emedinews
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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 April 2013, Tuesday

Heart Care Foundation president trains over 11,000 people in CPR

HT Correspondent, Hindustan Times New Delhi, April 08, 2013

First Published: 00:26 IST(8/4/2013) | Last Updated: 00:27 IST(8/4/2013)

By training more than 11,000 people in cardio pulmonary resuscitation (CPR) in a single day, Dr KK Aggarwal, president, Heart Care Foundation of India, created a world record on Sunday.

In all, 11,459 people were trained that mostly comprised school children. The earlier record was of training 5,000 persons.

The event was organised at the Dr Sampoornanand Sarvodaya Kanya Vidyalaya, Yamuna Vihar, on the occasion of World Health Day.

"CPR 10 is based on the mantra - "Within 10 minutes of death (earlier the better) for the next at least 10 minutes (longer the better), compress the centre of the chest of the victim with a speed of 10x10=100 per minute," said Dr Aggarwal, who has trained 35,000 people so far.

More than 24 lakh people die in our country every year with sudden deaths and 18 lakh of them die before reaching the hospital. Around 12 lakh people can be saved if CPR 10 can be taught to even 1 per cent of the society.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Weight loss may improve sexual health of obese diabetes

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

WHO Day Celebrated

Over 11459 people trained in Hands Only Cardiopulmonary Resuscitation (CPR 10) in one day

 
Dr K K Aggarwal
    National News

Plastic waste time bomb ticking for India, SC says

NEW DELHI: "We are sitting on a plastic time bomb," the Supreme Court said on Wednesday after the Central Pollution Control Board (CPCB) informed it that India generates 56 lakh tonnes of plastic waste annually, with Delhi accounting for a staggering 689.5 tonnes a day. "Total plastic waste which is collected and recycled in the country is estimated to be 9,205 tonnes per day (approximately 60% of total plastic waste) and 6,137 tonnes remain uncollected and littered," the CPCB said. The four metros are major culprits in generating such waste, with Delhi producing 689.5 tonnes a day, followed by Chennai (429.4 tonnes), Kolkata (425.7 tonnes) and Mumbai (408.3 tonnes). The figures only serve to confirm the common sight of mounds of plastic in industrial, residential and slum areas of Indian cities and towns. A shocked court asked civic authorities of five cities — Delhi, Agra, Jaipur, Faridabad and Bangalore — to submit reports on the steps taken to contain dumping of plastic waste and implementing the ban on gutka. As 40% of plastic waste is not recycled, the daily addition to untreated plastic in Delhi is estimated at 275.6 tonnes, followed by Chennai (171.6 tonnes), Kolkata (170 tonnes) and Mumbai (163.2 tonnes). This waste is a source of continuing pollution as plastic is not bio-degradable and poisons the environment for decades. The CPCB said a survey conducted in 60 major cities found that 15,342.46 tonnes of plastic waste was generated every day, amounting to 56 lakh tonnes a year. (Source: TOI, Apr 4, 2013)

Medical mistakes in Indian movies

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

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

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

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)

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

Child Maltreatment

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Child neglect
  1. Child maltreatment is intentional harm or threat of harm to a child by a person who is acting in the role of caretaker.
  2. There are four categories of child maltreatment

For Comments and archives…

    Valvular Heart Disease Update

Percutaneous balloon valvotomy is not indicated in patients with mitral obstruction due to mitral annular calcification.

(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)

New medical schools aim to double primary care graduates

Among the nation's newest medical schools are 2 that stand out for the career path they are emphasizing: primary care. Quinnipiac University's Frank H. Netter MD School of Medicine in North Haven, Connecticut, and the University of California–Riverside School of Medicine both will admit their first students in August. They hope to at least double the percentage of graduating physicians who typically choose primary care. A study published online December 4 in JAMA found that only 21% of third-year residents planned to enter internal medicine. (Source: Medscape)

Amiodarone linked to cancer risk in men

The risk of cancer was increased in men taking the antiarrhythmia drug amiodarone (Nexterone), particularly in those with extensive exposure to the drug, a retrospective study found. (Source: Medpage Today)

HER2 expression predicts breast cancer survival

Advanced HER2-positive breast tumors expressed variable amounts of protein -- a measurement which had a significant correlation with survival, a biomarker analysis of a large clinical trial showed. (Source: Medpage Today)

CKD patients may be overexposed to PICC

Patients with chronic kidney disease (CKD) received percutaneous inserted central catheters (PICC) in the acute care setting more often than other patients, despite professional guidelines that discourage PICC use in a CKD population, researchers said at the National Kidney Foundation meeting. (Source: Medpage Today)

T cell treatment promising in blood cancers

Genetically modified immune cells are yielding promising results in difficult-to-treat childhood blood cancers, a researcher said at the annual meeting of the American Association for Cancer Research. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Live in Aajtak that fb friends are the cause of insomnia pic.twitter.com/AYxGSNDjqV

@DrKKAggarwal: Nobody can tell what is going on in the realm of potentiality. Pls read this article written by Lothar Schafer http://nyurl.com/crl8p3n

 
    Spiritual Update

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

Namkaran Sanskar

In India, a person is identified by his/her name, which usually is a reflection of his/her own family. It may contain not only your maiden name but also the name of your father and your surname/caste.

When you are born, you are usually given your special name, which you carry throughout your life unless it is changed for a specific purpose. For example, the surname may change after marriage or the in-laws may change your name, specifically, when you are a girl.

For Comments and archives…

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

What is surgical sperm retrieval?

Sperm are usually present in the reproductive tract of spinal cord-injured men. Microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction (TESE) and percutaneous testicular sperm aspiration are examples of techniques that are used for men with acquired or congenital obstructions along their reproductive tract. Compared to MESA and TESE, the percutaneous methods have the advantage of not requiring an incision into the scrotum; however, MESA is the technique with the lowest amount of contamination with blood cells, and the method that is most likely to obtain sufficient amounts of fluid for immediate use with ICSI as well as for sperm cryopreservation.

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

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

Blood Donation – Gift of Liquid Love

Blood is the lifeline for any hospital. In India, about 9 million units of blood are required every year. But unfortunately only about 7 million units are collected every year. Thus there is a shortage of more than 25-30%. The gap between the demand and supply is increasing. Therefore, lakhs and lakhs of patients suffer due to non–availability of proper blood at proper time.

Under the directive of honorable Supreme Court of India, it is illegal to take blood from any professional donor. It is best is to take blood from non–remunerative voluntary donors.

For Comments and archives…

 
    An Inspirational Story

The Hedgehogs

It was the coldest winter ever. Many animals died because of the cold.

The hedgehogs, realizing the situation, decided to group together to keep warm. This way they covered and protected themselves; but the quills of each one wounded their closest companions.

After awhile, they decided to distance themselves one from the other and they began to die, alone and frozen. So they had to make a choice: either accept the quills of their companions or disappear from the Earth.

Wisely, they decided to go back to being together. They learned to live with the little wounds caused by the close relationship with their companions in order to receive the heat that came from the others. This way they were able to survive.

The best relationship is not the one that brings together perfect people, but when each individual learns to live with the imperfections of others and can admire the other person's good qualities.

For comments and archives

 
   Cardiology eMedinewS

Hearts respond positively to optimism Read More

AIM-HIGH not final word on HDL focus Read More

 
   Pedia News

Laser treatment halts retinopathy in extreme prematurity Read More

Varicella vaccine works well over time Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: One whole family came for typhoid vaccination.
Dr Bad: Bring your family tomorrow for vaccination.
Dr Good: Also bring your servants and food handlers at home for vaccination.
Lesson: Along with vaccinating your family members, it is equally important to simultaneously vaccinate the workers at your home, especially the food handlers to break the cycle.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

 
  Quote of the Day (Dr GM Singh)

A total commitment is paramount to reaching the ultimate in performance. Tom Flores

 
  Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. Medical students who have completed their MBBS in India and got selected for Residency training in US universities are being required to submit an application to the Health Ministry for issuing a Statement of Need (No-Objection Certificate) to avail a J1 visa. Despite duly applying in the prescribed format and even giving an undertaking to comply with the orders as and when the same are changed, the Ministry has been sitting on these application of hundreds of students for the last several months. The government is now asking for a Rs. 5 lakh bond from a relative and also a surety from a Govt official.

My questions are:

i)What is the remedy to end this misery of the students who are getting frustrated, first by not getting a postgraduation opportunity in India and then not being able to go to USA despite having cleared various USMLE steps?

ii) What is the legal justification for the government to ask a doctor to return or to pay the bond amount if it has no obligation to offer a suitable job on his return?

Should not the IMA fight for this injustice?

Ans.

  1. Firstly, I do not agree that getting an MBBS degree and then not being able to go to USA is a misery. If somebody gets an MBBS degree in India with the sole purpose of going to USA after getting the degree, it is foolish of him as well as treacherous of him (in case he has got cheap medical education at a government medical college at public expense).
  2. Secondly, I do not agree that it is a misery not to be able to get admission to a PG course immediately after passing MBBS. A young doctor can join service or start practice even without a PG degree.
  3. Thirdly, this has not come as a bolt from the blue. The government had announced 6 months ago that issuance of certificate of NORI (No obligation to return to India) had been stopped. The following news item appeared in the Times of India dated 10-9-2012. It is summarised below—

    “In a bid to prevent medical students who go to the US for higher studies from settling down there, the health ministry has suspended issuing 'no obligation to return' certificates which is mandatory for Indian doctors who have completed up to nine years of medical education to settle in the US. In fact, before they head there, the US requires the health ministry (of all developing countries) to issue a "statement of need" certificate, stating "the student is being allowed to go and study medicine in the US because he is required to return and serve India".

    Joint secretary in the health ministry S K Rao said only 30% of those who go to the US return to work. "This year, we haven't issued a single NORI certificate," he said.

    Guidelines for medical study abroad by 2013

    In a bid to tackle brain drain in the medical profession, the government, for the first time, is drawing up guidelines for medical students going to the US for studies. The guidelines, expected by January 2013, will also apply to students who have gone to the US this year.

    "We have sent the guidelines to the law ministry for their comments. It will specify the conditions for medical students to leave India and go to the US for higher education," joint secretary in the health ministry S K Rao said. "We have no problem with students going to the US to study. But the US wants us to first issue a certificate saying we are allowing the student to go and study there because he or she is needed in India and then issue another mandatory certificate nine years later saying he isn't needed in India so that he can settled down there," added Rao, who handles international health.”

    —http://timesofindia.indiatimes.com/india/Govt-makes-it-harder-for-doctors-to-stay-on-in-US/articleshow/16330652.cms
  4. Fourthly, non-issuance of the NORI certificate is not a violation of human rights as defined in section 2(d) of the Protection of Human Rights Act, 1993. It is not also a violation of the fundamental rights guaranteed in part three of the Constitution. The decision not to issue NORI to doctors is a matter of policy of the state and such policy is permissible as long as it does not violate any fundamental right. That the above policy is not violative of FR is clear from the fact that nobody has filed a WP against it even though the government has stopped issuing NORI certificate.
  5. Fifthly, there is no obligation on the part of the government to offer a job to any citizen. Such expectation is futile and unrealistic.
  6. In my opinion, the IMA or anybody else is unlikely to succeed if the government decision is challenged in a court.
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    Mind Teaser

Read this…………………

Nurse Ted is administering I.V. fluids to an infant. Infants receiving I.V. therapy are particularly vulnerable to:

a. Hypotension
b. Fluid overload
c. Cardiac arrhythmias
d. Pulmonary emboli

Yesterday’s Mind Teaser: A 45-year-old male patient reports pain in his foot that moves up along his calf. The patient states, "My right foot feels like it is on fire." The patient further describes that he has no previous history of injuries or falls, and that his pain started yesterday. Which components of pain assessment has the patient reported?

1. Aggravating and alleviating factors
2. Exacerbation, and associated signs and symptoms
3. Intensity, temporal characteristics, and functional impact
4. Location, quality, and onset

Answer for Yesterday’s Mind Teaser: Location, quality, and onset

Correct answers received from: Dr Sushma Chawla, Dr KV Sarma, Dr Jayashree Sen & Dr Bitaan Sen, Dr Suresh Arora, Dr BB Gupta, Dr PC Das, Dr Bharat Bhushan Aggarwal, Dr Ayyavoo, Dr (Maj. Gen.) Anil Bairaria, Yamini Alsi, Chandra Pal Singh, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr K Raju,
Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta Jain, Deepali Chatterjee.

Answer for 7th April Mind Teaser: Alcohol

Correct answers received from: Dr Thakor Hitendrsinh G.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A doctor had just bought a villa on the French Riviera, when met an old lawyer friend whom he hadn’t seen in years and they started talking. The lawyer, as it turned out, owned a nearby villa. They discussed how they came to retire to the Riviera. “Remember that lousy office complex I bought?” asked the lawyer, “Well, it caught fire, and I retired here with the fire insurance proceeds. What are you doing here?”

The doctor replied, “Remember that real estate I had in Mississippi? Well, the river overflowed, and here I am with the flood insurance proceeds. It’s amazing that we both ended up here in pretty much the same way.”

“It sure is,” the lawyer replied, looking puzzled, “but I’m confused about one thing – how do you start a flood?”

 
  Medicolegal Update

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

Doctor must record dying declaration in terminally injured patient

Under section S.32 of Indian Evidence Act a written or oral statement of an injured/sick dying person is called dying declaration, it must be recorded by the doctor attending an injured/sick person/patient who is dying/under medical expectation of death as a result of some unlawful act, relating to the material facts of cause of his death or bearing on the circumstances. The dying declaration/statement carries legal importance to identify the offender or to clear innocent persons

  • If there is time, the doctor should call the area Magistrate to record the statement/declaration. The doctor should certify that the person is conscious and his mental faculties are normal at the time of recording the statement. If the victim is very serious, and there is no time to call a Magistrate, the doctor should take the declaration in the presence of two witnesses particularly any attendant of other admitted patient. As far as possible, choosing nurses and paramedics as witness should be avoided to maintain the legal credibility of declaration. While recording the dying declaration, oath is not administered, because of the belief that the dying person will tell the truth. The statement should be recorded in the man’s own words, without any alteration of terms or phrases. Leading questions should not be put.
  • The declarant should be permitted to give his statement without any undue influence, outside prompting or assistance. If a point is not clear, question may be asked to make it clear, but the actual question and the answer received should be recorded. It should then be read over to the declarant, and his signature or thumb impression is taken.
  • The statement made must be of fact and not opinion. If the declaration is made in the form of an opinion or conclusion, questions should be asked by the recorder to bring out the facts that are the basis for the conclusion. While recording the statement, if the declarant becomes unconscious, the doctor recording it must record as much information as he has obtained and sign it. If the dying person is unable to speak, but is able to make signs in answer to questions put to him his can be recorded and it is considered as a "verbal statement".
  • The doctor and the witness should also sign the declaration. If the statement is written by the declarant himself, it should be signed by him, the doctor and the witnesses. The declaration is admissible not only against an accused that killed the declarant, but also against all other persons involved in the same incident which resulted in his death.
  • The declaration is sent to the Magistrate in a sealed cover. It is produced at the trial and accepted as evidence in case of death of the victim in all criminal and civil cases, where the cause of death is under enquiry. The person recording the declaration will have to give evidence in the Court of law under oath to prove it. If the declarant survives, the declaration is not admitted but has corroborative value, and the person is called to give oral evidence under oath.
  • In India, if the declarant is in a sound state of mind at the time of making the declaration, it is admissible in Court as evidence, even if the declarant was not under expectation of death at that time.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Leech Therapy

Blood-sucking leeches - used for thousands of years in Ayurvedic medicine – also approved by US FDA are a tool for healing skin grafts or restoring circulation, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and National President Elect IMA.

Doctors have used these small aquatic worms for several thousand years in the belief that bloodletting helps to cure a wide range of complaints from headaches to gout. They reached their height of medicinal use in the mid-1800s.

Today, doctors around the world use leeches to remove blood pooled under skin grafts for burn patients or to restore circulation in blocked veins by removing pooled blood. Leeches are particularly useful in surgeries to reattach body parts such as fingers or ears. The leeches can help restore blood flow to reconnected veins.

FDA has approved leeches as a medical device. When leeches begin feeding, they inject salivary components (e.g., hirudin) that inhibit both platelet aggregation and the coagulation cascade. This results in a marked relief of venous congestion. The anti-coagulant causes the bite to ooze for up to 48 hours following detachment, further relieving venous congestion. By feeding for 10 to 60 minutes, leeches consume from 1 to 2 teaspoons of blood. Results from clinical studies showed that the success rate of salvaging tissue with medicinal leech therapy is 70 to 80%.

Indications

  • Poor venous drainage (venous congestion/venous outflow obstruction); or
  • Salvage of vascularly compromised flaps (muscle, skin, and fat tissue surgically removed from one part of body to another).
  • Salvage of vascularly compromised replants (limbs or other body parts re-attached after traumatic amputation).
  • Knee osteoarthritis, inadequate arterial supply or tissue ischemia, and for all other indications.
 
    Readers Response
  1. Really appreciable effort… It’s necessary for every human being to learn CPR procedure. It’s very helpful in time of emergency. One can save somebody’s life. Bhagvati.
 
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