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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

  Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 15 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
 
  Editorial …

5th February 2013, Tuesday

Even typhoid can present with chills and rigors

Changing trends have been reported in typhoid fever since last decade. Continuous and intermittent fever with rigors and chills, headache, bodyaches, abdominal pain, enlarged spleen, enlarged liver, high pulse rate, and deranged liver functions are more commonly observed in typhoid fever, reports Dr NS Neki, Assistant Professor Dept. of Medicine Govt. Medical College Amritsar, Punjab in January issue of Indian Journal of Clinical Practice.

In the study of 100 patients 48, 30, 14 and 8 were in the age group of 20-30, 31-40, 41-50 and 51-60 years, respectively. In all the patients, fever (100-104°F) was the major presenting symptom. Duration of fever was one week in 32%, 1-2 weeks in 40%, 2-3 weeks in 20%, 3-4 weeks in 7% and >4 weeks in 1% patients. 65 patients presented with continuous fever and 32% with intermittent fever and 3% with remittent fever.

Sixty percent patients presented with rigors and chills and 40% without rigors and chills. Headache was reported in 80%, body ache in 60%, abdominal pain in 13%, cough in 10%, nausea in 4%, constipation in 2% and vomiting is 2% cases.

Clinical findings were enlarged spleen in 70%; high pulse rate in 65%; enlarged liver in 23%, coated tongue 12%; relative slow pulse rate in 3% and irritation of the brain layers in 3% with stupor in 1%.

Laboratory findings were anemia with Hb 6-11 g/dl in 25%; severe anemia with Hb <6 g/dl in 16%; neutropenia or low white cells in 9%; lymphopenia in 4%; lymphocytosis in 2%; low platelet count in 4 %; raised liver enzymes SGOT and SGPT in 42%; raised alkaline phosphatase in 7% and raised serum bilirubin in 5% cases.

Presence of fever with child and rigors does not always mean malaria or urinary tract infection.

If the fever is continuous, then one should look for typhoid. Raised SGOT and SGPT levels can be present in most viral fevers especially in the dengue season, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, Editor in Chief IJCP.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

   Constipation Update

What is the role of endoscopy in constipation?

Colonoscopy can identify lesions that narrow or occlude the bowel. Colonoscopy is preferable in constipated patients with anemia, rectal bleeding, hemoccult-positive stools, obstructive symptoms, recent onset of constipation, weight loss, a change in stool caliber, or rectal prolapse because of the ability to visualize the entire colon.

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Rapid flu test more accurate when positive

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions. Dr Ramesh Kumar Bapna awarded with emedinews Doctor of the year award

 
Dr K K Aggarwal
    National News

15th Feb is International Pediatric Cancer Day. Watch Dr KK in chat with Dr Gauri Kapoor on Cancers in Children.

http://emeditube.in/chatwithdrkk.aspx, under section Cancers (Dr Gauri Kapoor on Cancer in Children)

GOOD NEWS:The state of UP may pass PROHIBITION OF VIOLENCE AGAINST MEDICARE SERVICE PERSONNEL AND DAMAGE TO PROPERTY IN MEDICARE SERVICE INSTITUTIONS Act shortly. BAD NEWS: CEA-2010 may also be implemented along with. Moreover, by inserting the word 'REGISTERED' in the definition of the medical care institution, the state govt. would compel the medical institutions to get registered under the CEA-2010.That is to say, if your institution is not registered with the health department, you cannot reap the benefits of the PROHIBITION OF VIOLENCE AGAINST MEDICARE SERVICE PERSONNEL AND DAMAGE TO PROPERTY IN MEDICARE SERVICE INSTITUTIONS Act. (Amitabh)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

 
    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Children in families with poor parent-child relationship, poor relationship between parents and absence of protective parents and presence of non-biologically related male in the home are more likely to be victims.

 

 
    Health debate of the day

Do we agree with National Commission for Women?

Issue: The National Commission forWomen (NCW) has advised the Union health ministry to push the time limit for abortions from 20 weeks of pregnancy to 24. Accordingly, the NCW wants that Section 3(2)(b) of the MTP Act to be tweaked to read, "where the length of the pregnancy exceeds 12 weeks but does not exceed 24 weeks".

About Section 3(2) in The Medical Termination Of Pregnancy Act, 1971

(2) Subject to the provisions of sub- section (4), a pregnancy may be terminated by a registered medical practitioner,-

(a) where the length of the pregnancy does not exceed twelve weeks, if such medical practitioner is, or

(b) where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioners are of opinion, formed in good faith, that-

(i) the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or

(ii) there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. Explanation I - Where any pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman. Explanation II - Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be presumed to constitute a grave injury to the mental health of the pregnant woman.

For comments and archives

 
    Valvular Heart Disease Update

On echocardiography, although a bicuspid aortic valve with a raphe may appear similar to a tricuspid valve during diastole, the systolic opening shape of a bicuspid valve is elliptical rather than the triangular pattern of a tricuspid valve.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For Comments and archives…

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Quick compensation for death and injury in drug trials

Pharma companies conducting drug clinical trial will no longer be able to get away with meagre and arbitrary payment of compensation in case of injury or death of subjects participating in such trials, reports TOI. The Indian government has notified rules for grant of compensation in case of serious adverse events like death and injuries on account of participation in clinical trials. There were no compensation provisions under the drugs and cosmetics rules which govern approval of clinical trials by the government. Compensation would now be awarded within three months of the reporting of injury or death. Drug Controller General of India will be the final authority for deciding the causes of injuries or death and approving the final compensation amount in each case (death, severe injury and minor injury). Ethics Committee of the medical institute conducting the trial, the sponsor of trial and its principal investigator will have to report the injury or death within 24 hours.

A little TLC boosts patency of bypass grafts

Saphenous vein grafts for bypass surgery may hold up better with a little TLC, researchers investigating a "no-touch" harvesting technique and an "external stent" suggested. (Source: Medpage Today)

Now Published: Flu virus can spread up to 6 feet, no cough or sneeze required

The influenza virus can spread up to 6 feet from a patient's head via submicron particles during routine hospital care, according to a study of patients admitted to the emergency department (ED) and throughout a tertiary care hospital with influenza-like illness during the 2010 to 2011 influenza season. It was previously thought that the virus traveled only a short distance via large particle droplets during coughing or sneezing. Submicron particles are released in the air during talking and breathing. (Source: Medscape)

Atrial size key to Afib-pacemaker link

Most patients with pacemakers have atrial fibrillation detected by the device, even if they don't have a clinical history of the arrhythmia, researchers found. (Source: Medpage Today)

FDA clears telemedicine robot for use in hospitals

The US Food and Drug Administration (FDA) has cleared a remote presence (RP) robot, RP-VITA (iRobot), for use in hospitals, according to an announcement from the manufacturer. The robot, which will be marketed by the telemedicine company InTouch Health, allows physicians to monitor patients remotely. (Source: Medscape)

Yoga may calm Afib

Patients with paroxysmal atrial fibrillation may see some relief from doing yoga, a small, proof-of-concept study suggested. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Ask Dr KK: I am 31, got angioplasty stent done this year. Can I think of getting married? Answer: Yes. Classical example is Saif Ali Khan.

@DrKKAggarwal: To step out of the river of memory & conditioning & see the world as if for the first time is a return to timeless mind #CosmicConsciousness

 
    Spiritual Update

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

You cannot serve two masters (God and Wealth)

This is true for both your internal spiritual journey as well as the external social journey in life. Wealth is an indicator of greed, one of the five known obstacles to the pathway of self-realization.

For Comments and archives…

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Which surgical treatments are used for endometriosis?

Laparoscopy is often used to treat recurrent endometriosis when the goal is to preserve future fertility. Ovarian cystectomy is superior to cyst drainage for treating pain and prevention of recurrent cysts. According to western figures, fertility–preserving endometriosis surgery improves pain for 60–80% of women. After surgery, medical therapy may be needed to control symptoms of endometriosis since 40–80% of women experience recurrent pain symptoms within two years of surgery. Recurrent symptoms occur within 5 to 10 years in more than 50% of women after completing a 6–month course of medical treatment.

Hysterectomy with removal of the ovaries is an effective approach after childbearing is completed. This surgery provides final relief from endometriosis–related pain in more than 90% of women. In contrast, if one or both ovaries are preserved, there is a much greater chance that symptoms may recur, and additional surgery will be required. If needed, low–dose hormone therapy reduces hot flashes and menopausal symptoms that occur after hysterectomy with bilateral removal of the ovaries.

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

(Dr (Prof) Sandeep Guleria, Senior Consultant Surgeon, Indraprastha Apollo Hospitals)

The real hero is the donor

No other specialty of medicine has revolutionized the treatment of disease as much as transplantation in the last century. Liver, heart, pancreas and renal transplantation are commonly performed operations in India today. With a cadaver program in its infancy the live donor is the foundation of any kidney or liver transplant program in India.

Renal Transplantation: The Live Renal Donor

Renal transplantation is the best treatment for patients with end stage renal disease. The shortage of cadaver kidneys for transplantation has resulted in patients waiting for a longer period to receive the benefits of transplantation. The presence in most normal individuals of two kidneys – each with a physiological reserve capable of providing 4 to 5 times the minimum required function has led to the acceptance of renal transplantation using living related or unrelated volunteers as organ sources.

Through the history of its evolution medical practice was paternalistic in the Hippocratic tradition. "Primum non nocere" (First do no harm) was a defining principle in the practice of medicine and live donor transplant was considered unethical as it involved putting a perfectly healthy individual at the risk of surgical complications without any advantages to his/her health. However, soon the life–saving potential of this procedure received widespread public support and with advancements in immunology the graft survival rates improved and transplantation received acceptance among the medical fraternity. The impact of public opinion and growth for consumerism in American culture led to a decline in the primacy of Hippocratic paternalism. The end result was that as long as the donor’s participation was voluntary, fully informed and un–associated with financial or psychological coercions, transplantation was considered acceptable.

Living kidney donation appears to be safe with low morbidity and mortality. It offers several potential benefits, including better results for the recipient enhanced self esteem for the donor and reduced financial burden to the society. The success of live kidney donor transplantation has been so overwhelming that from 2000 to 2004 in the United States, the number of live donor kidneys surpassed that of cadaver donors. However, in most parts of the world, cadaver organ donation is still limited and live kidney donors are the most common source of organs for organ transplantation.

Conservative estimates put the annual incidence of end–stage renal disease (ESRD) in India at 80–100 per million populations (PMP). This would mean approximately 80,000 to 1, 00,000 new patients every year not including the patients living in rural areas who never seek specialist advice because of ignorance and poverty. The final acceptance rate of patients for renal replacement therapy turns out to be less than 5 PMP per year.

The high costs associated with long–term dialysis makes renal transplantation the only viable alternative for long term survival of ESRD patients in the developing nation. Organized cadaver donor programs do not exist and transplants are almost exclusively done using living donors.

Despite reduced morbidity and mortality of the donation process it is important to discern patients who are not candidates for organ donation because of the risk on immediate and future health. However, singular abnormalities such as well–controlled hypertension and obesity are no longer considered absolute contraindications to organ donation. Living donors present unique ethical, legal and social implications that must be addressed to protect the health and rights of the donor.

There is a fascinating account of Jochum Hoyer, the German Transplant Surgeon, who donated one of his kidneys to an unknown stranger to publicize the relevant safety of living kidney donation to the German medical profession and public. Dr Hoyer was exposed to quite incredible hostility by many of his colleagues but the growth of live kidney donation in Germany was in no small part related to this act

For Comments and archives…

 
    An Inspirational Story

Padma Shri to Shanti Teresa Lakra

Recently, I met a young nurse Shanti Teresa Lakra who had received a Padma Shri a year after I received it, at the Lady Reading Nursing School, attached to Bada Hindu Rao Hospital. She is a public health nurse who when posted in a tribal area ended up working for them for five years and during this period, she did a lot of service to humanity by serving tribes who were totally disconnected with the outside world. I was so touched with devotion for the cause. In 2010, she received the Florence Nightingale Award which is equivalent to the Dr. BC Roy National Award for doctors. The Florence Nightingale Award was given to her by Vice President Shri Hamid Ansari and after meeting her during the Award function, it was our Vice President who was so impressed with her that he nominated her for the Padma Shri.

Let the story of Shanti Teresa Lakra be an inspiration for our nursing profession to work for the humanity and to aspire for such awards.

For comments and archives

 
   Cardiology eMedinewS

SODA (screening of obesity and diabetes in adolescents) Read More

Yoga for irregular heart Read More

 
   Pedia News

Infant breast milk exposure to tacrolimus negligible Read More

Chlorhexidine baths in PICU cut infections Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient with postprandial hyperglycemia was put on oat bran breakfast.
Dr Bad: It will not work.
Dr Good: It is good for diabetes.
Lesson: Oat bran flour is rich in high beta–glucan and has a low glycemic response. It acts as an active ingredient by decreasing postprandial glycemic response of an oral glucose load in subjects with type 2 diabetes (Source: Nutr Metab Cardiovasc Dis 2005;15(4):255–61).

Make Sure

Situation: A 19-year-old presented with severe acne on face and back. Shall I prescribe only topical ointments?
Reaction: No, prescribe doxycycline as well.
Lesson: Make Sure: Doxycycline is very effective in the treatment of acne vulgaris.

 
  Quote of the Day (Dr GM Singh)

It is only possible to live happily ever after on a day-to- day basis. Margaret Bonnan

 
    Mind Teaser

Read this…………………

What instructions should the client be given before undergoing a paracentesis?

A. NPO 12 hours before procedure
B. Empty bladder before procedure
C. Strict bed rest following procedure
D. Empty bowel before procedure

Yesterday’s Mind Teaser: After Billroth II Surgery, the client developed dumping syndrome. Which of the following should the nurse exclude in the plan of care?

A. Sit upright for at least 30 minutes after meals
B. Take only sips of H2O between bites of solid food
C. Eat small meals every 2-3 hours
D. Reduce the amount of simple carbohydrate in the diet

Answer for Yesterday’s Mind Teaser: A. Sit upright for at least 30 minutes after meals

Correct answers received from: Dr.Jayashree Sen & Dr.Bitaan Sen, Dr Kanta Jain, Dr.(Maj. Gen.) Anil Bairaria,, Dr. P. C. Das, Dr Jainendra Upadhyay, Dr.Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr.K.Raju, Dr. Bharat Bhushan Aggarwal, drjella, Dr.Rejju Rajan, Dr Jainendra Upadhyay Dr. Thakor Hitendrsinh G, DR Chandresh jardosh, Muthumperumal Thirumalpillai, Dr Arpan Gandhi, Dr Kanta jain, Dr Avtar Krishan

Answer for 3rd February Mind Teaser: Contact sports.

Correct answers received from: Dr. Bharat Bhushan Aggarwal, Dr. Bharat Bhushan Aggarwal, drjella, Dr.Jayashree Sen & Dr.Bitaan Sen, Dr Jainendra Upadhyay, Dr. Thakor Hitendrsinh G, DR Chandresh jardosh, Muthumperumal Thirumalpillai, Dr Arpan Gandhi, Dr Kanta jain, Dr Avtar Krishan

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

On Trial

After a trial had been going on for three days, Finley, the man accused of committing the crimes, stood up and approached the judge's bench. "Your Honor, I would like to change my plea from 'innocent' to 'guilty' of the charges."

The judge angrily banged his fist on the desk. "If you're guilty, why didn't you say so in the first place and save this court a lot of time and inconvenience?" he demanded.

Finley looked up wide-eyed and stated, "Well, when the trial started I thought I was innocent, but that was before I heard all the evidence against me."

 
  Medicolegal Update

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

What is the World Medical Association Declaration on Terminal Illness?

On October 1983, the 35th World Medical Assembly in Venice, Italy adopted as below:

  • The duty of the physician is to heal and, where possible, relieve suffering and act to protect the best interests of his patients.
  • There shall be no exception to this principle even in the case of incurable disease or malformation.
  • This principle does not preclude application of the following rules
    • The physician may relieve suffering of a terminally ill patient by withholding treatment with the consent of the patient or his immediate family if unable to express his will.
    • Withholding of treatment does not free the physician from his obligation to assist the dying person and give him the necessary medicaments to mitigate the terminal phase of his illness.
    • The physician shall refrain from employing any extraordinary means which would prove of no benefit for the patient.
    • The physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person.
  • The certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.
  • These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Low cholesterol linked to anxiety, depression, suicide, hemorrhagic stroke and cancers

People with very low cholesterol levels are at increased risk of developing stomach cancer, according to a study published in the International Journal of Cancer, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

The study involved 2,600 residents of Hisayama, Japan, who were followed for 14 years. Gastric cancers developed in 97 subjects. After accounting for age and gender, stomach cancer rates rose significantly with descending cholesterol level. For example, among subjects with the highest cholesterol levels, the gastric cancer rate was the equivalent of 2.1 cases per 1000 persons per year; among those with the lowest cholesterol, the rate was 3.9 per 1000 persons per year.

Patients with low serum cholesterol should consider periodic gastrointestinal examination for the prevention of stomach cancer, said Dr Aggarwal.

Low cholesterol has been earlier linked to depression, anxiety and suicide in both men and women. Another earlier report has also shown that people with cholesterol level below 180 had twice the risk of brain hemorrhage as compared to those with cholesterol levels of 230.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 26331 people since 1stNovember 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

 
    Readers Response

Suggestions on IMA Health Budget Reg Health Insurance for elderly,

  1. Premium amount should be graded with free insurance for poor elderly (BPL Category) and payment by those who can pay.
  2. Rajiv Gandhi Swasthya Beema Yojna to be modified so as to make it more elder friendly.

    Prof. Vinod Kumar, Emeritus Professor, Dept. of Medicine, St Stephens Hospital ,Delhi
 
    Forthcoming Events

ANNOUNCEMENT

Sri Aurobindo Ashram – Delhi Branch will organize the 6th Study Camp on ‘Mind-Body Medicine and Beyond’ for doctors, medical students and other health professionals at its Nainital Centre (Van Nivas) from June 8-14, 2013. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind-body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of the Mind-Body Medicine Clinic at AIIMS, and the author of Back to Health through Yoga, Eating Wisely and Well and Essays on Yoga. For more details, send an e-mail to the Ashram (aurobindo@vsnl.com) or to Dr. Bijlani (rambij@gmail.com).

 
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