“Woh to theek hai, par mara kyon”? Preventable deaths should be unacceptable

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Most deaths are preventable as most deaths are caused by preventable factors. People with diseases such as heart attack, cancer, stroke, pneumonia, chronic respiratory diseases, vector-borne diseases, diarrhea, tuberculosis should live and not die unless there is a complicating factor.

India ranks first among countries with the highest number of child deaths in the world. In 2015, out of the total 5.9 million child deaths globally, 1.2 million i.e. 20% of the world’s share, occurred in India. A significant majority of these deaths are due to preventable causes such as diarrhea, pneumonia, malnutrition etc.

Whenever a person dies of preventable illnesses, questions should arise as a routine “Why did he die”? Was the death preventable?

All deaths should be self-audited to look for preventable causes. If no cause is found, then virtual autopsy can be done. Virtopsy or virtual autopsy is an alternative to traditional autopsy, conducted with scanning and imaging technology. IMA is for establishing virtual autopsies at clinical level for non-medicolegal cases (whole body CT, whole body MRI, postmortem angio, molecular autopsy).

In every death, IMA members should give an option for virtual biopsy with or without mini FNAC/ tissue biopsy. And informed refusal must be noted.

“Woh to theek hai, par mara kyon” is one of the major IMA campaigns this year to audit every preventable death with the objective of preventing these avoidable illnesses and mortalities through strategic planning, awareness campaigns and mutual collaboration with concerned authorities. If we are able to find a cause of death, then we must act on preventing a second such death in the family; look for preventable complications in the future.

Nobody should die a preventable death in this time and age.

Dr KK Aggarwal
National President IMA

IMA, eMedinewS and eMediNexus congratulate all Padma Awardee Doctors for the year 2017

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Padma Awards – one of the highest civilian Awards of the country, are conferred in three categories, namely, Padma Vibhushan, Padma Bhushan and Padma Shri.

These awards are conferred by the President of India at ceremonial functions which are held at Rashtrapati Bhawan usually around March/ April every year.

Padma Bhushan
1. Shri Tehemton Udwadia, Medicine, Maharashtra Padma Shri
2. Dr. Subroto Das, Medicine, Gujarat
3. Dr. (Smt.) Bhakti Yadav, Medicine, Madhya Pradesh
4. Dr. Mohammed Abdul Waheed, Medicine, Telangana
5. Dr. Madan Madhav Godbole, Medicine, Uttar Pradesh
6. Dr. Devendra Dayabhai Patel, Medicine, Gujarat
7. Prof. Harkishan Singh, Medicine, Chandigarh
8. Dr. Mukut Minz, Medicine, Chandigarh

New integrated guidelines for management of axial spondyloarthritis

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The Assessment of SpondyloArthritis international Society (ASAS) and the European League Against Rheumatism (EULAR) have integrated guidelines for ankylosing spondylitis (AS) and axial spondylitis (axSpA), as well as for the use of tumor necrosis factor inhibitors (TNFi) into one set of recommendations. Published January 13, 2016 in the Annals of the Rheumatic Diseases, these guidelines have 13 recommendations.

• Treatment should be individualized according to signs and symptoms of the disease including comorbidities and psychosocial factors. Similarly, the guidelines also recommend individualizing frequency of monitoring and predefined treatment target.
• Patients should be educated about axSpA and encouraged to exercise regularly and stop smoking.
• An NSAID is recommended as the first-line drug for patient who complain of pain and stiffness, taking into consideration the associated risks and benefits.
• Consider paracetamol and opioid-(like) drugs for residual pain after previously recommended treatments have failed, are contraindicated and/or poorly tolerated
• Guidelines advise against the use of systemic glucocorticoids and conventional synthetic DMARDs (csDMARDs) for patients with axial disease.
• Biological disease-modifying anti-rheumatic drugs (bDMARDS), including TNFi and IL-17 inhibitors should be considered in patients with persistently high disease activity despite conventional treatment.
• Switch to another TNFi or an anti-IL-17 therapy If TNFi therapy fails.
• Taper a bDMARD if the patient is in sustained remission, but do not stop.
• Consider total hip arthroplasty in patients with refractory pain or disability and radiographic evidence of structural damage, independent of age; spinal corrective osteotomy may be an option in patients with severe disabling deformity
• If a significant change in the course of the disease occurs, causes other than inflammation, such as a spinal fracture, should be considered and evaluated accordingly.

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