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
  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 …

4th June 2012, Monday

New 2012 heart failure guidelines

  1. Compared with the ESC’s 2008 guidelines, the new guidelines call for a more liberal use of mineralocorticoid–receptor antagonists (MRAs) i.e. aldosterone antagonists in heart failure. They are recommended for most patients who remain symptomatic despite treatment with both ACE inhibitors and beta–blockers. It can now be given to NYHA class 2 patients with an LVEF <35%.
  2. The new guidelines also give weight to reduction of heart rate (HR) as a specific treatment target by adding ivabradine if the rate remains 70 bpm or higher despite triple–drug therapy: optimized beta blockers, ACE inhibitors, and MRAs (SHIFT trial).
  3. Drugs that should not be given specifically for heart failure include statins and oral anticoagulants, except in patients with atrial fibrillation.
  4. Drugs that may actually be harmful in heart failure include thiazolidinediones and calcium–channel blockers that are negatively inotropic i.e. most of them.
  5. In AF it is possible of course to use the new anticoagulants (oral direct thrombin inhibitors and oral factor Xa inhibitors). But these drugs are contraindicated in severe renal impairment––and a lot of patients with heart failure, as we know, have this condition.
  6. Patients expected to survive with good functional status for more than one year should receive CRT if they are in sinus rhythm, their LVEF is low (<30%), and QRS duration is markedly prolonged irrespective of symptom severity.
  7. Application to NYHA class 2 heart failure is what’s new based on the MADIT–CRT and RAFT trials, in addition to reduced certainty that CRT will benefit patients with a right–bundle–branch–block QRS morphology or atrial fibrillation.
  8. CRT should be done in patients with NYHA class 2 with a QRS duration >130 ms with a left bundle branch block (LBBB) morphology and LVEF <30%.
  9. For non–LBBB morphology, look for a QRS width of >150 ms, and that gets a class IIa (‘should be considered’) recommendation.
  10. In considering CRT in NYHA class 2 patients within the QRS–duration window of 120–150 ms take a clinical decision. "Do you see strong convincing evidence of mechanical dyssynchrony with an imaging technique? Is there left ventricular dilatation? Is there LBBB? Has the patient recently been more symptomatic?"
  11. Recommendations for use of CABG in heart failure have broadened as a result of the STICH trial, which saw benefits from the surgery in patients with systolic heart failure but only mild angina.
  12. As a result of the PARTNER trials, transcatheter aortic valve implantation (TAVI) enters the guidelines. It should be considered in patients with aortic stenosis who are not appropriate candidates for conventional surgery.
  13. Left ventricular assist devices (LVADs) are now "recommended" in patients who are also candidates for transplantation and have "should–be–considered" status for destination therapy.
  14. LVADs may be increasingly used in selected patients with less severe disease than end stage, "before right–ventricular or multiorgan failure develops.
  15. The ventricular assist devices may ultimately become a more general alternative therapy to transplantation, because the current 2–3 year survival rates with continuous–flow devices seem superior not only to medical therapy but also to pulsatile flow devices.
  16. In the new guidelines there is a smaller presence of recommendations relating to lifestyle changes. With only two exceptions, you will not see in the new guidelines any recommendation in relation to lifestyle. The exceptions, both class IA recommendations: "Regular aerobic exercise is encouraged in patients with heart failure to improve functional capacity and symptoms," and patients are advised to enroll in a "multidisciplinary–care management program" to lower the risk of heart–failure hospitalization. (www.escardio.org/guidelines)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

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

New 2012 heart failure guidelines

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

No Tobacco Day 2012

DMA and Heart Care Foundation of India demanded ban on Gutka, Tobacco and Tobacco Products in Delhi on the occasion of World No Tobacco Day. Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal expressing his views against Tobacco use..

 
Dr K K Aggarwal
 
    National News

Centre to start routine immunisation plan for rapid improvement of health scenario

ALLAHABAD: With an aim to improve the immunization coverage in both rural and urban sectors, the Union government has come up with a novel plan to utilize a week/month for providing RI (routine immunization) services to people on priority areas. The officials of district health department will implement the plan from June. Notably, the Union government has declared 2012–13 as the year of intensification of routine immunization (IRI). Four rounds of immunization weeks will be held in low performing areas including urban slums, migrant and mobile populations and marginalized population etc to rapidly improve the health scenario. District immunization officer (DIO), Dr Ashutosh Kumar told TOI that "Department has selected four days of a month (from June to September) wherein ‘Immunization Round’ would be taken on priority areas." He added that primary targets will be children under two years and pregnant women who have not received all due vaccines according to the National Immunization Schedule (NIS). (Source: TOI, Jun 1, 2012)

For comments and archives

Doctor held for medical negligence

Bangalore, May 26 2012, DHNS: The Peenya police have taken Dr Purad alias Muttu of a private hospital into custody, following a patient’s death due to his alleged negligence. He is booked under Section 304 A (causing death by negligence). Madhukumar, 30, of Kammagondi, was admitted to the hospital after he complained of severe shoulder pain. Dr Purad attended to Kumar and gave him a pain killer injection and tablet. He was taken back home later, said a police officer. Sometime later, Kumar complained of giddiness, vomiting and fell unconscious. He was immediately rushed back to the same hospital. The doctors declared him dead on arrival, said the police. His family members staged a protest, alleging that the doctor’s negligence claimed Kumar’s life. They demanded a stern action against the hospital staff. Dr Manjunath, Medical Superintendent of Ravi Kirloskar Hospital said Madhukumar visited the hospital complaining right shoulder pain with no other symptoms. "The patient was administered Diclofenac (pain killer) injection to ease the pain. He had no anaphylactic reaction (life–threatening type of allergic reaction to a drug). But, the patient died after nearly an hour of administering the injection. So the reason for death could be either heart attack or a respiratory problem. There have been no reported cases of patients dying after being given Diclofenac drug. However, we are awaiting post–mortem reports of the patient," he added. Dr Purad, an MBBS graduate, has been working in the hospital for the past one year and this is the first time such a case has been reported against him and the hospital.

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)

ASCO: Avastin slows resistant ovarian cancer

Progression of platinum–resistant ovarian cancer slowed by more than 50% in patients who received bevacizumab (Avastin) plus chemotherapy compared with nonplatinum chemotherapy alone, results of a randomized trial showed. (Source: Medpage Today)

For comments and archives

Genetics don’t help predict type 2 diabetes

Currently available genetic risk scores do not improve on clinical and biological data for predicting whether an asymptomatic individual is at high risk for type 2 diabetes mellitus (T2DM), a new prospective study shows. Dr. Pedro Marques–Vidal of the University Hospital Lausanne in Switzerland, the senior author on the study, told Reuters Health, "You don’t need a special (genetic marker) to assess the risk of developing diabetes…Provided you have a good clinical or biological score, there’s no need to assess genetics or genes in your patient." (Source: Medscape)

For comments and archives

Dark chocolate: Sweet prevention for CV events

Dark chocolate may be an inexpensive way to help prevent cardiovascular events in patients at risk for heart disease, researchers found. (Source: Medpage Today)

For comments and archives

Medtronic’s Resolute zotarolimus–eluting stent effective in NIDDM patients

With Medtronic’s Resolute zotarolimus–eluting stent, patients with non–insulin dependent diabetes mellitus (NIDDM) have outcomes just as good as nondiabetics, according to a presentation at the 21st Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists in Philadelphia. The Resolute stent consists of a thin–strut cobalt chromium bare–metal stent and a durable, biostable polymer that allows drug elution up to 180 days. It has been approved by the US Food and Drug Administration (FDA) for use in patients with and without diabetes, said lead author Dr. Scott Lee, from Medtronic Diabetes and Loma Linda University Medical Center in Loma Linda, California. "The Resolute stent addresses two fundamental problems in coronary artery disease in diabetes," Dr. Lee told. "First is the purely anatomic aspect of maintaining patency with the physical placement of the stent, but secondly and more importantly, the ability of the stent to deliver locally zotarolimus, which is very effective in preventing neointimal hyperplasia secondary to smooth muscle cell proliferation," he explained. (Source: Medscape)

For comments and archives

 
    Prayer Meeting

Dr. Vidya Prakash Sood (13/04/1936 – 03/03/2012)

A prayer meeting will be held to pay homage to the departed soul of Dr VP Sood
(Issue Editor – Asian Journal of Ear, Nose and Throat) who passed away peacefully on March 3, 2012 in USA.

Date: Sunday 10th June 2012
Venue: Chinmaya Mission (Auditorium), 89, Lodhi Road, New Delhi.
Time: 11 A.M – 12 Noon

(IJCP and eMedinews)

 
  Twitter of the Day

@DrKKAggarwal: Smoking Can Cause Erectile Dysfunction
http://blog.kkaggarwal.com/2012/05/31/smoking–can–cause–erectile–dysfunction/

@DrKKAggarwal: Emotional resilience is one of the strongest indicators for longevity

 
    Spiritual Update

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

What a Doctor should know about a Christian patient?

Christians believe in the doctrine of the holy trinity, which affirms that there are only three persons in one God – Father, son (Jesus Christ) and the Holy spirit.

Christians believe that Jesus is both fully divine and fully human. The basic tenet of Christianity is Jesus. By his life, death and resurrection (return to divine), he has broken the bonds of death and one eternal life for all.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the symptoms of Ectopic Pregnancy?

Delayed or abnormal menstruation can be an early sign of an ectopic pregnancy. If pregnancy is confirmed, early abnormal levels of human chorionic Female reproductive system showing sites of ectopic pregnancy and normal intrauterine pregnancy gonadotropin (hCG), pelvic pain, and/or irregular bleeding in the first weeks of pregnancy can indicate an ectopic pregnancy. ectopic pregnancies were often not diagnosed until six to eight weeks into the pregnancy, when the patient was experiencing pelvic pain, irregular vaginal bleeding, possible internal bleeding, and a tender feeling in the pelvis. Under these circumstances, this represented a life–threatening emergency, and major surgery (laparotomy) was required to remove the pregnancy and control bleeding.

For comments and archives

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

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

Dietary recommendations in anemia

  • Improve food choice to increase amount of total dietary iron
  • Include a source of vitamin C at every meal
  • Include (meat, fish, poultry) at every meal if possible
  • Avoid drinking large amounts of tea or coffee with meals (both contain tannin)

Note: A high protein diet (1.5g/kg body weight) is desirable both for liver function and blood regeneration.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Do we really love?

A story is told about a soldier who was finally coming home after having fought in Vietnam. He called his parents from San Francisco. "Mom and Dad, I’m coming home, but I’ve a favor to ask. I have a friend I’d like to bring home with me." "Sure," they replied, "we’d love to meet him".

"There’s something you should know," the son continued, "he was hurt pretty badly in the fighting. He stepped on a land mine and lost an arm and a leg. He has nowhere else to go, and I want him to come live with us."

"I’m sorry to hear that, son. Maybe we can help him find somewhere to live." "No, Mom and Dad, I want him to live with us."

"Son," said the father, "you don’t know what you’re asking. Someone with such a handicap would be a terrible burden on us. We have our own lives to live, and we can’t let something like this interfere with our lives. I think you should just come home and forget about this guy. He’ll find a way to live on his own."

At that point, the son hung up the phone. The parents heard nothing more from him. A few days later, however, they received a call from the San Francisco police. Their son had died after falling from a building, they were told. The police believed it was suicide. The grief–stricken parents flew to San Francisco and were taken to the city morgue to identify the body of their son. They recognized him, but to their horror they also discovered something they didn’t know, their son had only one arm and one leg.

The parents in this story are like many of us. We find it easy to love those who are good looking or fun to have around, but we don’t like people who inconvenience us or make us feel uncomfortable. We would rather stay away from people who aren’t as healthy, beautiful, or smart as we are.

Thankfully, there’s someone who won’t treat us that way. Someone who loves us with an unconditional love that welcomes us into the forever family, regardless of how messed up we are.

Tonight, before you tuck yourself in for the night, say a little prayer that God will give you the strength you need to accept people as they are, and to help us all be more understanding of those who are different from us!!!

For comments and archives

 
  Cardiology eMedinewS

Medicare to Pay for TAVI Read More

Risk Score Shows Likely Long–Term ICD Benefit Read More

 
  Pediatric eMedinewS

IL–10 Allele Appears To Offer Protection from Asthma Read More

Symptoms From Childhood Smoke Exposure Last Into Adulthood
Read More

Colonized Bacteria Linked With Bronchiolitis Severity Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with laryngopharyngeal reflux was not responding.
Dr. Bad: Increase the drugs.
Dr. Good: What diet do you take?
Lesson: Foods and beverages containing caffeine (coffee, tea, sodas, etc), alcohol, chocolate and peppermints weaken the protective esophageal sphincters that normally hold stomach contents in the stomach and esophagus.

For comments and archives

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

For comments and archives

 
  Legal Question of the day

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

Q. A 30–year–old man came to hospital OPD with complaints of severe pain in right shoulder. The doctor gave him injection Diclofenac. The patient went back. Later he complained of giddiness, vomiting and fell unconscious. He was brought back within an hour of being discharged. He was dead on arrival. Police arrested the doctor. Autopsy report is not yet available. What are your comments?

Ans: My comments are as follows:

  • You are obviously referring to the following report http://www.deccanherald.com/content/252493/doctor–held–medical-negligence.html
  • According to the report dated 31–5–2012 in Deccan Herald published from Bangalore, the Peenya police in Karnataka have taken Dr Purad alias Muttu of a private hospital into custody 4 days ago, following a patient’s death due to his alleged negligence. He is booked under Section 304 A (causing death by negligence).
  • There does not appear to be medical negligence prima facie.
  • Even if there was medical negligence, this does not give a right to the police to arrest a doctor unless, as per the SC judgment in Jacob Mathew v. State of Punjab (2005) 6 SCC 1.
  • Some observations made by the SC in the above case are as follows:
    • Indiscriminate prosecution of medical professionals for criminal negligence is counter-productive and does no service or good to the society.
    • Negligence in the context of medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. Similarly, when the charge of negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that particular time (that is, the time of the incident) at which it is suggested it should have been used.
    • "(6) The word ‘gross’ has not been used in Section 304A of IPC, yet it is settled that in criminal law negligence or recklessness, to be so held, must be of such a high degree as to be ‘gross’. The expression ‘rash or negligent act’ as occurring in Section 304A of the IPC has to be read as qualified by the word ‘grossly’.

      (7) To prosecute a medical professional for negligence under criminal law it must be shown that the accused did something or failed to do something which in the given facts and circumstances no medical professional in his ordinary senses and prudence would have done or failed to do. The hazard taken by the accused doctor should be of such a nature that the injury which resulted was most likely imminent.

      (8) Res ipsa loquitur is only a rule of evidence and operates in the domain of civil law specially in cases of torts and helps in determining the onus of proof in actions relating to negligence. It cannot be pressed in service for determining per se the liability for negligence within the domain of criminal law. Res ipsa loquitur has, if at all, a limited application in trial on a charge of criminal negligence.

      In view of the principles laid down hereinabove and the preceding discussion, we agree with the principles of law laid down in Dr. Suresh Gupta’s case (2004) 6 SCC 422 and re-affirm the same. Ex abundanti cautela, we clarify that what we are affirming are the legal principles laid down and the law as stated in Dr. Suresh Gupta’s case."
    • Guidelines re: prosecuting medical professionals –– As we have noticed hereinabove that the cases of doctors (surgeons and physicians) being subjected to criminal prosecution are on an increase. Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken. The investigating officer and the private complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the accused medical professional amounts to rash or negligent act within the domain of criminal law under Section 304–A of IPC. The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment. He has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards.

      We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient. All that we are doing is to emphasize the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions. Many a complainant prefer recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.

      Statutory Rules or Executive Instructions incorporating certain guidelines need to be framed and issued by the Government of India and/or the State Governments in consultation with the Medical Council of India. So long as it is not done, we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient. A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor. The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation.

      A doctor accused of rashness or negligence, may not be arrested in a routine manner (simply because a charge has been levelled against him). Unless his arrest is necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make himself available to face the prosecution unless arrested, the arrest may be withheld.
  • The above observations of the SC in Jacob Matthew case make it very clear that the police action in arresting the doctor in this case is violative of law.
  • Young doctors cannot be expected to go to hire competent lawyers and approach the court for redressal of the injustice meted out to them and for getting the police officers punished and making them pay compensation causing harassment and loss of reputation. It is the organisations like the IMA that should actively pursue such cases in courts on behalf of doctors concerned and the medical profession in general.
  • The IMA needs to actively support the case of doctors in situations like this. The IMA should pursue cases in the courts on behalf of doctors and should meet legal expenses. It must have a strong media cell to protest and take necessary action immediately. The absence of a strong media presence on the part of the IMA results in situations like this whereby the news of a doctor arrested wrongly by police needs four days to trickle down to the national level.

For comments and archives

 
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    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Considerations for vaccine administration

Proper administration of vaccines is extremely important to ensure efficacy of response and safety. The Healthcare provider must ensure the following for administration of vaccine:

  • Aseptic precautions should be taken while administering the vaccine.
  • The child should not have dermatitis/exanthematous lesions.
  • The vaccine should not be expired, should not be turbid/damaged in any way.
  • Vaccine manufacturers’ guidelines should be followed to reconstitute and administer.
  • Identify the child who is being vaccinated. The right vaccine in the right dosage should be administered to the right child.
  • Administer the vaccine at the recommended site, through the right route, at the right time, using the right recommended needle/equipment.
  • Document all the details of vaccination.

There have been reports of untoward reactions, beyond the usual side effects of vaccine wherein the child suffered grievous injury. Such incidents can be avoided simply by being vigilant and following the above checklist while administering a vaccine

 
  Quote of the Day

(Dr GM Singh)

The question is not what you look at, but what you see. Henry David Thoreau

 
    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Laboratory Tests for superficial Fungal Infections

Many fungal skin infections are diagnosed by the doctor based on a clinical evaluation and his experience. A clinical evaluation cannot, however, definitively tell the doctor which microorganism is causing a fungal infection. A few laboratory tests may be useful in detecting and confirming a fungal infection and may help guide treatment. They may include: Microscopic examinations, such as potassium hydroxide (KOH) preparation and calcofluor white stain; Fungal culture and susceptibility testing.

 
    Mind Teaser

Read this…………………

Mang Jose with rheumatoid arthritis states, "the only time I am without pain is when I lie in bed perfectly still". During the convalescent stage, the nurse in charge with Mang Jose should encourage:

a. Active joint flexion and extension
b. Continued immobility until pain subsides
c. Range of motion exercises twice daily
d. Flexion exercises three times daily

Yesterday’s Mind Teaser: A male client has undergone spinal surgery, the nurse should:

a. Observe the client’s bowel movement and voiding patterns
b. Log–roll the client to prone position
c. Assess the client’s feet for sensation and circulation
d. Encourage client to drink plenty of fluids

Answer for Yesterday’s  Mind Teaser: c. Assess the client’s feet for sensation and circulation

Correct answers received from: Yogindra Vasavada, Yogindra Vasavada, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr Jainendra Upadhyay, Anil Bairaria

Answer for 2nd June Mind Teaser: b. Heart disease
Correct answers received from: Dr P C Das

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Right Click

Tech Support: "I need you to right–click on the Desktop."
Customer: "Ok."

Tech Support: "Did you get a pop–up menu?"
Customer: "No."

Tech Support: "Ok. Right click again. Do you see a pop–up menu?"
Customer: "No."

Tech Support: "Ok, sir. Can you tell me what you have done up until this point?"
Customer: "Sure, you told me to write ‘click’ and I wrote click’."

 
    Medicolegal Update

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

Medicine and law have been interrelated from the most basic time as per Gradwohl’s Legal Medicine. The role of the doctor and the police is nothing but like solitary person, sage, kazi and priest. They are intermediary between God and man. The purpose of medicine is to maintain the patient in the best health, to overcome his diseases, injury and to lengthen his healthy life. The purpose of law is to maintain peace and order in the society, respect of humans through human rights and to provide equality of opportunity. To achieve these purposes medicine emerges from the laboratory by the scientific process and law emerges from the society by the process of experience. "People follow medicine and Law follows people".

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Shaving before operation may be harmful

Specific recommendations to reduce the incidence of surgical site infections highlight that hospitals should remove all razors from the premises and work with purchasing department so that razors are no longer procured by the hospitals. They also emphasize on the use of reminders, and educating patients not to self-shave preoperatively, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Hair removal is commonly performed before many surgical procedures in order to provide the surgeon with a "clean" field and to prevent hair from falling into the surgical site. However, most studies have shown an increased risk for surgical site infections (SSI) in patients undergoing preoperative hair removal.

The rates of SSI are highest when shaving is performed compared to clipping the hair or use of depilatory creams. Scanning electron micrographs show that razors cause gross skin cuts, clippers cause less injury and depilatory agents cause no injury to the skin surface.

The lowest rates of SSI are reported when hair is removed by clipping or using the cream just prior to the surgical incision. The take home message is that one should not shave near the surgical site. Shaving can irritate the skin which may lead to infection. For men who shave their face every day, one should ask the surgeon if it is okay to do so.

 
    Readers Response

Dear Aamir Khan, do you know?

  1. What is the average cost of treatment in USA?
  2. What is the average salary of doctors in USA and England?
  3. The amount you have taken for a program, most of the best doctors cannot earn in their entire lifetime.
  4. The amount you take to cut a ribbon or attend a marriage is more than the annual income of many doctors.
  5. How many patients is a doctor allowed to see in England?
  6. No patient can take medicines without medical prescription in USA and in England.
  7. Patient is a consumer and medicine is a profession./industry.
  8. A patient does not go to a surgeon just because some doctor has referred him. He selects his surgeon by his ability and experience not as the so–called specialist from USA said he could not succeed as he did not gave commission. Ask any of the surgeons how he established his image in public.
  9. For every sms, TV channels charge their commission.
  10. All the TV channels telecast advertisements for such drugs like increasing height, personality development, curing arthritis, sugar control have no scientific basis and many of these advts. are done by your fraternity just for money.
  11. Many film actors including you promote many things just for money without thinking about the harm it could do to the public.
  12. The huge irrational amount you charge for a film is being paid by people.
  13. You compared Indian doctors with UK doctors. Do you know that in the UK no treatment can be started without full investigation. Do you want that every patient of India should be investigated like them before starting treatment?
  14. In European countries, every doctor has the database of all registered restaurants so that if any sick patient claims that he has food poisoning, the doctor can immediately inform the authorities to take against them.
  15. Recently on a TV show on CNN, Indian doctors were mocked about the fact that they worked on such low salaries.
  16. Indian film industry runs on black money.
  17. We work in one of the most corrupt systems, please do not single out doctors.
  18. What is the production cost and MRP of goods sold in India like coke.
  19. How are the boys and girls exploited in the film industry?

Please don’t think that we do every thing only for money.

Regards: Dr Sundeep Nigam

 
    Forthcoming Events
Dr K K Aggarwal

4th Asia Pacific Vascular Intervention Course (APVIC–IV)

Date: June 8–10–2012

THE OBEROI, Dr. Zakir Hussain Marg, New Delhi
In association with ‘International Society of Endovascular Specialists’ ‘Vascular Society of India’ ‘Society of Cardiovascular Angiography & Interventions’

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

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

 
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

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

4. eMedinewS ebooks (This may take a few minutes to open)

HCFI
Activities eBooks

  HCFI

  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

 
    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, Dr Usha K Baveja