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
  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

 
  Editorial …

12th June 2011, Sunday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Most hunger strikers usually do not wish to die as per the medical literature

Many medical professionals who graduated before 1990 may not be aware about the guidelines as regards hunger strikers. This is because the first declaration of World Medical Assembly was adopted in 1991, revised in 1992 and then again revised in 2006. It is called the ‘WMA Declaration of Malta on Hunger Strikers’. It describes the duties of a doctor and guidelines for the management of hunger strikers.

Most hunger strikers usually do not wish to die as per the medical literature. It is the duty of the physicians to take the hunger striker in confidence in isolation and find out his or her intention before and during the fast.

As per the WMA Declaration, all physicians are bound by Medical Ethics even when not providing therapy. They must try to prevent coercion or maltreatment of detainees and must protest if it occurs.

They must respect the autonomy of the hunger strikers and should not forcibly give any treatment, if they refuse. Artificial feeding should be done only if there is explicit or implied consent.

Every doctor must exercise his or her skill and knowledge while examining a hunger striker and evaluate the benefit versus harm.

When caught in a position of dual loyalty, the primary duty of the doctor should be towards the individual patient and not the employing authority.

The physicians should not allow third party to influence their medical treatment. They must maintain confidentiality of the striker. For any declaration to the media or, issuing a medical bulletin, they should not divulge any confidential information unless that information sharing is necessary to prevent serious harm.

They should create bond with the hunger striker because gaining of trust can often help to resolve difficult situations.

The Declaration of Malta states that the physician should first assess the individual’s mental capacity and should declare that the person who is on hunger strike is in stable state of mind to take independent decisions.

Before the fast, a physician should carry out a complete medical checkup of the hunger striker and declare whether that person is medically fit to do the fast or not. As a pre–fast counseling, they should explain to the hunger striker about all the potential health consequences that may follow and forewarn him in his own language or dialect about all advantages and disadvantages.

Physicians should also encourage hunger strikers to increase their fluid intake so that they can maintain fast better. At every step, options should be given by the doctors to the hunger strikers to take intravenous saline solutions or other forms of medical treatment as this does not break their fast.

A dialogue between the physicians and hunger striker should be in privacy and out of bounds of other people.

Treatment or care of the hunger striker must not be conditional upon the suspension of the hunger strike. If a physician is unable, for reasons of conscience, to abide by the refusal of the hunger striker for artificial feeding, the physician should make it clear at the outset and refer the case to another physician who is willing to abide by his refusal.

A physician should keep continuous communication with the striker and counsel him every day whether he is willing to break the fast on medical grounds.

If at any given time the hunger striker loses consciousness or is unable to take a decision then a physician should know of the person who would take decisions on his or her behalf. And this information should be available in writing with the treating doctors. If no advance instructions exist, then the doctors should act according to what they judge to be in the person’s best interest.

If after being given resuscitation and having regained their mental stability, hunger strikers want to continue their fast, that decision should be respected.

As per the Declaration, it is ethical to allow a hunger striker to die in dignity than to subject him or her to repeated interventions against his or her will.

Artificial food can be ethically given only after a consent. It can also be given if the striker person has left no advance instructions for refusing it. Forcible feeding is never ethically acceptable.

Face saving after the Satyagraha

Whenever a person undertakes a Satyagraha, he invariably wants to win and, if he fails to do so, he looks for some face saving justifications.

Any Satyagraha may have one or the other of the following outcomes:

  1. Your demands are met and then you break your fast.
  2. Your demands are not met but promises are made and then you break the fast.
  3. Your demands are not met but a committee is constituted to look into the demands and then you break the fast.
  4. You break the fast on the request of some religious or an important person in the society.
  5. You break the fast after the Prime Minister or President request you.
  6. You break the fast on the advice of a doctor.
  7. You are forcibly taken to the hospital and given IV fluids.
  8. You break the fast when police interferes and takes you to the hospital.
  9. The local administration interferes and provides you medical care.
  10. The respective court gives an order and you break the fast on the order of the Court.
  11. You break the fast on the request of your followers.
  12. Your break the fast by saying "I am shifting from complete fast to a symbolic fast".
  13. After being resuscitation and having regained mental clarity, you can decide to continue the fast.

Which direction will Baba Ramdev’s fast take, only time will tell.

Dr KK Aggarwal
Editor in Chief
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  Changing Practice – Evidence which has changed practice in last one year

Initial chemotherapy for metastatic pancreatic cancer

Start folfirinox rather than gemcitabine for patients with metastatic pancreatic cancer who have a good ECOG performance status and a serum total bilirubin level that is <1.5 times the upper limit of normal. (October 8, 2010)

(Ref: Conroy T, Desseigne F, Ychou Y, et al. Randomized phase III trial comparing FOLFIRINOX (F: 5FU/leucovorin (LV), irinotecan (I), and oxaliplatin (O)) versus gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial (abstract 4010). J Clin Oncol 2010; 28:303s. (abstract available online at
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=
74&abstractID=41562, accessed August 18, 2010).

 
  eMedinewS Audio PostCard

Diabetes Update

Dr Vinod Sanghi Speaks on
‘The Steno–2 study’

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Medifinance conference

A Medifinance Conference for Portfolio management for doctors and Budget 2011 was organized by the Heart Care Foundation of India

 
Dr K K Aggarwal
 
    National News

Shatabdi Express may get Wi–Fi network soon

CHENNAI: Passengers of the Chennai–Bangalore Shatabdi Express might soon be able to use a transit Wi–Fi network that would enable them to stay connected to the Internet during the journey. While such wireless connectivity is available in many rail transit systems across the world, including the Dubai Metro, it will be the first time an Indian train is equipped with on–the–go Wi–Fi connectivity. A feasibility trial has been completed on a 120–km stretch between Chennai Central and Arakkonam. Southern Railway Divisional Railway Manager S. Anantharaman said that the results have been sent to the Research Design and Standards Organization, an advisory body to the Railway Board, for approval. "Tenders would be floated once the design is approved." Explaining the rationale behind the proposal, J.Shivkumar, Chief Technology Officer of wi–5, a wireless solutions provider which acted as the project consultant, says: "Most Shatabdi users are sitting idle in the train for five to six hours. We conducted a survey and found out that many of them carry a laptop. A captive audience for such a service is readily available." (Source: The Hindu, June 09, 2011)

IGIC to start DM course within a month

PATNA: Doctors of Medicine (DM) Course would soon start at the Indira Gandhi Institute of Cardiology (IGIC), Patna. Stating this here on Thursday, IGIC director Dr S N Mishra said the Medical Council of India (MCI) had given its permission to start DM course at the Institute. It would start within a month, he added. A team of Diplomate of National Board (DNB) had also carried an inspection recently to review the three–year DNB course currently underway at the institute, Dr Mishra informed adding that increase in DNB seats are in offing. At present, the institute has 38 sanctioned DNB seats, he said. (Source: TOI, Jun 10, 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

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

At play

  • Go dancing instead of going to a movie.
  • Play active games like Frisbee or soccer when you go to a park.
  • When going to a sporting event, take 10 minutes before the game to walk around the grounds or stadium.

(Dr Monica and Brahm Vasudev)

FDA warns against use of high–dose simvastatin

The FDA has recommended that the highest approved dose of simvastatin –– 80 mg –– be used only in those patients who have already been taking it for at least 12 months without signs of myopathy. That dose should not be used in new patients, the agency said.

An FDA review launched in the wake of a controversial 2010 meta–analysis by Dr Ilke Sipahi (University Hospitals Case Medical Center, Cleveland, OH) et al suggesting an increased risk of cancer among patients taking angiotensin–receptor blockers (ARBs) has concluded that the drugs do not pose a cancer risk to patients. The European Medicines Agency (EMA) was the first to react to that initial meta–analysis, announcing it was going to review the possible cancer risks associated with ARBs; the FDA announced its own review shortly thereafter. The EMA has not yet released any conclusions from its review. Several subsequent meta–analyses, published last year and again in 2011, failed to confirm the alarming findings of the first, as reported by heartwire. Now, in a safety alert issued yesterday (02–06–2011), the FDA states that its findings are in keeping with those of the subsequent meta–analyses that showed no sign of a cancer risk. "The FDA has concluded that treatment with an ARB medication does not increase a patient’s risk of developing cancer."

FDA conducted a trial–level meta–analysis of clinical trials in which patients had been randomized to an ARB treatment or a non–ARB treatment. This analysis included 31 trials and approximately 156,000 patients, including nearly 156,000 patients randomized to an ARB (84,461 patients) or a non–ARB comparator (71,355 patients) who were followed for an average of 3 years and 3 months, far more than the approximately 62,000 in the published analysis. According to the FDA’s analysis, incident cancer events in the ARB group were 1.82 per 100 patient–years, compared with 1.84 per 100 patient–years in the non–ARB group. The lack of a difference between the two groups was maintained, no matter what statistical method was used or whether the comparator group was taking a placebo or another drug, the FDA adds. An analysis looking at differences between groups based on type of cancer also showed no signal of cancer risk with ARBs.

Reference–http://www.fda.gov/Drugs/DrugSafety/ucm257516.htm

WHO all set to celebrate World Blood Donor Day 2011 on 14th June

Geneva (ABC Live): World Medical fraternity is all set to celebrate World Blood Donor Day on 14 June 2011 to raise awareness of the need for safe blood and blood products and to thank voluntary unpaid blood donors for their life–saving gifts of blood. "More blood. More life." This theme reinforces the urgent need for more people all over the world to become life–savers by volunteering to donate blood regularly. World Blood Donor Day builds on the success of World Health Day 2000, which was devoted to the theme ‘Blood Saves Lives. Safe Blood Starts With Me’. The enthusiasm and energy with which this day was celebrated was a powerful and positive response to the opportunity to thank the millions of people who give the precious gift of life through their donation of blood every year. The aim of designating this annual day and linking it to a global celebration was to promote voluntary non–remunerated blood donation throughout the world. (Source:
http://abclive.in/health/530–world–blood–donor–day–2011.html, June 10, 2011)

IUD safe right after abortion

Women undergoing an abortion can have an intrauterine device (IUD) safely placed immediately after the procedure, with similar rates of expulsions and other complications, a randomized trial found. (Source: Medpage Today)

MI progress weighed down by rising BMI

Expanding waistlines are holding back progress in reducing the rate of MI, researchers found. In a cohort of British civil servants, the rate of fatal and nonfatal MI fell by 74% (95% CI 48% to 87%) from 1985 to 2004, Sarah Hardoon, MSc, of University College London, and colleagues reported online in the European Heart Journal. (Source: Medpage Today)

 
  Twitter of the Day

@DrKKAggarwal: Dr K K Aggarwal: Baba Ramdev Special: How to medically face a patient
http://drkkaggarwal.blogspot.com/2011/06/baba–ramdev–special–how–to–medically.html?spref=tw

@DeepakChopra: #ScienceSpirituality 30 Looking forward to our debates http://amzn.to/kU5JH6

 
    Spiritual Update

Hanuman Chalisa

Pawan Tanay Sankat Haran, Mangal Murti Roop
Ram Lakhan Sita Sahit, Hriday Basahu Sur Bhoop


Meaning: O Son of the Wind, you destroy all difficulties. Your form is all auspicious, and you always reside in my heart together with Rama, Lakshmana and Sita.

Spiritual Significance: You are the controller of Prana Vayu and can handle all the diseases. To control Soul, Mind and body (Rama, Lakshamana and Sita), one needs to keep meditating on the Anhata Chakra by focusing the breath (Prana Vayu or Hanumana) in that area.

 
    An Inspirational Story

(Dr Paramjit Chadha)

Pearls of thought

  • Prayer is not a "spare wheel" that you pull out when in trouble, but it is a "steering wheel" that directs the right path throughout life.
  • Do you know why a car’s windshield is so large and the rear view mirror is so small? Because our past is not as important as your future. Look ahead and move on.
  • Friendship is like a book. It takes few seconds to burn, but it takes years to write.
  • All things in life are temporary. If going well, enjoy it, they will not last forever. If going wrong, don’t worry, they can’t last forever either.
  • Often when we lose hope and think this is the end, God smiles from above and says, "Relax, it’s just a bend, not the end!
  • When God solves your problems, you have faith in His abilities; when God doesn’t solve your problems, He has faith in your abilities.
  • Worrying does not take away tomorrow’s troubles, it takes away today's peace.
  • When you pray for others, God listens to you and blesses them, and sometimes, when you are safe and happy, remember that someone has prayed for you.
 
    Pediatric Update

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

What is the role of peak expiratory flow in asthma?

Standard values for various populations have not been defined. Thus, the currently accepted norm is to utilize personal best values as a benchmark. In order to obtain personal best values, monitoring of PEF should be performed over 1 to 2 weeks (8.00 a.m. and 8.00 p.m. daily) during asymptomatic periods. This limits the role of PEF in initial diagnosis and assessment of severity but makes it better suited to monitor therapy and in follow up for reassessment of the grade of severity. Technique, compliance and reproducibility are also difficulties that may be encountered. Children can be trained to use the peak flow meter after approximately 5 years of age. Asthma, being a dynamic condition as mentioned earlier, the only merit of PEF monitoring over spirometry is that it can be performed over a one to two week period at home thereby giving a temporal profile.

Note that a peak flow of less than 80% of the patient’s personal best indicates a need for additional medication and a peak flow below 50% indicates severe exacerbation.

 
    Do You Know

(Dr Uday Kakroo)

Very Interesting Anecdotes

If you are right handed, you will tend to chew your food on the right side of your mouth. If you are left handed, you will tend to chew your food on the left side of your mouth.

 
    Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is intrauterine insemination?

The IUI procedure consists of washing an ejaculated semen specimen to remove prostaglandins, concentrating the sperm in a small volume of culture media, and injecting the sperm suspension directly into the upper uterine cavity using a small catheter threaded through the cervix. The insemination is timed to take place just prior to ovulation, typically using home urine luteinizing hormone (LH) measurement. In couples with mild male infertility, IUI does improve pregnancy rates in couples when compared to intracervical insemination or timed natural cycles.

 
    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady died.
Dr Bad: Declare her dead.
Dr Good: Deliver the infant within 5 minutes.
Lesson: "Five minute rule", the best outcome with regards to neonatal neurological outcome is most likely when delivery occurs within five minutes of maternal cardiac arrest.

Make Sure

Situation: A rape victim became pregnant.
Reaction: Oh my God! Why was an emergency contraceptive not given to her?
Lesson: Make sure that all victims of rape are given an emergency contraceptive.

 
  SMS of the Day

(Dr GM Singh)

We do not inherit the earth from our ancestors; we borrow it from our children. ~ Hide Indian Saying

 
    GP Pearls

(Dr Pawan Gupta)

  1. Prasugrel is more potent and rapid acting than clopidogrel in preventing MI and stunt thrombosis, but with increased complication of Hemorrhagic complications.
  2. Ticagrelor is new standard of care in ACS. How ever cost and hemorrhagic complications are limiting factors.(The Lancet 2010–375–263–265)
 
    Medicolegal Update

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

What is a dangerous injury?

  • Some examples of injuries which endanger life are: Stab on the abdomen or head or vital part, hurt causing rupture on spleen, squeezing testicles, incised wounds on the neck, compound fracture of the skull, rupture of an internal organ, and injury of a large blood vessel.
  • Danger to life should be imminent.
  • Injuries are extensive and implicate important structures or organs, so that they may prove fatal in the absence of surgical aid. For instance, a compound fracture of the skull.
  • Wound of an artery or rupture of some internal organ such as the spleen, should be considered "dangerous to life".
  • There is a fine distinction in the degree of body injury between dangerous to life and likely to cause death.
  • Another type of bodily injury which is sufficient in the ordinary course of nature to cause death is also to be recognized. But the injuries which prove fatal remotely by incurrent diseases such as tetanus should not be considered as dangerous.
  • If an opinion as regards the nature of a particular injury cannot be formed at the time of the examination as in the case of an extensive swelling of a limb when its fracture cannot be detected, or in the case of a head injury where the symptoms are obscure, the injured person must be either re–examined 12–24–48 hours after the initial clinical examination or admitted under observation until a definite opinion can be formed and the police should be notified of the fact.
 
    Vitamins—Open Secrets revealed

(Dr Jitendra Ingole, MD Internal Medicine)

Vitamin D from food

What the research on vitamin D tells us is that unless you are a fisherman, farmer, or otherwise outdoors and exposed regularly to sunlight during mid day hours for sufficient period, you are unlikely to obtain adequate amounts of vitamin D from the sun.

For food sources to provide us with vitamin D, the source must be sunlight exposed. Poultry and eggs contain varying amounts of vitamin D obtained from insects, fishmeal, and sunlight containing UV–B or supplements. Fish, unlike mammals, birds and reptiles, do not respond to sunlight and rely on vitamin D found in phytoplankton and other fish. Salmon must feed on phytoplankton and fish in order to obtain and store significant vitamin D in their fat, flesh, skin, and organs. Thus, modern farm–raised salmon, unless artificially supplemented, may be a poor source of this essential nutrient.

Modern diets usually do not provide adequate amounts of vitamin D; partly because of the trend to low fat foods and partly because we no longer eat vitamin–D–rich foods like naturally reared poultry and fatty fish such as kippers, and herring. Often we are advised to consume the egg white while the D is in the yolk or we eat the flesh of the fish avoiding the D containing skin, organs and fat. Sun avoidance combined with reduction in food sources contribute to escalating D deficiencies. Vegetarian and vegan diets are exceptionally poor or completely lacking in vitamin D predisposing to an absolute need for UV–B sunlight. Using food as one’s primary source of D is difficult to impossible.

(Ref: Bjorn LO, Wang T. Vitamin D in an ecological context. Int J Circumpolar Health 2000;59:26–32.)

 
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Docconnect
Docconnect
    Mind Teaser

Read this…………………

A 37–year–old woman from New Mexico is admitted to the hospital with a rapidly progressive bronchopneumonia. She was feeling well until 2 days ago when she developed fever, cough, hemoptysis, dyspnea, and chest pain. Within hours of admission to the hospital, gram–negative bacilli are identified in a sputum sample. Two days after admission she is placed on a ventilator to manage respiratory failure.

Which of the following most strongly suggests the possibility that this patient’s illness is the result of a bioterrorist attack?

A. Isolation of Yersina pestis from the sputum and blood
B. The presence of inguinal buboes
C. A cluster of similar cases in previously healthy people
D. Respiratory failure

Yesterday’s Mind Teaser: A previously healthy 16–year–old boy is evaluated in the office for dysphagia. Starting this morning he had difficulty swallowing, with fluid regurgitating out of his nose when he tried to swallow milk. He also reported having "double–vision" while reading the morning newspaper. On physical examination, he is afebrile, his blood pressure is 120/70 mm Hg, and pulse is 70/min. He has bilateral ptosis and enlarged, sluggishly reactive pupils. The mouth is dry and the pharynx is injected. Muscle strength is good with normal deep tendon reflexes, and there are no sensory changes. The mental status examination is unremarkable. A patient with similar symptoms was evaluated yesterday. This patient was found to have diplopia, dysarthria, dysphonia, and dysphagia as well as hypotonia of the neck muscles.

Which of the following is the most likely diagnosis?

A. Botulism
B. Guillain–Barre polyradiculopathy
C. Myasthenia gravis
D. Poliomyelitis
                                    

Answer for yesterday’s Mind Teaser:
C. Myasthenia gravis

Correct answers received from: Dr MRK Rao, Dr Prabodh Kumar Gupta, Dr KV Sarma, Dr Sandhya,
Dr Anil Bairaria.

Answer for 10th June Mind Teaser: 1. ECF volume contraction
Correct answers received from: Dr Rakesh Bhasin, Dr Karan, Dr Swarn, Dr Anupama, Dr Shweta.

Send your answer to ijcp12@gmail.com

 
    Medi Finance Update

(Dr. GM Singh)

Financial update

It is noteworthy that being risk averse is well appreciated by us. But if your age, income, ability to take risk and financial goals permit you to take equity exposure, one should not ignore the same.

 
    Laugh a While

(Dr. Jagjit Singh)

10 Commandments of Marriage

Commandment 1: Marriages are made in heaven. But so are thunder and lightning.
Commandment 2: If you want your wife to listen and pay strict attention to every word you say; talk in your sleep.
Commandment 3: Marriage is grand — and divorce is at least 100 grand!
Commandment 4: Married life is very frustrating. In the first year of marriage, the man speaks and the woman listens. In the second year, the woman speaks and the man listens. In the third year, they both speak and the neighbors listen.
Commandment 5: When a man opens the door of his car for his wife, you can be sure of one thing: Either the car is new or the wife is.
Commandment 6: Marriage is when a man and woman become as one. The trouble starts when they try to decide which one.
Commandment 7: Before marriage, a man will lie awake all night thinking about something you say. After marriage, he will fall asleep before you finish.
Commandment 8: Every man wants a wife who is beautiful, understanding, economical, and a good cook. But the law allows only one wife.
Commandment 9: Marriage and love are purely matter of chemistry. That is why wives treat husbands like toxic waste.
Commandment 10: A man is incomplete until he is married. After that, he is finished

 
    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name

Indication

DCI Approval Date

Metformin 500/850/1000mg + Sitagliptin Phosphate 50/50/50mg (Additional Indication)

A) FDC is indicated as triple combination therapy with a PPAR γ agonist (i.e a thiazolidinedione) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a PPAR γ agonist. B) FDC is also indicated as add–on to insulin (i.e triple combination therapy) as an adjunct to diet and exercise to improve glycemic control in patients when stable dosage of insulin and metformin alone do not provide adequate control.

02/08/10

 
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Will the patient be in pain after surgery?

Mild discomfort at the incision sites is common. Pain medications are often prescribed to help with any discomfort.

 
    IMSA Update

International Medical Science Academy (IMSA) Update

Ankylosing spondylitis and interleukins

The increased serum IL–17 and IL–23 levels in ankylosing spondylitis (AS) patients found in a preliminary study suggest that these two cytokines may play critical roles in the pathogenesis of AS.

 
    Public Forum

(Press Release for use by the newspapers )

Heat stroke depends not only on temperature but relative humidity

Development of heat stroke and other heat disorders not only depends on the temperature but also on relative humidity, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

The temperature of more than 110°F (>44°C) can cause heat stroke when there is a continuous exposure to sunlight. At a humidity of 40%, a temperature of 1100F behaves like a temperature of 130°F and is classified under the high risk red zone.

Dr Rajesh Mishra, Anesthesiologist, Artemis Hospital said that when the humidity is between 30–40% at the same temperature, persons are likely to suffer from sun stroke, heat stroke and heat exhaustion. However, heat stroke can occur with prolonged exposure and/or physical activity.

Till the temperature is lower than 85°F the chances of heat cramp, heat exhaustion and heat stroke will continue. At this stage only fatigue is possible that too with prolonged exposure and/or with associated physical activity.

Dr. Aggarwal said that if heat disorder is suspected a person may require fluid resuscitation of up to 4–8 litres which should include lemon water with salt. The main parameter to differentiate heat stroke and heat exhaustion are that in heat stroke there is no sweating. Absence of sweating with high temperature should be treated as an emergency to prevent charring of inside organs.

 
    Readers Response
  1. Dear Dr Aggarwal, I was watching TV news regarding deterioration in the health of Baba Ramadev while fasting in Hardwar. Camera showed the blood sample being taken by the technician. What striked me was the way the blood sample was taken.This shows a casual approach which exists in most hospitals also amongst paramedics .
    There was no privacy while the sample was being taken- Should we show the procedure on TV ? The technician was not wearing gloves at all There was no injection tray with the technician and the camera showed the syringe filled with blood lying on table This news will be having a worldwide viewership. Is this what we want to show the world? We become complacent while giving injections/taking samples. In a recent study the whole paper was published showing drastic reduction in rate of septicemia in the hospital if only proper hand washing is done. Small precautions do have a role in medical science.
    Sincerely, Dr. R.S. Bajaj , Consultant Paediatrician Rohini Delhi.
  2. Respected Dr KK Aggarwal Sir
    a. Initially Baba Ram Dev Ji’s BP on 7.6.2011 in Haridwar was 110/80 pulse 68/ min wt 60 kg ,urinary ketone 4+, S.bilirubin 1.3 Hb 15.
    b. He started his fast on 4.6.2011 in Delhi. According to him his wt was 64 kg before fasting.
    c. On 10.6.11 when he was shifted to Jolly grant Dehradun his wt was 58.5 kg. S. bilirubin 2 (on 7.6.2011 S. bilirubin was 1.3) his ketone remain between +2 to +4.
    d. Urine albumin was negative on 7.6.2011 but on 10.06.2011 albumin was in traces.
    e. Hb was raised to 16 on 10.6.2011 (from 15 gm on 7.6.2011).
    f. KFT was normal.
    g. Due to starting derangement of LFT, Haemoconcentration due to dehydration falling pulse below 60 (56 to 58 per min) and BP 104/64 he was advised for admission for complete evaluation and treatment.
    h. You have rightly commented Swami Ramdev ji was vocal in all these days, and he was among his thousand of followers in a Tent in this summer weather, where Hawan was being performed. He was involved in all the activities.
    i. When he reached jolly grant his pulse was 56 per min BP 110/74. One more comment from you about The World Medical Association and Declaration of Malta on Hunger Strikers, in its Article 21, unambiguously state that force feeding is a form of inhuman and degrading treatment. In that case what a doctor should do.He can only advice to take feed as soon as ketone start coming in urine.
    Regards Dr Sundeep Nigam
 
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National Conference on "Insight on Medico Legal Issues"
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 <.. Click here ..>

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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

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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 Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta