Thursday, 30 April 2015

IMA asks the government to act on Ramdev for violation of PCPNDT act

IMA asks the government to act on Ramdev for violation of PCPNDT act

As per the media reports, there was uproar in Rajya Sabha after Janata Dal-United MP KC Tyagi flashed a packet labeled 'Putrajeewak Beej' (son-bearing seeds) allegedly produced by Baba Ramdev's company, Patanjali Yoga Peeth.

Supported by many other members including Jaya Bachchan and Javed Akhtar, Tyagi asked how the government is allowing the sale of such herbs.

"Ramdev is the brand ambassador of BJP-ruled Haryana. This is against the PMs campaign of Beti Bachao, Beti Padhao."

Union minister Mukhtar Abbas Naqvi said the government will find out more about it.

Health Minister JP Nadda called it a serious matter and assured the House of appropriate action.

Commenting on the subject Dr A Marthanda Pillai National President and Dr KK Aggarwal Honorary Secretary General IMA said that if doctor does it, it's a violation of PCPNDT act and a confirmed jail. Will the government put him to the jail.

As per the act section 22: Prohibition of advertisement relating to pre-natal determination of sex and punishment for contravention.

(2) No person or organization shall issue, publish, distribute, communicate or cause to be issued, published, distributed or communicated any advertisement in any manner regarding prenatal determination or pre-conception selection of sex by any means whatsoever, scientific or otherwise.

(3) Any person who contravenes the provisions of sub-section (2) shall be punishable with imprisonment for a term which may extend to three years and with fine which may extend to ten thousand rupees.

For the purposes of this section, "advertisement" includes any notice, circular, label, wrapper or any other document including advertisement through internet or any other media in electronic or print form and also includes any visible representation made by means of any hoarding, wall-painting, signal, light, sound, smoke or gas.

Travelers to Nepal must take precautions to prevent cholera

Travelers to Nepal must take precautions to prevent cholera

Post earthquake the biggest fear is cholera epidemic. One must learn lessons from the Haitri cholera epidemic where ten months after the largest urban disaster in modern history, a devastating 7.0-magnitude earthquake on January 12, 2010 that killed over 316,000 and affected 3 million, Haiti faced an outbreak of cholera.

By the end of 2011, the outbreak resulted in over 500,000 infections and 7,000 deaths. Cholera also spread to the Dominican Republic which by end of 2011 recorded over 21,000 cholera cases and 363  deaths.  In the epidemic patient zero was identified as a 28-year-old Haitian who was exposed to cholera while bathing in, and drinking from, a river near the peacekeepers.

Ending the epidemic requires a concerted, multi-sectoral effort; reconstruction of water, sanitation and hygiene (WASH) infrastructure; hygiene education and free access to cholera treatment.
Cholera is a bacterial disease that can cause diarrhea and dehydration. It spreads through the ingestion of contaminated food or drinking water.

Indian Travelers to Nepal need to protect themselves, said Dr Aggarwal. Travelers should  take their own supplies to help prevent the disease and to treat it. Items to pack include a prescription antibiotic to take in case of diarrhea; water purification chlorine tablets; oral rehydration salts, said Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical Association.

Travelers should drink and use safe water. Bottled water with unbroken seals and canned/bottled carbonated beverages are safe. One should use safe water to brush teeth, wash and prepare food, and make ice. One should clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse. One should not use piped water, drinks sold in cups or bags, or ice.  All drinking water and water used to make ice should be boiled or treated with chlorine.
Safe water can be prepared by boiling it for one minute or treating the water with chlorine
purification tablets or household bleach.

One can add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking.

One should always store your treated water in a clean, covered container.

Washing hands is the best bet. One should wash hands often with soap and safe water before eating food, before preparing prepare food, before feeding children, after using the latrine or toilet, after cleaning child’s bottom and after taking care of someone ill with diarrhea. If no soap is available one can scrub hands often with ash or sand and rinse with safe water.

One should use latrines or bury the feces. One should not defecate in open. One can use chemical toilets. One should clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water.

One should defecate at least 30 meters away from any body of water and then bury the feces. One should dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water.

Regarding cooking food, one should cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables.

Remember the formula,  Boil it, cook it, peel it, or leave it.

Sea food precautions, be sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through.

Wash children, diapers, and clothes at least 30 meters away from drinking water sources.

17th May is World Hypertension Day

17th May is World Hypertension Day

Post Earthquake symptoms may include High Blood Pressure.  Any stress, including earthquake can increase Blood Pressure leading to heart attack & paralysis said Padmashri Awardee , Dr. A. Marthanda Pillai,  National President and Padmashri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA.

Hypertension is a silent killer and may not have symptoms for decades.

17th May, all over the country is being observed as “Hypertension Day”.

IMA has issued an Advisory that all patients should have their BP check-up done on 17th May. Over 15% of the people may have high blood pressure and they may not be aware about it.

The first symptom of  high blood pressure may be a bleeding from the nose or brain-hemorrhage.  BP is higher 5 mm in winter, as compared to summer. In any given time, BP should be kept lower by 120/80.

Reducing salt intake and white sugar intake can reduce BP.  All patients whose abdominal girth is more than 80 CM should make sure that their BP is kept normal.

IMA will be sensitizing over 2.5 lacs doctors to do a mass screening of BP on 17th May.

Wednesday, 29 April 2015

Team IMA to leave on 30th April

Team IMA to leave on 30th April

New Delhi: April 28th, 2015: Team IMA to Nepal led by Padma Shri Awardee, Dr. Ashok Gupta, Former Member, Board of Governors; MCI  will be leaving India on 30th April 2015 to provide medical assistance to the earthquake hit area of Nepal. They will be back by 5th – 6th May, 2015.       

The team will include Dr. Kanhan Gupta from Mumabi; Dr. Shashank  Sringarpure from Vadodara; Dr. Sujit Adsul from Pune; Mr.Amitabh J. Chaudhary from Delhi and Dr. Mansukh Kanani; Dr. Bhavesh Vaghasiya; Dr. Girish Patel; Dr. Dinesh Patel; Dr. Shailesh Jepiwala; Dr. Pankaj Patel, Dr. Rajubhai Rabadia and Mr. Bharat Gharedia all from  Ahmedabad.

 Local arrangements have been made by Heart Care Foundation of India Nepal Office, said Mr Vivek Kumar Trustee Heart Care Foundation of India.
Giving the details, Padma Shri Awardee, Prof (Dr) A. Marthanda Pillai, National President and Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General IMA Dr. Chetan Patel, Chairman, IMA Disaster Management Cell, IMA jointly said that the team will have super specialist in plastic surgery, orthopedics and general surgery.

Tuesday, 28 April 2015

Another case of one crore compensation

Another case of one crore compensation

National Consumer Disputes Redressal Commission: Consumer Case No. 104 Of 2002:
Dr (Mrs) Indu Sharma, Complainant(s) vs Indraprastha Apollo Hospital
Course of events

The patient was hospitalized in OP-1 hospital (Indraprastha Apollo Hospitals) after midnight due to rupture of membranes on 10.6.1999. On the same morning, Dr Sohini Verma (OP-3) advised IV fluid with 1 ampule of Syntocinon (Oxytocin) to speed up the delivery. According to the patient, she was administered the maximum dose of oxytocin and there was a fall in the fetal heart rate, which was 80/min during the midnight of 11/12-6-1999.

She underwent emergency caesarean section (LSCS) and delivered a female baby at 3.36 am, birth weight 3.7 kg. The baby did not cry immediately after birth and it took almost 5 minutes.

The baby was kept on ventilator in NICU. The condition of baby deteriorated further, till 29.6.1999. The baby was unable to suck milk. The patient was discharged on 16.6.1999, while the baby was discharged from OP-1, on 30.6.1999. The patient had taken treatment from OP-3 for infertility and thereafter, spontaneously she conceived after 4 ½ years.

After 2 ½ months, from 23.08.1999, the baby was admitted to Holy Family Hospital with complaints of loose motions and strong clonic seizures from 23.8.1999. CT scan showed severe brain atrophy which could lead to severe mental retardation. The complainant observed that at age of 1 year 8 months, the baby’s milestones were delayed; episodes of seizures persisted. Also, the baby was unable to hold her neck and unable to suck milk.

From 21.09.1999 to 03.12.2002, the child was treated at AIIMS. The Disability Board of AIIMS, New Delhi certified the baby as ‘95% disability’.

The baby survived for 12 years with disabilities and with mental retardation and died on 15.1.2012.

• No senior doctor available at the time of admission to the hospital; patient examined by resident doctor.

• Oxytocin administered in maximum dose, following which the fetal heart rate began to drop (80/min), but none attended the patient immediately.

• OP-3 failed to perform LSCS within 12-18 hours after membrane rupture and was abnormally delayed for about 27 hours.

• Excessive dose of oxytocin led to fetal distress and cerebral anoxia-palsy.

• Further CT scan and x-ray reports of the baby were declared as normal by the OP; but, in the opinion of doctors in the US and brother of the patient (a pediatric surgeon in USA) the severe atrophy of baby’s brain cortex was due to birth asphyxia and that the child might remain severally mentally retarded for as long as she lives.

• OPs made number of corrections /interpolations on the case sheets; the neonatal record was also tempered with.

• The Complainant never received the CTG graphs from the OP.

• The OP-3 failed to take proper care during delivery, which resulted in birth of an asphyxiated baby.

The complainant filed a complaint in the NCDRC alleging medical negligence on the part of the treating doctors and the hospital where she delivered her baby. And sought a total compensation of Rs.2.5 crores plus Rs.5 lacs for the mental agony and Rs.25,000/- as costs of litigation.

The commission examined three separate affidavits of evidence by Dr Sohini Verma, Senior Consultant and Gynaecologist, (OP-3), the Neonatologist, Dr Saroja Balan working at OP-hospital, and the Medical Superintendent, Mr. Singhal of OP-1 including that of the two witnesses from hospital, one of the sister In-charge Retnamma K. Nair and the other of Dr Poornima Dhar, the Anesthetist.

OP-3 was allowed to argue and assist the counsel for OP. The counsel argued that as the complaint was filed after delay of 264 days, it was barred by limitation. According to OP-3, oxytocin was given only for 17 hours and not for more than 24 hours; total 66 units of oxytocin was given by controlled infusion pump with proper monitoring. The delay in LSCS was due to non-cooperative attitude of patient. The FHR was normal throughout. OP-3 denied that during the last two hours of the progress of the labour, in question, no uterine activity and FHR recording were mentioned in the nursing chart. The CTG records were handed over to the complainant at the time of discharge, along with other documents.

The counsel asked for the complaint to be dismissed as there was no negligence on the part of OP-1 and/or OP-3.

Observations of the Commission
• On 03.03.2003, the Complainant filed an application for Condonation of 264 days delay in filing the complaint. The Commission disregarded the defense of the OP that the complaint was time barred as the delay of 264 days in filing the complaint had been condoned on 16.12.2011. Also the cause of action remains continuous till the patient or the complainant comes to know about the real injury.

• The Complainant has not produced any medical expert evidence, and has not produced any witnesses from Holy Family Hospital and AIIMS where the baby was treated after discharge from OP-1. Initially on 27.03.2006 complainant filed one application for referring the case to the medical expert of AIIMS to take medical expert opinion but she withdrew the said application. The Complainant relied upon the medical textbooks, the research articles.

• The OPs produced three expert opinions from doctors in own hospital, namely Prof (Dr.) Kamal Buckshee, Senior Consultant with Department of Obstetrics & Gynaecology of OP-1 Hospital, Dr. (Mrs.) Urmil Sharma and Dr.(Mrs.) Harmeet Malhotra, all have examined the treatment papers, opined that the treatment given to the patient was correct, and that there was no deficiency or negligence on the part of the treating doctors.

• 'There was delay in performing LSCS by OP-3; waiting period should not have been more than 24 hours and FHR should be carefully monitored.

• The child was consulted at several hospitals like Holy Family Hospital, New Delhi from 29.091999 to 08.09.1999 and took treatment at AIIMS from 29.09.1999 to 2003 for cerebral palsy and brain atrophy.

• The Commission did not accept the defense of OP-3 that it was induction failure and instead stated that OP-3 decided emergency LSCS because of fetal distress/non-reassuring fetal heart rate, and not induction failure. The Commission also did accept the contention of OP-3 that the baby was born with pre-existing (prenatal) neurological disability in the absence of any signs of foetal hypoxia or birth asphyxia

• The medical records of the baby were produced after a decade i.e. on 20.11.2014.

• All investigations (blood and urine test, USG, colour Doppler, CTG) done in antenatal period were normal. Triple marker test was not done as there was no previous family history of any genetic disorder.

• Repeat USG was not done at the time of admission to recheck a loop of cord around neck seen in previous USG done 12 days back. Pelvic adequacy by clinical pelvimetry was not checked for including adequacy of fluid even when the patient was leaking profusely. The FHS recorded was 146/minute, therefore the condition of foetus was good prior to delivery.

• In the instant case, the resident and nurses failed to appreciate the signs of distress on the foetal heart monitor, and they failed to inform the attending OP-3 of the non-reassuring heart tracings.

• OP-3 did not follow the standard of care for a hospital to quickly deliver a baby by emergency C-section when necessary. “Standard of care allow obstetricians two options to ensure that the continuation of labour is safe for the baby. One option is to perform a test to make sure that the baby is not acidotic. (If a baby is acidotic, it means inadequate gas exchange is taking place and the baby is being deprived of oxygen.) If that test is not performed, the Oxytocin must be stopped. However, if stopping the Oxytocin did not improve the heart tracing, the standard of care required C-section delivery since vaginal delivery was not imminent. Even if the foetal acidosis test is not familiar to some obstetricians, all obstetricians are familiar with the necessity of calling a stat C-section when a fetal heart tracing does not improve despite resuscitative measures. A good trial on fetal resuscitation would require randomization based on fetal distress diagnosed using the “gold standard” of fetal scalp blood pH < 7.2, testing the methods used for resuscitation, and accounting for the variables.”

• In this case, the long labour process brought about by poor and negligent medical management caused the birth of asphyxiated child with cerebral palsy and seizures. The birth record voluminously speaks about the asphyxia.

• The medical records showed many cutting, erasing marks, pin holes; some handwritten insertions, over writings and discrepancies in the doctor’s and sister’s chart, which showed that the records were apparently manipulated and fabricated.

• The OPs were obliged to explain how the baby’s cerebral palsy occurred if the required treatment had been given. In the absence of such exculpatory evidence, the invocation of the maxim res ipsa loquitur, is justifiable in this case.

• The records of the patients should be maintained by doctors and hospitals. “It is wise to remember that “Poor records mean poor defense, no records mean no defense”.

• The Commission rejected the contention of the OP that the delay in cesarean section was due to the reluctance on the part of the patient stating that “it was the bounden duty of the doctor to decide, the correct line of treatment; doctor wouldn’t just blindly obey the wishes of the patient…”

• The Commission also rejected the expert opinions produced by OP-3 from the three experts of OP-1 hospital, as they had given their opinion on the basis of tampered medical records, they were from same hospital and more chances of interested witnesses.

• It is the responsibility of the medical team to closely monitor the heart tracings so that they know when the baby becomes distressed.

• The say of OP that the patient was informed about emergency LSCS which was rejected by the patient or by her husband. The OP did not take written consent or signature of the complainant or her husband about refusal of C-section. The progress sheet clearly shows some insertion made by OP/staff to show that patient was informed. Thus, the entry was also tampered one.

Conclusions of the Commission
• The patient had pregnancy after 4 ½ years of infertility making it a precious pregnancy.

• Corporate hospitals and Specialists must perform at a higher level than other hospitals/GPs as they represent themselves as possessing highest standard facilities and care, superior skills and additional training.

• The records clearly showed fetal distress indicated by hypertonic contractions and fall in FHR below 120/min and OP-3 failed to take proper decision for emergency C-section making it an act of omission, thus negligence.

• The medical records of the mother and baby are tampered at many places.

• The substandard care administered to the patient during labour resulted in poor outcome despite using modern technology of CTG. Inability to interpret the CTG trace, i.e., poor pattern recognition, failure to correlate to the pathophysiology that caused the CTG changes, not taking into consideration the clinical situation that may suggest fetal distress and delay in taking appropriate action due to poor communication and team work were reasons for the poor outcome.

• Taking into account the sufferings of mother and child for 12 years, treatment and other expenses, the metal agony and trauma to the parents who suffered loss of their baby and thereon the quantum of interest on such amount, the Commission allowed a lump sum award of compensation of Rs. One crore by relying upon the judgments of Hon’ble Apex Court for award of compensation.

• The Commission further imposed punitive costs of Rs.10 lacs on OP-1 as OP had not issued entire medical record to the patient, indulged in the unethical medical practices and professional misconduct like tampering of medical records. It was the duty of the hospital to preserve the CTG tracings. Thus OP did not follow the standard of medical practice, not maintained medical records.

Final judgement
The commission found the OPs guilty of medical negligence and fixed total compensation of Rs. One Crore; out of which OP-1 will pay Rs.80 lacs and OP-3 will pay Rs.20 lacs to the patient/complaint within 90 days from the date of receipt of this order. The insurance company shall indemnify the respective OPs, as per law. Rs.10 lacs was imposed as punitive cost which OP-1 shall deposit in the Consumer Legal Aid Account, NCDRC within 90 days from the date of receipt of this order. If the order is not compiled within 90 days, the OPs are liable to pay interest @ 9% per annum, till its realisation.

Saturday, 25 April 2015

Vedic Interpretation of earthquake

Vedic Interpretation of earthquake

The current earthquake incidence can be interpreted on many levels.

As per Deepak Chopra, there are seven types of people with different consciousness levels.

The first level is people with Fight and Flight response, who either fight or flight an adversity. Second level is people with reactive response, who are fault finders when an adversity comes.

Third, fourth and fifth levels are people with restful alertness, intuitive, and creative responses respectively. These people treat every adversity as an opportunity to do something different and work in the interest of the community.

Finally sixth and seventh levels are the people with visionary and sacred responses. These people are people with wisdom who understand consciousness and treat the microcosm within the body and the macrocosm of the nature as one.

People who share the fight, flight or reactive response, they would interpret it as if the God is punishing us for our sins.

Those who are in the restful alertness, intuitive or creative response, would think of earthquake as a creative opportunity to create a globalization-based new humanity on the culture or compassion instead of exploitation. Finally those who are with visionary or sacred response might see a link between the turbulence in collective consciousness of the people and the turbulence in nature.

Many theorists propose that the earth is a living biological organism. This is known as GAIA hypothesis. We and other biological organisms are just patterns of behavior in this living biological organism that we call Mother Earth. When we are agitated and turbulent our extended body or Mother Earth reflect that turbulence. In other words, the turbulence in nature and the turbulence in human beings co-arise inter-dependently.

We all know that during full moon, the mind is more agitated than during the new moon. The high tides in the ocean influence the high tides (vata function) in the human body and the human mind.

Many intellectuals have suggested that turbulence in nature can be managed by collective meditation (more than 1% of the population together at the same time) or through rituals by introducing intentions in the field of pure potentiality. This uses the principles of dharna, Dhyana, and samadhi of Yoga Sutras of Patanjali. This was the original purpose of yagnas which unfortunately today have become as empty rituals as they are not based on basic methodology of true consciousness.

Earthquake can be considered as a localized pralay involving the element of earth.  The classic pralay will involve all five elements.  If an earthquake like instance occurs affecting the whole earth, it will be the pralay mentioned in Purans.

Friday, 24 April 2015

25 points all doctors must know about malaria

Salient features of Malaria in India

Dr K K Aggarwal and Dr A.C.Dhariwal

1. Malaria is endemic throughout India except in areas located 5000 ft above sea level.

2. It is largely prevalent in 16 states of India including 7 North-Eastern states. These are Odisha, Jharkhand, Chhattisgarh, Madhya Pradesh, Assam, Tripura, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Andhra Pradesh, Gujarat, Maharashtra, West Bengal and Karnataka.

3. Intensity of transmission varies from area to area. The areas having conducive geo-ecological and climatic conditions, inaccessible terrains, poor infrastructure, lack of health seeking behavior, poor availability of health services and high vector load have high disease burden and high mortality rates.

4. The districts which have predominant tribal population are the most affected due to poor availability of health services & lack of health seeking behavior.

5. Main plasmodium species causing malaria in India are P.vivax and P.falciparum, each responsible for 50% of the cases in the country.

6. Malaria incidence has been brought down from 2 million cases annually during the last decade to around 1 million cases annually during the beginning of current decade   and it has been contained at that level for the last 3 years. Similarly annual deaths due to malaria have also declined during this period.

7. 152 Districts have been identified as high endemic.

8. During the year 2014, there was an increase in total cases and deaths due to Malaria as compared to the year 2013. A total of 11 States/ UTs reported case rise in 2014 as compared to the previous year. The major states which reported increased malaria include- Odisha, Madhya Pradesh, Chhattisgarh, Maharashtra, Andhra Pradesh, Tripura, Meghalaya and Mizoram.

9. Some of the main reasons identified for this upsurge are increased surveillance since the introduction of Bivalent Rapid Diagnostic Test (RDT) in 2013 and focal outbreaks such as in the states of Tripura, Madhya Pradesh, Maharashtra, and Meghalaya.

10. With the ultimate goal of bringing down malaria incidence to the level that it is no more a public health problem, National Vector Borne Disease Control Programme is taking intensive malaria control measures.

11. To achieve effective control of malaria, the programme aims at early case detection through active, passive and sentinel surveillance and prompt & complete treatment of all the detected cases.

12. As per National Drug Policy for Treatment of Malaria- 2013, all fever cases suspected of malaria are to be investigated by microscopy or Rapid Diagnostic Test (RDT) for malaria.

13. Although microscopy is the Gold standard test for malaria but in remote, inaccessible areas, during malaria epidemic, for travelers and military forces bivalent RDTs are being recommended and used to detect malaria.

14. NVBDCP recommends only Antigen-based Bivalent RDTs  (Pf and Pv.) for diagnosis of malaria.

15. As per the National Drug Policy (2013), P.vivax cases are to be treated with chloroquine for three days and Primaquine for 14 days.

16. As per the National Drug Policy (2013), P. falciparum cases are to be treated with Artemisinin Combination Therapy (ACT) i.e Artesunate 3 days + Sulphadoxine-Pyrimethamine 1 day and single dose Primaquine on day 2.

17. However, in NE states all Pf cases are to be treated with ACT-AL (Artemether-Lumefantrine combination) + Primaquine on day 2.

18. All severe cases should be treated with injection Artesunate followed by complete oral ACT course i.e of three days.

19. The referral services are being strengthened for the management of severe cases. The referral mechanism under NHM is being used for referring cases.

20. Special measures are being taken for epidemic preparedness and rapid response, through co-ordination with IDSP.

21. To reduce the risk of Transmission, Integrated Vector Management is being done through Indoor Residual Spraying  (IRS) in selected high risk areas with API>2 (-~80 million pop./annually), Use of Long Lasting Insecticidal Nets (LLINs) and use of larvivorous fish and source reduction.
22. Other important Supporting Interventions of the program include Behaviour Change
Communication/ Information, Education & Communication (BCC/IEC), capacity building and Inter-sectoral collaboration and NGO or Public Private Partnerships.

23. In urban areas > 60% of the population seeks health services from private sector and other public undertaking and organized sectors. Their involvement in the programme is of paramount importance.

24. To ensure timely action, actual disease burden, reporting from all the sectors needs to be captured and monitored.

25. Any confirmed malaria case not responding to treatment within 72hrs. may be suspected for resistance. Such cases should be given alternative anti-malarials and should be reported to the programme for detailed investigation.

Thursday, 23 April 2015

Treating uncomplicated malaria with single oral anti malarial drug negligence

Suspect malaria in any febrile illness: IMA
Treating uncomplicated malaria with single oral anti malarial drug negligence

On the occasion or World Malaria day to be observed on 25th Aril, IMA has come out with guidelines for public and physicians.

Giving the details Padma Shri Awardees, Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical Association, said that malaria should be suspected in patients with any febrile illness. The initial symptoms and signs of malaria are nonspecific and may also include high pulse rate, high respiratory rate, chills, rigors, malaise, fatigue, sweating, headache, cough, loss of appetite, nausea, vomiting, abdominal pain, diarrhea, joint pains and muscular pains.

Groups at high risk for severe malaria and its consequences include young children (6 to 36 months) and pregnant women.  Older children and adults develop partial immunity after repeated infection and are at relatively low risk for severe disease.

Travelers to areas where malaria is endemic generally have no previous exposure to malaria parasites and are at very high risk for severe disease if infected with Plasmodium falciparum.

The incubation period for P. falciparum infection is usually 12 to 14 days as agaist dengue which is 4-10 days. Longer incubation periods are more likely in semi-immune individuals and individuals taking inadequate malaria prophylaxis at the time of infection. The relapsing malarias (P. vivax) can cause clinical illness several weeks or months after the initial infection.

Rapid diagnostic tests for detection of malaria antigens are accurate and easy to use. They require no electricity or lab infrastructure, give results within 15 to 20 minutes. However they provide a qualitative result but cannot provide quantitative information regarding parasite density.

Uncomplicated malaria consists of symptomatic malaria without evidence of vital organ dysfunction and parasite count of less than 5% with the ability to take oral therapy. 

Giving monotherapy of oral anti malarial drug in uncomplicated malaria may amount to negligence

Artemisinin derivatives are the only rapidly acting anti- malarials as of date and if used alone, can lead to the development of artemisinin resistance.

Hence, they should not be administered as monotherapy for uncomplicated malaria except for specific studies on artemisinin resistance as injectables for severe malaria.
Injectable artemisinin derivatives should be used only in severe malaria.

Using these drugs in uncomplicated malaria may amount to negligence said Padma Shri Awardees, Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General Indian Medical association.

Drugs Controller General of India banned oral single drug formulations of artemisinin and its derivatives in July 2009. WHO recommends access to quality-assured artemisinin-based combination therapies (ACTs) only.

For oral artemisinin-based monotherapies to be effective in eliminating malaria parasites, they need to be taken as a full seven-day treatment course. However, due to the rapid clinical response – i.e. clearance of signs and symptoms within 2-3 days – most patients do not complete the full regimen leading to resistance.

Artemisinin-based therapies are the mainstay of recommended malaria treatments today, and their efficacy must be preserved, as no new class of antimalarial medicines is expected to enter the market within the next few years.

The anti-malaria drug artemisinin and its derivatives are artesunate and artemether

Monday, 13 April 2015

ACID Burn Rape Victims Must Get Free Treatment

Victims must get full treatment: SC


In an order likely to have far-reaching effects, the Supreme Court ruled on Friday that private hospitals could neither “turn away” victims of acid attack nor wash their hands of after providing first aid.

The court made it mandatory for these hospitals across the country to provide full and free medical treatment to the victims. The order said the term “treatment” included reconstructive surgery, free medicines, bed, rehabilitation and aftercare.

The order came on a public interest litigation petition filed by Laxmi, an acid attack victim, following nine years of fighting for the rights of victims.

Ms. Laxmi was only 15 when three men, one of whom she had refused to marry, threw acid on her near Tughlaq Road in New Delhi. She has been fighting a lonely battle since 2006 in the Supreme Court, and in the process, succeeded in getting the Indian Penal Code amended to make acid attack a special offence. She further persuaded the court to increase the compensation for victims to Rs. 3 lakh, besides procuring a complete ban on over-the-counter sale of acid.

Friday’s order dealt with Ms. Laxmi’s final demand for getting victims proper treatment, aftercare and rehabilitation.

In its order, the Social Justice Bench of Justices Madan B. Lokur and U.U. Lalit directed that “all States should take up with private hospitals and ensure that they do not deny treatment to acid attack victims. We see there is a reluctance on the part of some private hospitals to provide free treatment.”

The court clarified that “free treatment would mean not only free medical treatment but also availability of medicines, food and reconstructive surgery.”

The court directed the State governments to take action against the hospitals turning away victims.

The Bench was interpreting Section 357C of the Criminal Procedure Code, inserted in Feb. 2013, to deal with the issue of cost of treatment of acid-attack victims.

IMA News Editors Comments
The above Supreme Court Judgment has large implications not only in acid burn cases but also victors of child sexual abuse and rape. Let us revise various provisions of law.

•             CrPC     Chapter XXVII: S. 357 C [Code of Criminal Procedure]: Treatment of victims [1]
Description: " All hospitals, public or private, whether run by the Central Government, the State Government, local bodies or any other person, shall immediately, provide the first-aid or medical treatment, free of cost, to the victims of any offence covered under section 326A, 376, 376A, 376B, 376C, 376D or section 376E of the Indian Penal Code, and shall immediately inform the police of such incident."

•             2. '326A. Whoever causes permanent or partial damage or deformity to, or burns or maims or disfigures or disables, any part or parts of the body of a person or causes grievous hurt by throwing acid on or by administering acid to that person, or by using any other means with the intention of causing or with the knowledge that he is likely to cause such injury or hurt, shall be punished with imprisonment of either description for a term which shall not be less than ten years but which may extend to imprisonment for life, and with fine:  Provided that such fine shall be just and reasonable to meet the medical expenses of the treatment of the victim: Provided further that any fine imposed under this section shall be paid to the victim.

•             376. (1) Whoever, except in the cases provided for in sub-section (2), commits rape, shall be punished with rigorous imprisonment of either description for a term which shall not be less than seven years but which may extend to imprisonment for life, and shall also be liable to fine.

(2) Whoever,—

being a police officer, commits rape— (i) within the limits of the police station to which such police officer is appointed; or (ii) in the premises of any station house; or (iii) on a woman in such police officer's custody or in the custody of a police officer subordinate to such police officer; or

(b) being a public servant, commits rape on a woman in such public servant's custody or in the custody of a public servant subordinate to such public servant; or

(c) being a member of the armed forces deployed in an area by the Central or a State Government commits rape in such area; or

(d) being on the management or on the staff of a jail, remand home or other place of custody established by or under any law for the time being in force or of a women's or children's institution, commits rape on any inmate of such jail, remand home, place or institution; or

(e) being on the management or on the staff of a hospital, commits rape on a woman in that hospital;
•             Refusal to provide medico legal examination and treatment is punishable by imprisonment for up to 1 year as per section 166B IPC.

Section 166B of  Indian Penal Code (IPC) 1860: " Whoever, being in charge of a hospital, public or private, whether run by the Central Government, the State Government, local bodies or any other person, contravenes  the provisions of section 357C of the Code of Criminal Procedure, 1973, shall be punished with imprisonment for a term which may extend to one year or with fine or with both]"

•             This examination can be performed by any registered medical practitioner (Section 164                 (A) CrPC).

•             Section 53 a of CRPC:      b)"registered medical practitioner" means a medical practitioner who possesses any medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956 and whose name has been entered in a State Medical Register.

•             Section-164 A of Cr.P.C.- Medical examination of the victim of rape.
                164 A. Medical examination of the victim of rape. – (1) Where, during the stage when an offence             of committing rape or attempt to commit rape is under      investigation, it is proposed to get the   person of the woman with whom rape is alleged or attempted to have been committed or                attempted, examined by a medical expert, such examination shall be conducted by a      registered medical practitioner employed in a hospital run by the Government or a local       authority and in the absence of a such a practitioner, by any other registered medical    practitioner, with the consent of such woman or of a person competent to give such consent on          her behalf and such woman shall be sent to such registered medical practitioner within twenty-        four hours from the time of receiving the information relating to the  commission of such               offence.
                (2) The registered medical practitioner, to whom such woman is sent shall, without delay,           examine her and prepare a report of his examination giving the following particulars, namely:-
                (I) the name and address of the woman and of the person by whom she was brought;
                (II) the age of the woman;
                (III) the description of material taken from the person of the woman for DNA profiling;
                (IV) marks of injury, if any, on the person of the woman;
                (V) general mental condition of the woman; and
                (VI) other material particulars in reasonable detail.
                (3)  The report shall state precisely the reasons for each conclusion arrived at.
                (4) The report shall specifically record that the consent of the woman or of the person competent to give such consent on her behalf to such examination had been obtained.
                (5) The exact time of commencement and completion of the examination shall also be noted in                the report.
                (6) The registered medical practitioner shall, without delay forward the report to the     investigation officer who shall forward it to the Magistrate referred to in section 173 as part of      the documents referred to in clause (a) of sub-section (5) of that section.
                (7) Nothing in this section shall be construed as rendering lawful any examination without the   consent of the woman or of any person competent to give such              consent on her behalf.
                Explanation. – For the purposes of this section, “examination” and “registered medical                 practitioner” shall have the same meanings as in section 53’

Sunday, 12 April 2015

Medical Fraternity needs to enlist all laws which are freedom to practice

Medical Fraternity needs to enlist all laws which are freedom to practice

Addressing a IMA leadership gathering of over 300 doctors from across the country, Mr. Mukul Rohatgi Attorney General of India said that the right to practice once profession is a fundamental right ever citizen has.

If any law of regulation obstructs that principle the same should be brought to the knowledge of the government or challenged in the Supreme Court.

Also the same applies to if there are  contradictions in the provisions of the law.

Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General Indian Medical Association, during the working committee meeting, posed many questions to him.

Following discrepancies were brought to his notice

1.       In PCPNDT act any MBBS can do ultrasound but in the rules you need an exam.
2.       In PCPNDT act, you need to fill F16 form, where the information you need to fill is against the ethics. A diagnostic person cannot divert the patient for further investigations without the consent of referral doctor.
3.       In the PCPNDT act the onus of proving non guilty lies on the doctor.
4.       MCI says doctors are service provider but CPA act says you are a commercial health provider
5.       MCI says do not discriminate patients on lines of Nationality but the Human Organs Transplant act says do not give preference to foreigners.
6.       MCI says consent is required of both partners in sterility cases  but Health Ministry guidelines says only one consent is sufficient.
7.       Delhi Medical Council act says the council can give compensation but MCI act has no previsions when it comes to an appeal.
8.       MCI says to doctors do not advertise but hospitals can as they are not covered under MCI act.
9.       Clinical establishment act says that doctors professional fee can be controlled by the government.
10.   Whether you are allopath, homeopath or Ayurveda expert you can write doctor
11.   Even health care providers who have no write to prescribe are writing doctor in front of their name: physiotherapists.
12.   In MCI act for the appeal against the state medical council order you have to approach health ministry but in MCU rules you can approach the MCI ethics committee.
13.   There is no statuary provision in MCIU act that state medical councils have to obey the decisions of MCI
14.   Medical profession says one need to get emergency care within four minutes of a medical crises but the government norms says you can not practice in residential areas
15.   Principals of natural justice says you can get pleaded by a lawyer in any court but Delhi Medical Council says you cannot bring a lawyer when there is a case against you.

Earlier in the day Dr Jayshri Ben Mehta President Medical Council of India interacted with the delegates.

Wednesday, 8 April 2015

Safe Food: From farm to plate

Safe Food: From farm to plate

Prof Dr A Marthanda Pillai

Access to sufficient amounts of safe and nutritious food is key to sustaining life and promoting good health. Unsafe food containing harmful bacteria, viruses, parasites or chemical substances causes more than 200 diseases, ranging from diarrhea to cancers.Foodborne and waterborne diarrheal diseases kill an estimated 2 million people annually, including many children. Diarrhea is the acute, most common symptom of foodborne illness, but other serious consequences include kidney and liver failure, brain and neural disorders, reactive arthritis, cancer and death.

Food safety is about preparing, handling, transporting and storing food to prevent infection and help to make sure that our food keeps enough nutrients for us to have a healthy diet. Unsafe food can lead to poor nutrition as well as illnesses including infections. At one side, a significant proportion of people are still facing scarcity of food while some countries have surplus food, which are being wasted. Foodborne diseases impede socioeconomic development by straining health care systems, and harming national economies, tourism and trade. Food now crosses multiple national borders from where it is produced to where it is consumed. Good collaboration between governments, producers and consumers helps ensure food safety.

Food can become contaminated at any point during slaughtering or harvesting, processing, storage, distribution, transportation and preparation. Lack of adequate food hygiene can lead to foodborne diseases and death. The contamination of food by microbes is a worldwide public health concern. Most countries have documented significant increase over the past few decades in the incidence of diseases caused by microorganisms in food, including pathogens such as Salmonella and Escherichia coli, and parasites such as cryptosporidium.

Chemicals can end up in food either intentionally added for a technological purpose (e.g. food additives), or through environmental pollution of the air, water and soil. Chemicals in food are a worldwide health concern and are a leading cause of trade obstacles.Toxic compounds like lectins are naturally present in some vegetables like potatoes and legumes. Many marine toxins in molluscs and mussels can lead to food poisoning in humans. Other toxic compounds like pesticides, heavy metals and toxins of fungal or bacterial origin could also contaminate food during manufacture, storage or transportation. India’s production of pesticides was 85,000 metric tonnes in 2004, and rampant use of these chemicals has lead to several short-term and long-term effects. The first report of pesticide poisoning in India was from Kerala in 1958, where over 100 people
died after consuming food made from wheat flour contaminated with parathion. Fungal toxins like aflatoxins in food have been related to rise in liver cancers in the country. Inorganic forms of Arsenic predominate in rice and spices, and are a real threat to human health. Remember the outbreak of food poisoning due to epidemic dropsy (mustard oil contaminated with argemone oil) reported from Delhi in 1998 in which 60 persons lost their lives and more than 3000 cases were hospitalized.

Food safety and Nutrition are inextricably linked, particularly in places where food supplies are insecure. When food becomes scarce, hygiene, safety and nutrition are often ignored as people shift to less nutritious diets and consume more 'unsafe foods'-in which chemical, microbiological, zoonotic and other hazards pose a health risk. Under the Integrated Disease Surveillance Project (IDSP) in India, food poisoning outbreaks reported from all over India in 2009 increased to more than double as compared to the previous year (120 outbreaks in 2009, as compared to 50 in the year 2008). This could be due to improved reporting, however the fact that etiological diagnosis was not made in any outbreak, though appropriate samples (food and/or stool) reached to the lab in 18 outbreaks points to the huge gap in our scientific approach to diagnosing and preventing food borne infections

Time is ripethat we change the way our kids eat in schools. Banning junk food and carbonated drinks in schools will set new standards for healthy foods that will make our kids feel better, grow better and learn better and it will improve the nutrition quality of school meals.This is about making sure children have nutritious school lunches and breakfasts every day.

Frying produce a chemical called acrylamide, which has been shown to produce cancer. With increased urbanization and resultant increase in the trend on consuming fried food items almost on a regular basis, especially by our young generation is a matter of grave concern.

Food label literacy is the need of the hour. As consumers, everyone has the right to know the contents of any packaged food item. Biscuits, packed items like bread and breakfast cereals contain hidden salt and sugar, which can produce Hypertension, Diabetes, osteoporosis, kidney stones etc.Encourage locally available fruits and vegetables.We should make it a habit to read and understand the salt and sugar content in any packaged food item before we purchase.

It is in this context that World Health Organization’s theme for this year’s World Health Day, which falls on 7th April -‘food safety’-, assumes importance. Let the message of this year motivate governments to improve food safety through public awareness campaigns and highlight their ongoing actions in this area and encourage consumers to ensure the food on their plate is safe, all the way from the farms

Reimbursement Income Tax Rules

Reimbursement Income Tax Rules

·         No transaction is allowed of more than 20,000 in cash in one day with one vendor.

·         Payments of more than Rs.2,000/- should be made in Cheque as far as possible.

·         Put a revenue stamp on every cash receipt.

·         If a vendor is charging service tax, the bill must carry service tax number

·         If the vendor is charging VAT or sales tax, TIN  number should be on the bill.

·         Never accept a bill on a latter head.

·         The bill must have a bill number.

·         Always hire audio visual equipment and run it yourself. If you hire a person for operating the system service tax will be applicable.

·         If you hire a car and run yourself, service tax is not applicable. But if you hire a car with the driver, service tax is applicable.

·         In Hotel and Restaurants, Service Tax is not applicable if, the total turnover of the Hotel/Restaurants is less than 10 lacs per annum; Hotel/Restaurant is not air-conditioned; if the room rent in the hotel is less than 1000 Rs per day per room.

·         All Bills should contain the word “Service Tax  not applicable” if it is not charged

·         Best way to take a bill is " inclusive of all applicable taxes"

·         If the vendor has only given a bill than a stamp of 'cash paid" should be there on the bill or a separate receipt should be procured. Remember both receipt and bill are needed.

·         In TB Project Every bill should be in the name of IMA-GFATM-RNTCP-PPM Project ( of IMA branch ).

Tuesday, 7 April 2015

Hostility, aggression & anger a dangerous mix

Hostility, aggression & anger a dangerous mix


Those who drive have experienced this feeling at some point of time — a surge of irritation and anger at possible aggressive or dangerous driving.

But few would stop, step out and physically assault another person. However, it’s a different picture on Delhi roads. The Capital records at least two to three cases of road rage a month.

Psychiatrists claim that over-crowding, oppressive weather, disturbed/tense state of mind are all contributing factors to road rage.

Physician and office bearer of the Indian Medical Association (IMA) Dr. K.K. Aggarwal said: “We have seen a rise in the number of road rage cases in the age group of 17-30 years. The youth today is showing what is now called AHA (anger, hostility and aggression). While city life takes its toll, ego and substance abuse create a dangerous situation on the road.’’

Dr. Samir Parikh, director, Mental Health and Behavioural Sciences at Fortis Healthcare said: “The rise in the number of these cases is a clear reflection of the fact that we are increasingly on the edge and stress is forcing us to disregard the consequences of our action. The non-interventional attitude of bystanders, too, is a case of worry and concern.”

Monday, 6 April 2015

IMA Swachh Bharat Swasthya Bharat Program to focus on food safety

IMA Swachh Bharat Swasthya Bharat Program to focus on food safety

The current budget of Modi Government if handles properly can take care of lakhs of people dying from food and water borne illnesses. 3 lac children alone die in India in a year before the age of 3 of diarrheal illnesses.

 33,152 crore earmarked for health; Separate budget for Swachh Bharat campaign with six crore toilets will bring hygiene and cleanliness;  6 crore new houses with a toilet each under Amrut Mahotsav (75th year of independence), 68968 crore for education and mid day meal; 5,300 crore for micro-irrigation, service tax, exemption in cold storage services and in transportation of  food stuff by rail/road; and thousands of crores for agriculture ministry if properly utilized India can think of a country free of food and water born diseases.

Addressing a press conference Padma Shri, National Science Communication and Dr B C Roy National Awardee, Dr K K Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India, said that Indian Medical Association will write to health ministry; commerce ministry, consumer ministry and agriculture ministry, to join hands with IMA to  get rid of diarrheal deaths in the country.

Heart Care Foundation of India and Indian Medical association jointly with Delhi Medical Association and NDMC, with support of Indian Oil and Lions Club are organizing a multiple stake holder panel discussion at 11am on 7th April at Talkatora Stadium. It will be open to public to attend. A series of tableau on health will also be released on the occasion.

Dr Ajay Lekhi President DMA and Dr P K Sharma MOH NDMC in a joint statement said that cut open fruits and vegetables are banned and one should not eat them.

Dr A Marthanda Pillai National President IMA in his message said that all over the world there are estimated 58 crore cases of 22 different food borne enteric diseases and 351 000 associated deaths. The enteric disease agents responsible for most deaths are Salmonella Typhi(52 000 deaths), enteropathogenic E. coli (37 000) and norovirus (35 000) and over 40% people suffering from enteric diseases caused by contaminated food are children aged under 5 years.

Facts released on the occasion 

1. Safe temperature for food to remain safe is between 5 to 60 degree temperature
2. Water has to be roll boiled for minimum one minute to kill all the organisms
3. Remember when in doubt follow " heat it, roll boil it, cook it, peel it or forget it"
4. Wash vegetable sin running water and not in a utensil
5. Keep cooked and uncooked food separately
6. Do not pick up multiple glasses contacting drinking water with one had using multiple fingers to support them
7. Give all your food handlers one tablet of de-worming every 3-6 months
8. If you allergic to any food, avoid it. Next allergic reaction may be more severe
9. Food poisoning can occur within 6 hours of food consumption ( vomiting predominant) or after 24 hours of food consumption (diarrhea predominant)
10.  Frozen things does not mean they are  sterilized. ICE should always be made out of pure safe water.
11. All food handlers must wear gloves while preparing food.
12. Always give food handlers a space for toilet with facilities of soap if they are going to stay overnight.
13. Bottled water does not mean it is safe, it can be recycled one.
14. Do not eat leftover food of more than 2 hours at room temperature
15. Cheaper Fruits and vegetables brought in morning out of abundance stock will always be fresh locally grown and seasonal
16. Do not buy vegetables if all of them are of the same size
17. Avoid buying vegetables which look very much colures with the same brightness
18. Food of plant in origin has no cholesterol
19. Combine all seven colures and six taste when buying vegetables and fruits
20. Food offered to GODS will always be satvik.