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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

  Editorial …

3rd June 2011, Friday                                eMedinewS Presents Audio News of the Day

Anti Tobacco Day Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Bihar doctors’ strike

On Monday night, I was invited by Mahuaa TV to join in a debate on the strike of Bihar doctors. 4000 government doctors of Bihar had gone on strike alleging that the government of Bihar had refused to interfere on their demand of providing protection to practicing government doctors.

The strike was in response to the death of a government doctor who was beaten to death, while on–duty, by some jail inmates over his refusal to sign a false certificate. The Government Doctors’ Association wanted the Bihar government to act and pass the Medical Protection Bill at the earliest.

From the TV reports, after listening to the statement of the Health Minister of Bihar, it appeared that there was a confrontation between the politicians and the medical doctors. The government refused to listen and talk to the doctors and the doctors insisted that they would continue to strike till the government listens to their demand. If both parties remain adamant, the ultimate loser would be the patient.

In a recent Delhi Medical Council order dated 07.12.2010, the council felt, "Under no circumstances doctor should resort to strike as the same puts the patients in severe jeopardy".

Looking at the genesis of a strike, no strikes are ever done, they are always allowed to be done. If the respective government body listens to the memorandum submitted by the so–called striking doctors in time and solves their demands in time, the strike would never take place. In this case, if the government had reacted in time and ordered an inquiry into the doctor’s death, the reactions of the doctors would not have ended up into this strike. Implementing Doctors’ Protection Bill is in the interest of the society as most of the states have already implemented it.

Follow up: The members of Bihar Health Services Association (BSHSA) resumed back to work at government hospitals on 1st June. Chief Minister Nitish Kumar ordered the transfer of the Inspector General (Jail) and Gopalganj District Magistrate on the basis of the report of the principal secretary (Home), who inquired into the incident. Kumar had also announced an ex gratia of Rs 10 lakh to the family of the victim. Health services were partially affected across the state with about 2,600 government doctors. During the protest, BSHSA had demanded a compensation of Rs one crore to the family of the deceased, besides ensuring adequate security to the doctors on duty and implementation of the Medical Professionals Protection Act.

Dr KK Aggarwal
Editor in Chief
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  Changing Practice – Evidence which has changed practice in last one year

Blood pressure control in children with chronic kidney disease

In children with chronic kidney disease have strict blood pressure control. Although, the K/DOQI guidelines recommend targeting systolic and diastolic BP below the 90th percentile for age, height, and gender, lower target levels (ie, 24–hour mean BP below the 50th percentile) significantly slow CKD progression.

  eMedinewS Audio PostCard

CKD Update

Dr KK Aggarwal Speaks on
‘Additional lab tests:eGFR <15–30’

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

Anti Tobacco Day 2011

Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India, explaining the ill effects of Tobacco to Cine Actor Rahul Dev.

Dr K K Aggarwal
    National News

A litchi a day to keep the doctor away

Dehra Dun: A litchi a day could soon keep the doctor away. A new research paper has claimed that litchi is not just a rich source of vitamins and minerals but a powerful antioxidant as well and could be a panacea for various ailments. The paper, presented by Dr. S.K. Purbey and Dr. Vishal Nath, scientists from the National Research Centre for Litchi, Muzaffarpur, in Bihar, says the fruit contains Vitamin K, Vitamin B6 and more Vitamin C than citrus fruits. "Minerals like magnesium, iron, calcium, copper, phosphorus and potassium are abundant in Litchi. It is low in sodium, saturated fat and cholesterol. They are also purported to have some anti–inflammatory properties, aid in gastrointestinal health and have as much fibre as an apple," it said. Scientists have also found that other parts of the fruit like the seed, root, bark and flowers could also be used for various medicinal purposes. (Source: The Hindu, Jun 01, 2011)

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 Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Physical activity prevents prostate cancer recurrence

After skin cancer, prostate cancer is the most common form of cancer in men, and it’s also the most lethal. In 2010, the disease killed approximately 32,050 men, according to the National Cancer Institute. However, recent research conducted by scientists at the University of California – San Francisco and the Harvard School of Public Health has concluded that high–intensity walking can reduce the risk of prostate cancer progression. Researchers analyzed medical records and physical activity logs of 1,455 men who had previously been diagnosed with prostate cancer. During the course of the study, the researchers differentiated between men whose prostate cancer progressed and those whose cancer did not worsen. Results showed that men who exercised or walked at a brisk pace for three hours or more per week were significantly less likely to experience a recurrence – 57 percent less likely, to be exact. Researchers noted that walking should be at a fast pace of 3 miles per hour or higher.

(Dr Monica and Brahm Vasudev)

Fracture risk tools useful for diabetics

Existing tools to assess the risk of fracture in older adults appear to work for individuals with type 2 diabetes, researchers found. Both the femoral neck bone mineral density T–score and the World Health Organization Fracture Risk Algorithm (FRAX) score were significantly associated with fracture risk in patients with diabetes, according to Ann Schwartz, PhD, of the University of California at San Francisco, and colleagues. However, they reported in the June 1 issue of JAMA that for any given T–score or FRAX score, the risk of fracture was higher in patients with diabetes than in those without diabetes. (Source: Medpage Today)

Stroke belt Sees more cognitive decline

In addition to a greater risk of stroke, residents in the Stroke Belt in the southeastern U.S. have greater odds of incident cognitive impairment, an analysis of the REGARDS study showed. Over an average of four years, individuals who lived in one of the eight Stroke Belt states were more likely to develop cognitive impairment than those who lived in other parts of the country (OR 1.18, 95% CI 1.07 to 1.30), according to Virginia Wadley, PhD, of the University of Alabama at Birmingham, and colleagues. "This study is the first known documentation of higher incident cognitive impairment in the Stroke Belt region of the United States than in the rest of the nation," they wrote online in Annals of Neurology. The findings suggest that there are shared risk factors between stroke and cognitive decline, they noted, adding that hypertension, diabetes, kidney disease, and metabolic syndrome are risk factors for both stroke and cognitive impairment. (Source: Medpage Today)

(Dr. Neeraj jain and Dr Vibha Jain, Pediatrician)

Diabetes in children: Some facts

  • Globally, there are close to 500,000 children under the age of 15 with type 1 diabetes.
    • Every day 200 children develop type 1 diabetes.
    • Every year, 70,000 children under the age of 15 develop type 1 diabetes.
    • Type 1 diabetes is increasing in children at a rate of 3% each year
    • Type 1 diabetes is increasing fastest in pre–school children, at rate of 5% per year.
    • Finland, Sweden and Norway have the highest incidence rates for type 1 diabetes in children.
    • Type 2 diabetes has been reported in children as young as eight and reports reveal that it now exists in children thought previously not to be at risk.
  • In Native and Aboriginal communities in the United States, Canada and Australia at least one in 100 youth have diabetes. In some communities, it is one in every 25.
    • Over half of children with diabetes develop complications within 15 years.
    • Global studies have shown that type 2 diabetes can be prevented by enabling individuals to lose 7–10% of their body weight, and by increasing their physical activity to a modest level.
    • Type 2 diabetes in children is becoming a global public health issue with potentially serious outcomes.
    • Type 2 diabetes affects children in both developed and developing countries.
    • Diabetes is a deadly disease. Each year, almost 4 million people die from diabetes– related causes. Children, particularly in countries where there is limited access to diabetes care and supplies, die young.
    • The increasing popularity of Caesarean births and having children later in life are contributing to a dramatic rise in cases of diabetes in young children," the Daily Mail reported. The newspaper said that "the number of children under five with type 1 diabetes is likely to double by 2020". It said that modern lifestyles, children being born to older mothers, caesarean sections and reduced exposure to germs are all contributing factors.
    • Govt to screen children for "silent killer" diabetes New Delhi, Nov 14 (PTI): "Noting that diabetes is emerging as a ‘silent killer’, Health Minister Ghulam Nabi Azad today said a programme is on the anvil to screen all children for the disease in the country

Some other alarming diabetes statistics include the fact that there is one person in the world dying of diabetes every 10 seconds. Also, there will be two new diabetic cases in the world being identified every ten seconds. And, what’s worse, these very same diabetes statistics tell us that by the year 2025, there will be as many as seven million new diabetic cases in the world.

(Dr GM Singh)

Key learning points to help reinforce educational impact: OSA

  • In patients with obstructive sleep apnea (OSA) being treated with continuous positive airway pressure (CPAP), residual apneic or hypopneic events can be evaluated using technology embedded in many CPAP devices. CPAP devices allow the automatic determination of adherence, and some CPAP devices also detect leaks in the mask.
  • The Epworth Sleepiness Scale is a self–rating of sleepiness filled out by the patient and consisting of 8 questions. Patients rate their likelihood of falling asleep in 8 different situations. The Epworth Sleepiness Scale measures the likelihood of dozing or falling asleep, in contrast to feeling tired.
  • Measuring CPAP efficacy at home and detecting mask leaks is part of troubleshooting residual sleepiness with CPAP. There are a variety of sleep masks. Mouth breathers may benefit from chin straps to reduce the mouth leaks. Some patients may benefit from the use of nasal pillows or a full facemask.
  • OSA is associated with hypertension and obesity. Mallampati score is a direct indicator of degree of airway crowding, and OSA is associated with airway crowding.
   Twitter of the Day

@DrKKAggarwal: If you have controlled your mind you are the conqueror of the whole world. ~ Swami Sivananda

@DeepakChopra: #vmdhealthblog Coping With Back Pain During Pregnancy is the title of my Health Tip this week. http://bit.ly/Dpak_Back

    Spiritual Update

Hanuman Chalisa

Ram Rasayan Tumhare Pasa
Sadaa Raho Raghupati Ke Dasa

Meaning: Oh Hanumanaji! You hold the essence of devotion to Ram, always remaining His Servant. Sri Rama gave you the power to heal. You are always His humble servant.

Spiritual Significance: By acquiring the qualities of Hanumana one gets in touch with the consciousness and one acquires the power to heal.

    An Inspirational Story

(Dr Anupam Sethi Malhotra)

Peace of mind

Once Buddha was walking from one town to another town with a few of his followers. This was in the initial days. While they were travelling, they happened to pass a lake. They stopped there and Buddha told one of his disciples, I am thirsty. Do get me some water from that lake there.

The disciple walked up to the lake. When he reached it, he noticed that some people were washing clothes in the water and, right at that moment, a bullock cart started crossing through the lake. As a result, the water became very muddy, very turbid. The disciple thought, How can I give this muddy water to Buddha to drink! So he came back and told Buddha, The water in there is very muddy. I don’t think it is fit to drink.

After about half an hour, again Buddha asked the same disciple to go back to the lake and get him some water to drink. The disciple obediently went back to the lake. This time he found that the lake had absolutely clear water in it. The mud had settled down and the water above it looked fit to be had. So he collected some water in a pot and brought it to Buddha.

Buddha looked at the water, and then he looked up at the disciple and said, See what you did to make the water clean. You let it be … and the mud settled down on its own and you got clear water… Your mind is also like that. When it is disturbed, just let it be. Give it a little time. It will settle down on its own. You don’t have to put in any effort to calm it down. It will happen. It is effortless.

What did Buddha emphasize here? He said, It is effortless. Having ‘peace of mind’ is not a strenuous job; it is an effortless process. When there is peace inside you, that peace permeates to the outside. It spreads around you and in the environment, such that people around start feeling that peace and grace.

    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

DMPA and osteoporosis

Clinicians should not perform dual energy x–ray absorptiometry (DXA) on premenopausal patients on DMPA, regardless of how long they have been on it. The American College of Obstetrics and Gynecology (ACOG) does not recommend BMD testing solely in response to DMPA use. There is no evidence that BMD testing in these patients correlates with future fracture risk. In general, BMD testing is not recommended for otherwise healthy premenopausal women.

The interpretation of DXAs for premenopausal women is very different than for postmenopausal women Pharmacotherapy such as with bisphosphonates, raloxifene, calcitonin, teriparatide, or denosumab should not be prescribed for young healthy patients with low bone density, as the safety and efficacy of these medications for the prevention and treatment of osteoporosis has not been established in otherwise healthy premenopausal women. There are currently no medications approved by the Food and Drug Administration for use in these patients.

According to the Adolescent Health Care and Gynecologic Practice Committees of ACOG, concerns about the effects of DMPA on BMD should not prevent clinicians from prescribing this method of contraception nor should its use be limited to 2 years. Although DMPA has a known link to BMD loss, studies show that most of the loss is temporary and similar to the BMD loss caused by pregnancy and breastfeeding.

Women should be thoroughly counseled about the risks and benefits of DMPA so they can make an informed decision about whether it is right for them:

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    Rabies Update

(Dr AK Gupta, Author of "RABIES – the worst death")

Why does a person not acquire immunity against natural rabies infection, as it occurs in other viral infections?

A person does not acquire immunity against natural rabies infection, as it occurs in other viral infections because there is no viremia in rabies and the virus is not accessible to the normal immune mechanism of the body. The antibody production starts only after travelling efferently from CNS via mostly autonomic nerves to different target organs. But by that time, the neuronal cells of patient’s brain stem are affected.

Can rabies be transmitted from man to man?

Man–to–man transmission of rabies is possible. Rabies can be transmitted following bite by a rabies patient. In 2004, three cases of human rabies were reported in U.S. following liver and kidney transplantation from rabies patients. Transplantation of rabies infected cornea can cause rabies in recipient. Therefore a careful neurological history of donor must be taken before cornea transplantation.

    Pediatric Update

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

Breastfeeding or breast milk for procedural pain in neonates

If available, breastfeeding or breast milk should be used to alleviate procedural pain in neonates undergoing a single painful procedure compared to placebo, positioning or no intervention. Administration of glucose or sucrose have been shown to have similar effectiveness as breastfeeding for reducing pain. The effectiveness of breast milk for repeated painful procedures is not established and further research is needed. These studies should include various control interventions including glucose/sucrose and should target preterm neonates.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with suspected dengue came with severe muscular pain.
Dr. Bad: Start aspirin.
Dr. Good: Start paracetamol.
Lesson: Aspirin or other NSAID agents should general be avoided because of the risk of bleeding complications and in children because of the initial risk of Reye syndrome.

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh my God! Why did you not give him nimesulide?
Lasson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

  SMS of the Day

(Dr GM Singh)

Train your brain to relax and your heart will be happier.

    Medicolegal Update

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

The Native American Graves Protection and Repatriation Act 1990

The Doctor and scientist have long sought to understand life in early civilizations through the excavation of burial grounds and exhumation of human remains. In the United States the attempt to understand early cultures led to the exhumation of the remains of Native Americans, many of which ended up in the nation's museums and archaeology labs. In an attempt to prevent the desecration of Native American graves, the Native American Graves Protection and Repatriation Act was introduced in Congress in July 1990 and subsequently passed into law.

  • The bill states that any human remains and objects found on federal or tribal lands after the date of enactment are to be considered owned or controlled by lineal descendants, the tribe on whose land it was found, the tribe having the closest cultural affiliation, or the tribe which aboriginals occupied the area. Anyone who discovers items covered by the bill must cease his or her activity, notify the federal land manager responsible and the appropriate tribe, and make a reasonable effort to protect the items.
  • Anyone who violates the provisions of the bill may be fined, imprisoned not more than one year, or both. The penalty may increase to five years for a second violation.
  • The Act further states that all federal agencies and museums receiving federal funds that have control over any of the items covered in the bill are to, within five years, inventory and identify the items, notify the affected tribes, and make arrangements to return such items if the appropriate tribe made a request. If an item was acquired with the consent of the tribe or if the item was part of a scientific study which was expected to be of major benefit to the country, the request for repatriation (i.e., return) could be denied.
  Vitamins—Open Secrets revealed

(Dr Jitendra Ingole, MD Internal Medicine)

Effectiveness of vitamin B12 supplementation

It is estimated that about 16% of older adults are vitamin B12 (cobalamin) deficient. This deficiency is mostly related to an inability to absorb cobalamin bound to food. Several experiments have shown that this problem does not affect people’s ability to absorb free or synthetic cobalamin. A lack of vitamin–B12 can lead to megaloblastic anemia and, if untreated, to irreversible neurological damage that may mimic Alzheimer's disease. There is ample evidence that injections of cobalamin can quickly correct a deficiency as can oral supplementation with 1–2 mg/day. It is not clear, however, whether smaller amounts, such as the 25 mcg or so found in multivitamins, are sufficient to correct a deficiency.

A team of researchers from the universities of Washington and Colorado has released a study designed to determine just how much oral cobalamin supplementation is required to reverse a deficiency. The study involved 23 older patients who had been diagnosed as being vitamin B12 deficient (serum cobalamin level less than 221 pmol/L and serum methylmalonic acid (MMA) level greater than 271 nmol/l). All participants received 25 mcg/day of cobalamin during the first 6 weeks, 100 mcg/day during the next 6 weeks, and 1000 mcg/day during the final 6 weeks of the study. Two participants achieved normal MMA levels with the 25 mcg/day dose, an additional 5 with the 100 mcg/day dose, but it took 1000 mcg/day (1 mg/day) before an additional 12 regained normal MMA levels. Thus 19 out of 23 patients (83%) normalized their MMA level and eliminated their vitamin B12 deficiency at a daily intake of 1000 mcg/day. The 1000 mcg/day dose was also effective in lowering homocysteine level in 75% of the patients, but folic acid supplementation was required in 4 of the patients in order to bring homocysteine concentrations down to an acceptable level. The researchers conclude that most cobalamin–deficient older people require more than 100 mcg/day of oral cobalamin to correct their deficiency.

(Ref: Rajan S, et al. Response of elevated methylmalonic acid to three dose levels of oral cobalamin in older adults. J Am Geriat Soc 2002;50:1789–95)

    Mind Teaser

Read this…………………

(Dr GM Singh)

Pre–treatment evaluation for lithium therapy should include:

1. Fasting blood sugar
2. Serum creatinine
3. Liver function tests
4. Platelet count

Yesterday’s Mind Teaser:
A 23–year–old grounds keeper for a university in Michigan is evaluated because of a series of ulcerating nodules on his right forearm. The first nodule appeared five days ago and since that time two more nodules, just proximal to the first nodule, have appeared. Yesterday, the first second nodule developed small ulcers. The ulcers and nodules are mildly painful. He reports having a low–grade fever, but otherwise is in good health. He has not traveled outside of the Midwest.

On physical examination, his temperature is 99°F (37.2°C). There are a series of nodules arranged in a linear pattern extending proximally from the mid–volar aspect of the right forearm to the elbow. The distal nodule is the largest, measuring 3×2 cm and it and the subsequent nodule are ulcerated, showing a red granular base. There are tender, enlarged lymph nodes in the right axilla. Which of the following is the most likely diagnosis?

A. Cutaneous anthrax
B. Sporotrichosis
C. Cutaneous leishmaniasis
D. Tularemia
E. Plague

Answer for yesterday’s Mind Teaser:
B. Sporotrichosis

Correct answers received from: Dr Jainendra Upadhyay, Dr U Gaur, Dr Sushma, Dr Girish, Dr Aaditya, Dr Saroj, Dr RN Malhotra, Dr Summit, Dr Sharad, Dr Gopal Das.

Answer for 1st June Mind Teaser: 2. Brain
Correct answers received from: Dr U Gaur, Sr. Naina Joseph, Dr Vijay Kansal, Dr Khurshid Alam,
Dr Neelam Nath.

Send your answer to ijcp12@gmail.com

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Stool Examination

Diarrhea is a common symptom of a gastrointestinal disturbance.
O & P (Ova and Parasite) testing: A microscopic evaluation of stool for parasites and the ova (eggs, cysts) of parasites. A basic test but very important!!

    Medi Finance Update

What is the rate of standard deduction on the net annual value of income from house property?

30% of net annual value shall be allowed as deduction from net annual value of income from house property.

    Laugh a While

(Dr GM Singh)

1st surgeon says: "Accountants are the best to operate on because when you open them up, everything inside is numbered."
2nd surgeon says: "Nah, librarians are the best. Everything inside them is in alphabetical order.
3rd responds: "Try electricians, man! Everything inside them is color coded."
4th intercedes: "I prefer lawyers. They're heartless, spineless, gutless and their heads and their butts are interchangeable."
To which the 5th surgeon, who has been quietly listening to the conversation, says: "I like engineers… they always understand when you have a few parts left over at the end."

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Nadolol tablet USP 20/40/80 mg
In the treatment of angina–pectoris, cardiac arrhythmias & essential hypertension.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

What are the advantages of the Laparoscopic Sleeve Gastrectomy?

The sleeve gastrectomy has several advantages over other bariatric procedures. During the laparoscopic gastric sleeve resection, the nerves of the stomach and the outlet valve (pylorus) are not altered, preserving the function of the stomach. Other advantages are:

  • The rest of the gastrointestinal tract anatomy is not altered, so the food ingested follows the normal course. This results in less chance of developing lack of vitamins and minerals and eliminates dumping syndrome.
  • The procedure decreases significantly the hunger by removing the part of the stomach that produces the main stimulating hormones.
  • Minimize the chance of developing ulcers.
  • Fewer office visits than the Lap Band, since there is no need for band size adjustments.
  • It does not require disconnecting or reconnecting the intestines.
  • It is a technically simpler operation than the gastric bypass or the duodenal switch. Some data suggest that the operation may be safer than gastric bypass or duodenal switch
  • It may be used as the first stage of a 2–stage operation.
    IMSA Update

International Medical Science Academy (IMSA) Update

Polio vaccination

The Advisory Committee on Immunization Practices has issued updated recommendations regarding routine poliovirus vaccination. The final dose in the series should be administered when the child is at least four years old.

    Public Forum

(Press Release for use by the newspapers)

Don’t break mercury thermometer

The mercury glass thermometer and blood pressure equipments can pose serious health problems if accidentally broken. Mercury readily turns into vapour at room temperature (22–24 degree Celsius) and when inhaled is absorbed into the bloodstream, lungs and attacks the nervous system. Even physical contact with the liquid, which is easily absorbed through the skin, is dangerous as some of it passes through the skin into the bloodstream, leading to tremors, nausea and blurred vision. It is also very dangerous when people play with it, as it appears as a silver ball. In such situations, it can be absorbed into the skin and the blood, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

India is the second largest user of mercury and imports 200 tonnes every year. Mercury can escape into the air and water, and from water into fish. Just one gram of mercury is enough to contaminate a 20–acre lake and make the fish unfit for eating. Around 70 thermometer breakages occur every month in 300– to 500–bedded hospitals. And, on an average, a hospital pumps almost 3 kg of mercury into the environment each year.

To clean the spilled mercury, use a syringe to suck up the liquid under water, maintaining great care all the while.

Mercury is a neurotoxin and attacks the brain. In small children, mercury poisoning has been linked to birth defects, learning disabilities, delay in walking and talking milestones and memory or attention problems. In adults, mercury poisoning leads to tremors, headaches, blurred vision, memory or concentration loss, hand and feet numbness, poor coordination, hair loss and nausea.

In extreme cases, mercury poisoning can lead to coma and death.

The symptoms of mercury poisoning can be reversed in adults. It takes about six months to a year for the body to naturally remove mercury once the exposure stops.

The major source of mercury that causes toxicity to the general public is from ingestion of contaminated fish. Other sources are amalgam fillings used in dentistry, chloralkali industries, thermometer factories and mercury mines.

A severe interstitial pneumonitis may result when mercury vapor is inhaled at concentrations in excess of 1000 µg/m3. Other signs and symptoms of severe poisoning include intention tremors, Inflammation of the gums with excessive salivation and psychiatric symptoms, such as excitability, insomnia, irritation, and shyness. Exposure to lower air concentrations of mercury ranging from 100 to 1000 µg/m3 may cause milder signs and symptoms of toxicity.

Small children who are exposed to high concentrations of mercury vapor may develop acrodynia (pink disease). The fetus is particularly vulnerable even if the pregnant mother shows no signs of toxicity.

Besides the brain, mercury is also toxic to the kidneys. Nephrotoxicity from mercury is manifested by the nephrotic syndrome and signs of dysfunction of the kidney tubules.

Clinically significant poisoning from mercury is unlikely if blood and urine levels are below 100 µg/L.

Treatment with chelators may be considered in patients with acute symptoms arising from the central nervous system due to confirmed mercury poisoning (e.g., via measurement of mercury in air, blood, or urine).

    Readers Responses
  1. Dear Sir/Mam, Government of India is considering revision of the National Policy on Mental Health which till now forms a part of the National Health Policy 2002. Likewise, National Mental Health Programme is also being planned for the 12th five year plan period (2012–17). A national policy shall reflect the aspirations of the people and set direction towards which the efforts of the stakeholders shall be directed. A programme aimed at people shall take in consideration their felt need and shall be actively planned with them in the center. In other words households and communities shall own the programme and actively participate in its development. You being leaders in the field of mental health and related disciplines are aware of the peoples needs and aspirations with respect to their mental health.
    I am compiling suggestions to be sent to the Government on behalf of the Indian Psychiatric Society. Please let me know your kind suggestions for mental health policy and the national mental health programme as soon as possible as the same is to be submitted to the Government soon. Please include what you would like to be covered in the mental health policy and the programme. Please provide your suggestions with an open mind. However, if you wish to have a look at the national health policy (2002) and programme it is available on www.mohfw.nic.in. Thanks and kind regards, Dr. Suman Kumar Sinha, (Consultant Psychiatrist)
  2. It is probably the most carcinogenic habit of all.........this one small thing can cause cancer of virtually any organ system in the body!!!!!!! Akshima Marwah
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    Forthcoming Events

National Conference on "Insight on Medico Legal Issues"
Date: Sunday, 10th July, 2011
Venue: Auditorium, Chinmaya Mission, 89, Lodhi Road, New Delhi 110003

eMedinewS and Heart Care Foundation of India are Jointly organizing the first ever National Conference on "Insight on Medico Legal Issues" to commemorate "Doctors’ Day".
The one day conference will have total insight into all the medico legal and ethical issues concerning the practicing doctors. The conference will be organised at the Auditorium of Chinmaya Mission Lodhi Road and will have both medical and legal experts interacting with the delegates on important issues.
You are requested to kindly register in advance as seats are limited. There will be no registration fee. You can register by sending us request at rekhapapola@gmail.com or at 9899974439.

Session: Ethical Issues in Medical Research (8 am to 8.30 am)
Topics: Rights of a patient in a clinical trial
           Ethical Issues in a clinical trial
           Statutory permits required for conducting a clinical trial

Session: Medical ethics and organ donations (8.30 am to 9.00 am)
Topics: Ethical issues in IVF practice
           100% voluntary blood donation
           Need for do not resuscitate law in India
           Ethical issues in organ transplantation

Session: Handling death (9.00 am to 9.30 am)
Topics: How to declare death?
           Spiritual considerations in a dying patient
           Medico legal and ethical issues in post mortem

Session: Medical Insurance (9.30 am to 10 am)
Topic: Indemnity Insurance
          Engaging a lawyer
          Understanding various court procedures

Session: How to handle medico legal case? (10 am to 10.30 am)
Topic: When to do the MLC?
          Checklist of a MLC case
          Medico legal record keeping

Session: Medical Consent (10.30 am to 11 am)
Topics: Types of consent
            Ideal consent
            Extended consent

Session: Fallacies in acts applicable to medical profession (11 am to 11.30 am)
Topic: MTP, PNDT Act
          Organ Transplant Act
          State Medical Councils & Medical Council of India Acts

Inauguration (11.30 am – 12 noon)

Session: Professional misconduct and professional ethics (12 noon – 1 pm)
Session: When It is Not a Negligence (1 pm – 2 pm)


September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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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 Naveen Dang, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta