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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 & 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 …

14th March 2013, Thursday

Triphala can help in reducing bronchial hyperreactivity

Triphala (TRP), a herbal extract, has been shown to affect lymphocytes and natural killer T (NKT) cell function. It has been shown to ameliorate bronchial hyperreactivity through immune-cell modulations.

In a study carried out at the Division of Allergy, Immunology and Pulmonary Medicine, Washington University in Saint Louis, Saint Louis, MO, asthma mouse models were generated through intraperitoneal (IP) injections of ovalbumin (OVA)/2 weeks followed by repeated intranasal OVA challenges.

Mice were then treated with normal saline (OVA/NS) or Triphala (OVA/TRP). Data were compared with mice treated with inhaled budesonide. Both TRP and budesonide significantly ameliorated functional and histological OVA-induced bronchial hyperreactivity.

Triphala causes a significant decrease in bronchial reactivity. It alters immune-cell distributions and show anti-oxidative properties. Immune-cell modulation with triphala can ameliorate lung injury.

(Ref: Horani A, Shoseyov D, Ginsburg I, et al. Triphala (PADMA) extract alleviates bronchial hyperreactivity in a mouse model through liver and spleen immune modulation and increased anti-oxidative effects. Ther Adv Respir Dis 2012 Aug;6(4):199-210).

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

DVT risk starts early, stays long after acute stroke

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.

 
Dr K K Aggarwal
    National News

Don’t use legal term ‘rape’ in medical reports: manual

NEW DELHI: The Health Ministry has advised doctors not to use the word ‘rape’ in medical reports on sexual assault victims, and even in court depositions. “Rape is not a medical diagnosis, it is a legal definition, hence the word should not be used while forwarding opinion,” says the latest Instruction Manual for Forensic Medical Examination Report of Sexual Assault (Victim) brought out by the Indian Council of Medical Research under the Department of Health Research (DHR). The victim must not be refused treatment and examination for want of police papers.

The recommendations, which also carry a draft of a ToolKit for Psychological Support for Women Survivors of Sexual Assault, are open to public opinion.

Importantly, the manual suggests that doctors should not identify a victim as ‘habituated to sexual intercourse’ on the basis of a ‘finger test.’ Such identification is an unlawful interference with her privacy and an unlawful attack on her honour and reputation and is violation of her human rights. “In a prosecution of sexual assault, where the question of consent is at issue, evidence of the character of the victim or of her previous sexual experience with any person is not relevant to the issue of consent or quality of consent.” As normal examination findings neither refute nor confirm forcible sexual intercourse, circumstantial and other evidence may be taken into consideration. The manual says forcible sexual intercourse is possible without leaving any medical evidence. Submission of the victim may be achieved by emotional manipulation, fear of violence or death or by verbal threats; the force used, or resistance offered, is insufficient to produce injury; bruises may not become apparent for 48 hours following an assault; a delay in reporting the incident will allow minor injuries to fade or heal, and the survivor becoming unconscious, under the effect of alcohol/drugs are some of the reasons cited for absence of injury.

Such cases shall be registered in hospital as a medico-legal case (MLC), whether the patient comes on her own or is brought by the police. If the patient comes on her own, the decision to inform the police shall be taken after obtaining due consent from her or her guardian. The doctor should examine such cases if the survivor reports to the hospital first without a First Information Report.

A victim may come to the hospital only for treatment of the effects of the assault. Under Section 39 of the Cr.PC, the doctor is not bound to inform the police of such cases. Informed refusal to inform the police should be documented. Neither the court nor the police can force the victim to undergo medical examination. It has to be done with her/parents/guardian’s informed consent (depending on age). The consent form will be signed by the person herself if she is above 12, the manual recommends. An important need identified by the DHR is making guidelines available to healthcare providers who work with victims of sexual violence. The manuals are meant, not to replace the standard textbooks, but to supplement them in such a way that these guidelines can be adapted easily to most healthcare provider situations in the country.

Most countries which have well-developed services for women subjected to sexual assault have realised the need for psychological support and the need for a survivor support worker who will help the woman through all stages — from the initial contact at the police station or health facility, helping her handle medical examination, discussing an emergency contraception and STD/HIV prophylaxis and subsequently helping her with court proceedings and to normalise her life.

The toolkit is meant to help nurses, doctors and counsellors give psychosocial support to survivors of rape, help them with the consequences of the experience and through recovery from trauma.

Describing rape and sexual assault as severely traumatic experiences often associated with immediate psychological reactions such as shock, shame, guilt, anger, numbing and psychological distress, the toolkit says women and young girls may not be able to discuss everything or reveal all details at the first contact at a police station or hospital. The clinical environment of a hospital or the alien atmosphere in a police station may add to the distress and often result in the survivor not revealing important information.

‘You are not to blame’ is the key message the survivor wants to hear. She should not be quizzed by too many professionals. ‘I believe you’ and ‘I understand your distress’ are two critical messages that will help a survivor in talking about her problem. The partner needs to be educated on the normal reactions to healing after sexual assault: how anger sometimes serves a function and how the partner may also need to talk about his own emotions with the counsellor. (Source: The Hindu, March 10, 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)

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

What is trafficking?

Trafficking is the moving, selling or buying of woman and children for prostitution within and outside a country for monetary or other consideration with or without the consent of the person subjected to trafficking. (SAARC Convention on Preventing and Combating Trafficking in Woman and Children for Prostitution)

For comments and archives

 
    Valvular Heart Disease Update

Valvular heart disease and CKD

Valvular heart disease is common in patients undergoing maintenance dialysis. Predisposing factors include secondary hyperparathyroidism, an elevated calcium-phosphorus product, vascular calcification, hypercalcemia, uremic milieu and hyperphosphatemia.

(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)

Ectopic pregnancies: Treatment does not alter fertility

The fertility of women after an ectopic pregnancy appears to be similar between those who received medical treatment and those who received conservative or radical surgery, according to the findings of a randomized controlled trial. (Source: Medscape)

Contraception: Unmet needs projected to rise by 2015

Despite an overall increase in contraceptive use worldwide among married or cohabitating women of reproductive age, 233 million women are projected to have an unmet need for modern family planning methods by 2015, according to results from a new study published online March 12 in the Lancet. The largest increases are expected in developing countries. (Source: Medscape)

Helmets: Limited defense against concussions

Protective sports equipment in use today does not lower the incidence of concussions among players, so the emphasis must remain on rapid assessment and appropriate removal from play, according to an updated consensus statement. (Source: Medpage Today)

PML not fatal if caught early

All multiple sclerosis patients taking natalizumab (Tysabri) who were diagnosed with progressive multifocal leukoencephalopathy (PML) before symptoms appeared were still alive a year later, researchers said(Source: Medpage Today)

Poor sleep may signal onset of Alzheimer's

Disturbed sleep quality may be an early sign of Alzheimer's disease, researchers reported. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Cardiovascular disease 10 to 15 years after the trial endedhttp://bit.ly/10L4oG1 #Health

@Dr Deepak Chopra: The paradox of existence http://www.youtube.com/watch?v=pfCI3JBAs-o&list=SPdrUeeBIMbrIRQZM8yUbWpZfRwP82AKYr …#CosmicConsciousness

 
    Spiritual Update

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

Do not inform others, it’s a secret?

Most Asians are known for two habits, firstly a crab nature and secondly the habit of telling others that “I am telling you a secret and please do not tell others”.

Crab nature mean pulling each other leg and not allowing any one to rise. Most people, especially women, will gossip and tell all secrets they know of. To clear their conscience, they will add the sentence that “I am telling you the secret but do not tell others.” The very fact you are telling it to someone means that it is no more a secret.

For comments and archives

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

What is the difference between a surrogate and a gestational carrier?

A surrogate is a woman who agrees to become pregnant using your partner’s sperm and her own egg. The child will be genetically related to the surrogate and your partner, and the surrogate will give you and your partner the baby after delivery.

A gestational carrier is an option for women who have had a hysterectomy but still retain their ovaries, or for women who should not become pregnant due to medical reasons. If you use a gestational carrier, your eggs are fertilized by your partner’s sperm and the resulting embryos placed in the uterus of the carrier. You and your partner will be genetically related to the child, but the carrier will not. She will give the baby to you and your partner at birth.

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

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

Anti-A and B produced in the mother being natural are IgM molecules and so do not cross placenta.

 
    An Inspirational Story

The Three Races

A fable retells the story of the young athletic boy hungry for success, for whom winning was everything and success was measured by such a result.

One day, the boy was preparing himself for a running competition in his small native village, himself and two other young boys to compete. A large crowd had congregated to witness the sporting spectacle and a wise old man, upon hearing of the little boy, had travelled far to bear witness also.

The race commenced, looking like a level heat at the finishing line, but sure enough the boy dug deep and called on his determination, strength and power… he took the winning line and was first. The crowd was ecstatic and cheered and waved at the boy. The wise man remained still and calm, expressing no sentiment. The little boy however felt proud and important.

A second race was called, and two new young, fit, challengers came forward, to run with the little boy. The race was started and sure enough the little boy came through and finished first once again. The crowd was ecstatic again and cheered and waved at the boy. The wise man remained still and calm, again expressing no sentiment. The little boy, however, felt proud and important.

"Another race, another race!" pleaded the little boy. The wise old man stepped forward and presented the little boy with two new challengers, an elderly frail lady and a blind man. "What is this?" quizzed the little boy. "This is no race" he exclaimed. "Race!" said the wise man. The race was started and the boy was the only finisher, the other two challengers left standing at the starting line. The little boy was ecstatic; he raised his arms in delight. The crowd, however, was silent showing no sentiment toward the little boy.

"What has happened? Why not do the people join in my success?" he asked the wise old man. "Race again", replied the wise man, "…this time, finish together, all three of you, finish together" continued the wise man. The little boy thought a little, stood in the middle of the blind man and the frail old lady, and then took the two challengers by the hand. The race began and the little boy walked slowly, ever so slowly, to the finishing line and crossed it. The crowd was ecstatic and cheered and waved at the boy. The wise man smiled, gently nodding his head. The little boy felt proud and important.

"Old man, I understand not! Who are the crowds cheering for? Which one of us three?" asked the little boy. The wise old man looked into the little boy’s eyes, placing his hands on the boy’s shoulders, and replied softly… "Little boy, for this race you have won much more than in any race you have ever ran before, and for this race the crowd cheer not for any winner!"

Sometimes, when we lose we win.

For comments and archives

 
    Cardiology eMedinewS

ACC: CAD is disease of the ancients Read More

ACC: LDL may rise in winter months Read More

 
    Pediatric eMedinewS

Beta-blocker clears infancy hemangiomas 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)

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

A study on management of human rabies concluded that the dismal outcome of patients with rabies provides little optimism for heroic efforts. Palliative therapy is of paramount importance in this fatal disease.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of recurrent miscarriage wanted to know her future risk of heart attack.
Dr. Bad: There is no risk.
Dr. Good: There is a future risk of heart attack.
Lesson: Women who suffer recurrent miscarriages have an increased risk of heart attack later on in life. Each miscarriage increases heart attack risk by 40% and having > 2 miscarriages increases the risk by more than four–folds. In women who had > 3 miscarriages, the risk is increased 9–folds. One stillbirth increases the risk of heart attack by 3.5 times (Kharazmi E, et al. Pregnancy loss and risk of cardiovascular disease: a prospective population–based cohort study (EPIC–Heidelberg. Heart 2011 Jan;97(1):49–54).

Make Sure

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that every time a patient is given penicillin injection, anti-anaphylaxis measures are available.

 
  Quote of the Day (Dr GM Singh)

HATRED weakens the liver; GRIEF weakens the lungs; WORRYING weakens the stomach; STRESS weakens both the heart and the brain and FEAR fails the kidneys…so stay HAPPY! LOOK GOOD, FEEL GOOD and DO GOOD!

 
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    Mind Teaser

Read this…………………

What is the number one cancer killer of women?

A. Colon cancer
B. Breast cancer
C. Lung cancer
D. Cervical cancer
E. Esophageal cancer

Yesterday’s Mind Teaser: According to the American Hospital Association's Patient's Bill of Rights, patients are responsible for:

1. Accepting the treatment decisions of the medical and nursing team.
2. Allowing HIV testing when a staff member experiences a body fluid exposure.
3. Participating in the hospital's research studies.
4. Providing information about past illnesses, hospitalizations, and medications.

Answer for Yesterday’s Mind Teaser: Accepting the treatment decisions of the medical and nursing team.

Correct answers: Dr Arpan Gandhi, Dr BB Gupta, Dr PK Sahu, Dr Kusum Mahajan, Dr B Srinivas, Dr PC Das, Dr Thakor Hitendrsinh G, Dr Jella, Raju Kuppusamy, Anil Bairaria, Dr KV Sarma, Dr Pankaj Agarwal,
Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta Jain.

Answer for 12th March Mind Teaser: Leg cramps

Correct answers received from: Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta Jain.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Side Effects of Alcohol.... and remedies!!!

  1. Symptom: Cold and humid feet.
    Cause: Glass is being held at incorrect angle (You are pouring the Drink on your feet).
    Cure: Maneuver glass until open end is facing upward...
  2. Symptom: The wall facing you is full of lights.
    Cause: You're lying on the floor.
    Cure: Position your body at a 90-degree angle to the floor.
  3. Symptom- The floor looks blurry.
    Cause: You're looking through an empty glass.
    Cure: Quickly refill your glass!
  4. Symptom: The floor is moving.
    Cause: You're being dragged away.
    Cure: At least ask where they're taking you!
  5. Symptom-You hear echoes every time someone speaks.
    Cause: You have your glass on your ear and trying to drink from it.
    Cure: Stop making a fool of yourself!
  6. Symptom: Your dad and all your brothers are looking funny.
    Cause: You're in the wrong house.
    Cure: Ask if they can point you to your house.
  7. Symptom: The room is shaking a lot, everyone is dressed in white and the music is very repetitive.
    Cause: You're in an ambulance.
    Cure: Don't move. Let the professionals do their job!!!!
 
    Medicolegal Update

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

No Narco test without valid informed consent, rules Supreme Court of India

The most exhausting/frustrating and laborious part of a criminal investigation for agencies like CBI or FBI is extracting information from an uncooperative alleged accused and suspects by investigators in India as well as abroad. No individual should be forcibly subjected to any of these techniques/method of interrogation in question, whether in the context of investigation in any criminal cases or otherwise. The narcoanalysis test began to be used with the presumption that it provides a simple, nonviolent method of finding out the truth. In a world where until quite recently, torture was employed in criminal cases, perhaps narcoanalysis is a simple, civilized way of conducting criminal investigation

  • The Supreme Court of India said that the so–called narcoanalysis, brain mapping and polygraph tests cannot be conducted on any person without their consent.
  • The Apex Court further said the confession of guilt during the course of the tests cannot be treated as evidence in court.
  • The results of narco test provided clues and did not have any evidentiary value. There is no scientific literature to prove that truth serum works; human rights groups have held the tests to be mental torture.
  • "The compulsory administration of any of these techniques is an unjustified intrusion into the mental privacy of an individual. It would also amount to ‘cruel, inhuman or degrading treatment’ with regard to the language of evolving international human rights norms," said a Bench comprising Chief Justice K G Balakrishnan and Justices R V Raveendran and J M Panchal. The police, instead of collecting real evidence, relied on these tests to spread rumors about the suspect, and selective leaks were made to the media that a particular suspect has made confession during the tests."

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Drugs as Good as Angioplasty for Stable Heart Disease

Aggressive drug therapy is just as good as angioplasty for patients with stable heart blockages, 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.

There has been a belief amongst cardiologists that all patients with chronic stable heart disease need to have either an angioplasty or heart bypass surgery.

Patients with stable heart disease make up about three–quarters of all the patients who undergo angioplasty and receive stents.

Quoting the results of the "Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation” (COURAGE) trial, Dr. Aggarwal said that optimal drug therapy, when combined with lifestyle changes, has equal results as that of angioplasty and optimal medical therapy combined.

The study published in the New England Journal of Medicine randomly assigned 2,300 patients with stable but significant heart disease to one of two treatment regimens. The first group received drug therapy alone, while the second group received the drug therapy plus angioplasty.

Follow-up showed that 19% in the angioplasty group had died or had a heart attack, compared to 18.5% in the group that only received drug treatment. The only benefit of angioplasty was that it reduced chest pain over the long–term compared with drug therapy alone. About 30% of the patients who received drug therapy alone did eventually undergo angioplasty because their symptoms couldn't be managed with drugs alone.

In addition, about 21% of the patients who received stents needed to have another procedure. Although angioplasty was better at relieving symptoms, it wasn’t better in preventing death or heart attack.

Dr. Sameer Shrivastava, Head department of Non-Invasive Cardiology at Fortis Escorts Heart Institute, New Delhi said that Drug therapy for patients with stable heart disease should be tried as first–line treatment. Angioplasty should be reserved for patients who have continuing symptoms.

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 31097 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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