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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 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

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

 
  Editorial …

3rd February 2012, Friday

Ethics principles

The previous edition of the American College of Physicians’ (ACP’s) Ethics Manual was published in 2005. The current publication updates this manual, with important new recommendations regarding the use of medical information and physician reimbursement practices.

  • Beneficence: the duty to promote good and act in the best interest of the patient and society; nonmaleficence: the duty to do no harm to patients; respect for patient autonomy; and justice: the equitable distribution of life–enhancing opportunities afforded by healthcare.
  • Face–to–face patient care is still encouraged above all, although other means of communication can be used to augment patient care. However, the act of writing prescriptions based solely on telephone conversations or the results of questionnaires with patients unknown to the physician is not an acceptable standard of care.
  • In the absence of a preexisting relationship, the physician is not morally bound to provide care for a patient unless it is an emergency or there are no other physicians available to see the patient.
  • In the rare case when the physician decides to end the relationship with a patient, the patient should be notified in writing and the physician should arrange for the appropriate transfer of care.
  • The physician is not obliged to provide secrecy in cases when a person close to the patient divulges information and asks that the patient not be informed of the disclosure.
  • Physicians should disclose errors made in the process of care to patients.
  • Patient competence to make clinical decisions can be difficult to assess, and should be evaluated for a specific decision at the time of that choice.
  • When a surrogate makes a medical decision for a patient, the physician should try to ensure that this decision fits with the patient’s beliefs and wishes, not what the surrogate may choose for herself or himself. Problematic cases can be referred to a hospital ethics committee.
  • If a physician refuses to provide reproductive services on moral grounds, he or she is still obliged to discuss all options or refer the patient appropriately.
  • In a catastrophic disaster, the moral guidelines of autonomy and beneficence may have to cede to utility, fairness, and stewardship.
  • Providing medical care to individuals with whom the physician already has a nonprofessional relationship, such as friends and coworkers, is discouraged.
  • Physicians who use social media should take care not to blur social and professional boundaries.
  • An order not to intubate a patient should be accompanied by a complete do–not–resuscitate order.
  • The ACP does not support the practice of physician–assisted suicide or euthanasia.
  • Physicians should disclose potential financial conflicts of interest with patients. They should not refer patients to treatment centers in which they have invested money, but do not provide direct care.
  • The practice of selling products out of the physician office is discouraged. Such products should meet urgent needs of patients, which would not apply to products such as supplements or cosmetic aids.
  • Physicians should not be involved in interrogations. The participation of physicians in the execution of prisoners, except to pronounce death, is considered unethical.
  • Physicians should not participate in strikes that reduce patient access to care.

(Ann Intern Med. 2012;156:73–104)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

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

Ethics principles

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    Photo Feature (From HCFI Photo Gallery)

3rd eMedinewS Revisiting 2011

Dr Manoj Sharma was awarded with eMedinewS Doctor of the Year 2011 Award in the recently concluded 3rd eMedinewS Revsiting 2011 CME.

 
Dr K K Aggarwal
 
    National News

Leprosy cases on the rise in urban India

New Delhi: India has achieved a huge milestone in eradicating polio but when it comes to leprosy, the chilling fact is that cases are on the rise. In fact, India accounts for 55 per cent of the world’s leprosy cases. India officially eliminated leprosy six years ago, but reports now suggest that the cases of leprosy are going up, especially in urban areas. Out of the 2.1 lakh cases in the world nearly 1.27 lakh are from India, that’s 55 percent of the total leprosy cases. But what’s worrying is that in cities like Bangalore, 121 cases out of 131 last year were infectious. The big reason, experts say is that most cases are going unreported at the early stages of the disease when it can be treated. That’s because India stopped leprosy surveys in 2002 following WHO guidelines.
(Source: http://ibnlive.in.com/news/leprosy–cases–on–rise–in–urban–areas–in–india/225706–17.html)

For comments and archives

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

 
    International News

Learning disability tied to cadmium burden

Greater exposure to the heavy metal cadmium may be associated with worse neurodevelopmental outcomes in children and teens, researchers found. (Source: Medpage Today)

For comments and archives

India deadliest place in world for girl child

NEW DELHI: It’s official – India is the most dangerous place in the world to be a baby girl. Newly released data shows that an Indian girl child aged 1–5 years is 75% more likely to die than an Indian boy, making this the worst gender differential in child mortality for any country in the world. Infant (0–1 years) and child (1–5 years) mortality are declining in India and across the world, though not as fast as was hoped in India. Simultaneously, most of the world is experiencing a faster fall in female infant and child mortality than in male, on account of well established biological factors which make girls better survivors of early infancy given equal access to resources. The world’s two most populous countries, however, buck this trend. Newly released United Nations Department of Economic and Social Affairs (UN–DESA) data for 150 countries over 40 years shows that India and China are the only two countries in the world where female infant mortality is higher than male infant mortality in the 2000s. In China, there are 76 male infant deaths for every 100 female infant deaths compared with 122 male infant deaths for every 100 female infant deaths in the developing world as a whole. The released data has found that India has a better infant mortality sex ratio than China, with 97 male infant deaths for every 100 female, but this is still not in tune with the global trend, or with its neighbours Sri Lanka (125) or Pakistan (120). (Source: TOI, Feb 1, 2012)

For comments and archives

Epidural plus fever during labor put baby at risk

A temperature spike during labor with epidural analgesia may indicate serious risks for the baby in an otherwise low–risk delivery, researchers found. (Source: Medpage Today)

For comments and archives

Obesity linked to lumbar disc degeneration

Magnetic resonance imaging (MRI) data show that obesity is associated with increased lumbar disc degeneration, according to a study published online January 30 in Arthritis & Rheumatism. (Source: Medscape Medical News)

For comments and archives

 
   Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Even the older should exercise in …: http://youtu.be/lXR9vHaIELs via @youtube

@DeepakChopra: Speak of love with others. Remind each other of your spiritual purpose.

 
    Spiritual Update

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

The Four Vedas Teach "All About Principles of Education"

  1. Rigveda or Gyankanda
  2. Yajurveda or Karma kanda
  3. Samveda or Upasana Kand
  4. Atharva Veda or reasoning

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What do you understand by multiple births?

Women who can get pregnant without fertility drugs or medical procedures usually have only one baby. Women who need fertility treatment are at higher risk to get pregnant with twins, and rarely with triplets or more. This is called multiple gestation.

For comments and archives

 
   An Inspirational Story

(Dr Anupam Sethi Malhotra)

Life may not give a second chance

Think about it…

It’s another morning………… Again I have to go to the office. Ohh!! this is me… I shouted, having a glance at my ‘photo’ in today’s news paper. But what the HELL is it doing in the death column??

Strange…

One second………Let me think, last night when I was going to bed I had a severe pain in my chest, but I don’t remember anything after that, I think I had a sound sleep. It’s morning now, ohh……… It’s already 10:00 AM, where is my coffee? I will be late for office and my boss will get a chance to irritate me.. Where is everyone…??? I screamed. "I think there is a crowd outside my room, let me check." I said to myself.

So many people…… Not all of them crying…… But why are some of them crying… WHAT IS THIS??? I’m lying there on the floor…

"I AM HERE" …… I shouted!!! No one is listening. "LOOK I AM NOT DEAD" … I screamed once again!! No one is interested in me. They all were looking at me on the bed. I went back to my bed room. "Am I dead??" I asked myself…

Where is my wife, my children, my Mom, my Dad, my friends? I found them in the next room, all of them were crying…still trying to console each other. My wife was crying… she was really looking sad. My little kid was not sure what happened, but he was crying just because his Mom was sad. How can I go without saying to my kid that I really love him, I really do care for him? How can I go without saying to my wife that she is really the most beautiful and most caring wife in this world? How can I go without saying to my parents that I’m what I am… just because of you??

How can I go without telling my friends that without them perhaps I would have done most of the wrong things in my life… thanks for being there always when I need them…and sorry for not being there when they really need me…

I can see a person standing in the corner and trying to hide his tears…Oh… he was once my best friend, but a small misunderstanding made us part, and we both have a strong enough ego to keep us disconnected.

I went there…… and offered him my hand, "Dear friend… I just want to say sorry for everything, we are still best friends, please forgive me." No response from other side, what the hell?? He is still preserving his ego, I am saying sorry... even then!!! I really don’t care for such people. But one second…… It seems he is not able to see me!!!! He did not see my extended hand.

My goodness…… AM I REALLY DEAD??? I just sat down near ME; I was also feeling like crying… "OH ALMIGHTY!!!! PLEASE JUST GIVE ME FEW MORE DAYS…" I just want to make my wife, my parents; my friends realize how much I love them……

My wife entered the room, she looks beautiful. "YOU ARE BEAUTIFUL" I shouted. She didn’t hear my words, in fact she never heard these words because I never said this to her. "GOD!!!!" I screamed… a little more time plzzzzz… I cried… One more chance please… to hug my child, to make my mom smile just once, to feel my dad proud of me at least for a moment, to say sorry to my friends for everything I have not given to them, and thanks for still being in my life…

Then I looked up and cried!! I shouted……… "GOD!!!! ONE MORE CHANCE PLEASE!!!!"

"You shouted in your sleep," said my wife as she gently woke me up. "Did you have a nightmare?" I was sleeping… Ohh that was just a dream…

My wife was there… she can hear me… This is the happiest moment of my life… I hugged her and whispered…

"YOU ARE THE MOST BEAUTIFUL AND CARING WIFE IN THIS UNIVERSE…… I REALLY LOVE YOU, DEAR"

I can’t understand the reason of the smile on her face with some tears in her eyes, still I’m happy…

"THANK YOU GOD FOR THIS SECOND CHANCE."

SO, now it’s not late… Forget the egos, the Past… and express your love to others……Be friendly… Keep smiling…… forever…It is another chance For you… Please let us do things more sincerely… and make our life worthwhile.

For comments and archives

 
   Cardiology eMedinewS

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

Eating fried food not always bad for the heart

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Both sexes enjoy statin benefits

Read More

Postoperative administration of amiodarone after lung cancer resection significantly reduced the risk of atrial fibrillation

Read More

 
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   Pediatric eMedinewS

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

5 Facts about kidney disease in Children

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The National Commission for Human Resources for Health Bill, 2011: Proposed draft: The seventh schedule: professional misconduct

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Highlights of American Academy of Pediatrics 2011 National Conference: October 15 - 18, 2011, Boston, Massachusetts

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    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Can patients with heart diseases drive?

After heart and/or lung transplantation one is not allowed to drive if he has persisting symptoms. If asymptomatic, (re–) licensing may be permitted provided that the exercise and arrhythmia requirements can be met.

For comments and archives

 
    Legal Question of the Day

(Dr MC Gupta)

Q. A fire occurred in AMRI hospital in Calcutta on 9/12/11 where 91 people lost their lives. The hospital is a joint venture with the Govt. of West Bengal. The Director Medical Education, WB, is the Chairman of the governing board which has, in addition, one more govt. official as member of the board. Some directors of the hospital have surrendered or have been arrested. Now, 45 days after the fire occurred, Managing Director– Dr Moni Chhetry (92 years old), along with another Director, the well– known gynaecologist Dr Pranab Dasgupta have been arrested. Police says they have incriminating evidences against them.

The medical community feels highly aggrieved by their arrest. Was the government sleeping for 45 days? Can you envisage any role of IMA in this onslaught on medical community? We all feel vulnerable as many doctors are board members of the hospitals and any mishap there may lead to arrest of doctors who may not be involved in day to day functioning and other non– medical aspects of the working of the hospital. What are the possible way out? Please suggest and guide.

Ans.

  1. Your question reflects genuine concern for doctors but is based on legally untenable premises.
  2. It is not clear what your grievance is if the MD and another director have been arrested 45 days after the incident. Would you have been less aggrieved if they had been arrested as soon as the incident occurred? It was probably because of their age and professional reputation that the authorities did not want to act in a hurry to satisfy public demand but delayed their arrest till such time as the police may lay hands on incriminating evidences against them.
  3. Age and reputation cannot be the reason for not arresting the accused in a crime if there is incriminating evidences against them. Right now an ex–PM of Israel is in jail for rape. Even Strauss–Kahn, 62, Head of the World Bank, who was expected to challenge and defeat French President Nicholas Sarkozy, was put in jail in USA last year for an alleged sexual offence.
  4. The only role for IMA that I can envisage is to provide the accused the services of high profile advocates for defence but this should not be necessary because the accused themselves are probably richer than the IMA.
  5. It is no defence to plead that doctors who may not be involved in day to day functioning & other non- medical aspects of the working of the hospital should not be arrested. The doctors have not been arrested for medical negligence committed against patients in the course of duties as physicians. They have been arrested for administrative negligence committed against public/patients in the course of duties as owners/managers of the hospital. Ansals were arrested in the Uphar cinema fire tragedy in Delhi for administrative negligence committed against public even though they were not involved in day to day functioning and cinematic or non–cinematic aspects of the working of the cinema. Doctors cannot be shown mercy for non–medical crimes simply because they are doctors. The law is same for all. If doctors do not want be arrested for negligence in the course of administrative duties while running the hospital, they would be well advised not to involve themselves in such activities and content themselves with patient care. One cannot eat the cake and have it too.
  6. The same doctors who now feel aggrieved for the AMRI hospital did not feel aggrieved for the patient Anuradha Saha who was admitted by Dr. Sukumar Mukherjee in AMRI hospital in 1998 and wrongly treated but the doctors of the hospital were acquitted by the WB Medical Council even though the mistake/negligence was such that even a fourth year medical student would never do it. The case went up to the SC (Malay Kumar Ganguly… V. Dr. Sukumar Mukherjee and others, SC, decided on 7 August 2009 by S.B. Sinha and Deepak Verma, JJ.) which found the hospital guilty and imposed a cost of Rs. 5 lakh on AMRI and Rs. One lakh on Dr. Mukherjee and referred the case to the National Consumer Commission for fixing the amount of compensation for medical negligence. The NC concluded that the amount payable to Dr. Kunal Saha, the husband of deceased Anuradha Saha, was Rs 1.73 crore. Dr. Mukherjee and AMRI were asked to pay Rs 40.4 lakh each.

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A 80–year–old male patient with acute heart attack was posted for reperfusion therapy.
Dr Bad: Chew 300 mg aspirin.
Dr Good: Chew 300 mg aspirin and 75 mg clopidogrel.
Lesson: Start clopidogrel 75 mg as opposed to prasugrel for patients older than 75 years of age who are treated with fibrinolytic therapy.

For comments and archives

Make Sure

Situation: Sir, he collapsed after sublingual nifedipine was given.
Reaction: Oh, my God! I forgot to check for LVOT obstruction.
Lesson: Make sure that the patient does not have LVOT obstruction (left ventricular outflow tract) before giving sublingual nifedipine.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

Love looks through a telescope; envy, through a microscope. Josh Billings

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Lipid profile

The patient should be instructed to be fasting for 10 to 12 hours and the dinner one evening before should be a non fatty, non greasy, non alcoholic dinner.

 
    Mind Teaser

Read this…………………

Which of the following historical figures was believed to have schizophrenia?

a) President Abraham Lincoln
b) Artist Vincent Van Gogh
c) Ballet dancer Vaslav Nijinsky
d) Author Virginia Woolf
e) All of the above
f) None of the above

Yesterday’s Mind Teaser: What word, when written in capital letters, is the same forwards, backwards and upside down?

Answer for yesterday’s Mind Teaser: NOON

Correct answers received from: Dr A Ramadevi, Dr Valluri Ramarao, Yogindra Vasavada, Raju Kuppusamy, Dr K Lakshminarayanan, Dr KV Sarma, Dr Thakor Hitendrasinh G, Sudipto Samaddar, Faustian, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Surendra Bahadur Mathur, Dr Vijay Kansal, Sudipto Samaddar.

Answer for 1st February Mind Teaser: Right between the eyes
Correct answers received from: Dr Vijay Kansal, Sudipto Samaddar, Dr Deepti Dongaonkar.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Communication technician

A communication technician drafted by the army was at a firing range. At the range, he was given some instruction, a rifle and 50 rounds. He fired several shots at the target. The report came from the target area that all attempts had completely missed the target. The technician looked at his weapon, and then at the target. He looked at the weapon again, and then at the target again. He then put his finger over the end of the rifle barrel and squeezed the trigger with his other hand. The end of his finger was blown off, whereupon he yelled toward the target area: "It’s leaving here just fine, the trouble must be at your end!"

 
    Medicolegal Update

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

  • A medicolegal autopsy means an examination of the body after death, which is conducted in cases where the circumstances of the death suggest that the death was caused by homicide, suicide or accident or is suspicious in nature where criminal investigation is instituted.
  • The Police/magistrate are empowered by the law in India to order a designated doctor to perform a forensic autopsy; hence no consent from the family/legal heir is required for forensic autopsy.
  • Autopsia cadaverum or an autopsy is the post–mortem examination of corpse by a registered doctor. It is a specialized surgical procedure that consists of a thorough examination of a corpse to determine the identity of corpse, the cause and manner of death and to evaluate any disease or injury that may be present. The autopsy must be performed by a specialized experienced medical doctor; however if possible, it should preferably be done only by a doctor qualified/experienced in forensic medicine.
  • The autopsy ideally includes both a thorough external examination of the body and a probing examination of the internal organs of the body. During the external examination, the doctor examines the body searching for wounds and injuries, noting deformities, absence of limbs, state of nutrition, and unusual features.
  • The doctor should examine the hands, fingers, fingernails, feet, teeth, scalp, tattoos, scars, hair, skeleton remains, hair fibers, jewelry, and clothing.
  • While conducting the internal examination, the autopsy surgeon should remove the deceased’s chest plate, lungs, heart, liver, intestines, etc. and, with the use of a scalpel, examine these organs for wounds, disease, and deformities.
  • There should be an arrangement to videotape the autopsy and must release a detailed report, including the cause of death to the police as early as possible. It is best and most transparent if the postmortem report is handed over along with dead body.
  • Autopsies, as well as the reports released by the medical examiner, vary in quality. Some medical examiners take little care in their work. A small percentage is outright incompetent.
  • Once an autopsy is complete the body must be well reconstituted by sewing or suturing it back together with cosmetic care of deceased body. Suturing from chin to pubic prominence should be masked by resembling skin color paste.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

All hypertensive patients should keep their sugar lower than 90mg%

Hypertension is a risk factor for type 2 diabetes. If not properly managed they are likely to end up with diabetes with subsequent high risk of kidney damage, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

The results of the Anglo–Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT–BPLA) study have shown that the major predictor of new–onset diabetes in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg%. The risk increases by 5.8 times for each 18mg% rise above 90 mg%. Other risk factors were higher weight, higher blood pressure and higher triglyceride levels. Also, those high BP patients taking atenolol (a beta–blocker drug) regimen with or without a diuretic were also at risk.

On the other hand, hypertensive patients on amlodipine (calcium channel blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use, and age older than 55 years had protection from developing diabetes.

 
    Readers Response
  1. Routine medical check up or total body check up is becoming a fashion statement in high society parties. We all know what is to be tested and when it is required. In a storm of commercialization we are forgetting routine detailed clinical examination and then advising required investigation .What is needed is good clinical checkup by your family physician, needless angiography and endoscopies are invasive investigations and should be used when required. vivekkumar, varanasi
 
    Forthcoming Events

Ajmer Health Fair: Ajmer’s Largest Ever Super Specialty Health Camp

Date: February 11 and 12, 2012
Venue: Patel Stadium, Ajmer
Organizer: Heart Care Foundation of India

IMSOCN2012

The Annual conference of Indian Menopause Society is to be held from 17 to 19th Feb 2012 in Hotel The Claridges, Surajkund, Faridabad. It is a multidisciplinary approach to the problems of midlife onwards in women. This conference has participation of the British Menopause Society and South Asian Federation of Menopause Societies and is an opportunity to hear international faculties.

For information contact Dr. Maninder Ahuja (Organizing Chairperson) 9810881048
Download forms at: http://indianwoman35plus.com/ or Indianmenopausesociety.org or http://fogsi.org/

Contact at ahuja.maninder@gmail.com
Call for free papers and posters on theme topics of conference.

National Summit on "Stress Management" and Workshop on "How to be happy and Healthy"

Date: Saturday 2PM–Sunday 4PM, 21–22 April 2012
Venue: Om Shanti Retreat Center, Bhora Kalan, on Pataudi Road, Manesar
Course Directors: Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal and BK sapna
Organisers: Heart Care Foundation of India, Prajapati Brahma Kumari Ishwariya Vidyalaya and eMedinewS
Fee: No fee, donations welcome in favour of Om Shanti Retreat Center
Facilities: Lodging and boarding provided ( One room per family or one room for two persons). Limited rooms for first three registrants.
Course: Meditation, Lectures, Practical workshops,
Atmosphere: Silence of Nature, Pyramid Meditation, Night Walk,
Registration: Rekha 9899974439 rekhapapola@gmail.com, BK Sapna 9350170370 bksapna@hotmail.com

 
    eMedinewS Special

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta