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 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 …

13th October 2011, Thursday

Is the waiting period in AIIMS for cancer patients justified?

It could take you as long as two years to get a date for a simple MRI scan in AIIMS while a CAT scan has a waiting period of more than four months, reports TOI. A waiting list – ranging from 2 months to a year or more – is the case with almost every department.

A study says 453 faculty members and 1,200 resident doctors handled 15.28 lakh outpatients, 84,000 admissions and 78,000 surgeries, teaching 1,661 students, investigating 381 projects and publishing 1,424 scholarly papers in 2009-10 alone. The work load is nearly 10,000 patients a day in OPDs against a capacity of 6,000.

  • Malignant surgeries have a waiting period of six months and benign surgeries 24 months.
  • A gynecological cancer surgery has a waiting period of 6 months and a benign tumor 12 months.
  • A corneal transplant has a waiting period of 6 months and retinal surgery 4 months.
  • Myringoplasty and a modified radical mastectomy have a waiting period of 24 months and cochlear implant surgery 2 months.
  • Young boys have to wait 2–4 months for a hypospadias repair.
  • For correction of a stricture urethra the waiting period is 6–8 months.

Emedinews comments

  • There is no justification of giving dates for malignancies if the time is not available as the patient will go back with an impression that the cancer will not spread during this time
  • How can one justify waiting for stricture urethra?
  • One cannot justify CT and MRI dates. In emergency department arrival to initial physician evaluation in a stroke patient should be less than 10 minutes in stroke or the mortality will be high. Door to neurologist time in stroke should be less than 15 minutes and door to CT scan time (time before which the CT should be done in suspected paralysis) should be less than 25 minutes. Door–to–CT Interpretation in stroke should be <45 minutes.
  • The study also does not talk about how many patients die during the waiting period or do not turn up for the due appointments and what happens to those appointments. Who fills these unturned appointments?
  • Medicolegally one cannot give an appointment for a test or a surgery if the same cannot be done in the required time. It is better to refuse than to give a date. I recall my days with AIIMS where I was training; I saw a patient who turned up exactly after 9 months for admission with TBM diagnosed 9 months back. He had been without any treatment during this period.

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 on

Is the waiting period in AIIMS for cancer
patients justified?

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

MTNL Perfect Health Mela 2010

Harmony - An Inter School Health Festival at Perfect Health Mela Education of school children should include health issues.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

The young also prone to arthritis

NEW DELHI: It was supposed to be a condition affecting the elderly. Till a few years back it was common knowledge that joint problems spared the young. But not anymore. According to orthopaedic surgeons and rheumatologists, sedentary lifestyle and high prevalence of obesity has contributed to an increase in the number of patients suffering from osteoarthritis, a degenerative disease where cartilage of the joints wears out. People as young as 35 years are being diagnosed with the disease with many of them having to undergo joint replacement surgeries, doctors said. On World Arthritis Day, being observed on Wednesday, the doctors said there was need for raising awareness about the disease so that patients can approach them on time. They said those unaffected should maintain a healthy lifestyle to keep the disease at bay. (Source: TOI, Oct 12, 2011)

The 2011/2012 the theme for World Arthritis Day is ‘Move to Improve’, which focuses on the benefits of physical activity for people with rheumatic and musculoskeletal diseases.

For comments and archives

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)

HIV project in India averted 100,000 infections: study

PARIS — A scheme in six Indian states that concentrated safe–sex campaigns on a few niche groups prevented 100,000 HIV infections over five years, according to estimates published in The Lancet on Tuesday. The so–called Avahan project was launched in 2003 in Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu, along with the northeastern states of Manipur and Nagaland, using a massive grant from the Bill and Melinda Gates Foundation. These states, with a total population of 300 million, had the highest prevalences of the human immunodeficiency virus (HIV) in India at the time. Avahan’s goal was to boost prevention among prostitutes and their customers, gays, injecting drug users and truck drivers to stop HIV from leaping from high–risk groups to the wider population. Tactics included one–on–one safe–sex counselling, free condoms, exchanging used needles for sterilised ones, clinics to treat sexually–transmitted disease and advocacy work within the community. "Overall, we estimated that 100,178 HIV infections were averted at the population level from 2003 up to 2008 as a result of Avahan," says the study.

For comments and archives

TB cases decline worldwide for the first time

For the first time, the number of people infected with tuberculosis (TB) each year is declining, according to Mario Raviglione, MD, director of the World Health Organization (WHO)’s Stop TB program. He spoke here today during a press conference to release Global Tuberculosis Control 2011, WHO’s 16th annual report on TB, which summarizes advances made and challenges ahead. The report features data on TB in nearly 200 countries with treatment results and financing trends. In a numbers–heavy talk, Dr. Raviglione highlighted a mix of positive and sobering news from the report. Among achievements, he noted that:

  • The number of people who were infected with TB decreased to 8.8 million in 2010, after peaking at 9 million in 2005.
  • In 2010, TB deaths declined to the lowest level in a decade, to 1.4 million deaths, after reaching 1.8 million deaths in 2003.
  • The TB death rate dropped 40% between 1990 and 2010.
  • All regions except Africa are on track to achieve a 50% decline in mortality by 2015.

In 2009, 87% of patients treated were cured, bringing the total successfully treated to 46 million cured and 7 million lives saved under WHO guidelines since 1995. "It’s a major achievement," he said. (Source: Medscape Medical News)

For comments and archives

Vitamin E may hike risk of prostate cancer

Men receiving vitamin E supplements in a large randomized trial showed a slight but statistically significant increase in prostate cancer diagnoses, researchers said. After being followed for up to 10 years after randomization, the hazard ratio for prostate cancer in SELECT trial participants assigned to vitamin E supplements was 1.17 (95% CI 1.004 to 1.36) relative to the study’s placebo group, reported Eric A. Klein, MD, of the Cleveland Clinic, and colleagues. (Source: Medpage Today)

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    Twitter of the Day

@DrKKAggarwal: f there is no breathing or pulse, the patient has had a CARDIAC ARREST. Within first 10 minutes place the palm of…http://fb.me/IZFCvQWx

@DeepakChopra: I’m a pseudoscientist, pseudospiritual, double pseudo, authentic, genuine fake

 
    Spiritual Update

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

Am I healthy?

Health is not mere absence of disease; it is a state of physical, mental, social, spiritual, environmental and financial well being. All aspects of health are not defined in allopathy. During MBBS, medical students are taught more about the physical health. Social and mental health is covered only in few lectures. Community health is a separate subject but never given its due importance. Spiritual health is not defined at all and financial health is hardly covered.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Whatever you give away today, or think or say or do will multiply about 10–fold and then return to you. It may not come immediately, nor from the obvious source but the law applies unfailingly, through some invisible force.

Whatever you feel about another, be it love or hate or passion will surely bounce right back to you in some clear (or secret) fashion If you speak about some person, a word of praise or two, soon, tens of other people will speak kind words of you.

Our thoughts are broadcasts of the soul, not secrets of the brain. Kind ones bring us happiness; petty ones, untold pain. Giving works as surely as reflections in a mirror. If hate you send, hate you'll get back, but loving brings love nearer.

Remember, as you start this day and duty crowds your mind, that kindness comes so quickly back to those who first are kind. Let that thought and this one direct us through each day.

The only things we ever keep are the things we give away.

For comments and archives

 
    Fitness Update

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

Hold On to Thinking and Memory with B12

The idiom "losing my marbles" is normally said in jest, but memory decline can be a truly frightening part of getting older. Fortunately, people can take heart in recent research showing that the right nutrients in the diet can help provide cognitive support. Now a new study reports that vitamin B12 may be crucial for preserving the brain.

Researchers at Rush University Medical Center in Chicago found that individuals with lower levels of vitamin B12 are more likely to have smaller brains as revealed by MRI scans and scored poorly on cognitive skills tests.

The results, published in the Sept. 27 issue of Neurology, came from a blood analysis of 121 subjects who are a part of the Chicago Health and Aging Project (CHAP), a large, ongoing prospective study of 10,000 subjects over the age of 65.

"Our findings lend support for the contention that poor vitamin B12 status is a potential risk factor for brain atrophy [shrinking] and may contribute to cognitive impairment," said Christine Tangney, Ph.D., a clinical nutritionist, who was the lead author of the study.

The brain relies on vitamin B12 because it is necessary for myelin synthesis, the protective sheath around neurons. Vitamin B12 is also required for detoxifying homocysteine, an amino acid that can be toxic to the brain, and known to be elevated in vitamin B12 deficient people. In this study, increases in homocysteine were associated with decreased cognitive scores.

For comments and archives

 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

What are the working hours prescribed for doctors by the government, the MCI or the ILO etc. Are the medical college teachers required to perform general medical duties and be on call duty? Are they entitled for extra remuneration for extra duties? Are the working time requirements different for Clinical and Non–Clinical teachers?

Ans.

1. I congratulate you for your boldness in raising an important issue that is rarely discussed in medical circles. Doctors are somehow reluctant to talk about their rights or injustice done to them. This mentality is ingrained in them from the day they join medical college by telling them that their job is to serve the suffering humanity. No one tells them that serving the suffering humanity does not mean silently suffering injustice.

2. As I see it, MCI and ILO etc. do not come into picture materially. Service is a contract between the employee and the employer. How many hours a teacher works in a medical college depends upon the contract of service, which means the terms and conditions of appointment. If the terms are silent about the working hours, these have to be determined as per common sense; equity and fair–play; precedence; legal principles; and, if necessary, judicial decision.

3. As regards common sense and equity and fair–play and the principle of equal pay for equal work, there is no reason why a professor of anatomy and a professor of medicine should put in differential amounts of work hours and yet get the same pay.

4. If the clinical faculty is required to put in more hours of work compared to the non–clinical faculty, the former should be monetarily compensated for the same through a suitable mechanism.

5. The situation will not change unless change is demanded by faculty members themselves. The proper way is for the faculty association of the some medical colleges/institutes to deliberate upon the issue and come out with statements, including recommendations and reasonable demands, if any. They should then submit a proper representation (proper means legally drafted) to the employing authority. If the employer does not take action, the next step should be to approach the High Court.

6. It would help and will be certainly desirable that a regional or national conference of medical college teachers is organised to discuss this issue and make recommendations to the government in this regard.

7. Mention may be made here of a judgment dated 17-2-2011 delivered by a division bench of the Madras High Court in a PIL by a PG student in surgery against the excessive and long duty hours of post-graduate students/residents.
The judgment can be viewed at http://judis.nic.in/judis_chennai/qrydisp.aspx?filename=29802

The case of the petitioner was stated in para 2 of the judgment as follows:

"2. The case of the petitioner is that a candidate, who joins a post graduate programme in any one of the affiliated colleges of the third respondent University, is compelled to work for 24 hours on all 365 days and the third respondent University has failed to frame any regulation to regulate the working hours, and no provision has been made by the University as regards the leave entitlement and the University has totally ignored the relevance of reasonable working hours and need for rest for the students." The prayer made to the Hon’ble court was as follows: "PRAYER: This writ petition is filed under Article 226 of the Constitution of India to issue a writ of Mandamus to direct the respondents to prescribe working hours, weekly off, leave including maternity leave, holidays, etc. for the post graduate degree students in the medical colleges affiliated to respondent 3-Tamil Nadu Dr. MGR Medical University, Chennai within a time as may be fixed."

The judgment noted that studies in USA had shown that long working hours induced fatigue in resident doctors leading to higher incidence of errors in judgment resulting in injury to patients. The concluding paras of the judgment are quoted below:

"14. We have referred to the above survey reports and study material with a view to impress upon to the respondent to take a fresh look in the matter bearing in mind that attentional failures in interns leading to medical errors may have disastrous consequences and ultimately affecting public health. Moreover the time schedule fixed in the Government hospitals as also corporate hospitals compelling the doctors doing post graduate courses/interns to work continuously 36 hours or even 24 hours at one stretch cannot be appreciated. Therefore, the respondents may take note of the above study and if so advice could constitute a team to conduct a study on the conditions prevailing in Tamil Nadu and if the study report reveals a disturbing trend in error of diagnosis or treatment, the respondent shall revisit the matter and frame fresh regulations to regulate the pattern of the postgraduate programme in line with the programme schedule adopted in other countries.

15. For the above reasons, we dispose of the writ petition with the above observations. No costs. Consequently, connected miscellaneous petitions are closed."

8. The approach taken by the Hon’ble High Court should have been different. An allegation was made that "the University has totally ignored the relevance of reasonable working hours and need for rest for the students". The court should have gone further into the matter and determined whether the working hours of doctors were reasonable or unreasonable. I do not think the Hon’ble court should have disposed of the writ petition by merely observing—". Therefore, the respondents may take note of the above study and if so advice could constitute a team to conduct a study on the conditions prevailing in Tamil Nadu and if the study report reveals a disturbing trend in error of diagnosis or treatment, the respondent shall revisit the matter and frame fresh regulations to regulate the pattern of the postgraduate programme in line with the programme schedule adopted in other countries."

9. In any case, the resident doctors’ association of TN should now follow up this issue and ensure that a proper committee is set up and gives a proper decision, failing which they should come to the HC again.

10. It is unfortunate that a single doctor had to file this PIL. It should have been filed by the RDA and even by the IMA since the majority of the residents may be presumed to be members of IMA. The IMA exists not only for doctors in private practice but for others also. It is also unfortunate that in its pleadings, the petitioner did not draw attention of the court to the SC decision in which the SC had ordered the institution of a residency scheme by the central government and had laid down in detail the maximum working hours for residents on per week basis and also on a continuous shift basis.

For comments and archives

 
    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What the National Drug Policy of India says

What is the treatment of uncomplicated P. falciparum cases in pregnancy?

  • 1st trimester: Quinine salt 10mg/kg 3 times daily for 7 days. Quinine may induce hypoglycemia; pregnant women should not start taking quinine on an empty stomach and should eat regularly, while on quinine treatment.
  • 2nd and 3rd trimesters: Artemisinin-based combination therapy (ACT) as per recommended dosage: Artesunate 4 mg/kg body weight daily for 3 days plus sulfadoxine (25 mg/kg body weight). Pyrimethamine (1.25 mg/kg body weight) on first day.

For comments and archives

 
    Medicine Update

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

Managing lead toxicity in children

  • A well–balanced diet is very important.
  • Children with empty stomachs absorb more lead than children with full stomachs.
  • Provide your child with 4 to 6 small healthy meals during the day.
  • A diet rich in calcium and iron can reduce the amount of lead a child absorbs.
  • Eating foods with vitamin C helps increase the amount of iron in the blood.

For comments and archives

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Globulin, A/G ratio

Globulin is increased disproportionately to albumin (decreasing the albumin/globulin ratio) in states characterized by chronic inflammation and in B–lymphocyte neoplasms, like myeloma and Waldenström’s macroglobulinemia. More relevant information concerning increased globulin may be obtained by serum protein electrophoresis.

Decreased globulin may be seen in congenital or acquired hypogammaglobulinemic states. Serum and urine protein electrophoresis may help to better define the clinical problem.

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim for the last seven years came for Executive Checkup.
Dr. Bad:
You will have to pay from your pocket.
Dr. Good:
You can claim it from Mediclaim.
Lesson:
In addition to cumulative bonus, the insured shall be entitled for a reimbursement of the cost of medical checkup once at the end of block of every four underwriting years provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount of 1% of the total amount of the average sum insured during the block of four claim free underwriting years.

For comments and archives

Make Sure

Situation: An asthmatic patient became worse after receiving a painkiller. Reaction: Oh my God! Why was he not put on a leukotriene receptor antagonist?
Lesson: Make sure that a patient with asthma is not given aspirin or he is put on a leukotriene receptor antagonist (zafirlukast or montelukast).

For comments and archives

 
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  Quote of the Day

(Dr GM Singh)

Forgiveness does not change the past, but it does enlarge the future. Paul Boese

 
  IDIOMS

Peeping Tom: Someone who observes people in the nude or sexually active people, mainly for his own gratification.

 
    Medicolegal Update

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

What are the WMA guidelines for medical doctors in biomedical research involving human subjects?

Medical progress is based on research which ultimately must rest in part on experimentation involving human subjects. The purpose of biomedical research involving human subjects must be to improve diagnostic, therapeutic and prophylactic procedures and the understanding of the etiology and pathogenesis of disease.

  • Any act or advice which could weaken physical or mental resistance/health of a human being may be used only in his interest.” In the field of biomedical research a fundamental distinction must be recognized between medical research in which the aim is essentially diagnostic or therapeutic for a patient, and medical research, the essential object of which is purely scientific and without direct diagnostic or therapeutic value to the person subjected to the research. The World Medical Association has prepared the following recommendations as a guide to every doctor in biomedical research involving human subjects. It must be stressed that the standards as drafted are only a guide to physicians all over the world. Doctors are not relieved from criminal, civil and ethical responsibilities under the laws of land applicable to them.
  • Biomedical research involving human subjects must conform to accepted scientific principles and should be based on adequately performed laboratory and animal experimentation and on a thorough knowledge of the scientific literature.
  • The designs and performance of each experimental procedure involving human subjects should be clearly formulated in an experimental protocol which should be transmitted to a specially appointed independent committee for consideration, comment and guidance.
  • Biomedical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest with a medically qualified person and never rest on the subject of the research, even though the subject has given his or her consent.
  • Biomedical research involving human subjects cannot legitimately be carried out unless the importance of the objectives is in proportion to the inherent risk to the subject.
  • Every biomedical research project involving human subjects should be preceded by careful assessment of predictable risks in comparison with foreseeable benefits to the subject or to others. Concern for the interests of the subject must always prevail over the interest of science and society.

(Reference 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).

For comments and archives

 
    Mind Teaser

Read this…………………

Which of the following statement is correct regarding systemic treatment of early stage breast cancer?

1. Aromatase inhibitors are standard adjuvant hormone therapy in premenopausal women.
2. Adjuvant chemotherapy is beneficial only in ER/PR negative breast cancer.
3. More than 80 percent of breast cancers overexpress HER2 protein and can be treated with trastuzumab.
4. Adjuvant chemotherapy benefits both premenopausal and postmenopausal women.

Yesterday’s Mind Teaser: A recent fitness walk left you breathless, and you’ve been having trouble sleeping. You’ve also been dealing with an upset stomach and occasional dizziness. These could be symptoms of:
A.
Depression
B. Heart disease
C. Diabetes
D. High blood pressure
E. All of the above

Answer for Yesterday’s Mind Teaser: B. Heart disease

Correct answers received from: Dr Shirish Singhal, Dr Kalpana Verma, Prabha Sanghi, Gita Arora, Dr.Sathiyamoorthy Veerasamy, Dr Chandresh Jardosh, Dr K Raju, Dr Prof HL Kapoor, Dr Neelam Nath, Anil Bairaria, Dr Rawat Purushottam Singh.

Answer for 11th October Mind Teaser
: a. Both L1 VLP and L2 VLP are being used for prophylactic HPV vaccine.
Correct answers received from: Muthumperumal Thirumalpillai, Jayant Navarange, Dr.Anil Kumar Jain,
Dr Rawat Purushottam Singh.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

An elderly lady is on the witness stand in a small town courtroom. The prosecutor asks her if she knows the defense attorney and she says,"Yes, I do. He’s a drunkard. He’s never sober. I’ve known him all his life." The defense attorney asks her, "Maam, do you know the prosecutor?’ She answers, "Yes, I do. He’s a cheat. He cheated all through school. He cheated on the bar exam and he cheats on his wife." The judge asks both lawyers to approach the bench. He says, "If either one of you asks that old woman if she knows me, you're both going to jail for a year."

 
    Public Forum

(Press Release for use by the newspapers)

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MTNL Perfect Health Mela to dedicate two days to Inter–School Festivals

In the forthcoming Perfect Health Mela starting from 14th October, two days i.e. 19th and 20th October will be dedicated to inter–school festivals Harmony and Eco Fest. Over 5000 children from various schools will participate in various competitions.

The competitions during Harmony will be Painting and slogan (Theme: Science behind maintaining good health), Healthy Model Display (Theme: Energy Conservation), Quiz (Theme: Nutrition for school going children) and Folk dance (Maintaining Good health).

The competitions during Eco Fest will be Cartoon Making (Theme: Reducing Pollution); Paper Bag Painting (Theme Pollution– Water & Noise), Creating best out of e–waste, Aerobics (Theme: Dance Your Way); Yoga (Theme: Spiritual Health) and Street Play (Theme Pollution Free Environment).

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Perfect Health Mela said that schools are the backbone of the society and lifestyle modifications in the family should start right in school age and children can only motivate their parents to change their lifestyle.

The Mela is being organized by Heart Care Foundation of India and World Fellowship of Religions jointly with Health Department, Government of Delhi, MCD and NDMC from October 14 to 23, 2011.

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    Readers Responses
  1. Dear Sir, I really enjoy reading emedinews daily. great work Sir. Regards: Dr Priya
 
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals ..

for complete programme details

Dr K K Aggarwal
 

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