Thursday, 25 May 2017

Proposed Revision of WMA Resolution on Tuberculosis: Inputs required

Document no:
SMAC 206/Tuberculosis REV/Apr2017
Proposed Revision of WMA Resolution on Tuberculosis

Constituent Members
Action(s) required:
For consideration
As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that the WMA Resolution on Tuberculosis should undergo a major revision. The Indian Medical Association (IMA) volunteered to undertake that work.
At its 204th session in Taipei (October 2016), the Council decided to circulate the proposed revised document within WMA membership for comments. The 206th Council session in Livingstone (April 2017) considered the revised version and decided to circulate it again within WMA membership for further comments.


1.            According to the World Health Organization, tuberculosis is a significant global public health problem affecting over 8 million cases every year with 2.2 million infectious cases and over 1.5 million deaths. South East Asian and African countries are most affected.

2.            In developing countries, the incidence of tuberculosis has risen dramatically because of high prevalence of HIV/AIDS, increasing migration of populations, urbanisation and over-crowding.

3.            The emergence of strains of tuberculosis bacteria resistant to first-line drugs have become a major public health threat in the forms of multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR TB) due to indiscriminate or inappropriate use, lack of access, poor compliance or incomplete treatment.

4.            MDR tuberculosis is a significant threat to development and the safety of global health.

5.            Community awareness and public health education and promotion are essential elements of tuberculosis prevention.

6.            Screening of high risk groups including PLHIV (people living with HIV) and vulnerable population including migrants, prisoners and the homeless is important in tuberculosis prevention.

7.            Rapid diagnosis with molecular tests and supervised daily treatment started at the earliest should help arrest the spread of disease.

8.            BCG (Bacille Calmette-Guérin) vaccination as early as possible after birth should continue until a new more effective vaccine is available.


8.       The World Medical Association, in consultation with WHO and national and international health authorities and organizations, will continue its work to generate community awareness about symptoms of TB and increase capacity building of health care providers in early identification and diagnosis of TB suspects and ensuring complete treatment utilizing Directly Observed Treatment Short course.

9.       The WMA supports calls for adequate financial, material and human resources for tuberculosis and HIV/AIDS research and prevention, including adequately trained health care providers and adequate public health infrastructure, and will participate with health professionals in providing information on tuberculosis and its treatment.

Health care professionals should have access to all required medical and protective equipment to prevent against the risk of infection and spread of the disease.

10.    The WMA encourages continuing efforts to build up the capacity of health care professionals about increase in the use of rapid diagnostics methods, their availability in the public sector and in the management of all forms of TB including (MDR and XDR).

11.    The WMA calls on its Member National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and in the community for early reporting.

12.    The WMA calls on its National Member Associations to propagate methods of TB prevention including respiratory hygiene, cough etiquettes, and safe sputum disposal.

13.    National Member Associations should encourage all its members to timely notify to relevant authorities, all patients diagnosed or put on TB treatment for initiation of contact screening and adequate follow up till the completion of treatment.

14.    National Member Associations should co-ordinate with their TB National Programme and promulgate the adopted guidelines to all members.

The WMA supports WHO's efforts and call upon all governments, communities, civil society and the private sector to act together to end tuberculosis world-wide.

All should jointly promote collaboration using new innovative approaches to achieve TB free World and achieve the Sustainable Development Goals (SDGs).

Postnatal depression is a silent killer in India

Postnatal depression is a silent killer in India Timely intervention can help cure 80% of such cases New Delhi 24 May 2017: Postnatal depression is an illness that affects about 20% of mothers in developing countries like India, according to the World Health Organization. However, this kind of depression is still not recognized much. There are roughly 130 million births every year in India and provided this situation is addressed, the number or women with clinical depression is only likely to increase in the coming years. There are many factors that trigger depression in new mothers, some of them being unplanned pregnancy, an abusive relationship, alcoholic spouse, pressures to have a male child, and hormonal changes. The symptoms of postnatal depression tend to often go unnoticed. Some of them include anxiety, crying spells, mood swings, lack of sleep, difficulty in bonding with the baby, and negative thoughts and hallucinations. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "A majority of new mothers experience some amount of distress. This may sometimes require medical help and counseling. However, the symptoms often go unnoticed in the excitement of welcoming a baby. Postnatal depression is often accompanied by phobia and anxiety. Timely intervention can help cure 80% of such cases in a matter of 5 to 6 months. However, the remaining 20% can develop severe mental depression and other related ailments." Postnatal depression can have other related effects as well. Stress can affect milk production in new mothers thereby hindering lactation. As a result, the baby may become irritable and not achieve adequate physical and mental growth. Dr Aggarwal further added, "One of the major challenges in addressing postnatal depression is the lack of awareness, ignorance and social stigma surrounding this condition. A majority of women do not recognize or are unable to understand the symptom that follow childbirth. Even if they do, many are unwilling to seek medical help as psychiatric problems are not taken very well in the Indian society even today. The need of the hour is to create awareness among pregnant women, new mothers, and the family and counsel them on how they can support the women through this phase. " Here are few things one can do as a new mother to understand and cope with their anxiety. • Get enough rest. Tiredness can make anxiety worse and give you a constant gloomy feeling. Try catching small naps when the baby is asleep. • Eat at smaller intervals. Low energy levels can impact mental health. • Try not to feel guilty about not helping around the house. Understand that this is a temporary phase and it is not wrong to ask for help. • Indulge in activities that can help you in getting distracted from any negative thoughts, such as reading a book and listening to music. Take a short walk if it helps you feel better • Lastly, do not compare yourself with other mothers. Each pregnancy is different and understanding this will help you feel better.

Wednesday, 24 May 2017

PCOS a major cause of infertility among Indian women

PCOS a major cause of infertility among Indian women Study finds about 25% of Indian women to be suffering from this condition, excess weight being a major contributing factor New Delhi 23 May 2017: According to a study by the PCOS Society, 1 in every 10 women in India suffers from polycystic ovary syndrome (PCOS). Out of every 10 women diagnosed with this condition, 6 are teenage girls. PCOS is a common endocrinal system disorder among women of reproductive age. Additionally, about 20% to 25% of the women in India who are in the childbearing age suffer from PCOS, shows a study conducted by the department of endocrinology and metabolism, AIIMS. Those with PCOS have been found to have higher than normal insulin levels. Such an increase in the level of insulin can make the ovaries produce more androgens such as testosterone. Such women therefore struggle with weight issues, complicating the disorder further. If left unchecked or undiagnosed, PCOS can lead to infertility and a host of other long-term health concerns. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "PCOS can lead to the development of cysts as the ovaries are unable to release eggs on time. As a result of this, the follicles keep growing and form multiple cysts, which appear like 'a string of pearls'. Women are more likely to develop PCOS if their mother or sister also have this condition. The symptoms of PCOS include weight gain, fatigue, unwanted hair growth, thinning hair, infertility, acne, pelvic pain, headaches, sleep problems, and mood changes. Symptoms can begin shortly after puberty and reach into early adulthood. Young girls with PCOS tend to have irregular periods or amenorrhea, and heavy or scanty bleeding during menses. PCOS can also make women vulnerable to other health complications like hypertension, high cholesterol, anxiety and depression, sleep apnea, heart attack, diabetes and endometrial, ovarian and breast cancer." Though PCOS cannot be cured, it can be managed by bringing about certain lifestyle changes such as losing up to 5% to 10% of body weight. It is also important to maintain an active routine and eat healthy. Adding further, Dr Aggarwal, said, "PCOS, particularly among young girls, is an urgent public health problem requiring careful assessment, timely intervention, and appropriate treatment. The best possible way to manage this condition is exercise and a healthy diet which in turn will regulate the menstrual cycle and lower blood glucose levels." Additionally, the following tips can help manage PCOS better. • Consume foods that are high in fibre such as broccoli, cauliflower, and spinach; nuts like almonds and walnuts; and foods rich in omega-3 fatty acids. • Have five small meals instead of three big meals as this will help in metabolizing food and maintaining weight. • Indulge in physical activity for about 30 minutes a day, five days a week to reduce or maintain a reasonable weight.

Straight from the heart: The plight of the medical profession today

Straight from the heart: The plight of the medical profession today IMA is the voice and represents the collective consciousness of the medical profession in the country. It practically covers all the doctors in India directly through its membership of 3 lakhs, spread over 30 States and 17 Local Branches, and indirectly through federation of medical associations to the rest of the medical professionals in the country. IMA also is connected to every medical professional in the world through the Confederation of Medical Associations in Asia and Oceania (CMAAO) & the World Medical Association (WMA). The medical profession is going through its toughest time with the nobility and dignity of medical profession at stake. Some black sheep amongst us are taking away the entire nobility and dignity of the medical profession. They must be exposed at the earliest. Medical profession was, is and will always remain noble. First and foremost, it is important for us to understand that we are medical professionals and not a business house. To run a business, a businessman does not require a registered degree or follow a professional code of conduct. But we, professional doctors, are being controlled by corporate houses whose ethics differ from that of ours. They can market, distribute commissions and advertise their services, which is unethical for professional doctors and is a professional misconduct as defined by the MCI Code of Ethics Regulations. Bureaucrats and legislators must look into this matter and allow only professionals to own, manage and/or run medical establishments. Have we ever heard of law firms and legal arbitrators owned by business houses? To prosecute a doctor for criminal medical negligence, any medical action taken by him/her, should have been done with an intention to harm or with the knowledge that it can cause harm and the patient is not informed about the same. But, this is not the case in a medical practice, we never treat with an intention to harm or treat without an informed consent. Then why are doctors again and again subject to criminal prosecution? Criminal prosecution of doctor should be an exception and not a routine. The situation today is that doctors now are being prosecuted in various special acts for non-professional activities like not wearing apron, not displaying a defined board or not keeping a copy of PC PNDT Act. Doctors are also being prosecuted for minor violations of privacy, confidentiality of patient information and data and violations of minor clauses in surrogacy, IVF and HIV-AIDS Acts. This is not acceptable to the medical profession. Doctors provide subsidy to the patients. Doctors, whose consultation fees may be more than Rs. 2,000/-, constitute only a small percentage. Most GPs in metro cities charge less than Rs. 200/- as their consultation fee; often this also includes dispensing medicines along with professional consultation. To err is human. Doctors are bound to make mistakes and are covered for the same under indemnity insurance. But the compensation awarded for negligence cannot be in crores. There are more than six cases on record, where the compensation awarded against the doctors have ranged between 1 and 12 crores. Also, the method used for calculation of compensation is based on the income of the patient and not the seriousness of the illness. For the same amount of fee charged by a doctor and for the same illness depending upon the income of patient, the compensation awarded may be in lakhs or crores. The formula 70 - age x annual income + 30% - one third should not be acceptable to medical profession as it discriminates a poor from the rich. The formula of compensation calculation for drug trials as defined by the Drugs and Cosmetic Act may be the best alternative. This formula depends on age and the seriousness of the patient. Doctors are professionals and professional autonomy is their right. It is the duty of the doctor to provide rational treatment, which includes rational use of drugs and investigations. No one can take away this autonomy from a doctor. The job of a doctor is also to provide affordable, quality and safe health care. Today, most doctors are not informed about any new drug launched in the country, drug/s banned in the country, drugs found to be substandard quality or fake/spurious drugs. Similarly, any drug labelling changes, whether deletions or additions, are not communicated to the doctors. So, all doctors today depend on the industry to update their knowledge. The government allows the same salt to be sold by the same company at three difference prices as generic-generic, generic-trade or generic-branch. Why does the government not adopt ‘one drug - one company - one price’ policy? How can the government grant a license to companies to sell drugs at different rates, but then forces doctors to choose only the cheaper drugs? It’s like giving licenses to open five star hotels, but simultaneously issuing an advisory to the public to not to go these hotels. Medical profession is not against accountability, but violence at any cost is not acceptable. Disturbing a doctor while he/she is on duty in the critical area, either verbally, mentally or physically, is not acceptable. Any act of violence against doctors should be made a punishable, non-bailable offence with imprisonment of up to 14 years. The doctors posted in critical areas are on a sensitive duty, where they look after critically ill patients and violence can endanger multiple lives. A stringent central law is the only answer. Every critical area in the hospital must have voice activated CCTV camera and adequate doctor-to-patient ratio. The government policy of allowing four minutes per patient needs to be changed. Doctors also want single window accountability for registration for license to practice and registration of their medical establishment. Let doctors concentrate on their professional work and not divert their energies in permissions and administration matters. MBBS doctors are the need of the hour. They need to be cultivated and empowered. They should be involved under retainership in all national health programs. More than 25,000 postgraduate seats need to be introduced in family medicine. There must be a simpler way for them to get PG after completing their MBBS. It does not make sense for them to appear in another exam (NEXT) to get license to practice. As per the government, there is a shortage of doctors in rural areas. A rural posting is challenging and a difficult posting. Therefore, doctors posted in rural areas must be given income tax-free double income compared to a person practicing in an urban area. The professional autonomy must also be respected for specialists and for regulatory bodies. Consultants cannot be given targets to achieve and the government cannot take away the autonomy of the regulatory body ‘Medical Council of India (MCI)’ and bring a nominated national medical commission in its place. A knife in the hands of a monkey and modern medicine in the hands of quacks, chemists and doctors of other systems of medicine can kill a person. The general public has right to get the best of the treatment. Every citizen has a right to receive affordable or free preventive and emergency health care. If the government cannot provide this, then it shall ensure its availability through private sector for which the government should reimburse the same. But all this is not possible without increasing the health budget to 5% of GDP. At present, the government is looking after only 20% of population in the government sector for which 1% of budget may seem reasonable to them. All our doctors in service, residents and medical faculty must get uniform conditions of service, may it be with regard to retiring age, salary, or other service conditions etc. No way doctors can be kept on contracts and not made permanent for decades. Doctors are often blamed of being in a nexus with chemists, industry, hospitals and laboratories. One must not forget that for any unethical act, the ethical act needs to be defined first. If a pharma company is updating my knowledge free of cost and if I choose a drug of that company out of over 50 brands available in the market, I cannot be blamed of being partial. Anyone can criticize me but not the MCI or the ministry as pharma companies are doing their job of updating my knowledge. Similarly, any referral with a service involved is not a cut or a commission. If I refer a patient to a specialist and make a detailed summary, then I am entitled for my services to be paid by the patient. Let the government not forget that they are supposed to look after 100% of the population and not differentiate the poor from the rich. Today the private sector is forced to cater to 80% of the health care and is overburdened. But at what cost? The private sector should in fact be provided with all possible subsidies for the same. All this is possible and not difficult to achieve. IMA is willing to spend two hours every day at Nirman Bhawan and work hand in hand alongside the government. To our fellow colleagues, I say, all doctors are good. Let us not criticise each other and defame the medical profession. I hope this “straight from the heart” reaches the “Mann ki Baat” of the Prime Minister

Tuesday, 23 May 2017

IMA to organize Dilli Chalo movement

IMA to organize Dilli Chalo movement Over a lakh doctors to join the movement digitally and physically to bring to light atrocities faced by the medical fraternity New Delhi, 22 May 2017: The National IMA is organizing the Dilli Chalo Movement on 6th June 2017 to bring forth the atrocities faced by the medical fraternity and has urged all its members to join the movement in entirety. The Protest March will start at 8:00 AM from Rajghat and reach the Indira Gandhi Indoor Stadium by 11:00 AM. The march, which will be joined by over a lakh doctors in the country, both digitally and physically, will be followed by deliberations on issues ailing the medical profession. The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of FOMA were also conducted. The IMA is undertaking targeted intensive lobbying in the month of May. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "The medical profession is facing the most difficult time of the era. Both doctors and patients have to understand that the 'Doctor–Patient' relationship is a sacred one and that the dignity of the profession should be maintained. It won't be wrong to say that justice has been denied to doctors even within the framework of the constitution of India. People are indulging in violence against doctors which is further being condoned by governments and other institutions. Prescription rights of doctors are being trampled upon which can have disastrous consequences for patients. There is absolutely no end to the injustice being heaped upon the medical fraternity and this noble profession. It is after having decided that enough is enough that the IMA has given this clarion call, Dilli Chalo." IMA is also initiating a signature campaign on the issues at hand on social media and has urged all doctors to join and collect hundreds of thousands of signatures to demand justice from the government. Adding further, Dr Aggarwal, said, "NEXT was stopped on track by the all-India strike by medical students on 1 February. IMA is now launching No to NEXT 2.0 on 6th June 2017. As part of this, all medical students and colleges in the country will go on strike and conduct protest meetings. The Pen Down Satyagraha will see all doctors across India, in all sectors, not giving any prescriptions for one hour between 10 am and 11 am in solidarity with the Dilli Chalo movement to save professional autonomy." The Dilli Chalo movement aims to address the following demands by the medical fraternity: • Implementation of the Inter-ministerial committee meeting report within six weeks • Stringent Central Act against violence on medical professionals • Single-window accountability with no criminal charges on doctors without intent to harm a patient • Single-window registration of doctors and medical establishments • Preserving professional autonomy by amending Indian Medical Council Act instead of bringing national medical commission • Uniform final MBBS exam instead of 'NEXT' • Pan-India uniform service conditions for medical doctors and other health care providers • Amendments in PC PNDT, Central CEA, and West Bengal CEA Acts • IMA member in every government health committee • No commercial rates on medical doctors providing subsidy • Anti-quackery laws (no one other than qualified MBBS or BDS can prescribe scheduled modern medicine drugs) • Protection of professional autonomy (no interference in freedom to choose quality affordable drugs, investigations, and treatment) • No variation in market prize for generic-generic, trade-generic, and brand-generic drugs • Reimbursement of all emergent services in private sector for people who cannot afford treatment • Health budget of 2.5% in the coming year • Promotion of family medicine in India with 25,000 PG seats in family medicine

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA This is not true: Indian Medical Association Dr KK Aggarwal National President IMA DNA has reported a Lancet study that India's poor ranking is primarily because of the rise in cases of tuberculosis (TB), diabetes, rheumatic heart disease and chronic kidney disease. India has failed to achieve in healthcare goals, badly lagging behind China, Sri Lanka and Bangladesh in terms of accessibility and quality. India was ranked 154th position in the ranking of healthcare quality amongst 195 countries, whereas some countries like South Korea, Peru and China have seen greatest improvements in healthcare access and quality since 1990. China, with a score of 74 on the index, has been ranked at 82 - far ahead of India, and Sri Lanka has scored 73 on the index. Similarly, Brazil and Bangladesh have score 65 and 52, respectively. India performed worse than expected in TB, diabetes, rheumatic heart disease and chronic kidney disease. The 32 diseases for which death rates were tracked included TB and other respiratory infections, illnesses that can be prevented with vaccines - such as diphtheria, whooping cough, tetanus and measles - several forms of treatable cancer and heart disease, and maternal or neonatal disorders. I do not agree. This is not the correct picture. Government statistics are based on data from government set ups, which cater to only 20% of the society. The remaining 80% are seen by the private sector. When we say 10 million cases of TB are missing from government data, this does not automatically mean they do not get treatment. In fact they might be getting better treatment than the government sector. Private sector results for all these 32 diseases may be better than in the government sector. We should not extrapolate any inference from such studies. Unfortunately, British media is always negative with regard to the Indian health scenario. Why, we do not know? Most of their stories against India are negative. Is medical tourism in India responsible for it?

Monday, 22 May 2017

IMA calls for issuing "Good Standing Certificate" to doctors

IMA calls for issuing "Good Standing Certificate" to doctors Writes to MCI in light of a recent incident to carry out probe against a doctor New Delhi, 21 May 2017: In light of a recent incident, the IMA has written to the MCI expressing its viewpoint about NRI doctors barred abroad working in India. As per the US court, the doctor has been ordered “not to practice medicine in any form within the United States or any other country". As per a recent court directive, based on news reports that an Indian-origin doctor, who has been barred from practicing by a US court, is now treating patients in Delhi and Gurgaon, the Member Secretary of Delhi State Legal Services Authority, Sanjeev Jain, was asked to verify the doctor's name and address, carry out an immediate probe, and file a report within four days. It also issued notice to the MCI to file a report on the mechanism, statutory regime as well as rules and regulations in place to scrutinize and check such practices and made the Ministry of Health and Family Welfare a party. Speaking collectively on behalf of IMA, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "IMA is for a defined policy in such cases. We believe that the MCI needs to issue a 'Good Standing Certificate' to all graduates and post graduates who wish to register with registering authorities in other countries. This will serve as an indication of a good track record and also be a proof of the fact that the concerned person has committed no ethical breach and/or violation. A similar condition should also be imposed for Indian doctors practicing in other countries and wanting to come back and practice in India after getting registered in another country. This will ensure transparency and hence, lesser mishaps of the nature." At Delhi High Court, a bench of Acting Chief Justice Gita Mittal and Justice V K Rao, took a suo moto note to examine the issue on whether Indian-origin doctors, barred from practicing by a foreign country can practice in India. Adding further, Dr Aggarwal, said, "It is just a way to ensure quality of doctors is maintained. If we are asked for a certificate when we go to practice abroad then why can’t we ask for it from those who want to practice in India. We had spoken to MCI officials about this and they asked us to write to them."

Vedas and fertility

Vedas and fertility Infertility has been known from the Vedic era. Examples of fertility and assisted reproduction can be read in cases of King Dashrath, Ganesha, Kartikeya, Dhritarashtra, Vidur and Pandu etc. The three Shahi Snans mentioned in our Vedic literature are undertaken in the month of Magh, Vaishakh & Kartik (Vikram calendar) months. Shahi snan denotes exposure to sunlight to get Vitamin D. The rituals also involve eating the calcium-rich sesame seeds in a fasting state. Increase in both vitamin D and calcium are necessary to increase fertility. The main wedding season starts from Devuthan Ekadashi, Tulsi Vivah followed by Amala Navami. The seeds of Shyama Tulsi are known to increase the viscosity of semen and in women they help the release of eggs, a clomiphene-like action. Amla also increases sperm concentration. Pooja means dharam karam i.e. whatever we offer to God, we should also offer to ourselves (God is in me, the basis of Advaita philosophy). Indian doctors have been practicing Fallopian tube patency test or HSG (hysterosalpingography) for years. In this test, water or medicated oil dye is used to test and flush the fallopian tubes. It was noticed that post-HSG, the women showed improved fertility. Now, with the advent of CT, MRI and hysteroscopy, use of HSG has reduced, while the need for IVF has increased. Can we consider the use of vedic era methods and HSG to get better fertility results? Unfortunately, IUI, which was done by GPs, has gone in disrepute because of some unethical practices by so-called sadhus and saints and is now in the domain of IVF specialists only to the extent that it is now being covered under a separate Act. Dr KK Aggarwal National President IMA & HCFI

Sunday, 21 May 2017

India is the diabetes capital of the world

India is the diabetes capital of the world As many as 50 million people in the country suffer from Type II diabetes with the number likely to reach 87 million by 2030 New Delhi, 20 May 2017: According to statistics, India is the diabetes capital of the world with as many as 50 million people suffering from type-2 diabetes. The country certainly has a challenge to face with the number likely to increase from 51 million in 2010 to 87 million in 2030. However, timely detection and right management can help patients lead a normal life, feel medical experts. The WHO fact sheet on diabetes indicates that an estimated 3.4 million deaths are caused due to high blood sugar. Diabetes mellitus is one of the world's major diseases. If not monitored on time, diabetes can lead to an increased risk of vascular complications like cardiovascular, renal, neural and visual disorders which are related to the duration of the disease. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Diabetes mellitus is caused due to insufficient production and secretion of insulin from the pancreas in case of Type-I diabetes and defective response of insulin Type-2 diabetes. Insulin, a hormone produced by the pancreas, helps lower the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize it. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. A lot of times, resistance and feeling of disbelief that 'I can have diabetes too' makes most patients defer on detection and treatment which can lead to complications." Although this is a chronic medical condition, it can be curbed at the initial level with lifestyle changes and controlled after its incidence with medicines in early stages and external insulin in advanced stages. However, this disease cannot be cured completely and lasts a lifetime. Adding further, Dr Aggarwal, said, "Regular check-ups and timely detection have a vital role to play in controlling and managing this condition. It is imperative for patients to adhere to medication and changes in lifestyle as this can help them lead a normal life." The following lifestyle changes can help manage this condition better. • Eat healthy What you eat affects your blood sugar levels. Consume plenty of vegetables, fruits, and whole grains and limit foods high in sugar and fat. • Exercise For those who are not active, now is the time to start. Walking, cycling, and running are all good to get you going. An active lifestyle helps you control diabetes by bringing down your blood sugar. • Get regular checkups Diabetes raises the odds of getting a heart disease. It is important to keep track of your numbers by getting regular checkups done. • Manage stress Stress shoots up the blood sugar levels. Find ways to relieve stress through breathing exercises, yoga, or hobbies that help you relax.

There is still confusion among doctors regarding the word “Generic”

There is still confusion among doctors regarding the word “Generic” Confusion still prevails among doctors as to what does the word “Generic” mean. I have tried to explain what is a generic drug as below. There are two types of drugs - patented or generic. The patented drugs are introduced in the market by the original company that researched the basic molecule. Let us take the example of Pfizer, which introduced two original molecules - Amlodipine and Sildenafil – and launched them in the international market as Amlogard (Amlodipine) and Viagra (Sildenafil). Being their research molecules, Pfizer had exclusive rights for 10 years based on their patent. These drugs are called patented drugs and the pharmaceutical company will have exclusive rights to them till the patent expires. After 10 years as the patent period expires, other companies can also market these molecules under their own brand name or as generic molecules. These are called non-patented generic version of the drugs. There is no difference by law in the quality of generic or patent versions of the drugs. For example, amlodipine in India is still available as Amlogard (Pfizer) @ Rs. 8/-; however, Dr. Reddy’s Lab also markets it as Stamlo, at less than Re.1/-. Similarly, Viagra (Sildenafil) was introduced @ Rs 600/- during the term of the patent, but the generic version is now available at less than Rs. 25/-. When we are asked to write generic name of the drug/s, this means that we should write the generic version of the drug/s and not the patented drug/s still marketed in India. Prescribing Amlogard or Viagra, when the generic Indian versions are available, cannot be justified. The generic version will be available at fraction of a cost than the patented versions. Let us take another example of the patented drug Clopidogrel, which is available as Plavix (original drug) and Deplatt, the Indian generic version. Plavix costs Rs.100/- and Deplatt Rs 5/-. Why write imported patented versions, when Indian generic versions are available. India is the largest exporter of generic versions of the drugs in the world as they can manufacture drugs at fraction of a cost compared to international brands. The word ‘Brand’ has nothing to do with the words ‘generic’ or ‘patented’ drugs. In India, generic versions of drugs can be sold in the name of molecule (generic-generic) or brand (generic-brand). The only thing that the Indian Medical Association (IMA) wants is that all generic versions of drugs in India should be permitted to be sold only at one price by one company. At present, the generic versions are being sold at three different prices (generic-generic, trade-generic and branded-generic) by the same company. Dr KK Aggarwal National President IMA & HCFI

Saturday, 20 May 2017

Cryptosporidium in swimming pools can cause of diarrhea

Cryptosporidium in swimming pools can cause of diarrhea Maintaining pool hygiene and self management are key to warding off this dangerous parasite New Delhi, 19 May 2017: In what can be called as avoiding another risk factor in the summer months, experts have advised against consumption of swimming pool water. Any inadvertent ingestion of even chlorinated pool water can produce cryptosporidium which results in stomach upset. Statistics indicate that the prevalence of this disease in diarrhoea patients in India is 1.3% from Northern India, 4.5% from the eastern part of the country (West Bengal), 5.5% from South to West (Mumbai), and 13.1% from South India.
"Cryptosporidium" or "Crypto", the microscopic parasite can make otherwise healthy adults and children feel incredibly sick with stomach cramps, nausea, and bouts of diarrhea lasting up to three weeks. Once a pool or water playground is infected with crypto, it is easy to spread, but not easy to get rid of. The parasite can survive up to 10 days in properly chlorinated water, and it takes just a swig to get sick.
Speaking about this, , Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr R N Tandon – Honorary Secretary General IMA in a joint statement, said, "The infection begins when a person ingests the one-celled cryptosporidium parasite. There are some strains of cryptosporidium which can cause more serious issues. This parasite can travel to the intestinal tract and settle into the walls of the intestines. Once this happens, more cells are produced and shed in massive quantities into the feces becoming highly contagious with time. It is difficult to eradicate this parasite because of its resistance to many chlorine-based disinfectants and filters." The only way to ensure the health of the water once it has been infected is to close the pool and treat it with extremely high levels of chlorine. At an individual level, it is important to take precautions when swimming in pools. Adding further, Dr Aggarwal, said, "Avoid swallowing any water and rinse it off in the shower once you get out of the pool. It is also better to avoid the pool while you are sick and wait for two weeks after symptoms subside from a suspected case of crypto before going swimming." Additionally, the following steps can be taken as part of self-management against contracting this disease. • Use the toilet before entering the pool • Shower and wash thoroughly all over with soap before entering the pool • Take kids on bathroom breaks. Check diapers, and change them in a bathroom or diaper-changing area–not poolside–to keep germs away from the pool.

New guidelines for ‘deprescribing’ PPIs

New guidelines for ‘deprescribing’ PPIs Proton pump inhibitors (PPIs) are a very commonly prescribed class of drugs for patients with acid peptic disorders. They have been generally regarded as safe and well tolerated. And, their long-term use is common. However, recently, there have been concerns about the use of PPIs, especially long-term use. PPIs have been linked to increased risk of osteoporotic fractures, pneumonia, Clostridium difficile infection and rebound acid hypersecretion, especially in the older population. Long-term use may also affect patient compliance to the prescribed treatment. Evidence-based recommendations published in the May 2017 issue of Canadian Family Physician to help the physician decide when and how to safely stop the PPIs or reduce their dose, called ‘deprescribing’ PPIs. This can be done in three ways: • Reducing the dose by ‘intermittent’ use for a fixed duration; ‘on-demand’ use or using a lower ‘maintenance’ dose. • Stopping the drug can be done by abruptly discontinuing the drug or via a tapering regime. • Stepping down means abrupt discontinuation or PPI tapering followed by an histamine-2 receptor antagonist (H2RA) These guidelines recommends deprescribing PPIs in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease (GERD) or esophagitis, and whose symptoms are resolved. • Decrease the daily dose or stop and change to on-demand use. This has been given a strong recommendation. • Or, an H2RA can be considered as an alternative to PPIs. This alternative has been given a weak recommendation due to the higher risk of symptoms recurring. These recommendations are not applicable to patients who have severe esophagitis grade C or D, or a documented history of bleeding gastrointestinal ulcers or have Barrett esophagus. (Source: Can Fam Physician. 2017 May;63(5):354-364) Dr KK Aggarwal National President IMA & HCFI

Friday, 19 May 2017

All IMA members should trace every positive HIV person

All IMA members should trace every positive HIV person It is imperative to start ART irrespective of CD count or clinical stage once a person is tested HIV positive New Delhi, 18 May, 2017: According to statistics, out of the 21 lakh people with HIV in India, only 14 lakh are on the registry. About two-thirds of people with HIV/AIDS die due to lack of access to antiretroviral drugs (ART). With these statistics as the basis, the IMA has adopted government 90:90:90 strategy: to identify 90% of those infected, place 90% of them on treatment, and ensure 90% have the virus under control. This is a part of IMA's commitment on “ending AIDS by 2030” in line with the Sustainable Development Goals (SDGs). As per the new policy, ART will be provided to anyone tested and found positive for AIDS, irrespective of CD count or the clinical stage they are in. This policy is being propagated in a big way by IMA and is also being practiced by the private sector. Speaking about this pertinent issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr R N Tandon – Honorary Secretary General IMA in a joint statement, said, "It is a fact that a majority of people diagnosed with HIV/AIDS in India lack access to the initial and most important phase of treatment. This policy being adopted is for all men, women, adolescents, and children who have been diagnosed with HIV/AIDS. It will improve the lifespan and quality of life of those infected, and save them from many opportunistic infections, especially TB. These benefits begin even when ART is started in early HIV infection, reducing the risk of HIV transmission as well. This collective step by IMA is a small step towards the larger goal of ensuring access to ART for all and achieving the target of ending AIDS by 2030." ART is an effective way of suppressing serum viral RNA levels and increasing CD4 cell counts in the vast majority of patients with acute and early HIV infection. Initiation of ART earlier after initial HIV infection can help in immune reconstitution to normal or near normal CD4 cell levels. Adding further, Dr Aggarwal, said, "In India, ART has been available since 2004. At ART clinics, HIV positive people have access to HTC, nutritional advice, and treatment for HIV and opportunistic infections. The need of the hour is for initiatives that can help provide a larger access to ART for those infected with HIV." People with AIDS still face much discrimination and stigma in the society. Although, India’s treatment programme is an example to the world of what can be achieved through committed collaboration, there is still a long way to go. Much has been learnt from the past experiences and it is important to continue building on the strong foundation created. Free ART, along with care and support services will ensure timely treatment and a positive outcome on this front.

Skipping physical activity for even 2 weeks may increase health risks

Skipping physical activity for even 2 weeks may increase health risks The importance of remaining physically active cannot be emphasized enough. Physical activity is critical for maintaining a healthy weight, controlling illness, promoting bone strength, reducing stress and improving general well-being.
The adverse effects of a sedentary lifestyle on health have also been well-documented. Adding to the body of evidence, a new study involving young and healthy adults, presented at the European Congress on Obesity in Porto, Portugal has shown that even taking a 2-week break from physical activity can adversely impact health.
Researchers from the University of Liverpool, UK have shown that just 2 weeks without regular physical activity can lead to metabolic and muscular changes in the body predisposing the individual to the risk of developing type 2 diabetes, heart disease and possibly even premature death. All the study participants were physically active and walked 10,000 steps daily on average and had an average body mass index (BMI) of 25 at baseline.
The exercise regime adopted during the study period of 2 weeks reduced their activity by more than 80%. And at the end of the study period, the daily step count was only around 1500. The amount of food consumed did not change.
The moderate-to-vigorous activity time reduced from a daily average of 161 min to 36 minutes. While, sedentary time increased by 2 hours and 9 minutes. Cardiorespiratory fitness declined. A loss of bone mass and increase in body fat, especially around the waist, was also observed. Pot belly obesity, we know, is associated with increased risk for type 2 diabetes, hypertension, high ‘bad’ LDL cholesterol and low ‘good’ HDL cholesterol.
Being physically active does not only mean ‘a certain period of exercise’ for example, spending an hour at the gym. Instead one should try to be more and more physically active throughout the day, along with eating a healthy diet. There are several ways you can do this:
• Avoid using a lift. Walk up the stairs as often as possible. • Get off the bus one stop early and walk the rest of the way to your office/destination. • Have “walk-meetings” instead of “sit-in” meetings. • Walk down to speak to your colleague instead of using the intercom/phone. • Take a walk around your building during lunch break. • Walk to the nearby shops instead of driving. • Stand up and walk while talking on the phone. The Indian Medical Association (IMA) has taken an initiative to promote physical activity through its campaign “Move, Move and Move”. Sit less and walk more and more … Make it a daily routine to undertake activities that keep you fit and active. Choose activities that not only promote strength, balance and flexibility, but most importantly, which you also enjoy… (Source: A 2-Week Lazy Holiday 'Could Be a Health Risk' - Medscape - May 17, 2017) Dr KK Aggarwal National President IMA & HCFI

Thursday, 18 May 2017

Enough is Enough: Dilli Chalo on 6th June

Enough is Enough: Dilli Chalo on 6th June Dear Colleague IMA has declared “Dilli Chalo” movement on the 6th of June to bring to the attention of the nation regarding atrocities faced by the medical profession. The charter of demands is as follows. Kindly go through these and suggest more and also suggest modifications in the existing ones. We want to cover all segments of the medical profession (specialities, service doctors, residents, junior doctors, students, practitioners, consultants etc.). How come the government and the celebrities are watching violence against doctors without any empathetic response? Make violence against health care providers a non-bailable act with minimum 14 years imprisonment How come, gradually and now consistently, modern medicine doctors are increasingly being tried as criminals? We are not against accountability but not to be tried under criminal provisions. We want a single window accountability under the council or under a central tribunal. Why is the health ministry sitting on the minutes of the inter-ministerial committee - regarding violence, amendments in PCPNDT act, Clinical Establishment Act, capping of compensation and cross pathy? We want time bound implementation in six weeks. Why should we be the victims of the limitations of the government? If the government cannot provide free primary and emergent care to all, why are they not engaging the service of doctors in the private sector to provide the same at government rates? Are AYUSH not qualified doctors in their respective field and are they not qualified to treat common illnesses, then why force them to leave AYUSH practice and treat patients with modern medicine drugs? Is this allowed in other professions? Is this not cheating and injustice to the patients? We respect AYUSH doctors and their pathies. Let AYUSH practitioners develop their own pathy and grow in their respective pathies and not indulge in crosspathy. Recently, the government banned 344 fixed dose combinations drugs on the plea that two drugs when combined becomes a new drug. Then why are some state governments allowing AYUSH to co-write allopathy modern drugs? Let the public be given the best of their system of medicine. Any mix has to be as per a clinical trial registry. Are we not short of doctors? Are our MBBS doctors before starting practice not giving enough exams conducted by recognized universities? IMA wants to uphold the highest standards in UG and PG medical education. We are against the proliferation and establishment of poor quality medical colleges. The limitations of the government are already being faced by the doctors, then why introduced another exam in the name of EXIT? Would anyone like an elected government to be run by a nominated panel of retired Supreme Court judges or similar eminent people? Then why is the government thinking of replacing it with 20-member nominated body instead of amending the Indian Medical Council Act? Can the same be done to the Bar Council of India and the Institute of Chartered Accountants of India? Do all the doctors not have the right to be treated equally in all states? Doctors are already facing the wrath of the limitations of the government, then why does the West Bengal Clinical Establishment Regulatory Commission provide extra separate provisions of fine, compensation and jail up to three years, thereby treating WB doctors like criminals ab-initio? Are we not supposed to provide easily approachable services e.g. tackle cardiac arrest within five minutes? Then why are we restricted from opening clinics in the vicinity of residences of citizens? This is the most needed facility available to any citizen. Are we not responsible for the treatment provided to our patients? IMA is committed to upholding the rights of the people to get good, reliable and competent medical care. Then how can the government take away our right to choose the drugs and the company? Will the chemist be responsible for any death that occurs? Will the government pass a legislation and ask the voters to vote and which button to be decided by the clerk helping the polling booth? Then how can the government allow a chemist to decide which drug is best for the patient and a lab technician to authorize a laboratory report? If the quality and cost of manufacturing of generic- generic, trade-generic and brand-generic is the same, then why is the government allowing them to be sold at three different prices by the same company? We want one drug, one company, one price policy. Every citizen in the country has a right to receive quality and safe medical treatment. Then why push the poorer to treatment from unsafe and unqualified people? We want 25000 extra seats for post MBBS 'Family Medicine' course to provide comprehensive primary and emergent care to the public. An ideal GP clinic can be a combination of a doctor, a nurse and a pharmacist. When Arabian countries provide income tax free pay to look after their patients in rural areas along with higher pays, why can’t Indian government do the same? Doctors posted in challenging and difficult distinct areas should be given income tax-free pay higher than that given in metro cities. Are doctors not entitled for equal work- equal pay? Then why the difference in working conditions and pay scales of residents, service doctors across the country? All doctors in the country should be treated at par. How can you allow doctors to work for years under contract without making them permanent? Doctors working in bad service conditions because of limitations of the government is injustice and should be resolved immediately pan India. Reporting the name of the victim of sexual assault is a punishable offence in POCSO and IPC. We want a central law that any allegation against a doctor be not reported by the media until the doctor is convicted. How come increasingly Judicial powers are been given to administrators in various acts. Are we not going back to a Jury system? A doctor should have powers to challenge any regulatory decision in lower courts and not directly in high courts. Why are the government IEC advertisements not that effective? Why can’t they involve Indian Medical Association (IMA) and eminent doctors in their advertisements? If the government is dependent on private sector and is asking all of us to provide free OPDs in government sector on 9th of every month then why not give IMA a room at Nirman Bhavan (similar to that has been allotted to WHO) and work together. This is the minimum they can do. This step will lead to result-oriented coordination between Government and Doctors. Public-Private Partnership is the need of the hour to uphold and develop health sector in India. Dr KK Aggarwal National President IMA & HCFI

IMA and HCFI propose the Rule of 20 in identifying factors associated with hypertension

IMA and HCFI propose the Rule of 20 in identifying factors associated with hypertension On World Hypertension Day, IMA and HCFI call for understanding the numbers, and also taking a step forward in identifying and managing the symptoms New Delhi, 17 May 2017: About one-third of India's urban population and one-fourth of the rural population are hypertensive, according to a recent study published in the Journal of Hypertension. It has been found that high blood pressure is responsible for almost half the ischemic strokes that are also called brain attacks, akin to a heart attack. It also increases the chances of hemorrhagic strokes. Hypertension often goes unnoticed as it attacks the body without showing any symptoms at all. The 17th of May every year marks the World Hypertension Day, with the theme this year being 'Know your numbers'. Experts opine that early detection of blood pressure and its management may reduce the complications of hypertension as also the risk of death. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "High blood pressure is one of the leading causes for stroke contributing to over 50% in blockages (ischemic stroke) and leads to bleeding in the brain. This condition can damage arteries throughout the body, creating conditions where they can burst or clog more easily. Weakened arteries in the brain, resulting from high blood pressure, put people at a much higher risk of stroke. There are many factors and conditions which can lead to high blood pressure, for example, smoking, lack of physical activity, excess salt in the diet, consumption of alcohol, stress, and genetic history of high blood pressure." The IMA recently conducted a national study on ambulatory blood pressure measurement amongst doctors in partnership with HCFI and Eris Lifesciences. The study revealed that 21% of the doctors surveyed had masked hypertension or isolated ambulatory hypertension. In simple terms, their BP readings were normal when evaluated through the conventional clinic measurement technique but high when checked through the ABPM technique. Masked hypertension is associated with an increased long-term risk of sustained hypertension and cardiovascular morbidity. "Ambulatory Blood Pressure Monitoring is globally accepted as the gold-standard method towards detecting hypertension. It evaluates a patient's BP continuously over a period of 24 hours and helps diagnose masked or white coat hypertension, conditions in which a patient's BP readings are inaccurate due to certain environments. It is important to increase your intake of fresh fruits, vegetables, olive oil, and omega-3 foods to help lower high BP levels. Apart from this, it is a good idea to consume sprouted or 100% whole grains as also reduce your sodium intake. The real culprits behind increased sodium intake include processed and ultra-processed foods," opined Dr Aggarwal. Understanding the Rule of 20 in Hypertension can go a long way in identifying and managing the causes and symptoms of hypertension. • Prevalence of hypertension is 20% in the society • Only 20% of people are aware about Hypertension at any given time. • The morbidity and mortality due to hypertension is 20%. • Only 20% people get treated for hypertension and at any given time. • Only 20% of hypertensives are well controlled at any given time. • The risk of CAD and heart attack in hypertension is 20% • Risk of peripheral vascular disease in hypertension is 20% • Risk of paralysis in hypertension is 20%. • The severity of hypertension is decided by increments of 20 mm Hg each • In white coat hypertension, a person can have rise of more than 20 mm systolic blood pressure. • 20 mm Hg systolic blood pressure can be reduced by life style management alone. • 20 mm Hg systolic blood pressure can be reduced by one drug intervention. • Up to 20 ML of 80 proof 40% whisky is safe in hypertension. • 10 KG weight reduction can reduce systolic blood pressure by 20 mm Hg • Reduction of salt to 6 grams and intake of DASH diet can reduce systolic blood pressure by 20 Mm Hg • Look for a cause of hypertension, if blood pressure first time appears before the age of 20 • Each and every IMA member should monitor BP of at least 20 patients per day. • 20 Cores people are seen by IMA member every year • In last 20 years, the community systolic blood pressure has gone up by 20 mm hg. • IMA has more than 20,000 office bearers.

Wednesday, 17 May 2017

First of its kind national study by IMA, HCFI & Eris Lifesciences through the ABPM method reveals high incidence of hypertension amongst the medical fraternity

First of its kind national study by IMA, HCFI & Eris Lifesciences through the ABPM method reveals high incidence of hypertension amongst the medical fraternity Record attempt of collecting 20,000 ambulatory blood pressure readings of over 500 doctors in 1 day Over 50% physicians found to be suffering from uncontrolled hypertension despite taking hypertensive medicines; 56% from irregular BP at night and 21% from masked hypertension New Delhi, May 16, 2017: In what can be called as a massive feat, the Indian Medical Association, in partnership with the Heart Care Foundation of India(HCFI) and Eris Lifesciences in the form of an unconditional educational grant attempted to record the maximum number of ambulatory blood pressure readings amongst the medical fraternity in a single day. About 20,000 readings were taken of 533 doctors including those of the IMA leadership spanning 33 Indian cities. The aim being to raise awareness about the benefits of ambulatory blood pressure monitoring (ABPM) in the timely and correct diagnosis of hypertension on the occasion of the World Hypertension Day 2017. Hypertension is one of the most common lifestyle diseases prevalent today with one in three Indian adults suffering from it. The incidence of hypertension is equally high amongst the medical fraternity owing to high-stress levels. Often hypertension is misdiagnosed given the difference in blood pressure readings at home and in a clinic. Ambulatory Blood Pressure Monitoring (ABPM) can help in getting a more accurate picture of a person's BP pattern in a span of 24 hour. “The IMA National study on ambulatory blood pressure measurement amongst doctors conducted in partnership with HCFI and Eris Lifesciences revealed that 21% of the doctors surveyed had masked hypertension or isolated ambulatory hypertension. In simple terms, their BP readings were normal when evaluated through the conventional clinic measurement technique but high through the ABPM technique. Masked hypertension is associated with an increased long-term risk of sustained hypertension and cardiovascular morbidity. In addition to this, 56% of the doctors evaluated suffered from irregular BP pattern at night making them prone to future adverse cardiac events. 37% doctors had nocturnal hypertension, which can never be diagnosed through in clinic BP measurement. Over 50% physicians had uncontrolled hypertension despite taking hypertensive medicines,” said Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA. Evaluating both daytime and nighttime blood pressure is crucial for predicting all cardiovascular events. It is a fact that a blood pressure reading obtained during one’s sleep is more accurate in helping predict all causes of mortality when compared to those obtained during waking hours. Ambulatory Blood Pressure Monitoring is globally accepted as the gold-standard method towards detecting hypertension. It evaluates the patient's BP continuously over a period of 24 hours and helps diagnose masked or white coat hypertension, conditions in which a patient's BP readings are inaccurate due to certain environments. Dr Shashank Joshi, President Hypertension Society of India opined, "Your doctor may suggest ABPM for the following reasons: to find out if your blood pressure readings are higher in the clinic than at home; to see the efficacy of your medicines in controlling blood pressure throughout the day, or to note whether your blood pressure increases at night. Since there are no visible signs of masked hypertension, it is always good to let your doctor know if you have a family history of high blood pressure. I congratulate IMA, HCFI and Eris on this initiative and believe that a collaborative effort towards raising mass level awareness on the prevention of hypertension, it's timely diagnosis and management is crucial in our country where every third person has high BP”. ABPM involves attaching a small digital blood pressure machine to a belt around your body. This is in turn is connected to a cuff around the upper arm. It does not cause any inconvenience, as it is small enough for you to carry on with your routine. This machine notes blood pressure readings at regular intervals during a 24 hour period: typically, every 15 to 30 minutes during the day and 30 to 60 minutes at night. Increasing your intake of fresh fruits, vegetables, olive oil, and omega-3 foods can help lower your high blood pressure levels. It is also a good idea to consume sprouted or 100% whole grains. Try to reduce your sodium intake, which does not necessarily come only from table salt or salt added while cooking. Processed and ultra-processed foods are the real culprits behind increased sodium intake. Disclaimer: This project is undertaken by the IMA under an unconditional education grant from Eris Lifesciences Ltd. Contents of this program are a copyright of IMA and are not influenced by any third party.

India gets Rare Diseases Registry

India gets Rare Diseases Registry ICMR has set up a registry of rare diseases. Apart from maintaining a database, the registry which was set up on April 28 this year, will also help formulate policies on funding, treatment and more. Some key points on rare diseases • A disease is defined as rare when it affects less than one in 2,500 individuals, • Over 70mn Indians suffer from such disorders and live with them throughout their lives. • There are only 500 FDA-approved drugs for over 7,000 rare diseases globally • There is often no cure, only supportive care. Treatment is extremely costly too, ranging from lakhs to crores a year. • The health ministry is currently discussing a draft policy for treatment of rare diseases. When I took over as the National President Indian Medical Association (IMA), in my presidential address on 28th December I had said, “IMA also wants the government to declare a special fund for rare diseases and orphan drugs.” IMA will focus on creating awareness about rare diseases and orphan drugs as part of its new initiatives. Dr KK Aggarwal National President IMA & HCFI

Tuesday, 16 May 2017

Can NRI doctors barred abroad work in India? IMA writes to MCI

Can NRI doctors barred abroad work in India? IMA writes to MCI At Delhi High Court, a bench of Acting Chief Justice Gita Mittal and Justice VK Rao, took a suo moto note to examine the issue whether Indian-origin doctors, barred from practicing by a foreign country, can practice in India? Based on news reports that an Indian-origin doctor, who has been barred from practicing by a US court, is now treating patients in Delhi and Gurgaon, the court directed the member secretary of Delhi State Legal Services Authority, Sanjeev Jain, to verify the name and address of this doctor, carry out an immediate probe and file a report within four days; issued notice to the MCI to file a report on the mechanism, statutory regime as well as rules and regulations in place to scrutinize and check such practices and also made Ministry of Health and Family Welfare a party. The next date of hearing was on May 15. As per the US court, the doctor has been ordered “not practice medicine in any form within the United States or any other country" IMA Response: IMA is for a defined policy in such cases. IMA wrote to the MCI on 9th in this regard. To The President Medical Council of India New Delhi Sub: imposing the condition of Good Standing Certificate for those who are Registered with registering authorities in other countries Respected Madam Greetings from Indian Medical Association! We deem it fit to bring it to your kind notice that any Graduate or Post Graduate from our country whenever intends to register with registering authorities for practicing modern medicine in the concerned countries, he/she is required to furnish a Good Standing Certificate for their verification issued by the Medical Council of India. This is solely to ensure that the concerned registered medical practitioner has a good track record and there is nothing against him/her, especially with reference to ethical breach and/or violation. In the same breath and vein, it is necessary that a similar condition needs to be imposed for Indian doctors who are practicing in other countries after getting registered in that country and intend to come back to India. Imposition of similar conditions would be required for Indian students getting their MBBS or equivalent course outside India and coming back for registration in India; foreigners to India and asking for temporary license to practice and also for Indian doctors seeking multiple registrations in different states. This would mean that before they are registered or re-registered with the registering authorities in India, they will have to furnish the similar Good Standing Certificate as a condition precedent. This will serve the similar purpose as the Good Standing Certificate issued by the MCI serves in respect of Indian Doctors seeking registration to the competent registering authority practicing modern medicine in foreign countries. Hence the suggestion. We are sure that the required decision will be taken, in this regard for the enforcement by all concerned. With kind regards Dr KK Aggarwal National President, IMA Padma Shri Awardee Dr RN Tandon Hony Secy General, IMA

IMA supports insurance for death due to mosquito bite

IMA supports insurance for death due to mosquito bite Recommends an all-encompassing effort from the community as a whole to address this issue New Delhi, 15 May 2017: According to the South Delhi Municipal Corporation, 79 cases of chikungunya and 24 cases of dengue have been reported in Delhi just three months since 1 January 2017. Of these, 11 patients acquired the infection from neighboring states. It is a fact that we have collectively failed last year in controlling the mosquito menace and consequently, the mosquito menace is back this year. There is a need to over report and act in time and not only when the cases start appearing. Failure to act can be attributed collectively to Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the private sector. It is time that last year's failure is converted into success this year. Speaking on this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "The mosquito menace requires a community approach which involves every component of the society. Every premise must display that it is mosquito-free. When you are invited to somebody’s place, you should ask 'I hope your premises are mosquito-free' and when you invite somebody, write 'Welcome to my house and it is mosquito-free. This should become a routine in a premises. Just like we do not clean our premises once in a week, it is important to look for and clean the breeding places daily." The fact that mosquito bites are a serious issue has been reiterated via a recent judgement by the National Consumer Disputes Redressal Commission (NCDRC) which ruled that the wife of a man who died due to a mosquito bite was eligible for claiming insurance. The commission ruled that 'It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act of omission on part of the victim'. It further said that death caused by mosquito bite is an accident, and directed the insurer to honor its policy to the widow. Adding further, Dr Aggarwal, said, "The need of the hour is a paradigm shift in the approach towards the dengue menace. We need to follow the formula of 20 to identify dengue fever: if there is a rise in pulse by 20; there is fall in upper blood pressure by 20; if there is a rise in hematocrit by 20%; there is a rapid fall in platelets to less than 20,000 with a rapid rise in hematocrit by 20%; if there is a petechial count of more than 20 in one inch after tourniquet test and a difference of less than 20 between the upper and lower blood pressure, then such patients should be given at least 20 ml of fluid per kg immediately followed by continuous fluids till they pass urine. This is one of the most immediate steps to combat the condition." IMA recommends the following approach to target the mosquito menace: Ghar ke ander maro aur ghar ke bahar maro; din me maro, sham me maro aur raat me maro; deewaron ke niche maro aur deewaron ke upar maro; chote pani ki collection me aur bade pani ke collection me maro; eggs ko maro, larve ko maro, pupa ko maro aur mosquito ko maro; chath me maro, kamre me maro, veranda me maro; container me pani ke niche maro aur container me pani ke upar maro, aedes ko maro, culex ko maro aur anopheles ko maro.

Monday, 15 May 2017

First uterus transplant in India

First uterus transplant in India Dr KK Aggarwal National President IMA & HCFI The Milann Fertility Centre in Bangalore has received permission for uterus transplant from ICMR in two female patients and the procedure will be undertaken as a research project as per the ICMR guidelines. The minimum requisite of experience to carry out this procedure, as per the Human Organ Transplant Act, by a Clinical team is not available in any group outside the Swedish group. Milann has obtained permission from Medical council of India (MCI) for the participation of Swedish doctors for the procedure which is yet another mandatory requirement. In 2012, the world’s first successful uterus transplant with a live donor was conducted by a team led by Dr Mats Brannstrom, Professor of Obstetrics and Gynaecology at the University of Gothenburg in Sweden. In October 2014, a woman who had received a uterine transplant gave birth to a healthy baby boy. About uterus transplant • Uterus transplantation is a complex, multi-step procedure for the treatment of absolute uterine factor infertility (AUFI). • AUFI refers to infertility that is fully attributable to the uterus because of absence (congenital or surgical) or abnormalities (anatomic or functional) that prevent embryo implantation or completion of a pregnancy to term. • About 1 in 500 women of childbearing age are affected by AUFI, defined as an absent or non-functional uterus • Uterus transplantation is a highly experimental procedure to treat absolute uterine factor infertility. o Once the intended uterus recipient and organ donor have been identified, the process begins with in vitro fertilization (IVF) to create and freeze embryos for the intended recipient. o Next the organ donor undergoes a radical-type hysterectomy followed by implantation of the donor organ into the recipient. o After at least 12 months of immunosuppressive treatment, the recipient undergoes embryo transfer, pregnancy, and, if the pregnancy is successful, delivery via cesarean delivery. o At the conclusion of childbearing, the transplanted organ is removed to avoid the need for lifelong immunosuppression. • Since initial attempts at Saudi Arabia and Turkey, uterus transplantation has been successfully performed in Sweden and attempted in the United States, the Czech Republic, China, Brazil and Germany. • Keys ethical points in considering uterus transplantation include the non-life-saving nature of the procedure; existence of proven alternatives; the experimental nature of uterus transplantation; and the risks and benefits to the donor, recipient, and developing fetus. • Gestational surrogacy and adoption both exist as alternative paths to parenthood • The uterus donor may be alive or deceased. o Advantages of living donors include larger potential supply of organs and ample time for preoperative testing, screening, and assembly of a multi-specialty surgical team. The main disadvantage is the extensive pelvic surgery for organ removal. o Use of deceased donors avoids the donor's surgical risk and allows for a more extensive graft harvest. Disadvantages of a deceased-donor organ include the limited availability of organs, unpredictable timing of organ procurement, potential that the donor uterus has not yet produced a term pregnancy, and potential ethical uncertainties regarding consent. • As human uterus transplantation is in the beginning stages, the optimal inclusion and exclusion criteria for both donors and recipients are not yet known. • Living donors and recipients undergo extensive testing to ensure medical and psychological appropriateness. • Protocol includes consultation by the following services: gynecology, transplantation surgery, psychology, clinical immunology, anesthesiology, internal medicine, and radiology. • Prior to removal, the donor uterus is evaluated with ultrasound and magnetic resonance imaging (if technically possible) to estimate the uterus size, rule out uterine pathology, exclude Müllerian anomalies and evaluate the vasculature. • The goals for the evaluation of the future genetic father are to exclude male-factor causes of infertility, exclude infectious diseases that could be transmitted to the immunosuppressed mother, and to identify relationship challenges that could negatively impact the outcome of uterus transplantation. • As part of the informed consent process, the uterus donor must be free from coercion; be fully informed of the risks, benefits, and alternatives for both the donor and the recipient; have access to an independent donor advocate; and be informed of the early and late surgical risks. The uterus recipient must be educated to the risks and benefits of uterus transplantation and then consented for the multiple steps of the process that will ultimately result in a live-born child, including gonadotropin stimulation, egg retrieval for the creation of embryos, uterus transplantation, immunosuppression, embryo transfer, pregnancy, cesarean delivery, and uterus removal. The consent for the genetic father mainly pertains to the in vitro fertilization treatments that he must undergo to create embryos prior to uterus transplantation. (Source: Uptodate)

Sunday, 14 May 2017

TNAI honors IMA National President Dr Aggarwal and Honorary Secretary General Dr Tandon on International Nurses Day

TNAI honors IMA National President Dr Aggarwal and Honorary Secretary General Dr Tandon on International Nurses Day The event saw emphasis on the relationship between doctors and nurses and the need to create synergy New Delhi, 13 May 2017: On the occasion of International Nurses Day, the Trained Nurses Association of India (TNAI) honoured Padma Shri Awardee Dr KK Aggarwal, National President IMA and Dr RN Tandon, Honorary Secretary General IMA for their contribution to the medical field. This is the first time that such an award has been instituted by the body. The event saw the presence of eminent dignitaries namely Ms Meenakshi Lekhi, Member of Parliament (Chief Guest); Dr Rathi Balachandran, Asst. Director General of Nursing, Ministry of Health (Guest of Honor); Dr Prakin Suchaxaya, Coordinator Gender, Equality and Human Rights at World Health Organization (Guest of Honor); Dr Anita Deodhar President TNAI; and Evelyn P Kannan Secretary General, TNAI. Congratulating Dr Aggarwal and Dr Tandon on the award, Ms Meenakshi Lekhi, in her statement said that nurses are the backbone of the entire healthcare system. She emphasized on the sacred relationship between doctors and nurses and the need to work together to heal the society. As per the MCI code of ethics, it is the responsibility of physicians to recognize and promote nursing as a practice and work in tandem with nurses whenever there is a need. Physicians are also responsible for the welfare of nurses. Receiving the award, Dr KK Aggarwal, said, "It is indeed an honor for me to receive this award from an association which is an integral part of the medical fraternity. I take this opportunity to wish all nurses and nursing fraternity, a very happy Nurses Day. All of you bring a lot of knowledge, experience, and skill sets with you, which is a result of years of hard work. This is an apt moment and day to emphasize the fact that nurses work in tough situations, which can have a bearing on their mental and physical health as well. On this day and every day, we should recognize their contribution to healthcare and the hard work, long hours, and duress that are a part of this profession." International Nurses Day is celebrated every year all around the world on the 12th of May to commemorate the birth anniversary of the Florence Nightingale and mark the contribution of nurses towards people’s health. The theme for 2017 is Nursing: A voice to lead – Achieving the Sustainable Development Goals. Ms Anita Deodhar congratulated Dr Aggarwal and Dr Tandon for their contribution towards betterment of the nursing profession as also the overall health care system in India. She mentioned that there are over 17 lakh nurses working in India andemphasized on the need for a stronger relationship between doctors and nurses, which is based on, trust and respect. Adding further, Dr Tandon, said, "I thank TNAI for bestowing this award upon us. Nurses are the most resilient entities in a healthcare setting. Patients put all their faith and trust in them while at the hospital. This is because they are the constant point of contact for them and nurses understand what they are going through. They become a confidante for them, no matter how emotionally draining the process may be. It is imperative that we recognize the contribution they make to the medical profession." The Trained Nurses’ Association of India (TNAI) is a national organization of nurse professionals at different levels. It was established in 1908 and was initially known as Association of Nursing Superintendents. The Government of India has recognized TNAI as a service organization in 1950. A similar recognition by all the State Governments has been an asset to the promotion of its objectives. Its objectives are to uphold in every way the • Dignity and honour of the nursing profession, • Promoting a sense of espirit de corps among all nurses, • To advance professional, educational, economic and general welfare of nurses