emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
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; Chairman Ethical Committee 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


2nd August, Monday, 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Preventing Sudden Cardiac Death

The forthcoming BSNL Dil Ka Darbar being organized at Maulana Azad Medical College on Sunday, the 26th September 2010 on World Heart Day will focus on prevailing sudden cardiac death. Over 24 lacs people die suddenly every year directly due to heart attack; 18 lacs of them die before reaching the hospital. Of these, 12 lacs can be saved by anticipating sudden cardiac death, learning a technique revival after death and timely removing the heart attack clot by drugs or angioplasty. Most heart attacks deaths occur early in the morning, in winter and amongst smokers, diabetics and in heart patients with low pumping activity.

The classical examples of sudden death have been personalities like Sunil Dutt, Krishankant, Sanjeev Kumar, Vinod Mehra, Shafi Inamdar, Amjad Khan etc.  Following people are at risk of sudden cardiac death.

• People who have survived a past cardiac arrest.
• Heart patient with pumping action of the heart less than 30%
• ECG showing wide QRS conduction of more than 120 msec.
• Inability to climb two flight of stairs without symptoms.
• Inability to walk 2 kms on level ground without symptoms.
• Inability to do exercise in the bed with the partner without symptoms.
• Patient with uncontrolled blood pressure, diabetes, smoking and people who drink more than 5 pegs of alcohol in one hour or 6 pegs of alcohol in one day.
• People who have uncontrolled smoring.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature (From HCFI file)

 Sudden Cardiac Death Campaign

Heart Care Foundation of India (HCFI), conducted a Press conference to spread awareness on CPR and preventive measures as a part of "Sudden Cardiac Death Campaign" on September 3, 2008.

In the photo: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI demonstrating the technique of Cardiopulmonary resuscitation (CPR) to Padmashri Ms. Geeta Chandran, famous Bhartanatyam Dancer. Also in the photo: Padma Bhushan Dr Naresh Tarehan, Renowned cardiologist, Medanta Medicity.

Dr k k Aggarwal

 

News and views

Fracture risk in postmenopausal Women Associated With Use Of Thiazolidinedione Diabetes Drugs.

A study published online in the Journal of Clinical Endocrinology & Metabolism has found that rosiglitazone and pioglitazone may increase the risk of fractures in postmenopausal women with type 2 diabetes. Rosiglitazone and pioglitazone are two commonly prescribed diabetes drugs. In addition, there was a fracture risk seen among men who had been prescribed either of these drugs along with a loop diuretic, but not when the drugs were administered individually.

Reduced Kidney Function, Protein In Urine May Place Person At Risk For Kidney Injury

Reduced kidney function and protein in the urine increase chances of kidney injury, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Preexisting problems with glomerular filtration could foretell up to 7–fold increased risk of acute kidney injury.

Individualized Care Necessary For Diabetic Patients With Kidney Failure.

Aggressive control of blood sugar does not improve survival in diabetic patients with kidney failure. The study results suggest that physicians should individualize blood sugar targets for these patients, and not rely on recommendations based on studies in the general population. In the COURAGe trial (The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), addition of percutaneous coronary intervention to optimal medical therapy in patients with Stable Angina did not improve 5–year survival or reduce MI or other major adverse cardiovascular events.

 

 

Legal Column

Medical profession and Clinical establishment bill 2010

On 3rd of May an important bill of Clinical Establishment bill 2010 was passed by vote of voice, without any discussion on the subject. It is a matter of serious concern for the citizens of the nation, who has always posed their faith in private health sector. The present data of Government agencies show that the 80% of the health services are looked after by the private health sector. This bill is anti people and will promote inspector raj when implemented by officials.

When the doctors and hospitals are covered under CPA and free to charge the fees, (can be challenged for the services, facilities provided to the patients under CPA), then why there should be a regulation of the clinical establishments.

As per Planning Commission, any professional whose degree is registered does not need any regulation by any regulatory body.
Some of the objectionable clauses in this bill are as follows:

1. Clause: Authority for registration: 10. (1) The State Government shall, by notification, set-up an authority to be called the district registering authority for each district for registration of                                     clinical establishments, with the following members, namely :-                                         (a) District Collector-Chairperson; b) District Health Officer  - Convenor.
Objection: Till now in all the central act for health services, the competent authority is from the medical profession (Government health services)
2. Clause 12. (1) For registration and continuation, every clinical establishment shall fulfil the following conditions, namely:  (i) the minimum standards of facilities and services as may be prescribed;  (ii) the minimum requirement of personnel as may be prescribed (Objection); (iii) provisions for maintenance of records and reporting as may be prescribed ( Objection: it is already covered under MCI);  (iv) such other conditions as may be prescribed. (Objection: gives wide scope to bureaucrats to use their power) 

3. Clause 13. (1) Clinical establishment of different systems shall be classified into such categories, as may be prescribed by the Central Government, from time to time.
(2) Different standards may be prescribed for classification of different categories referred to in sub-section (1): (Objection: This will promote corruption at the hands of the inspectors)

4. Clause 26--As soon as Cl Es 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.
(Objection: The bad elements of the society will get an opportunity to blackmail and raise wrong allegation to the competent authority, so to hinder the process of permanent registration.)
5. Clause: 33--The authority or an officer authorised by it shall have the right to cause an inspectionof, or inquiry in respect of any CE, its building, lab .mequipment. work conducted or done by CE.(Objection: likely to be misused)
6. Clause47--No suit, prosecution or other legal proceedings shall lie against any authority or member of National/State/District council or any officer authorised. (Objection: this gives total immunity to the Officials and will result in excesses)

Dr. Yash Sharma, Ex-member Punjab medical council, IPP IMA Punjab , M 098140-66944

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Cross–examination debate for standards of medical care

A system of the cross examination trial/debate format in medical cases in the western countries has been developed by Medical Forums and Forensic Associations to self–regulate the standard of medical care delivery system and defend the cases of medical negligence with decorum as a lesson for further improvement in quality medical care and reducing medical error. Cases of medical negligence against a doctor greatly disturb the medical professional. There are no guidelines available in our country to defend the same by Medical Associations/Councils.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

(Dr. Neelam Mohan – Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity)


Toxic Toys

  • Exposure to phthalates can damage the reproductive system –– premature breast development in females and poor semen quality in men. These toxins have also been linked with pre–term birth in humans, they can also trigger asthma and allergies.

  • Taiwanese and Chinese toys are found to be the most contaminated. Many toys in which the claim on labels are fraudulent – "no one checks." In totality, 60 per cent of soft toys and 20 percent of hard toys exceed the safe limits.

  • Toys and childcare articles meant to be placed in mouth by children with phthalates concentrations over 0.1 per cent (1000 ppm or 1 gm per kg) need to be banned.

Question of the day

Are steroids contraindicated in Kawasaki's disease? (Dr Sujata Sawhney)

Until about a decade ago steroids were contraindicated in Kawasaki disease. This followed a publication by Kato et al in 1979, which suggested that patients who receive steroids had a very high incidence of coronary artery aneurysms. This study was however followed by several subsequent publications by Nonaka, Shinohara and Hashino, all of which showed that glucocorticoids are helpful in reducing duration of fever and also in the rapid improvement in markers of inflammation. No study has thus far been able to decisively show the influence of steroids on coronary artery outcomes. Currently steroids are used in patients with persistent disease regardless of two doses of IVIG. The role in the initial treatment of Kawasaki disease is not well defined to date.

References

  1. Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics 1979;63:175–9.

  2. Nonaka Z Maekawa K, Okabe T, et al. Randomized controlled study of intravenous prednisolone and gamma globulin treatment in 100 cases with Kawasaki disease. In Fifth International Kawasaki Disease Symposium. Philadelphia, Elsevier Science, 1994.

  3. Shinohara M, Sone K, Tomomasa T, Morikawa A. Corticosteroids in the treatment of the Kawasaki disease. J Pediatr 1999;135(4):465-9.
 

Advantages of Breastfeeding

Advantages of Breastfeeding (Dr. Satwika Sinha, MMC, Khammam)

Breastfeeding protects from allergies
a. Allergic families
b. Eczema

 

Public Forum (Press Release for use by the newspapers)

Preventing Sudden Cardiac Death

Dr. K.K. Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee said that most heart attacks deaths occur early in the morning, in winter and amongst smokers, diabetics and in heart patients with low pumping activity. Patients with low pumping action of the heart may require an internal electric shock device or drugs to prevent sudden death. 

 

Commonwealth Medical Association 

(Dr. S. Arulrhaj, MD., FRCP (Glasg), President)

Commonwealth Foundation

Lots of innovative concepts and health care options link the developed and developing countries. IMA is a major beneficiary in areas of Health Care, Medical Education etc.

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An Inspirational Story

Confidence is your greatest ally, fear your only enemy

What a trap it is to forget you are the creator of your reality.

It’s a terrible state to be lost in your experience, wondering why you are so far from where you want to be. Not knowing why you can't get a break or how much work you have to do before you see some sign of success.

I can’t think of just about anything worse than trying everything you know to do, and still coming up short.

That feeling of helplessness is a killer. The anxiety of racking your brain with "Where did I go wrong?" "Why isn’t it working?"

I believe these mental states are a place called hell. It’s not a place you want to stay. You stay in that place too long and you'll turn nightmares into reality.

"You shall know the truth and the truth shall make you free." John 8:32

Knowing you are the creator of your experience, and how you do it, makes you free! That feeling of freedom is absolute bliss, it’s heaven. Nothing to fear nothing to worry about.

It’s the launching pad for an exceptional life. Grab this truth and hold on to it. Receive it, accept it, and love it. Feel good about it. In fact, make it your daily routine to meditate on it, and feel good about it.

As you keep focusing on this truth, your worries will begin to disappear. Your anxiety will begin to transform into peace. Your peace will transform into confidence. Your confidence will transform into boldness, and your boldness will transform into absolute fearlessness. Your personality will be transformed, and you will feel like a new person. Understand, how you feel is incredibly important.

As you think and speak about your future in this state of confidence and peacefulness, circumstances and troubles that you have been trying to change for ages will fade away.

That success that you desperately wanted, but seemed beyond your grasp, will flow to you effortlessly. This is because you are the creator of your experience....But to create the life you desire you must know it and feel it!

 

IJCP Special

Dr Good Dr Bad

Situation: A patient vomits 15 minutes after taking 4 tablets of Chloroquine.
Dr.Bad: Take Chloroquine again.
Dr.Good: There is no need to repeat Chloroquine.
Lesson: Chloroquine is absorbed within 15 minutes.

Make Sure

Situation: A patient with second episode of blood in urine was found to have bladder cancer. Reaction: Oh my God! Why was cancer not suspected at the time of the first episode.
Lasson: Make sure that one treats all patients with painless blood in the urine as cancer bladder unless proved otherwise.

Quote of the Day

"Laughter is instant Vacation." Milton Berle

Are you fit to fly?

Heart Patient

  1. Patients with heart attack complicated by severely depressed cardiac function or an untoward event during treatment should not fly until two weeks after they are deemed medically stable.

  2. Unstable angina is a contraindication to air travel.

  3. Stable angina is generally well tolerated during flight.
 

International Medical Science Academy Update (IMSA)

A randomized UK trial showed that one–time screening by sigmoidoscopy in individuals aged 55 to 64 years decreased the incidence of colorectal cancer and overall mortality at 11 year followup. (BMJ 2009; 338:b1846)

 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Levobetaxolol HCl Ophthalmic Suspension 0.5%

For lowering of intraocular pressure in patients with chronic open–angle glaucoma or ocular hypertension.

16–Jan–10

 

Medi Finance

Q. Are donations deductible expenses for doctor?

Ans. Yes, if donations are given within the limits prescribed u/s. 80G.

Filing of income tax return deadline extended till Aug 4
The Income Tax Department extended the last date of filing income tax returns to August 4 due to inclement weather and some technical snags.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

First Trimester Screen

Pregnancy–associated plasma protein–A (PAPP–A): To assess the risk of the fetus carrying a chromosomal abnormality such as Down syndrome (trisomy 21) or Edward’s syndrome (trisomy 18). The first trimester screen is not used as commonly as the triple/quad screen that is offered in the second trimester.
 

Lateral thinking

from Dr Vijay Kansal

Read this……………

"O_ER_T_O_"

Send in your answer to emedinews@gmail.com

The answer for yesterday’s puzzle "two degrees below zero"

Correct answers received from: Dr Ashok Kumar MD Medicine

 

Humor Section

Jokes

Did you hear about the nurse who swallowed a razor blade? She gave herself a tonsillectomy, an appendectomy, and circumcised three of the doctors on her shift.

Fumy One Liners

What is the difference between men and pigs? Pigs don't turn into men when they drink.

 

Readers Responses

  1. Dear Sir, I think the 'practice of surgery by Ayurvedic, Homeopathic doctors, should imply the surgery as taught and practiced by their own textbooks/system and to be judged as per the prevailing standards of their own system which the patient has chosen to avail of. Logically, they should not be judged by other system viz. Allopathy! Yours, Dr. Gurdev Singh,

     
  2. This should generate a serious debate after this interesting judgement of single bench Madras High court. If the syllabi of these systems incorporate surgical management then these systems must be having all the necessary equipments and drugs etc according to their systems, in that case allopathy has no clash of interests and we have no locus stand. I am sure judge knows what he is delivering in the judgement but then the other judge would have also known...Hope it is not a comedy of errors. To err is human but then spare the humans from gross errors costing lives. Wake up allopathy to save humanity. Dr Prof. H.L. Kapoor, D-13A, SFS, Mayur Vihar, Phase - III, New Delhi - 110 096. Mob: 0091 (0) 94184 51510, Cancer Consultation and Counselling Services president Indian Medical Association (Mandi branch HP)
 

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

26th September: BSNL Dil ka Darbar A day–long 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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