Saturday 21 January 2017

IMA is a member of National Medical and Wellness Tourism Board

IMA is a member of National Medical and Wellness Tourism Board IMA is a member of National Medical and Wellness Tourism Board. The following recommendations are likely to be implemented: • Government to facilitate e-Medical Visa. • Normally e-Visa given for 60 days but e-Medical Visa will be for 6 months. • e-Visa will have a permission for double entry, but e-Medical Visa will permit Triple entry. • e-Visa will be extendable to e-Medical Visa. • e-Medical Visa will be available at five major Indian Ports i.e. Mumbai, Cochin, Goa, Chennai and Mangalore. • e-Medical Visa will be available for 161 countries. • Presently, medical attendants are given Visa but the Committee has recommended that medical attendants should also be given e-Medical Visa. • The Committee also recommended that all hospitals should have a common Greet and Meet Counter and it should be at major Airports / Ports. • Free SIM card at entry will be given to e-Medical Visa patient. • Committee have recommended a Translation App at Airports/ Ports • All Medical Tourism Hospitals will have to be NABH or JCI Accredited. We are pushing for IMA accreditation also. • The Committee also recommended that fee for e-Visa and e-Medical Visa should be the same. Dr KK Aggarwal National President IMA Dr RN Tandon Hony Secretary General IMA

There is an urgent need to reduce the incidence of Infant and child mortality in India: IMA

There is an urgent need to reduce the incidence of Infant and child mortality in India: IMA In 2015, the under-five mortality rate in India was 48% per 1000 live births New Delhi, Jan 16, 2017: India ranks first among countries with the highest number of child deaths in the world. In 2015, out of the total 5.9 million child deaths globally, 1.2 million i.e. 20% of the world’s share, occurred in India. The Millennium Development Goal (MDG)-4 to reduce child mortality had established a target of two-third reduction in under-five mortality by 2015, a mark India has failed to achieve. There are large inequities in the under-five mortality rates across socio-economic groups and various states of India. This has largely impeded the acceleration in government programs. A significant majority of these deaths are due to preventable causes and IMA recognises the urgent need to improve the quality of perinatal care for increasing the chances of childhood survival under the United Nations Sustainable Development Goals 2030. Padma Shri Awardee Dr KK 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, “Much of the progress towards reducing under-five mortality has been undermined by the persistence of several risk factors associated with infant and child mortality such as nutritional status of the mother, maternal education (less than class 8), early childbearing (earlier than 20 years) and inadequate birth spacing (less than 24 months). To clearly address the growing burden of infant deaths, these determinants must first be tackled at the grassroot level.” The top most preventable causes of under-five mortality across the world are the following: Pneumonia 1. Preterm complications 2. Newborn infections 3. Diarrhea 4. Birth complications 5. Malaria 6. Childhood malnutrition “The progress in infant mortality programs needs to complement the issues at the socio-economic level where the major determinants of child mortality are centered. Awareness about important factors like immediate and exclusive breastfeeding, skilled attendants for antenatal, birth, and postnatal care especially in rural areas; access to adequate nutrition, knowledge of symptoms of danger signs in the child’s health; water, sanitation and hygiene and immunizations needs to be created”, added Dr Aggarwal. More than 6 million children still die before their sixth birthday, each year. Clearly, more needs to be done to improve child survival rates. These solutions (as above) are amongst the various interventions suggested by the World Health Organization (WHO). Reducing maternal mortality is equally important for progress in this regard. Medical institutions, private government and charitable organizations need to join hands to further this cause. Sources 1. http://data.worldbank.org/indicator/SH.DYN.MORT?year_high_desc=true 2. https://www.worldvision.org/health-news-stories/child-mortality-top-causes-best-solutions 3. http://unicef.in/CkEditor/ck_Uploaded_Images/img_1364.pdf

New IDSA guidelines on diagnosis of TB in adults and children

New IDSA guidelines on diagnosis of TB in adults and children A task force supported by the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA) has published new guidelines on the diagnosis of tuberculosis (TB) and latent tuberculosis infection (LTBI) in adults and children. The guidelines published in the January 2017 issue of the Clinical Infectious Diseases journal include 23 evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary TB and extrapulmonary TB. The six strong recommendations include: • An interferon-γ release assay (IGRA) rather than a tuberculin skin test (TST) should be done in individuals 5 years or older who are likely to be infected with Mtb, who have a low or intermediate risk of disease progression, and in whom it has been decided that testing for LTBI is warranted. • Acid-fast bacilli (AFB) smear microscopy is recommended in all patients suspected of having pulmonary TB. • Rapid molecular drug susceptibility testing for rifampin with or without isoniazid is recommended using the respiratory specimens of persons who are either AFB smear positive or Hologic Amplified MTD positive and who meet one of the following criteria: (1) have been treated for tuberculosis in the past (2) were born in or have lived for at least 1 year in a foreign country with at least a moderate tuberculosis incidence (≥20 per 100 000) or a high primary multidrug-resistant tuberculosis prevalence (≥2%) (3) are contacts of patients with multidrug-resistant tuberculosis, or (4) are HIV infected. • Mycobacterial cultures should be done on specimens collected from sites of suspected extrapulmonary TB. • Genotyping should be done on one culture isolate from each mycobacterial culture-positive patient.

Preventable illness and mortality due to air, water and soil contamination is unacceptable: IMA

Preventable illness and mortality due to air, water and soil contamination is unacceptable: IMA Each year, about 13 million of all deaths worldwide result from preventable environmental causes. New Delhi, Jan 15, 2017: Environmental risk determinants, such as air, water and soil pollution, chemical and insecticide exposures and global climate change contribute to more than 100 different diseases and injuries. More than a quarter of the mortality in India can be attributed to living in an unhealthy environment. The largest burden is that of air pollution, which kills about 1.4 million people in India every year. The other major causes of preventable mortality are poor water quality and sanitation. IMA is for preventing these avoidable illnesses and mortalities through strategic planning, awareness campaigns and mutual collaboration with concerned authorities. Padma Shri Awardee Dr KK 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, “Sixty percent of deaths occurring in our country are preventable. A healthy environment is a pre-requisite to a healthy population. Using clean technologies and fuel for cooking, lighting and heating can significantly reduce air contamination, which will ultimately lead to a decline in acute respiratory infections, chronic respiratory diseases and heart diseases. Providing clean water, especially to rural areas, is also imperative as poor water quality is the top most cause of diarrhea-related mortality in children under five and about 37.7 million Indians are affected by waterborne diseases annually. More than 60 million people across 20 states of India are exposed to fluoride contamination. Increasing soil contamination by widespread pesticide use is also leading to ever increasing risks of cancer, colorectal disorders and foodborne diseases.” The WHO report on ‘Preventing Disease through Healthy Environments’ states that about 1 in 4 deaths globally is due to environmental factors like poor air, water and soil quality. The problem is more severe in developing nations like India, which lags only behind China in terms of air quality index. “The link between environment and health is a very tangible one, and the grim situation calls for an urgent need for investing in strategies and planning to reduce environmental risks in our cities, homes and workplaces. Organisations and government bodies need to join hands and address this cause on a national platform. The first step would be to strengthen national environmental health policy, strategy and infrastructure”, added Dr Aggarwal. The concept of “One Health” by IMA strives for the integrative effort of multiple disciplines aiming towards optimal health for people, animals and the environment. Sources • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461729/http://cseindia.org/content/cse’s-inaugural-state-india’s-health-report-connects-most-environmental-factors-some-gravesthttp://www.who.int/mediacentre/news/releases/2016/deaths-attributable-to-unhealthy-environments/en/

The Ideal IMA Hospital: Suggestions required

The Ideal IMA Hospital: Suggestions required I recently came across a story in the Daily Mail UK about a teacher in Iran who visits the ICU every day, where his student, who had cancer, was admitted. Why? So that the child could keep up with his studies and not miss out on any lessons. The two communicate with each other via phone. This is indeed a noble act. Teachers can make a difference in the lives of their students. Doctors are meant to not just treat the disease, but also the patient as a whole. The focus should also be on the psychosocial aspects and not just the science of treating a disease. All hospitals owned by IMA doctors should be hospitals with a difference, where • We work with compassion and care. • We have provisions for a prayer room • We respect the dead body. • In every case of death, we ask the relatives for organ or tissue donation. • We allow the patients to give exam or attend important meetings, if feasible. • We allow and facilitate student patients to continue their classes in hospitals. • We respect the cultural sentiments of the patients. • We accept checks and credit cards for payments. • We allow interest-free easy installments to the needy in the establishment. • We observe 2 hours silence in the hospital 12-2 p.m. where everyone speaks softly. • We provide the cheapest quality drugs to the patients. • We do not indulge in unethical practices. • We have a separate charity fund for poor patients. • Our premises are mosquito-free. • We follow national antibiotic policy and other National Health Programs. Dr KK Aggarwal National President IMA (With inputs from Dr RV Asokan)

Importance of pharmacovigilance and reporting of adverse drug events

Importance of pharmacovigilance and reporting of adverse drug events IMA urges its 2.8-lakh members to report each and every adverse drug reaction to reduce incidence of preventable deaths New Delhi, January 12 2016: Recently, the pace with which newer drugs are being introduced in India and worldwide has been increasingly steadily. These drugs come from a tightly regulated pipeline of clinical trials and safety evaluations. The drug, once in the market can then be subjected to a final round of scrutiny by monitoring adverse drug reactions (ADR). Reporting of ADR can facilitate early detection of signals of new, rare and serious ADRs. It also can potentially provide information about the safety and efficacy of the drug in the long run and ultimately safeguards the patients. The specific aims of pharmacovigilance are as follows: • Improve patient safety and care regarding the use of medicines and medical or paramedical therapeutic interventions. • Improve public health and safety regarding the use of medicines • To facilitate the assessment of effectiveness, risks involved and safety of medicines • Encourage safe, rational, effective and cost effective use of medicines • Promote an understanding, training and general awareness about pharmacovigilance and its effective communication to the general public 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, “In India, pharmacovigilance programs to monitor ADR are operational however, the limitation lies in under- reporting. Adverse drug events (ADEs) result in significant injuries and deaths every year. Estimates suggest that over 50% of all adverse drug reactions treated in hospitals and emergency care are preventable.” Many ADE related injuries, mortalities and incurring hospital costs can be decreased if healthcare institutions strengthen their systems for preventing and detecting ADEs. Research studies have also found that the type and severity of ADE affects length of stay and costs in hospitals. Patients with severe ADEs like arrhythmia, bone-marrow depression, seizures, or bleeding averaged a 20-day hospital stay while those with less severe cases, for 13 days and those with no ADE, only 5 days. Hospital costs for them were much higher as compared to non-ADE patients. Many preventable drug reactions like drug overdoses and internal bleeding associated with the improper use of blood thinners and painkillers are life threatening especially in the elderly. There are many reasons for these reactions and may include poor coordination of care, lack of time and knowledge among health professionals, and lack of patient education. Medication errors are a frequent cause of adverse drug events, the factors that may lead to such errors. Common medication errors that can precipitate adverse drug events include: • Missed dosage • Illegible prescription • Wrong technique • Duplicate therapy • Drug interactions • Equipment failure • Preparation or formulation error • Improper monitoring Both in a clinical setting and at the patient community level, adverse drug reactions can be detected and prevented up to a significant extent resulting in significant healthcare cost reductions, decreased hospital stay and patient mortality reduction. Doctors and patients should be more proactive about reporting adverse drug events. “ADR monitoring and reporting is still inadequate in India; Pharmacovigilance program of India (PvPI) is doing a commendable job. Current adverse drug incident reporting system need to be improved, moreover, strengthening nursing medication and monitoring systems is also required. What is crucial is to create a better environment for healthcare professionals so that they report ADRs without hesitation or fear of punishment or severe repercussions” added Dr KK Aggarwal. The practice of self-medication also needs to be curbed. Lack of knowledge of where, what and how ADRs should be reported also affects reporting. To strengthen existing ADR monitoring programs, awareness needs to be raised amongst the population about the long-term benefits of reporting the side effects of drugs. Government and local medical organizations can take the initiative in form of mass media distribution through newspapers, radio, television and awareness campaigns.

IMA Advisory: Alert on use of sodium valproate in pregnant women

IMA Advisory: Alert on use of sodium valproate in pregnant women These five congenital anomalies could have been saved Dear Colleague Sodium valproate in pregnant women is widely prescribed by the clinicians of many hospitals, which is a matter of great concern as this drug belongs to pregnancy category D (There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.). A total of 5 individual case safety reports have been reported in the NCC-PvPI database. These children born were identified to have congenital anomaly after receiving sodium valproate by their mothers during pregnancy. Kindly DO NOT PRESCRIBE sodium valproate in pregnancy. Report immediately at 9717776514 if such issues are identified with the use of sodium valproate for further actions. Dr KK Aggarwal National President IMA (Contributions from Dr V Kalaiselvan, Principal Scientific Officer, NCC-PvPI, Indian Pharmacopoeia Commission)

Antibiotic-related research in India must be accelerated: IMA

Antibiotic-related research in India must be accelerated: IMA Spurious use of antibiotics has resulted in several important life-saving drugs becoming obsolete. Research towards developing new antibiotics is imperative as we head towards the post-antibiotic era. New Delhi, Jan 14, 2017: Antibiotic resistance has emerged as a global threat, and the problem is particularly stark in India. The total mortality burden of infectious diseases in India is about 416/1000 persons every year. In this scenario, simple infections have the potential to turn deadly, and the situation clearly warrants that research in antibiotic development must be accelerated. The problem of antibiotic resistance in India is further exacerbated by a constellation of factors like poor public health systems and hospital infection, high rates of infectious disease, inexpensive antibiotics and rising incomes. All of these factors contribute to increasing prevalence of resistant microbes, resulting in the rising burden of infection-related mortality like neonatal sepsis. Padma Shri Awardee Dr KK 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, “Antibiotics work by targeting specific mechanisms within the microorganisms essential for growth and survival. However, bacteria have certain defence systems that gradually evade these effects, and become resistant. Spurious use of antibiotics can speed up this defence system much faster than we can counteract them. The pipeline of antibiotic drug development is fast drying up. There is a need to speed up and support research on new drug molecules and drug targets. The idea of repurposing old antibiotics also merits more attention”. “Over prescription and unguided over-the-counter usage of antibiotics have reduced efficacy of valuable drugs like carbapenems and colistin. We are fast running out of life-saving options as the medical community at present heavily relies on antibiotics right from treating simple infections to complex surgical procedures. Doctors need to put an end to unnecessary prescriptions, and patients themselves need to check over-the-counter use of antibiotics. The use of antibiotics in poultry and farming also needs to be vigilantly monitored. Time is short, and R&D initiatives need to look for alternatives to salvage this situation”, added Dr Aggarwal. Medical science still lacks a clear knowledge about how resistance develops and evolves. There are several gaps in the understanding of cellular and molecular processes involved. These factors make antibiotic research a very fertile ground and concerned authorities need to wake up to the absolute need and potential of this field. Source: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001974

Execution steps for IMA on Twitter

Social media for IMA Execution steps for IMA on Twitter Goal: The basic goal is to motivate all the 2.7 lakhs members of IMA to create their profile on Twitter and start using it. Then again it is not enough to create a profile, doctors must see the Tweet they receive regularly, just like they see their phones for WhatsApp. All members must fix their own photo in the Profile Photo space. However, all would display similar Header Photos. This big photo will display our Emblem, photo of our President with his dream projects and similar thoughts. This will create a sense of solidarity. Sample Profile: https://twitter.com/IMA_Hapur This army of members would serve two major proposes. • They will Re-tweet anything we wish to make popular and reach media such as an assault on any doctor. • We can easily send any medical knowledge or motivational text, photo or video to 2.7 lakhs members with a simple Tweet by IMA India account. For example, the pioneer programs such as Ask Dr KK, Dil Ki Baten, Jiska Koi Nahin Uska IMA, Walk with Doc, Main Hoon Na and others can be sent by a simple touch on your screen. We will develop the IMA India Twitter account as an authentic source of information about cause of diseases and medicines for both the doctors and non-medico followers. This is like having a news channel in which doctors of India can share their thoughts as journalists. Execution of IMA on Twitter For IMA on Twitter (IMAT), I would start from the state executives. We would request each of them to fix up my lecture on IMAT in their state. Whenever there is any assembly of local executives of their state they should invite me. At the time of lecture, we will find some Tech savvy executives, request them to learn more about Twitter and start teaching in their state. We have to encourage tech savvy executives of each state. We will offer them a portfolio. Without that portfolio they will not provide their full effort and valuable time. The portfolio may be State Head/ State Secretory/ State Chairman etc. for IMA on Twitter. These State Secretaries IMAT will consult me for their problems. Teaching is not enough, we would call the State Secretaries IMAT to promote this mission send the progress report each month. This all exercise needs dedicated and vigorous efforts for a year or more. We have to teach Twitter to doctors just as Chinese taught Indians to drink tea, and we know the consequence. However, our purpose is to provide a platform for the solidarity to our community, not any profit making. This all is almost 50% of my plan; I would start several more activities on Twitter later on. But those are much complicated and not possible to explain in this small article. I have done marathon efforts to read several books and articles on Twitter, and that helped me visualize IMA on Twitter. I wish to put all my knowledge and efforts for my dream project—IMA on Twitter. How to Create a Twitter Account • Open the website www.twitter.com on laptop or Download Twitter App on mobile • Create your profile just as you do to create your Facebook account. Name: Mail or Mobile: Password: • You will be asked for a validation code sent on your mobile: Fill up • You will be asked to provide your email: fill up • You will be asked for a user name: Fill Up • Twitter will enquire about your interests: Fill Up • You will be asked to import your contacts: Say Yes or No • Then you will see several Twitter accounts of your contacts: You may or may not follow them • Twitter will show you some popular accounts on Twitter as per your interests: You may or may not follow them • After creating Twitter Account, fix your profile pictures. • Follow the Local IMA, State IMA and IMA India Accounts. • Re-Tweet every Tweet with #Save_Doctors you receive from these three Accounts. • Try to find friends, relatives, patients, journalists, politicians around you who are on Twitter. Offer them your following and seek their following back. • Write your Twitter Handle on your visiting card. Dr KK Aggarwal National President IMA & HCFI (Contributions from Dr Ajay Kansal)

International Meet on Combating Air Pollution on March 10-11, 2017 in New Delhi

International Meet on Combating Air Pollution on March 10-11, 2017 in New Delhi Urgent need to address air pollution through Private Public Partnership Environment is the most important social determinant of health, causing morbidity and mortality in a given population. The WHO’s comprehensive global assessment of the burden of disease from environmental risks reveals that globally, an estimated 24% of the burden of disease and 23% of all deaths can be attributed to environmental factors. Further, globally, non-communicable diseases (NCDs) deaths, attributable to air pollution, are amounting to 8.2 million of the total 12.6 million death. NCDs, such as cardiovascular diseases including stroke, cancers and chronic respiratory disease, now claim nearly two-thirds of the total deaths caused by unhealthy environments. The Global Burden of Disease (2010) data showed that household air pollution was ranked at the 3rd position and ambient air pollution at the 9th position among the leading risk factors that contribute to morbidity and Disability-adjusted life years (DALYs). Household and ambient air pollution are the leading risk factors contributing to burden of disease in India. Household air pollution contributed to nearly 3.5 million deaths and a loss of 3.5% DALYs globally (2010). Ambient air pollution contributed to another 3.1 million deaths and 3.1% DALYs. The ambient ozone pollution had a lower effect than the above and led to 0.2 million deaths and 0.2% DALYs in 2010. Cognizant of the fact that air pollution needs to be addressed in right earnest, a Steering Committee was constituted, by the Ministry of Health & Family Welfare (MoHFW), Govt. of India in 2014, with members drawn from both health and non-health sectors. The report of this Committee, released in December 2015, has been able to shift the historical ‘urban air pollution centric focus’ to the ‘burning of biomass fuel across rural and periurban pockets in India’. According to the Institute of Health Metrics and Evaluation (IHME), air pollution was found to be the leading cause of mortality and disability in India. In Indian settings there is need reducing sources of emissions, improving access to clean fuel and raising public awareness on health effects of air pollution. Major risk factors are household and ambient air pollution contributing to burden of disease in India. • Household air pollution is caused by solid fuels like wood, charcoal, coal, dung, crop wastes are being used by over 3 billion people for cooking at home. These inefficient cooking methods lead to indoor air pollution especially in houses that are poorly ventilated. • Indoor air pollution not only has adverse health effects but also has adverse social and environmental effects. • Household energy and Poverty: Poor households are unable to afford LPG and other cleaner fuels and reliance on inefficient fuels reduces the time they could spare for income generating activities and education. As a result, a vicious cycle of poverty leading to use of inefficient fuels and these in turn contributing to poverty starts • Gender issues: In most of the cases, women carry out the household chores and hence are the major sufferers of indoor air pollution. • Environmental impact and climate change: Reliance on wood for fuel leads to deforestation and consequent loss of habitat and diversity. The simple biomass and other fuels are inefficient and incomplete combustion takes place. The pollutants like black carbon and methane that are produced as a result of incomplete combustion leads to climate change. Major health effects of indoor air pollution include acute lower respiratory infections, chronic obstructive pulmonary disease (COPD), lung cancer, cardiovascular disease, burns Emerging evidence suggests that household air pollution in developing countries may also increase the risk conditions such as: low birth weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer and cervical cancer. Considerable evidence suggests that exposure to air pollution leads to adverse respiratory outcomes. Perinatal exposure to air pollution can impair organogenesis and can lead to long term complications. Exposure to air pollution during pregnancy has also been linked to decreased lung function in infancy and childhood, increased respiratory symptoms, and the development of childhood asthma. The WHO’s Ambient Air Pollution database for 2016, showed that the levels of PM10 and PM 2.5 in Delhi are way above the normal levels. The annual PM 10 level was found to be 229 μg/m3 and that of PM 2.5 was found to be 112 μg/m3. In a study conducted at Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India by Garg Suneela et al in 2016, a total of 3019 individuals were screened through spirometry. Of these, 34.35% were found to have lung impairment. Almost 32.5% of the individuals screened were from the age group of 41-50 years. More than half of the subjects (57.6%) had been living in Delhi for more than 20 years. Initiatives taken by the government for combating the problem of air pollution • Stringent regulations, development of environmental standards, control of vehicular pollution, spatial environmental planning including industrial estates and preparation of zoning atlas. • Use public mode of transportation: Encourage people to use more and more public modes of transportation to reduce pollution. Use of carpooling. The odd/even rule wherein cars with odd-numbered registration plates would ply on odd dates and those with even-numbered registration plates would do so on even dates. • Conserve energy: Switch off fans and lights when you are going out. Large amount of fossil fuels are burnt to produce electricity. Ban on burning of waste and fine on emission of construction dust • Understand the concept of Reduce, Reuse and Recycle: Do not throw away items that are of no use to you. Reuse them for some other purpose. For e.g. you can use old jars to store cereals or pulses. • Emphasis on clean energy resources: Clean energy technologies like solar, wind and geothermal are on high these days. Governments of various countries have been providing grants to consumers who are interested in installing solar panels for their home. This will go a long way to curb air pollution. • Use energy efficient devices: CFL lights consume less electricity as against their counterparts. They live longer, consume less electricity, lower electricity bills and also help you to reduce pollution by consuming less energy. • So there is a urgent need for body like Indian Medical Association (IMA) and other CMAAO countries to address the problem of air pollution in India with the objectives of • Creating awareness on the burden of health effects of air pollution • Discussing main sources of air pollution in India (source apportioning) • Facilitate mitigating the health impacts of air pollution through private public partnership. • Examine preparedness and capacities of respective ministry to address the problem of air pollution emanating from development driven activities. Dr KK Aggarwal National President IMA & HCFI (Contributions from Dr R N Tandon HSG IMA and Dr Ajay Kumar, Advisor CMAAO)

Familial hypercholesterolemia is genetic and can raise the levels of LDL cholesterol in the body leading to several cardiovascular complications

Familial hypercholesterolemia is genetic and can raise the levels of LDL cholesterol in the body leading to several cardiovascular complications Awareness and lifestyle modification can help you combat the potent risk factor. New Delhi, Dec 22, 2016: Familial hypercholesterolemia currently has a prevalence of 1 per 1 million persons. LDL or bad cholesterol is produced naturally in the body however; some people inherit genes from their families that can cause excessive production of LDL. High cholesterol level is a potent risk factor for heart diseases, stroke and hypertension. High cholesterol can accumulate into arteries and vessels and can cause atherosclerotic plaques. Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Children affected with the disorder are at a risk of sudden cardiac deaths and early coronary events, leading to premature mortality. Padma Shri Awardee Dr. K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Elect Indian Medical Association (IMA), stated that, “Patients may develop premature cardiovascular disease at the age of 30 to 40. A person is said to be suffering from premature heart disease when it occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I”. About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk. First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents. Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL “bad cholesterol”) levels and premature heart disease. To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL. “Several lifestyle changes can be adopted to decrease the impact that this risk factor has on your health in terms of cardiovascular and other complications. Good dietary and physical activity habits are crucial to a preventive management approach to familial hypercholesterolemia”, added Dr K.K Aggarwal. Following are some lifestyle tips to manage your risk: • Get regular checkups for cholesterol levels, blood pressure and blood glucose. • Eat a heart healthy diet composed of fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts. It is best to limit significantly the consumption of sugary beverages, sugary fruits and red meat. • Physical activity is crucial for preventing a variety of lifestyle disorders and the same applies to high cholesterol. Couple your healthy diet to a complementary exercise routine. • Avoid smoking at all cost; exposure to secondhand smoke should also be avoided as much as possible.

MCI Code of Ethics Regulation 7.5: Conviction by Court of Law

MCI Code of Ethics Regulation 7.5: Conviction by Court of Law SC convicts docs for giving 'med asylum' to accused ex-MLA Amit Anand Choudhary | TNN | Dec 22, 2016, 05.17 AM IST NEW DELHI: The Supreme Court has convicted two senior doctors of a private hospital in Gurgaon for contempt of court for providing "medical asylum" to a former Haryana MLA who was allowed to be admitted in the hospital for 527 days without any ailment in order to frustrate the court's order to send him behind bars in a murder case. A bench of Chief Justice TS Thakur and Justices R Banumathi and UU Lalit held that the doctors — Dr Munish Prabhakar and Dr K S Sachdev — and former MLA Balbir had tried to obstruct administration of justice as there was no medical reason to justify his admission in the hospital for such a prolonged period. It directed them to be personally present in the court when it will decide the quantum of punishment for contempt of court. Such incidents harm the image of the medical profession in the society. Giving false certificates, medical asylum, filing false Mediclaim forms all spoil the image of the profession. Both doctors are convicted. Regulation 7.5 “Conviction by Court of Law: Conviction by a Court of Law for offences involving moral turpitude / Criminal acts”. Such conviction amounts to professional misconduct.

80% doctors concerned about violence at work: IMA Survey

80% doctors concerned about violence at work: IMA Survey A survey conducted by IMA for consultant specialist doctors has revealed the frightening epidemic of violence against doctors. New Delhi, Jan 09, 2017: IMA is committed to promoting and providing a secure environment to healthcare professionals to practice their work. In this regard, a survey was conducted documenting the concerns of consultant specialist doctors regarding increasing incidences of violence and aggressive behaviour aimed at them. One of the most staggering results of the survey suggests that about 80% of doctors have had to face some degree of violence or aggression from patients and their relatives. Padma Shri Awardee Dr K.K Aggarwal - National President Indian Medical Association (IMA) & Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement said, “Maximum violent outbursts were faced by doctors working in emergency care. According to 90% of the doctors surveyed, patient’s relatives often subject doctors to unruly behaviour, verbal abuse and physical assault post surgery”. Some other significant findings of the survey were: • 83% of the doctors said that their patients get upset if the doctors are late in their appointments. • 30% of the patient’s relatives do not stand up when the doctors enter in patient’s room. • 17% of the consultants felt that fee splitting is unethical. “One other problem in this context is under-reporting of such incidences by doctors. While doctors may feel confident in voicing their concerns under the veil of an anonymous survey but when it come to routine practice, they are often reluctant to report such behaviour either out of fear or due to regard to patient’s distress and well-being, which they consider of supreme concern. Most of the reported cases were when the issue had gone out of hand, and the doctors feel that their own or family’s life is under threat”, added Dr Aggarwal. The rising incidences of such cases highlight the urgent need of boosting security measures at hospital premises. Strengthening doctor- patient relationships to ensure accountability and openness is also likely to play a key role in reducing violence and diffusing tense situations often encountered in the medical setting.

IMA observes “National Solidarity Day” in light of the increasing violence against doctors

IMA observes “National Solidarity Day” in light of the increasing violence against doctors New Delhi, Jan 17, 2017: The concept of observing National Solidarity Day is a reminder of fundamental unity, a foundation that is also integral to the medical profession. IMA observed National solidarity day today in protest against the increasing cases of assault on medical professionals especially the recent assaults in Allahabad Karnataka, Pune and Haryana. IMA stands united for this cause, and all members were requested to wear black badges in protest all over the country. 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 that “IMA is for promoting a secure environment to healthcare professionals to practice their work. The increasing violence against doctors is a matter of grave concern, and we must restore the nobility of the profession. Failure of treatment does not mean negligence for no matter what you do, 5% of the seriously ill patients will die. If every death were to end up in violence with no protection from the Indian judicial system or the law enforcement agencies, it would only deter doctors from practising and fulfilling their basic duties. A survey was recently conducted by IMA documenting the concerns of consultant specialist doctors regarding increasing incidences of violence and aggressive behaviour aimed at them. Unfortunate results of the study suggest that about 80% of doctors have had faced some degree of violence or aggression from patients and their relatives during their practice. “Those who work in volatile settings like ICUs and emergency units are more prone to cases of violence which, can sometimes border on verbal abuse and physical assault. The current situation is completely unacceptable on all grounds and warrants that strict action must be taken in this regard. There is an urgent need of boosting security measures at hospital premises and the enforcement of a Central Protection Act for doctors. IMA has been demanding removing doctors from the Consumer Protection Act since the past two years as well as the capping on compensation that is awarded for medical negligence cases. The government must act swiftly for the medical community is more at threat than ever before,” added Dr Aggarwal. Following highlights marked the National Solidarity Day observed by IMA members: • All IMA leaders across its 30 State branches wore black badges to mark their protest. All 2.7 lakh IMA members were requested to do so too • IMA ensured that no medical services were affected due to this protest • Members were encouraged to book the perpetrators of violence in accordance with the law at the earliest. • A white paper on the safety of medical practitioners was released • Two minutes silence was observed at the National IMA headquarters for those who have been victims of violence cases

New ACP/AAFP guidelines on treatment of hypertension in adults older than 60 years

New ACP/AAFP guidelines on treatment of hypertension in adults older than 60 years New clinical practice guidelines developed jointly by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) for the pharmacologic treatment of hypertension in adults aged 60 years or older have been released. Published January 17, 2017 in the Annals of Internal Medicine, the guideline includes clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older. The treatment goals should be individualized. The three recommendations are: • Treatment should be started if the systolic blood pressure continues to be 150 mm Hg or higher to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. • Start or intensify pharmacologic treatment if these patients have a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke. • Clinicians should consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Source: Annals of Internal Medicine)

How to prevent kidney diseases: IMA

How to prevent kidney diseases: IMA Chronic kidney disease can strike any one. 17% of urban Indians suffer from kidney disease, as per latest estimates. New Delhi, Jan 19, 2017: Diabetes and high blood pressure are the two leading causes which today account for 40–60% cases of CKD in India. Other risk factors for kidney disease include heart disease and a family history of kidney failure—a severe form of kidney disease. 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 that, “If you have these risk factors, it is important to be screened for kidney disease. That usually involves simple laboratory tests: a urine test to look for kidney damage, and a blood test to measure how well the kidneys are working. The urine test checks for a protein called albumin, which is not routinely detected when your kidneys are healthy. The blood test checks your GFR—glomerular filtration rate. GFR is an estimate of filtering ability of your kidney. A GFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure.” “Younger people seldom go for preventive check-ups. This results in delayed diagnosis. Without treatment, kidney disease often gets worse. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis. Optimal hydration is the key to maintaining good kidney health. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body, which in turn, results in a “significantly lower risk” of developing chronic kidney disease. CKD is also associated with metabolic disorders and bone disease and is an important risk factor for peripheral vascular diseases, cardiovascular disease and stroke”, added Dr. Aggarwal. The Golden Rules to avoid or delay reaching the point of kidney failure: 1. Keep fit and active, it helps reduce your blood pressure and on the move for kidney health. 2. Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage. 3. Monitor your blood pressure: High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular diseases. 4. Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease (CKD). Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). 5. Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50 percent. 6. Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly. 7. Get the kidney function checked if you have one or more of the ‘high risk’ factors. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446915/

Inaccurate diagnosis of fungal infection aggravates antibiotic resistance

Inaccurate diagnosis of fungal infection aggravates antibiotic resistance Indiscriminate use of antibiotics is a major contributory factor in the escalating problem of antibiotic resistance, a fact which we are all well aware of. The first global report on antibiotic resistance “Antimicrobial resistance: global report on surveillance” released by the WHO in 2014 highlighted antibiotic resistance as a significant public health problem, which was prevalent worldwide across all age groups. Now a new study published in the February 2017 issue of CDC’s journal Emerging Infectious Diseases says that lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. Aptly titled “Delivering on antimicrobial resistance agenda not possible without improving fungal diagnostic capabilities”, the study concluded that “the lack of availability and underuse of nonculture fungal diagnostics results in overprescribing, prescription of unduly long courses of antibacterial agents, and excess empirical use of antifungal agents and leaves many millions of patients with undiagnosed fungal infections”. Four common clinical situations have been cited as examples, where lack of routine diagnostic testing for fungal diseases often worsens the problem. · Inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis. · Failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis. · Misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease. · Overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. Improving and adhering to diagnostic tests for fungal diseases will help curb the inappropriate use of antibiotics, which compromises measures to control antimicrobial resistance. (Source: Emerging Infectious Diseases. 2017;23(2):177-183)

Tobacco, drug use in pregnancy can double risk of stillbirth

Tobacco, drug use in pregnancy can double risk of stillbirth

D KK Aggarwal
National President IMA
New Delhi, Jan 20, 2017: Smoking tobacco or marijuana, taking prescription painkillers, or using illegal drugs during pregnancy is associated with double or even triple the risk of stillbirth, according to the National Institutes of Health. Researchers based their findings on measurements of the chemical by products of nicotine in maternal blood samples; and cannabis, prescription painkillers and other drugs in umbilical cords. The calculated increased risk of stillbirth for each of the substances examined were: • Tobacco use — 1.8 to 2.8 times greater risk of stillbirth, with the highest risk found among the heaviest smokers • Marijuana use — 2.3 times greater risk of stillbirth • Prescription painkiller use — 2.2 times greater risk of stillbirth • Passive exposure to tobacco — 2.1 times greater risk of stillbirth 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 that, “Stillbirth occurs when a fetus dies at or after 20 weeks of gestation. Smoking while pregnant leads to subtle changes in children's brain development and behavior, because of restricted development in the womb, and large doses of nicotine can damage brain cells. Growth-restricted babies born in such conditions are more likely to have health conditions such as diabetes and high blood pressure in early adulthood. Likely exposure to secondhand smoke can elevate the risk of stillbirth, birth weight, premature birth, respiratory disorders, and increased risk of sudden infant death syndrome (SIDS).” “It's not a choice to be made lightly. Cigarettes contain dangerous concoction of chemicals, such as nicotine, carbon monoxide, and tar. Most of the associated pregnancy complications can be fatal for the mother or the baby. Smoking also more than doubles the risk that an infant will die during, shortly after, or shortly before birth. There is also prominent dose related proportionality in the risk of stillbirth from smoking. If you smoke and are planning to conceive, quitting this dangerous habit should be a priority”, added Dr. Aggarwal. Other rarer complications from smoking can lead to problems with the placenta or slow fetal development. These issues can also cause a miscarriage or stillbirth or lead to respiratory and cardiovascular problems in the child’s early adulthood. Source: • https://consumer.healthday.com/encyclopedia/smoking-and-tobacco-cessation-36/smoking-cessation-news-628/smoking-and-the-fetus-645311.htmlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372174/

“Koi Dekh to Nahi Raha”: Doctors are brand ambassadors of health

“Koi Dekh to Nahi Raha”: Doctors are brand ambassadors of health

Dr KK Aggarwal

National President Indian Medical Association
Doctors in India have been equated to God since ancient times. This has continued even today even after modern medicine has taken over. No other profession perhaps enjoys the same exalted status as that of the medical doctors. A common man usually perceives God as a force for whom nothing is impossible, as the one who is the final decision maker, whose decisions cannot be challenged, who can provide instant relief and who overcomes miseries. He can also answer the unknown as He is omniscient i.e. all-knowing. A doctor is a healer and helps the patient overcomes his problems, and at times, saves the life of a patient. Most of us have faith in God and trust that He will do right by us. Similarly, during illness or during any acute emergency, patients and/or their families repose the same faith and trust in their doctor. Doctors are different, they are role models and icons. They are expected to act in a manner befitting their position in the society. Regulation 1.1.1 of the MCI Code of Ethics also requires a physician to “uphold the dignity and honour of his profession”. Doctors look after the health of not only their patients, but also that of the community and are therefore regarded as “Brand Ambassadors of Health”. This public role puts a responsibility on all of us to practice what we teach our patients about healthy habits and lifestyle. And also maintain our dignity and integrity before the patients. For example, if they see you drinking even if it is social or indulging in any other ‘questionable’ personal action, this would make them suspicious of your integrity or regard it as hypocrisy. This moral code of ethics therefore must be respected at all times. Despite a public role, doctors deserve a personal time, which should be off-limits for patients. The two should not mix. Therefore whenever you are in your private life see “ Koi dekh to nahi rha”

Sunday 8 January 2017

Measles-Rubella initiative: IMA urges support in favor of the campaign

Measles-Rubella initiative: IMA urges support in favor of the campaign About 139 million children in India under the age of 9 months to 10 years are susceptible to Measles and Rubella infection. The medical community needs to support the campaign and accelerate its progress. New Delhi, Jan 03, 2017: India, along with other WHO-SEAR countries, in September 2013, resolved to eliminate measles and control rubella/congenital rubella syndrome by 2020. Accordingly, Ministry of Health & Family Welfare has introduced Rubella vaccine in its Universal Immunization Programmed as Measles-Rubella vaccine. The MR (Measles-Rubella) vaccination campaign is scheduled from February 7 to February 24 and will cover the city schools in its first week. Karnataka, Tamil Nadu, Goa, Puducherry and Lakshadweep are places where the vaccine will be introduced. Padma Shri Awardee Dr. KK Aggarwal, President Heart Care Foundation of India (HCFI) and National President, IMA and Dr RN Tandon, Honorary Secretary General of Indian Medical Association (IMA), in a joint statement said that, “MR vaccine is a single injection and administered by trained professionals. The vaccinations will be free of cost and will target children in the age group of 9 months to 15 years. It is a single injection combined and administered in two doses - one, for children between 9 to 12 months and the second for children between 16 months and 24 months. Unlike the polio drops every child between the age of 9 months and 15 years needs to reach the booths for the vaccination.” The campaign aims to rapidly build up immunity against measles and rubella, and also provides a second opportunity for vaccination against measles for children left out in routine immunization. As per 2015 data, measles- rubella vaccination coverage has been more than 90% at the national level and about 80% at the district level. The reported incidence rates have reduced up to less than 5 cases per million. “Vaccine availability and management are big challenges to the campaign. Moreover quality training, micro planning & monitoring remain imperative. There is a need to sensitise patients and their relatives through mass level awareness campaigns. Doctors are urged to contribute by making their clinic a part of vaccination center duly coordinated by the state health and family welfare department along with other bodies.”, added Dr. Aggarwal. Vigilant monitoring of adverse effects is also a crucial component of the campaign to improvise existing schemes and strategies. Patient and doctor contribution is of utmost importance in this regard. Caretakers and patients can use IMA PvPI number – 9717776514 – to report adverse events. Source: http://www.measlesrubellainitiative.org/wp-content/uploads/2014/09/Country-Update-India.pdf

Koi Sun to Nahi Raha?’ A Campaign on medical confidentiality

Koi Sun to Nahi Raha?’ A Campaign on medical confidentiality Privacy and confidentiality are important tenets of ethical medical practice. Article 9 of the Universal Declaration on Bioethics and Human Rights of UNESCO states as follows: “The privacy of the persons concerned and the confidentiality of their personal information should be respected. To the greatest extent possible, such information should not be used or disclosed for purposes other than those for which it was collected or consented to, consistent with international law, in particular international human rights law.” Patients have a legal right to data privacy, and there are laws in place to guide healthcare professionals about how to store, collect and distribute information. The patient is the supreme consent giver, and without such consent, no action on their health record can be taken. The hospital owns the records, but the information therein is owned by the patient. Data protection and confidentiality are important cornerstones of medical ethics and essential to good practice. Moreover, it is also crucial with respect to patient safety. Patients often share private and intimate details about themselves with their doctors who in turn have an obligation to keep this information safe and private. Patient-doctor confidentiality helps build trust and fosters a trusting environment, which is crucial to encourage the patient to seek care and to be as honest as possible during the course of a treatment. IMA wants to streamline the rules relating to medical privacy and confidentiality. ‘Koi Sun to Nahi Raha?’ is a campaign focused on building and strengthening this trusting relationship. Apart from existing patient data protection laws and practices, we intend to bring out the discussion in everyday practice. Through this campaign, we wish to draw the attention of the general public to the rights that they are entitled to. Small but important routine practices in healthcare settings often breach this privacy unknowingly. For instance, IMA is against the operation theatre list being displayed in corridors; this discloses personal and sensitive information about the patients. A coding based system can be devised instead so that the full identity of the patient is not disclosed. Calling out the name of the patient in the corridors outside ICU also falls under this breach. These are small but often overlooked details in daily medical practice, which directly go against the medical ethics of doctor-patient confidentiality. IMA intends to highlight these issues and raise awareness about them among the patient and doctor community.

Every preventable newborn death must be audited: IMA

Every preventable newborn death must be audited: IMA IMA organises a workshop on Newborn Care in association with the Trained Nurses Association of India (TNAI) and Heart Care Foundation of India (HCFI). New Delhi, Jan 04, 2017: The Newborn care workshop organised in by IMA today in association with the Trained Nurses Association of India (TNAI) and Heart Care Foundation of India (HCFI) highlighted some critical issues in the context of neonatal and infant healthcare. India ranks the topmost among countries with the highest number of child deaths in the world. In 2015, 1.2 million of the world’s total 5.9 million child deaths, (48% per 1000) live births occurred in India. The majority of these deaths are due to preventable causes. Recognising this issue, IMA has ordered that every newborn death in India must be audited at each level of medical care to prevent further deaths. This is a part of the organisation's undertaking to achieve the United Nations Sustainable Development Goals 2030. Padma Shri Awardee Dr K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that “20% of world’s newborn mortality occurs in India. A majority of these are due to preventable causes and can be avoided. Auditing of such mortality cases will ensure that the cases are duly documented. This will help prevent further child deaths in future. This step will also ensure stringency in child care at hospitals across the nation as medical institutions will now have to be accountable to concerned authorities. Along with such stringent measures from the medical community, generating mass level awareness across socio-economic groups across India is also important.” The top most preventable causes of newborn across the world are the following: • Preterm complications • Newborn infections • Birth complications • Mother’s malnutrition Dr R N Tandon, Honorary Secretary General, Indian Medical Association added, “All newborn should be breastfed in the 1st ½ hour to reduce chances of infection.” Ms Anita Deodhar, President, TNAI, in her message, said that nurses and doctors can complement each other in reducing neonatal mortality. Ms P. Kannan, Secretary General, TNAI, stated that "Over 3 lakh children 0-6 years die because of preventable diarrhoea and, all these lives can be saved by giving timely ORS.” Dr Tanvi Pal, Sr. Paediatric Skin Specialist at BL Kapoor Super Speciality Hospital said, “It is a myth that one should remove the white layer on the skin of the newborn and that the mother should clean the cord of the newborn on a daily basis. While massaging the newborn baby is good for the health, avoid vigorous massage in the 1st month.” The workshop also stressed that mass sensitization needs to be encouraged on aspects like immediate and exclusive breastfeeding, hospital birth and postnatal care especially in rural areas; access to adequate nutrition, knowledge of symptoms of danger signs in a child’s health; sanitation, hygiene and vaccinations.

All IMA members should Support MR Campaign

All IMA members should Support MR Campaign Dr KK Aggarwal National President IMA & HCFI India, along with other WHO-SEAR countries, in September 2013, resolved to eliminate measles and control rubella/congenital rubella syndrome by 2020. Accordingly, the Ministry of Health & Family Welfare has introduced Rubella vaccine in its Universal Immunization Programme (UIP) as Measles-Rubella (MR) vaccine. The MR vaccination campaign is scheduled from February 7 to February 24 and will cover the city schools in its first week. Karnataka, Tamil Nadu, Goa, Puducherry and Lakshadweep are places where the vaccine will be introduced. MR vaccine is a single injection and administered by trained professionals. The vaccinations will be free of cost and will target children in the age group of 9 months to 15 years. It is a single injection combined and administered in two doses: one, for children between 9 to 12 months and the second for children between 16 months and 24 months. Unlike the polio drops campaign, every child between the age of 9 months and 15 years needs to reach the booth for the vaccination. The campaign aims to rapidly build up immunity against measles and rubella, and also provides a second opportunity for vaccination against measles for children left out in routine immunization. It will be coordinated by the state health and family welfare department along with other bodies. What you can do to support the campaign • Sensitize patients and their relatives. • Use IMA PvPI number – 9717776514 – to report adverse events. • You can make your clinic a part of the vaccination center.

IMA Advisory: In every unexplained death give an option to conduct a virtual autopsy

IMA Advisory: In every unexplained death give an option to conduct a virtual autopsy New Delhi, Jan 05, 2017: IMA is for establishing virtual autopsies at the clinical level for non-medicolegal cases. Virtual autopsies can be facilitated by currently available techniques like whole body CT, whole body MRI, post mortem angiography and molecular autopsy. 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, “Virtopsy or virtual autopsy is an alternative to traditional autopsy, conducted with scanning and imaging technology. The methods used are whole body or limited CT and or MRI. One can add to it CT guided post mortem biopsies for histopathological and genetic correlations. CT is well suited to show foreign objects, bone and air or gas distribution throughout the body, whereas MRI sequences are strong in detailing organ and soft tissue findings. A comprehensive analysis of both surface and deep tissue findings may require fusion of CT, MRI and 3D surface data.” Virtual autopsy using the whole body CT scan or MRI can done in no time and will leave no scar which may offer a reliable alternative to conventional autopsy in certain cases. “Virtual autopsy can be the answers in finding the cause of death and also evaluate the cause in unexplained deaths. The same is necessary to prevent further such episodes in the community. It is also the answer for most medicolegal disputes. In every death IMA members should give an option for virtual biopsy with or without mini FNAC/ tissue biopsy. And informed refusal must be noted”, added Dr. Aggarwal. Considering the increasing number of unexplained deaths in the medicolegal and non- medicolegal settings, virtual autopsies may help accelerate the investigation process. Due guidelines for ethical practice of Virtopsy should also be defined to prevent any misuse.

GPs are the backbone of the society: Wake up

GPs are the backbone of the society: Wake up 
  • General Practitioners are the backbone of medical practice.
  • General Practitioners are mini multi-specialists.
  • Family Physicians are first contact and all-purpose doctors.
  • General practitioners are the most complete and comprehensive doctors.
  • GPs are the foundation stone of Medical practice.
  • GPs, wake up now and hoist the flag of affordable medical practice.
  • GPs are most relevant in today's India.
  • Family Physicians only can lead India's health delivery system.
  • GPs are primary health deliverers.
  • GPs are the most economical Practitioners, yet the most neglected ones.
  • GPs are the most complete and abundant subset of doctors.
Dr KK Aggarwal
National President IMA and HCFI

Indian Medical Association celebrates its Founder’s Day

Indian Medical Association celebrates its Founder’s Day Shi C K Mishra, Secretary Health, Ministry of Health & Family Welfare, Govt. of India commemorates the event by delivering an oration on affordable healthcare IMA leadership speaks out against the Medical Exit Exam - NEXT New Delhi January 07, 2017: The Indian Medical Association is celebrating its Founders Day today. To commemorate the event a State President and Secretaries and National Leadership meet was held at the IMA headquarters this morning. The IMA leaders reached a consensus to oppose the Medical Exit Exam – NEXT at the meeting. An oration will be delivered by Shi C K Mishra, Secretary Health, Ministry of Health & Family Welfare, Govt. of India this evening for over 1000 IMA doctors and influencers on Affordable health care and achievement of sustainable development goals. Having recently taken over as the 88th President of Indian Medical Association, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal said, “In today’s IMA leadership meet that saw representation from all Indian States, it was decided that we will unanimously oppose the Medical Exit Exam, now termed as NEXT. It is not fair for a person who has passed his MBBS to give another exam to practice. We are however for the Centralized final MBBS Exam.” IMA under Dr Aggarwal’s leadership in 2017 will be working towards making affordable and accessible healthcare a reality. IMA has proposed the launch of medical centres across India that will offer common surgeries at fixed price of Rs.15, 000/- to the public. Addressing the conference, Dr R N Tandon, Hony. Secretary General, IMA said, “IMA is for reservation of seats for doctors in service who have served in rural areas, but the same should be rationalised and proportional to their number in the States.” The Past National Presidents of IMA – Dr V.C.V Patel, Dr S. Arulrhaj, Dr Ajay Kumar, Dr M. Abbas, Dr Vinay Aggarwal & Dr A. Marthanda Pillai in a joint statement said, "IMA will standardise medical education and launch IMA Clinics. All doctors in the country can participate in the National Health Programmes; that will be certified by IMA as ‘IMA Clinics’.” 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 specialised 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.

Required Request in Every Death: “Puchna mat Bhulo”

Required Request in Every Death: “Puchna mat Bhulo” Dr KK Aggarwal National President IMA IMA is committed to promoting eye and organ donation. To this end, IMA will launch a campaign at branch and state levels called “Puchna Mat Bhulo” to promote “mandatory required request’. All IMA members should, in case of routine death, request the relatives or legal heirs for donation of eyes (in case of death) and organs (in case of brain death). As per Transplantation of Human Organs and Tissues Rules, 2014 any doctor in ICU in a situation of brain stem death, in consultation with transplant coordinator (if available) shall ascertain from the next of kin or the legal heir of the body whether the dead person, while he was alive, had authorised for donation of his or her organs either by filling form 5 or in driving license. If yes, then the RMD is duty bound to request the next of the kin or the legal heir to submit the aforesaid authorisation and sign the declaration/authorisation. Also the doctor SHALL ascertain, after certification of brain stem death of the person in ICU from his or her adult near relative or, if near relative is not available, then, any other person related by blood or marriage, and in case of unclaimed body, from the person in lawful possession of the body the following (a) whether the person had, in the presence of two or more witnesses (at least one of who is a near relative of such person), unequivocally authorised before his or her death as specified in Form 7 or in documents like driving license, etc. wherein the provision for donation may be incorporated after notification of these rules, the removal of his or her organ(s) or tissue(s) including eye, after his or her death, for therapeutic purposes and there is no reason to believe that the person had subsequently revoked the aforesaid authorisation; (b) where the said authorisation was not made by the person to donate his or her organ(s) or tissue(s) after his or her death, then the registered medical practitioner in consultation with the transplant coordinator, if available, SHALL make the near relative or person in lawful possession of the body, aware of the option to authorise or decline the donation of such human organs or tissues or both (which can be used for therapeutic purposes) including eye or cornea of the deceased person and a declaration or authorisation to this effect shall be ascertained from the near relative or person in lawful possession of the body as per Form 8 to record the status of consent, and in case of an unclaimed body, authorisation shall be made in Form 9 by the authorised official as per sub-section (1) of section 5 of the Act; (c) after the near relative or person in lawful possession of the body authorises removal and gives consent for donation of human organ(s) or tissue(s) of the deceased person, the registered medical practitioner through the transplant coordinator shall inform the authorised registered Human Organ Retrieval Centre through authorised coordinating organisation by available documentable mode of communication, for removal, storage or transportation of organ(s) or tissue(s). • "Mandatory" or required request for donation of the organs of patients dying in hospitals is likely to increase the rate of organ harvest and will alleviate the critical shortage of transplantable organs. • “Required request” or “required referral” is defined as “that it shall be illegal, irresponsible and immoral to disconnect a ventilator from an individual who is declared dead following brain stem testing without first making proper enquiry as to the possibility of that individual's tissues and organs being used for the purposes of transplantation”. • IMA policy is that in every death, the doctor should explore about corneal donation. India needs 2 lakh donor eyes per year to take care of corneal blindness. One is able to collect only 25,000 donor eyes per year. For every 1000 population, 7.89 persons die every year. If request is made for eye donation at the time of death and even if 1% people of total deaths donate eyes, one will be able to cover the shortage. IMA Slogans #Puchna mat bhulo: IMA policy is that in every death, the doctor shall explore about corneal donation. #Puchna mat bhulo: India needs 2 lakh donor eyes per year and only collects 25,000 donor eyes. #Puchna mat bhulo: For every 1000 population 7.89 persons die every year. #Puchna mat bhulo: Required request, it is illegal, irresponsible & immoral to disconnect a ventilator from a patient declared brain dead without enquiring possibility of that patients tissues and organs donation #Puchna mat bhulo: IMA member SHALL make the near relative or person in lawful possession of the body, aware of the option to authorise or decline the donation of human organs or tissues or both #Puchna mat bhulo: All IMA members should, in case of routine death, request the near relations for corneal and whole body donation and in situations with brain stem death for organs donations. #Puchna mat bhulo: As per Transplantation of Human Organs and Tissues Rules, 2014: Required request is mandatory.

Tuesday 3 January 2017

IMA embraces the Prime Minister’s Digital India Movement; pledge to function in a paperless manner in 2017

IMA embraces the Prime Minister’s Digital India Movement; pledge to function in a paperless manner in 2017 New Delhi, Jan 1, 2017: Technological advancements have helped bridge geographical boundaries in our country. The Prime Minister since the beginning of his term has been pushing Indians to embrace the digital era through his many campaigns and policies. Keeping in line with the dynamics of the changing world, the Indian Medical Association, the only representative voluntary organization of over 2.8 lakh doctors of the modern scientific system of medicine has decided to go digital. The new governing body the organization has already started functioning in a paperless manner since the beginning of their term last week. Through 2017, the Association will amplify key policies and messages to both its 2.8-lakh doctor members and the public at large through the digital medium. Padma Shri Awardee Dr. K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that, “IMA is in the process of becoming a paperless Association. It has been our constant endeavor to make the medical profession more transparent and effective along with raising large-scale public health awareness about matters of National importance. We echo our Prime Minister’s belief in the potential of a Digital India and will be using this as a medium to communicate with both doctors and the public.” IMA has already created a digital group called Team IMA, which will make daily communication between over 2500 Central Council Members possible. Since January 2016 year, over 2 lakh doctor members of the IMA are being sent daily updates on the organization and key health matters through the medium of text messages and emails. This will continue in 2017. “The official communications including notifications for CME events, information given out by IMA headquarters, communication from the government to IMA and other periodic updates will all be preceded electronically. There are plans to start publishing our official magazine as an online version too” added Dr. Aggarwal. All official communication sent IMA will be through the digital medium. As part of a project to make theirs a paperless organization, the association has also developed a mobile app to ease communication.

A paradigm shift in the thinking of IMA this year

A paradigm shift in the thinking of IMA this year IMA represents the collective consciousness of 2.8 lakh doctors across 1700 local branches and 31 state branches. To further strengthen the Association, this year we have envisaged a proactive role for IMA: moving on from what “IMA can do” to what “IMA Should Do” or “IMA to Do”. We have also defined our guiding principles for this year. In 2017, IMA policies will be based on • Collaboration rather than cooperation • Right action and not convenient action • Good plans and not quick plans • Good Governance • Financial stability • Effective time management • From professional to community priority Our endeavor would be a collaborative approach to problem solving or tackling issues and challenges, where, unlike in cooperation, we work together in partnership towards one common goal. A collaborative approach accomplishes more than what can be done at an individual level. I ask all IMA leaders to close their eyes and imagine themselves as President of IMA for a minute and think of what they could do to help the organization and the community via the Association. And that is what they contribute to the working of IMA. Give 2 minutes of your time every day to IMA and come out with ideas and plans and submit them to IMA HQs for review and possible implementation. Right action taken at the right time yields the desired result, which is long-lasting. The path of right action may be tough, yet it is the one we will choose to solve a problem, rather than a more convenient action. A convenient action gives immediate gains, while the right action may not give immediate results. Our aim is not to meet short-term goals. Hence, we want policies to be guided by good plans, which lay down a solid foundation. Good plans increase efficiency of working, facilitate effective utilization of resources, provide direction, promote teamwork and are goal-oriented. The gains from a good plan trickle down generations. Good plans therefore are not quick plans. Governance simply means decision making and implementation of decisions. Good governance has 8 major characteristics as described by the United Nations Economic and Social Commission for Asia and the Pacific. It is participatory, consensus oriented, accountable, transparent, responsive, effective and efficient, equitable and inclusive and follows the rule of law. Let us all follow these principles in one voice and make the Indian medical profession the best in the world. Dr KK Aggarwal National President IMA and HCFI

IMA President Installation

      IMA President Installation


                 1. IMA NATCON 2016 - Sister Shivani Verma on Self-Motivation https://www.youtube.com/watch?v=qoDA0qjg2k0

2. Oath Taking Ceremony - Team Digital IMA (2017-18):  https://youtu.be/1aLCvBpZrjA

3. 
Dr Ketan Desai, President World Medical Association, addressing during IMA NATCON 2016: https://youtu.be/JqTnhGTlOdw

4. 
Hon'ble Shri A.R. Kohli, Former Governor, Mizoram speaking during IMA NATCON 2016 https://youtu.be/bIOyOH5Ov6E

5.  
Dr K K Aggarwal, National President IMA addresses during IMA NATCON 2016: https://youtu.be/ZbWliJZ2zk0


    

IMA-No Incentive Initiative

IMA-No Incentive Initiative
During the Central Council Meeting in Amritsar, I had said in my presidential speech that IMA will have zero tolerance for unethical practices including sex selective abortions for non-medical purposes and cuts and commissions. And that IMA and the medical profession will boycott any person indulging in unethical sex selective practices. I am happy to note that IMA Bagalkot Branch in Karnataka, under the Presidentship of Dr Shekhar Mane has taken up the “IMA-No Incentive Initiative”. The draft undertaking by the branch states “INCENTIVES in any form cash, cheque, gifts, articles, parties etc. will NOT be given to or taken from any of our colleagues, referring doctors, RMP, quacks, ASHA workers, ambulances, laboratories etc.” Incentive means where no service is attached. The branch also nominated an Ethical & Vigilance Committee comprising of 15 doctors with President and Secretary as ex officio member. If any doctor or hospital violates this model code of conduct, then the complaint can be investigated by this ethical committee. The committee will discuss and counsel the doctor/s involved and send a notice to them directing compliance. The matter will also be brought to the notice of the Executive Committee or General Body for warning. The punitive action includes suspension from the local IMA branch and report to the MCI, KMC and other govt. regulatory authorities for necessary action. In order to discourage crosspathy, the branch further resolved that all modern scientific medicine (allopathic) doctors must stop going to hospitals owned by practicing non allopathic doctors as visiting consultants. Dr KK Aggarwal National President IMA and HCFI