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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 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

3rd May 2012, Thursday

Disclosure, Apology, and Offer, or DA&O as against blame, finger–pointing, and secrecy

The Massachusetts Medical Society (MMS) wants to prove that clinicians and hospitals can keep medical malpractice out of the courtroom by owning up to their mistakes with apologies — and sometimes cash as well.

MMS and 5 other state healthcare organizations announced the start of a pilot program to promote a process called Disclosure, Apology, and Offer, or DA&O as against the usual of blame, finger–pointing, and secrecy.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

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

Do not give citalopram more than 40mg

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day organized at DPS Mathura Road

World Earth Day was celebrated by Heart Care Foundation of India jointly with Delhi Public School

 
Dr K K Aggarwal
 
    National News

Medical entrance candidates to be fingerprinted now

CHENNAI: Mobile phone jammers and fingerprint scanners will greet aspiring medicos who appear for the All India Pre–Medical/Pre–Dental Test (AIPMT) at exam centres across the country on May 13. Candidates taking the exam will also be videographed. The Central Board of Secondary Education (CBSE), which conducts the test, has pulled all stops to check malpractice. The board has planned to take two sets of fingerprints and photographs of examinees, which will be matched with the candidates at the time of counselling or joining the college. As many as 30,788 candidates will take the test this time. One mobile jammer is expected to be used for a room seating 24 students. Cellphone jammers are expected to block cellphone/bluetooth service, including CDMA, GSM, 3G, 4G, spy camera and Wi–Fi. Considering the power cuts, the board is planning to use jammers that work on battery. "Parents, guardians are advised to ensure their wards don’t indulge in unfair activities or malpractices which breach examination rules. If any candidate is found to have indulged in any such activity, he or she shall be debarred from taking this examination permanently in future and shall also be liable for criminal action," the CBSE has said. The banned items include cellphones, pagers, electronic gadgets, slide rules, calculators, log tables, geometry box and digital watches with calculators. Text material, printed or written, papers bits and envelopes are also prohibited. So is tea, coffee or snacks. (Source: TOI, May 1, 2012)

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

(Contributed by Dr Monica and Brahm Vasudev)

Brain bleed size affects therapy in Afib patients

The size of the brain bleed appears to determine which medications, if any, are given to atrial fibrillation patients after an intracerebral hemorrhage, a retrospective study showed. (Source: Medpage Today)

For comments and archives

Scars, seizures common in discoid lupus

Patients with the discoid form of cutaneous lupus erythematosus typically have worse skin damage than patients with systemic lupus, but they are also at risk for severe neurologic manifestations, analysis of data from a large cohort revealed. (Source: Medpage Today)

For comments and archives

Rare brain condition yields to prompt Tx

A condition known as anti–NMDA encephalitis may be frightening to see, but it usually responds to prompt, aggressive treatment, researchers said at the American Academy of Neurology’s (AAN) annual meeting. (Source: Medpage Today)

For comments and archives

FDA expands everolimus label

The FDA has approved a new indication for everolimus (Afinitor), granting it orphan drug status to treat non-cancerous kidney tumors not requiring immediate surgery in patients with tuberous sclerosis complex (TSC). The drug blocks uncontrolled activity of the mTOR kinase protein, which is critical to non–cancerous tumor development and growth in TSC patients. (Source: Medpage Today)

For comments and archives

People more likely to eat fruits within reach

Want to stay healthy – then place fruits in a clear bowl within arm’s reach, so that you could help yourself whenever you felt the urge to eat. The new study says that when fruits are within reach, people are more likely to eat them. Greater visibility of fruit increases their intake, but the same does not hold true for vegetables. Researchers Gregory J. Privitera and Heather E. Creary, both from St. Bonaventure University, Olean, U.S., tested a total of 96 college students by placing apple slices and carrot cuts in either clear or opaque bowls at a table close at arms’ length or at a table two metres away. Participants watched as the food was taken out of its packaging and were told that they were welcome to eat it, the journal Environment and Behaviour reports. After leaving the students alone with the food for 10 minutes, the researchers found that when apples and carrots were left close to the participants, those healthy foods were more likely to be eaten, according to St. Bonaventure statement. (Source: The Hindu, May 1, 2012)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: Which Vaccines Should Be Provided To Healthcare Workers?
http://blog.kkaggarwal.com/2012/04/27/which–vaccines–should–be–provided–to–healthcare-workers/

@DeepakChopra: A true friend tells you the truth and accepts who you are without judging you

 
    Spiritual Update

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

How to quit smoking?

Quitting at any time reduces one’s fear of getting or dying of heart disease and lung cancer. It also reduces chances of getting osteoporosis. Quitting smoking can also help the smoker look younger and improves appearance in both men and women.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

When do I need to see an Infertility counsellor?

Counseling is considered if you are feeling depressed, anxious, or so preoccupied with your infertility that you feel it is hard to enjoy life. You may also want to consider counseling if you are feeling "stuck" and need to sort out your options and alternatives. Counseling include:

  • Persistent feelings of sadness, guilt, or worthlessness
  • Social isolation
  • Loss of interest in usual activities and relationships
  • Depression
  • Agitation and anxiety
  • Increased mood swings
  • Constant preoccupation with infertility
  • Marital discord
  • Difficulty concentrating and remembering
  • Increased use of alcohol or drugs
  • A change in appetite, weight, or sleep patterns
  • Thoughts about suicide or death
  • Difficulty with scheduled intercourse

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr. Sujay Shad, Senior Consultant Cardiac Surgeon and Director of Heart–Lung Transplantation, Sir Ganga Ram Hospital, New Delhi)

Heart: Failure, Therapies & Transplantation

When humanity must take over from medicine (Part 1):

Shyam Dass, 42 years young, had a heart that was really not going to see him through even a year. He suffered from Dilated Cardiomyopathy, had a low blood pressure and his sodium was low – factors that all predict a very poor survival without a transplant. He had already undergone a cardiac resynchronization therapy that left him poorer by half a million rupees and unfortunately gave him no relief from breathing difficulty.

He was desperate when he came over to me seeking a transplant. We assessed him and found him suitable for the surgery and he waited for a suitable organ donation. That was taking time, and as he waited his breathing difficulty got worse.

So we gave him home oxygen, we stopped his monitoring hospital visits and got him monitored at home, his BP, daily weight and blood tests were done from home. Few weeks later he needed to come back into the hospital when he just couldn’t breathe.

To be Continued…………

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

A lesson for a lifetime

When I arrived at 6 a.m. in the large hospital kitchen, Rose was already checking name tags on the trays against the patient roster. Stainless steel shelves held rows of breakfast trays which we would soon be serving.

"Hi, I’m Janet." I tried to sound cheerful, although I already knew Rose’s reputation for being impossible to work with. "I’m scheduled to work with you this week."

Rose, a middle–aged woman with graying hair, stopped what she was doing and peered over her reading glasses. I could tell from her expression she wasn’t pleased to see a student worker. "What do you want me to do? Start the coffee?" Rose sullenly nodded and went back to checking name tags.

I filled the 40–cup pot with cold water and began making the coffee when Rose gruffly snapped, "That’s not the way to make coffee." She stepped in and took over. "I was just doing it the way our supervisor showed us to do it," I said in astonishment. "The patients like the coffee better the way I do it," she replied curtly.

Nothing I did pleased her. All morning her eagle eyes missed nothing and her sharp words stung. She literally trailed me around the kitchen. Later, after breakfast had been served and the dishes had been washed, I set up my share of trays for the next meal. Then I busied myself cleaning the sink. Certainly Rose couldn't criticize the way I did that.

When I turned around, there stood Rose, rearranging all of the trays I had just set up! Totally exhausted, I trudged the six blocks home from the University of Minnesota Hospital late that June afternoon. As a third year university student working my way through school, I had never before encountered anyone like Rose.

Fighting back tears, I wrestled with my dilemma alone in my room. "Lord, what do you want me to do? I can't take much more of Rose." I turned the possibilities over in my mind. Should I see if my supervisor would switch me to work with someone else? Scheduling was fairly flexible. On the other hand, I didn’t want to be a quitter. I knew my older co–workers were watching to see if my actions matched my words.

The answer to my prayer caught me completely by surprise –– I needed to love Rose. Love her? No way! Tolerate, yes, but loving her was impossible. "Lord, I can’t love Rose. You'll have to do it through me."

Working with Rose the next morning, I ignored the barbs thrown in my direction and did things Rose's way as much as possible to avoid friction. As I worked, I silently began to surround Rose with a warm blanket of prayers. "Lord, help me love Rose. Lord, bless Rose."

Over the next few days an amazing thing began to happen. As I prayed for this irritating woman, my focus shifted from what she was doing to me, and I started seeing Rose as the hurting person she was. The icy tension began to melt away.

Throughout the rest of the summer, we had numerous opportunities to work together. Each time she seemed genuinely happy to see me. As I worked with this lonely woman, I listened to her––something no one else had done. I learned that she was burdened by elderly parents who needed her care, her own health problems, and an alcoholic husband she was thinking of leaving.

The days slipped by quickly as I finished the last several weeks of my summer job. Leaves were starting to turn yellow and red, and there was a cool, crispness in the air. I soon would be returning as a full–time university student. One day, while I was working alone in one of the hospital kitchens, Rose entered the room. Instead of her blue uniform, she was wearing street clothes.

I looked at her in surprise. "Aren’t you working today?" "I got me another job and won’t be working here no more," she said as she walked over and gave me a quick hug. "I just came to say good–bye." Then she turned abruptly and walked out the door.

Although I never saw Rose again, I still remember her vividly. That summer I learned a lesson I’ve never forgotten. The world is full of people like Rose – irritating, demanding, unlovable – yet hurting inside. I've found that love is the best way to turn an enemy into a friend.

For comments and archives

 
    Cardiology eMedinewS

80% of Medical Colleges In South India: Azad Read More

Eplerenone Reduces New–Onset Atrial Fibrillation/Flutter In Mild Heart Failure Read More

FDA panel gives nod to novel LVAD Read More

 
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    Pediatric eMedinewS

Antenatal Steroids No Benefit In Late Preterm Neonates Read More

Is The Obesity Tide Turning Among Preschoolers? Read More

Challenges Facing World’s 1.2 Billion Adolescents Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came with subclinical hypothyroid state.
Dr. Bad: No treatment is required.
Dr. Good: You need treatment.
Lesson: Treatment of subclinical hypothyroidism with thyroid extract is associated with fewer coronary heart disease events.

For comments and archives

Make Sure

Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on a sulfa drug?
Lesson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. I practice in MP. I have a DGO from the College of Physicians and Surgeons, Mumbai, which is recognised by the medical council in Maharashtra but not in MP. How can I continue to practice ordinary/basic level Gyn–Obs in MP without violating "Regulation 7.20 of the MCI Regulations, 2002"?

Ans.

  • "Regulation 7.20 of the MCI Regulations, 2002" states—", "A Physician shall not claim to be specialist unless he has a special qualification in that branch".
  • When you put your name etc. on your prescription form etc., you can put as follows: "Dr. XYZ, MBBS, DGO(CPS)"
  • The above manner of portrayal achieves the following:
    • It places the correct position before the one who reads it without infringing any law.
    • It tells the general public that you are a general physician and surgeon by virtue of your MBBS and that you have a special interest in gyn–obs.
  • With the above portrayal, you can safely continue to practice as a general physician and surgeon with special focus on gyn–obs patients.
  • If you are not an MD/MS/DGO from a regular university, that, legally speaking, does not mean that you can treat female patients having gyn-obs problems.
  • In Surinder Kumar (Laddi) and anr. V. Dr. Santosh Menon and Ors. 2000;(III) CPJ 517, the Punjab State Consumer Commission held that there is no bar against an MBBS performing a Caesarian section merely on the ground that the doctor does not have a qualification in Gynae–Obs.
  • According to AP medical Council:
    "What can an MBBS Doctor do:–
    • He can do all the Minor Surgical Procedures for which he is trained in MBBS Course and Houseman Ship.
    • He can do Deliveries and its related procedures as trained.
    • He can do National Programmes like Tubectomies & Vasectomies.
    • In emergencies if a qualified surgeon is not available in the near vicinity as a life saving measure he can do first aid and a Surgical Procedure based on his experience.
    • He should not do Elective Major Surgical procedures and the care should be taken to refer to a nearby Hospital where a Surgeon/Gynecologist available.” http://imaapstate.blogspot.com/2010/12/can–mbbs–doctor–do–surgery.html
  • Please note that nothing entitles a doctor to claim indemnity against a charge of medical negligence simply because he or she has a specialist degree in the concerned subject.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

Life is an Adventure – Dare it.
Life is a Beauty – Praise it.
Life is a Challenge – Meet it.
Life is a Duty – Perform it.
Life is a Love – Enjoy it.
Life is a Tragedy – Face it.
Life is a Struggle – Fight it.
Life is a Promise – Fulfill it.
Life is a Game – Play it.
Life is a Gift – Accept it.
Life is a Journey – Complete it.
Life is a Mystery – Unfold it.
Life is a Goal – Achieve it.
Life is an Opportunity – Take it.
Life is a Puzzle – Solve it.
Life is a Song – Sing it.
Life is a Sorrow – Overcome it.
Life is a Spirit – Realize it.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Allergies are hypersensitivities, overreactions of the immune system to substances that do not cause reactions in most people.

Allergen specific IgE testing: Immunoassay and LINE BLOT TESTS are blood tests that are used to screen for type I allergen–specific IgE antibodies.

 
    Mind Teaser

Read this…………………

The Canary Islands in the Pacific are named after what animal?

Yesterday’s Mind Teaser: What is a healthy blood–pressure level?

A. 110/70.
B. 125/85.
C. 135/90.
D. 140/95.
E. 150/95.

Answer for Yesterday’s Mind Teaser: A. 110/70.

Correct answers received from: Yogindra Vasavada, Dr PC Das, Prabha Sanghi, Dr Satyanarayana Akupatni, Dr vinod kr. Goel, Dr Ragavan Sivaramakrishnan Moudgalya, Ravuri Sreenivas, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr SK Verma, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Anil Bairaria, Papa Dasari.

Answer for 1st May Mind Teaser: B. Giving yourself a treat, like comfort food or a cocktail.

Correct answers received from:
Dr Usha, Dr Pritam, Dr Shivam, Dr Fiza, Dr TP Ghosh
.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.

 
    Medicolegal Update

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

Sudden death due to cardiac origin–autopsy

Right coronary artery supplies blood to electrical area of heart

The most common cause of sudden cardiac death in adults over the age of 40 has been coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in AIIMS mortuary.

  • The most common finding at postmortem examination is chronic high–grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
  • A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
  • In 75 cases out of hundreds, the clots were seen in right coronary artery supplying the electrical area of heart.
  • Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall, which induces an ventricular arrhythmia/fibrillation and no changes in the myocardium is seen during postmortem examination.
  • The absence of histological signs of acute necrosis and a healed infarct are a common finding.
  • Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
  • Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Underactive thyroid: a marker of heart disease

Men and women with underactive or overactive thyroid without symptoms are at an increased risk of heart disease. Silent or "subclinical" thyroid dysfunction represent a potentially modifiable risk factor for coronary heart disease.

Quoting a study from the University of Lausanne in Switzerland, by Dr. Nicholas Rodondi and published in Annals of Internal Medicine, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India said that the likelihood of coronary heart disease, heart–related death and death from any cause is higher by 20 percent, 18 percent and 12 percent, respectively, in subjects with an underactive thyroid without symptoms –– also referred to as subclinical hypothyroidism.

Their findings are based on pooled data from 12 studies identified through a search of MEDLINE (1950 to 2008). Ten of the studies involved population–based groups that included 14,449 subjects.

Heart Care Foundation of India’s own data from visitors of Perfect Health Mela estimates 3% hypothyroidism (thyroid hypo function) in Delhi.

People with an overactive thyroid but without symptoms (silent hyperthyroidism) also had 21 percent, 19 percent, and 12 percent greater odds, respectively, of heart disease, heart–related death, and death from any cause.

The screening test for thyroid is TSH blood test. The normal values are 0.3 to 3 mIU/L. A value between 3 and 10 is considered subclinical hypo active thyroid and a value of less than 0.3 without symptoms is considered subclinical over active thyroid.

 
    Readers Responses
  1. Dear Sir, I read the emedinews daily. It is full of information. Regards: Dr Sheena.
 
    Forthcoming Events
Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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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