Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels. Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contributes to high lipid levels and high blood pressure”, added Dr. K.K Aggarwal further. It is important that those with preexisting Diabetes or those with a family history of type 2 Diabetes mellitus maintain a healthy body mass index. This will not only help in improving the course, severity and extent of the existing disease but also help in preventing the development of serious complications in high risk individuals.

BMJ reports Satyagraha

BMJ reports Satyagraha Doctors protest against bill to dissolve the Medical Council of India BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6259 (Published 22 November 2016) Priyanka Pulla Around 270 000 doctors across India took to the streets on 16 November to protest against the newly proposed National Medical Commission bill which seeks to dissolve the Medical Council of India (MCI) and replace it with a body of 20 members who would be nominated by the government.1 K K Aggarwal, the president elect of the Indian Medical Association, told The BMJ that the association was strongly opposed to the idea of a regulatory body with no elected members, and with members from fields other than medicine.2 In March this year a parliamentary panel urged the government to dismantle the Medical Council of India, saying that it could no longer be trusted with its responsibilities in view of its “massive failures.”3 It also said that the council had not done enough to tackle corruption in the medical profession. It recommended that a new regulatory agency be established and a draft bill creating a 20 member National Medical Commission, a new apex body for medical education, was published in August.1 The Indian Medical Association wants to retain the current structure of the MCI—with two thirds of the body elected and one third nominated—Aggarwal said. “They can’t replace a 130 member body with a 20 member body that is completely nominated,” he said, equating the action with dissolving the Indian parliament and replacing it with a group of nominated members. The association postponed countrywide protests against the proposed bill last year after the government agreed to meet leaders to discuss their demands.2 The Indian Medical Association is calling for a new law to protect doctors against violence; for the enforcement of existing laws that stop alternative medicine practitioners from prescribing modern drugs; for changes to laws to exempt doctors from penalties for clerical mistakes, for the end to cumbersome requirements for single doctor hospitals such as the maintenance of electronic health records and minimum staff numbers; and for the introduction of a cap on the amount of compensation paid to victims of malpractice. But the association has been frustrated with the slow progress in meeting these demands and is calling for the health minister, J P Nadda, to intervene. “Nadda has been saying for the last two years that he agreed with our demands in principle, but we want results,” Aggarwal told The BMJ. Aggarwal said that corruption in the Medical Council of India was just a matter of perception and that the current council had taken steps to quell this notion, including implementing a common entrance exam for medical colleges across India, tackling the issue of capitation fees, and introducing biometric identification cards for medical college faculties to ensure that they met their teaching commitments. He said that the association was planning to submit to the government a list of amendments to the act to ensure more transparent working of the council. References 1. Mudur G. Draft bill for new regulatory structure for medicine in India prompts criticism. BMJ 2016;354:i4541. 2. Bagcchi S. Indian Medical Association calls off protest after government agrees to discuss demands. BMJ. 2015;351:h6194. 3. Mudur G. Indian medical council should be scrapped, says parliamentary committee. BMJ2016;352:i1610. (Source: BMJ)

ADA’s first position statement on psychosocial care for people with diabetes

ADA’s first position statement on psychosocial care for people with diabetes It is well known that psychosocial factors, which include environmental, social, behavioral, and emotional factors, affect diabetes, both type 1 and type 2. The American Diabetes Association (ADA) has released its first Position Statement on ‘Psychosocial care for people with diabetes’, which encourages comprehensive, personalized mental health assessment and treatment as part of routine care of diabetes and recommends care based on factors like age, type of diabetes and family support system. The most common psychological factors affecting people with diabetes, including diabetes distress, depression, and anxiety and eating disorders are covered in the guidelines. The emotional health and life circumstances of a person with diabetes should be evaluated during an initial visit followed by examinations at regular intervals for timely diagnosis and management. Few key recommendations are: • Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life. • Providers should consider an assessment of symptoms of diabetes distress, depression, anxiety, and disordered eating and of cognitive capacities using patient-appropriate standardized/validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. Including caregivers and family members in this assessment is recommended. • Consider assessment of life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies. • Addressing psychosocial problems upon identification is recommended. If an intervention cannot be initiated during the visit when the problem is identified, a follow-up visit or referral to a qualified behavioral health care provider may be scheduled during that visit. The position statement was published online November 22, 2016 and is to be published in the December 2016 issue of the journal Diabetes Care. (Source: Diabetes Care, ADA Press Release November 22, 2016)

An Anti-Obesity Day awareness initiative

An Anti-Obesity Day awareness initiative Obesity has continuously been undermined as a factor of deteriorating public health in India India is the third most obese country in the world with more than 30 million people suffering from moderate to severe obesity According to a report, around 11 percent of adolescents and 20 percent of adults are overweight and have a body mass index higher than 25 kg/m2 to 30 kg/m2 New Delhi, 25th November 2016: Over 30% of the Indian population including children is found to be suffering from Potbelly abdominal obesity. The incidence of metabolic syndrome, characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high blood sugar is at an all-time high in the country and continues to rise. The reason for this is the unhealthy lifestyle choices made my majority of the population including consumption of a diet, which predominantly has high trans fat and sugar levels, long hours spent working in closed spaces with minimal physical exercise and dependence on evils such as alcohol and cigarettes. In fact, nowadays seeing the surge in preventable deaths annually, obesity is being considered as a new killer disease. It makes the young vulnerable to long-term chronic diseases like cardiovascular issues, diabetes and blood pressure fluctuations. Obesity is not only prevalent in youngsters or adults but is also plaguing the children. Children often become overweight due to innumerable factors like lack of physical activity, unhealthy eating habits, increasing reliance on convenience foods and hormonal issues. However, weight problems are also linked to medical heredity complications. Thus, if obesity runs in the family, one must ensure that adequate prevention measures are taken to prevent it from becoming a part of their offspring's life as well. Speaking about the growing problem, Padma Shri awardee Dr. K.K Aggarwal, President HCFI and National President Elect IMA said, “Very few people are aware of the fact that obesity can be prevented and managed if one's weight and eating habits are monitored properly. As the first step in this direction, all individuals should adopt a healthy eating pattern, which includes cutting down on the consumption of processed and convenience food items, as they boost the deposition of bad cholesterol in the body. A balanced diet should consist of items of all six tastes and all seven colors and associated vitamins and minerals to help condition the human body to perform better and build a shield against diseases. Secondly, watching the portion size of each meal is crucial. Eating small portions in regular intervals will help you in balancing the energy intake and output. In addition to this, one should always plan an exercise routine, being physically active helps our body to function flexibly and avoid joint pains and bone fractures." Few tips to keep in mind maintain a healthy lifestyle: • Follow a healthy eating plan. Make healthy food choices, keep your calorie needs and your family's calorie needs in mind, and focus on the balance of energy IN and energy OUT. • Focus on portion size. Watch the portion sizes in fast food and other restaurants. The portions often served are enough for two or three people. Cutting back on portion size will help you balance energy IN and energy OUT. • Be active. Make personal and family time active. Find activities that everyone will enjoy. For example, go for a brisk walk, bike or rollerblade, or train together for a walk or run. • Reduce screen time. Limit the use of TVs, computers, DVDs, and video games because they limit the time for physical activity. Health experts recommend 2 hours or less a day of screen time that does not work- or homework-related. • Keep track of your weight, body mass index, and waist circumference. Also, keep track of your children's growth. • Ensure that your abdominal circumference is lower than 80 cm/90cm (women and men) • Keep fasting sugar lower than 80 mg% and blood pressure lower than 80 mm Hg. • Keep heart rate lower than 80 per minute and bad LDL cholesterol lower than 80 mg%. • Do not consume more than 80 grams of caloric solid or liquid food at once. • Observe carbohydrate fast 80 days a year. • Consume at least 80 fruits and vegetables servings in a week. As they say, you reap what you sow, and hence, to be able to live a disease free lifestyle, one should give up all the addictions this anti-obesity day, which may put them in a danger of suffering from life-threatening diseases in the future.

Saturday 5 November 2016

Delhi chokes under deadly smog

Delhi chokes under deadly smog The days after Diwali have been filled with thick smog blanketing the city. Delhi has recorded its worst ever pollution record with harmful gaseous cocktail reaching upto 42 times the safe limit. This warrants urgent attention and the concerned authorities need to take prompt measures, otherwise the health of 10 million city residents hangs in balance. New Delhi, 02nd Nov, 2016: Air pollution in the capital increased to dangerously high levels post-Diwali. Pollution in the national capital reached extremely unhealthy levels as a dangerous cocktail of noxious gases and respirable pollutants were coupled to low temperature and negligible wind movement, which caused the pollutants to remain close to the surface and be easily breathable. Ultra fine PM (Particulate Matter) 2.5 considered to be the most dangerous particulate matter pollutant rose to "hazardous" levels – and reached up to about 999 micrograms in various areas of the city, which is several times higher than the safe limit of 60 micrograms per cubic meter, standardized by the WHO Central Pollution Control Board. To offer a comparative perspective, Air quality index levels in London on Monday morning was 139 and that in China hovered from 380-400. Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) & National President Elect IMA, added, “The hazardous levels definitely are a reason to panic. Respiratory problems and heart conditions will only worsen in the coming days. PM2.5 is absorbed in lung and enters circulation. It increases free radicals, cholesterol deposition and precipitate heart attack, stroke, and hypertension. Short-term exposure to PM2.5 pollutants is associated with acute coronary ischemic (insufficient blood flow in the coronary arteries of the heart) events and the chances of irregular heart rhythm jumps by 26% for each 6 mcg/cu mm increase in PM 2.5 levels. Such high levels are potent and can trigger endothelial dysfunction, blood thickening and atrial fibrillation (within 2 hours of exposure)”. Noise pollution also breached the safe barrier in the city. Decibel level readings show that the noise pollution ranged from 66.1 decibel (A) and 75.8 dB(A) while the safe levels are around 55dB. Speaking further about the city’s debilitating air condition, Dr. K.K Aggarwal said, “Delhi’s air remains in the “unhealthy” category with respect to air quality index levels throughout the year, Diwali just added to this burden. Moreover, recent crop stuble burning in neighboring states of Punjab and Haryana has also exacerbated the issue. The timing also seems to be crucial, this changing weather has moisture hanging in the air that traps pollutants and acts as a sustained reservoir, and low speed winds are unable to sweep away this particulate matter. There is an urgent need to take prompt and stringent actions, there needs to be a blanket ban on firecrackers, especially those illegally imported that fail to meet pollution standards.” Other measures that can prove fruitful to city’s air quality include imposing a strict ban on garbage burning, and increasing the tax on tobacco. Vehicular emissions need to be controlled further as clearly, current measures are insufficient. Crop burning in agriculture oriented neighboring states needs to be controlled and vigilantly monitored

Fog vs Smog

Fog vs Smog Whenever the humidity is high, air movement is less and temperature is low, fog is the automatic result. It occurs when water droplets are suspended in the air. Smog, on the other hand, is the combination of smoke and fog. When the level of pollutants is high in the atmosphere, the pollutant particles get mixed into the fog, thereby reducing the visibility further. The result is called smog. The smoke includes toxic emissions from vehicle pollutants, open burning of crops or industrial pollutants. Fog and smog are more common during wet or early winter. Wet winter is characterized by fall in temperature along with high humidity. Whereas, dry or late winter is characterized by absence of fog, smog and presence of chilly airy winds. Exposure to smog has known adverse health effects. Acute ill-effects may include redness of eyes, coughing or throat irritation, difficulty in breathing. Smog can trigger acute asthma attacks; it may even trigger a heart attack, stroke, arrhythmia. Children, elderly, patients with diabetes, heart and lung diseases are especially vulnerable to the adverse effects of smog and so should take special precautions to protect themselves. • Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days. • Avoid exertion or activities like running, jogging in conditions of smog. • Avoid walking during smog hours. • Avoid going out as much as possible. • Drive slowly during smog hours. • Heart patients should stop their early morning walk during smog hours. • Remember to get flu and pneumonia vaccination.

Toxic Benzene levels in Delhi air

Toxic Benzene levels in Delhi air

Dr K K Aggarwal Most of the times, we worry about PM 2.5 and PM 10 levels. But, we ignore benzene levels, which indicate the yearly pollution stays of an area. The normal levels are 5 µg/m3. Following is the yearly average in most parts of Delhi for example. • Anand Vihar: 44.3 µg/m3 • Mandir Marg 9.2 µg/m3 • Punjabi Bagh 2.2 µg/m3 • RK Puram 17.0 µg/m3 • IGI Airport 12.68 µg/m3 • Civil Lines 23.14 µg/m3 Some facts about benzene • Benzene is a pollutant often released from oil refineries and traffic exhaust. • Benzene is a compound of crude oil and petrol that can be harmful even at trace levels. • Apart from vehicular exhausts, evaporation from petrol filling stations can also cause benzene levels to rise. • Benzene is a hazardous air pollutant. • Benzene is a known human carcinogen. Long-term exposure to high levels of benzene in the air can cause leukemia and lymphomas • Human studies suggest that maternal exposures to benzene during pregnancy may increase risk for miscarriages, low birth weight infants and childhood cancers. • Pregnant women living in areas with higher air levels of benzene are more likely to have babies with neural tube defects. Women living in the areas with the highest benzene levels are at a two times greater risk for their children to be born with spina bifida. • Delhi should install vapor recovery systems at petrol pumps as soon as possible to deal with high benzene levels. • The air quality index (AQI) recently launched by the Centre does not monitor the quantity of benzene. The AQI deals with pollutants that have immediate short-term impacts like respiratory or cardiovascular diseases. Benzene, on the other hand, is an air toxin and a carcinogen which can cause damage in the long run. • Benzene levels are higher when the temperature is lower. • Benzene rises after sunset and peaks early morning. • Benzene gets mixed with blood while breathing.

IMA Satyagraha on 16th November

IMA Satyagraha on 16th November New Delhi November 04, 2016: “All the 30 State Branches and 1765 Local Branches of IMA are organizing a 2-hour Dharna as part of Stop NMC Satyagraha, in every district in India from 11 am 1 pm on 16th November. The dharna is organized as a reminder to the Government to intervene and sort out the major problems faced by the medical profession” said Dr K K Aggarwal, National President Elect and Honorary Secretary General, IMA. “Last year, We had postponed our Satyagraha scheduled for16th November2015 on the favourable assurances received from the Government of India” said Dr S S Agarwal, National President, IMA. “Not only the interministerial committee slept over the issues, the Government of India has gone ahead with scrapping of MCI and is replacing it with a totally nominated body called National Medical Commission. The bill is anti people in character” said Dr A Marthanda Pillai, Immediate Past National President, IMA. “On 16th November thousands of doctors across the country will participate in the dharna, press meet and will hand over a memorandum addressed to the Prime Minister to the respective district magistrates” said Dr Ravi Wankhedkar, National President Elect 2018 IMA. In a joint statement, Dr R N Tandon, incoming Honorary Secretary General and Dr R V Asokan, Chairman, Action Committee said the “NMC has authority to allow private medical colleges to fix their own rate for 60-99% of the MBBS and postgraduate seats”. Dr Rakesh Gupta President DMA and Dr Ashwani Goyal Honorray Secretary DMA in a joint statement said Ayurvedics, Homeopaths and others will get registration in modern medicine through Schedule IV of NMC. This will affect the Patient Care and Patient Safety. We will give six weeks to the Government to meet our demands or will be forced to take further course of action. IMA has been fighting for the following 6 demands: • To stop NMC and to suitably amend Indian Medical Council Act without compromising the autonomy of the profession. • Capping of compensation under Consumer Protection Act. • Amendments to abolish license Raj and exemption to single doctor clinics in Clinical Establishment Act. • Punitive punishments only for sex selective abortion and not for clerical errors under PC PNDT Act. • A Central Act to protect doctors and hospitals from violence. • To prevent unscientific mixing of modern medicine and indigenous systems. Scheduled drugs to be prescribed only by modern medicine graduates.

How can I help in reducing the pollution?

How can I help in reducing the pollution?

Dr K K Aggarwal As soon as the pollution levels peaked post-Diwali, headlines highlighting the insufficiency of the government in bringing down pollution, banning crackers and reducing industrial or vehicular pollutants dominated the newspapers. It is easy and very convenient to sit on the sidelines and crib about how the government is lacking in stringent measures to bring down the recently spiked pollution levels. It takes courage and determination to take matter into one’s own hands and take a step towards making a difference. Each of us is a sentient member of the society and the contribution from each of us, no matter however small, matters. Every little step taken at the individual level will only work towards the goodwill of the society as a whole. Do not ask what the governing bodies are doing, instead introspect within yourself and ask what you are doing! We ourselves have brought on this onslaught of toxic smog, and it is our moral duty as an active member of the society to take measures at the individual help to control it. Take the step to do your bit; you may make your significant contribution by taking the following pledges: 1. I will not burn agarbatti, incense sticks and dhoopbatti at my home or workplace till pollution levels drop. 2. I will not burn flame producing candles. 3. I will not use kerosene oil or ‘mitti ka tel’ for any purpose. 4. I will not use wood and coal for any purpose be it cooking or heating. 5. If any unfortunate death occurs in my family, I will bravely opt for electric cremation. 6. I will not smoke cigarettes nor allow anyone else to. 7. I will not smoke beedi or allow anyone else to. 8. I will resort to wet mopping the floors in my house and workplace. 9. Wherever possible, I will practice carpooling. 10. I will opt for public transportation as much as possible. 11. I will immediately get my vehicles checked for pollution standards. 12. I will walk or cycle for short distance commute. 13. I will make sure that the AC at my home does not have a choked filter. 14. I will check if the AC in my car or workplace has a choked filter, if yes I will get it restored. 15. I will check air purifiers at my home and workplace for choked filters and replace them if necessary. 16. I will not burn leaves. 17. I will not burn garbage. 18. I will reduce paper waste and not burn excess paper. 19. I will provide enough time for the AC and air purifiers to stabilize the ambient temperature before entering the room. 20. I will raise my voice against air pollution. 21. If at a petrol pump, I see no mechanism for absorbing toxic vapors, I will speak up. 22. I will object to any unsafe construction in my vicinity. 23. I will not allow construction material to linger on roads after the work is finished. 24. I will insist that the roads in my vicinity are cleaned only mechanically between 12 pm to 5 am. 25. I will talk to my RWA to plant more trees and make sure that pavements have no exposed soil. 26. I will sell my diesel car and buy a CNG one. 27. I will avidly vote for heavy taxes on crackers and tobacco. 28. I will educate people every day to avoid contributing to air pollution, and how to avoid pollutant

Wednesday 2 November 2016

Day four of Heart Care Foundation of India (HCFI)’s MTNL Perfect Health Mela sees enthralling performances bymedical and nursing students

Day four of Heart Care Foundation of India (HCFI)’s MTNL Perfect Health Mela sees enthralling performances bymedical and nursing students Key events included fashion show, choreography and singing competitions attended by 0ver 4000 students Topics covered include the prevention of lifestyle, water-borne and environmental diseases such as diharrea, chikungunya, dengue, malaria, obesity and heart disease New Delhi, 28th October 2016: Heart Care Foundation of India, a leading national non-profit organization committed to making India a healthier and disease free nation on the 4th day of its annual flagship event- MTNL Perfect Health Mela organized the Medico Masti festival an inter college youth fiesta at the Talkatora Stadium, New Delhi. Thousands of students offrom over 30 colleges participated in the event. On the spot competitions like fashion show, choreography, rock band, etc were organized as part of the festival. Other competitions included western and classical dancing, quiz contest, singing competition, etc. Infotainment is a new concept of creating health education and in this module education is interlinked with entertainment. Addressing the event, Padma Shri Awardee Dr KK Aggarwal - President of the Heart Care Foundation of India and President Elect said “That to prevent the increase of heart diseases in the nation, the prevention must start in college life. He said that college students should follow the principles of formula of 80 which is as under: To live more than 80 years without life style diseases keep your Abdominal Circumference, Lower Blood Pressure, LDL (bad) Cholesterol, Pulse Rate and Fasting Sugar all lower than 80.Anyone who gains weight of more than 5 kg after the age of 18 in girls and 20 in boys is obese and overweight. Any weight gain at this age should be avoided.” The Mela is providing free facilities like 3D echocardiography, ECG and consultations from all pathies. Those people can afford treatment will be guided and people who cannot afford treatment will get a subsidiary or free heart surgery. Keeping in mind the healthcare needs of the poor and needy, special free of diagnostic facilities and cardiac interventions will be provided by National Heart Institute for rheumatic heart disease and Medanta –Medicity will focus on congenital heart disease and also MTNL had set up live video conferencing unit at the mela with Medanta-Medicity. All medical students and other participants were also trained in the life-saving technique of Hands-only CPR 10 for the revival of people after a sudden cardiac arrest. The Hands-only CPR 10 formula is –within 10 minutes of the cardiac arrest (earlier the better) for 'at least' 10 minutes (longer the better) compress the center of the chest of the victim, continuously and effectively, with a speed of at least 10 x 10 (i.e.100) per minute. Early intervention can help save lives. An annual flagship event of the Heart Care Foundation of India, the MTNL Perfect Health Mela is taking place at the Talkatora Indoor Stadium from October 25-29, 2016. Shri Satyendar Jain – Hon’ble Minister of Health & Family Welfare, Govt. of NCT of Delhi and Dr SY Quirishi Former Election Commissioner, inaugurated the event on

Day two of Heart Care Foundation of India (HCFI)’s MTNL Perfect Health Mela educates school children about the prevention of modern day health epidemics

Day two of Heart Care Foundation of India (HCFI)’s MTNL Perfect Health Mela educates school children about the prevention of modern day health epidemics Key events included Heritage, Harmony, and eco-fest, which were attended by over 3000 students Topics covered include the prevention of lifestyle, water-borne and environment related diseases such as obesity,heart disease, diharrea, chikungunya, dengue, & malaria, etc. New Delhi, 26th October 2016: To ensure the health and well-being of a nation and to tackle the increasing incidence of lifestyle disorders from its very root, early preventive health education is extremely important. Keeping this in mind, the 23rd edition of Heart Care Foundation of India’s annual flagship event, the MTNL Perfect Health Mela dedicated its second day to inter-school competitions all themed around preventive health. Various competitions such as Indian classical dance, instrumental orchestra, eco-model creation, collage making along with paper bag making were held. The topics included saving mother earth, preventing water and mosquito-borne diseases by keeping one's environment clean, prevention of the depletion of the ozone layer for a cancer free society amongst others. Over 66 schools participated including DPS Mathura Road, DPS R K Puram, Cambridge Foundation, Aravali International School, Faridabad, The Indian School, Armay Public School, Dhaula Kuan and St. Mark’s Girls Sr. Sec. School. The students from St. Mark’s Girls Sr. Sec. School stole the show by bagging four awards in total. Speaking about the event, Padma Shri AwardeeDr. KK Aggarwal - President HCFI and President elect IMA said, “It has been Heart Care Foundation of India’s constant endeavor to continuously develop engaging and consumer driven modules to educate the masses about the importance of preventive healthcare and the Perfect Health Mela has been one of the most successful examples. Children from their early school years itself must be educated about basic disease prevention and the importance of health and hygiene. By keeping one's surroundings clean over 50% of the country's disease burden can be eliminated. In addition to this, children must also be taught about the dangers of smoking, obesity and eating unhealthy high-trans-fat food." In addition to the inter-school competitions, the Punjabi Academy showcased in a special event, a dance recital depicting the beauty and culture of Punjab. A total of 10 participants mesmerized the audiences by their performance. School students and other participants were also trained in the life-saving technique of Hands-only CPR 10 for the revival of people after a sudden cardiac arrest. The Hands-only CPR 10 formula is –within 10 minutes of the cardiac arrest (earlier the better) for 'at least' 10 minutes (longer the better) compress the center of the chest of the victim, continuously and effectively, with a speed of at least 10 x 10 (i.e.100) per minute. Early intervention can help save lives. An annual flagship event of the Heart Care Foundation of India, the 23rd MTNL Perfect Health Mela is taking place at the Talkatora Indoor Stadium from October 25-29, 2016. Shri Satyendar Jain – Hon’ble Minister of Health & Family Welfare, Govt. of NCT of Delhi and Dr SY Quirishi Former Election Commissioner, inaugurated the event on October25th. To know more about the Perfect Health Mela, please visit www.perfecthealthmela.com

Running clinics is not a commercial activity: High Court

Running clinics is not a commercial activity: High Court Vaibhav Ganjapure | Times of India | Oct 25, 2016 “A clinic run by a private doctor or their partnership firm can't come under the definition of 'commercial establishment' as per the Bombay Shops and Establishments Act, 1948, the Nagpur bench of Bombay High Court has held. Pronouncing the verdict on the plea filed by the Indian Medical Association (IMA) challenging the validity of Section 2 (7) of the Act, a division bench comprising justice Vasanti Naik and justice Indira Jain, made it clear that doctors or their partnership firms come under the category of 'professionals'. While quashing an amendment of 1977 carried out in the Bombay Shops and Establishments Act, 1948, the judges termed it as ultra vires (beyond the powers). The Maharashtra government through an amendment had brought all these professionals under the Act's ambit through an amendment and issued notices to them in 2005. They were threatened with imposition of fine which will increase with each passing day. In 2005, the Indian Medical Association (IMA), through counsel Bhanudas Kulkarni, challenged this amendment of inclusion of doctors contending that since they are governed by different Acts and even statutory bodies like Medical Council of India (MCI), and hence they are professionals. Citing Supreme Court's 1968 verdict and one more by the high court while hearing a criminal appeal, Kulkarni argued that the maternity home/clinic run by the doctor can't be termed as a commercial activity, as doctors provide service to patients. He pointed out that chains of hospitals can be termed as commercial activity, as doctors were paid for rendering their service. The government opposed his contentions, stating that similar plea by Matru Seva Sangh (MSS) was dismissed by the court earlier, but it failed cut ice with judges.”

The health hazards of Delhi’s increasing air pollution levels

The health hazards of Delhi’s increasing air pollution levels New Delhi, 31 October, 2016: Delhi’s increasing air pollution levels continue to concern the medical fraternity. Air pollution is linked to increased rates of morbidity and mortality, in particular from cardiovascular and respiratory illnesses. Environmental pollution, especially with high particulate matter PM 2.5 exposure, has also been proved to be linked with an increased prevalence of diabetes. It is thus important to raise awareness about the health hazards of high air pollution levels and necessary steps each one of us must take to stay healthy. “The extremely high level of air pollution in Delhi is a matter of concern for the medical fraternity as a whole and it is necessary that each one of us do our bit to help reduce this. It is important that people consider environmentally friendly options like carpoolling and should be encouraged to use public transport. Proper disposal of waste material is also essential”, said Padma Shri Awardee Dr. KK Aggarwal – National President Elect IMA & President Heart Care Foundation of India. “People at high risk include those with existing lifestyle diseases, children and the elderly. This group must not stay in densely polluted areas for a long period of time, wear masks and should avoid engaging in strenuous outdoor activities”, Dr. KK Aggarwal added. Research indicates that a decrease in the concentration of the fine particulate pollution (PM2.5) by 10 micrograms per cubic meter is associated with an increased life expectancy of 0.77 year and 15 percent of the overall increase in life expectancy. Air pollution is also associated with adverse effects on lung development and decreased lung function in children. In children with and without asthma, improvements in air quality (decreased levels of nitrogen dioxide and particular matter) is associated with improvements in both forced expiratory volume in 1 second and forced vital capacity between age 11 and 15.There is a known correlation between levels of air pollution and lung disease, but the association between air pollution and asthma is less clear. Here are a few tips to reduce your risk of illnesses triggered by high pollution levels- • Limit exposure to pollution • Eat a healthy diet with lots of fruits, vegetables and a diet rich in vitamin C, which can reduce the effects of air pollution • Drink plenty of water • Do not smoke, if you smoke, stop doing it • Avoid passive smoking • Avoid industrialized areas where pollution levels are high and air quality is at dangerous levels • Close the car's windows during peak traffic hours • Make sure that children wear anti-pollution masks while going outdoors • Practice good hygiene such as washing hands frequently, especially after you’ve been in a public place • In case you suffer from asthma, ensure that you always keep an inhaler handy • Do not exercise in outdoor spaces when the pollution levels are high

Calcium supplements cardiac safe

Calcium supplements cardiac safe A new joint clinical guideline, published online October 24, 2016 in the Annals of Internal Medicine, from the National Osteoporosis Foundation and the American Society for Preventive Cardiology states that dietary and supplemental calcium are safe for cardiovascular health if consumed in recommended amounts. The recommendation applies to calcium consumed either alone or with vitamin D that does not exceed the National Academy of Medicine's tolerable upper intake limit of 2000 to 2500 mg/day. Discontinuation of supplemental calcium for safety reasons is not necessary and may be harmful to bone health when intake from food is suboptimal A 2010 meta-analysis concluded that calcium increased the risk for myocardial infarction and stroke, while a 2011 meta-analysis concluded that calcium had no statistically significant effects on coronary heart disease events or mortality. Dietary calcium should be recommended over supplements. Calcium intake over the recommended dietary allowance is not better than intakes that just meet the allowance.

Pradhan Mantri Surakshit Matritva Abhiyan

Pradhan Mantri Surakshit Matritva Abhiyan Dear Colleague Government of India (GOI) is launching the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Programme on 4th November, 2016. Let us all support this programme and offer our services for providing antenatal check-ups to pregnant woman at government premises on 9th of every month. You can send your names to the undersigned or register yourself directly at 1800 180 1104. You can send SMS at PMSMA <space> <name> and send it to 5616115, or you can register at www.pmsma.nhp.gov.in. This is an important Government Initiative and IMA is committed to join hands with this Programme. You are requested to register with them and send your team on the 9th of every month. We must make sure that no mother should die due to lack of care during their pregnancy. Currently over 44,000 pregnant women die of annually of preventable high risk pregnancy. Dr S S Agarwal National President, IMA Dr K K Aggarwal National President Elect & Honorary Secretary General, IMA

High levels of fine particulate matter (PM2.5) in the air are extremely dangerous caution IMA & Heart Care Foundation of India

High levels of fine particulate matter (PM2.5) in the air are extremely dangerous caution IMA & Heart Care Foundation of India New Delhi, 1st Nov 2016: Air pollution has reached alarming levels in the light of recent Diwali celebrations coupled with changing weather conditions. The effects are also exacerbated by the cold weather to create poisonous smog. In light of this, IMA & HCFI have issued an advisory urging people to take necessary preventive steps and to stop adding to the environmental damage by bursting crackers. “Particle size PM2.5, the most dangerous air pollutant is extremely permeable to lung tissue linings and is undetectable by the naked eye. Its levels have crossed the 1000 mark in most parts of Delhi, a situation that is extremely dangerous for one’s health. People are requested to stay indoors as much as possible and to not exercise in the open,” said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) & National President Elect IMA. Air pollution can lead to symptoms like irritation of the eyes, nose, and throat, coughing, phlegm, chest tightness and shortness of breath in healthy people. These symptoms should go away when air quality improves. However, in people with pre existing health conditions like lung disease, asthma and COPD, the symptoms are much worse. These include the inability to breathe as deeply or as vigorously as normal, coughing, chest discomfort, wheezing, shortness of breath, and unusual fatigue. If you have any of these symptoms, reduce your exposure to particles and consult your doctors. “Heart patients and those with respiratory disorders need to be extremely cautious about particle exposure as it can cause serious problems – including worsening of your disease – in a short period of time,“ Dr KK Aggarwal added. HCFI & IMA’s emergency guide to tackle the ongoing crisis • Pollution is hazardous and steps must be taken to reduce the amount of polluted air that is inhaled by each one of us • Stay indoors: In a room or building with filtered air • Reduce activity levels. Avoid activities that make you breathe faster or more deeply. This is a good day for indoor activities, such as reading or watching TV. • Avoid using anything that burns, such as wood fireplaces, gas logs, gas stoves and even candles or incense. • Keep the room clean – but don’t vacuum unless your vacuum has a HEPA filter. That stirs up particles already inside your home. Wet mopping can help reduce dust. • Don’t smoke. • When the air quality improves, open the windows and air out your home or office. • Do not rely on dust masks for protection. Paper "comfort" or "dust" masks are designed to trap large particles, such as sawdust. These masks will not protect your lungs from small particles such as PM2.5. Scarves or bandanas won’t help either. • Disposable respirators known as N-95 or P-100 respirators can help if one is outdoor for a period of time. It’s important that one wear the respirator correctly, however. • Particle pollution can seep indoors, so consider purchasing an air cleaner if you live in an area with high levels of particle pollution. • Air cleaners that remove particles include high-efficiency mechanical filters and electronic air cleaners, such as electrostatic precipitators. Avoid using an air cleaner that works by generating ozone, which will increase the pollution in your home. • If you do not have air cleaners in your home, try to go somewhere that does have air filtration. • If you cannot buy filters for your entire home, create a clean room for sleeping. A good choice is a room with as few windows and doors as possible, such as a bedroom. • If the room has windows, keep them closed. • Run an air conditioner or central air conditioning system if you are certain your air conditioner does not draw air from outdoors and has a filter. If the air conditioner provides a fresh air option, keep the fresh-air intake closed. Make sure that the filter is clean enough to allow good air flow indoors. • Use an air filter in that room. • Air cleaners alone may not be enough. Because particle pollution from the outdoor air can easily get inside

All about pollution - Air pollution in the capital increased to dangerously high levels post-Diwali

All about pollution - Air pollution in the capital increased to dangerously high levels post-Diwali ‘One Health’ initiative is human health, animal health and environmental health together. It recognizes that the health of humans, animals and environment are all interrelated. Vedic science clearly says ‘As is the microcosm, so is the macrocosm’. This topic is especially relevant today as diseases like Dengue, Chikungunya, Zika, Japanese encephalitis are a cause of much concern today. With regard to animals, Bird flu has been in the news lately. And, environmental health is the rising pollution levels. Pollution has become a major threat to the health of society today. While earlier, one took note of the weather forecast, it is now time that one also take note of pollution levels in the area that you will be traveling to and accordingly plan your activities. Some key aspects of air pollution • Sulphur dioxide (SO2), oxides of nitrogen (as NO2), suspended particulate matter (SPM) and respirable suspended particulate matter (RSPM/PM10) are measured as part of air quality monitoring. • Particulate matter or suspended particles less than 10 micrometer in diameter are called PM-10. • PM10 will remain in the lungs and can damage the lung alveoli causing asthma and COPD and may later on permanently damage the lungs. • For India, the PM10 levels should be less than 100 and PM 2.5 levels should be less than 60. As per international recommendations, both PM 10 and PM2.5 should be less than 40. • Particulate matter or suspended particles less than 2.5 micrometer in diameter are called PM 2.5. • PM2.5 is absorbed in lung and enters circulation. It increases free radicals, cholesterol deposition and precipitate heart attack, stroke, hypertension. • Short-term exposure to PM2.5 pollutants is associated with acute coronary ischemic (insufficient blood flow in the coronary arteries of the heart) events. • Exposure to CO2, NO2, SO2, PM10, PM2.5 is associated with increased risk of heart attack (1.25%). • PM2.5 exposure can increase the resting blood pressure due to sympathetic overactivity. • PM2.5 exposure causes endothelial dysfunction. • PM2.5 exposure causes thickening of the blood. • PM2.5 exposure is linked with blockages in the heart. • High SO2 and NO2 levels may precipitate asthma attacks, or acute exacerbations of COPD. • High levels of NO2 and PM 2.5 can trigger atrial fibrillation with 2 hours of exposure. • The chances of irregular heart rhythm jumps by 26% for each 6 mcg/cu mm increase in PM 2.5 levels.

Monday 31 October 2016

The 23rd HCFI MTNL Perfect Health Mela concludes with star gazing performances and success of mass health awareness campaign

The 23rd HCFI MTNL Perfect Health Mela concludes with star gazing performances and success of mass health awareness campaign New Delhi 29thOctober 2016- Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation concluded its annual flagship event – the 23rdMTNL Perfect Health Mela today. The five-day event was organized in association with the IMA, MTNL, MCD and NDMC, Ministry of Science & Technology and Handicraft, Coca-Cola, LIC, AYUSH GOI, DCW, Women & Child Dev., Govt. of Delhi, DTTDC, Johnson & Johnson, Dept. of Environment Delhi Govt., DSACS, DHS, Drugs Control, Family Welfare Delhi Govt. & Delhi AIDS Cancer Society. The theme for this year’s event was ‘One Health’, a global concept; that recognises that the health of humans is connected to the health of animals and the environment. Experts at the Mela deliberated, debated and formulated a comprehensive strategy for the National management of new age health epidemics such as bird, flu, chikungunya, zika, malaria, dengue and swine flu. The Health Mela is a confluence of tradition and modernity and has successfully since the past two and a half decades been working towards creating mass awareness on all aspects of health; using a consumer-driven model as the medium. The grand inauguration of the event took place on 25th October in the presence of Shri Satyendar Jain – Hon’ble Minister of Health & Family Welfare, Govt. of NCT of Delhi and Dr SY Quirishi – Former Election Commissioner. Speaking at the valedictory, Padma Shri Awardee Dr KK Aggarwal, President HCFI & National President IMA urged everyone to have a healthy Diwali and to take necessary precautions to protect oneself and others from injury and harm. He strictly advised all to not burst crackers since the increasing pollution levels in our city are hazardous to one’s health and well-being. The five-day event served as a podium for over 50 on the spot competitions that witnessed participation of over 10,000 students. The various categories included Indian and western dance, fashion show, rock band, Mehendi art, collage making, painting, slogan writing amongst others. Special performances by the Punjabi Academy were the highlight of the event. The purpose behind the event was to bring forward infotainment as a way of imparting health education to the masses. As we all know that present day, India suffers from a plethora of modern day epidemics like Dengue, Swine Flu, and Diarrhea. A special focus was given during the event to educate the public about essential prevention measures and the need to maintain cleanliness and hygiene. A one of its kind inter-religious meet was also organised on the last day of the Mela. The panel constituted eminent Dharma gurus like Dr A K Merchant, Sec. General Temple of Understudy, Ven. Sumithananda Thero, Sec. Mahabodhi Society, Fr. (Dr.) M D Thomas, Christian Priest and Scholar, Dr. Hanif Md Khan Shahtri, Muslim & Hindu Scholar, Dr, Amrit Kaur Basra, Sikh Scholar, Acharya Dr. Ravindra Nayar, Priest, Birla Mandir, Acharya Vivek Muni, Jain Monk and Scholar, Sant Krishan Shah Vidyarthi, Head Prist, Valmiki Mandir, Mr. Keki Darnwala, Zoroastrian Scholar Ayuvedacharya & Hath Yogi, and Mr. Sahil Nath. The discussion ended with a conclusion that "everyone should learn how to tolerate each other in order to maintain peace and harmony and to avoid any disruptions and violence." Speaking at the valedictory Dr Dr ABP Mishra from DST ,said that "We all thank everyone who came and attended the 23rd Perfect Health Mela and made it such a success. We encourage everyone to inculcate healthy habits in their everyday lives and live diseases-free.” Heart disease patients belonging to the economically weaker section in need of surgical intervention were also provided financial and technical assistance by the Sameer Malik Heart Care Foundation Fund another project of HCFI. All visitors were also trained in the life-saving technique of Hands-only CPR 10

Pradhan Mantri Surakshit Matritva Abhiyan

Pradhan Mantri Surakshit Matritva Abhiyan Dear Colleague Government of India (GOI) is launching the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Programme on 4th November, 2016. Let us all support this programme and offer our services for providing antenatal check-ups to pregnant woman at government premises on 9th of every month. You can send your names to the undersigned or register yourself directly at 1800 180 1104. You can send SMS at PMSMA <space> <name> and send it to 5616115, or you can register at www.pmsma.nhp.gov.in. This is an important Government Initiative and IMA is committed to join hands with this Programme. You are requested to register with them and send your team on the 9th of every month. We must make sure that no mother should die due to lack of care during their pregnancy. Currently over 44,000 pregnant women die of annually of preventable high risk pregnancy. Dr S S Agarwal National President, IMA Dr K K Aggarwal National President Elect & Honorary Secretary General, IMA

Professionals are not doing commercial activity

Professionals are not doing commercial activity In the High Court of Judicature at Bo Bombay Nagpur Bench at Nagpur Writ petition no. 4579/2005 Petitioner: Indian Medical Association through its President Dr. Kishor Taori, Having office at IMA House, North Ambazari Road, Nagpur Respondents 1. State of Maharashtra, through its Secretary, Industries and Labour Department, Mantralaya, Mumbai -32 2. The Commissioner of Labour, State of Maharashtra, Mumbai. 3. The Deputy Commissioner of Labour State of Maharashtra, Nagpur Division, 240, Bhosla Chambers, Civil Lines, Nagpur. Shri B.G. Kulkarni, Advocate for petitioner and Shri A.V. Palshikar, AGP for respondents Coram: smt. Vasanti A Naik, and Kum. Indira Jain, JJ. Date: 21.10.2016 Oral judgment (Per: Smt. Vasanti A Naik, J) By this writ petition, filed by the Indian Medical Association, the petitioner has sought a declaration that the establishments of individual medical practitioners and the medical practitioners working in partnership are not commercial establishments within the meaning of Section 2 (4) of the Bombay Shops and Establishments Act, 1948. By amending the writ petition, the petitioner - Association has sought a declaration that the inclusion of the term `medical practitioners’ in the definition of 'commercial establishments' in Section 2 (4) of the act by amendment is violative of the provisions of Article 14 of the Constitution of India. Shri Kulkarni, the learned Counsel for the petitioner - Association states that the Hon’ble Supreme Court has held as early as in the year 1969 in the judgement, reported in 1969 Mh. L.J. 391 that the professional establishments of Doctors do not fall within the ambit of the definition of ‘commercial establishments' under the Bombay Shops and Establishments Act . It is stated that the judgment of the Hon'ble Supreme Court is followed by this Court in the judgment, reported in 1981.Mh. L. J. 635. It is stated that this Court has held in the order, dated 12.6.2014 in Criminal Writ Petition No.1731/2002 that the amendment, that is, sought to be challenged by the petitioner -Association in this case is ultra vires and is liable to be struck down. It is stated that by the order, dated 12.6.2014, Criminal Writ Petition No.1731/2002 was allowed after striking down the amendment, that is, sought to be challenged. It is stated that a similar view is expressed by this Court time and again and the prayers made by the petitioner need to be granted. Shri Palshikar, the learned Assistant Government Pleader appearing for the respondents does not dispute the position of law as laid down by the Hon’ble Supreme Court and this court in the aforesaid judgments. It is admitted that the questions involved in this writ petition stand answered in favour of the petitioner – Association, in view of the aforesaid judgments. Hence for the reasons recorded in the judgement, reported in reported in 1969 Mh. L. J. 391 and 1981 Mh. L. J. 635 and the unreported order, dated 12.6.2014 in Criminal Writ Petition No. 1731/2002,we allow this writ petition. In fact, we find that the declarations that are sought by the petitioner – Association already stand granted by the judgement that are rendered by the Hon’ble Supreme Court and this Court. Hence, we make the Rule absolute in terms of prayer clauses (i) and (i-a). No order as to costs.

Sulfa allergy

Sulfa allergy What are sulfa-containing antibiotics? Sulfa-containing antibiotics are sulfonamide antimicrobials and include trimethoprim/sulfamethoxazole (TMP/SMX), sulfadiazine and erythromycin/sulfisoxazole. How common is allergy to sulfonamides? About 4% individuals report an allergy to sulfonamide antimicrobials. What are non-antimicrobial sulfonamides? Commonly prescribed non-antimicrobial sulfonamides include furosemide, hydrochlorothiazide, acetazolamide, sulfonylureas and celecoxib. Do both causes hypersensitivity reactions? Sulfonamide antimicrobials differ in chemical structure from non-antimicrobial sulfonamides. These structural differences are implicated in the hypersensitivity associated with sulfa antimicrobials. What is drug allergy? Drug allergy or “hypersensitivity” is an immune-mediated response against any drug. The reaction may occur either immediately within an hour or it can be delayed occurring between 1 and 48 hours. • Immediate hypersensitivity is generally immunoglobulin E (IgE)-mediated and manifests as urticaria, angioedema, rhinitis, bronchospasm or anaphylaxis. • Delayed hypersensitivity is T-cell dependent and may present as either a maculopapular rash or more serious blistering and mucosal involvement, predicting development of Stevens-Johnson syndrome or toxic epidermal necrolysis. Is sulfonamide antimicrobial hypersensitivity immediate or delayed? Sulfonamide antimicrobial hypersensitivity is predominantly T-cell mediated and presents as delayed cutaneous reactions, such as a pruritic maculopapular rash, which occurs 1-2 weeks after exposure. IgE-mediated immediate hypersensitivity with sulfonamide antimicrobials is less commonly reported. What is the hallmark of sulfa antibiotic sensitivity? Skin involvement is the hallmark of most drug allergies. About 63% of reported TMP/SMX allergies are rash and hives. Sulfonamide-induced rashes usually start at the trunk and spread toward the limbs and generally resolve within 2 weeks after discontinuation of the medication. If mucosal membranes are involved or there are blisters, the patient may require hospitalization. More severe cases can present as a syndrome, including fever and organ damage, in addition to a generalized maculopapular rash. Rarely, sulfonamides have been associated with toxic epidermal necrolysis and Stevens-Johnson syndrome. Who are at risk of allergy? Patient-specific risk factors include a history of other drug allergies and previous use of the suspected medication or medication class. Drug hypersensitivity is reported more in women and individuals with comorbidities, such as HIV infection and systemic lupus erythematosus are known to be more susceptible to drug hypersensitivity. Drug-specific factors, including duration of exposure and dose, should be considered to differentiate drug toxicities from drug allergies. If a drug allergy is suspected, it is important to review the current medications, including non-prescription medicines and supplements that the patient may be taking to determine if the sulfonamide drug is solely responsible for symptoms. What is the role of desensitization protocols? Implementation of a desensitization protocol should be delayed for 1 month after resolution of symptoms. Can there be cross-reactivity with non-antimicrobial sulfonamides? Clinically significant cross-reactivity between antimicrobial and non-antimicrobial sulfonamides is not a concern. What are sulfites? Sulfites are found in processed foods and medication preparations, and they can trigger asthma exacerbations in patients with a history of asthma. Sulfites are chemically different from sulfonamides, so this reaction is unrelated to sulfonamide hypersensitivity. There is no risk for cross-sensitivity between antimicrobial sulfonamides and sulfur-containing compounds, such as sulfites. What are sulfur and sulfate? They are found naturally in the body; sulfa-containing amino acids (e.g., cysteine) and sulfate-containing drugs (e.g., ferrous sulfate) and dietary supplements (e.g., glucosamine sulfate) and are not allergenic in patients with antimicrobial sulfonamide hypersensitivity. What are topical sulfonamides? Topical sulfonamides are silver sulfadiazine and ophthalmic sulfacetamide/prednisolone. They are contraindicated in patients with documented sulfonamide allergy. What about sulfasalazine? A small study of 5 participants has reported cross-reactivity with sulfasalazine and antimicrobial sulfonamides owing to similarities in chemical structures. Points to ponder • The onset and types of symptoms, as well evaluation of pertinent patient data including previous exposure to an offending mediation can guide in the differential diagnosis of an allergic reaction to a suspected agent. • Sulfonamide hypersensitivity reactions frequently present as a maculopapular rash that resolves approximately 2 weeks after sulfonamide discontinuation. • Clinicians should be aware of signs of potentially serious delayed reactions, including blistering and involvement of mucosal membranes. • Cross-reactive hypersensitivity between sulfonamide antimicrobials and nonantimicrobials is unlikely. • Cross-sensitivity with sulfur-containing compounds, such as sulfites and sulfonamide antimicrobials does not occur. • Sulfur and sulfate-containing drugs are not allergenic in patients with antimicrobial sulfonamide hypersensitivity. • Topical sulfonamide antimicrobials are contraindicated in patients with sulfonamide hypersensitivity. (Source: Medscape)