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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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  Editorial …

5th August 2011, Friday

Sonia Gandhi to undergo surgery in US

UPA chairperson Sonia Gandhi will undergo surgery in the United States for an undisclosed medical condition. Not disclosing her condition is her right. Her doctors also cannot disclose her condition. Health bulletins are not allowed in the US.

Its time to revise can a doctor disclose the medical condition of the patient? (1998) 8 SCC 296: Supreme Court of India: CIVIL APPEAL NO. 4641 OF 1998 JUDGMENT S. SAGHIR AHMED. J.

  1. Principle of "duty of care", as applicable to persons in medical profession, includes the duty to maintain confidentiality.
  2. Duty to maintain confidentiality has its origin in the Hippocratic Oath, which is an ethical code attributed to the ancient Greek physician Hippocrates, adopted as a guide to conduct by the medical profession throughout the ages and still used in the graduation ceremonies of many medical schools and colleges. Hippocrates lived and practiced as physician between third and first century BC. He has referred to by Plato as a famous Asclepiad who has philosophical approach to medicine. His manuscripts, the Hippocratic Collection (Corpus Hippocracticum), contained the Hippocratic Oath which is reproduced below:

    "I swear by Apollo the physician and Aesculapius and health and all–heal and all the gods and goddesses that according to my ability and judgment I will keep this oath and this stipulation – to reckon him who taught me this art equally dear to me as my parents, to share my substance with him and relieve his necessities if required, to look upon his offspring in the same footing as my own brothers and to teach them this art if they shall wish to learn it without fee or stipulation and that by precept, lecture, and every other mode of instruction I will impart a knowledge of the art to my own sons and those of my teachers and to disciples bound by a stipulation and oath according to the law of medicine but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked nor suggest any such counsel, and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my art. I will not cut persons laboring under the stone but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption, and further, from the seduction of females or males, of freeman and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad. I will not divulge as reckoning that all such should be kept secret. While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times, but should I trespass and violate this oath, may the reverse be my lot."
  3. The Hippocratic Oath consists of two parts. The first, or covenant, is the solemn agreement concerning the relationship of apprentice to teacher and the obligations enjoined on the pupil. The second part constitutes the ethical code.
  4. It is on the basis of the above that the International Code of Medical Ethics has also laid down as under: "A Physician shall preserve absolute confidentiality on all he knows about his patient even after his patient has died."
  5. The Indian Medical Council Act controls medical education and regulates the professional conduct. Section 20A, which was inserted by the Indian Medical Council (Amendment) Act 1964 provides as under: Professional Conduct: 33: Code of ethics: "Do not disclose the secrets of a patient that have been learnt in the exercise of your profession. Those may be disclosed only in a Court of Law under orders of the presiding judge."
  6. In the doctor–patient relationship, the most important aspect is the doctor’s duty to maintain secrecy. A doctor cannot disclose to a person any information regarding his patient which he has gathered in the course of treatment nor can the doctor disclose to anyone else the mode of treatment or the advice given by him to the patient.
  7. Hippocratic Oath as such is not enforceable in a court of law as it has no statutory force.
  8. Medical information about a person is protected by the code of Professional Conduct made by the Medical Council of India under Section 33(m) read with Section 20A of the Act.

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  eMedinewS Audio PostCard

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

Sonia Gandhi undergoes surgery in US

Audio PostCard
 
    Photo Feature (From HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issue

Dr Sudhir Gupta was felicitated in the National Conference on Insight on Medicoleagl Issues held on 10th July, 2011.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook – Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

eMedinewS congratulates Dr K Srinath Reddy on his grand achievement

Dr K Srinath Reddy was awarded D. Sc. by the University of Aberdeen on 6th July, 2011. He is the first Indian to be awarded in the last 2 years.

Post–immunisation surveillance stepped up

India has taken major steps to improve surveillance and case management for Adverse Events Following Immunisation (AEFI), Health Minister Ghulam Nabi Azad said on Tuesday. It had also joined the global post–marketing surveillance network for new vaccines, with Maharashtra as the participating State. The monitoring mechanism for AEFI was strengthened and new reporting guidelines were published and widely disseminated. "We are now closely monitoring AEFI cases to enhance public confidence in our immunisation programme." Mr Azad was addressing a high–level ministerial meeting of the South East Asia Region of the World Health Organisation (WHO) on ‘Increasing and Sustaining Immunisation Coverage’ here. "India strongly believes that vaccination is one of the most cost–effective public health interventions since it provides direct and effective protection against preventable morbidity and mortality. Therefore, we remain committed to increasing and sustaining quality immunisation coverage."
(Source: http://www.thehindu.com/news/national/article2317188.ece, August 3, 2011)

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

(Dr Monica and Brahm Vasudev)

Colon detox not backed by science

Colon cleansing has no evidence to support its use, and can lead to pain, vomiting, and fatal infections, according to a new report. "A search of the literature using the terms ‘colon cleansing,’ ‘herbal colon cleanse,’ ‘colon detoxification,’ and ‘colon irrigation,’ yielded no scientifically robust studies in support of this practice," wrote Ranit Mishori, MD, of Georgetown University in Washington, D.C., and colleagues, in the August Journal of Family Practice. (Source: Medpage Today)
For comments and archives

IL–13 blocker helps asthma control

Asthma patients with poorly controlled symptoms on inhaled steroids had significant improvement in lung function during 12 weeks of treatment with an investigational interleukin–13 (IL–13) inhibitor, investigators reported. Forced expiratory volume at one second (FEV1) increased by 9.8% with lebrikizumab versus 4.3% in placebo–treated patients, according to Jonathan Corren, MD, of Allergy Medical Clinic in Los Angeles, and co–authors. Treatment with the anti–IL–13 monoclonal antibody did not reduce exacerbations in the overall population, but was associated with a 60% decrease in the exacerbation rate among patients with elevated levels of type 2 helper T cell (Th2), they reported online in the New England Journal of Medicine. (Source: Medpage Today)
For comments and archives

Urine test may help detect, stratify prostate cancer

In men with elevated prostate specific antigen (PSA), an investigational urine test can detect and stratify prostate cancer, researchers reported. The test is based on the detection of a gene fusion that is specific to prostate cancer, combined with another marker, according to Arul Chinnaiyan, MD, PhD, of the University of Michigan Medical School in Ann Arbor, and colleagues. Stratifying patients by the combined marker identified groups with markedly different risks of cancer, high–grade cancer, and clinically significant cancer on biopsy, Chinnaiyan and colleagues reported online in Science Translational Medicine. The noninvasive test could allow some men with elevated PSA to avoid a needle biopsy, the researchers noted. (Source: Medpage Today)
For comments and archives

Study warns parents about rise of children multi–screening

Parents should be aware of the rise of "multiple screen" viewing among children on devices including televisions, smartphones and portable games consoles, when monitoring whether they are being active enough, researchers say. A sedentary lifestyle – linked to spending lots of time watching TV and playing computer games – is thought to increase the risk of obesity and mental health problems, researchers at Bristol and Loughborough universities said in a study published on Wednesday. (Source: http://www.guardian.co.uk/society/2011/aug/03/study–children–multi–screen–viewing, 3 August 2011)

For comments and archives

 
   Fitness Update

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

Chew more, eat less?

Nutritionists in China found when both lean and obese young men chewed more at a meal, they ingested fewer calories and had more favourable levels of gut hormones in their blood, lending credence to the old Swedish proverb that says, among other things, "Eat less, chew more", and "all good things will be yours". You can read about the study by Jie Li and colleagues from the School of Public Health at Harbin Medical University, in the August issue of the American Journal of Clinical Nutrition. Li and his team invited 16 lean and 14 obese young men to take part in two studies. In the first study, they observed the differences in chewing habits between the lean and the obese group.
For comments and archives

 
   Twitter of the Day

@DrKKAggarwal: #AJD We’re eating less sugar –– but still far too much We’re eating less sugar –– but still far too much… http://fb.me/15NTDC5AA

@DeepakChopra: Let’s change the way we engage with the world. What if 100 people took my challenge for dedicated consciousness today?

 
    Dr KK Answers

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

What are the medical interventions for carotid blockages?

The interventions are management of hypertension, smoking cessation, use of statin drugs and low–dose aspirin.
For comments and archives

 
    Spiritual Update

As is the atom so is the universe

Yatha Pinde Tatha Brahmande or as is the atom so is the universe, is a traditional Vedic saying, which has a deep social meaning in today’s context.
For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

A good person

What really constitutes a good person? This is one of the questions I have in my life that I long to find the answer for. Does being an upright citizen equate to being a good man?

Does going to church regularly and paying your colleagues compliments that they are due make you virtuous and moral? Is it enough to do good things for other people to make you an ethical and just human being?

With all the norms that the society we live in sets for being good, sometimes, it’s just too easy to be bad. Whether that takes the form of gossiping about your co–worker, cheating on a test, changing lanes too fast or merely having malicious thoughts of others, I’ve done all sort of things that I can never be proud of, nor justify. Sometimes, it’s just way too easy to be bad.

The idea of being good is occasionally easier said than done. Doing something I already regard as greatly noble may not be good enough to the person sitting next to me. Let’s admit it; we can never please everyone, no matter how we try.

I've just recently stopped apologizing for my existence and started to accept and love myself. I have realized that the key to becoming a truly good person is in also accepting the parts of my personality that I am not very proud of. I have stopped resisting my nature, instead, tried to work my way around it. I have come to admit that I am not perfect and I do succumb to temptation sometimes. What matters is the fact that every day, I try to be a better person than I was yesterday. If I fail, I try again.

Somebody once said, "I may not be a nice person, but I am a good human being". Being good is like beauty. It is a biased, prejudiced, over–rated and subjective issue. I’ve learned not to put too much pressure on myself with all the standards that our society has. Instead, I try to simplify them by struggling not to step on anyone’s shoes. Then maybe… just maybe, I can be a good person in the process.
For comments and archives

 
    Idioms

(By Ritu Sinha)

Back to the drawing board: When an attempt fails and it’s time to start all over.

 
    Pediatric Update

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

What are the criteria/warning signs for Dengue?

Warning signs (require strict observation and medical intervention)

• Abdominal pain or tenderness
• Persistent vomiting
• Clinical fluid accumulation
• Mucosal bleed
• Lethargy, restlessness
• Liver enlargement >2 cm
• Laboratory: increase in HCT concurrent with rapid decrease in platelet count

Probable dengue

• Living in /travel to dengue endemic area.
• Fever and 2 of the following criteria:

◊ Nausea, vomiting
◊ Rash
◊ Aches and pains
◊ Tourniquet test positive
◊ Leukopenia
◊ Any warning sign

Laboratory–confirmed dengue (important when no sign of plasma leakage)

For comments and archives

 
    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

What is the importance of Hepatitis A vaccine?

Hepatitis A vaccine (HA) is recommended for any women at high risk, including those receiving clotting factor concentrates, those with chronic liver disease, women working with HA virus or HA–infected laboratory animals, women traveling to countries with a high prevalence of HA infection, and intravenous drug users. The vaccine contains inactivated virus and poses no known risk to the fetus.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Creatine kinase–MB

Also known as: CK MB, CPK MB

CK–MB is one of three forms of the enzyme creatine kinase (CK). CK–MB blood concentration rises when there is damage to heart muscle cells.

CK–MB levels, as well as total CK levels, are tested in persons who have chest pain to diagnose whether they have had a heart attack. Since a high total CK could indicate damage to the heart but also to other muscles, CK–MB helps to distinguish between both cases.
For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with community–acquired pneumonia was put on 750 mg levofloxacin.
Dr Bad: Take 500 mg for 10 days.
Dr Good: Take it for 5 days.
Lesson: The anti–pneumococcal fluoroquinolones (e.g., levofloxacin, moxifloxacin, gemifloxacin) have been used for 5 to 14 days in inpatients and outpatients with community–acquired pneumonia with most patients having a good clinical response within 2 to 3 days. Using a higher dose of a levofloxacin may decrease the duration of therapy; 750 mg for five days was as effective as 500 mg for 10 days and was associated with a more rapid resolution of fever (Clin Infect Dis 2003;37:752–60).
For comments and archives

Make Sure

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.
For comments and archives

 
  Quote of the Day

(Dr GM Singh)

Man’s troubles are rooted in extreme attention to senses, thoughts, and imagination. Attention should be focused internally to experience a quiet body and a calm mind. Buddha

 
    Medicolegal Update

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

What are the organo phosphorous poisons?

They are derived from phosphoric acids and form two series of compounds known as alkyl phosphates, and aryl phosphates

  • These are basically chemical insecticides and used to prevent agricultural products but when ingested by humans adversely affect health or may become life–threatening.
  • Fatal dose: TEPP 50 mg IM or 100 mg orally/OMPA 80 mg IM or 175 mg orally/Parathion 80 mg IM or 175 mg orally/HETP 60 mg IM or 350 mg orally/Malathion and diazinon 1g orally
  • The fatal period is usually within 24 hours in untreated cases and within 10 days in those treated cases when treatment is not successful. In non–fatal cases, the acute effect lasts for 6 to 30 hours which disappear in 2 to 3 days but may sometime persist for 2 weeks. Complete recovery occurs in 10 days in patients treated early.
  • Atropine is the antidote.
  • Cause of death is by paralysis of respiratory muscles, respiratory arrests due to failure of respiratory centre or intense bronchi constriction resulting in respiratory failure.

For comments and archives

 
    Mind Teaser

Read this…………………

The earliest manifestation of increased intracranial pressure following head injury is:

a. Ipsilateral papillary dilation
b. Contralateral papillary dilatation
c. Altered mental status
d. Hemiparesis

Yesterday’s Mind Teaser: Which of the following is true about Langer’s line of the skin?

a) These are in the direction of muscle fibres
b) These are perpendicular to the long axis of underlying muscle fibres
c) Most favorable incision is circular over an exposed area
d) Most favorable incision is a rhomboid shaped one over an exposed area

Answer for yesterday’s Mind Teaser: b) These are perpendicular to the long axis of underlying muscle fibres

Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay,
Dr Surendra Bahadur Mathur, Dr Chandresh Jardosh, Dr Suneera.

Answer for 3rd August Mind Teaser: 3. Duct papilloma
Correct answers received from: Dr Yogindra Vasavada, Dr Dilip Kumar Jha, Dr Prashant Bharadwaj,
Dr Ragavan, Dr Prabha Sanghi, Dr Priyanka Sharma.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Funny defination:

Cardiovascular: "The three kinds of blood vessels are arteries, veins, and caterpillars."

For comments and archives

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
Indication
DCI Approval Date
Dasatinib 20mg/50mg/70mg (Additional Indication)
Treatment of newly diagnosed adults with chronic myeloid leukaemia (CML) in chronic phase.
16.03.11
 
    Public Forum

(Press Release for use by the newspapers)

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

Bloated and Gassy Feeling in the abdomen is related to faulty lifestyle

If you constantly feel bloated or gassy, then you can cut down on foods and food habits that worsen symptoms of gas in the abdomen said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

As per traditional Ayurveda, foods that split equally into two parts produce gas. The examples are pulses, Rajma (Red Kidney Beans), Chole (Chickpeas) etc. One should cook them after soaking them in water for few hours or cook them with asafoetida.

Foods that grown on the ground surface such as cauliflower, broccoli, cabbage etc. if eaten raw produce gas. Similarly, foods that grow under the ground e.g. onion, radish, carrot etc produce gas if eaten raw or without soaking them in water.

What can be done?

  1. Cut down on gas–producing foods such as beans, dairy products, bran and whole wheat foods.
  2. Limit gas–forming vegetables such as onions, broccoli, cabbage and brussel sprouts.
  3. Limit gas causing fruits such as peaches, apples and pears.
  4. Some people are fructose–intolerant and do not tolerate fruits.
  5. Those who are fructose–intolerant may find that many sodas contain fructose and produce the same problems.
  6. Limit sugary fruit drinks and carbonated soft drinks.
  7. Limit artificial sweeteners such as maltitol, mannitol, sorbitol, xylitol and other sugar alcohols, as they can increase bloating.
  8. Several habits can increase the amount of air you take in. These include: Eating too quickly, gulping beverages, loose or poorly–fitted dentures, drinking though a straw, excessive swallowing due to nervous tension, excessive swallowing due to postnasal drip and chewing gum or sucking on candy.
  9. Avoid swallowing excessive air by eating slowly and chewing thoroughly. If you gulp food, or eat too quickly, you may swallow excess air, leading to gas and bloating. Normally, about half of passed gas comes from swallowed air.
  10. Too much stress can cause your stomach and colon to go into spasms, leading to uncomfortable gas and bloating. When under stress, one also eats more.
  11. Exercising helps the body to absorb gases in the colon. Aerobic exercise for at least 30 minutes every day can help to counter constipation.
  12. Lactose–intolerance is a relatively common food allergy. Milk, dairy products, and medications that contain lactose can produce gas. Lactose that is not completely digested will pass to the colon where gas is produced by the bacteria trying to break it down.
  13. Certain vegetables produce more gas. Baked beans, Broccoli, Brussels sprouts, Cabbage, Cauliflower, Lentils and Lima beans and Fatty foods (they slow digestion, giving food more time to ferment).
  14. Starches that produce gas are wheat, corn and potatoes
  15. Some drugs such as those that inhibit digestive enzymes or contain indigestible sugars like lactulose or sorbitol, can cause gas-related symptoms. Antibiotics are known to cause excess gas because they kill the beneficial bacteria in the colon that normally aids in digestion.
  16. Most people tilt their head forward when they use a straw to drink. This puts the air in your mouth above the liquid when you swallow and leads to more gas in your system.

For comments and archives

 
    Readers Responses
  1. Dear Sir Your editorial on Nag panchmi was very informative. Regards: Dr Priya
 
    Forthcoming Events

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.

...more

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