IMA Maharashtra State President's Message

IMA - Maharashtra State
Contents
Office Bearers............................................................................................................................................. 2
President’s Message................................................................................................................................... 3
Prayer & Information & necessary Action by Hon. Secretaries.......................................................... 6
Secretary Message...................................................................................................................................... 7
Clinical Establishment Act The Battle Ahead........................................................................................ 8
Information of IMA Member.................................................................................................................. 11
IMA MS Social Security Scheme............................................................................................................. 13
IMA MS Hospital Board of INDIA......................................................................................................... 14
IMA MS Hospital Board Membership Form......................................................................................... 15
H.F.C. ........................................................................................................................................................ 16
Important Days of IMA............................................................................................................................ 17
Sub Committees......................................................................................................................................... 18
CWC Report.............................................................................................................................................. 19
Public Health Education Necessity of Hour.......................................................................................... 20
Why Become an IMA Member?.............................................................................................................. 22
IMA- Application Form for New Branch Formation........................................................................... 23
Model Letterhead for Local Branch........................................................................................................ 24
Monthely Report Format.......................................................................................................................... 25
Local IMA Branch Protocol Order......................................................................................................... 26
IMA- Membership Form.......................................................................................................................... 27
Model Agenda for any meeting : Broad Guidelines.............................................................................. 28
Procedure For Transfer Of Membership ............................................................................................... 29
IMA- HFC Valid Membership Strength as on 31-12-12...................................................................... 30-34
Articles & Advertisment........................................................................................................................... 35-63
Editorial Board
Editor: Dr. Deepak Jumani
Members
Dr. Anil Suchak Dr. Gopinath Indumati Dr. Sanjay Deshpande
Dr. P. N. Rao Dr. Subramanium Jayaram Dr. Gurudatt Bhat
Dr. Ajoy Saha Dr. Avinash Bhondwe Dr. Ravi Patel
Dr. Jayesh Lele Dr. Niranjan Vaidya Dr. Govind Dhawale
Dr. Rajesh Subhedar Dr. Rajendra Gandhi Dr. Ajay Tilwe
Dr. Y. S. Deshpande Dr. Vyankantesh Metan Dr. B. S. Mehta
Dr. Balkrishna Inamdar Dr. Krishneshkar
Published by : IMA Maharashtra State IMA Bldg, 2nd floor, J.R. Mhatre Marg, JVPD,
Contact for write-ups, articles, interviews and Scheme, Juhu Mumbai - 400 049.
advertisements : Editor : Dr Deepak Jumani Office : 26233890 / 2623 2965 / 32231456
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imamaharashtrastate@gmail.com
Website: www.imamaharashtrastate.org
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DISCLAIMER : Opinions expressed in the various articles are those or the authors and do not reflect the views of Indian Medical Association Maharashtra State Branch. The appearance
of advertisement in MAHIMA is not a guarantee or endorsment of the product or the claims made for the product by the manufacturer.
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OFFICE BEARERS FOR THE YEAR 2012 – 13
Dr. Anil Pachnekar President 9869001873 dranilpachnekar@rediffmail.com

Dr. Milind Naik IMM. Past President 9422102623 milindnaik178@gmail.com
Dr. Jayesh Lele Hon. Secretay 9819812996 drjayeshlele@gmail.com
Dr. Shivkumar Utture Hon. Treasurer 9820089321 utture@yahoo.com
Dr. Dilip Sarda President Elect 9823041533 dilip2in@yahoo.com
Dr. Vivek Bilampelly Senior Vice President 9822874215 dr.billampellyvivek@gmail.com
Dr. Mahendra Doshi Vice President 9423221919 mrd_ramanhosp@yahoo.com
Dr. Vijaya Mali Vice President 9922251777 mvijaya_777@yahoo.com
Dr. C. M. Dharia Vice President 9820120216 dharia.chandrakant@yahoo.com
Dr. Nisar Shaikh Hon. Jt. Secretary 9823018408 drnisar_54@yahoo.co.in
Dr. Vasant Lunge Hon. Jt. Secretary 9822564655 ldr.bharati@yahoo.com
Dr. Parthiv Sanghvi Hon. Jt. Secretary 9820304284 dr_parthiv@rediffmail.com
Dr. Ajoykumar Saha Hon. Jt. Secretary 9820151272 drajoysaha@rediffmail.com
IMA MS SOCIAL SECURITY SECHEME
Dr. Shrikant Kothari Chairman 9821012970 drshkothari@yahoo.co.in

Dr. Shailendra C. Mehtalia Hon. Secretary 9820377174 drskcmehtalia@gmail.com
Dr. Kaizer Barot Hon. Treasurer 9869746446 kaizerbarot@yahoo.com
IMA MS FACULTY OF CGP

Dr. Akil Contractor Director 9892084360 raziakil@hotmail.com
Dr. Sujatunissa Attar Hon. Secretary 9322995993 sujatunnisa2000@rediffmail.com
Dr. Meenal Wankhedkar Hon. JT. Secretary 9422296495 raviwankhedkar@gmail.com
IMA MS AMS CHAPTER
Dr. Ravi Wankhedkar Chairman 9422296495 raviwankhedkar@gmail.com

Dr. Ravindra Jagtap Vice Chairman 9921992168 jagtaprd@yahoo.co.in
Dr. Pragji Vaza .S Hon. Secretary 9820482375 vajapragjis@yahoo.in
IMA MS PROFESSIONAL PROTECTION SCHEME
Dr. Krishna Parate Chairman 9823050572 krishnaparate@rediffmail.com

Dr. Anand Kate Co – Chairman 9822278590 anand.kate@gmail.com
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PRESIDENTIAL SPEECH
DR. ANIL PACHNEKAR
PRESIDENT
IMA MAHARASHTRA STATE
President IMA Maharashtra State 2012-13

Dean CGP elect IMA Headquarters 2013-14
Hon. Jt. Secretary for IMA HQ Delhi for the year 2007-09
Regular Central Working Committee[CWC] Member from 2006-12
Maharashtra state RNTCP Co-ordinator for National IMA RNTCP
Programme from 2009 onwards
Director CGP Studies for IMA Maharashtra State for 2010-12
Sr. Vice-president of IMA Maharashtra State for the year 2008-09
President of IMA Mumbai Br. for two consecutive years from 2007-09
Respected dignitaries sitting on the dias, off the dias & my dear friends – wish you all a very good evening.
Friends at the outset let me thank all of you, for showering your love & affection, & bestowing your faith on me & electing
me unopposed as President of IMA Maharashtra State. I owe u, & I will always remain under your obligation of trust.
Friends it is proud moment for all of us that today’s Chief Guest – Hon. Health Minister of State – Mr. Suresh Shetty
as per promise is present amongst us. It is the need of the hour that all health care workers & govt. should get aligned for
betterment of society & for better health of nation. Hon. Health Minister – Mr. Suresh Shetty sir is very courteous & cordial
personality, he has always given time for us & for IMA & has always heard us very carefully & has always given needed
help. We thank you Sir for all this. We have Guest Of Honour none other than Dr. N. Apparao Sir, our national leader, national
co-ordinator, loved by one & all, respected by one & all, we all IMA members bow down in front of Dr. N. Apparao Sir for his
simplicity, hardwork & dedication towards IMA. Our another Guest Of Honour – Dr. D. R. Rai Sir, our Hon. Sec. General of
National IMA HQ is a force reckon in IMA. Sir is an excellent orator & has represented IMA very powerfully on each & every
forum, whether in front of the ministry, in front of media, or in front of common people.
Friends as all of you know our IMA is largest NGO in Asia and in the World. We have more than 2.5 lakh members from
all over India. We have nearly 2,000 branches in every nooks & corner of India. We work in 3-tier system i.e. local level, state
level & national level. As everyone know, we are the primary health care workers of society. Government & BMC takes health
care of only 30% - 40% of people, wherein we private practitioners take care of 60% - 70% of people. While working for
IMA organization we cater our service free of charge towards organization & towards society. We are all selfless workers
while working for IMA.
We are always on forefront in implementing national health programmes whether it is Pulse Polio, RNTCP, Anaemia Free
India, Save The Girl child, Aao Gaon Chalein, ORS & Zinc to control diarrhea, for eradication of HIV & AIDS, Hypertension,
Diabetes, Heart diseases & Blindness.
In IMA apart from conducting Continuation of Medical Education Programme (CME) from our faculty like CGP & AMS, we
also implement project like Social Security Scheme, at state level & national level, where members beloved ones gets death
insurance benefit cover without much paper work. In Professional Protection Scheme, our legal team takes the charge to
tackle the legal issues of the court & help the doctor legally, financially & emotionally. We conduct free public awareness
camp on Hypertension, Asthma, Dengue, Diabetes, Malaria, HIV & AIDS. We organize free medical camps for down trodent
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people of villages & adopt villages. In Aao Gaon Chalein Project wherein we not only take care of the health of the villagers,
but we also look into matters of problem of drinking water, road, sanitation, food & housing. We in IMA conduct different
talent search programmes like singing, dancing & sports to promote the talents of members & their family. We celebrate
World Health Day, & we also celebrate different days, to commomorate different occasions like Doctor’s Day, World Heart’s
Day, Diabetes Day, Elder’s Day etc.
Friends medical fraternity is going through turmoil, lots of rules & regulations trying to engulf medical fraternity. There is
a black sheep in each & every profession, but instead of identifying & punishing black sheep, if you will put, whole profession
at stake, what kind of law is this? I am assuring you all, not a single doctor will like to harm his patient, but sometime
somewhere something goes wrong, things happen incidentally, but to damage the hospital, beat the doctors what kind of
mentality is this? Here I assure you all, we will not like to take the side of doctors who is wrong doing, who is in unethical
practice, who get caught in foetal sex determination scam, who found guilty. Here we will all support government to hang
them till death, but please do not unnecessarily harass the genuine doctor who likes to serve poor people selflessly.
Now there is a law against assault on doctors in Maharashtra state, where the law states that, an attack on doctor is
a non-bailable offence, with fine of Rs. 50,000, three years of imprisonment & double the amount of recovery of damage
caused to the property. We thank government for such needed law, but the only hitch lies is that this law order should be
circulated properly in all police stations of Maharashtra, as most of the time police persons seem to be unaware of it.
The NCHRH bill has been defeated in Standing Committee of Parliament. It is victory of IMA struggle against injustice.
IMA kept nation-wide bandh on 25th June to protest NCHRH bill. Kudos in our national IMA leader Dr. N. Apparao’s vision. The
BRHC (Bachelor Of Rural Health Care Worker) has been converted into B.Sc. (community health) after IMA’s genuine request.
But now the Clinical Establishment Act, wherein doctor needs a specific space to start his practice, he needs to have
specific paraphernalia in his clinic, he should have casualty ward to stabilize the patient in his clinic. We earnestly request
Hon. Health Minister to take into consideration the cost to have such space in a mega city & what kind of subsidies they
will give us to have all this, for needed space & for needed specific paraphernalia. As we are already registered with
Bombay Nursing Home Act 1961, then again why to register with the centre through different window, why can’t the central
government take the all necessary information they want from state only.
In PC-PNDT Act, those who found guilty should be hanged till death, IMA is supporting you, but not to unnecessarily
harass genuine doctors on technical ground. Doctor has also taken loan to purchase machine & for place & if his earning
source is sealed how he should payback his bank loan & how he should feed his family. Government should take the
technical error sealed cases on fast track as per Hon. Chief Minister – Prithviraj Chavan’s promise & release the machines
as early as possible if not found guilty.
Firefighting is also an issue where doctor has to cough up huge amount of money for just a piece of license. Government
should be very kind & helping while solving this issue because at the end ultimately all this will repurcate in costly health
care services.
Issue about less doctor’s in villages , Govt. should thought of good paraprenalia ,such as good working place ,availability
of medicine , residence quarter’s, special consideration in income tax, schooling of children and female doctor’s safety.
Friends it will prudent on my part if I will not mention my friends who supported me & guided me to accomplish my
venture. Our IMA state president Dr. Milind Naik has guided us on how to lead IMA on the forefront & he had always showed
brotherly affection for us. Dr. Milind Naik has taken keen interest to visit local branches all over Maharashtra along with
Dr. Ashok Adhao Sir, Dr. Jayesh Lele, Dr. Bakulesh Mehta, Dr. Ravi Wankhedkar, Dr. Anil Suchak & me. About Dr. Shivkumar
Utture Sir whose meticulous planning & guided support is always a guiding force for all of us. He is very dedicated, unbiased
& trustworthy personality. Needless to say Dr. Shivkumar Utture is an asset of IMA. Dr. Hozie Kapadia senior member of
IMA Mumbai Branch has played a lions role in getting this venue & educational grant for this Mastacon Conference 2012.
Our state secretary Dr. Jayesh Lele is very honest & disciplined personality but at the same time always ready to lend you
a needed helping hand in your activities. Dr. Ashok Adhao past national president is a fatherly figure of Maharashtra who
always vouch for your right direction & always ready to assist you personally. He is the pioneer personality in building IMA
strongly in Maharastra & at national level. I love my friend Dr. Ravi Wankhedkar for his dynamism and great leadership quality
although he is from small district. I thank my guru Dr. Vijay Panjabi sir, Dr. Ram Arankar sir, Dr. Jayaghosh Kaddu sir, Dr.
Arun Pawde, Dr. D.K. Shirole, Dr. Purnapatre. I also thank my personal friends Dr. Sudhir Patil, Dr. Rajendra Trivedi, Dr. Salim
Sachani, Dr. H.S. Shingan, Dr. Ajoy Saha, Dr. Sunita Kshirsagar, Dr. Yogesh Shah, Dr. Kaizer Barot, Dr. Suresh Doshi, Dr. Akhil
Contractor, Dr. Dilip Sarda, Dr. Ashok Tambe, Dr. Praji Vaza, Dr. Sujatunissa Attar, Dr. Manjusha Pandav, Dr. Megha Ghate, Dr
Vijaya Mali, Dr. Parthiv Sanghvi, Dr. Nissar Sheik, Dr. Anant Kate, Dr. Krishna Parate, Dr. Anil Laddhad & Dr. Y.S. Deshpande.
I thank my wife Rohini and my children Luv & Kush (soon they will also become doctors) for their unstinted support and
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sacrifice while I am busy doing IMA work.
Friends while serving IMA we should always think that what I have given to IMA and how I should serve IMA, instead
of what I get from IMA. If now we will not take care of our honest profession then the coming doctor generation will never
forgive us. My wish is, we should all work together honestly in society to bring back the lost glory of our noble medical
profession. I wish each and every member registered with Maharashtra Medical Council should be a member of IMA just
like British Medical Organization, because we stay in democracy and democracy is a game of numbers. If we are in large
numbers, then & then only we will have say in government. Govt should elect member from doctor’s fraternity on raj-sabha.
We should have our own channel on tv, and own medical column in newspaper, where we can serve people continuously
through public awareness programme on different health issuses. I will again like to visit all branches of Maharashtra State
to know their problems, to bring them into the main stream of IMA working, and last but not least during my presidential
tenure, I wish IMA Maharashtra State should have their own building premises.
Friends after taking proper care of our family and our practice we should always utilize our time for our area of interest,
for our fraternity, for IMA organization, where we get to learn so many things from our leaders. We get platform to express
our views, we become useful to our fraternity and to our society. I think this is total personality development. Before ending
my speech, friends at the end I will like to say again that, now time has come to pay back to the society, what name, fame
and glory society has given to us.
Thank You.
DR. ANIL S. PACHNEKAR

PRESIDENT
Area wise Distribution of work.

SR. NO. Area Vice Presidents/
Jt Secretaries
1 Raigad, Ratnagiri, Sindhudurga, Mumbai Subs, Mumbai. Dr. C.M Dharia
Dr. Ajoy Saha
2 Kolhapur, Thane, Satara, Pune, Sangli Dr. Vivek Billampelly
Dr. Parthiv Sanghvi
3 Nagpur, Chandrapur, Gadchiroli, Bhandara, Latur, Hingoli, Nanded, Dr. Mahendra Doshi.
Akola, Buldhana, Amravati, Wardha, Gondia, Yavatmal, Washim Dr. Vasant Lunge.
4 Nashik, Dhule, Ahmednagar, Jalgaon, Dr. Vijaya Mali.
Dharashiv - Osmanabad, Parabhani, Beed, Jalna, Aurangabad, Dr. Nisar Shaikh
Nandurbar, Solapur.
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PRAYERS
lMA Prayer Flag Salutation
May everybody be happy
May every one of us see to it stand here to salute our national flag.
That nobody suffers from Its honour and glory shall be our light and strength
any pain of sorrow and its course shall be our course.
I do not ask for crown We pledge our allegiance to it and realizing our
Nor I wish to be in Heaven responsibilities as the accredited members
Or reborn of this national organization,
I only want to alleviate the suffering of those people we swear we will dedicate everything in our power
Who are burning in fire of sorrow to see it 11v high in the comity of nations
We, the members of Indian Medical Association
Jai Hind !
Long Live IMA!
Physician’s Prayer Convocation Pledge

Gear Lord, “We shall, in thought, word and deed,
Thou Great Physician Ever endeavour, to be scrupulously honest.
I kneel before thee In the discharge of our duties,
Since every good and perfect gift In our profession, and
Must come from thee, I pray Shall uphold the dignity, and
Give skill to my hands, Integrity of our profession, and
Clear vision to my mind The honour of our university.
Kindness and sympathy to my heart We shall uphold, and advance social order, and
Give singleness of purpose, Strength The well-being of our fellow members, and
To lift at lest a part of the burden shall devote all our energy
Of my suffering fellow-men and a true to promote the unity, and integrity, and
Realization of thee privilege that is mine the secular or our country”
Take from my heart all guile and
Worldliness that with the simple
Faith of a child I rely on thee
For information and necessary action by Hon. Secretaries

1) Branch email id should be created under gmail & inform the office for record.
For example imaxxxxxx@gmail.com, or imaxxxxx2012@gmail.com. This will expedite our communication to you and
effective & all branches shall be connected on gmail.
2) We shall send official communication by email as and when required for the branch as well as for members, please
circulate the same to your members.
3) Please write to us your branch activities, your suggestions and input as it is valuable to us.
4) Please let us know whether your branch is having place/ hall for conducting CMES / meetings etc. give this information
by phone/ email/ letter at your earliest.
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HON. SECRETARY MESSAGE
Dear members
I thank all the members from IMA MAHARASHTRA for unanimously electing State Secretary for the 3rd consecutive years. I
shall do my best to the Aassociation.
The new team under the dynamic leadership of President Dr Anil Pachnekar has started functioning. The very first challenge
was the proposed Clinical Establishment Act 2010, which was being proposed by the Hon Health Minister in the winter
session. We took the help of every available force and friends, through all our office bearers and branch leaders met many
political bigwigs and requested them the drawbacks of the act in the present format. We have so far succeeded in it, but the
battle has not ended. We will have to continue the struggle.
Another issue has cropped up is the proposed allopathic short term courses for the homeopathy and other doctors allowing
them to regularize the allopathic practice. But members at the recently held Council as well as executive meeting have
strongly opposed and requested IMA MS office bearers to take legal opinion and if necessary file writ petition. We are
working on the matter.
We are happy to inform you that HBI National Board shall be shifted under the IMA Maharashtra. It will add boost to our
IMA HBI Maharashtra Chapter. Our past president Dr Pawde, who is the Chairman of this board, is working hard to increase
members for the Maharashtra Chapter. We have enclosed the forms for you, please join at the earliest and make it strong.
IMA Maharashtra membership is nearing 31,000 with 195 branches across the state, which is one of the largest Medical
Associations. The strength is growing leaps and bound. This is the time we must impress upon our friends who are still
not members. The HFC is increased from 1st April by IMA HQs, so please once again request all your friends to join IMA
brotherhood.
IMA Maharashtra has done wonderful presentation of the strength and unity at the IMA National front which is due our
seniors and leaders, who are guiding force to the juniors. IMA Maharashtra won many awards at the recently concluded
Central council meeting.
We have had a meeting of most of the Chairperson and Co-chairperson of various Sub-Committees of IMA MS. The meeting
saw lot of new inputs and new ideas from them. We shall discuss them at the 1st State Executive Meeting being held at IMA
Baramati on 2nd and 3rd Feb 2013. We have also invited Western Maharashtra IMA Branches Presidents and Secretaries at
Baramati to have interaction with IMA MS Office Bearers.
IMA Baramati is hosting MAHASPORTS 2013, sports meet. IMA Baramati Team under leadership of Dr Ashok Tambe and
Dr Mahendra Doshi is working hard for last 2-3 months. It shall be good opportunity for doctors to participate in the sport
events.
We request all members to check MMC website about their renewal status and information, as it is in the final stages of
printing MMC ID cards. The link and email is given separately. Please inform all your friends also.
Please do communicate to us, as your feedback and views are important to us.
DR JAYESH LELE
HON STATE SECRETARY
Cell +91 981 981 2996
Email: drjayeshlele@gmail.com
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CLINICAL ESTABLISHMENT ACT

THE BATTLE AHEAD
Dr. Shivkumar S. Utture
We have been successful in persuading the Hon. Minister Mr Suresh Shetty to postpone the tabling of CEA 2010 in this
Maharashtra Vidhansabha session in. This has been possible due to the united efforts by all leaders and members of IMA
and multiple medical organisations. This is the First victory in this battle, for us and doctors unity, but our struggle continues
till final war is won.
I am aware that there still exists a lot of confusion and queries in the minds of a majority of IMA members. Hence I take this
opportunity to dissect the draconian aspects of CEA 2010 for the benefit of all members.
CEA 2010 would lay down basic criteria for operationalising clinics, hospitals, laboratories etc.
For the uninitiated person, who has no idea about the masala of Indian healthcare, the natural response would be - ‘Great,
this is something each citizen would definitely benefit from. Access to quality healthcare at your beck and call’. Well,
appearances can be very deceptive.
The late Field Marshall Sam Manekshaw had made the following comment on lawmakers with regard to their knowledge of
defence matters of the country. “I wonder whether those of our political masters who have been put in charge of the defence
of the country can distinguish a mortar from a motor; a gun from a howitzer; a guerrilla from a gorilla, although a great many
resemble the latter.” I think the same applies to the healthcare sector. Could I paraphrase it this way. ‘I wonder whether those
of our political masters who have been put in charge of the healthcare of the country can distinguish labour pains from the
labour department, an operation theatre from a cinema theatre, an obstetrician from an orthopedician, a consultant from a
generalist, a quack from a quake . . . although a great many resemble the latter
Let me take individual issues and make some observations
1. CEA 2010 has been passed by the cabinet and hence it is mandatory for States to adopt it. FALSE
Clarification--The state is not obliged to adopt the Act.
(a) The state, if it wants, is free to modify the Act and adopt it in a modified form.
(b) Nothing happens if the state does not put in place such an Act, in toto or modified.
2. Doubts are being raised about our projection of increase in health care cost.
Let me give you a simple example.
CEA made by Assam that for a Maternity Home (Hospital with Obstetrics Department) you need the following -
a. Full time qualified gynaecologist with PG Degree/Diploma in Obstetrics
b. Full time qualified paediatrician with PG Degree/Diploma in Paediatrics
c. Full time qualified anaesthesiologist with PG Degree/Diploma in Anaesthesia
d. Part time/Full time Physician with PG Degree/Diploma in Medicine
Who would foot the bill for payment for these full-time staff---obviously, the common citizens who patronise these institutions
What would the CEA lead to in most of the regions of the country -
a. Healthcare which is already expensive would become more expensive.
b. Healthcare would become inaccessible to most of the Indian poor unless they live in a state which has good public
healthcare.
c. Specialists would become more in demand. Their salaries would rocket sky-high
d. Most of the small nursing homes and hospitals especially government PHC centres and low budget trust and mission
hospitals would have to be closed down.
e. Healthcare would become an industry rather than a service.
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3. Stabilisation in emergency cases (our major concern)
To stabilise’ (with its grammatical variations and cognate expressions) means, with respect to an emergency medical
condition specified in clause (f), to provide such medical treatment of the condition as may be necessary to assure, within
reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the
transfer of the individual from a clinical establishment
We are not against giving First Aid in the Golden Hour. In Modern Medicine, it is impractical to stabilize the patient in many
of the cases especially in primary and secondary set up. Making it mandatory through an Act is not democratic and will
not serve the purpose. When it is made mandatory through an Act, all the doctors will try hectically to stabilize the patient
which will make the patient lose the Golden hour and may even end up in death of the patient and the Government will be
responsible for the consequences. The doctor involved cannot be tagged with the life of a patient
The likely outcome of section 12 (2) will be that anybody having or perceiving or claiming a medical emergency would be
able to enter any hospital in Maharashtra and be legally entitled to free investigations and treatment under the Bill and,
moreover, claim compensation in a consumer forum for medical negligence and, furthermore, using his clout, threaten the
hospital with the prospect of paying a fine up to Rs. 5 lakh or even face closure under the Bill.
Section 12(2) is even in conflict with the existing laws. Regulation 2.1.1 of the Indian Medical Council (Professional conduct,
Etiquette and Ethics) Regulations, 2002, clearly states that “a physician is not bound to treat each and every person
asking his services”. The proposed Act hits at the very roots of professional freedom by making it obligatory for a doctor /
hospital to treat each and every person asking his services in the garb of emergency treatment.
The effect of Section 12(2) read with section 2(o) would be to force a doctor to treat a patient even when he does not consider
himself competent to treat because of a variety of genuine reasons. This may even amount to forcing a doctor by statute
to do what is prohibited by another statute. Attention is drawn to regulation 2.1.1 of the Code of Ethics Regulations, 2002,
which clearly states that “when a patient is suffering from an ailment which is not within the range of experience of
the treating physician, the physician may refuse treatment and refer the patient to another physician”.
Section 12(2) also violates the fundamental right granted under article 19(g), under which all citizens have a fundamental
right to “to practise any profession, or to carry on any occupation, trade or business”. Practising any profession or carrying
out any occupation, trade or business means doing so for profit and not for charity. The proposed Bill restricts the right to
earn and to practice the medical profession freely in order to earn the wherewithal.
Here let me quote from EMERGENCY MEDICAL CARE TO VICTIMS OF ACCIDENTS AND DURING EMERGENCY MEDICAL
CONDITION AND WOMEN UNDER LABOUR ( Draft Model Law ) AUGUST 2006
Hospitals and medical practitioners have to initially screen the persons to decide if the persons require emergency medical
treatment. If they do not require such treatment, the further provisions of the Act will not apply. If it is determined that the
persons require emergency medical treatment, first they have to be stabilized and thereafter, they must be given treatment.
If the hospital or medical practitioner does not have facilities for screening, stabilization or emergency medical treatment, the
persons have to be transferred to another hospital or to a medical practitioner having facilities. As to what safeguards have
to be taken while making the transfer, as to calling for the services of an ambulance or other vehicle, as to how the persons
should be taken care of during transit, all these matters are provided in detail in the Bill annexed to the Report. The hospitals
and medical practitioners have to maintain registers as to screening, stabilization, treatment or transfer.
We have also provided that the States must publish a scheme for reimbursement of expenditure incurred by hospitals,
medical practitioners or for ambulances and the States must allocate separate funds for this purpose. The duty of the States
in this behalf can be traced to Art. 21 as well as to Directive Principles of State Policy enunciated in the Constitution of India.
It is noteworthy that while recommending that all hospitals, nursing homes, private practitioners etc should be obligated to
provide necessary and possible “medical care to victims of accidents and during emergency medical condition and women
under labour”, the Law Commission had also envisaged an appropriate compensatory mechanism to the providers of such
services. This mechanism is explained on pages 102-103 of the report:
(I) Scheme for reimbursement to hospitals and medical practitioners, ambulance for transfer etc to be framed by State
Governments: States to allocate Funds:
The State Government must frame a scheme for reimbursement to hospitals, medical practitioners, ambulances and those
who provide vehicles for transport. The State must notify an authority which will deal with reimbursement. The State must
set apart substantial money for purpose of reimbursement. The scheme must provide for the procedure for reimbursement.
The scheme must be published in State Gazette. These are provided in the Draft Bill in section10.
The insult to the wisdom of the Law Commission lies in the fact that while the Law Commission had explained and envisaged
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a mechanism for compensation to the medical profession for performing the proposed statutory duty of mandatorily providing
emergency care to all, the health ministry, in its foolishness and wickedness, totally deleted this sensible recommendation of
the Law Commission by the simple mechanism of putting the Law Commission report itself under wraps
4. Standardisation of treatment and infrastructure in CEA 2010 would lead to closure of majority of single doctor
owned and small neighbourhood nursing homes.
It is mandatory under CEA that each category of clinical establishments shall comply with the Standard Treatment Guidelines
and maintain electronic medical records of every patient as may be notified by the Central Government from time to time
90% of the healthcare institutions in this country are manned by single practitioners, it does not take much to understand
that the target of these regulations are these single practitioners. By imposing standards unachievable by them these
regulations are going to lead to closure of majority of these small institutions. India is well served by its army of family
physicians and small hospitals. They provide low cost service at the doorsteps of the common man 24x7.Any law resulting
in diminution of the role of single practitioners will seriously hamper the accessibility and affordability of healthcare
Let me state what the planning commission had suggested when it rejected CEA way back in 2007:
Due care would have to be taken to avoid over emphasis on standards for infrastructure. Otherwise investments required to
comply with standards might have a spiralling effect on service costs in the health sector. Greater focus would, therefore, be
required on standards for service delivery.
As far as possible, registration should be done on the basis of documents certified by licensed professionals such as
Chartered Accountants, approved valuators, assessors etc. The setting up of administrative paraphernalia for inspection is
to be discouraged.
There need not be any direct role of the Central Government in the registration process except for maintaining a National
Register of Clinical Establishments and for determining uniform minimum standards. Such a pattern already exists in the
registration of medical, dental and nursing professional.
Government have no right to prescribe standard treatment guidelines and require the clinical establishments to comply.
It is emphasized that various treatment protocols approved by the medical profession alone will be abided with. Each
medical condition is an abstract situation requiring multiple approaches and the plurality of the opinions inside the medical
profession have to be respected. Practice of medicine is an ocean. There are multiple modalities of treatment for any one
given condition. It is the right of a doctor to choose a particular modality as per his judgments. Any mandatory rule to comply
with the treatment guidelines of the Government are not only unacceptable but betrays lack of sensitivity on the part of the
Government in understanding what they are regulating. This clause infringes on professional independence and seriously
impacts patient care
5. Rate Chart
Each category of clinical establishments shall charge the rates for each type of procedure and service within the range of rates
to be notified by the central government from time to time, for such procedures and services.Every Clinical Establishment
shall display the rates charged for each type of service provided and facilities available, for the benefit of the patients at a
prominent place in the local dialect and as well as in English language.
Professional services by the medical profession cannot be equated to that of other services in a hotel, shop or bank. The
charges or the final bill for an ailment varies with the age, clinical conditions, associated diseases and many other factors.
Depending on the qualifications and experience of the doctor, his consultation fees will vary. Depending on the facilities
available, the charges in a hospital will also vary. Exhibiting the rate chart is practically impossible since it is unpredictable.
The services cannot be structured into a fixed rate pattern; Neither it is aesthetic to display the same as in a ration shop, It
is however possible that the process be made transparent through preadmission counselling.
6. Filling of Objections
Display of information for filing objections. - As soon as the clinical establishment submits the required evidence of having
complied with the prescribed minimum standards, the authority shall cause to be displayed for information of the
public at large and for filing objections, if any, in such manner, as may be prescribed, all evidence submitted by the clinical
establishment of having complied with the prescribed minimum standards for a period of thirty days before processing
for grant of permanent registration
This would open a Pandora’s Box and expose the doctors to extortion at the hands of so called social activists
11
7. Qualification and the terms and conditions for the members of the authority
The Central Government prescribes that 3 members of the District Registering Authority under Section 10 sub-section (1)
clause (c) shall be nominated by the District Collector /District Magistrate and they shall include one representative from
the City Police Commissioner (or his/her nominee) or SP or SSP, (as the case may be); one representative from a reputed
Non-Governmental Organization working in the district / State in the area o health and related issues for a minimum period
of 3 years and one representative from i professional medical association or body, having jurisdiction in the district or at the
state level (as the case may be)
Our Objection: What is the role of Police Official in this Committee? It is obvious that it will lead to “Police Raj” with all the
connotations of this world.
One among the multiple thoughts I had about the CEA was the fact that in spite of quite stringent rules, all through these
years quacks and allied health professionals have been practicing medicine in almost the whole of our country and the
Central Govt. is not serious about tabling our decade old demand of tabling the ANTI-QUACKERY LAW. I wonder why the
government should insist on regulating qualified medical practitioners and turn a blind eye to the larger menace of Quacks.
In conclusion I would like to state that CEA is a good step to standardise the quality of healthcare facilities in the country,
but unfortunately appears to have been made by people who have no idea about grassroot level issues. There are umpteen
number of pre-requisites to attain before we can plan to think of implementing the CEA. Almost all of the pre-requisites
require a great amount of planning and willpower to operationalize with a long term vision. Otherwise the CEA would become
another of the many Indian legislations which appear rosy on paper but has no use in bringing about the necessary changes.
We are not against the Act. It is a good Act, but it cannot be implemented in its present format. There should be a committee
with representatives of doctors and the state government, to discuss CEA properly before implementing it.
Dr. SHIVKUMAR. S. UTTURE

EXECUTIVE COMM. MAHARASHTRA MEDICAL COUNCIL
TREASURER IMA MAHARASHTRA STATE
PAST PRESIDENT IMA MUMBAI BRANCH
CWC MEMBER (IMA H.Q)
PROF. OF SURGERY GRANT MEDICAL COLLEGE
IMA MS Professional Protection Scheme

Statistical Information
The IMA’s Maharashtra state Professional Protection scheme was started on Doctor’s day 1st July 2008, in the 1st year
up to 31st March 2009 there were 190 member enrolled in the scheme and up to 31 July 2012 the membership strength
has grown to 551(Total enrollment 586-35 Deletions till date), due to the efforts of branch coordinators from various IMA
branches and special efforts taken by IMA Maharashtra state branch, office bearers & local branches and past presidents
and functionaries and active IMA workers of IMA Nagpur Branch.
Membership 31/03/2010 31/03/2011 31/03/12 01/08/12

Growth
330 429 535 586
Renewal notices 02 Members renew- 06 No. of Deletions 06 No. of Deletions 21 No. of Deletions
sent to all members al fees not received during the year during the year during the year
before 28/02/2012 as on 13/06/2011 (List enclosed with (List enclosed with (List enclosed with
(List enclosed) reason) reason) reason)
Fixed Deposits 12,00,000/- 20,00,000/- 30,00,000/- 45,00,000/-
12
13
REPORT
IMA MS SOCIAL SECURITY SCHEME
Date: 19/01/2013.
The Scheme was launched on 1st October 1990.
The Effective membership as on 19/01/2013. 6381 -182 (Exp) – 417 (Deletion) = 5782
Rise of membership 1st April 2012 to 19th January 2013 = 187
Total No. of death since 1990 – 182 (Barring 2 members, nominees of all are paid the death benefit. In the year 2012-2013
No. of deaths 19. & the nominees of each of 15 expired members is paid Rs. 3, 94,300/- within few days of getting
information of the death.(the amount payable to 4)
Young members, do not over look the security of family, thinking we are too young to die.
Mishaps & deaths can occur any time unpredictably.
The younger – you join the less you pay – the more you accrue benefit for your members.
Request to members of the scheme:-
- Please keep the IMA MS SSS certificate in secured place with all FFC receipts.
- Please keep your nominee informed of your membership of the scheme & how to act in case of
Unfortunate death to get the death claim amount.
Please update your details of change of name, change of address, land line no. with code no., mobile no., Email id, name
of nominee etc. immediately on a printed letterhead.
Request to the President / Hon. Secretary of each Local Branch. :-

1) Please incorporate the above matters in your news bulletins / correspondence to members.
2) On death of any member inform & inquire with IMA MS SSS Office, whether he / she was member of IMA MS SSS, if
yes, please help in expediting the process of sending death claim benefit to the nominee.
3) Advise members to send proper amount as mentioned above along with filled in form with Xerox of age proof & IMA
Life Membership certificate in case of new membership.
4) The notices for FFC 2013 will be posted to individual members by 10 th April 2013. In case, member not receiving the
notice latest by 30th April 2013, he should inquire with the IMA MS SSS Office & make the payment before 31st May 2013
without late fee. Please note, excuse of non receipt of post will not be entertained.
5) The local branch may collect FFC 2013 & send it collectively along with the notice cum receipt of all duly filled in. The
same must reach to the office before 31st May 2013. Please do not combined FFC payment & new application amounts in
one cheque, make separate cheques for each.
6) IMA MS SSS recognizes the Best Working of Local Branches for propagation of the SSS. Please enroll larger no. &
receive award for your Branch. Please motivate all your members to join IMA MS Social Security Scheme & achieve 100%
membership Award for your branch.
Dr. Shrikant H. Kothari Dr. Shailendra C. Mehtalia

Chairman Hon. Secretary
I M A M S S o c I a l S e c u r I t y S c h e m e.
14
IMA Hospital Board of India

Maharashtra State Chapter
IMA MW Building, 2nd floor, J. R. Mhatre Marg, J.V.P.D. Scheme, Juhu, Mumbai-400 049
Tel. (022)26232965/32231456 Tel. Fax.. (022) 26233890, Email – imamsmumbai@yahoo.co.in
Dr. Anil Pachnekar Dr. Jayesh Lele Dr. Arun B. Pawade Dr. Anil Suchak
President Hon. State Secretary Chairman HBI (MS) Secretary HBI (MS)
Mob: 9869001873 Mob: 9819812996 Mob: 9373240703 Mob: 9820080151
LETTER OF APPEAL FOR JOINING HBI
Dear Member / Nursing home or Hospital owner / Doctor, etc.

Greetings from IMA Maharashtra State…!!!!
It is with great pleasure that we announce the formation of the
Hospital Board of India (HBI) - Maharashtra State.
As you are aware, there has been no organized body so far to look after the interests of Hospitals
and Nursing homes at a State & National level.
The issues pertaining to the healthcare establishments have become increasingly complex and
have aggravated in variety and intensity. These include infrastructural, legislative administrative,
financial and sheer logistics.
In view of this, an urgent need to form a Body like HBI was felt and IMA MS has taken the initia-
tive. Undoubtedly, the leadership in healthcare delivery has slowly and steadily been passing
into the hands of entrepreneurs of all backgrounds and the medical profession is at risk of being
relegated to the sidelines.
The pre-eminent and dominant position of medical professionals in this vital sector needs to be
redefined and emphasized.
Some of the objectives of HBI are:
• To assist and equip all healthcare institutions to provide quality healthcare by various means,
including Accreditation.
• To represent and safeguard the interests of all healthcare institutions and their personnel,
• To monitor and intervene in all legislations regarding hospitals being considered by the Parlia-
ment or State legislatures.
• To represent and negotiate on behalf of the hospitals, issues of concern to hospitals, with Gov-
ernments and other appropriate National and International authorities.
• To develop, adapt and endorse standards and protocols for hospital services.
It is our great pleasure to extend to you an invitation to become a member of HBI and help fulfill
the above objectives by making HBI a strong and effective Body. We enclose herewith the enrol-
ment form and other details.
In case of any clarifications you are welcome to contact us.
Enclosing the membership forms.
With best wishes and looking forward to your early response.
Yours sincerely,
Dr. Anil Pachnekar Dr. Jayesh Lele Dr. Arun B. Pawade Dr. Anil Suchak
15
INDIAN MEDICAL ASSOCIATIONMAHARASHTRA STATE

[REGISTERED UNDER BOMBAY PUBLIC TRUST ACT 1950, NO. F/165 (PUNE)]
IMA MWS Building, 2nd floor, J. R. Mhatre Marg, J.V.P.D. Scheme, Juhu, Mumbai - 400 049
Tel: (022) 26232965 / 32231456 Tel. Fax: (022) 26233890 Time: 10.30 AM - 5.30 PM.
Email – imamsmumbai@yahoo.co.in Web: www.imamaharashtrastate.org
Dr. Anil Pachnekar Dr. Jayesh lele Dr. Arun B. Pawade Dr. Anil Suchak
IMA Maharashtra State IMA Maharashtra State IMA Maharashtra State IMA Maharashtra State
Mob: 9869001873 Mob: 9819812996 Mob: 9373240703 Mob: 9820080151
Sr. No. ___________ State No. ______________ IMA HQ NO. _______________________
IMA MAHARASHTRA STATE HOSPITAL BOARD MEMBERSHIP FORM

(Please fill this form in Capital Letters & should be sent through IMA Local Branch only)
Branch __________________ Life Membership No. _____________________________________________________
Name: ___________________________________________________________________________________________
Name of the Hospital ______________________________________________________________________________
Name of Hospital Owner ___________________________________________________________________________
Qualification : ______________________________________________
Address (Residential) ______________________________________________________________________________
________________________________________________________________ Pin Code_________________
Tel: ___________________________, Fax: ______________________ Mob: ___________________________
Email: ___________________________________________
Address (Clinic / Hospital) ___________________________________________________________________
__________________________________________________________________Pin Code
Tel . _____________________________, Fax: ______________________ Mob: _______________________
Email : __________________________________________
1) Primary Healthcare institution (Clinics & without inpatient care)

2) Secondary healthcare institution (Institution with the secondary care)
3) Tertiary healthcare institutions (Institution with tertiary Care)
Strength of Hospital Beds : (Please put the √)
(0 – 20) (21 – 50) (51 & above)
Specialities available: _______________________________________________________________________

_____________________________________________________________________________________________________
________________
Registration with Local Authority / State Authority

Hospital Registration Number ______________________
APPLICANT SIGNATURE Verified by:
President / Hon. Secretary IMA____________________Branch

(With Seal)
Hon. Secretary IMA HBI (Maharashtra State)

Affiliation fee : Chq / DD- payable at Mumbai in favour of ,”IMA MS HBI- A/C”
A . IMA HBI HQ : ` 500/- Rs. Per Institution for Five years, through HBI State Chapter.
(` 100/- Rs. Per year.)
B. HBI IMA MS Fe :
Entrance Fee `500/- once for all.
1. Primary Healthcare Institutions: Clinics and institutions without inpatient care: ` 100/Rs. per year.
(Clinics,OPD, Labortary etc.)
2. Hospitals up to 20 Beds : ` 500/- per year. Total ` 2500 + `500 + `500 =` 3500/- for five years
3. Hospitals 21 to 50 Beds : `1000/- per year. Total ` 5000 + `500 + ` 500 =` 5500/- for five years
4. Hospitals 51 Beds & above : ` 2000/- per year. Total `10000 + `500 + `500 =`10500/- for five years
16
IT WAS RESOLOVED & APPROVED IN THE ANNUAL STATE METTING HELD ON

23.11.2012 THAT THE HFC RATES FOR NEW MEMBERS FROM 1 st JANUARY 2013
INCREASED BY RS. 1000/- & RS. 1500/- FOR LIFE / COUPLE LIFE MEMBERS RESPECTIVELY
EXISTING MEMBERS ARE ALSO REQUESTED TO CONTRIBUTE GENEROUSLY TO STATE SHARE
AS PER REVISED RATES.
WE ARE ALSO GIVING A NEW HFC STRUCTURE APPLICABLE FROM 1st APRIL 2013 FOR YOUR
INFORMATION
HFC RATES
From 01.01,13 Till 31.0.3. 2013 From 1st APRIL 2013
CATEGORY STATE H.Q. TOTAL STATE H.Q. TOTAL
SHARE SHARE SHARE SHARE
Annual Single 95 243 338 109 282 391
Annual Couple 131 338 469 176 410 586
Life Single 2420 3650 6070 2635 4230 6865
Life Couple 3470 5065 8535 3960 6330 10290
Club 1050 1415 2465 2550 1900 3225
New Br.Formation 150 150 300 150 150 300
The Secretaries / Presidents are requested to send New

Membership forms in duplicate by the latest 20th March 2013
as per HFC rates from 1st Jan to 31st March 2013. As we need
time to prepare the forms & data to send to IMA HQ before
31.03.2013. There after New HFC rates shall be applicable from
1st April 2013
Please attach a copy of MMC Reg. Certificate with Life

Membership form & Marriage Certificate in case of Couple Life
Membership.
BRANCH CAN COLLECT ADDITIONAL AMOUNT THAN HFC AS

DECIDSED BY GENERAL BODY FOR THE RESPECTIVE
BRANCHES BENEFIT OF CORPUS OF THE BRANCH
17
Important Days of IMA of the year 2013.
15th January IMA Community Services Day

30th January Anti Leprosy Day
8th March International Womens Day
24th March World TB Day
31st March Measles Immunization Day
7th April World Health Day
17th April International Hemophilia Day
7th May World Asthma Day
12th May World Nurses Day
15th May International Family Day
31st May World No Tobacco Day
5th June World Environment Day
26th June Anti Drug Abuse Day
1st July Doctors Day
11th July World Population day
1st - 7th August World Breast feeding Day
12th August International Youth Day
25th August 8 th September Eye Donation Fortnight
1st October Blood Donation Day
1st October International Senior Citizen Day
2nd October Anti Quackery Day
10th October World Mental Health Day
16th October World Food Day
10th November World Immunization Day
14th November World Diabetes Day
17th November National Epilepsy Day
25th November International Womens Safety Day
1st December Worlds AIDS Day
3rd December International Handicapped Day
18
SUB COMMITTEES 2012 - 13

SR. NO. COMMITTEES Chairperson Co - Chair Person Mobile
1 ACTION SUB COMMITTEE Dr. Hozie Kapadia 9833793005
Dr. Prashant Nikhade 9822221938
2 ANTI QUACKERY CELL Dr. Kishor Gandecha 9821097481
3 BLOOD DONATION Dr. Rajendra Chawhan 9823133779
Dr. R. S. Londhe 9422464039
4 BIO - MEDICAL WASTE Dr. Sanjeev Sharangpani 9422429224
Dr. Anil Patil 9420557250
5 CONSTITUTION COMMITTEE Dr. Shailendra Mehtalia 9820377174
6 DASS DR. Y. S. Deshpande 9823083841

Dr. Swati Gadgil 9820100541
7 GEREATRIC CARE COMMITTEE Dr. Ajit Deshpande 9822327544
Dr. Sanjay Deshpande 9823013341
8 LEGAL CELL COMMITTEE Dr. Suhas Pingle 9322250830
Dr. Rajendra Gandhi 9822037779
9 MAHIMA EDITORIAL BOARD Dr. Deepak Jumani 9821044556
10 MEDICAL EDUCATION SUB COMMITTEE Dr. Sanjay Dudhat 9820232606

Dr. Maya Tulpule 9923709210
11 MEMBERSHIP PROMOTION COMMIT- Dr. Jayant Makrande 9960766675
TEE
Dr. Jayendra Parulekar 9422054620
12 NATIONAL HEALTH PROGRAMME Dr. Vilas Bhole 9850085603
13 NEW PREMISES / BUILDING COMMIT- Dr. Ashok Adhao 9423103966
TEE
Dr. Krupal Deshpande 9822901019
14 ORGAN TRANSPLANT Dr. Anil Suchak 9820080151
Dr. Anil Laddhad 9822565225
15 RESOURCE & FINANCIAL Dr. Ashok Tambe 9423009223
COMMITTEE
Dr. Uday Phute 9225334177
16 RURAL HEALTH COMMITTEE Dr. Babasaheb Patankar 9422494148
17 SAVE FEMALE CHILD Dr. Warsha Dhawale 9822204338
COMMITTEE
Dr. Manjusha Pandav 9869019834
18 SPORTS COMMITTEE Dr. Mangesh Gulwade 9822565130
Dr.Vikrant. S. Dhopade 9579592117
19 WOMENS DOCTORS WING Dr. Megha Ghate 9850829865
20 YOUNG DOCTORS WING Dr. Pranita Ashok 9850062612
Dr. Mehul Bhatt 9320407074
21 HOSPITAL BORAD OF INDIA - IMA MS Dr. Arun Pawade 9373240703
Dr. Anil Suchak 9820080151
19
CWC Regular
Sr. No. Name Branch Cell No.
1 Dr. Anil Pachnekar - President Mumbai 9869001873
2 Dr. Jayesh Lele - Hon. State Secretery MWS 9819812996
3 Dr. Harish Chandak Nagpur 9822239830
4 Dr. Akil Contractor MWS 9892084360
5 Dr. Uddhav Deshmukh Amravati 9422159840
6 Dr. Y.S. Deshpande Nagpur 9823083841
7 Dr. Rajendra Gandhi Aurangabad 9822037779
8 Dr. Mangesh Gulwade Chandrapur 9822565130
9 Dr. Jayaghosh Kaddu Wai 9822409291
10 Dr. Hozie Kapadia Mumbai 9833793005
11 Dr. Anand Kate Nagpur 9822278590
12 Dr. Vijaya Mali Dhule 9922251777
13 Dr. Bakulesh S. Mehta MWS 9820131926
14 Dr. S.C. Mehtalia MWS 9820377174
15 Dr. M.S. Patwardhan Miraj 9423036173
16 Dr. Jayant Pawar Malegaon (N) 9422756783
17 Dr. Arun Pawade Arvi 9373240703
18 Dr. D.B. Punse Wardha 9822220046
19 Dr. Sachani Salim Mumbai 9892631484
20 Dr. Sanjeev Sharangpani Chiplun 9422429224
21 Dr. Dilip. M. Sarda Pune 9823041533
22 Dr. Ramesh Shah Mumbai 9820097203
23 Dr. Devendra Shirole Pune 9822108183
24 Dr. Anil Suchak MWS 9820080151
25 Dr. Ashok Tambe Baramati 9423009223
26 Dr. Rajendra Trivedi Mumbai 9833783382
27 Dr. Shivkumar Utture Mumbai 9820089321
28 Dr. N. R. Vaidya MWS 9320442122
20
PUBLIC HEALTH EDUCATION

NECESSITY OF HOUR
- Dr. Anjali Dawle
(M.S. Gen. Surgeon)
Dear colleagues, you will agree with me, that who so ever be the doctor whatever may be his faculty, Counseling of the
patient and public health education can make the treatment more easier.
Dear friends, State IMA’s Dr. Suresh Nadkarni Awards, is for IMA life member, who works regarding public Health Awareness.
This is motivation programme of state IMA to encourage doctors to work on this field.
Since last ten years being female surgeon in a small town, Nanded, Marathdawa, people initially were not knowing that lady
doctor can be other than a obstretian and gynecologist. See from centuries together this concept yet not evaporated that if
a doctor is female she has to be gynaecologist only.
To wash out this concept I had to work hard, and gradually I made society aware that there can be Female surgeon, Female
ophthalmologist etc etc.
On this concept, 1st level is to treat society that what are the particular diseases for which you work?
Give them assurance, make the town doctors know that such a entity is available in your city.
I am particularly and exclusively working on breast diseases and colorectal diseases and laparoscopic surgeries.
While working on breast diseases awareness, it has taken long curve to turn the patient on concern that breast diseases
awareness, it has taken long curve to turn the patient on concern that breast diseases are dealt with a surgeon. Gradually by
writing in various local news papers in Marathi / Hindi/ English- people came to know. Started asking the queries regarding
it.
I have also used even Urdu and Punjabi news papers with help of language transformer person, so that female at every level
can be made aware.
Once that has developed, on every international women’s day 8th march I started taking free breast camps for patients. This
camp consists of examination of breast, how to do self exam of breast, mass education of females with help of projector
screens and videos.
After that I use to motivate them to ask lot of questions about breast and related problems.
While working on these, I had tremendous help of Government Medical College, FNAC team, ultrasound team, dean sir, for
which I am really thankful.
Because for breast diseases you have to have physical examination: mammography (X-ray or USG) and FNAC or Biopsy.
Surgeon, pathologist and radiologist we use to sit together and discussion was there on how we can do more better, what
are probable diagnosis etc.
Friends for every camp on 8th march since last 9- years, around 90-120 patients I use to examine alone and send them
accordingly for investigations.
It gives me immense pleasure really today when I saw satisfactory smile on their faces after these long years. Malignancy
breast is rapidly increasing today in India, for this I conducted mass educations camps at various levels like Anganwadi level,
Teacher’s Associations meetings, college girls to aware about lumps in breast, radio talke on FM- Nanded to tell and make
easy for the patient about surgical diseases various articles on cancer- how to diagnose earlier in month of October, as it is
cancer awareness month.
I have also taken help of Madhurangan sakal manch and Sakhi-Manch Lokmat for awareness about colorectal diseases
21
initially people use to go to quacks or Gynecologist to show anorectal problems with gradual camps and mass education
now almost 70-80% people in town started to consult surgeon.
Initially many doctors also don’t want to work on this disease, when I started colorectal clinic mine was the only clinic now
there are more than 7-8 surgeons are there who have also started to work on this.
Around ten Ayurveda Clinics have opened after this, my point is doctors too have accepted that it is necessity to work on
this issue.
I think this is success of my work which I did for many years.
Friends looking at the increasing incidence of Hemorrhoides, I also started doing recent techniques of piles like Doopler
Guided Haemorrhoidal Artery ligatioin (DGHAL) and M.I.P.H. minimal invasive surgery for Hemorrhoides by stapler method.
Up till now completed > 170 surgeries by stapler method, which nobody does in Marathwada Region till today.
I have presented this paper in many state and international conferences also.
On every world piles day 20th November Every year since last nine year, we take free camp for colorectal diseases.
This process is still going on at my own Dawle hospital and will continue. It will be incomplete if I do not mention the name
of my life partner Dr.Arvind Dawle (Ahaesthesiologist), who has helped me through all means. I am really thankful to him for
motivation.
I will request you friends that you should also work on such issues so that society can be more benefited.
I am thankful to Dr.Jayesh Lele and Dr.Milind Naik sir for considering me for Dr.Nadkarni award. By this I have become more
responsible doctor and bound to give still better service to mankind!
Thank you
Long live IMA!
Dr.Anjali Dawle
(M.S. Surgery)
dawle.anjali@rediffmail.com
IMA- Nanded branch
Secretary
For information of IMA Members

MAHARASHTRA MEDICAL COUNCIL, MUMBAI
189 – A, Anand Complex, 2nd Floor, Sane Guruji Marg,
Arthur Road Naka, Chinchpokali (W), Mumbai – 400011
Tel No. 23072464
Email : mmcrenewalregcorrection@gmail.com
Website : http://www.maharashtramedicalcouncil.in/Login.aspx
http://imamaharashtrastate.org/?page_id=33
22
Why become an IMA Member ?
Privileges of Membership - Central IMA where various Branches are having accommodation in
1. Members of the Association can participate in various buildings of their own. (list attached in this booklet also)
programmes organized by the Association and its Branches 11. Social Security Schemes for the welfare of members are
to which they belong. being floated at State lever with the objective of providing
2. Members have the right to attend and take part in discussion assistance to family of members in the event of their death.
in all general, clinical meetings, lectures, demonstrations, 12. Post-graduate members of IMA (Ob & Gynae) can avail of
refresher coursed etc. organized for continuing medical the special laparoscopic training program & become eligible
education by the Association. for purchase of laparoscopes at heavily subsidized rates
3. Members have the right to attend medical conferences 13. Members are eligible to procure vaccines for immunization
organized by the Association or any of its branches on such of their patients. They can also avail of contraceptive pills
terms as laid down in the bye-laws. and ILJDS etc. through the good offices of the IMA.
4. Member can participate in the Central Council and the 14. IMA Benevolent Fund established to help dependants.
Working Committee of the Association to raise various issues Members are even entitled to also secure loans from
affecting the medical profession and for the health of the Benevolent Fund to meet some unpredictable exigencies.
people. 15. IMA members through special arrangements with General
5. Members can join study tours organized within the Insurance Companies get special insurance covers to protect
country or aboard for professional interaction. members against possible medico legal eventuality during
6. A Scientific publication monthly Journal of the Indian discharge of the their normal professional work.
Medical Association is supplied to its members. The Journal 16. IMA NPPS:
is of high academic order and enjoys international reputation
and recognition.
7. A monthly publication “IMA NEWS” is published from Join IMA-
the Headquarters to give its member information about the l . IMA is a forum for friendship.
activities of the Association and other news from the medial 2. IMA is a forum for learning.
world and the same is available to the members at a nominal 3. IMA is a forum for Community Service.
yearly subscription. 4. IMA is a forum for Family get-together.
8. Members are stimulated to do research in various aspects 5. IMA is a forum for Family protection.
of the field of medicine through its academic wings. 6. IMA is a forum for Professional Protection.
9. Members are eligible to compete for various award 7. IMA is a forum for Fighting Quackery.
instituted by IMA to stimulate original thinking amongst its 8. IMA is a forum recognized National & Internationally.
members particularly young doctors and students. 9. IMA is a forum for peace of mind.
10. The members of IMA with their families are entitled to 10. IMA offers Health Insurance.
stay at IMA Guest House in Delhi on payment of nominal 11. IMA offers Bio Medical Waste sdisposal project.
subsidized charges. This privilege is alsc available in cities 12. IMA always protects your rights if you are right.
23
INDIAN MEDICAL ASSOCIATION

(HEAD QUARTERS)
I.M.A. HOUSE, INDRAPRASTHA MARG, NEW DELHI 110002
(APPLICATION FOR OPENING A NEW LOCAL BRANCH) .

(To be filled by the proposed new local branches)
1. Name of the branch ------------------------------------------ 2. Number of Members --------------------- --
3. Name & address of Office- Bearers ---------------------------------------------------------------------------- --
1 . President --------------------------------------------------------------------------------------------------------- --
---------------------------------------------------------------------------------------------------
2. Vice President-------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------
3. Hon.Secrtary---------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------
4. Names of Members of the Managing Committee :
l. -------------------------------------------------------------- 2. -----------------------------------------------------
3. -------------------------------------------------------------- 4.------------------------------------------
5. -------------------------------------------------------------- 6.----------------------------------------------------
5. Address of the Office : ------------------------------------------------------------------------------------------

RESOLUTION
A Meeting of members of medical profession of -------------------------------- was held on -----------------
--------------- under the chairmanship of Dr. --------------------------------------------------------------------
and it was unanimously resolved that a branch called ----------------------------------- branch of
Indian Medical Association be formed at ----------------- from --------------------- and that .
Dr. --------------------------- Hon. State Secretary be authorized to take all necessary steps as required
Under I.M.A. Rules.
Forwarded to State/ Territorial Secretary---------------------------------------- State! Territorial Branch Office of

LM.A. for information and favor of forwarding the same to the Headquarters. office of I.M.A.
New Delhi for further action along with Cheque/ Bank Draft for Rs. ---- towards H.F.C. for
the members as per list with effect from---------------.
----------------------------- ------------------------
Hon. Secretary President
(To be filled by the State/Territorial Branches Concerned)
Forwarded to the hon. General Secretary Indian Medical Association, I.M.A. House Indraprastha
Marg,.New Delhi for information and necessary action along with requisite.
H.F. C. Rs.-------------------
Dated---------------------------- --------------------------------------------
Address -------------------------------------- Hon. Secretary
------------------------------------ -----------------State/Territorial
Branches Indian Medical Association
(for use in Headquarters office)
Formation to the---------------------------------- Branches approved by the working committee, I.M.A.
--------------Meeting held at ------------------- on---------------------
---------------------------
Hon. General Secretary
Indian Medical Association
24
Model Letterhead for Local Branch

Indian Medical Association
.......................................Local Branch
Address: ..............................Ph.....................................Fax:...........................
Website(if Any) : ...........................................E-mail: _...........
President Hony. Secretary Hony. Treasurer

Dr____________________Dr.____________________Dr._______________________
Address:________________Address: __________________Address:________________
Ph:_____________________ Ph:______________________Ph:____________________
email:_____________________email:_____________________email:________________
Immediate Past President

Dr.________________________
President Elect
Dr.________________________
Vice President
Dr.________________________
Joint Secretary
Dr.________________________
Central Council Members

Dr.________________________
Dr.________________________
Dr.________________________
State Council Members

Dr.________________________
Dr.________________________
Dr.________________________
Dr.________________________
(Chairman & Secretaries of various Wings & Schemes)
All communications intended for Branch office should be addressed to the Hony. Branch Secretary
25
Monthly Report Format

Name of the Local Branch
Name of the State Branch
Branch Email ID (Correspondence)
Membership Strength
1 st April 20_’_ to 31St March, 20 _ _ )
(pl. attached details on separate sheets)
I . Topics for CME Name of Speakers
2. Community Related Projects done
a. Any Combined District/ Zonal/
State/ National meets Sponsored by
your Branch
b. Details of Participation in any State/
National IMA events by your Branchh
c. Govt: Health Programmes Imple-
mented by your branch during this
month
d. Observation of any International
/ National Designed dates/ weeks/
month by your branch.
e. Any Immunization activity by your
branch
3. Social / Cultural
4. Any legal members concern issues
and solution by your branch
5. Any Other
NB: - 1. Additional sheets may be attached if necessary

2. Please enclose documents in the form of Invitation/ Notice/Photographs/News Cuttings/Appreciation letters/Certificates etc.
3. Please send the report along with the Documents to the following address so as to reach on or before 10`s of the next month.
26
National Past President of IMA if present to be invited on the dias

Local IMA Branch Protocol Order
I. IMA Local Branch President
2. Chief Guest/Guest of Honour/IMA HQs. Office bearers/State HQs. Office Bearers
2. Immediate Past President
3. Branch President Elect
4. Branch Vice Presidents
5. Branch Secretary
6. Branch Treasurer
7. Chair Persons of Various wings
8. Branch Joint Secretary
9. Secretaries of Various wings
Past National President or Past State President of IMA if present to be invited on the dial
Installation & Other Functions

IMA Local Branch
Wing Chairpersons, Past Presidents & Joint Secretaries
Conf. Secy.-E HQs.OB Guest of Chief Branch Branch Branch Irnm. Past Vice State Conf.
Chairman if any if any Honour Guest Pres.-E Secretary President President Fin. Secy Secretary
President
Audience Audience Audience Audience
NB:- For Installation function the Incoming President will sit on the left side of the President and
immediately after Installation they will exchange the Chair.
27
INDIAN MEDICAL ASSOCIATION

LM.A. HOUSE, INDRAPRASTHA MARG, NEW DELHI-110002
Tel. +91-11-2337 8680, 2337 0473; Fax: +91-11-2337 9470, E-mail: inmedici@vsnl.com
MEMBERSHIP APPLICATION FORM Photo
Annual/Life/Direct Membership Application Form
(All details to be filled in Block Letters
Member’s Signature
Membership Proposed by Dr.____________________IMAHgrs.’ Membership No.______________________
To,
The Honorary Secretary General, IMA
IMAHouse, LP. Marg, New Delhi-110002
Dear Sir,
I hereby apply to be enrolled as a member of the Indian Medical Association as____________member through
Local Branch_______________under the_______________________State/Territorial Branch of IMA.
Member’s Name(as per MCI/SMC Certificate; IN BLOCK LETTERS): __________________________________
____________________________________________________________
Father slHusband’s Name:_______________________ Date of Birth DD MM YYYY
Address(Permanentl Correspondence): __________________________________________________________
Clinic/HospitalAddress: _______________________________________________________________________
__________________________________________________________________________________________
Mobile No._______________________ Tel, (R)______________________Tel. (Clinic/Hospital)_____________
Email ID. _________________________________________________ Fax No.__________________________
QUALIFICATION M.B.B.S. (1) (2) (3)
COLLEGE
UNIVERSITY
Designation (Practice/Job): ___________________________________________________________________

Registration Details: (Photocopy of Registration Certificate to be enclosed with IMA Hqrs. Form }
Registration No. of Medical Council of lndia/State Council________________________Date: _______________
Service (details): ____________________________________________________________________________
I declare that I am registered with MCI/State Medical Council. I
certify that all details/documents furnished are true. If my statement
is found to be incorrect my membership would stand to be cancelled
and the fee paid by me to all sections of IMA will be liable to be Date: ________________ ______________________
forfeited by them. I hereby give undertaking that I shall abide by the Place:___________________ Signature of the Applicant
Rules and Regulations of MA.
Certified that I have verified the qualifications and registration of the ___________________
applicant and his eligibility as per rules of IMA for being enrolled as Signature & Stamp of
member of the Indian Medical Association. Forwarded to the Hony.
Secretary General along with HFC. Hon. Secretary, Local Branch
Forwarded to IMA Hqrs. alongwith HFC on_________________ Received at IMA Hqrs. alongwith HFC on_________________
______________________________ ______________________________
Signature & Stamp of Hon. Secretary Signature & Stamp of Hon. Secretary General
NB: The Local Branch secretary will keep a photocopy of this form & forward the original form to Statefferr. Branch Secretary along with Admis-
sion Fee & HFC and the State will also retain a photocopy of this form & send the original form along with Admission Fee and HFC to IMA HQs.
for proper record Maintaining. The Journal Office will be informed by the Hony.Secretary General by Providing Addressograph list to JIMA.
Membership will commence only after it is approved and confirmed by the Hony. Secretary General, IMA (HQs.)
28
Model Agenda for any Meeting : Broad Guidelines

• Silent Prayer
• Flag Salutation
• Medallion
• Meeting call to Order
• Address by President
• Secretary’s Report
• Introduction and welcome of the Chief Guest
• Address by the Chief Guest
• Award/Felicitation, if any
• Vote of Thanks
• National Anthem
Business at All India Medical Conference

Inaugural programme to be conducted by the Organising Secretary
in consultation with the Hony. Secretary General
i) Address of Chairman, Reception Committee:

ii) Address by the Outgoing National President
iii} Installation of incoming National President by the Retiring National President
iv) Address of the National President
v) Address by the Guest(s) of Honour
vi) Address by the Chief Guest
vii) Vote of thanks by the Organising Secretary
Criteria for Nominating State Executive and State Council

Member to Maharashtra State Branch.
The Hon. Secretaries are requested to nominate the local Branch members as Executive Members to IMA Ma-
harashtra State Branch. As per following criteria and send a list to IMA MS every year or after changing your
managing committee.
State Executive
50 to 199 members – 1 Member
200 to 299 members – 2 members
300 to 399 members – 3 members & so on
State Council :-
The Representatives from the branches to be nominated by the branches according to the following.
A) One representative for the first 20 members or less.
B) One additional representative for a complete unit of ten subsequent members. Names of the representative
shall be communicated to State Office at least six weeks before the Annual Meeting of the State Council.
C) In case any of the representatives of a branch is unable to attend the meeting of the Maharashtra State Coun-
cil, the President of the said branch may nominate any other member of the branch to deputize for him for that
particular meeting.
D) The names of such members, who are deputized, shall be communicated to the Hon. State Secretary of the
Maharashtra State branch before the meeting
29
PROCEDURE FOR TRANSFER OF MEMBERSHIP OF IMA
A. TRANSFER FROM BRANCH TO BRANCH IN MAHARASHTRA
1 : Member should give written application to original local branch (branch ABC) the intention of transfer TO
new (branch DEF) local branch requesting for NOC and transfer the branch share of Life membership to new
(branch DEF). Send a copy to IMA – Maharashtra State office.
2 : Member to give fresh membership app lication form duly filled in at new branch. Attach the copy of letter
written to original (branch ABC).
3 : Original local (branch ABC) branch has to transfer the branch share of LM fees retained at the time of his
joining the IMA to new (branch DEF) branch along with NOC for transfer, and send the intimation to IMA-MS
office.
4 : New branch (branch DEF) will confirm the receipt of branch share of LM fees, confirm the Membership –
may collect the difference of branch share – if any from the member and inform the IMA – MS office.
5 : New branch to collect the HQ – Life Membership Certificate and ID card from the member and send it to
IMA MS office.
6 : IMA MS office has to send the certificate and ID card to HQ for cancellation of old certificate & issue of new
certificate & ID card.
B. INTER STATE TRANSFER TO MAHARASHTRA STATE
1 : Member should give written application to original local branch (branch ABC) the intention of transfer TO
new (branch DEF) local branch requesting for NOC and transfer the branch share of Life membership to new
(branch DEF). With a similar letter to original State Branch for NOC and to transfer State share of LM fees to
Maharashtra State branch.
2 : Member to give fresh membership application form duly filled in at new branch. Attach the copy of letter
written to original (branch ABC).
3 : Original local (branch ABC) branch has to transfer the branch share of LM fees retained at the time of his
joining the IMA to new (branch DEF) branch along with NOC for transfer, and send the intimation to IMA-MS
office. To Original State Branch also to transfer State share to Maharashtra State office.
4 : New branch (branch DEF) will confirm the receipt of branch share of LM fees, confirm the Membership –
may collect the difference of branch share – if any from the member and inform the IMA – MS office.
5 : New branch to collect the HQ – Life Membership Certificate and ID card from the member and send it to
IMA MS office.
6 : IMA MS office has to send the certificate and ID card to HQ for cancellation of old LM-number and issuance
of new LM Certificate and ID card – after receiving the State share.
30
INDIAN MEDICAL ASSOCIATION MAHARASHTRA STATE BRANCH

H.F.C. VALID MEMBERSHIP STRENGTH AS ON 31st DECEMBER 2012
SR. NO. NAME OF THE LOCAL BRANCH A/S A/C L/S L/C CLUB TOTAL
1 AHMEDNAGAR 195 79 0 353
2 AHMEDPUR 18 5 0 28
3 AJARA 9 1 0 11
4 AKLUJ 83 26 0 135
5 AKOLA 195 132 1 460
6 AKOLE 11 4 0 19
7 AKOT 6 6 0 18
8 ALIBAG 57 24 0 105
9 AMALNER 33 13 0 59
10 AMBARNATH-BADLAPUR 66 23 0 112
11 AMRAVATI 299 150 0 599
12 ANANDWAN WARORA 11 2 0 15
13 ANJANGAON 5 2 0 9
14 ARNI 12 2 0 16
15 ARVI 10 5 0 20
16 ATPADI 8 2 0 12
17 AURANGABAD 199 198 8 603
18 BALLARPUR 9 0 0 9
19 BARAMATI 65 30 1 126
20 BARSHI 57 22 4 105
21 BEED 106 41 1 189
22 BHANDARA 77 26 1 130
23 BHIWANDI 102 43 0 188
24 BHOR 7 4 0 15
25 BHUSAWAL 84 28 0 140
26 BIDRI 6 4 0 14
27 BOISAR 66 16 0 98
28 BRAMHAPURI 41 9 0 59
29 BULDHANA 65 18 0 101
30 CHALISGAON 20 14 0 48
31 CHANDRAPUR 166 66 0 298
32 CHEMBUR 367 121 0 609
33 CHIKHALI 11 5 0 21
34 CHIPLUN 41 18 0 77
35 CHANDURBAZAR 3 1 0 5
36 CHOPDA 2 28 9 0 48
31
37 DAHANU 4 20 9 0 42
38 DAHIWADI 8 3 0 14
39 DAPOLI 24 7 0 38
40 DAUND 6 12 0 30
41 DEGLOOR 13 4 0 21
42 DHARANGAON 6 2 0 10
43 DHARSHIV OSMANABAD 29 21 0 71
44 DHULE 48 19 147 90 0 413
45 DIGRAS 12 7 0 26
DIRECT MEMBER 15 2 0 19
46 DOMBIVALI 50 16 88 50 0 270
47 DONDAICHA 9 5 0 19
48 GADCHIROLI 32 8 0 48
49 GADHINGLAJ 34 10 0 54
50 GARGOTI 5 3 0 11
51 GHUGHUS 15 2 0 19
52 GONDIA 66 20 0 106
53 HADAPSAR 7 5 17
54 HINGANGHAT 21 11 0 43
55 HINGOLI 29 19 0 67
56 ICHALKARANJI 30 1 41 19 0 111
57 INDAPUR 44 19 0 82
58 ISLAMPUR 18 13 0 44
59 JALGAON 158 106 0 370
60 JALNA 70 50 0 170
61 JAMNER 8 5 0 18
62 JATH 16 3 0 22
63 JAYSINGPUR 24 8 0 40
64 JINTOOR 9 2 0 13
65 JUNNER 3 1 0 5
66 KALLAM 15 3 0 21
67 KALYAN 1 156 72 0 301
68 KAMPTI-KANHAN 29 7 0 43
69 KANKAWALI 13 10 0 33
70 KARAD 113 57 0 227
71 KARANJA 31 2 0 35
72 KARJAT (AHMEDNAGAR) 4 3 10
73 KARJAT (RAIGAD) 15 4 0 23
74 KATOL 2 17 7 1 34
75 KAWATHE-MAHANKAL 13 5 0 23
32
76 KHAMGAON 45 21 0 87
77 KHED 21 5 0 31
78 KHOPOLI 7 1 0 9
79 KOLHAPUR 7 1 169 80 0 338
80 KOLHAR-BHAGWATI 5 2 0 9
81 KOPARGAON 34 7 0 48
82 KOREGAON 6 6 18
83 KUDAL 34 13 0 60
84 KURDUWADI 17 6 0 29
85 KURUNDWAD 15 0 0 15
86 LAKHANDUR 4 0 0 4
87 LASALGAON 13 3 19
88 LATUR 119 70 0 259
89 LONAND NEERA 21 4 0 29
90 LONAWALA 16 4 0 24
91 MAHAD 10 9 0 28
92 MAJLGAON 15 6 0 27
93 MALEGAON (AKOLA) 14 3 0 20
94 MALEGAON (NASHIK) 45 38 0 121
95 MALKAPUR 20 10 0 40
96 MALVAN 8 5 0 18
97 MANGALWEDHA 12 1 0 14
98 MANGAON TALA 25 3 31
99 MANMAD 1 6 4 0 15
100 MAYANI 9 1 0 11
101 MEHKAR 19 8 35
102 MHASWAD 16 16
103 MIRA BHAYANDAR 117 26 1 170
104 MIRAJ 45 14 93 42 0 250
105 MORSHI 4 0 0 4
106 MULUND 320 83 0 486
107 MUKHED 8 2 12
108 MUMBAI 54 7 2301 530 10 3439
109 MUMBAI WEST 2434 601 26 3662
110 MURTIZAPUR 5 2 0 9
111 N.E.B.S 564 93 0 750
112 NAGPUR 1368 647 4 2666
113 NALLASOPARA 20 15 0 50
114 NANDED 189 133 0 455
115 NANDURA 6 2 0 10
33
116 NANDURBAR 1 48 18 0 85
117 NARKHED 7 1 0 9
118 NASHIK 189 104 0 397
119 NASHIK ROAD 49 15 0 79
120 NAVI MUMBAI 189 48 0 285
121 NEWASA 7 2 0 11
122 OMERGA 31 13 0 57
123 PACHORA 15 7 0 29
124 PALUS 1 7 6 20
125 PANDHARPUR 77 20 0 117
126 PANVEL 32 15 0 62
127 PARATWADA 22 7 0 36
128 PARBHANI 123 69 0 261
129 PARGAON 3 5 0 13
130 PARLI VAIJANATH 37 11 0 59
131 PATHARDI 13 13
132 PAUNI 7 1 0 9
133 PEN 26 10 0 46
134 PETH VADGAON 15 2 0 19
135 PHALTAN 13 4 25 24 0 94
136 PULGAON 2 3 0 8
137 PUNE 3 1 1942 699 15 3360
138 PUSAD 37 22 0 81
139 RAHATA 16 6 0 28
140 RAHURI 21 9 0 39
141 RAJAPUR 5 3 0 11
142 RAMTEK 17 2 0 21
143 RATNAGIRI 36 29 0 94
144 ROHA - NAGOTHANE 14 5 0 24
145 SAILU 1 0 0 1
146 SAKRI 1 16 5 0 27
147 SANGAMESHWAR 17 2 0 21
148 SANGAMNER 1 81 23 0 128
149 SANGLI 119 37 0 193
150 SANGOLA 12 6 24
151 SAONER 33 9 0 51
152 SATANA 10 7 24
153 SATARA 1 92 45 1 184
154 SAWADA FAIZAPUR 6 1 0 8
155 SHAHADA 30 9 0 48
34
156 SHEGAON 8 6 0 20
157 SHEVGAON 8 1 0 10
158 SHIRALA 8 4 0 16
159 SHIRDI 18 13 44
160 SHIRPUR 12 2 0 16
161 SHIRUR 37 11 0 59
162 SHRIRAMPUR 1 66 27 0 121
163 SHRIVARDHAN 4 1 0 6
164 SINNAR 6 7 20
165 SOLAPUR 72 27 252 110 1 599
166 TALEGAON 26 13 0 52
167 TAPTIVALLY 9 10 0 29
168 TASGAON TAL. 18 8 0 34
169 TELHARA 7 2 0 11
170 THANE 402 168 0 738
171 TULJAPUR 6 3 0 12
172 TUMSAR 24 13 0 50
173 UDGIR 51 16 0 83
174 ULHASNAGAR 69 22 0 113
175 UMERKHED 9 5 0 19
176 UMRED 27 4 0 35
177 VADUJ 11 1 13
178 VAIJAPUR 7 4 0 15
179 VASAI ROAD 99 45 1 190
180 VIRAR 44 23 0 90
181 VITA 31 9 0 49
182 WADA 12 5 22
183 WAI 33 13 0 59
184 WANI 16 5 0 26
185 WARDHA 52 44 0 140
186 WARORA 1 1 0 3
187 WARUD 19 6 0 31
188 WASHIM 8 7 0 22
189 WASHIM CITY 11 7 0 25
190 YEOTMAL 129 52 0 233
191 YOGESHWARI 21 7 0 35
TOTAL 338 90 17065 6296 76 30251
35
Clear Vision Eye Centre is....
The only centre with dedicated facilities for complete management of Keratoconus.
From Diagnosis to Contact Lenses to Corneal Cross Linking to Cornea Transplant.
All under one roof by qualified personnel.
Keratoconus, also called Conical Cornea, results in the Cornea changing from
dome shaped to cone-shaped through the progressive thining of the Cornea.
0 Months 12 Months 24 Months
36 Months 48 Months
R
RE FO
CENT EA &
CORN ACT
R
CATA ERY
SURG
Clear Vision Eye Center is focused on

treating individuals with Keratoconus
201, Bhavya Plaza, Station Road, Khar (W), Mumbai - 400 052.
Tel.: 91-22-260406898 Fax: 91-22-2604 1847 E-mail: drvinay.agrawal@gmail.com
36
Vital Facts about Keratoconus

that you should know...but don’t
Dr. Vinay Kumar Agrawal
MS (Bom), DNB (Opgth), DO (Fed)
Cornea Fellow (L V Prasad Eye Institute, Hyd.)
Fellow (Univ. of Rochester USA)
Keratoconus is a disease of the front surface of the success rate is greater than 95%, when done by an
eye that often is visually debilitating. It affects about expert corneal surgeon. Please note that glasses or
1/2000 of the population, so in India it is estimated contact lenses are normally required after surgery,
that at least 50,000 people suffer with this condition. but visual quality is normally very good. It is important
Many struggle to function in everyday life due to to understand vision correction is still required in
inappropriate treatment options or advice. most cases.
Somewhere along the line we always get reasonable
An important point is that most eye-care practitioners vision
see about 2,000 eye patients per year, so on average
an eye care expert will only see one to five patients How do you know that you have keratoconus?
with keratoconus per year. It does not matter how Getting the diagnosis correct is the first step.
smart you are; if you do not involve yourself frequently Many patients are not diagnosed till quite late in the
with an activity course of the disease.
you will never develop the skill to deal with it
effectively and efficiently. Because there is a lack of Pointers to a possibility of keratoconus are:
experience in the keratoconus area often a person Fluctuating vision (or your child says this all the time).
that has keratoconus will accidentally be steered in a Rapid and repeated changes of spectacles.
totally incorrect direction. “Unclear Vision” despite “new” spectacle numbers.
Inability of the optician to give you a “correct number”
Keratoconus does not lead to blindness for spectacles.
It is amazing that most patients with keratoconus by
us believe that they will go blind sometime in their Family history of keratoconus
life. This occurs simply because they have seen their The correct diagnosis depends on a number of skilled
vision get worse and worse so they believe that the clinical evaluations. None can replace your skilled eye
eye condition will continue to degrade to the point surgeon and his examination skills.
that nothing can be done to recover the vision.
Some people have seen a number of eye care What are the current management options for
practitioners over time and no one has been able to keratoconus?
fit them with contact lenses or glasses and they are Being at the forefront of keratoconus management
too scared to pursue corneal transplant surgery. They Clear Vision Eye Center offers a variety of cutting
then try to function with poor vision and believe it is edge options for its patients.
only a matter of time before they will see nothing at • The typical management pathway we offer
all. consists of checking refraction and working out
The reality is that no one goes blind from keratoconus. suitability of spectacles.
There are currently multiple options before corneal • Alternatively contact lenses are fitted for visual
transplantation might be required. restoration.
If corneal transplantation is finally required its • If progression is demonstrated then we offer
37
Corneal Collagen Cross Linking with Riboflavin to fifteen centers around the country that look after
(C3R) to stabilize the cornea. many keratoconus patients. Clear Vision is proud to
• This can be followed by addition of Intra Corneal mention that it is probably the only centre in private
ring segments (ICRS) to further stabilize the practice where a single trained surgeon offers all the
vision. care in keratoconus.
• Most patients can return to contact lenses after
these two treatments. This includes
• In the rare event that an eye with keratoconus • All the different contact lenses (RoseK, modified
needs surgery Clear Vision offers all surgical keratoconus CL, Soft perm [soft edge], Scleral
options ranging from Deep Anterior Lamellar lenses),
Keratoplasty (DALK) to Penetrating keratoplasty • Para surgical therapies like Corneal Collagen
(PK). Cross Linking with Riboflavin (C3R),
• Intracorneal Ring Segments (ICRS), and
Keratoconus specialists are far and few between • corneal transplantation (both lamellar and
At the beginning of this report I mentioned the penetrating keratoplasty).
prevalence of keratoconus in the general Indian • This makes us one of the few national centers
population is guessed to be about 1/2000 to 1/3000. with end-to-end expertise in keratoconus
There are approximately 13,000 eye surgeons in management.
India so if patients with keratoconus were evenly
distributed to every eye surgeon, each would have If you read this report and have or know someone
only 30 keratoconus patients to look after. No eye with keratoconus that is having a difficult time, I invite
surgeon in the country could possibly develop any you to contact me via email at: drvinay.agrawal@
expertise in this area. gmail.com or contact through our websites www.
clearvision.org.in or www.corneatransplant.net
The good news is that there are approximately twelve
38
HYPERBARIC OXYGEN
THERAPY - A Boon to Medical Field
Hyperbaric Oxygen Therapy is now considered as one of the best adjuvant treatment modality
available in medical field. Various research activities and evidence based medicines has proven
the efficacy of this therapy in many conditions.
This modality of treatment was discredited a few decades ago but, views have changed and its
application in treatment of conditions has been accepted worldwide.
HBOT is a definite cure particularly in diabetic foot and non healing wounds. It helps in augmenting
the healing of wounds faster
How does it work? DR MANOJ GUPTA

The earth’s atmosphere normally exerts 14.7 pounds per HBOT Specialist Hyperbaric Specialist
square inch of pressure at sea level, which is equivalent to 1 9322237369.
atmosphere absolute. Normally we breathe approximately 20 Email: drmdg1973@gmail.com, info@hbot.in
percent oxygen and 80 percent nitrogen. PRANA Hyperbaric Oxygen Therapy Center- Borivali,
During HBOT, the pressure is increased up to two times the
normal and the patient breathes 100 percent oxygen while
the entire body is totally immersed in 100 percent oxygen.
Side Effects
Since the oxygen is under increased atmospheric pressure,
When used in standard protocols, hyperbaric oxygen
there is increased diffusion of this oxygen into the plasma,
therapy is safe. The commonest side effect may be slight
resulting ultimately in sustained delivery of increased oxygen
pain in the ears (aural barotraumas) due to blocked
to the oxygen deprived tissues.
eutachian tube. Pneumothorax and air embolism and
transient reversible myopia after prolonged HBOT
Mechanism of action
are rare complications. An occasional patient may be
Hyperbaric Oxygen acts in following ways: claustrophobic.
• It stimulates immune system and helps in restoring WBC Contra Indications

Anyone with any of the following conditions may not be
function
suitable candidate for HBO -
• Increases new vessel formation in hypoxic areas by -Pneumothorax
-Asthma
accelerating of fibroblastic activity. - Congenital spherocytosis
- Cisplatin
• Vasoconstriction - reduces edema in normal tissues with
- Disulphiram (antabuse)
increased Oxygen delivery. - Bleomycin
- Doxorubicin (adriamycin)
• HBO therapy (works as an antibiotic) is bactericidal for - Emphecyma with CO2 retention
- High fever
anaerobic organisms.
- History of middle ear surgery or disorders
• Reduces the half-life of Carboxyhaemoglobin from 4-5 - Optic neuritis
- Upper respiratory tract infection
hours and is the treatment of choice in Carbon monoxide - Viral infection
- Pregnancy
(CO) poisoning.
39
Various Conditions and mechanism of action

Sr. No Condition MOA
1 Diabetic Wound Improved fibroblast and collagen synthesis (New tissue formation) and angiogenesis
(new blood vessel formation),
2 Problem Wounds Increases Fibroblasts and collagen network, Increases Fibroblasts and collagen network,
angiogenesis , Promotes healing
3 Craniocerebral/Traumatic Brain Reduces oedema in brain, repairing the metabolic injury in the brain cells. It also prevents
Injury the inflammation in case of severe brain injuries with just a few sessions in first 72 hours
after the damage.
4 Compromised Skin Grafts and Improved fibroblast and collagen synthesis (New tissue formation) and angiogenesis
Flaps (new blood vessel formation), also are likely to benefit a compromised graft or flap.
5 Crush Injury and Compartment Reduces blood flow that allows capillaries to resorb extra fluid, resulting in decreased
Syndrome edema.
As a gradient of oxygenation is based on blood flow, oxygen tissue tensions can be
returned, allowing for the host defenses to properly function.
6 Necrotizing Soft Tissue Infections Control the infection and reduce tissue loss. First, HBOT is toxic to anaerobic bacteria.
Next, HBOT improves polymorphonuclear function and bacterial clearance.
HBOT may decrease neutrophil adherence based on inhibition of beta-2 integrin function.
In the case of clostridial myonecrosis, HBOT can stop the production of the alpha toxin.
7 Refractory Osteomyelitis HBO provides periodic elevation of bone and tissue oxygen tensions from hypoxic of
normal or hyperoxic levels. This promotes angiogenesis, increased leukocyte killing,
aminoglycoside transport across bacterial cell walls and osteoclast activity in removing
necrotic bone.
8 Thermal Burns Decreases fluids ,
Decreases full thickness injury
Decreases edema
Decreases inflammation
Increases leukocytes
9 Intracranial abscess HBOT induces high oxygen tensions in tissue, which helps to prevent anaerobic bacterial
growth, including organisms commonly found in ICA.
HBOT can also help reduce increased intracranial pressure (ICP)
10 Exceptional Blood Loss Supply enough oxygen to support the basic metabolic needs in cases where patient has
lost sufficient red cells mass to compromise respiratory requirements.
11 Radiation Tissue Damage Increases Angiogenesis Increases immune stimulation
Promotes healing
Decreases morbidity
12 Post Anoxic Encephalopathy Increases oxygen supply to ischemic neurons, reduces edemas and reverses the reduced
flexibility of erythrocytes.
13 Cerebral Palsy / Autism Significant improvements in motor function, speech, attention, memory, and functional
skills
14 Ischaemic Stroke It also stimulates the growth of new blood vessels and repairs the damaged ones,
aiding the stroke patient in reduction in spasticity, swelling and improvement in their
neurological status
Besides above condition, HBOT is very useful in decompression sickness, Carbon monoxide poisoning, cyanide poisoning,
Air embolism, acute migraine etc.
“Timely advice saves the life and cost of patients” PRANA Hyperbaric Oxygen Therapy Center
“A promise for Healthier and Happier Life” Borivali (west), Mumbai
022-65656660
40
Robotic surgery for a

SoundLESS sleep and
a healthy heart !!!!!
Dr Vikas Agrawal Dr. Kaushal Sheth

MS(ENT), DNB, DORL, FCPS, MS(ENT),DNB, DORL
USMLE (Gold Medalist)
Sleep Apnea & Transoral Robotic Sleep Apnea & Transoral Robotic Surgeon
Surgeon at Asian Heart Institute at Asian Heart Institute
Have you realized that the most common time, when If the choking episodes occur frequently and for a longer
someone gets a heartattack or dies suddenly is late night or duration (severe OSA),one is prone to heart attack,heart
early morning, when the person is actually is in sound sleep. failure,stroke etc...
Worldwide research and statistics prove beyond doubt,that For many years,OSA was being treated with an air mask,is
Obstructive Sleep Apnea(OSA) is one of the important applied on the face throughout the night,lifelong,to push
conditions responsible for it. extra air into the airway,to prevent it from collapsing.
Snoring,a very common sociel problem,is the vibratory However,approximately two third people are not able to
sound produced when the air passage at the back of throat tolerate this and remain untreated.
gets partially blocked during the so- called deep sleep.
When the air passage gets completely blocked,it is called With the latest American Technology,using the Da Vinci
Obstructive Sleep Apnea(OSA). When this happens,the oxygen Robotic System,most patients of the Obstructive Sleep
in the body reduces,which makes brain wake up the person Apnea can be cured for life by a one time minimally invasive
from deep sleep,resulting in the temporary opening of the procedure called Trans Oral Robotic Surgery(TORS)
airway,so as to resume breathing. This cycle continues the
whole night leading to sleep fragmentation and inadequate Palatal and tongue base surgery ha been challenging due
rest. The result is daytime sleepiness,irritability,fatigue and to the difficulty of manipulating surgical instruments in a
in the long run leads to blood pressure,diabetes, and heart limited operative field where illumination and visualization is
disease. restricted. However,with a high definition 3-D camera with
advanced imaging technology,
41
TORS allows surgeons to visualize areas of the mouth and movements into smaller,more precise movements of tiny
throat at a level of detail, that could only be seen in the instruments inside the body,
past at a level of detail, that could only be seen in the past allowing the surgeon to access the tight space at the base of
through open incisions. therefore TORS offers a minimally the tongue precisely.
invasive and effective treatment option for OSA patients. Dr.Vikas Agarwal and Dr.kaushal Sheth are TORS Dr.Vikas
The beauty of TORS is that it provides surgeons with Agarwal and Dr.kaushal sheth are TORS SURGEONS at the
much improved dexterity and precision to access the base of asian heart institute for Robotic Surgery.
the tongue for surgical procedures. TORS is conducted with Asian Heart Institute Is the First Hospital In Mumbai to start
the use of robotic arms operated by surgeons. The surgeon the TORS Program.
controls the system which translates the surgeon’shand
FOR further information contact-doctor@enthospital.com
Dr.Vikas Agarwal : Speciality ENT Hospital – Thakur complex,

Kandivli(East),Mumbai. Ph: 9820407543, 28547525.
Dr.Kaushal Sheth : Excel ENT Hospital – 60 feet road, Ghatkopar (East),

Mumbai -77 Ph: 9820800536, 65206668.
42
43
Functional Endoscopic Sinus Surgery (FESS)
Dr. Pradeep Gadiwan

M.S.( ENT )
Introduction affected major

Introduction of Endoscopes in the sinus surgery has brought sinuses-the frontal, the maxillary and the ethmoidal sinuses.
about a revolution in the approach to the surgery of the
paranasal sinuses. This technical achievement has been the Indications for Functional Endoscopic sinus surgery are
critical in the evolution of the functional philosophy of sinus 1.Recurrent sinusitis with stenosis of the ostiomeatal unit,
surgery. The goal of this surgery is to return the chronically which has been not responding to the medical treatment.
inflammed nose and the Para nasal sinuses to a normal 2.Chronic hyperplastic sinusitis with obstructive nasal
functioning state through conservative surgery rather than polyposis.
completely exenterating the nasal and sinus cavity. The 3.Chronic sinusitis with mucocele formation.
physiological basis of the functional sinus surgery rests on 4.Fungal sinusitis in patients with diabetes or in immuno-
the concept of the ostiomeatal unit being the central area compromised states.
of the mucociliary clearance mechanism of the nose and 5.Diagnosis of the neoplasm in the nasal cavity and the Para
the Para nasal sinuses and the site of recurrent sinusitis. nasal sinuses.
Eradication of the ostiomeatal unit disease with adequate 6.Orbital Cellulitis/Abscess unresponsive to the medical
ventilation improves the drainage of the inflamed sinuses treatment.
and this will allow resumption of the mucociliary clearance 7.Sinus headache
and return of the near normal physiological function.
Pre-operative Management:
Physiology of the nose: - The nasal cavity is lined with 1.Endoscopic examination - Diagnostic nasal endoscopy
a psuedostratified ciliated columnar epithelium containing is the essential part of the pre-operative evaluation of the
basal cells, columnar cells that bear microvilli cilia, and patient with recurrent sinusitis to know the exact anatomical
goblet cells, which forms mucous secretions. Nasal mucous landmarks or any abnormality in order to plan the exact
secretions serve to move the protective particles to the local surgical steps during the procedure.
infections, transport noxious elements out of nose and aid 2.Radiological Assessment - CT scan of PNS (Para nasal
in humidification and olfaction. The activity of the cilia is the sinuses) demonstrates changes deep to ostiomeatal unit,
primary mechanism of mucous transport in the Para nasal which are not visible endoscopically and provide useful
sinuses. surgical and anatomical variations in the roof of the ethmoid
In the maxillary and the frontal sinuses the mucocillary and sphenoid sinuses and evaluating the integrity of the
clearance is directed towards the ostia. In the maxillary bony walls of the orbit.
sinus mucociliary flow originates on the floor and radiates
up along the sinus walls to reach the ostium. In the frontal 3.Pre-operative Assessment – a] Routine blood
sinus, mucociliary clearance proceeds up the septal walls, investigations to know about any bleeding disorders that
to the roof of the sinus then laterally along the roof and patient may have and should be adequately done prior to
medially along the floor to the ostium. So, on the right side surgery; CBC / ESR / Blood sugar < fpp/ VDRL / BT/CT / PT
this flow is anti clockwise and on the left side it is clockwise. / PI / HbsAg / HIV / Urine routine done.
Blockage of the middle meatus, due to mucosal inflammation 4.No medications, which are prostaglandin inhibitors for at
following infection of the anterior ethmoid sinuses or as a least 14 days prior to surgery. E.g., Aspirin or Indomethacin.
result of an anatomical variation, results in a ventilation block 5.No FESS in acute infective stage, Patient should be
and an accumulation of the secretions in the secondarily properly treated to bring to the quiescent stage.
44
Anesthesia: - FESS can be performed under local or general is the mainstay of the treatment. If haemorrhage is due
anesthesia. Advantages of local anesthesia are in the to systemic coagulopathy, non-adherent nasal packing
maintenance of excellent haemostasis and preservation of is helpful. b] Injury to the periorbita is not very significant,
sensation. But General Anesthesia offers efficiency, reduced but can lead to subcutaneous emphysema, orbital cellulites
pain, and controlled ventilation, which is important for and abscess; either because of damages to bony orbit or
asthmatics and avoidance of aspiration. a bony dehiscence. Patient instructed not to blow their
nose and is placed on oral antibiotics. Orbital emphysema
Surgery: - Surgery depends on the extent of the disease. usually resolves spontaneously within one week without
Septoplasty or Submucous resection of septum may be further sequele. c] Injury to the extra ocular muscles may
needed before proceeding for functional endoscopic sinus occasionally occur during FESS and will result into limitation
surgery. According to the extent of the disease, uncinectomy of ocular motion or diplopia. Opthalmological consultation
with or without agger nasi cell exenteration, bulla is advisable. d] Orbital haemorrhage though rare but
ethmoidectomy, removal of sinus laterlis mucous membrane, sometimes an acute emergency can lead to non-reversible
optic nerve injury and permanent blindness. Ophthalmic
consultation must. e] Cerebrospinal fluid rhinorrhoae (CSF
Leak) is also a rare and usually is a result of dural dehiscence
and penetration. The site is identified and the leak is closed.
Diamox and stool softener given and patient is asked not to
blow the nose.
All above complications are very minimal in experienced

expert hands.
II.Delayed complication is nasal crusting and synechiae
formation :-
Nasal Crusting can be extremely bothersome for some
patients post operatively, and adequate humidification of
nasal cavity is important in preventing crusting. Nose saline
anterior ethmoidectomy, posterior ethmoidectomy, middle irrigation and steam inhalation are useful and should always
meatal antrostomy, sphenoidectomy and striping of M.M be followed by oil-based cream for early epithelisation.
may be required.
Email – drpradeep@gadiwanhospital.com
Post operative management:- Website – www.gadiwanhospital.com
1.In the postoperative period, diligent endoscopic care with Mobile: 9821036939
regular debridement requirement and should be examined
at the frequent intervals for about 4 weeks, in order to
ensure satisfactory re-epithelisation. Dried blood and crusts
are removed and the cavity is lubricated with antibiotic
ointment.
2.Synechiae formation between middle turbinate and lateral
nasal wall are common. Non-adherent gel film can be
inserted in between and can be removed after 2 weeks after
healing has occurred.
3.Synechiae should be lysed if they develop under local
anesthesia.
Complications: - The complication of FESS though rare

but can occur and can be classified for convenience into an
immediate and a delayed group.
I.The immediate complications of FESS includes a] Epistaxis
which is the most common complication and is usually
due to trauma to a vessel or systemic coagulopathy. Direct
control, using bipolar electrocautary and nasal packing
45
Dr. Sushil Jain

Consultant Interventional Pulmonologist
46
Airways Stenting
Dr. Sushil Jain
Consultant Chest Physician and Interventional Pulmonologist
Director, MUMBAI CHEST CENTER
Hospital Affiliations:
• S.L. Raheja Hospital, Mahim, Mumbai • Criticare Hospital, Juhu, Mumbai
Contact: 022-40211192 / 9321133781 E-mail: mumbaichestcenter@gmail.com
Airway stents or tracheobronchial endoprostheses are hollow 4) Palliation of recurrent intraluminal tumour growth; and
prosthetic devices used to re-establish airway patency, 5) central airway fistulae (oesophagus, mediastinum and
either to support the tracheobronchial wall in stenosis or pleura).
malacia or to seal off airway fistulas. They are also used after
bronchoscopic resection of endotracheal or endobronchial Technique
tumours or in cases with extrinsic compression of the central The type, length, and diameter of the stenosis are assessed
airways, to maintain there patency. by bronchoscopy. Additional information is obtained by
Airways stents are available in various shapes (such as CT scan (e.g. local anatomy, airways distal to stenosis,
straight stents, Y stents, hourglass stents etc), diameters pulmonary artery patency), which is usually done prior to
and lengths. Stents are made of polymers, metal, or a bronchoscopy. Some degree of airway patency needs to
combination of both (hybrids). The airways stents are placed be established before placement of airways stent. Options
either with rigid bronchoscope or with a flexible bronchoscope include dilatation of extrinsically compressed airway or
(depending upon the type of stent). Fluoroscopic guidance resection of endoluminal lesions with laser, electrocautry
may be required in some situations. or a microdebrider. The optimal length of the stent should
exceed the margins of the stenosis; the external diameter
Indications should be slightly larger than the normal diameter of the
Indications for airway stenting are: 1) extrinsic compression involved airway. Selection of a specific stent depends on the
of central airways (i.e. trachea and the main bronchi) with type of the stenosis. The stent is then placed with flexible
or without intraluminal components due to malignant or or rigid bronchoscope. Bronchoscopic and radiological
benign disorders. e.g. Esophageal cancer causing external confirmation of stent position and patency are essential after
compression and / or invasion of trachea 2) selected cases the placement of the stent.
of tracheobronchial stenosis 3) tracheobronchial malacia
Figure 1 (A) CT scan image showing severe tracheal narrowing due to extrinsic compression by malignant
tumour (B) Tracheal lumen is opened up after dilatation of stenosis and tracheal stenting (C) Bronchoscopic
image showing opened tracheal lumen after stenting
(A) (B) (C)
47
Contraindications of airway walls.
Airways stenting should be done only in carefully selected
cases, in well equipped centers, only by experts who are Outcome
trained for it (usually an Interventional Pulmonologist). Symptomic relief with improvement in quality of life and
Metallic stents should not be placed in benign cases (except pulmonary function can be achieved in the majority of
in certain specific situations). Uncovered metallic stents patients. However, long term results depend upon the
should be avoided whenever tissue ingrowth (tumour, underlying disease and associated co-morbidities.
granulation) may cause obstruction and if removal of the
stent is anticipated. In general, stent placement should be Conclusion
avoided if nonviable lung is present beyond the obstruction. Airways stenting is a very useful procedure for patients with
central airways obstruction. It can be a life saving procedure
Complications for many patients, if it is done at the right time, by an expert
The following complications can happen with airways trained for the same. A multidisciplinary team approach for
stenting: Displacement of stent, mucus impaction, the care of patients with central airways obstruction should
granuloma formation at stent ends, re-obstruction by tumour be emphasized as it ensures that the patients will receive
or granuloma, halitosis and infection, and rarely perforation the most appropriate treatment.
IMA
MAHARASHTRA
STATE
48
Dr. Trivedi’s Total Women’s Health Care

& Non Surgical weight loss Centre
Gynaecological Endoscopy, Infertility-IVF Test tube baby, Sonography & Color Doppler,
Female Urinary Leak correction, Aesthetic & Cosmetic Care Centre
National Institute of Laser & Endoscopic Surgery (NILES) Endoscopist at Jaslok & BARC Hospital
Consulting Lounge: 501/502, Sai Heritage, 5th floor,
Above AXIS Bank, Tilak Road,
Opp. Gautam Bldg.. Ghatkopar (E), Mumbai -400 077
Hospital: 1,2,3, Gautam Bldg., Opp. Balaji Temple, Tilak Road,

Ghatkopar (E), Mumbai-400 077
Ph.No.: 61480707 / 21022875 / 3920 Fax No.: 21021913
Email: dr.ptrivedi@gmail.com / ptrivedi0208@gmail.com
• Website: www.nilesaakarivf.in
Aakar IVF-Test tube baby Centre

Most advanced Test tube baby Lab. & Embryo Freezing unit
3D Laparoscopy Surgery • IVF-ICSI Test tube baby for Blocked tubes, low count or no
Gynaec.Endoscopy, Fertility enhancing sperms.
surgery & Urogynaecologist Centre • > 40% pregnancy rate in IVF-ICSI
> 25000 Buttonhole surgeries done for • More than 25% twins, 3% triplets
• Excessive menstrual bleeding, Laser treatment • Even 51 year old lady had twins in 2001
• Removal of Fibroids, Uterus, Ovarian • Hormones, Sonography-Color Doppler under one roof
cysts with • Scientifically based continuous success
International set-up & safety.
• New vessel sealing device
makes surgery bloodless
• Laser, Laparoscopy
& Hysteroscopy
for Women Total Women’s Health Care Centre
Best Italian Sonographic Non Surgical fat loss machine takes 4~6 cms of fat
circumferentially from abdomen, thighs, double chin etc.
Treatment for wrinkles, Facial rejuvenation, pigmentation, Excessive hair,
anti-ageing & by Microderma abrasion & Peels etc.
Special post delivery abdominal tone up to remove stretch marks & flabby abdomen.
RE
REGAIN ORIGINAL SHAPE
Proslimelt Proellixe
Correction of Urinary leak

For female urinary leak on Cough, sneeze & laugh
• Button hole surgery & Specially designed “TSUIT” – Trivedi’s New Tape for
urinary leak - one day stay only “National Award Winning” Tape New Tablets for
Urinary leak relief
49
3D Laparoscopic Surgery makes

removal of Fibroids & uterus easy, fast, and safe.
Mrs. Purnima Desai 48 year old lady with Menorhagia, raises the expense of the patient as any institutes Robotic
multiple fibroids & two Caesarean sections was keen to surgery set up survives on revenue recovered. Further,
remove the uterus Laparoscopically, but she was Confused there are very few genuine trained Gynaecologists as
whether to do with 3D Laparoscopy or Robotics or regular Robotic Surgeon, This any of the regular Laparoscopist can
Laparoscopic or single port surgery. She visited the Total also pick up. In terms of timing docking the robotic arms
woman health care Consulting lounge at Mumbai & inquired after anaesthesia is given to the patient takes time. The
with Dr.Prakash Trivedi, especially with respect to cost, time Laparoscopist also takes longer operating time. Apart from
of surgery, duration of stay & most important safety. this technical hang ups with the instrument in abdomen
Dr.Trivedi did her Sonography & Color Doppler as all needing urgent change for bleeding can be dangerous. One
investigations were already done for a major surgery. She has to understand that it is the expert Operator than controls
had 3 large fibroids & uterus was 16 weeks in size, she the robotics & not the other way. Hence more cost & time for
had Pfannenstiel scars & was moderately obese. She was the surgery. Only as the Operator is sitting away from the
advised earlier a open surgery. Dr. Trivedi explained that as patient at a console operating at wrist level is comfortable.
she had two scars of Caesarean if a Consultant advises a Thus this Robotic surgery may be useful in future but not at
open surgery is perfectly fair as every Gynaecologists or present for all removal of uterus or fibroids.
a Surgeon need not do Laparoscopically. She interrupted If patient is young can only the fibroids can be removed
but she wanted Laparoscopically by any of the methods & Asha, daughter in law asked? Yes removal of Fibroids by 2D
wanted to know what was the difference ? or 3D Laparoscopy is an excellent option which can be done
Apart from the patient a fair number of relatives were keeping the uterus. Further availability of new barbed & V
present hence Dr. Trivedi explained that in Laparoscopic lock sutures have made Laparoscopic removal of fibroid a
route through 3-4 small keyholes of 5 to 10 mms, a art of excellence.
Laparoscope connected to the camera & all other small A option of 3D heavy camera with a remote control arm to
special instruments are used. These originally were like hold the camera called as robotic arm is neither good light
any surgical instruments, since last decade there are very 3D Laparoscopic surgery nor any where near actual robotic
specific instruments like a vessel sealing device which can surgery ~ Hype over nothing.
precisely seal & cut the vessels & supports of the uterus,
harmonic scalpel which can dissect tissues meticulously. Mrs. Desai insisted on 3D light Laparoscopic removal of
Quite often only to close the vagina sutures are needed. uterus & at Total Woman Health care centre, Mumbai the
Further if the uterus is very big it can be morcellated into surgery took 80 minutes & she was discharged on the next
long small strips by a dedicated morcellator. In any of the day with no extra cost.
above methods patient is discharged within a day or two &
she is back to routine work within a week.
Amongst the methods Dr.Trivedi told that Single port
Laparoscopy was not suitable as it is better for simpler
cases wherein the uterus can be removed vaginally also. Off
the regular 2D & good 3D Laparoscopy the instruments used
are same only the vision with 3D is immaculate with depth
& layer perception which makes the surgery safe with less 3D Laparoscopy
blood loss & saves time. However in hands of experts 2D
Laparoscopy will remain as a option. At his centre there is
no difference between the expenses of Open or Vaginal or
2D or 3D Light Laparoscopic surgery. This he feels are the
choice of the Operator with his or her ease & expertise, for
technologies though costly the patient need not spend extra
as it gives Operator comfort. Buttone hole or Laparoscopic removal of fibroid
For Robotic Laparoscopic removal of uterus, fibroids the
instruments used are different, costly & keep on changing.
The main Robotics set up cost 8-10 crore which automatically
50
51
The Apex Swap Transplant Registry (ASTRA)

A unique opportunity for patients in need of a kidney
Kidney Transplants – The problem of organ shortage. of blood group mismatch within that family, now have a
There is a serious problem of end stage renal disease in unique opportunity to undergo the kidney transplant. The Apex
India. The prevalence of renal failure is about one per one Swap Transplant Registry (ASTRA) has been conceived with
lakh population and every year about two lakh patients get the objective to develop a scientific and credible database of
added to the pool of patients with kidney failure. About 3% all such patients who have a donor within their families but
of these patients eventually undergo a kidney transplant continue to be on dialysis because of incompatibility of the
with a family donor. The rest continue to remain on dialysis blood groups of that donor recipient pair. This new regional
either because they have no family member, or their family database promises to help find matches for those frustrated
members have medical problems which preclude them from pairs so they can be part of so-called kidney exchanges and
being a kidney donor or their family members do not have cut the wait for a transplant. The ASTRA will register all these
compatible blood groups. patients and search and match swap pairs from the data
Current options for patients with kidney failure who do pool and hand this pair to the primary nephrology caregiver
not have a family donor. of those particular patients. “More the people register,
1. The Deceased Donor Program (Cadaveric Transplant more the people match,”. This is a humanitarian effort of
program). the Apex Kidney Foundation with the idea to increase the
This has evolved to cater to patients of the above 3 number of living donor transplants successfully and legally.
categories. However noble the motive behind this program, Which patients could potentially benefit by registering at
the ground reality is that there are not enough cadaveric ASTRA 1. Patients with kidney failure who have a family
donors available. This is primarily because of lack of donor, but the blood groups are incompatible. 2. Patients
information, logistical problems related to cadaveric organ with kidney failure who have a blood group compatible
harvesting in remote areas and religious inhibitions. Every donor, but their lymphocyte cross match is positive 3.
year Mumbai does on an average 250 living donor kidney Patients with kidney failure who have a suitable donor
transplants and about 25 cadaveric kidney transplants. This within the family, but such a donor has tested positive for
number has definitely improved from 1997, when the first Hepatitis B or C. Such patients may enter the ASTRA to find
one happened in our state. However the absolute number a possible virus positive recipient. Such pairs will have to
still remains very small. however undergo mandatory liver tests to assess their liver
2. The Swap Transplant Program function status as well as their suitability to give and receive
Swap involves an exchange of the organ between two a kidney. 4. Patients who have kidney failure and a blood
families, who cannot donate the organ to their own family group compatible donor, who would like to participate in
member because of blood group incompatibility. This is the swap transplant program to enable another unfortunate
in a sense ‘paired exchange’. This would minimise this patient to undergo a kidney transplant, along with their own.
shortfall of organs and increase transplant numbers legally. Role of the primary Nephrologist. The ASTRA is primarily a
A unique opportunity has evolved. This is called as the Swap match-making database. Once a patient is referred to the
Transplant Program. In this method there is a mechanism for ASTRA, he would be registered, after ensuring medical and
organ sharing between two unrelated donor-recipient pairs. documentary compliances. As soon as a possible swap
Family A Family B Donor Donor Recipient Recipient match is generated by the database, this information would
be conveyed to the 2 primary Nephrologists of these two
Family A Family B patients. Further workup, assessment, legal formalities
and the procedure of transplant would be the prerogative
Doner Doner of these two nephrologists, in mutual consultation at the
Hospital of their choice.
Those patients who desire to benefit from this unique
Recipient Recipient opportunity can register at: The Apex Swap Transplant
Registry. Apex Kidney Care -Sushrut Hospital, Swastik Park,
Chembur, Mumbai 400071. Tel. 2527 8908, 2527 8909
By doing a swap, two patients with kidney failure who in Dr.Ganesh Sanap. ASTRA Coordinator Tel: 8655294212,
normal circumstances cannot undergo a transplant because drganeshakc@gmail.com www.apexkidneyfoundation.org
52
53
Divarication of
Divarication of Recti is the most common contour
deformity encountered usually in post- partum
females.
Divarication of Recti is a hernia where the abdominal
Recti y
contents bulge out through the widened rectus
t
sheath due to spreading out of the two recti from
s
the midline.
a
Indian females lack a proper system of exercising to
pl
maintain the tone of the abdominal muscles and the
&
weakness of the abdominal muscles is aggravated
o
during pregnancy when the foetus grows inside and
n
pushes the muscles out and wide. Most females
i
also lack necessary vitamins and Ofcourse the most
common Hypothyroidism adds to the further weaked
m
tone. Multiple pregnancies and Caerserian section
o
also leads to the decreased tone.
d
Pre-OP
When the female is healthy and exercising
b
the tone is sufficient to contain the
A
foetus without the muscles getting
wide apart.
In tummy tuckor Abdominoplasty,
the excess skin flap is removed, some
Intra-OP
rectus separation seen is repaired, n e w
free umbilical skin
umbilicus is created and a cosmetic appearance
graft done for neo
ensured.
umblicus
In patients like the below one if divarication is the
weak recti and abd
prominent problem and the skin flap is very thin, Post -OP muscles with no
entire rectus sheath is very widely stretched with
umblical stalk
weakness of abdominal muscles, then a three or four
layer rectus sheath repair along with extra skin flap
excision is required which gives a good cosmetic
result.
After repair we expect the acquired lordosis and

posture to be corrected with abdominal exercises.
Though the patient with divarication has a
recurrence of the muscle laxity if not exercising
post op. I believe as a general misnomer is
prevailed in the surgeons that divarication has
recurrence, but after a proper repair and post op
exercise regime the risk is reduced and atleast
we give a chance to the patient to live a confident
life in the society.
Dr Nageshwari Sharma is a practising Plastic

Reconstructive and cosmetic Surgeon in
thane, Bethany Hospital. Specialises in
breast augmentation, mastopexy, liposuction,
Abdominoplasty, breast reduction,
54
Scareless Face Lift :

Ribbon Lift / Thread Lift
“NO DOWNTIME SURGERY WITH AMAZING RESULT”
The Ribbon Lift layers of our face and suspend the face, thus creating
The Ribbon Lift / Face Lift is the latest revolutionary ‘Anti Gravity or Anti-aging effect’. These specially designed
cosmetic surgery trend with stars like Maddona reportedly threads are inserted through the soft tissues of the face
having done this procedure for subtle, natural and long- gently and this helps in suspension of the aging face.
lasting youthful look. This technique is now available in The sagging Skin, Fat and Muscle is hence pulled and
India. Dr. Sunita More an expert in cosmetic surgery has the suspended to the anchoring deeper layers of the scalp,
distinction of introducing it in India for the First Time. the number of threads used varies depending on the pull
In simple terms it involves the use of slender tale like device required. The incisions are very small and hidden.
which is placed underneath the face skin though a tiny HOW DOES IT WORK?
hidden incision. This slender has many tiny hooks on it that When we look at the mirror and hold our face back at the
another the loose, sagging skin of the face to the muscles & temples with our fingers, we know what it looks like with
soft tissue for better support of the face. a face lift, similar effect is noted after thread lift. Here the
When the tape is pulled up, it lifts the sagging face and threads take the place of the fingers to give you the desired
makes it look years youngsters & fresh. It take ten years fresh, refreshing look.
off your face, it can be the secret of your youthful look. [SEE HOW LONG DOES IT LAST?
PHOTO FOR THE REFERENCE]. It is long lasting (depending on various factors).
Yes, the Ribbon tape is absolutely safe as it is made of AREAS THAT CAN BE TREATED ARE
absorbale material is used routinely during in various EYEBROW LIFT / FOREHEAD LIFT
important surgeries this it has a safety record.the ribbon For a refreshed face jawline and neck. Ideal for correcting
dissolves in 2 to 3 months. signs of aging in the laugh lines, expression lines, the jowl
The beauty of the procedure is that it is very short procedure and the neck.
is that it is very short procedure and usually takes an hour. HOW SAFE ARE THE THREADS?
There is no downtime so Ribbon Lifts are getting very popular This is a day care procedure and the downtime required is
worldwide, you can get refreshed in an hour and walk off very less (2-5 days).
with an amazing yet subtle & natural transformation. POTENTIAL SIDE EFFECTS?
The most important advantage of Ribbon Lift / Face Lift is, Negligible and extremely rare in expert hands and also with
there are no scars as seen with traditional face lifts, thus latest threads.
your face does not DOES IT GIVE AN EFFECT SIMILAR TO TRADITIONAL
reveals its secrets. It is FACELIFT?
- For a fresher you. Yes…Yes.
In today’s busy world, ADVANTAGES OVER TRADITIONAL FACE LIFT
minimally invasive
surgeries assume an important role, as they require period Day care procedure.
and it unables us to lead normal social life at the earliest. No hospitality stay required.
Plus these techniques do not have long, visible scars. Minimal downtime, early recovery to normal activities and
In this century we are moving towards procedures which social life.
are quick, have less recovery time and do not require the Gentle, natural looking and refreshed face.
‘Surgeon’s knife’ to achieve them. The success of these No big, visible scars.
procedures lies in their popularity worldwide and for their Natural and long lasting results.
safe, natural and long lasting result.
The bonus is “Fresh, Natural, Gentle look”.
HOW IS THE PROCEDURE DONE?
US - FDA approved threads are used for the suspension.
These threads have clogs so that they anchor the deeper
55
56
10
Dr. Aamod Rao
Cosmetic Surgeon
Myths
Plastic surgery patients are more savvy than ever.
Often before a patient visits my office, she/he has
done extensive research on the procedure(s) they
About
desires. Usually the source of the research is world
wide web. The internet has made it easy to share
information. More often than not, this is a good thing. However in the
area of plastic surgery, it can make it hard to distinguish what is fact
and what is fallacy. Allow me to clarify some of the more common
Plastic
misconceptions about plastic surgery.
1. Plastic surgery is not “real” surgery.

Plastic surgery should not be taken lightly. While there are great
benefits to undergoing plastic surgery (improved appearance,
Surgery
improved self-esteem, etc.), there are also risk. Every operation, no potential problems.
matter how minor, has certain risks involved, though their likelihood
is small. The specific risks to any procedure you are seeking should 4. There are no limitations with plastic
be discussed during your consultation with your plastic surgeon. surgery in terms of changing your
appearance.
2. After a plastic surgery procedure, you will have no scars.
Plastic surgeons are doctors, not
All surgical incisions cause scarring. Plastic magicians! Preexisting factors will
surgeons have gained a reputation for creating determine how much of a change
“scarless” incisions. The reason for this is that your surgeon can perform. For
plastic surgeons are skilled in hiding scars in example, an overweight or obese
inconspicuous areas. The truth is scars will never person should not expect to use liposuction
disappear completely. While scars are permanent, as a substitute for proper nutrition and
they are usually rarely noticeable. Everyone heals exercise. While liposuction can make an
differently, due to genetics and personal health factors. overweight person smaller than when
she started, liposuction will not make an
3. Plastic surgery does not require follow-up examinations. overweight or obese person look skinny.
Liposuction is usually reserved for spot
While it is nice for your plastic surgeon to see reduction, not weight reduction
the long-term outcome of your results (and to
see you!), follow-up visits are for your benefit, 5.Only one plastic surgery procedure can
not the surgeon’s! It is important to keep follow- be done at a time.
up appointments to make sure everything is
healing normally. It may save you from having undergo a revisional In general, it is indeed possible to have
operation. Plastic surgeons have been trained to detect early signs more than one procedure at the same time.
of complications, which may become worse if left untreated. If you However, safety is always the first concern.
do not follow-up with your plastic surgeon, he cannot detect these Combined procedures require more time
57
under anesthesia. Candidates for a combined treatment 8.Cosmetic injections with BOTOX Cosmetic and
plan must be able to endure a more prolonged anesthetic dermal fillers such as JUVEDERM, RESTYLANE,
time. All patients should have a physical examination RADIESSE, etc., can replace a facelift.
and should be medically cleared by a doctor before
undergoing surgery. Cosmetic Injections are among the most popular
elected medical treatments today, and with good
6. Plastic surgery requires general anesthesia. reason. In well-trained hands they provide natural,
beautiful enhancements. Cosmetic injections are a good
Not all plastic surgery procedures require general alternative for individuals who do not want to undergo
anaesthesia. Many procedures can be done with a surgery, however they do not take the place of surgery
combination of sedation and local anaesthesia. Which when there is a significant amount of loose facial or neck
type of anesthesia you desire is mutually decided on by skin. In these situations, surgical excision of this excess
you and your surgeon. Local anesthetic with sedation skin is the solution.
involves numbing the area to be treated, accompanied
by supplementary medications for sedation. You will be 9. Plastic surgery is for people who are vain.
able to hear and respond to questions and instructions.
Afterward, however, you will recall little or none of the Plastic surgery is not about vanity. If you feel good about
surgical experience. If you are the type of person who your body, you feel better about yourself and the world
does not want to be awake, you can choose to have a around you. When you finally undergo plastic surgery
general anesthetic. to improve the area(s) that trouble you, you will then be
better able to concentrate on other aspects of your life.
7.Breast augmentation is a one-time only procedure.
10.Plastic surgery is only for wealthy people.
Breast Augmentation can be a very
fulfilling procedure for a woman. However, Women of all financial backgrounds are acceptable
every woman should be aware that candidates for plastic surgery. Your plastic surgeon is
the likelihood of needing subsequent not concerned about your income. However, your plastic
surgery is high. Why? Many women opt surgeon would like to be paid for services rendered. If
to change their initial size, or they may necessary, there are various avenues for financing your
need additional surgery due to breast plastic surgery procedures. Your plastic surgeon will have
changes from aging, pregnancy, and weight fluctuations. information on financing programs.
Additionally, a breast implant can hardened or sometimes
rupture, necessitating removal or replacement.
58
Uterine Fibroids
Uterine fibroids, also known as leiomyomas, are non- Submucosal fibroids protrude inwards into the cavity
cancerous tumors of the womb or uterus. These tumors of the uterus and are commonly associated with heavy
start in the myometrium(muscle) of the uterus. Fibroids bleeding and may cause infertility
occur in more than 25% of women over 30 years of age.
Commonest cause for hysterectomy in women under 50 Intramural fibroids grow within the muscle of the uterus.
years. They grow, making the uterus larger and distort its shape.
This type of fibroid may play a role in heavy periods and
Fibroids only occur after puberty and shrink after pressure symptoms.
menopause. The female sex hormones such as oestrogen
and progesterone are most likely involved in tumour Subserosal fibroids grow and protrude from the outer
growth. However, other growth factors as well as some surface of the uterus, vary greatly in size, and may be
genetic factors may also be involved. multiple.
Symptoms of Fibroids Fibroids and Fertility
• Heavy Periods (Menorrhagia) with clots and pain Presence of fibroids reduces fertility. Small fibroids do
• Bowel and Bladder pressure Symptoms not need to be removed before attempting pregnancy.
• Lump in abdomen or Bloating Removal of fibroids before pregnancy may be required if
• Sexual Discomfort or Difficulty they are large ,cause severe bleeding, grow rapidly, or
• Inability to conceive protrude into the uterine cavity
• Pain during periods
Detection and Diagnosis
Clinical Examination
Ultrasonography
Computerised tomography
Magnetic Resonance Imaging (MRI)
Management Strategy
No Treatment may be required
• No symptoms
• Small fibroids
• After menopause
Treatment may be required

Symptoms – heavy bleeding, pain
Large fibroid in young women
Rapid growth in fibroid
Infertility related to fibroid
Suspicion of cancerous fibroid
(sarcoma)
Medical Treatment
Types of Fibroids, Symptoms and Progression Gonadotrophin hormone-releasing hormone analogues

(GnRHa) are the most commonly used medical treatment
59
for shrinkage of fibroids, eg :Zoladex. .They have Laparoscopic Myomectomy
two major disadvantages : expense and undesirable
side effects .GnRha work by decreasing the level of Laparoscopy or visualization of the inside of the abdominal
oestrogen, effectively causing a menopausal state and cavity is a popular procedure used to help in the diagnosis
thus hot flushes, vaginal dryness and mood swings of many gynaecological disorders. Performed under general
They should not be continued for longer than 6 months anaesthesia this is the preferred method of removal of
as constant low oestrogen levels can increase the risk fibroids of 5-10 cm.
of oesteoporosis and fractures. The availability of high definition cameras, xenon cold
light source and high resolution medical monitors allows
Embolization of Fibroids magnification of the abdominal cavity in detail and
precision.The harmonic ultracision for capsule insicion and
Embolization is a technique used by interventional the suturing skills of the surgeon make the laparoscopic
radiologists , performed under local anaesthesia removal of fibroids the desired mode of management
through a tiny puncture in the groin and branches of whereby blood loss can be decreased and the myoma bed
the uterine artery are blocked. and capsule sutured to obtain perfect haemostasis and
approximation .
The fibroid shrinks because it is starved of blood. This The use of Morcellators : an instrument which can retrieve
may prevent it from producing growth factors which the fibroid once it is separated has revolutionized the
may disturb the mentstrual cycle. The shrinkage of the laparoscopic management of fibroids .
fibroid is slow and may take up to 3 months. Depending on the size and number of fibroids either
multiport laparoscopy can be used or single port
Removal of Fibroids (Myomectomy) laparoscopic surgery can be done
Myomectomy, the surgical removal of fibroids while Removal of Uterus (Hysterectomy) –

preserving the uterus and its child bearing function is
the definitive treatment . Hysterectomy is usually advised after the age of 45 years
and after completion of family.
There is general agreement that the only absolute
Techniques of removal indications for hysterectomy are cancer or other life-
threatening bleeding. Most other indications are relative,
1. Hysteroscopic as they are about quality of life issues rather than life-
Telescope via birth passage threatening conditions. Hysterectomy is not the only
2. Laparoscopic treatment option for fibroids, but in some cases it is the
By small incisions in the abdomen best option, if:
3. Laparo-hysteroscopic
By a combination of 1 & 2 Uterus is very large
4. Laparotomy Risk of uterine cancer is increased, e.g. in women with
By an incision in the abdomen diabetes, obesity and high blood pressure.
If fibroid is cancerous (rare) abdominal hysterectomy is
Hysteroscopic Myomectomy recommended.
If definite cure is necessary and fertility is no longer
The fibroids protruding into the cavity are easily required.
detected by hysteroscopy and removed with the Laparoscopic hysterectomy results in quicker recovery &
help of a resectoscope .This surgery requires high shorter hospitalization.
technical skill and knowledge of electrosurgery and
fluid management. Dr Rakesh Sinha
M.D.
Electrosurgical resection usually takes only10-30 Chief Gynecological Endoscopic Surgeon
minutes and the patient is can be discharged from the BEAMS Hospitals Pvt Ltd.
hospital 4 – 6 hours after the procedure.
60
JOINT REPLACEMENT-
Newer Trends = Better Results
Dr Girish Dewnany or more!!
MS, DNB, MCh (Orth) UK, FRCS, FRCS (Orth) UK There is constant ongoing
Consultant Joint Replacement Surgeon research and development in
Fellowship Training: UK & Australia the field of joint replacement. The aim is to develop
Over a decade of training & experience in UK techniques and implants which would improve
M: 9820486176; E: girishdewnany@hotmail.com accuracy, function and longevity of the artificial joint
prostheses and replicate normal joint function as much
Arthritis is the condition where the surface of the joint as possible.
(cartilage) is damaged or worn out causing bone to rub I have had a chance to work for a long time in the UK
against bone which is painful when walked on or moved and Australia and would like to share my experience
against each other with you of what is new and exciting in the world of
Arthritis of weight bearing joints i.e. the knee and joint replacement. We are fortunate that we now have
hip is an ever growing problem with an increase in in India –all the possible options available, to give our
the longevity of the average Indian patient. The hip is patients the best in joint replacement surgery.
more affected in younger individuals, secondary to 1.Computer assisted Knee Replacement
inflammatory joint disease like ankylosing spondylitis Computer-assisted surgery helps surgeons align the
or due to avascular necrosis of the femoral head. The artificial joint implants with a degree of accuracy not
knee is more commonly affected in osteoarthritis which possible with the naked eye.
is an age related degenerative process. The artificial knee joint is aligned to within 3 degrees of
A complete cure of arthritic disease process is normal in all 3 planes.
unfortunately not yet known; as age progresses, so does A well-aligned knee replacement lasts longer and
arthritis achieves better function, much like a well-aligned car
Joint Replacement Surgery is the only definitive cure tyre.
for arthritis of the hip and knee, wherein the worn
out arthritic joint is replaced by metal and plastic It is especially helpful in our scenario where patients
constructs. In case of hip replacements we are also now present late for surgery with complex deformities.
using ceramic components. The new joint is designed to Computer navigation reduces intra operative risks,
mimic the natural joint as much as possible to restore allows quicker post operative recovery and rehabilitation
normal function.
Elimination of pain, restoration of joint movement,
maintaining independence and improving quality
of life are primary objectives of joint replacement
surgery.
The success of joint replacement surgery is in excess
of 97%.
The lifespan of the replaced joint is affected by patient Computer Navigated Knee Replacement
weight, activity and type of joint used 2.Uncemented Hip Replacements
With appropriate activity modification, a well done Hip arthritis in India is more often seen in younger
knee and hip replacement can last for up to 15-20 years individuals in the 30-55 age groups. The demand in
these patients is of a long lasting prosthetic joint with a
61
higher range of movement. replacement, due to either infection or mal alignment-
Uncemented hip systems are now the most suitable repeat surgery is needed. Newer and better revision joint
option for this group of patients rather than the older replacement systems, which I have used extensively
cemented options which last for 8-10 years. Cemented in the UK, are now available in India to give a result
systems still have a role in the elderly population and a as good as primary hip and knee surgery, BUT at an
subset of patients with poor bone stock (osteoporosis). increased cost.
Among the uncemented systems, ceramic bearings The components are of the uncemented variety
have shown to have the lowest wear rate compared in revision hip replacements with larger sizes to
to polyethylene bearings and therefore have a higher compensate for bone loss and improve stability. In case
longevity among all available systems worldwide. of revision knee replacements, cement is used sparingly,
This latest state of art technology is now available to us but the implants have a higher constraint to compensate
in India. The Ceramic bearings last longer, allow a better for inadequate soft tissue balance. Rehabilitation is
range of movement and when used without cement; more prolonged after any revision surgery to allow
their expected survival is up to 20 years in most patients.
In the current scenario hip resurfacing and metal on
metal hip replacements are best avoided due to adverse
reports of early failures secondary to metal debris from
these bearings.
Uncemented Ceramic hip replacement
better implant integration,

develop muscle strength and proprioception.
The revision joint replacement is technically a far more
demanding procedure than a primary joint replacement
and should only be done by those specifically trained in
it and in a centre with all the facilities and backup i.e.
bone grafting etc, available-not something for the faint
hearted!
3 .
All in all joint replacement surgery is poised to grow
further and the more primary joint replacements being
Revision Hip and Knee Replacement done-more will be the demand for revision surgery
With all the care and expertise there is still a risk of and the need for better systems and implants to give
failure of a joint replacement in the early or late post improved results after both primary and revision joint
operative phase. The commonest reasons of early replacement surgery.
failure are either infection or mal-alignment (which is
iatrogenic).Late failures are due to wear and loosening.
Failure rates are in the range of 2-3% in the best centers Hosp Affiliations:
with experienced surgeons.
A failed joint replacement can be worse than “NO” Bombay Hospital
joint replacement and all possible steps have to be Hinduja Healthcare Surgical
taken to avoid infection (laminar air flow etc), with an S L Raheja-Fortis Hospital
experienced well trained surgeon to decrease iatrogenic
problems.
In the unfortunate scenario of a failed primary joint
62
Prince Aly Khan Hospital

NABL Accredited
ISO 9001:2008 Certified

Certificate No: M-0392
The Prince Aly Khan Hospital is proud to announce that the (Clinical
Pathology Laboratory has achieved the NABL (National Accreditation Board
for Testing and Calibration Laboratories) accreditation (for clinical pathology,
hematology, biochemistry and serology)”, thus joining an elite group of labs
in India with this distinction.
This accreditation is a
recongnisation of our lab’s
ability to provide high-quality,
accurate and consistently
reliable testing services.
The laboratory provides the full

range of investigations in
hematology, biochemistry, serology, microbiology and histopathology,
including frozen section. Fully automated and manned by well-trained
technicians, under the supervision of experienced pathologists, it provides
24x7 services.
The NABL accreditation adds another feather to the cap with our existing ISO
certification.
Aga Hall, Nesbit Road, Mazgaon, Mumbai – 400 010

Contact No. : 022-2377 7800 / 2377 7900
Website: www.princealykhanhospital.com
63

IMA Maharashtra State President's Message

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IMA - Maharashtra State

OFFICE BEARERS FOR THE YEAR 2012 – 13

Dr. Anil Pachnekar President 9869001873 dranilpachnekar@rediffmail.com

IMA MS SOCIAL SECURITY SECHEME

Dr. Shrikant Kothari Chairman 9821012970 drshkothari@yahoo.co.in

IMA MS FACULTY OF CGP

IMA MS AMS CHAPTER

Dr. Ravi Wankhedkar Chairman 9422296495 raviwankhedkar@gmail.com

IMA MS PROFESSIONAL PROTECTION SCHEME

Dr. Krishna Parate Chairman 9823050572 krishnaparate@rediffmail.com

President IMA Maharashtra State 2012-13

DR. ANIL S. PACHNEKAR

Area wise Distribution of work.

Physician’s Prayer Convocation Pledge

For information and necessary action by Hon. Secretaries

HON. SECRETARY MESSAGE

CLINICAL ESTABLISHMENT ACT

Dr. SHIVKUMAR. S. UTTURE

IMA MS Professional Protection Scheme

Membership 31/03/2010 31/03/2011 31/03/12 01/08/12

Request to the President / Hon. Secretary of each Local Branch. :-

Dr. Shrikant H. Kothari Dr. Shailendra C. Mehtalia

IMA Hospital Board of India

LETTER OF APPEAL FOR JOINING HBI

Dear Member / Nursing home or Hospital owner / Doctor, etc.

With best wishes and looking forward to your early response.

INDIAN MEDICAL ASSOCIATIONMAHARASHTRA STATE

Sr. No. ___________ State No. ______________ IMA HQ NO. _______________________

IMA MAHARASHTRA STATE HOSPITAL BOARD MEMBERSHIP FORM

1) Primary Healthcare institution (Clinics & without inpatient care)

Specialities available: _______________________________________________________________________

Registration with Local Authority / State Authority

APPLICANT SIGNATURE Verified by:

President / Hon. Secretary IMA____________________Branch

Hon. Secretary IMA HBI (Maharashtra State)

IT WAS RESOLOVED & APPROVED IN THE ANNUAL STATE METTING HELD ON

Annual Couple 131 338 469 176 410 586

Life Single 2420 3650 6070 2635 4230 6865

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The Secretaries / Presidents are requested to send New

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BRANCH CAN COLLECT ADDITIONAL AMOUNT THAN HFC AS

Important Days of IMA of the year 2013.

15th January IMA Community Services Day

SUB COMMITTEES 2012 - 13

6 DASS DR. Y. S. Deshpande 9823083841

10 MEDICAL EDUCATION SUB COMMITTEE Dr. Sanjay Dudhat 9820232606

PUBLIC HEALTH EDUCATION

I think this is success of my work which I did for many years.

For information of IMA Members

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INDIAN MEDICAL ASSOCIATION

(APPLICATION FOR OPENING A NEW LOCAL BRANCH) .

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