Saturday, 31 January 2015

Every pharmacist must know certain MCI Rules: IMA

IMA White Paper: Every pharmacist must know certain MCI Rules

Not only doctors, Pharmacists too have a role in ethical dispensing of prescription medicines. Safe and effective use of medicines is a complementary effort.

MCI Code of Medical Ethics ( Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 and subsequent amendments) has some provisions in it that are of relevance to the pharmacists.

Regulation 5.3 states that physicians should recognize and promote the practice of pharmacy as profession and should seek their cooperation wherever required.

According to Regulation 3.7.1, a doctor’s prescription should also make clear if he/she has himself or herself dispensed any medicine to the patient.

Regulation 7.10 states that a registered medical practitioner shall not issue certificates of efficiency in modern medicine to any unqualified or non-medical person but he/she can issue such certificates to dispensers after proper training.

No physician, as per Regulation 6.3, can run an open shop for sale of medicine for dispensing prescriptions prescribed by other doctors or for sale of medical or surgical appliances. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.

Regulation 1.5 stipulates that as far as possible, drugs should be prescribed with generic names. Every doctor should make sure that there is a rational prescription and use of drugs.

A Pharmacist should be aware that it is improper for a doctor to affix his/her signboard at a pharmacist’s shop. This is as per Regulation 7.13.

Regulation 7.19 does not allow doctors to use touts or agents for procuring patients. So, a pharmacist should not indulge in such activities.

A pharmacist should know that according to Regulation 1.1.3, no person other than a doctor who holds qualification/s that are duly recognized by MCI and is registered with MCI or State Medical Council can practice allopathic medicine. A practitioner of other systems of medicine cannot practice allopathic medicine. A pharmacist cannot practice and prescribe drugs.

Regulation 1.4.1 requires that every prescription should carry the registration number of the prescribing doctor. The pharmacist should check every prescription he comes across while dispensing medicines.

A pharmacist should also know that according to Regulation 1.4.2, doctors can add as suffixes only those degrees/ certificates/diplomas that are recognized by the regulatory bodies or those memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.

Regulation 1.9 requires all doctors to abide by the laws of country that regulate the practice of medicine and also follow the provisions of State Acts like Drugs and Cosmetics Act, 1940; Pharmacy Act, 1948; Narcotic Drugs and Psychotropic substances Act, 1985; Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954. Neither the doctor nor the pharmacist should be a party to helping others evade these laws.

A pharmacist should check that all the drugs prescribed by a physician are carrying a proprietary formula and clear name. Regulation 6.5 prohibits dispensing of secret remedial agents by doctors whose composition they do not know. This regulation also considers their manufacture or promotion of their use as unethical.

According to Regulation 6.7, practicing euthanasia is regarded as unethical conduct for the doctor. The pharmacist has a responsibility to check that every prescription is ethical.

As per regulation 7.20, a Physician shall not claim to be specialist unless he has a special qualification in that branch.

As per regulation 7.3 not displaying the registration number accorded to a physician by the State Medical Council or the Medical Council of India in his or her prescriptions violates the provisions of MCI regulation 1.4.2.

As per Regulation 7.8 a registered medical practitioner shall not contravene the provisions of the Drugs and Cosmetics Act and regulations made there under. Accordingly,  Prescribing steroids/ psychotropic drugs when there is no absolute medical indication and or selling Schedule ‘H’ & ‘L’ drugs and poisons to the public except to his patient shall constitute gross professional misconduct on the part of the physician.

Monday, 26 January 2015

eMedinewS and IMA Congrates and Salutes all Padma Awardee Doctors of the year 2015

Padma Bhushan

  1. Dr. Ambrish Mithal (Medicine), Delhi

  1. Dr. Ashok Seth (Medicine), Delhi

Padma Shri

  1. Prof. Alka Kriplani (Medicine), Delhi

  1. Dr. Harsh Kumar (Medicine), Delhi

  1. Dr. Manjula Anagani (Medicine), Telangana

  1. Dr. Rajesh Kotecha (Medicine), Rajasthan

  1. Dr.Tejas Patel (Medicine), Gujarat

  1. Dr. Narendra Prasad (Medicine), Bihar

  1. Prof. Yog Raj Sharma (Medicine), Delhi

  1. Dr. Nikhil Tandon (Medicine), Delhi

  1. Dr.Hargovind Laxmishanker Trivedi (Medicine), Gujarat

  1. Prof. (Dr.) Yogesh Kumar Chawla (Medicine), Chandigarh

  1. Dr. Sarungbam Bimola  Kumari Devi (Medicine), Manipur

  1. Dr.  Randeep  Guleria (Medicine), Delhi

  1. Dr. K. P. Haridas (Medicine), Kerala

  1. Smt. Jayakumari Chikkala (Medicine), Delhi

  1. Dr. Dattatreyudu Nori (NRI/PIO) (Medicine), USA

  1. Dr. Raghu Rama Pillarisetti (NRI/PIO) (Medicine), USA

  1. Dr. Saumitra Rawat (NRI/PIO) (Medicine), UK

  1. Dr. Gyan  Chaturvedi (Literature and Education), Madhya Pradesh

Sunday, 25 January 2015

Politician should declare their health record too

Like their financial health all politicians should also declare their physical  health said Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary General Indian Medical Association and President Heart Care Foundation of India.

It is the right of the voter to know their candidates health status and whether or not they will be able to bear the stress of politics for the next five years.

Politicians are icon celebrities of the society and their habits influences the younger generation.
If they are out of shape, have abdominal obesity, if they smoke or drink the younger generation will get a wrong message.

Even if they are suffering from a disease disclosing it makes sense. We know Dr Venugopal who did first heart transplant in India operated for bypass 7 days later his own bypass. The message went loud and clear to the society that after bypass one can be active in one week.

Bharat Ratna Awardee Atal Ji when got operated for knee replacement in India the quality of Ortho surgery in Indi took a positive turn.

When somebody wants to join a public sector or any other high-level job, he or she is required to go through a fitness test.  And if their medical examination reveals any pre-existing serious disease then he or she is disqualified for the job. No cricketer or any other sportsperson is allowed to play without undergoing a vigorous and methodical medical fitness test.

Then how come a politician who is responsible for the governance of one of the largest democracies in the world is allowed to fight an election without his/her health checkup to ascertain his/hers medical fitness?

The time has come for a mandatory medical fitness test at every level whether it is a job or a public service or a political career.  When one has to declare one’s financial & criminal record, it should also be mandatory that one declares one’s previous health record prior to contesting an election.

Somebody may argue that politicians are advisors and they have to be only mentally sound and that it does not matter if they have any physical ailments. But this is not true.  The politicians should not only be mentally but physically sound too.  If they are not physically sound and only intellectually of use to the community, they can become advisors to the government but not active political leader.

The job of a politician is to work at the grass root level and provide services to the community.  They are supposed to be physically active people who can reach places of disaster in no time, walk for miles to reach the community and provide for what the public wants.

What Keeps The Politicians Alive?

It’s the power and love for limelight that makes the heart of the politicians beat, said Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary General Indian Medical Association and President Heart Care Foundation of India.

Late Sh. P.V. Narasimha Rao, the former Prime Minister, is a sure case for that matter. Ailing with a severe heart problem, he strived to fight the elections despite cardiologists repeated instructions for rest. Physically, too weak, the weaning for power made him the PM of this biggest democracy in the world.

Such cases don’t reveal the politician’s lust for power but the proven biological phenomenon among living beings. It was first observed among chimps. The study revealed that any chimp who was made the leader of the group, behaved entirely in a different way from his fellow beings. This was termed as “The Itch of Power”. The biological reason behind this change in temperament was due to the rise in the secretion of Serotonin (Neurochemical). The more the secretion the more vigour it produces. The increase in the secretion of neurochemicals is spontaneous with the power one accumulates.

Many studies revealed that most of the U.S. Presidents were different in their power tenure than otherwise in their later or former years. Human system is such, that limelight brings a potential, which radiates confidence and vitality in the individual.

Amazingly, speeches over the audio and video media present a personality differently from what he is in front of a large audience. Applause from the gathering most automatically gives the individual that spirit and gaiety, which is a characteristic of any man in power.

Power brings positivity into the life. One gets boosted by the strength of his inner self and out lives the diseases and aliments which otherwise were quite prevalent in this physical stature.

Saturday, 24 January 2015

Indian Medical Association, Indian Academy of Pediatrics, National Neonatology Forum and Federation of Gynecology Societies of India to join hands to reduce the infant mortality rate in the country

New Delhi, January 24, 2015: The 52nd Annual Conference of Indian Academy of Pediatrics is ongoing in the city and aims to discuss and debate one of the most crucial aspects of healthcare in our country – the quality development of children. Attended by over 8,000 doctors the PEDICON 2015 is the largest gathering of pediatrics in the country.

In a special session Padma Shri Awardee and Honorary Secretary General IMA, Professor Dr K K Aggarwal said that no infant should die just because preventive and infrastructure facilities are not available. For every infant death someone should be accountable. He added that every infant’s death should be made a public outcry.  Our country has in the recent past woken up to violence and abuse against women, they must now also come together and raise their voice against preventable infant deaths.

“Why report a rare Congo- Hemorrhagic death and not report a preventable infant death", Dr Aggarwal asked the hall full of doctors listening to his talk.

Talking about children in the age group of 0-5 years, Dr Aggarwal added that, “Today over 2 lakh children die of diarrhea and 3 lakh from pneumonia every year. This is not acceptable to the medical profession. IMA will take up the task of sensitizing over 2.5 lakh of its member doctors on these subjects. Bangladesh, one of the world’s poorest countries, is a leader in the fight against diarrhea. There is no reason why India should not too”.

In addition to this IMA will also open 1700 adolescent clinics in the country to educate girls on lifestyle, reproductive and mental health.

Congratulating this initiative and discussing the existing problem, Dr. Ajay Gambhir Organizing Chairperson of PEDICON 2015 said, “There has been a decline in infant and neonatal mortality rates in our country but the rates are still relatively high in urban slums and rural areas. It is our aim to bring this number down by 2020 in accordance with the millennium development goals through programs on immunization, women empowerment and reduction in female feoticide and infanticide. I thank the Indian Medical Association for supporting this initiative and look forward to working with them towards this cause.

Adding to this, Dr Anupam Sachdev, Organizing Secretary, PEDICON 2015 said,” It is unfortunate that India has the highest newborn mortality and it is a need of the hour to tackle this situation. The PEDICON 2015 has been unique for it has brought together not only doctors but also government leaders, NGO’s and International organizations to discuss a cause of national importance under one roof. I thank the Indian Medical Association for their support and hope that we can together put an end to preventable child deaths’.

Bangladesh, one of world’s poorest countries, is a leader in the fight against diarrhea, which is the number two killer of children under age 5 worldwide after pneumonia. Diarrhea claims 1.5 million kids annually – more than AIDS, malaria and measles combined. There is no reason why India should not lead over Bangladesh in this issue.

IMA releases white paper on Crimean-Congo Hemorrhagic Fever

Zee News New Delhi:  The Indian Medical association (IMA) today sought to inform the public about preventive measures to counter Crimean Congo Hemorrhagic (CCHF) after tests confirmed that a patient who recently died at AIIMS here had contracted the disease.

The white paper compiled by Dr KK Aggarwal, the IMA Secretary General, explains what the disease is and what preventive measures should be taken to check it. The advisory came after tests at National Institute of Virology (NIV) at Pune confirmed that the patient, who was referred to AIIMS from a hospital in Jodhpur, had succumbed to CCHF.

As per the white paper, CCHF is a severe, potentially fatal disease in humans caused by tick-borne virus (Nairovirus) and mainly occurs in Africa, Asia, Eastern Europe and Middle East.
CCHF was first confirmed in a nosocomial (originating in a hospital) outbreak in 2011 in Gujarat. Another outbreak occurred in July, 2013, in Karyana village of Amreli district in Gujarat, IMA said.
"There is no vaccine available for either people or animals. Preventions that one can take include reducing the risk of human-to-human transmission in the community, avoiding close physical contact with CCHF-infected people, wearing gloves and protective equipment while taking care of ill people, washing hands regularly after caring or visiting ill people," stated the white paper.

Health workers caring for patients with suspected or confirmed CCHF, or those handling specimens from them, should implement standard infection-control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.
Transmission of CCHF in humans occurs through tick bites, contact with a patient with CCHF during the acute stage of infection or contact with blood or tissue from infected livestock.

"Human-to-human transmission can occur resulting from close contact with the blood, secretions organs or other bodily fluids of infected persons. The four distinct phases of the disease are incubation, pre-haemorrhagic, hemorrhagic and convalescence," it added.

The incubation period that follows a tick bite is usually short and lasts for between three to seven days. The pre- hemorrhagic period is characterized by the sudden onset of fever, headache, myalgia, and dizziness. Additional symptoms of diarrhea, nausea and vomiting are also seen in some cases.
"Nearly three days later, hemorrhagic manifestations from petechiae, large haematomas and frank bleeding (vaginal, gastrointestinal, nose, urinary, and respiratory tracts) usually follows.

"The convalescence period begins in survivors about 10 to 20 days after onset of the illness," the white paper says.

The disease is diagnosed by ELISA and immunofluorescence assays from about seven days after its onset.

Treatment of CCHF is mainly supportive. Ribavirin is effective, to be given for 10 days (30 mg/kg as an initial loading dose, then 15 mg/kg every six hours for four days, and then 7.5 mg/kg every eight hours for six days).

Meanwhile, the report said that a study on Vector Borne and Zoonotic diseases looked at the prevalence of CCHFV among bovine, sheep and goat populations from 15 districts of Gujarat and found antibodies in all the 15 districts surveyed; with positivity of 12.09 per cent in bovine, 41.21 per cent in sheep and 33.62 per cent in goats.

"Anti-CCHF virus (CCHFV) immunoglobulin G (IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals," the white paper said.


Friday, 23 January 2015

IMA White Paper on Crimean-Congo Hemorrhagic Fever: No panic

IMA White Paper on Crimean-Congo Hemorrhagic Fever: No panic

National Institute of Virology in Pune  has confirmed a 35-year-old male nurse who died of extensive internal bleeding at AIIMS was suffering from Congo contagious fever. The male nurse from a private Jodhpur hospital, was among five members of the nursing staff who developed flu like symptoms. Two nurses showed a fall in blood platelet count and suffered internal bleeding with one dying on Sunday in Jodhpur while the other died of multi-organ failure after being admitted to AIIMS with Ebola-like symptoms.

Indian Medical Association, National President  today released a white paper on  Crimean-Congo Hemorrhagic Fever for the benefit of its members and public. The paper in the form of question and answers is compiled by Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary General IMA.

No panic said IMA. Its not a new disease in India. 

What are hemorrhagic fevers?

                1. Dengue
                2. Yellow fever
                3. Ebola
                4. Marburg hemorrhagic fever. It is rare and limited to countries in Central Africa
                5. Crimean-Congo hemorrhagic fever

What is Crimean-Congo hemorrhagic fever?

 A: It is a severe, potentially fatal disease in humans caused by CCHF  tick-borne virus (Nairovirus) of the Bunyaviridae family.

In which countries the disease is seen?

Africa, Asia, eastern Europe, and the Middle East.

Is it seen in India?
                    CCHF was first confirmed in a nosocomial outbreak in 2011 in Gujarat State. Another notifiable outbreak occurred in July, 2013, in Karyana Village, Amreli district, Gujarat State.
                    Anti-CCHF virus (CCHFV) immunoglobulin G (IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals.
                    A study published in Vector Borne Zoonotic Dis. 2104 looked at the prevalence of CCHFV among bovine, sheep, and goat populations from 15 districts of Gujarat State and found antibodies in all the 15 districts surveyed; with positivity of 12.09%, 41.21%, and 33.62% in bovine, sheep, and goat respectively.

What is the mode of human transmission?

                    Transmission to humans occurs through tick bites, contact with a patient with CCHF during the acute stage of infection, or contact with blood or tissue from infected livestock.
                    Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.

 What are the four distinct phases of the disease?

The typical course of CCHF has four distinct phases
·         Incubation
·         Pre-hemorrhagic
·         Hemorrhagic
·         Convalescence

What is the incubation period?

The incubation period that follows a tick bite is usually short (three to seven days).

What are the clinical symptoms?

·         The pre-hemorrhagic period is characterized by the sudden onset of fever, headache, myalgia, and dizziness.

·         Additional symptoms of diarrhea, nausea, and vomiting are also seen in some cases.

·         Nearly three days later , hemorrhagic manifestations from petechiae, large hematomas, and frank bleeding (vaginal, gastrointestinal, nose, urinary, and respiratory tracts) usually follow.

·         The convalescence period begins in survivors about 10 to 20 days after onset of illness.

How serious is the disease?

The case fatality rates range from 3 to 30 percent

What is the cause of death?

                    Disseminated intravascular coagulation
                    Vascular dysregulation
                    Higher serum levels of proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)

What are the ultrasound findings?

Liver and spleen enlargement, paraceliac abdominal enlargement of lymph         nodes, gall bladder wall thickening, and intra-peritoneal and pleural effusion. These become prominent on the third day of disease in some patients.

How is the diagnosis made?

                    Viral isolation in bio-safety level four laboratories
                    2. IgM and IgG antibodies are detectable by ELISA and immunofluorescence               assays from about seven days after the onset of disease
                    Specific IgM antibodies decline to undetectable levels approximately four months after presentation.

What is the differential diagnosis?

All hemorrhagic fevers including dengue and ebola. All cases of dengue like illness with negative ebola or dengue test one should suspect it.

What is the treatment?

                    Treatment is mainly supportive.
                    Ribavirin is effective, to be given for 10 days (30 mg/kg as an initial loading dose, then 15 mg/kg every six hours for four days, and then 7.5 mg/kg every eight hours for six days)

Is a vaccine available?

There is no vaccine available for either people or animals.

What is the prevention?

                    Reducing the risk of human-to-human transmission in the community
                    Avoid close physical contact with CCHF-infected people;
                    Wear gloves and protective equipment when taking care of ill people;
                    Wash hands regularly after caring for or visiting ill people.
                    Health-care workers caring for patients with suspected or confirmed CCHF, or handling specimens from them, should implement standard infection control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

What is common in homorganic fevers?

Vascular dys-regulation with severe intravascular leak. Clinical it will present with low pulse pressure. And responds to massive vascular resuscitation with fluids.

What is the clinical clue?

Dengue like illness, pleural effusion on ultrasound, gall bladder thickening in ultrasound, negative dengue serology and signs of intra vascular leak.

Thursday, 22 January 2015

Day Care and Home Care Need of the Hour in India

Why Promote Day Care and Home Care Health Care

Dr K K Aggarwal, Padma Shri Awardees, Honorary Secretary General IMA

There is a shortage of hospital beds in the country. The international requirement is one bed for every 800 patients and in India the number is one bed for every 2500 patients.

Few issues

1. Are we really short of doctors: As per international standards doctor work for no more than 48 hours and sees no more than 8-10 patients in day. In India where doctors see over 50 patients a day these shortage may not be real.

2. Are we really short of beds: The World Health Statistics say that India ranks among the lowest in this regard globally, with 0.9 beds per 1,000 population - far below the global average of 2.9 beds. India's National Health Profile 2010 says India has a current public sector availability of one bed per 2012 persons available in 12,760 government hospitals — around 0.5 beds per 1,000 population. 

This shortage of beds can be tackled by bringing the concept of minimum hospitalization days and promoting day care and home care.

3. Minimum Hospitalization days: Hospitals are not hotels and prolonged hospitalization should be discouraged.

Healthy people, especially children should not be allowed to stay in the hospital.
There should be a separate night shelter away from the sick patients unit.
The discharge process should be quick so that the patients stay is shortened.
Package days does not mean one has to stay for that long.
Pre op admissions should be avoided just for investigations.
Post op care should be day care, clinic care or home care based.
Rehab care should not be in the settings and vicinity of serious patients.
Mediclaim does not recognize day care treatment for all conditions and in  ot networked nursing homes or hospitals.  Minimum 24 hour hospitalization is needed for most conditions. For example if a person gets admitted at 7 pm in the evening and gets stabilized in few hours will  remain in the hospital till next evening to complete 24 hours and invariably will gets discharged the next morning, consuming two night stay in place of 4 hours stay. A bed unnecessarily gets blocked for two nights apart from more charges and more chances of infection.

4. Promoting day care and home care?

In Ganga Ram Hospital alone in the year 2014, out of total 29494 surgeries 12473 surgeries were done as day care (13223 out of 28666 in the year 2013; 11942 out of 27186 in 2012 and 9955 out of 25135 in 2011). They have been able to reduce the need of beds by promoting day care surgeries.

Day care will also reduce the hospital acquired and health case associated infections and subsequent need for more beds.  Longer the duration of treatment more will be the chances of infections.

Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one Hospital Acquired Infection. The estimated rate in USA was 4.5% in 2002, corresponding to 9.3 infections per 1000 patient-days and 1.7 million affected patients, with 99.000 deaths annually. The European centre for Disease Prevention and Control reports an average prevalence of 7.1% in European countries. The cumulative incidence of infection an adult high-risk patients is 17.0 episodes per 1000 patient-days. HAI in low- and middle-income countries; at any given time, the prevalence of HAI varies between 5.7% and 19.1%.

Day and home care will have early IV to oral switch in antibiotics with less resultant cost and less antibiotic resistance.

IMA Rare Blood Group Online Blood Bank Directory

IMA has started an online voluntary rare group blood bank, where a list of all rare blood groups will be displayed.

IMA has appealed to all people with rare blood groups, especially the Bombay blood group to pass on their name, address, email and mobile numbers so that the same can be uploaded on the IMA website.

People with rare blood groups can often be given a blood, when needed, only from people with the same blood group. And in life threatening such a website directory will come handy to save lives.

What is a rare blood group?

A: A rare blood is the one that, on the basis of the blood group characteristics, which is found in a frequency of 1: 1000 random samples in a given population. From blood transfusion point of  view, a rare blood is the one with red cells lacking a high-frequency blood group antigen.  Besides, a blood that lacks multiple common antigens may also be considered as a rare since such donor's blood may be useful for the transfusion recipient who has developed multiple antibodies to corresponding antigen.

Are rare blood groups present all over the world?

No. Rare nature of a blood type may vary from one country  to another and therefore a blood type rare in one country may not be considered rare in another.

Which is the commonest rare blood group in India?

Bombay blood group.
Bombay (Oh) phenotype. Bombay hh.

Why it is called Bombay blood group?
The Bombay phenotype is found almost exclusively in individuals from India, with an incidence of 1/10,000.

What is lacking in Bombay blood group?

In the Bombay phenotype, fucosyl transferase, which conveys H antigen specificity, is lacking. Since the H antigen is the building block for the A and B antigens, neither A nor B can be produced, even in the presence of their respective transferase enzymes. Thus, red cells of the Bombay phenotype lack A, B and H antigens. These individuals naturally produce anti-A, anti-B, and broad thermal range anti-H antibodies, and they can only be transfused with blood from other individuals of the Bombay phenotype (usually a relative, although autologous blood can be obtained by apheresis prior to a surgical procedure or risk a severe hemolytic transfusion reaction.

Can Bombay blood group patients donate blood?

They are universal (ABO) donors.

How will one detect Bombay blood group?

Tests would show them to be O, unless further tests were performed. Cross matching of blood from an individual with this phenotype will show hemolysis with all group O screening cells and panel cells, alerting the blood bank to the need for further investigation.

If an individual with the Bombay phenotype needs blood in an acute emergency and blood from a Bombay phenotype donor is not available what are the options?

Look at IMA website for potential donor in that city
Get blood tests done of all your relatives one of them may be Bombay Blood Group.
Use artificial blood could be used instead.
Autologous blood can be obtained by apheresis prior to a surgical procedure

What are other rare blood groups?

- D -/- D -
A host of weaker variants of A, B and H antigens
CdE/CdE (ryry)

What about AB negative blood group?

AB negative overall, though different parts of the world have different instances of blood type. In the US, AB negative is extremely rare, but not in Asia. Still, overall, it is the rarest, unless  you consider the Bombay a group.

[Compiled by Prof Dr K K Aggarwal, Padma Shri Awardee, Honorary Secretary General IMA 2014-16]

Sterilization Menace an International Concern

Some concerns of World Medical Association, answered by Prof Dr K K Aggarwal, Padma Shri Awardee, Honorary Secretary General IMA

Q 1:      Some doctors would be offered compensation to do as many sterilizations as possible in the camp. Is this the case? if so, this would constitute a clear unethical inducement, not placing the health of their patients as their first consideration.

A:  Ministry has targets for the government doctors. Normally private doctors do not do such camps.   Central Council decision of IMA on 27th December: "IMA has asked for defined protocols for medical professionals for organizing medical and surgical camps. IMA is against any unrealistic targets given to government doctors.

As per IMA guidelines which are also consistent with Govt. guidelines, in one day, more than 30 such surgeries should not be done.   IMA wrote to Shri Lov Verma, Health Secretary, Deptt. of H&FW, in early January, to ensure that no unrealistic targets are given to any government doctor in any state.  

As per MCI ethics regulation 1.7 it is the duty of a doctor to expose the unethical acts of others.
MCI 1.7 Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.      

Q 2: Women would undergo surgeries in very questionable hygienic conditions (on the ground, without sterilized medical instruments). Here again, by doing so, doctors would obviously not place the health of their patients as their primary consideration. In addition, this would clearly be contrary to the dignity of the women. Has the Indian Medical Association checked these facts?          

A:  IMA has written to the health ministry regarding this.  Hygienic conditions gets worse only if they surpass their targets. In the present Vilaspur case there were some cases of infections. IMA is in process of uploading its and governments guidelines regarding infection control in camps.  
As per MCI ethics regulation 2.4 the patients once taken charge must not be neglected.
MCUI 2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.      

Q 3:  Some doctors would do as many sterilizations as possible under pressure by the State for fear of losing their position. Doctors would then be coerced, undermining their autonomy to carry out their mission according to medical ethics principles. Have you investigated such a potential coercive action by government authorities?                  

A: See answer to first column as the IMA response. Also only a doctors can put pressure under the junir one and here the MCI ethics regulation 1.7 apply.
q 4:   Women would be proposed sterilization as the only contraception method. Can you confirm these information? This would touch upon the right to information of the patients. How can women make a decision on such a key and intimate issue without other options offered?  Linked to this, the issue of consent of the patients should also be investigated: the women being sterilized would be living in poverty and be illiterate. In these conditions, are they not likely to be influenced (if not manipulated), potentially lacking the capacity to take the best decision for their health and well-being?  There is a clear scope to question the validity of the informed consent of the patients. Has the Indian Medical Association inquired about these facts?                    

A: Weather in government or in private sector in India no surgery can be done without informed consent.   As per MCI ethics regulations 7.16 Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed.   In the informed consent all women are given choices of all forms of contraception. Failed sterilization also has a compensation clause.

Q 5: All these factors would bring us to the conclusion of cases of forced and coerced sterilization condemned by the WMA  as well as by other health and human rights organisation. The recent inter agency statement (WHO, UNICEF, OHCHR, UN Women, UNAIDS, UNDP, UNFPA). Eliminating forced, coercive and otherwise involuntary sterilization goes along the same line.

A: IMA is against forced, coercive and otherwise involuntary sterilization  so is Indian government.          

Q 6: Therefore, the issue of the spurious drugs supplied by the Government in these camps that you mention in your response is just one amongst many other issues that are of very serious concerns to us. If the reports are correct, we see various reasons to raise our voice, given the severe violations of medical ethics and unprofessional behavior as potentially coercive action by government authorities.

A: The issue of spurious drugs is under criminal investigations.  Law will takes its own action. Soon in all government supply only government quality approved drugs are to be supplied.              

Wednesday, 21 January 2015

Indian Medical Association Concern Over Violations of Fundamental Health Rights in Camp Liberty

The Indian Medical Association has expressed its concern to the Iraqi Prime Minister about "worrying health conditions" in Camp Liberty, the former United States military installation in Baghdad, now being used to house the members of the People's Mujahedin of Iran who previously resided in Camp Ashraf.

In a letter written to the Prime Minister Hon Dr. Haider al-Abadi, Padma Shri awardee Prof Dr A Marthanda Pillai National President; Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary general and Dr S S Aggarwal President Elect, Indian Medical association said " We at Indian Medical Association, the largest medical NGO of the world with over 250,000 doctors as members express our deep concerns about the disturbing health conditions in Camp Liberty in Iraq.

As per the information received by IMA, from Amnesty International and other global human rights organisations, it looks that the inmates of Camp Liberty are being subject to violations of their fundamental health rights. These restrictions amount to very serious breaches of basic human rights, including the right to health and the right to be free from inhuman and degrading treatment."
" The violations include:
·         Restricted access to health professionals for sick persons
·          No privacy with failure to respect the ordinary rights of patients to medical confidentiality
·          Denial of travel outside Camp Liberty to receive urgent medical treatment
·          Failure to provide interpreters during interactions with health professionals.
·         Hospitalization of patients and purchase of medicine have been prevented.
·         Cancellation of medical appointments, delayed transfers of patients to hospital, or denial of permission to travel outside the Camp to receive treatment.
·         These on-going obstructions have resulted in the rapid deterioration of the health conditions of several patients of the Camp Liberty and even in the death of some.  As per reports lack of timely and appropriate care have resulted in deaths of up to 22 residents of the camp. " 

I MA communication said " We at IMA are extremely concerned by this situation that reveal flagrant violations of medical ethics principles and human rights standards. The right of everyone to the enjoyment of the highest attainable standard of physical and mental health is a fundamental element of human rights enshrined in article 14 of the International Covenant on Economic, Social and Cultural rights that Iraq has ratified in 1971.

We urge the Iraqi authorities to respect its commitment and take action as a matter of urgency in order to ensure to the residents of the Camp Liberty full access to adequate health care facilities, whether inside or outside the camp. "

IMA has asked the Iraqi Prime Minister to " Kindly ensure that health personnel work with the assurance that medical ethics principles, such as confidentiality, are entirely respected without any reservation." 

Already World Medical Association and British Medical Association have also raised similar concerns.

Tuesday, 20 January 2015

IMA White paper on Dr Ketan Desai

Is Dr Ketan Desai a member of Indian Medical Association(IMA)
Yes, he is a valid member through Gujarat State Branch. He is a National Past President of IMA
Was he ever suspended by the state branch or National IMA
Is he enrolled on Indian Medical Register (IMR)  of Medical Council of India(MCI) as on date.
Was he suspend by MCI in the year 2010?
 He was never an employee of the MCI.  As such, there is no question of suspension. Under the Indian Medical Council Act, 1956 - grant of registration as a registered medical practitioner is by State Medical Council. Any suspension / removal of the name of any registered medical practitioner can only be by a State Medical Council.  All those names, which get registered in a State Medical Register, are then required to be entered into the Indian Medical Register. Further, it is only when registration of a registered medical practitioner by a State Medical Council is suspended/removed that the consequential entry is also required to be made by the MCI in the Indian Medical Register.  Without there being any suspension of registration by the State Medical Council, his name was suspended from the Indian Medical Register in 2010. However,  his suspension has been revoked by the MCI in December 2013.
Was he ever suspended by state medical council

Was he caught red handed by CBI taking bribe of 2 crores
How much money was recovered during CBI search from Dr. Ketan Desai's all premises?
As per seizure memo filed by the CBI in the competent CBI court, it was placed on record that only a sum of Rs. 53600/- in all (approx. 900 USD) in cash were recovered by the CBI during search of  all the premises belonging to  Dr. Ketan Desai and his family .

What was his Disproportionate Case(DA)?. What is the status of the case?
On the basis of certain allegations, CBI had initiated investigation whether Dr. Ketan Desai possessed any asset which was disproportionate to his income. Such position is loosely described as Disproportionate Case.

Disproportionate Case(DA) was registered by CBI in May 2010 against Dr. Desai and his family members for a period from 1/1/1997 to 22/04/2010. After a detailed investigation by the CBI over a period for 2 years - the CBI  in May 2012 had filed closure report in competent court submitting that all assets in possession of Dr. Ketan Desai and his family members are genuine possessions known to legal sources of his and the income of his family members In 2012, the competent court after due  scrutiny accepted the closure report submitted by the CBI. As a consequence thereof, the appropriate order for  removal of any impediment in relation to the assets and bank accounts - was also made.    
What do you mean by DA case has been closed
The case for disproportionate assets, invariably, begins with the allegation that the assets held are disproportionate to known legal sources of income and therefore, it has to be assumed / accepted that possession of such assets, which are beyond the known legal sources must be from illegal sources say bribe etc.  If upon thorough investigation, the investigating authority concludes that the assets, which are held by the person under investigation, are proportionate to the known sources of his income then in that case, all the allegations of illegal sources of income  such as bribe etc. would deserve to be rejected. No such allegation would then survive. Thus, it can be safely stated that Closure of DA case means that all corruption charges against a person are found to be false and baseless.
What are the current CBI cases against him
With a view to avoid any ambiguity and / or incorrect interpretation etc., it would be useful to refer to and reproduce the entire content of the relevant communication of the CBI in this regard.

 The Central Bureau of Investigation had sent a communication to IMA dt. 22.04.14, inter alia, stating therein as under:-

1. “Dr. Ketan Desai was arrested by CBI in case RC 02(A)/2010/ACU-IX/CBI/New Delhi on 22.04.2010 on the allegation that he had accepted bribe of Rs.2.00 Crores from the owner of Gian Sagar Medical College, Patiala through a middleman namely Sh. J.P. Singh. However, no cash was recovered during the personal search of Dr. Ketan Desai.

2. Case RC 3 (A)/2010/ACU-IX/New Delhi DA Case against Dr. Ketan Desai was closed after investigation and the closure report filed in the competent court has been accepted.
3. In Case RC 0102010 A 0017/Kolkata, Closure Report has been filed in the Competent Court.
4. In Case RC MA1 2010 A 0025 dated 29/06/2010 of CBI ACB Chennai, no action has been taken against Dr. Ketan Desai. However, a Charge Sheet has been filed on 30.12.2011 against other accused person and is pending trial in the court of ACMM Chennai.
5. In Case RC MA1 2010 A 0024 dated 21/05/2010 of CBI ACB Chennai, no action has been taken against Dr. Ketan Desai. However, a Charge Sheet has been filed on 30.05.2012 against other accused person and is pending trial in the court of Principal Special Judge, Pondicherry.
6. In case RC 15 (A) 2010/CBI/ACB dated 26/05/2010 of CBI ACB Hyderabad, no action has been taken against Dr. Ketan Desai. However, a Charge Sheet has been filed against other accused person and is pending trial in the court of ACMM, Hyderabad.

7. In case RC 2 (A)/2010/ACU-IX/New Delhi, Charge Sheet was filed against Dr. Ketan Desai, Sh J P Singh, Sh N S Bhangu, Dr. Sukhvinder Singh and Dr. Kamal Jeet Singh on 16.09.2011 u/s 7, 8, 12 & 13 (2) r/w 13(1)(d) of PC Act 1988. The trial proceeding has been stayed by the Hon'ble Supreme Court.

8. In case RC 006 2010 A0015 dated 22.05.2010 of CBI ACB Lucknow, charges are yet to be framed by the competent court.
Yours faithfully
(H.C. Sharma)
I/c SP/CBI/ACU-IX/New Delhi”

Was there any allegation/inquiry against  Dr Desai  earlier while he was  President MCI?

Way back in 2001, Delhi High Court had ordered CBI inquiry against Dr. Desai and appointed an Administrator Mr. Jhingan who was in MCI for one year. CBI after detailed investigation had submitted a closure report in competent court stating that that there is  no evidence against Dr. Desai in reference to allegations levelled against him. Upon satisfaction the competent  CBI Court and upon due scrutiny had accepted the closure report.

For the period from November 2002 till 2009, another committee of four eminent Doctors was constituted by the Hon’ble Supreme Court which had participated in the functioning of the Council for six and a half years. They had submitted three reports regarding the functioning of the council, to the Hon’ble Supreme Court and had concluded in their report that the council is functioning as per the rules and regulations and all the decisions taken during the five yr tenure of Dr Desai from 1996 to 2001 were as per rules and regulations.  It is reiterated that from 2002 to 2009, this Ad hoc Committee appointed by the Hon’ble Supreme Court had worked with the Executive Committee in all the decision making process and therefore, there cannot be any scope for any allegation during this period.  Thus, for the period 1996 to 2001, the Ad hoc Committee had verified / scrutinized the decisions taken by the MCI during its functioning and which decisions were found to be in accordance with its rules and regulations.  For the period from 2002 to 2009, the Ad hoc Committee itself was a part of the decision making in the functioning of the MCI.

From 2010 for 3 ½ years, the entire decision making in the MCI was through Board of Governors nominated by the Government of India.  Thus, it was virtually the Ministry of Health, Govt. of India who has discharged the functions of the MCI for a period of 3 ½ years from May 2010 to December 2013. Thus, no allegation can be made against any office bearer of MCI for this period.

What is World Medical Association
It's an association of National Medical Associations of about 110 countries
What is the link  between MCI and WMA
There is no link between MCI and WMA. MCI is a statutory authority constituted under the provisions of the Indian Medical Council Act, 1956 and is  discharging statutory functions assigned there under. MCI is not a private body. It is not a private association.  As such, MCI has nothing to do with the activities of World Medical Association, which is a non-statutory private association. Similarly, a President of the MCI who gets elected under the provisions of the Indian Medical Council Act and the statutory regulations made there under to the said office, has nothing to do with any office in the WMA or WMA as such.

For further understanding, this aspect can be explained by another example. Various State Bar Councils and the Bar Council of India are statutory authorities constituted under the provisions of the Advocates Act, 1961.  Various bar associations in various courts in different states in India are only private associations.  Whereas different Bar Councils discharge statutory functions, on the other hand, Bar Associations being private entities do not discharge any statutory functions.

Can one be president of MCI and WMA at the same time
It is possible that one person may hold an office in the MCI and may also independently hold an office in the World Medical Association but that does not create any kind of connection and / or linkage with the statutory body like MCI and a non-statutory private association as IMA or WMA.

Dr. Ketan Desai is a Member of the Indian Medical Association and its past  national President. By fulfilling the conditions for membership / election for office of the President, WMA, Dr. Ketan Desai had stood elected as President of  WMA and will be  taking over in 2016.

Who can become the President of WMA
Any member through the respective member association i.e. member association of WMA. 
Is Dr Ketan Desai the president elect of WMA
Is he the president elect because of his past MCI post
No, he is president elect through Indian Medical Association.  Holding any position of a member or any position of office bearer in the MCI does not have any impact / bearing in relation to either the membership or holding of any office in WMA, which is a private association.

What is the stand of IMA on a doctor who has been charge sheeted with any offence
IMA is clearly of the view / stand that unless any doctor member is convicted of any offence, he cannot be made to suffer any adversity or prejudice because of any charge sheet.

IMA has also been given to understand that no State Medical Council in any of the State in India suspends / revokes registration of any medical practitioner only on a charge sheet. They take action only on conviction by a competent court of jurisdiction. 
What is the status of CBI cases mentioned above as on date.
There is no change in the status.