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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


1st July, 2010, Thursday

HAPPY DOCTOR's DAY

emedinews wishes all readers a happy and healthy Doctor's day.

 

Preventing neck pains

Prevention is worth a pound of cure. One cannot control age–related wear and tear, but one can work at minimizing the risk. One place to start is to look at how one sleeps.

Two sleeping positions are easiest on the neck: on the side or on the back. If you sleep on your back, choose a rounded pillow to support the natural curve of your neck, with a flatter pillow cushioning your head. This can be achieved by tucking a small neck roll into the pillowcase of a flatter, softer pillow, or by using a special pillow that has a built–in neck support with an indentation for the head to rest in. Here are some more tips for side–and back–sleepers:

  1. Try using a feather pillow, which easily conforms to the shape of the neck. But feather pillows collapse over time and so should be replaced every year or so.

  2. Another option is a traditionally shaped pillow with "memory foam" that conforms to the contour of your head and neck. Some cervical pillows are also made with memory foam. Manufacturers of memory–foam pillows claim they help foster proper spinal alignment.

  3. Avoid using too high or stiff pillows. These keep the neck flexed overnight and can result in morning pain and stiffness.

  4. If you sleep on your side, keep your spine straight by using a pillow that is higher under your neck than your head.

  5. When you are riding in a plane, train, or car, or even just reclining to watch TV, a horseshoe–shaped pillow can support your neck and prevent your head from dropping to one side if you doze. If the pillow is too large behind the neck, however, it will force your head forward.

Sleeping on your stomach is tough on your spine, because the back is arched and your neck is turned to the side. Preferred sleeping positions are often set early in life and can be tough to change. We don't often wake up in the same position in which we fell asleep. It's worth trying to start sleeping on your back or side.

Beyond sleep position

Not just sleep position, but sleep itself, can play a role in musculoskeletal pain, including neck and shoulder pain. In a study in 2008, researchers compared musculoskeletal pain in more than 4000 healthy men and women, with and without sleeping problems. Sleeping problems included difficulty falling asleep, trouble staying asleep, waking early in the mornings, and non–restorative sleep. They found that people who reported moderate to severe problems in at least three of these four categories were significantly more likely to develop chronic musculoskeletal pain after one year than those who reported little or no problem with sleep. Sleep disturbances disrupt the muscle relaxation and healing that normally occur during sleep. (Source Harvard Newslwetter)

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

 

Logo and Theme of 17th MTNL Perfect Health Mela released

The Logo and Theme of 17th MTNL Perfect Health Mela were released by Former international cricketer Sh Chetan Chauhan during a press conference on 30.6.2010. The theme for this year is  "Rising Problems of Lifestyle Disorders"

Dr k k Aggarwal
Other dignitaries present on the occasion were: Padma Shri and Dr BC Roy awardee Dr KK Aggarwal, President HCFI and Acharya Dr Sadhna Ji Maharaj, chairperson, World Fellowship of Religions.

 

News and views

Potential link found between diabetes and heightened risk of heart disease, sudden cardiac death (Dr Monica and Brahma Vasudeva)

A potential association between diabetes and a increased risk of heart disease and sudden cardiac death has been discovered, according to a study published in the journal Neuron. The researchers found that high blood sugar prevents critical communication between the brain and the autonomic nervous system.

Low-dose transdermal HRT does not increase risk for stroke (Dr Varesh Nagrath)

Low–dose, transdermal hormone replacement therapy (HRT) does not appear to increase the risk for stroke compared with no HRT use, according to a study published June 3 in the BMJ. In contrast, high–dose transdermal HRT is associated with an increased risk for stroke–a risk that is at least equal to if not higher than the risks associated with oral HRT use.

Traditional gingival tattooing is common in some countries and is performed for cosmetic reasons (Dr GM Singh)

Teenaged girls usually undergo gingival tattooing. The gingiva is pierced with a needle or a thorn, and charcoal, plant pigments, and burnt seed are used. There are reported cases of gingival tattooing performed for the management of periodontal disease, because some believe the bleeding decreases the gingival "congestion."

Diabetes Responsible for 10% of vascular deaths

More than one in 10 heart disease deaths may be attributable to diabetes. In a meta–analysis of more than 100 studies by Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues, diabetes was associated with a 2-fold increased risk of the disease and accounted for 11% of vascular deaths.

MCI Update

Former president of Medical Council Of India, Dr Ketan Desai was brought to Ahmedabad by CBI officials on Wednesday. According to CBI, he was brought to probe into the properties owned by him in and around the city. Sources said that CBI wanted to verify the exact number of his assets and scope of his properties. As per CBI some of his assets have been identified and a disproportionate asset case was filed against him. However, there is likelihood that  he owned even more properties, still accounted for. His wife Alka Desai had recently approached the Gujarat High Court seeking anticipatory bail. She has sought transit anticipatory bail because CBI has named her as one of the accused in the chargesheet filed in Delhi. She runs a private hospital in the city since 1991, has expressed fear that CBI may arrest her .(Times of India)

 

 

Legal Column

What are the main issues involved in a medical negligence claim?

There are many issues which are related to medical negligence claims, the most common of which are, failed sterilization, operations and unsuccessful surgeries amongst others. However, there is a varied field of other issues which the courts deal with; some of them are given in the cases described below.

  • The complainant had been operated by the defending doctor after an accident. The after–effects of the operation were not as desired and after repeated consultations with other doctors, the complainant filed this complaint against the treating doctor. The court held that the defending doctor had followed all proper medical principles and had not done any wrong. Merely having some bad after–effects or side effects were not enough to constitute a claim, there had to be a definite instance of negligence on the part of the doctor in question due to which injury was directly caused.

  • A complainant’s wife had discovered that she had a boil on her vagina after she had given birth to a child. The wife was a gynecologist herself. The respondent doctor in this case performed a surgery and then left for some other work with the instructions to be called if anything went wrong. There were some complications which arose when the doctor was called and despite all attempts, the wife died. The complainant who was the deceased husband, filed for medical negligence on part of the doctor, saying that he just wanted to make money and hence ordered for a needless operation due to which the patient’s condition worsened. After hearing the contentions of both sides and examining the documents on record, the court held that there was no evidence of any foul play by the doctor and he did everything as per established procedure. This is another case which shows that mere failure of a procedure does not entail medical negligence.

Forensic Column

Dr Sudhir Gupta, Associate Professor, Forensic Medicine, AIIMS

Gratuitous medical services should also be rendered with reasonable skill & care

The legal and ethical duties imposed on the doctor to exercise due skill and care in catering medical services only arise where a doctor/patient relationship comes in contractual existence as per Indian Evidence Act. If a doctor is passing/crossing the scene of an road traffic accident/any medical emergency in which some person has been injured/sick and is in need of urgent medical/surgical attention/intervention to save the life or limb of the injured he/she would not be held to have been negligent, if he does not render/provide medical assistance to the patient in the eye of law for violation of code of ethics/civil/criminal or consumer law , as in such cases no doctor / patient relationship has been established/came in force for medical care delivery and in consequences the doctor owes the patient/injured person no legal/ethical.

If, the doctor goes to the medical assistance of a person who is injured in an accident site revealing/pronouncing himself as doctor and offer to assist the injured, then a doctor /patient relationship is at once established in implied manner and the doctor is ethically bound and has a duty to exercise reasonable/required standard skill and care in providing medical care possible at that length of situation regardless of whether or not his medical services are being given gratuitously.

 

Experts’ Views

Interesting tips in Hepatology & Gastroenterology

Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi

Coeliac Disease (continued)

What’s Latent coeliac disease ?

Latent coeliac disease is where the coeliac disease antibodies are positive in the blood, but no obvious damage to the intestines, these individuals need to be on regular surveillance.

What’s Silent coeliac disease ?

Silent coeliac disease refers to patients who have abnormal antibody blood tests for coeliac disease as well as loss of villi in the small intestine but have no symptoms or signs of coeliac disease, even on a normal diet that contains gluten. Like patients with latent coeliac disease, these patients can develop signs or symptoms of coeliac disease later in life.

What’s Refractory coeliac disease ?

Refractory coeliac disease is defined as symptoms and small intestinal inflammation that persist after one year on a strict gluten–free diet. Some patients never respond to a gluten–free diet, others initially responded but have a recurrence of symptoms and intestinal inflammation. Refractory sprue appears to be typical of adults, especially middle–aged or elderly people, and is never encountered in the pediatric population. Refractory coeliac disease is divided into two types based on special studies or flow cytometric analysis of lymphocytes performed on small intestinal biopsies. Patients with Type I have a normal T–cell population interspersed along the intestinal lining and usually have a good response to treatment with steroids or azathioprine and a good prognosis. Those with Type II have an abnormal T–cell population interspersed along the intestinal lining, respond poorly to steroid treatment, often require intravenous nutrition, and have a high chance of developing T–cell lymphoma.

Question of the Day

What is the recommended screening regimen for diabetic retinopathy? (Dr Ashok Kumar Das, Pondicherry)

Screening regimen for diabetic retinopathy are

Noninsulin-dependent diabetes mellitus

  • No diabetic retinopathy: Annual check–up

  • Mild nonproliferative diabetic: Annual check–up retinopathy

  • Moderate nonproliferative diabetic: Once in 6 months retinopathy

  • Severe nonproliferative diabetic: Once in 3 months retinopathy

Insulin–dependent diabetes mellitus

  • 5 years of diagnosis

  • Yearly thereafter

  • Diabetic retinopathy present

  • Screening regimen as for NIDDM
Mental exercise to prevent dementia: Dr Anupam Sethi Malhotra

The only vegetable or fruit never sold frozen, canned, processed, cooked, or in any other form but fresh? Lettuce

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Public Forum (Press Release for use by the newspapers)

Doctors' Day Observed

To express gratitude to doctors and acknowledge their dedication and commitment towards society, Doctors' Day is celebrated in India on 1st July every year. First of July happens to be both the birth and the death anniversary of late Dr B C Roy.

On this occassion, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India said that the unique thing of medical profession compared to other professions is its commitment for the weaker sections of the society. For this, all doctors are morally expected to spend ten percent of their time for charity. This also has been the basis of the government alloting charitable lands at subsidized rates.

More than one lakh prescription errors occur in the US alone. The number is much more in our country. The only way to avoid this is to follow defined guidelines. As far as possible doctors should write prescriptions in capital words and not use abbreviations. For example, giving insulin one should write ‘4 units’ and not ‘4 u’ as 4 u may be misinterpreted as 40 ending up in harming the patient.

Most medical mishaps in the society are medical accidents and not medical negligence. Difference of opinion and error of judgment are not negligence. A doctor is required to possess an average degree of skill and knowledge and not the maximum degree of skill and knowledge. Between doctor and patient there is a duty. Only if there is a breach of this duty resulting into damage can it be called as negligence in the Civil Court.

The medical profession today is facing many challenges as many new epidemics have come up in the society. These epidemics include those of diastolic heart failure, atrial fibrillation, enlarged left atrium, sudden cardiac death, obesity, high blood pressure, metabolic syndrome and uncontrolled diabetes.

There have also been new advancements in cardiology like biventricular pacing, atrial devices, implantable cardiac defibrillators, etc which are now available in the country and awareness needs to be created both amongst the public as well as the doctors regarding the same.

The public also should reinforce their faith in the doctors and every case of medical mishap should not be projected to the media without having been through a proper enquiry.

Right communication at the right time can prevent most doctor–patient mishaps.

 

An Inspirational Story (Anuj Goyal)

Albert Einstein's wife often suggested that he dress more professionally when he headed off to work.

"Why should I?" he would invariably argue.

"Everyone knows me there." When the time came for Einstein to attend his first major conference, she begged him to dress up a bit. "Why should I?" said Einstein.
……… "No one knows me there!"

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with laryngopharyngeal reflux wanted to know whether he could have soft drinks.
Dr Bad: Yes, you can take.
Dr Good: You must avoid carbonated beverages.
Lesson: Carbonated beverages should be avoided. Many contain caffeine and loosen the sphincters, causing stomach contents to come up with each burp. Carbonated drinks with alcohol have similar effects.

Make Sure

Situation: A patient with acute rheumatic fever was directly put on penicillin prophylaxis.
Reaction: Oh my God! Why was the full initial course of penicillin not given?
Lesson: Make sure that patients with acute rheumatic fever are initiated on antibiotic therapy as delineated for eradication of streptococcal pharyngitis, whether or not pharyngitis is present at the time of diagnosis.

Mistakes in Clinical practice

Do not write "AU, AS, AD" for both ears, left ear, right ear: it can be mistaken as the abbreviation "OU" (both eyes), "OS" (left eye),"OD" (right eye)

Mnemonic of the Day: Dr Maj Prachi Garg

Ranson criteria for pancreatitis at admission – LEGAL

Leukocytes > 16.000
E
nzyme AST > 250
Glucose > 200
A
ge > 55
LDH > 350

 

International Medical Science Academy Update (IMSA)

The 7th edition revision of the combined AJCC (American Joint Committee on Cancer) and UICC (International Union Against Cancer) TNM (tumor, node, metastasis) cancer staging manual took effect in January 2010. The criteria by which individual TNM categories are defined, as well as the stage groupings (combinations of T, N, and M that comprise stage I to IV disease) have changed for multiple cancer sites. The most prominent changes are in lung, esophageal, gastric, biliary, colorectal, and prostate cancer. In addition, new TNM staging systems have been developed for gastrointestinal stromal tumors (GIST), intrahepatic cholangiocarcinoma, and carcinoid tumors.

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Retapamulin Ointment 1%

For the topical treatment of bacterial skin and skin structure infections: Primary impetigo, secondarily infected traumatic lesions, secondarily infected dermatoses.

25.04.2009

Medi Finance

Personal Accident individual
Risk Group II: Builders, contractors and engineers engaged in superintending functions only, veterinary doctors, paid drivers of motor cars and light motor vehicles and persons engaged in occupation of similar hazard and not engaged in manual labour. All persons engaged in manual labour (except those falling under group III) cash carrying employees, garage and motor machines operators, drivers of trucks or lorries and other heavy vehicles, professional athletes and sportsmen, wood working machinists and persons engaged in occupations/activities of similar hazards.

Lab Medicine

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Hemoglobin A1c; HbA1c

To monitor a person's diabetes and to aid in treatment decisions; to screen for and/or diagnose diabetes and prediabetes.

 

Humor Section

"Doctor, please hurry. My son swallowed a razor-blade."
"Don't panic, I'm coming immediately.
Have you done anything yet ?"
"Yea, I shaved with the electric razor."

Funny Definitions

Tablet………… A small table

Medical bloopers on medical charts!

Patient has chest pains if she lies on her left side for over a year.

 

The Ten Traits of the True Spiritual Warrior: Guy Finley

The true spiritual warrior knows that the path of spiritual liberation that he has chosen must lead him to one encounter after another with conditions that always seem greater than he is.

 

Obituary

Padma Shri Dr L C Gupta passed away on 27th May 2010. He was a recipient of the Padma Shri this year.

  Readers Responses
  1. BK Mittal: It is extremely good to read your greetings but it is very time consuming. Once a week you should add jokes and events col. It will be more relevant. You can add free advert. on one day to start with like requiring surplus medicine or useful to common doctors etc.

  2. Dear Dr. Aggarwal, A few weeks ago there was a good and informative article on "HONEY" in eMedinewS. May I take liberty to state a few facts about Honey.

    a. THE HOLY QURA'AN says: "Your Lord revealed to the bees 'Build dwellings on the mountains and the trees, also in the structures which men erect. Then eat from every kind of fruit and travel the paths of your Lord, which have been easy for you to follow. From inside them cometh a drink of varying colors containing HEALING FOR MANKIND. There is certainly a sign in that for people who reflect" ( CHAPTER 16 ayah 68–69).

    b. My Personal experience: I have been using 100% pure honey obtained directly from the BEE–HIVES from the forest/mountains for dressing of large non–healing ulcers, Bed sores, Diabetic ulcers, Trophic ulcers and often after drainage of superficial abscess, viz Inguinal, Axillary, Post–operative infections, and drainage of large Pilonidal Abscess, Perineal abscesses, Post–Fistulectomy wound with excellent results. It helps in MRSA cases as well.

    c. Last time I met Mr. Nyhus , World Hernia surgery Expert in 2003 in San Francisco after my talk on "Surgical Management of Complications of Hepatitis B". Afterwards while discussing with him about his experience on Hernia Surgery; he mentioned that in large Ventral Hernias he soaks mesh in pure honey. In fact I haven’t used it myself. Till now I used to soak in Providone Iodine and after fixation put Antibiotic solution in each layer. With best of regards. Fazl–ur–Rahman, MS FRCS FACS FICS, Consultant General and Laparoscopic Surgeon.

  3. Dr KKA’s SMS service advised some days ago to have five servings of fruits every day. With the prevalence of ripening of fruits, especially mangoes, papayas and bananas by Calcium Carbide, it seems a dangerous advice. Looks like it is not just the Chemical which killed and made thousands of people in Bhopal sick, our own fruit–dealers are busy doing that by inducing cancers among people. There are no statistics on how many Indians get cancer just because of fruits ripened with Calcium Carbide. I am perplexed why the Government could think of out–lawing it through PFA Act so late. Bigger question will remain how to enforce this new stipulation. Who will see that fruits are not ripened the wrong way? There should be some NGO with the help of Govt coming forward for mass awareness among this illiterate section of the society, the fruit–dealers. Here English will not work. Only Hindi, Telugu, Tamil, Oriya etc would do better. There should be TV ads in Indian languages advising against using Calcium Carbide. To me, even more shocking is the revelation that safer Ethylene is not easily available to most fruit dealers. End result of the situation is–– I am unhappy as I was enjoying this seaason my mangoes daily, at least twice a day, now onwards I shall look at them with suspicion–Brutus thou too!!! Vinod Varshney sss
  4.  Dear colleagues, Wish you all a happy & healthy Doctors Day, 2010

    IMA has started changing; Professionalism has started. I am confident it will meet the expectations of members. The following are my expanded thought process on the above discussions on  “Action Plans”.

    1. Sensitize the membership at large through a special issue of JIMA. Same Dharnas, processions, Black Badge wearing and memorandum to Health Ministers & District Authorities must be continued at state level and Branch level.

    2. Sensitize the political leaders, both Ruling and opposite parties - MLAs & MPs, on the health agendas. They must be contacted through our members and quickly lobbying to be done so that further progress of these issues are halted immediately & favourable outcome becomes visible. Since Health is a state subject state Govt lobbying too is vital.

    3. Working with MOH & Govt of India with alternate solutions for the three issues. We should look at the issues from the Government the side, public angle and Doctors’ side. Unilateral analysis will not yield. Alternate amicable and friendly solutions to be developed by IMA leaders and discuss with MOH so that the issues are solved to everybody’s satisfaction. I learn Health Ministry is having an open mind as on date.

    4. Media , both print and electronic must be turned positive. They are to be convinced by IMA leaders and members to support the cause. Press Statements, TV messages & dialogues have to be initiated.

    5. Net Working: We should widen our base by ropingin the Government Doctors’ Association, ESI Doctors, Other Speciality Organization like API, ASI, IAP etc, Dental Surgeons and other Para Medical Associations and Councils. They also form part of the Health workforce and BRHC & Clinical regulation Bill will affect them too.

    6. Take public with us. Public must be explained what for Doctors are fighting. After all we are striking to provide better Health Care to the commonman. They should join hands with the profession. IMA can open a website “Healthy India” & invite views of public and consumer associations.

    7. Approach the President of India & Prime Minister to Declare “Health as a fundamental right” of Indians &  a infrastructure category. This will relieve most of the burden we are fighting.

    8. Last but not the least is the legal battle. Already Kerala State IMA has gone to court against BRHC. Bihar State has gone to court on behalf of the members of MCI. PIL has to be filed by IMA / Voluntary Agencies against the CEB. Other States of IMA & IMA members can join these case.

    9. All the above can be achieved with our continued unity & carrying on the struggle till the cause is reached. This needs a committed team under the National President of IMA with members having expertise, interest and contacts in all the above clauses. This is the need of the ours, collegues. TIME IS OF ESSENCE. COHESIVE WORKING LEADS TO SUCCESS. CONTINUED FOLLOWUP ALWAYS YIELDS. I am confident of our progress towards a “Healthy India”

    Dr. Arulrhaj, MD., FRCP (Glasg)

 

Forthcoming Events

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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