Straight from the Heart: IMA-HBI Initiative

Straight from the Heart: IMA-HBI Initiative

Thank you to Team HBI led by Dr RV Asokan for the wonderful work being done and for winning the Best Wing Award for the year 2017.

Here are some of my views about IMA HBI to be implemented by 28th December and put in the HBI agenda book.

Thanks for initiating over 768 pre-entry level NABH accreditation certification process, launching a HBI portal, bringing out 12 HBI e-Connect newsletters and a practical guide on hospital start-ups, conducting GST and insurance summits, digital Team HBI and aiming for 10,000 affiliated memberships.  

Hospital Board of India may consider re-naming itself as ‘IMA Clinical Establishment” Board of India. This will give it a better branding and broader scope in working.

As per the last CWC resolution, all state IMA branches having nursing home wings have already become part of HBI and the same should be implemented as early as possible

HBI adopted medical emblem.

NABH will not be able to cope up with numbers required by IRDA regarding pre-accreditation entry level certification of clinical establishments. Today, NABH requires a
3-month period of self-certification prior to application. This period may be certified by IMA. 

IMA certified clinical establishments means they are ready for entry level NABH certification. IRDA is being approached so that IMA certified establishments may be recognized by them for insurance purposes.

Medical tourism ministry has allowed IMA to run Mumbai airport facilitation centre. The same is to be coordinated by IMA HBI.

IMA HBI should tie up with IMA Insurance web page and IMA SBI card policy

Why NABH IMA white paper should be promoted to all?

IMA HBI should adopt IMA Aao Gaon Chale wing

HBI issues

• Can technicians sign lab reports?

• CEA Karnataka issue to be put in full page advt in one of the national dailies.

• IMA HBI costing department to come out with its recommendation (part 1 by the 2^nd week of December). The aim of IMAHBI costing department should also be how to reduce the cost. The IMA sanctioned budget of six lakh to be used by IMA HBI for this purpose.

• IMAHBI to implement one price, one drug, one company policy

• IMAHBI Transgender Policy: to have toilets for disable people to be used as toilets for transgenders

IMAHBI to come out with minimal requirement for ICU facility in small health care establishments in view of the Supreme Court judgment.

Small health care organizations should be promoted as they are the only cost-effective setups.

HBI to have a separate agenda book this year in central council. 

About 90% of the estimated malaria cases in the Southeast region are from India

About 90% of the estimated malaria cases in the Southeast region are from India

India also needs a stronger malaria surveillance system to combat the disease

New Delhi, 02 December 2017: As per recent reports, India accounts for about 6% of the world’s new cases of malaria and 7% of deaths caused by the disease. India accounts for about 90% of the estimated number of malaria cases followed by Indonesia (9%) and Myanmar (1%) in the Southeast Asia region. The country has also been found to be one of the weakest in terms of malaria surveillance systems. Despite efforts at various levels, malaria remains an acute public health challenge in India.

Malaria is a life-threatening mosquito-borne blood disease caused by a Plasmodium parasite. It is transmitted to humans through the bite of the Anopheles mosquito. Once an infected mosquito bites a human, the parasites multiply in the host's liver before infecting and destroying red blood cells.

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, "Malaria is transmitted by the bite of a female anopheles mosquito. The mosquito bite occurs mainly between dusk and dawn. Five types of Plasmodium parasite can infect humans. They are found in different parts of the world. Some cause a more severe type of malaria than others. Malaria can also be transmitted through blood transfusion, or via sharing of contaminated needles. The behavior of the mosquitoes may differ. Some may prefer to rest indoors and feed indoors in the night. Some may prefer to rest and feed outdoors earlier in the day. Preventive therapy of malaria can be instituted during pregnancy in high risk areas. The malarial mosquito feeds every third day compared to the dengue mosquito, which feeds three times in a day.”

Symptoms of severe malaria include the following: fever and chills; impaired consciousness, prostration, or adopting a prone position; multiple convulsions; deep breathing and respiratory distress; abnormal bleeding and signs of anemia; and clinical jaundice and evidence of vital organ dysfunction.

Adding further, Dr Aggarwal, said, “Pregnant travelers should defer travel to areas where risk of malaria is high until after delivery. For non-immune pregnant women who cannot defer travel, chemoprophylaxis with chloroquine and mefloquine depending on travel to areas with chloroquine-sensitive or resistant malaria is recommended. Pregnant women from endemic areas, who due to prolonged exposure to malaria, have developed natural immunity benefit from chemoprophylaxis.”

Here are some tips to prevent malaria.

• Malaria mosquitoes grow in fresh water collected in the house. It is therefore important to not let water stagnate in your house and the surrounding areas. Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is cleaned properly once in a week, there are no chances of mosquito breeding.
• Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered. If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
• Using mosquito nets/repellents in the night may not prevent malaria because these mosquitoes bite during the day time.
• Malaria mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
•  Wearing full sleeves shirt and trousers can prevent mosquito bites. Mosquito repellent can be helpful during the day. 

Never declare a patient dead under conditions of hypothermia

Never declare a patient dead under conditions of hypothermia

 Dr KK Aggarwal, Dr R N Tandon

A core body temperature below 95°F is hypothermia. Core temperature 90-95°F is mild hypothermia, 82 to 90°F is moderate hypothermia and core temperature below 82°F is severe hypothermia.

In conditions of severe hypothermia in children, body metabolism is suspended, which may protect against hypoxia. Patients with core body temperature 82°F have been known to survive anoxia for 12-18 minutes and up to 60 minutes or more at core body temperature 68°F. Sometimes, hypothermic patients can be successfully revived with CPR even with total resuscitation time of 9 hours. Because of dilated pupils, asystole, hypoventilation, absence of shivering, the patient appears dead. Because of failure to recognize this state, the patient may be declared dead.

Successful revival is also possible in adults because of the neuroprotective effects of hypothermia. Several hours of CPR may be required for this. Efforts to revive the patient should be continued till the core body temperature reaches 90-95°F i.e. bring the temperature from severe hypothermia to mild hypothermia or normal. If the patient still cannot be revived with CPR, then he/she can be declared dead.

The recent incident of a premature (22 weeks) newborn, who was alive, but allegedly declared dead at a private hospital in the National capital has captured headlines. The other twin was stillborn. While being taken for the funeral, the newborn was discovered to be alive and is now on life support system.

In light of this incident, IMA has issued an advisory that patients should not be declared dead under conditions of hypothermia. 

It is important to recognize hypothermia so that patient can be timely revived using all resuscitative measures, including rewarming, CPR.

Even those with HIV/AIDS have the right to good health

Even those with HIV/AIDS have the right to good health

More efforts are needed to combat this disease entirely by 2030

New Delhi, 01 December 2017: By the end of last year, there were 2.1 million people living with HIV, with new infections falling to 80,000 in 2016 from 150,000 in 2005. Of these, 9,100 infected were children under age 15 years. Although there has been a registered 20% annual decline in new infections over the past few years, more efforts are required to completely combat the disease by the year 2030. There is a need to create awareness about the fact that everyone with AIDS must be accorded treatment at the right time to help them achieve good health.

This year, the theme for World AIDS Day is “Right to Health”. The WHO will highlight the need for all 36.7 million people living with the condition, to reach the goal of universal health coverage by 2030.HIV is a condition which targets the immune system and weakens people’s defence systems against infections and some types of cancer. The virus destroys and impairs the function of immune cells, thus gradually making infected individuals become immunodeficient.

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, "HIV/AIDS continues to affect the Indian population despite various mass awareness campaigns, availability of various state-of-the-art medical interventions, and evolving technology. A large part of this is also due to the social stigma that our society has associated with the disease. This is also one reason why people avoid routine checkups. There is an urgent need to educate the masses about the various disease prevention measures along with the fact that people with HIV can live a normal life. The government and various healthcare associations must also ensure the availability of condoms in smaller cities and towns where the disease is more rampant.”

HIV and AIDS are different terms. HIV or Human immunodeficiency virus attacks and destroys white blood cells or T Lymphocytes in the immune system making the body prone to all types of diseases. AIDS, on the other hand, is a condition, which develops in the advanced stages of HIV infection due to a weak immune system.

Adding further, Dr Aggarwal, said, “HIV can spread from an infected woman to her child during pregnancy and childbirth. It can also be passed from a mother to her child through breastfeeding.All pregnant mothers should get HIV test done.Antiretroviral therapy (ART) should be started at the earliest to prevent HIV transmission to sexual or drug using partner/s or from the mother to the infant during pregnancy or breastfeeding.”

Here are some other facts about the disease.

• ABC for safe sex: Abstain, Be faithful to your partner and if you cannot, use Condoms.
• Drinking alcohol or taking drugs interferes with judgment. Even those who understand the risks of AIDS and the importance of safer sex may become careless after drinking or using drugs.
• People with STIs should seek prompt treatment and avoid sexual intercourse or practice safe sex.
• Used infected razor blades, knives or tools that cut or pierce the skin also carry some risk of spreading HIV.
• HIV-positive people may remain asymptomatic but can still pass on the virus to others.

Beware of email frauds

Beware of email frauds

We often come across multiple scam activities carried out under the names of organizations such as WMA, IMA, CSI. The frequency and aggressiveness of these scams have increased in recent past and they have become more convincing.

You may receive e-mails informing you that a person you know is stuck somewhere while traveling (money lost, accident, visa problems etc.) and urgently needs cash. Names of WMA/ IMA/CSI or other such names are used as senders to convince you to help or that the person in need is somebody you might actually know.

In a second wave people will call you (!) and urge you to help. The calls are very demanding, the stories sound reasonable. But upon checking, you will find them to be false.

Please do not react to such demands, if you cannot verify authenticity of the writer and/or caller.

E-mail addresses and phone numbers mentioned are no insurance for authenticity.

Do not reveal any other data, like mentioning other names or organizations.

If you think you need to help, ensure authenticity first through an independent pathway that is not mentioned in the scam, to make sure the request is real.

Pneumonia still a major cause of mortality in Indian children

Pneumonia still a major cause of mortality in Indian children

Many children lack access to the Pneumococcal Conjugate Vaccine

New Delhi, 30 November 2017: About 20 children die every hour due to pneumonia in India, reveal recent statistics. Despite efforts being made toward universal immunization, more than 25 million children in India were not immunized with Pneumococcal Conjugate Vaccine (PCV) in 2016.Pneumonia claims more lives in children around the world than any other infectious disease. A majority of those who die are from low and middle-income countries. If this continues, the disease is likely to claim 22,587 lives 2030.

Pneumonia is an acute respiratory infection which affects the lungs. It causes difficulty in breathing and limits oxygen intake. It can be caused by bacteria, fungi or viruses and is a contagious 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, "Pneumonia in India in children under five is caused by malnutrition, low birth weight, non-exclusive breastfeeding, lack of measles immunization, indoor air pollution and overcrowding. When the germs reach the lungs, the lungs become inflamed and fill up with fluid. This causes breathing difficulties, which makes it difficult for enough oxygen to enter the bloodstream. The body's cells can't function as they normally would, and infection can't be flushed from the body. If untreated, the infection may continue to spread, leading to death. Certain children whose immune defenses or lungs are weakened by other illnesses, such as cystic fibrosis, abnormalities in the immune system or cancer (as well as by the chemotherapy used to treat cancer), may be more likely to develop pneumonia. Children whose airways or lungs are abnormal in other ways may have a higher risk.”

Pneumonia usually produces a fever, which in turn may cause sweating, chills, flushed skin, and general discomfort. Children can lose their appetite and seem less energetic than normal. Babies and toddlers may seem pale and limp, and cry more than usual.

Adding further, Dr Aggarwal, said, “Pneumonia can be treated with antibiotics. A large majority of the cases can be tackled at home itself. Hospitalization is recommended only in very severe cases. Pneumonia is not contagious, but the upper respiratory viruses and bacteria that lead to it are. It is a good idea to keep kids away from anyone with stuffy or runny nose, sore throat, cough, or respiratory infection in general”.

Here are some tips to prevent pneumonia in children.

• Breastfeed regularly as it is a great way to boost immunity.
• Wash hands frequently with alcohol based sanitizer every time you blow your nose, use bathroom and before eating and preparation of food.
• Children younger than 5 should be vaccinated against pneumococcal pneumonia a common form of bacterial pneumonia.
• Keep children away from people suffering from colds, flu or other respiratory infections. This greatly increases their risk of catching an infection.

6MWT in Heart Failure

6MWT in Heart Failure

Exercise intolerance, along with dyspnea, fatigue are cardinal symptoms of heart failure, which adversely impact quality of life of the patient. Exercise improves well-being in heart failure. ESC (2016) and AHA/ACC (2013) heart failure guidelines recommend exercise to improve functional capacity, QOL and also to reduce the risk of hospitalization in stable HF patients (Class IA).

The 6-minute walk test assesses functional capacity or exercise tolerance in patients with heart failure and defines prognosis.

A 6-minute walk distance less than 200 m indicates lower functional capacity and carries a poor prognosis. If the walk distance is more than 500 m, the prognosis is good. If the 6-minute walk distance ranges between 200m and 500 m, patient can continue to exercise with oxygen supplementation.

Oxygen saturation during 6MWT also has prognostic significance. A fall in oxygen saturation (SpO2) during 6MWT of more than 4% indicates significant desaturation and is a predictor of mortality.

The aim should be to increase exercise tolerance even if with oxygen supplementation.