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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 & 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 …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

9th March 2013, Saturday

Why is age verification of an assaulted child important?

  • Age estimation of trafficked victim is mandatory under Section 15(5A) of the ITPA.
  • Under the Juvenile Justice Act (JJA) if a trafficked victim is a child (below 18 years of age), then the child would be treated as a victim in need of care and protection and sent to a protective home. Thus, the future of the victim greatly depends upon a correct age determination test.
  • According to the Immoral Trafficking (Prevention) Act (ITPA): Trafficking of minors is a more heinous offence warranting more stringent punishment against the trafficker as per Sections 4(1), 5(1), 6(2), 6(2-A), 7(1-A) of ITPA.
  • Victim <18 years- JJA would automatically apply.
  • Victims between the ages of 16 and 21 years- exercise utmost caution and thoroughness.
  • Sometimes at the time of medical examination, the medical officer is further pressurized by the traffickers or their agents to certify that she is more than 18 years of age.
  • To avoid malpractice, a panel of doctors should conduct the medical examination, especially the Age Determination Test.
  • No single method alone should be adopted for Age Determination. A combination of examination of physical and secondary sexual characteristics, dentition, and bone ossification should be taken into consideration before recording the final opinion.
  • The medicolegal report should be submitted to the Investigating Officer within 48-72 hours of conducting the examination.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Ventilator-associated tracheobronchitis

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, was organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions. Doctors in large numbers attended the conference.

Dr K K Aggarwal
    National News

Rare genetic disorder hits two girls of Raipur

RAIPUR: Senior Loken Syndrome (SLS), an extremely rare genetic disorder, caused due to mutation of at least five genes and has a prevalence rate of one in a million people the world over, has hit a family in Chhattisgarh. Despite its extreme rarity, the disease has affected two sisters, Shivani (9) and Sania (7), who are now admitted at the Dr Ambedkar Hospital here for treatment with no known permanent cure for the disease.

SLS is characterized by the combination of a chronic kidney disease and a retinal dystrophy (progressive degeneration of tissue) and doctors say that its progression can lead to acute or chronic renal insufficiency and finally to end stage kidney disease and early onset severe visual loss due to retinal dystrophy.

In rare cases, other additional clinical signs may be observed like liver fibrosis, obesity and neurological disorders. Since the SLS has no know permanent cure, the life span of a patient depends on the complications he/she develops over the years. When Shivani was born blind, her parents Dhim Sahu and Parvati, residents of Bagbahara, were very sad but accepted it as a "God's will". However, when their second daughter was born blind too, they didn't know what hit them.

The deteriorating health of Shivani, who is now on dialysis, took them to various doctors and despite treatment, her frequent bouts of vomiting, fatigue and weakness never ended. Finally they were referred to Ambedkar Hospital where they learnt the truth. "My daughters were diagnosed with SLS recently. We had never heard about this disease and now doctors tell me that there is no permanent cure for it. Shivani will have to be on dialysis all through her life and is she is only 9 years old now", says Bhim Sahu, a farmer by profession. Though Sahu is grateful to the hospital authorities for not having charged him anything till now, he worries how he would cope with things later as his income in very limited. The helpless mother, Parvati, who calls herself "hapless" too, doesn't know much about the disease but she understands its gravity and knows well that both her kids will never be like the other children on the streets. "I was happy when Shivani was born but my world came crashing down when I was told that she was blind. It took me long to accept this and by the time I did, another stroke of bad luck hit us with Sania too suffering from the disorder", she told TOI. However, unlike the mother, young Sania is oblivious to her disease. The chubby young girl (who suffers from obesity) is enjoying all the attention from the doctors and the nurses as she plays around on her bed in Ward 14.

Dr Puneet Gupta, Nephrologist at the hospital, who is treating the sisters, said that after detailed diagnosis "we" realised that this wasn't a simple disease but a syndrome. "Further tests only confirmed our suspicions," he said adding that while Shivani is already suffering from renal failure and is on dialysis, Sania too has started showing signs of early changes in kidney functioning. Dr Gupta said unlike some other states, Chhattisgarh so far doesn't have facilities to diagnose genetic disorders or mutations in unborn children. He said, "There could be a possibility that more children could be suffering from this disease and we are contacting the Discovery Science Centre for going into the details"

So far this disorder has been diagnosed in Syria in United States (1961), Chennai (2006) and Dubai (2007). (Source: TOI, Mar 7, 2013)

For comments and archives

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)


Parental risk factors include young or single parents, parents with lower levels of education, and unstable family situations.

    Valvular Heart Disease Update

Severity of aortic stenosis

Based upon a variety of hemodynamic and natural history data, clinicians generally grade the severity of stenosis as mild, moderate, severe, or critical

  • Mild: Valve area exceeds 1.5 cm2
  • Moderate: Valve area of 1.0 to 1.5 cm2
  • Severe: Valve area less than 1.0 cm2

(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)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Weekly therapy matches TB care standard

novel TB treatment regimen featuring once-a-week therapy produced results equivalent to those seen with the standard once-daily approach, a researcher said at the Conference on Retroviruses and Opportunistic Infections. (Source: Medpage Today)

Home monitoring helps lower blood pressure

Usual care was no match for a home blood pressure monitoring program for keeping hypertension in check, a randomized trial found. (Source: Medpage Today)

In HIV, old drug is new again

A new version of an old standard HIV drug appeared to be safer but equally efficacious in an early clinical trial, a researcher said at the Conference on Retroviruses and Opportunistic Infections. (Source: Medpage Today)

Novel system delivers postop pain relief

An investigational technology combining a novel device to deliver sublingual sufentanil demonstrated efficacy for management of post-surgical pain, according to top line results from a phase III trial. (Source: Medpage Today)

ECG for eyes sorts strokes from vertigo

A device described as an ECG for the eye accurately distinguishes stroke from other causes of dizziness in the emergency department (ED), a small proof-of-concept study showed. (Source: Medpage Today)

  Twitter of the Day

@DrKKAggarwal: International Women’s Day – 8th March: Focus on the heart of your beloved http://blog.kkaggarwal.com/2013/03/international-women%e2%80%99s-day-%e2%80%93-8th-march-focus-on-the-heart-of-your-beloved/ …

@DeepakChopra: No matter what aggravates you, remember it is just a thought & you can let it go

    Spiritual Update

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

The Spiritual Meaning of Lord Shiva

Most of us worship Lord Shiva without understanding the deeper meaning behind him. In Hindu mythology, Shiva is one of the three forms of God (Brahma, Vishnu & Mahesh).

The Parmatama or spirit or GOD can be equated to a mixture of three forces representing Generator (Creator or Brahma); Organizer (Maintainer or Vishnu) and Destroyer (Winding

For comments and archives

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

What are the risks of hysteroscopy?

Only 1% of women have complications from an office hysteroscopy. Complications with operative hysteroscopy include absorption of fluid, infection, bleeding and uterine perforation. If a perforation occurs during an operative hysteroscopy, you may need another procedure to ensure there is no damage to nearby organs such as your intestines, bladder, or blood vessels.

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

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

Dietary recommendations in anemia

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

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

For comments and archives

    An Inspirational Story

Behind a smile

Do you ever wonder what people are feeling when they smile? Do they smile because they're happy or do they smile because they want people to believe they're happy? Maybe they smile because they want you to smile and be happy.

A smile can touch a person's life in ways you can never imagine. It's infectious and can cause a chain reaction. It can be memorable to someone you pass on the street or the mall or driving... and it only takes a split second to smile and forget, yet... to someone that needed it, it can last a lifetime. Maybe I should smile more often.

For comments and archives

  Cardiology eMedinewS

Insomnia triples risk of heart failure Read More

Health secretary plans to tackle UK's high cardiovascular disease death rate Read More

  Pediatric eMedinewS

CDC issues warning over superbug Read More

Suctioning type, timing affect length of baby's hospital stay Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

A person started with PVRV wants to change over to HDCV or PCECV or PDEV or vice versa. What should be done?

The currently available TCVs such as HDCV, PCECV, PVRV, and PDEV, are all equally good and approved by WHO. All are interchangeable following non availability of one brand or due to allergy to one of the CCVs or PDEV. All are considered protective against different strains of rabies viruses in different parts of the world.

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was on aerobic exercise protocol.
Dr Bad: Continue it.
Dr Good: Add resistance training also.
Lesson: According to a study published in the Journal of the American Medical Association, people with diabetes should mix aerobics with weight training to get the best results in lowering blood sugar.

Make Sure

Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to remember that most painkillers (barring nimesulide) are not kidney–friendly drugs.

  Quote of the Day (Dr GM Singh)

Do not spoil what you have by desiring what you have not; remember that what you now have was once among the things you only hoped for. Epicurus

    Mind Teaser

Read this…………………

When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information?

a. The client sets the drainage bag on the floor while sitting down.
b. The client keeps the drainage bag below the bladder at all times.
c. The client clamps the catheter drainage tubing while visiting with the family.
d. The client loops the drainage tubing below its point of entry into the drainage bag

Yesterday’s Mind Teaser: A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
b. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days.
c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.
d. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.

Answer for Yesterday’s Mind Teaser: a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

Correct answers received from: Dr Bharat Bhushan Aggarwal, Anil Bairaria, Dr Pankaj Agarwal, Dr KV Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr kanta Jain, Bal Kishan Agarwal.

Answer for 6th March Mind Teaser: The presence of a boggy mass

Correct answers received from: Dr Bharat Bhushan Aggarwal, Muthumperumal Thirumalpillai, Dr kanta Jain.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Father is a lawyer...

While in Atlanta on vacation, Little Johnny's Daddy took one afternoon to see historic sites downtown.

Two young families were also in line to the see the sites. Little Johnny struck up a conversation with one of the boys in line.

"My name is Tommy. What's yours?" asked the first boy.

"Johnny". "My Daddy's an accountant. What does your Pop do for a living?" asked Tommy.

Little Johnny replied, "My Daddy's a lawyer."

"Honest?" asked Tommy.

Johnny replied, "No, just the regular kind."

    Medicolegal Update

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

Lacerated wound

The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound as seen in MLC cases.

  • Lacerations are tears or splits of skin, mucous membranes, muscle or internal organs produced by application of blunt force to a broad area of the body, which crushes or stretches the tissues beyond the limits of their elasticity.
  • Crush injury from a direct blow may produce an irregular or stellate laceration with a variable degree of devitalized tissue, abrasion and visible contamination.
  • Do not close a laceration if there is visible contamination, debris, non–viable tissue or signs of infection. Wounds may involve vascular areas of the face and scalp where the risk of infection is low or extremities where infection becomes a greater risk, along with the possibility of tendon and nerve damage. The elderly and patients on chronic steroid therapy may present with "wet tissue paper" skin tears following relatively minor trauma.
  • When produced by a blunt weapon, such as club, crowbar, stone, brick etc., a lacerated wound is usually accompanied by a considerable amount of bruising of the surrounding and underlying tissues, and has inverted and irregular edges. The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound.
  • When a heavy weight such as the wheel of a heavy cart or a truck passes over an extremity, by its shearing and grinding force, it tears the skin from the underlying tissue and crushes the muscles and soft part lying beneath it realizing considerable blood and fat in them.
  • Crush injury syndrome or fat emboli may follow a lacerated wound. The tear, avulsion, split are types of laceration.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Ten ways to ease neck pain

Neck stiffness is common and can be uncomfortable enough to hamper day to day life. Following 10 easy steps can prevent neck pain, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and National Vice President-Elect IMA.

10 steps to prevent neck stiffness

  1. Don’t stay in one position for too long
  2. Keep the computer monitor at eye level.
  3. Use the hands-free function of the phone or wear a headset.
  4. Prop your touch-screen tablet or the ipad on a pillow so that it sits at a 45° angle, instead of lying flat on your lap.
  5. Keep your prescription glasses updated to prevent leaning your head back to see better.
  6. Don’t use too many pillows as it can stifle your neck’s range of motion.
  7. Before you move a big wardrobe across the room, consider what it might do to your neck and back, and ask for help.
  8. Sleep well.
  9. Call your doctor if the pain in your neck is associated with radiating pain, weakness, or numbness of an arm or leg.
  10. Also call the doctor if you have fever or weight loss associated with your neck pain, or severe pain.

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 30313 people since 1st November 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.”

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