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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

2nd January 2012, Wednesday

Punishment to a rapist

  • One needs to distinguish between paraphiliac and non-paraphiliac rapists. Paraphiliac rapists have excessive sexual desire. Paraphiliac offenders commit sex offences because they are sexually aroused by the act. On the other hand, non-paraphiliac sex offenders are instigated by violations or ego-hurt or for taking revenge.
  • False allegations of rapes can occur in the following situations: if one of the partners in live-in relationship refuses to marry, if two consensual partners are caught in the sexual act by the society, someone exploits secrete of the other person.
  • One may lose intellect under the influence of alcohol and may end up in raping somebody if instigated.
  • Chemical castration is reversible and the effect of the injection lasts only 3-6 months. The injections are costly and need to be given by medical doctors.
  • Chemical castration in the long run leads to thinning of the bone (osteoporosis), feminine characteristics and increased tendency for cardiovascular diseases.
  • Chemical castration drugs are not safe and healthy.
  • In the long run influential people convicted for chemical castration will start paying bribes to doctors and get a water injection in place of chemical castration injection.
  • Chemical castration does not mean dissolving the male organ with a chemical. It only means reducing the blood testosterone levels to that of pre-puberty levels.
  • Non-injectable oral drugs, which block the action of testosterone are costlier and need to be taken every day. Therefore, they cannot be a part of chemical castration as punishment.
  • Surgical removal of testis will remove sexual desire permanently and the same can only be given as a punishment in patients who are spending life-term in the prison.
  • Depo Provera is another injection which can be given every three months to patients with paraphiliac sexual abnormality.
  • Deprivation of sex and non-fulfillment of sexual desires is one of the main causes of rapes.
  • If female commercial sex workers are banned in the society, the incidents of rape will increase as sexually deprived people with strong sexual urges will end up raping the minors.
  • People under the influence of alcohol and drugs will keep raping girls if not treated and counseled in time.

Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President-Elect IMA.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

    Constipation Update

How does chronic constipation affect quality of life for a patient?

Chronic constipation has been associated with considerable impairment in quality of life as it can be physically and mentally troublesome for many patients, and can significantly interfere with their daily living and well-being. Individuals with constipation have higher medical care (outpatient and emergency) use, which leads to large individual healthcare costs, and represents a burden to healthcare delivery systems.

 
Dr K K Aggarwal
    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

AHA – ACS update new–2

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela 2012

Students’ from various schools actively participated in the MTNL perfect Health Mela.

 
Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Tribute to Dr. B.D. Triguna

Padma Vibhushan Awardee Dr. BD Triguna, a giant in the field of Ayurved, passed away on 1st January, 2013 in the evening hours. He was 95 years and still active in the practice of Ayurved.

My association with him goes back to the era when Dr. Deepak Chopra was actively associated with Maharshi Mahesh Yogi. Maharshi Mahesh Yogi fell sick and developed acute pancreatitis and was treated in his house at Golf Link which was converted into a mini ICU. Late Dr. (Col.) KL Chopra, Dr. Deepak Chopra, myself, Dr. HK and Trigunaji were treating him.

One day I just showed him my hand, he checked my pulse and said that I was suffering from a severe acidity which was true.  Once he saw a person in my presence, checked his pulse and said that he had stone in the right ureter and the person was surprised as he had no symptoms. When he got himself  investigated, it was there.

He was a master of Ayurved pulse diagnosis. With him an era in Ayurved practice has been lost. May God put his soul into peace and give courage to his family including my friend Devender, also Padma Bhushan Awardee to bear the loss!

Dr. KK Aggarwal
Padmashri & Dr. BC Roy National Awardee

Green passports in Kerala for young wildlife enthusiasts

THIRUVANANTHAPURAM: The holders of this passport may play a key role in protecting the virgin green zones of the state in the near future. The forest department has started issuing unique 'green passports' to young wildlife enthusiasts, an official stamp of approval for future conservation activities to be done along with state wildlife officials across wild life sanctuaries and parks in the state. Forest officials have already issued green passports to 40 school students from 17 schools situated in and around the Periyar tiger reserve. These students were an integral part of nature clubs activities in their respective schools and were nominated by the student coordinators based on their. "The passport holders who are selected are guided by foresters and ranger officers on various conservation issues and provided an insight into the flora and fauna in national parks and sanctuaries across the state. Their passports will have a stamp of approval from the wildlife warden each park after they complete these rounds. They will then have acquired the minimum knowledge required to be drafted as budding wildlife conservationist," said deputy director Periyar tiger reserve Sanjayan Kumar. The state has a forest cover of 29.1%, well above the national average of 20%. The total forest area in the state is 11,309.50 square kilometres. (Source: TOI, Jan 1, 2013)

 

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

When should the first echo be done after valve replacement?

For all patients receiving a prosthetic heart valve, a baseline echocardiogram is suggested at the time of hospital discharge or at their first postoperative follow–up visit 2 to 4 weeks after discharge.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Kidney disease classification to include albuminuria

The National Kidney Foundation has updated its chronic kidney disease (CKD) classification system to include cause, glomerular filtration rate (GFR), and albuminuria levels. The Foundation's new Kidney Disease Outcomes Quality Initiative guideline, published in the January 2013 issue of Kidney International Supplements, is intended to increase prognostic accuracy by using blood and urine tests together rather than either test alone. (Source: Medscape)

For comments and archives

Does coiling beat clipping for ruptured aneurysms?

For endovascular treatment of ruptured intracranial aneurysm, coiling yields a better clinical outcome than clipping, with the benefit greatest in patients with a good preoperative grade, according to a new meta-analysis of relevant studies. (Source: Medscape)

For comments and archives

Black race, diabetes with complications CRVO risk factors

Black race and diabetes mellitus (DM) with complications are 2 previously unrecognized risk factors for central retinal vein occlusion (CRVO), according to a large study of healthcare claims. The data also confirm that hypertension (HTN), which accelerates stiffening of arteries, and vascular disease are significant risk factors for CRVO. (Source: Medscape)

For comments and archives

FDA approves first antidiarrheal drug for HIV/AIDS

The US Food and Drug Administration (FDA) today approved crofelemer (Fulyzaq, Salix Pharmaceuticals under license from Napo Pharmaceuticals, Inc) to relieve diarrhea in patients with HIV/AIDS who are undergoing antiretroviral therapy. Diarrhea is a common reason for patients with HIV/AIDS to stop or switch therapies, according to a news release from the FDA. The newly approved drug is intended for use in patients with HIV/AIDS whose diarrhea is not caused by infection by a virus, bacteria, or parasite. The drug is dosed twice daily to manage watery diarrhea caused by secretion of water and electrolytes in the gastrointestinal tract, the news release notes. (Source: Medscape)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: Chemical castration decision should be done after discussing with medical fraternity

@DrKKAggarwal: How to make the best use of your timehttps://www.deepakchopra.com/video/view/473/ask_deepak__how_to_maximize_the_use_of_our_time …

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Alcohol takes your power of judgment away

Under the influence of alcohol, you may lose your power of judgment. I recall one of my friends who shot himself under the influence of alcohol after his wife refused to cook food for him and his friends at 11 pm. When he said, “mujhe khana do nahin to mein khud ko shoot kar loonga”, to which she said, “Shoot kar lo” and he shot himself.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What precautions should be carried while carrying a multiple pregnancy?

  • Metabolic and nutritional considerations: There is an increased need for maternal nutrition in multiple pregnancies. An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. With multiples, weight gain of approximately 45 pounds is optimal for normal weight women. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.
  • Activity precautions: Women with multiple pregnancies are usually advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may increase birth weight up to 20%. Intercourse is generally discouraged when bed rest is recommended.
  • Monitoring a multiple pregnancy: Prenatal diagnosis by chorionic villus sampling can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities. Amniocentesis is performed between 16 to 20 weeks. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation. Tocolytic agents are medications that may slow or stop premature labor. These medications are given in hospital "emergency" settings in an attempt to stop premature labor.
  • Cesarean section: Vaginal delivery of twins may be safe in some circumstances. Many twins can be delivered vaginally if the presenting infant is in the head first position. Most triplets will be delivered by cesarean section. Appropriate anesthesia and neonatal support are essential, whether delivery is performed vaginally or requires Cesarean section.
 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Does donor need any rest after donating blood?

Yes. The donor should rest for about 20–30 minutes before resuming his routine work; it takes only 3–8 minutes to take blood from a donor.

 
    An Inspirational Story

A man must constantly exceed his level!

This inspiring story is about Bruce Lee, a legendary martial art master.

“Bruce had me up to three miles a day, really at a good pace. We’d run the three miles in twenty-one or twenty-two minutes. Just under eight minutes a mile (Note: when running on his own in 1968, Lee would get his time down to six-and-a half minutes per mile).

So this morning he said to me “We’re going to go five.” I said, “Bruce, I can’t go five. I’m a helluva lot older than you are, and I can’t do five.” He said, “When we get to three, we’ll shift gears and it’s only two more and you’ll do it.”

I said “Okay, hell, I’ll go for it.” So we get to three, we go into the fourth mile and I’m okay for three or four minutes, and then I really begin to give out. I’m tired, my heart’s pounding, I can’t go any more and so I say to him, “Bruce if I run anymore,” –and we’re still running-” if I run any more I’m liable to have a heart attack and die.” He said, “Then die.” It made me so mad that I went the full five miles. Afterward I went to the shower and then I wanted to talk to him about it. I said, you know, “Why did you say that?”

He said, “Because you might as well be dead. Seriously, if you always put limits on what you can do, physical or anything else, it’ll spread over into the rest of your life. It’ll spread into your work, into your morality, into your entire being. There are no limits. There are plateaus, but you must not stay there, you must go beyond them. If it kills you, it kills you. A man must constantly exceed his level.”

From The Art of Expressing the Human Body

By Bruce Lee, John Little

For comments and archives

 
    Cardiology eMedinewS

Inflammatory marker tied to depression Read More

FDA approves apixaban to prevent stroke in nonvalvular AF Read More

 
    Pediatric eMedinewS

Children eat fewer calories when offered healthier snacks Read More

Clinical consequences of cancer drug shortage Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came with non–responding cough.
Dr. Bad: It may be TB.
Dr. Good: Rule out acidity.
Lesson: Chronic cough along with dysphonia/hoarseness, globus pharyngeus, mild dysphagia, chronic cough and nonproductive throat clearing are often important otolaryngologic manifestations of occult or silent GERD (Laryngoscope 1991;101:1).

Make Sure

Situation: A 28–year-old male presents with increased frequency and occasional blood in urine. Examination of urine shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Lesson: Make Sure to rule out TB in patients with frequency, dysuria and hematuria. Sterile pyuria is the first clue to diagnosis.

 
  Quote of the Day (Dr GM Singh)

Always ask God to give what you deserve and not what you desire because your desires may be few but you deserve a lot.

 
    Legal Question of the Day (M C Gupta)

Q. What is a medical board and what is its significance? Who appoints it? Who can be the members? What are the eligibility criteria? Can a Company/PSU appoint a Medical Board for their employees? Will a Medical Board consisting of “the Bank’s Medical Officer, Specialist in the field and a Physician of repute” be valid in a court of law? Can non-medical persons (cardiac nurse, psychologist, physiotherapist etc.) or AYUSH physicians be members of the board?

Ans.

  • A medical board simply means a group of doctors appointed for a particular purpose, usually to give opinion or advice. It usually has 3 or more persons.
  • The significance of a medical board is as follows:
    • It reflects pooled wisdom and hence minimizes bias.
    • It reflects the opinion of persons from different medical specialties relevant to the case/patient concerned. A diabetic patient may have been operated. The medical board may consist of a physician, a surgeon and an anesthetist. Any one of these individuals working alone would obviously not be competent to give opinion about negligence etc.
    • A board’s opinion is much more likely to be viewed by the court as an independent opinion and hence more reliable than the defence rendered by the defendant or even the expert opinion procured by him privately from an expert.
  • The appointing authority is the head of the organization or somebody authorized on his behalf.
  • Eligibility criteria would be the common sense and discretion of the appointing authority, subject to anything that may be provided in the rules, if any.
  • A board consisting of “the organisation’s Medical Officer; Specialist in the field; and a Physician of repute” should be OK legally (unless it is violative of the rules applicable to the organization) if appointed by any Company/PSU/Bank.
  • As regards whether a non-MBBS person can be a member of a medical board, it should be remembered that a medical board can be constituted in the following circumstances:
    • By the hospital director entirely at his own discretion: He can appoint any appropriate person he deems fit, even if he not a practitioner of modern medicine, as per the facts and circumstances of the case. Inclusion of such persons, unless outright unreasonable, will not affect the legal validity of the opinion given by the board.
    • By the hospital director under some rules: Here he would have to appoint the board as per the rules.
    • By some other authority empowered to do so in respect of the hospital/patient concerned: Here the hospital director has no option but to follow the orders of the higher authority.
 
    Mind Teaser

Read this…………………

Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the

A. Left lower quadrant
B. Left upper quadrant
C. Right lower quadrant
D. Right upper quadrant

Yesterday’s Mind Teaser: Treatment with hemodialysis is ordered for a client and an external shunt is created. Which nursing action would be of highest priority with regard to the external shunt?

A. Heparinize it daily.
B. Avoid taking blood pressure measurements or blood samples from the affected arm.
C. Change the Silastic tube daily.
D. Instruct the client not to use the affected arm.

Answer for yesterday’s Mind Teaser: B. Avoid taking blood pressure measurements or blood samples from the affected arm.

Correct answers received from: Dr PK Sahu, Dr KV Sarma, Dr Thakor Hitendrsinh G, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Dr Kanta Jain, Dr Avtar Krishan, Dr BK Agarwal, Dr C Mohan,
Dr Sudesh agrawal, Chandra Pal Singh, Dr PK Sahu.

Answer for 30th December Mind Teaser: A. Hyponatremia

Correct answers received from: Dr Avtar Krishan, Dr BK Agarwal,
Dr C Mohan, Dr Sudesh Agrawal, Chandra Pal Singh, Dr PK Sahu.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Funny meanings...

Boss: Someone who is early when you are late and late when you are early.

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Autopsy findings in hanging

  • The mark on the neck in hanging oblique/incomplete placed high up with pattern abrasions.
  • The circumstances will usually indicate the fact of hanging, but sometimes the rope will break or become detached, and the deceased will be found lying with a ligature around his neck.
  • The victim may sit or slump on a chair, bed or floor with the rope attached to a point only slightly above neck level. Very confusing for public perception.
  • Postmortem hypostasis will occur in the legs and hands if the body has been in the vertical position for at least a few hours. When the body is cut down and laid horizontal for a considerable time, some or all of this may flow back into the usual pattern.
  • Petechial hemorrhages are the exception rather than the rule; most series have reported them in about 25% of cases.
  • There are no injuries on the hands and other part of the body of victim in the form resistance
  • Dribbling of saliva is considered to be a sign of antemortem hanging but it is not necessarily seen in all the cases of hanging since the secretion of saliva in hanging is dependent upon, the stimulation of salivary glands by ligature material during the course of hanging.
  • In a case of partial hanging when only partial body weight is working as constricting force on neck, the ligature mark is faint. Hence, in this case or any other case of hanging particularly partial hanging where the salivary glands are not pressurized by the constricting force of ligature, no dribbling of saliva is seen and the same in this case cannot be ruled out.
  • The neck of the deceased will not be stretched and elongated in this case since as it is a case of partial hanging and complete body weight is not working as stretching force.
  • The eyes may remain open in a case of antemortem hanging.
  • As per literature suicide notes are left only in about 25% cases.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Screen all patients with diabetes and high BP for snoring

Snoring at night or sleepiness during the day may be symptoms of obstructive sleep apnea, a potentially life-threatening problem affecting one out of three diabetics, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & Vice President Elect IMA.

As per the recommendation from the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention, all doctors should assess their diabetic patients for sleep apnea symptoms and to screen sleep apnea sufferers for metabolic disease.

Sleep apnea occurs when a person's airway becomes blocked during sleep. It's usually caused by the collapse of soft tissue in the back of the throat during sleep. Between snores, breathing stops for a period of 10 seconds or longer, and this pattern repeats itself multiples times over the course of a night. It not only deprives the person of a good night's sleep, it may also increase the risk for high blood pressure and heart disease.

Obstructive sleep apnea affects just 2 percent of women and 4 percent of men in the general population but is much more prevalent among diabetics.

In a study published in the journal Endocrine Practice, researchers examined data from 279 men and woman with type 2 diabetes. Overall, 36 percent had obstructive sleep apnea. Men with diabetes were particularly vulnerable. Below age 45 years, they had more than a one-third increased chance of developing sleep apnea, and this risk doubled above age 65 years. For women below 45 years, the chances of having sleep apnea were small: between 5 percent and 8 percent. But, females aged 65 years and older had a one-third increased chance of having the sleep disorder.

Successful treatment of sleep apnea may have a greater impact to improve blood sugar than any single thing you can do in a diabetic.

Previous research has also shown that people with mild to moderate sleep apnea were twice as likely to develop high blood pressure, compared to those without the sleep disorder. Those with severe sleep apnea were three times as likely to have high blood pressure, a risk factor for cardiovascular disease.

 
    Readers Responses
  1. Dear Sir, I must compliment that it is highly informative page that is sent daily. I am continuously following all the news articles and have learnt a great deal. I wish you all a very very Happy n Prosperous NEW YEAR 2013................... Regards, Alok Sharma, Business Development Manager – VS.
 
    Forthcoming Events

4th eMedinews Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013 (8 AM to 8 PM).

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Eminent Faculty:

Dr Praveen Chandra (Cardiology)
Dr NK Bhatia (Transfusion Medicine)
Dr Ambrish Mithal (Diabetes)
Dr Kaberi Banerjee (Infertility)
Dr Yougal Mishra, Dr Manju Gupta, Dr Somesh Juneja, Dr Deepak Khurana (Valve Surgery)
Dr Rajnish Malhotra (Cardiology)
Dr Vivek Bhatia (GI)
Dr Ashish Jain (Ortho)
Dr Kailash (GI)
Dr Navdeep Chabbra (Beriatric Surgery)
Dr IM Chugh

Register at: www.emedinews.in/

rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

Dr Pawan Gupta, Past President IMA Haryana, Organizing Secretary

4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

 
    eMedinewS Special

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3. eMedinewS audio lectures (This may take a few minutes to open)

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