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
Dr KK Aggarwal

From the Desk of Editor in Chief
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


6th August, 2010, Friday

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

In MLC case, dead body can not he hander over to relations: DMC 

  

 In a meeting of Delhi Medical Council held on 20th July, 2010 under the chairmanship of Dr. A K Agarwal, President, various issues were discussed and many important decisions were taken.

  1. It is the duty of the hospital to inform the patient beforehand about all types of medical treatments being offered by them which are not covered under the CGHS scheme by displaying this information in a conspicuous place in the hospital premises so that it comes into public notice.
  2. In a situation where there is a deficiency of service, it will be the collective responsibility of the whole unit starting from the Consultant HOD to the Junior Resident. Disciplinary action may be taken against all of them even if the senior did not see the patient.
  3. If a patient is admitted whose MLC has been done in another hospital, it is the duty of the hospital to inform the police regarding the same. Similarly, if a MLC patient is being discharged, Police needs to be informed.
  4. If an MLC patient, whether or not MLC was done in your set up dies, the police needs to be informed.
  5. In MLC death, the body has to be handed over to the police and in no case released to the relations.
  6. “That I am seeing a large number of patients in General OPD” cannot be the excuse for not documenting the findings at the OPD card. A prescription containing only drugs without findings is not a valid prescription as per the Council.
  7. ‘Can a general surgeon do gynecology surgery’ was a matter of debate. Most of the members were of the view that unless it is a life-threatening situation, a surgeon should operate only in the presence of gynecologist. 
  8. For a complaint to be valid in Delhi Medical Council, it has to be submitted in writing and must be signed by the complainant. Email complaints are not solicited. 
  9. It was clarified that professional deficiencies can also be covered under professional misconduct since as per Medical Council of India, any violation of MCI Ethics Act comes under professional misconduct and the act clearly defines the physician’s responsibility towards the patient and any neglect in the patient care is a violation of the medical ethics act.
  10. How many patients should a doctor see in an hour? Though the matter did not take a formal discussion, one of the council members quoted that as per the CGHS rules, a doctor can see up to a maximum of 40 patients in 3 hours. 
  11.  As per Clause 6.11 of the Medical Council of India Act, “Soliciting of patients directly or indirectly by a physician, by a group of physicians, or by institutions or organizations is unethical”.  It was discussed that the recent mushrooming of advertisements being released by various hospitals and institutions is unethical under the clause 6.11 of the Act. DMC may issue an advertisements / send letters to all hospitals about this clause. It was further discussed that soliciting of patients directly or indirectly also covers keeping marketing executives/departments  to solicit patients by way of giving commission. 
  12.  Paid editorials –  Advertorials or paid editorials are unethical under the Medical Council of India Act.
  13.  The clause 2.4 of the Medical Council of India Act:  in this a doctor is free to choose his patients but he is bound to assist any emergency.

Dr KK Aggarwal
Editor in Chief
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Photo Feature (From HCFI file)

A press conference was organised to announce the event eMedinewS Revisiting 2009 held on January 10, 2010 at Maulana Azad Medical College, New Delhi. ‘eMedinewS Doctor of the Year Awards’ were also presented to eminent physicians during the event.

 In the photo: Vipin Aneja, Singer and Padma Shri & Dr B C Roy National Awardee Dr KK Aggarwal, President HCFI, Dr Anupam Sibbal Medical Director Apollo Hospitals.

Dr k k Aggarwal

 

News and views

National News

Meeting of the State Medical Councils on 9th August, 2010

The Board of Governors of Medical Council of India has called for an interactive meeting with all the State Medical Councils on 9th August, 2010. The meeting will deliberate on methods to ensure registration of all medical graduates and postgraduates, composition of ethical committee of the country, status of complaints reports of the last one year etc.

Hrithik says no to smoking!

Bollywood heartthrob Hrithik Roshan has finally decided to quit smoking and asked his fans to join in. Good news for all of us. Use this oppertunity to ask our patients to quit smoking by saying " when hrithik has decided to quit why can't you".

International News

Evaluation and treatment of severe asymptomatic hypertension (Dr G M Singh)

It is important to distinguish hypertensive emergency from severely elevated BP without signs or symptoms of end–organ damage (severe asymptomatic hypertension) in cases presenting with severely elevated BP (i.e., systolic BP ≥ 180 mm Hg, or diastolic BP ≥ 110 mm Hg). Most patients who are asymptomatic but have poorly controlled hypertension do not have acute end–organ damage and, so do not require immediate workup or treatment (within 24 hours). However, BP readings readings should be confirmed and the hypetensive state appropriately classified. A cardiovascular risk profile serves as an important guide to the treatment of severe asymptomatic hypertension; higher risk patients may benefit from more urgent and aggressive evaluation and treatment. Oral agents may be initiated before discharge, but intravenous medications and fast–acting oral agents should be reserved for true hypertensive emergencies. High blood pressure should be treated gradually.

As people live longer, more will develop cataracts

Most people who live into their 70s and beyond will develop cataracts at some point of time. A baseline eye screening exam should be done at age 40 when early signs of disease and vision change may be evident. Risk factors for cataract include family history, having diabetes, smoking, extensive exposure to sunlight, serious eye injury or inflammation, and prolonged use of steroids, especially combined use of oral and inhaled steroids. The risk of cataract can be reduced by wearing UV–rated sunglasses and a wide–brimmed hat when outdoors, and quitting smoking. Diabetics should carefully control their blood sugar levels through diet, exercise and, if needed, medications. (American Academy of Ophthalmology)

Steroid injections may alleviate sciatica (Dr Monica and Dr Brahm Vasudev)

Findings of a randomized trial suggest that injection of steroids into the affected spinal nerve may relieve lumbar radicular pain better than other types of injections, albeit in only a proportion of patients. In their study, Nikolai Bogduk, MD, of the University of Newcastle, Australia, and colleagues found that transforaminal corticosteroids relieved at least half of the back pain at one month in 54% of patients (95% confidence interval 36% to 72%).

Polyarthritis, ESR predict psoriatic arthritis outcome

Certain clinical features such as polyarthritis and elevated erythrocyte sedimentation rate lessen the likelihood that patients with psoriatic arthritis will achieve sustained minimal disease activity. On multivariate logistic regression analysis, the odds ratio for minimal disease activity among patients with more than four tender or swollen joints was 0.296 (95% CI 0.171 to 0.511, P<0.0001). These findings were noted in an observational cohort study as reported by Laura C. Coates, MBChB, of the University of Leeds in England, and colleagues

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Medical Testimony of Doctor in the Court of law (Contd …)

Medical literature/document produced as evidence in the court of law must be a published one. For a document to serve as legitimate evidence in a trial/debate, it must exist in the public domain i.e. the document must potentially be available to any debater researching the topic or lawyer/interested party of cross examining side. Unpublished documents are privileged information, and using such information gives the doctor an unfair advantage. Academic debate does not have a discovery rule. The only opportunity your opponents have to examine your documents prior to a trial/debate is to have found the documents during their own research. That they may not have taken the opportunity to do so, or did not discover a document, does not obviate the rule. The advent of the Internet has created a new form of publication – electronic documents like this e–medinews. Electronic documents are accepted as published if they are accessible by the general public. Thus, electronic files to which other debaters would be denied access are not published. However, files and documents which other debaters may access, even if they have no subscription to a commercial service to do so, satisfy the publication rule.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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


Chronic pancreatitis

  1. Chronic pancreatitis is where permanent morphological changes are seen in the pancreas either the glands or duct.

  2. Recurrent pancreatitis may be familial as a result of inherited biochemical or anatomic abnormalities.

Question of the day

What is the management for constipation in infant, children and adolescents?

Treatment of constipation depends on the cause. Generally, treatment of refractory constipation is prolonged and is a combination of diet correction, laxatives and enemas.

  • In case the child has a fissure, local application of xylocaine jelly and Seitz baths relieve pain.

The commonest laxative used is liquid paraffin, but prolonged use can result in seepage and irritation and reduced absorption of fat soluble nutrients. Lactulose can be used for longer periods.

  • It is important to investigate the child to know the exact cause of constipation during palliative treatment.

  • Barium enema and anorectal manometry to rule out Hirschsprung's disease.

  • Full thickness rectal biopsy.

  • A study of colonic transit time is also done to see which part of the large bowel is responsible for stagnation of the bowel contents.
 

Public Forum (Press Release for use by the newspapers)

People who are both obese and have diabetes are highly likely to develop heart disease during their lifetime, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil ka Darbar & MTNL Perfect Health Mela.

In a study published in the journal Diabetes Care, it has been shown that women who are obese and diabetic have 80% and men 90% chance of developing heart disease at some point. In the study, lifetime risk was based on the likelihood that a 50–year–old would develop heart disease in the next 30 years.

Obesity and diabetes commonly go hand–in–hand. Diabetes on its own significantly raises the lifetime risk of heart disease, and that obesity worsens the situation.

The lifetime heart disease risk of normal-weight women who do not have diabetes is 34 percent. The risk for normal-weight women with diabetes is 55 percent.

Among obese women, those who do not have diabetes, there is 47 percent chance of developing heart disease, while the risk for those with diabetes is 79 percent.

The pattern is similar for men, with a lifetime heart disease risk of 49 percent among normal–weight, non–diabetic men, and a 77 percent risk for normal–weight men with diabetes. Obese men without diabetes have 67 percent lifetime heart disease risk, while the risk for obese diabetic men is 87 percent.

 

Conference Calendar

ICPP 2010 - International Conference on Positive Psychology: A New Approach to Mental Health

Date: August 6-8, 2010,
Venue: Amity University, Jaipur, Rajasthan.

 

Medi Finance

Q. A doctor’s minor son is getting income (bank interest). Is it taxable in the doctor’s account?

Ans. Yes, according to provisions of ‘clubbing of income’ it is taxable. However, a deduction of Rs. 1,500 is allowable from such income.

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An Inspirational Story

How Rich Are We?

One day a father and his rich family took his son on a trip to the country with the firm purpose to show him how poor people can be. They spent a day and a night on the farm of a very poor family. When they got back from their trip, the father asked his son, "How was the trip?" "Very good Dad!" "Did you see how poor people can be?" the father asked. "Yeah!" "And what did you learn?"

The son answered, "I saw that we have a dog at home, and they have four. We have a pool that reaches to the middle of the garden; they have a creek that has no end. We have imported lamps in the garden; they have the stars. Our patio reaches to the front yard; they have a whole horizon." When the little boy was finished, his father was speechless. His son added, "Thanks, Dad, for showing me how 'poor' we are!"

Isn’t it true that it all depends on the way you look at things? If you have love, friends, family, health, good humor and a positive attitude towards life –– you’ve got everything! You can't buy any of these things. You may have all the material possessions you can imagine, provisions for the future, etc.; but if you are poor of spirit, you have nothing!

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with burn injury on the hand came with blisters.
Dr.Bad: I will puncture them.
Dr.Good: Be careful to not puncture them.
Lesson: Blisters are a natural dressing and should not be punctured.

Make Sure

Situation: A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.
Reaction: Oh my God! Why was the anti–platelet agent started?
Lasson: Make Sure that before starting intergrilin the BP is checked. Severe hypertension i.e., systolic BP ≥ 200 mmHg or diastolic BP >110 mmHg not adequately controlled on antihypertensive therapy is a contraindication for intergrilin therapy.

Good Slogans (Dr Chandresh Jardosh)

Sign on a railway station at Patna: 
Aana free, jaana free, 
pakde gaye to khana free.

Are you fit to fly?

Low Hemoglobin

  1. Patients with hemoglobin < 8.5 g/dL generally should be given supplemental oxygen, unless the anemia is known to be well compensated.

  2. Anemic patients are at risk for lightheadedness and loss of consciousness during flight, even with minimal exertion, e.g, walking to the lavatory.
 

International Medical Science Academy Update (IMSA)

A systematic review found no evidence supporting the use of PSA velocity for clinical decision making (J Clin Oncol 2009;27:398)

 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Piroxicam 20mg tab & Paracetamol 500mg tab combikit

For treatment of fever and pain associated with acute upper respiratory tract inflammation, acute musculoskeletal disorders, pain after operative intervetion and following trauma, chronic condition like rheumatoid arthritis, osteoarthritis etc for short term management of acute painful episodes.

19–Jan–10

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Laboratory Tests for Lung Diseases

  • Blood gases: An arterial blood sample is collected to evaluate blood pH, oxygen and carbon dioxide
  • Complete blood count (CBC): To look for anemia.
  • Cystic fibrosis tests: CF Gene Mutation Testing
  • Alpha–1 antitrypsin: To determine if patient has AAT deficiency.
  • Sputum culture: To diagnose lung infections caused by bacteria.
  • AFB smear and culture: to diagnose tuberculosis and nontuberculous mycobacteria (NTM).
  • Blood cultures: To diagnose bacteria and sometimes yeast infections that have spread into the blood.
  • Influenza tests.
  • Lung Biopsy and Sputum cytology: To evaluate lung cells for abnormal changes and for cancer..
 

Lateral thinking

Read this………………

ecnalg

Send in your answer to emedinews@gmail.com

The answer for yesterday's puzzle "he’s by himself"

Correct answers received from: DR. ASHOK WASAN, Dr Ashok Kumar, Dr Santvana Pandey

More Correct answers received of 4th August Puzzle: Dr Ashok Kumar

 

Humor Section

Jokes

Dentist begging the patient: Could you help me? Could you give out a few of your loudest, most painful screams?
Patient: Why? Doc, it isn’t all that bad this time.
Dentist: There are so many people in the waiting room right now and I don't want to miss the 4 o'clock ball game.

Funny One Liners

A French in a hotel in NY, phoned room service for some pepper.

Attendant: Black pepper or white pepper?

French: Toilette pepper!

 

Readers Responses

  1. Dear Dr Aggarwal: Namastey, At the outset I wish to express my gratitude for doing such a noble job for the first time in the history of medicine by bringing such an informative and update medical newspaper early in the morning without any break. It is well fitting to write here AS THE HEART NEVER TAKES ANY REST SO DOES Dr K.K. AGGARWAL as far as the daily eMedinews is concerned.  Some times back I came across a small write up of ECP in one of your daily eMedinews but it should be quite detailed one. Because in patients who are not fit for any intervention, we are left with no option but to advise ECP particularly if the patient is not responding to an optimal anti-ischemic therapy. So it would be nice of you if you could accept my request to write a Detailed & an update on ECP. Secondly is there any rationale of performing an angiogram in a case of cardiomyopathy? Dr Arnav Garg
     
    eMedinewS Responds: ECP(external counterpulsation) is not yet approved by FDA for general use and is reserved for only refractory angina cases. In cardiomyopathy angio is only neede if the DSE dobutamine stress echo is positive and you want to rule out an ischemic angioplastable lesion.
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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