emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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

 

eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

 
  Editorial …

8th July 2011, Friday

Wrong–site surgery is not that uncommon

In a recent report by the Joint Commission Center for Transforming Healthcare it has been shown that despite intense efforts to prevent wrong–site surgery (WSS) the adverse event "that should never happen" occurs about 40 times a week nationwide in the US. Research has shown that there is usually no single root cause of failure. Instead, such events are frequently the result of a cascade of small errors.

The 1999 Institute of Medicine report, To Err Is Human reported that over 100,000 such errors occur annually in US alone. Of great concern is WSS, which encompasses:

1. Surgery performed on the wrong side of the body
2. Surgery performed on the wrong site of the body
3. Wrong surgical procedure performed
4. Surgery performed on the wrong patient

This includes cases done in OT or outside the OT such as a special procedures unit, an endoscopy unit, and an interventional radiology suite.

WSS is a sentinel event (i.e., an unexpected occurrence involving death or serious physical or psychological injures) by the Joint Commission which found WSSs to be the third–highest–ranking event. State licensure boards impose penalties on surgeons for WSS and some insurers no longer pay for WSS. Surgery performed on the wrong site or wrong person has also often been held compensable under malpractice claims.

Regardless of the exact number of WSSs, they are seen as a preventable medical error if certain steps are taken and standardized procedures are implemented in the peri–operative setting.

Risk factors associated with WSS were identified as emergency cases, multiple surgeons, multiple procedures, obesity, deformities, time pressures, unusual equipment or setup, and room changes.

Dr KK Aggarwal
Group Editor in Chief

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  Changing Practice – Evidence which has changed practice in last one year

Patients treated with spironolactone or eplerenone should undergo serial monitoring of the plasma potassium concentration and renal function.

 
  eMedinewS Audio PostCard

Padma Shri & Dr BC Roy National Awardee
Dr K K Aggarwal on

Wrong-site surgery is not that uncommon

Audio PostCard
 
    Photo Feature (From HCFI Photo Gallery)

Delhi Medical Association Doctors’ Day Function

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal addressing the gathering at a function organized by the DMA on the occasion of Doctors’ Day.

 
Dr K K Aggarwal
 
    National News

14 deaths during Amarnath Yatra so far

So far, over 150,000 pilgrims have performed the Amarnath Yatra from both the north and the south Kashmir routes and 14 pilgrims have died most with cardiac arrests.

The arterial partial pressure of oxygen (PaO2) decreases with altitude, resulting in progressive reduction in tissue oxygen. High–altitude illness is a collective term for diseases that can develop following an initial ascent to high altitude or following a further ascent while already at high altitude. High–altitude illness includes acute mountain sickness; high–altitude cerebral edema, which afflict the brain; and high altitude pulmonary edema, which afflicts the lungs. Individual factors associated with an increased risk for high–altitude illness include: past history of high–altitude illness (strongly predictive if conditions are similar); rate of ascent; vigorous exertion prior to acclimatization; substance abuse (alcohol); associated diseases that interfere with respiration (neuromuscular disease) or circulation (pulmonary hypertension).

Tough checks on clinical trials mooted

HYDERABAD: Tough regulations are in the pipeline to monitor clinical trials on human subjects in the country. The bio–medical research on human participation (promotion and regulation) bill which is expected to be introduced in Parliament later this year will provide for a single agency monitoring mechanism. As of now there is confusion between various government agencies on who exactly should be monitoring the clinical trials on human subjects. Though the Drugs Controller General of India (DCGI) is the body which does the monitoring now, other government agencies also have a role to play. "We can even think of making it necessary for volunteers for human clinical trials to register with a government body first. This way we can make sure that their interests are protected when clinical trials are conducted on them," said Indian Council of Medical Research (ICMR) director–general V M Katoch. (Source: TOI, Jul 5, 2011)

New voting system put on trial run

JAISALMER: A voter after casting his vote on the electronic voting machine (EVM) will now get a receipt which has to be put in a ballot box. The new system is part of changes being adopted by the Election Commission of India (ECI). The ECI has decided to experiment new process in EVM as pilot project in one district each in five states selected on geographical conditions. The five districts include Jaisalmer, Cherapunji, Ladakh, Tiruvanthapuram and Delhi. Training for the new system called Voter Verifiable Paper Audit Trail (VVAT) was organised on June 25, experimental voting will be done on July 24 under the new voting system at 35 voting centres in the district. (Source: TOI, Jul 4, 2011)

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

 
    International News

(Dr Monica and Brahm Vasudev)

Little evidence of benefit of glucosamine & chondroitin for osteoarthritis

The preponderance of evidence from high quality trials has shown little evidence of clinically meaningful benefit of Glucosamine and chondroitin for osteoarthritis. These conclusions are supported by a network meta–analysis of the large randomized trials in patients with osteoarthritis of the knee or hip that compared glucosamine, chondroitin, or their combination and showed no evidence of clinically relevant benefit. The findings were published in 2010 in the British Medical Journal. Similar findings are seen in a two year follow–up of the GAIT trial published in 2010 in Ann Rheum Dis, in which over 1500 patients with painful osteoarthritis of the knee were randomly assigned to receive either placebo, glucosamine hydrochloride, chondroitin sulfate, glucosamine plus chondroitin sulfate, or celecoxib.

Needle biopsy can aid in breast cancer triage

In newly diagnosed invasive breast cancer, preoperative needle biopsy of the axillary nodes can help triage women directly to axillary node dissection, a new meta–analysis shows. The approach could be particularly useful in women at higher risk of metastases, such as those with tumors of at least 20 mm, said coauthors Dr. Nehmat Houssami of the University of Sydney, Australia and colleagues. (Source: Medscape)

Anticholinergics linked to mental decline in seniors

The use of medications with anticholinergic effects was associated with significant cognitive decline and increased mortality among older adults, a longitudinal British study found. (Source: Medpage Today)

European lipid guidelines released

Lifestyle interventions should be tried before anything else in patients with dyslipidemias, new guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) state. Only if changes in diet, exercise, and other behaviors fail should drug treatment be initiated, according to the guidance, which was crafted by a task force chaired by Alberico Catapano, MD, of the University of Milan, for the EAS and Zeljko Reiner, MD, PhD, of the University of Zagreb in Croatia, for the ESC. The recommendations were published online in Atherosclerosis and the European Heart Journal.

 
   Fitness Update

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

New findings challenge conventional wisdom, find shorter warm–ups of lower intensity are better for boosting cycling performance

Warming up increases muscle temperature, accelerates oxygen uptake kinetics and increases anaerobic metabolism, all of which enhance performance. However, the question of how long and strenuous a warm–up should be is more contentious, with some in the sports community advocating longer warm–ups and others espousing shorter ones. Now researchers at the University of Calgary Human Performance Laboratory in Calgary, Alberta, Canada have found evidence indicating that less is more. In a study comparing the effects of a traditional, intense warm–up with those of a shorter, less strenuous warm–up on the performance of 10 highly trained track cyclists, the researchers found that the shorter warm–up produced less muscle fatigue yet more peak power output. The findings are captured in the study entitled, "Less is More: Standard Warm–up Causes Fatigue and Less Warm–up Permits Greater Cycling Output," published in the Journal of Applied Physiology. The study was conducted by Elias K. Tomaras and Brian R. MacIntosh.

 
   Twitter of the Day

@DrKKAggarwal: Dr K K Aggarwal: How to Attain Spiritual Health
http://drkkaggarwal.blogspot.com/2011/07/how–to–attain–spiritual–health.html?spref=tw

@DeepakChopra: #CosmicConsciousness Your personal desire is also a manifestation of the total universe

 
    Spiritual Update

Science behind Hanuman Chalisa

Nava Nidhi

Kaadi Vidya: Just as one does not feel hungry or thirsty in Haadi Vidya, similarly in Kaadi Vidya a person is not affected by change of seasons, i.e. summer, winter, rain, etc. After accomplishing this Vidya, a person shall not feel cold even if he sits in the snow–laden mountains, and shall not feel hot even if he sits in the fire.

 
    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

A farmer had some puppies he needed to sell. He painted a sign advertising the 4 pups and set about nailing it to a post on the edge of his yard. As he was driving the last nail into the post, he felt a tug on his overalls. He looked down into the eyes of a little boy. "Mister," he said, "I want to buy one of your puppies." "Well," said the farmer, as he rubbed the sweat off the back of his neck, "These puppies come from fine parents and cost a good deal of money." The boy dropped his head for a moment. Then reaching deep into his pocket, he pulled out a handful of change and held it up to the farmer. "I’ve got thirty–nine cents. Is that enough to take a look?" "Sure," said the farmer. And with that he let out a whistle. "Here, Dolly!" he called. Out from the doghouse and down the ramp ran Dolly followed by four little balls of fur.

The little boy pressed his face against the chain link fence. His eyes danced with delight. As the dogs made their way to the fence, the little boy noticed something else stirring inside the doghouse. Slowly another little ball appeared, this one noticeably smaller. Down the ramp it slid. Then in a somewhat awkward manner, the little pup began hobbling toward the others, doing its best to catch up. "I want that one," the little boy said, pointing to the runt. The farmer knelt down at the boy’s side and said, "Son, you don’t want that puppy. He will never be able to run and play with you like these other dogs would."

With that the little boy stepped back from the fence, reached down, and began rolling up one leg of his trousers. In doing so he revealed a steel brace running down both sides of his leg attaching itself to a specially made shoe.

Looking back up at the farmer, he said, "You see sir, I don’t run too well myself, and he will need someone who understands." With tears in his eyes, the farmer reached down and picked up the little pup. Holding it carefully he handed it to the little boy. "How much?" asked the little boy.

"No charge," answered the farmer, "There’s no charge for love."

The world is full of people who need someone who understands.

 
    Pediatric Update

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

What is the general management plan for croup?

The management of croup, usually a self–limited disease, is dependent on the severity of respiratory symptoms. The most important task is airway maintenance. General management principle includes:

  • Traditionally, patients with croup have received humidified air to sooth the inflamed mucosa, thereby decreasing the amount of coughing due to mucosal irritation. Nevertheless, Neto and colleagues described that mist therapy was not effective in improving clinical symptoms in children presenting to the emergency department with moderate croup. Because these treatments are harmless, many practitioners still use mist therapy, particularly in patients who have received racemic epinephrine and are being observed.
  • The use of glucocorticoids for moderate–to–severe croup has long been recognized as a treatment modality. In comparison with placebo, oral or intramuscular dexamethasone was found to decrease hospitalization rates Although the standard dose of dexamethasone has been accepted to be 0.6 mg/kg, Geelhoed and colleagues showed similar efficacy in patients with moderate croup using lower doses of 0.15 mg/kg and 0.3 mg/kg. Because the half–life of dexamethasone is 36 to 52 hours, it is the preferred agent for croup therapy, and it is not necessary to discharge the patient with additional doses of steroids.
  • Nebulized racemic epinephrine containing levo (L) and dextro (D) epinephrine isomers is the mainstay of treatment for moderate–to–severe croup. Although racemic epinephrine does not alter the natural course of croup, it may reduce the need for emergent airway management. The preferred dose is 0.25 to 0.5 mL with 3 mL of saline.
  • In patients who have severe croup that is unresponsive to nebulized epinephrine, corticosteroids, and heliox, endotracheal intubation and ventilation may be necessary. If intubation is necessary, an endotracheal tube with a diameter smaller than recommended for the patient’s age and size should be used.
  • Antibiotics are not routinely recommended in croup but may be used in children suspected of concomitant bacterial pneumonia
 
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    Did You Know

(Dr Uday Kakroo)

The tooth is the only part of the human body that cannot heal itself.

 
    Rabies Update

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

Can rabies infection be transmitted through environment?

Rabies infection can be transmitted through aerial (by aerosol) route. This is the suspected route in bat rabies in Latin America where men while passing through caves containing carcasses of bats reportedly acquired bat rabies infection. Bats have small teeth and claws, it is possible to be bitten by a bat and not know it. Therefore, if you find you’ve been sleeping in the same room with a bat you should see a doctor as soon as possible. This also applies if a bat is found in a room with a child or a mentally impaired or intoxicated person. Bats that are the easiest to approach and capture (unable to fly, etc.) are the most likely to have rabies, so it is best to never handle any bat. Bat rabies is not present in India.

What should be done if there is a human rabies case?

The patient should be admitted in a quiet isolation room and must be sedated along with administration of antipyretics, analgesics, antihistamines, and anticonvulsant. Intravenous rehydration is a must. The cerebral edema has to be managed with mannitol. Mechanical ventilation of lungs, cardiac pacemaker, and intensive nursing care are indicated.

 
    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

Physical activity and breast cancer risk in Japanese women

Although the underlying mechanisms remain unclear, physical activity has been consistently shown to reduce breast cancer risk in postmenopausal women. More recently, there is evidence that the risk reduction is even seen in premenopausal women. However, it is still unknown whether the reduction in risk of breast cancer is similar in Asian women, as most of the previous studies were performed in Western people. Suzuki and colleagues have recently conducted a hospital–based, case–control study in Japanese women that considered age and intensity of physical activity. They found that strenuous but not moderate physical activity at the age of 12 years was inversely associated with both pre– and postmenopausal breast cancer risk across estrogen receptor (ER) and progestogen receptor (PR) subtypes (overall odds ratio 0.24; 95% confidence interval 0.14–0.43), and that moderate physical activity in the preceding 5 years was associated with a decrease in risk for postmenopausal breast cancer, but only for ER+ and PR+ tumors, suggesting that the time and optimal intensity of physical activity are involved in the reduction in risk of breast cancer. They also showed that physical activity at the age of 20 years was weakly associated with breast cancer risk, but only when the physical activity was of moderate intensity.

Physical activity increases serum levels of sex hormone binding globulin, decreases the level of insulin and bioactive IGF–I and causes positive effects on non–estrogen–related mechanisms such as immune function and antioxidant enzymes (As reported in Menopause live 13th Sept.2010)

 
    Urology Update

(Dr Narmada P Gupta, Chairman, Academic & Research Urology, Medanta Kidney and Urology Institute, Medanta – The Medicity)

Study suggests 50 percent of men with prostate cancer die due to the disease

The UK’s Telegraph (6/15, Adams) reports, "Half of men with prostate cancer die from the disease itself," according findings presented at the National Cancer Intelligence Network conference. Researchers at King’s College London examined records for "20,181 men with the disease who died between 1997 and 2007," and found prostate cancer was the "principal cause of death in 49 per cent of them. Some 12 per cent of deaths were due to other cancers, 17 per cent to heart disease, eight per cent from pneumonia and 13 per cent from other causes." The findings were presented at the National Cancer Intelligence Network (NCIN) conference in London.

 
    Contrary Proverbs

(Mr Vipin Sanghi)

Look before you leap. BUT Strike while the iron is hot.

 
    Legal Question of the Day

(Dr MC Gupta, Advocate)

Q. A young girl, whose father is no more, joined internship and on the very first day an incident occurred causing death due to mismatched blood transfusion. A magisterial inquiry held that three persons were guilty – the intern, the house surgeon and the lab technician. A case under 304A has been filed against them. What defence does she have? Can she escape liability on the ground that she was an intern and not a fully registered medical practitioner?

Ans.

  1. There is nothing like a fully or partially registered medical practitioner. An intern who is registered as a medical practitioner under section 25 of the IMC Act, 1956, is a registered medical practitioner in real terms. The Act nowhere says that his responsibilities, duties and liabilities are different or lesser compared to those registered under section 15.
  2. However, in practical terms, the judge may give lighter punishment if the crime is proved. Young age; being just a fresh intern who had barely spent 1 day as a doctor; being an unmarried girl whose father is no more; lack of malafide; being the first day on job; lack of adequate supervision; heavy load of work in a govt. hospital––all these can be pleaded as attenuating factors while determining punishment which can be as light as just a fine for which not even a minimum amount is mentioned in section 304A.
 
    IJCP Special

Dr Good Dr Bad

Situation: A physician referred a sample to the lab for parasite count.
Dr Bad: It’s a very sophisticated test.
Dr Good: This is a simple calculation–based bedside test.
Lesson: To determine parasite density, the parasites in each thick smear field are counted until 200 white cells have been observed (assuming an average white blood cell count of 8000/microL). The total white blood cell is divided by 200 (for example, 8000 divided by 200 equals 40), and the result is multiplied by the number of parasites, which indicates the number of parasites per microliter of blood (for example 10 parasites multiplied by 40 equals 400 parasites per microL). The percent parasitemia is 400 divided by 8000 times 100, or 5 percent. Leukopenia may confound population studies that utilize these techniques.

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia after taking light breakfast.
Reaction: Oh my God! Why was insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

 
  SMS of the Day

(Dr GM Singh)

The future belongs to those who believe in the beauty of their dreams.

 
  GP Pearls

(Dr Pawan Gupta)

The GOLD guidelines recommend a dose of 30–40 mg of prednisolone continued for between 10–14 days for acute exacerbation of COPD. Prolonged treatment is not advantageous and increase incidence of side effects, especially hyperglycemia. The NICE guidelines recommend that patients receiving multiple courses of oral steroids should receive prophylaxis against osteoporosis (Postgrad Med J 2004;80:497–505).

 
    Medicolegal Update

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

What is the importance of antemortem and postmortem injuries?

One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding

  • The injuries which are received in the body prior or before death are called the antemortem injuries. These injuries may be a contributing factor in the death or even the cause of death or they may have occurred many days/months or years ago.
  • During an autopsy, the autopsy surgeon assesses the age of antemortem injuries, as well as distinguishing them from postmortem injuries i.e. injuries occurring after death. Postmortem injury can be from various sources such as deliberate mutilation of a body by a murderer following a homicide, predation by wild animals, or careless handling in the mortuary. Postmortem injuries can cause confusion over the manner and cause of death.
  • One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed. After death, the body usually does not bleed. However, there are exceptions. For instance, when a person drowns, their body usually floats face down and this results in the head becoming congested with blood.
  • If the cadaver receives a head injury by colliding with blunt object/force, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood. It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration to the head and scalp which may be very hard to interpret.
  • After death, the blood stays liquid in the vessels and no longer clots. Careless handling of a cadaver may produce some post–mortem bruising which may need to be distinguished from ante mortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as lividity or discoloration. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with ante–mortem bruising.
  • Recent research has focused on improved techniques for distinguishing between an ante mortem and a postmortem injury by analyzing damaged tissue. Ante mortem injuries show signs of inflammation, while postmortem injuries do not. Some research suggests that tissue from antemortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help the doctor for assessment of the injuries more accurately.
 
    Mind Teaser

Read this…………………

sailing
ccccccc

Yesterday’s Mind Teaser: Q. Which one of the following is the most common location of hypertensive bleed in the brain?

1. Putamen/external capsule
2. Pons
3. Ventricles
4. Lobar white matter

Answer for yesterday’s Mind Teaser:
1. Putamen/external capsule

Correct answers received from: Dr YJ Vasavada, Dr BB Aggarwal, Dr Priyanka Sharma, Dr Surendra Bahadur Mathur, Dr Jainendra Upadhyay, Dr Anil Bairaria.

Answer for 6th July June Mind Teaser: Out in the middle of nowhere
Correct answers received from: Dr YJ Vasavada.

Send your answer to ijcp12@gmail.com

 
    Medi Finance Update

(Dr GM Singh)

Saving to income ratio

Total monthly saving

Saving 2 income ratio = --------------------------------------------------

Total monthly income

You should save at least 20% of your monthly income and invest.

 
    Laugh a While

(Dr. Anupam Sethi Malhotra)

Awesome Answers in IAS(Indian Administrative Service) Examination

Q. If you had three apples and four oranges in one hand and four apples and three oranges in the other hand, what would you have?
A. Very large hands. (Good one) (UPSC 11 Rank Opted for IPS)

 
    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
Indication
DCI Approval Date
Nicotinic Acid and Laropiprant Modified Release Tablets:
Nicotinic Acid.........1000 mg Laropiprant...........20mg
1. For the treatment of dyslipidaemia, particularly in patients with combined mixed dyslipidaemia (characterised by elevated levels of LDL–cholesterol and triglycerides and low HDL-cholesterol) and in patients with primary hypercholesterolemia (heterozygous familial and non–familial).

2. In combination with HMG–CoA reductase inhibitors (statins), when cholesterol lowering effect of HMG–CoA reductase inhibitor monotherapy is inadequate. It can be used as monotherapy only in patients in whom HMG–CoA reductase inhibitors are considered inappropriate or not tolerated. Diet or other non–pharmacological treatments (e.g. exercise, weight reduction) should be continued during therapy.
26/03/2010
 
    Public Forum

(Press Release for use by the newspapers)

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

Modification of four risk factors can reduces chances of death in women

Data from the Nurses’ Health Study has shown that women who adhered to a healthy lifestyle have as much as a 90% reduction in the risk of sudden cardiac death as compared with those with a high–risk profile, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President, Heart Care Foundation of India.

About 80% of attributable risk for sudden cardiac death was found to be associated with four lifestyle factors: Smoking, overweight, inactivity, and poor diet. Compared with women with none of the low–risk attributes, the risk of sudden cardiac death declined linearly as the number of these attributes increased, ranging from a 46% reduction for a woman who had one to 92% for those who had all four.

The study, published in July 6 issue of JAMA, defined a low-risk lifestyle as no smoking, BMI less than 25, at least 30 minutes of exercise daily, and top 40% of the alternate Mediterranean diet score. The diet emphasizes consumption of vegetables, fruits, nuts, legumes, whole grains, and fish, and moderate alcohol consumption.

Sudden cardiac death accounts for more than 50% of deaths due to coronary heart disease. Most episodes occur in people who have underlying coronary heart disease. Sudden cardiac death is the first manifestation of coronary heart disease in the majority of people, especially women.

Most cardiologists focus only on high risk groups to prevent sudden cardiac death and advocate implantable electric shock device (ICD) in patients with severe left ventricular dysfunction, but this intervention has not been able to reduce the mortality as only a minority of sudden cardiac death events occur in this high–risk group. Prevention strategies need to be focused to reduce sudden cardiac death incidence in lower–risk populations.

 
    Readers Responses
  1. Dear Sir, The editorial mentions the words ‘India Vs Bharat’ on the basis of urban dwelling and economic background. Bharat never denotes poverty. Rich and poor, rural and urban all are and were in Bharat with all its pristine glory. I feel, the word 'Bharat' denoted the people who believe in its rich cultural heritage and follow it. India represents the group who try to follow the western culture at the cost of Indian traditions. Regards, Dr. Jena.
 
    Forthcoming Events

National Conference on "Insight on Medico Legal Issues"

Dr K K Aggarwal

Date: Sunday, 10th July, 2011
Venue: Auditorium, Chinmaya Mission, 89, Lodhi Road, New Delhi–110003

eMedinewS and Heart Care Foundation of India are jointly organizing the first-ever National Conference on "Insight on Medico Legal Issues" to commemorate "Doctors’ Day".
The one–day conference will provide total insight into all the medicolegal and ethical issues concerning the practicing doctors. Both medical and legal experts will interact with the delegates on important issues.
You are requested to kindly register in advance as seats are limited. There will be no registration fee. You can register by sending your request at rekhapapola@gmail.com or at 9899974439.

For Programme Details

Programme Schedule 10th July MEDICO LEGAL CONFERENCE
Time Session Chairperson Moderator Speaker Topic
8 Am–8:30 Am Ethical Issues in Medical Research   Dr KK Aggarwal
Dr Girish Tyagi
   
8 am–8.10 am       Ajay Agrawal Rights of a patient in medical trial
8.10–8.20 am       Dr Ranjit Roy Chaudhury Ethical Issues in a medical trial
8:20–8.30 am       Priya Hingorani Statutory permits required for conducting trials
8.30–9.10 am Medical ethics and organ donations Dr N V Kamat Dr KK Aggarwal    
8.30 am–8.40 am       Dr Anoop Gupta Ethical issues in IVF practice
8.40 am–8.50 am       Dr N K Bhatia 100% voluntary blood donation
8.50 am–9.00 am       Dr Rajesh Chawla Need for do not resuscitate laws in India
9.00 am–9.10 am       Dr Neelam Mohan Ethical issues in organ transplantation
9.10 am–9.30 am Handling cases of death Mr S K Saggar
Dr Arvind Chopra
Dr KK Aggarwal
Dr Girish Tyagi
   
9.10 am–9.20 am       Dr S C Tewari Spiritual considerations in a dying patient
9.20 am–9.30 am       Dr G.K. Sharma Medico legal and ethical issues in post mortem
9.30 am–9.50 am Medical Insurance Mr Vibhu Talwar
Dr H K Chopra
Dr Vinod Khetrapal
Dr KK Aggarwal    
9.30 am–9.40 am       Meenakshi Lekhi Engaging a lawyer
9.40 am–9.50 am       Maninder Acharya Understanding various court procedures
9.50 am–10.20 am How to handle medico legal cases? Dr Anil Goyal
Dr Rajiv Ahuja
Ajay Agrawal
Dr Girish Tyagi
   
9.50 am–10.00 am       Dr M C Gupta When to do the MLC?
10.00 am–10.10 am       Dr Sudhir Gupta Checklist of MLC case
10.10 am –10.20 am       Siddarth Luthra Medico legal record keeping
10.20–10.50 am Medical Consent Dr Vinay Aggarwal
Dr P K Dave
Dr KK Aggarwal
Dr Girish Tyagi
   
10.20 am–10.30 am       Indu Malhotra Types of consent
10.30 am–10.40 am       Dr Manoj Singh Ideal consent
10.40 am–10.50 am       Dr N P Singh Extended consent
10.50 am–11.20 am Fallacies in acts applicable to medical profession Dr Anup Sarya
Dr Sanjiv Malik
     
10.50 am–11.00 am       Dr Kaberi Banerjee MTP, PNDT Act
11.00 am–11.10 am   Dr Anupam Sibal   Dr Sandeep Guleria Organ Transplant Act
11.10 am to 12.00 noon Inauguration

Justice A K Sikri, Delhi High Court

Justice Vipin Sanghi, Delhi High Court

Dr HS Risam, Board of Director, MCI

Dr P Lal, Board of Director, MCI

Dr A K Agarwal, President DMCl
     
12.00 noon–1.00 PM Professional misconduct and professional ethics Dr A K Agarwal
Dr. D S Rana
Dr H S Rissam
Dr KK Aggarwal
Dr Girish Tyagi
   
12.00–12.10 pm       Dr Sanjiv Malik Doctor-pharma relationship
12.10 pm–12.20 pm       Dr M C Gupta Advertisement and medical practice
12.20 pm –12.30 pm       Dr Navin Dang Rights of a patient
12.30 pm–12.40 pm       Dr Ajay Gambhir Rights of a doctor
12.40 pm– 12.50 pm       Dr Ashok Seth Kickbacks, touts and commercialization in medical practice
1.00 pm to 2.00 pm When it is not a negligence? Dr Prem Kakkar
Dr S K Sama
Dr O P Kalra
Dr KK Aggarwal
Dr Girish Tyagi
  Complaints of a doctor against doctor
1.00 pm–1.10 pm       Dr Girish Tyagi What is medical negligence?
1.10 pm–1.20 pm       Dr Vijay Aggarwal Medical accidents
1.20 pm–1.30 pm       Mukul Rohatgi Professional Misconduct
1.30 pm–1.40 pm       Dr K K Aggarwal How to defend a complaint?

………………………………………………………………

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

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

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

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

………………………………………………………………

Medifilmfest (1st International Health Film Festival in Delhi)

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

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

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

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

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

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at
medifilmfestinhealthmela@gmail.com

………………………………………………………………

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Naveen Dang, Dr Pawan Gupta, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta