eMedinewS14th August 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

MCI Update

Ministry of Health & Family Welfare, Government of India has taken cognizance of the recommendations made by Medical Council of India Ethics Committee and has passed the following Office Memorandum.

"F.No. S–11011/21/2014 (HEC), Directorate General of CGHS, Office of the Addl. Director (HQ), CGHS, CGHS Bldg, RK Puram –Section –12, New Delhi,

OFFICE MEMORANDUM, Dated the 1st August, 2014

Sub: Withdrawal from the list of Diagnostic Labs and Imaging Centers empanelled under CGHS, Delhi–as per recommendations of the Ethics Committee of Medical Council of India

With reference to the above mentioned subject it is stated that the subsequent to the sting operation titled "Operation Jonk" aired by a TV Channel, the Ethics Committee of Medical Council of India conducted an enquiry into the matter as per the directions of Ministry of Health & Family Welfare. In the interim report submitted by MCI, nine Diagnostic Centers have been prima facie found involved in unethical medical practices. In view of the recommendation of the Ethics Committee of MCI, it has been decided that pending investigation the empanelment of these centres with CGHS be withdrawn.

Accordingly the empanelment of the Diagnostic Laboratories and Imaging Centres under investigation, under CGHS, Delhi is withdrawn with immediate effect till further orders till further orders.

(Dr.D.C.Joshi), Addl. Director (HQ), CGHS"   

MCI further took suo moto action on the NDTV sting in which three doctors were found to be involved in proving a nexus between them and a pharmaceutical company. One of them was found to be a quack and was handed over to the Police and in the other two cases, MCI took suo moto action pending investigations under MCI Regulation 8.5 and also referred the matter to Delhi Medical Council to complete investigations within 60 days.

News Around The Globe

  • Women with a rare gene mutation and associated hereditary endocrine disease are at an increased risk for breast cancer, according to a letter published in the August 7 issue of the New England Journal of Medicine. The rare disease is known as multiple endocrine neoplasia type 1, or MEN1, and is caused by germline mutations in the MEN1 tumor–suppressor gene. MEN1 patients are susceptible to various benign and malignant tumors, such as parathyroid tumors, duodenopancreatic neuroendocrine tumors, and pituitary adenomas.
  • In order to slow the spread of HIV, certain people who do not have the virus but are at risk should take medication to prevent becoming infected. That’s the recommendation of the Centers for Disease Control and Prevention and, just recently, the World Health Organization. The preventive treatment includes a drug called Truvada, and it is known as PrEP, for pre–exposure prophylaxis.
  • The first-ever DNA–based screening test for colorectal cancer has received FDA approval and preliminary approval for Medicare coverage of the test. The Cologuard test detects hemoglobin and mutant DNA in cells sloughed into stool by cancers and adenomatous polyps. A positive test indicates a need for colonoscopy to identify or rule out colon cancer.
  • A new study in JAMA Internal Medicine reports that taking bisphosphonates for osteoporosis doesn't appear to be protective against breast cancer in postmenopausal women.
  • Canadian researchers report that a couple handfuls of tree nuts a day may improve glycemic control in patients with type 2 diabetes. Tree nuts include almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts (but not peanuts, which are legumes). The findings are published in PLOS One.

Rabies News (Dr A K Gupta)

An unvaccinated or partially vaccinated pet dog or cat is bitten by a stray dog. What should be done?

If an unvaccinated or partially vaccinated pet dog or cat is bitten by a stray dog, wounds should be thoroughly washed with water and povidone iodine should be applied. If the stray dog is suspected to be rabid, then the pet dog should be put to sleep (Euthanasia). But if the owner is not ready or the rabid status of the stray dog is not known, post–exposure vaccination of the pet with cell culture vaccine and simultaneous careful observation of the pet are recommended for up to 2 months (up to six months is desirable) for possible signs of rabies in the pet. During this period, if the dog becomes sick, the owner should take the dog to the veterinarian to get rabies ruled out at the first instance. It should be noted that post–exposure vaccination is not very successful in dogs. Simultaneously, pre–exposure vaccination of all household members is necessary.

Cardiology eMedinewS

  • The identification of high–risk plaque features using noninvasive CT imaging is a useful and independent predictor of acute coronary syndrome (ACS) in patients presenting to emergency departments with acute chest pain. According to findings from a substudy of the Rule Out Myocardial Infarction/Ischemia Using Computer–Assisted Tomography II (ROMICAT–II) trial, the presence of high–risk plaque features such as positive remodeling, spotty calcium, and napkin–ring sign on coronary CT angiography was a clinically meaningful predictor of ACS in patients with chest pain and negative initial ECG and troponin. The results are reported in the Journal of the American College of Cardiology.
  • A study in the Journal of the American College of Cardiology has found that digoxin was associated with increased risk of death in patients with newly diagnosed atrial fibrillation (Afib), independent of drug adherence, kidney function, cardiovascular comorbidities, and concomitant therapies. The American Heart Association and American College of Cardiology Foundation recommendations from March of this year point out that digoxin "is not usually first–line therapy. It may be combined with a beta blocker and/or a nondihydropyridine calcium channel blocker when ventricular rate control is insufficient and may be useful in patients with HF."

Pediatrics eMedinewS

  • According to a study in the Proceedings of the National Academy of Sciences, postnatal development of intestinal microflora in premature neonates is most strongly influenced by gestational age, with the microbial population assembling slowest for the most premature infants. The pace of progression of the gut bacterial community is only minimally influenced by environmental factors such as mode of delivery, antibiotics, or feeds.
  • Extremely premature infants in a neonatal intensive care unit (NICU) had fewer infections when medical staff donned gloves after washing their hands compared with hand washing alone in a randomized controlled trial published in JAMA Pediatrics. According to the authors, gloving after hand hygiene prior to all patient and line contact should become part of our care of preterm infants.

Dr K K Spiritual Blog

Ganesha, the Stress Management Guru

If Lord Krishna was the first counselor who taught the principles of counseling, Lord Ganesha taught us the principles of stress management.

We should worship Lord Ganesha and become like him whenever we face any difficulty or are stressed out.

The elephant head of Lord Ganesha symbolizes that when in difficulty, use your wisdom, intelligence and think differently. It can be equated to the Third Eye of Lord Shiva. Elephant is supposed to be the most intelligent animal in the kingdom. Here, wisdom means to think before speaking. Lord Buddha also said that don’t speak unless it is necessary and is truthful and kind.

The big elephant ears of Lord Ganesha signify listening to everybody when in difficulty. Elephant ears are known to hear long distances. Elephant eye see a long distance and in terms of mythology, it represents acquiring the quality of foreseeing when in difficulty. The mouth of Lord Ganesha represents speaking less and hearing and listening more.

The big tummy of Lord Ganesha represents digesting any information gathered by listening to people in difficulty. The trunk denotes using the power of discrimination to decide from the retained information. It also indicates to do both smaller and bigger things by yourself. Elephant trunk can pick up needle as well as a tree.

The teeth, broken and unbroken, signify to be in a state of balance in loss and gain. This implies that one should not get upset if the task is not accomplished and also not get excited if the task is accomplished. In times of difficulty, Ganesha also teaches us not to lose strength and control one’s attachments, desires and greed.

The four arms of Lord Ganesha represent strength. Ropes in two hands indicate attachment, Laddu or Sweet in one hand represent desires and mouse represents greed. Riding over the mouse indicates controlling one’s greed.

Lord Ganesha is worshipped either when a new work is initiated or when one finds it difficult to complete a job or work. In these two situations, these principles of Lord Ganesha need to be inculcated in one’s habits.

Wellness Blog

50% of adverse drug reactions can be prevented

Over 50% of all adverse drug reactions treated in hospitals and emergency care are preventable.

Many preventable drug reactions like drug overdoses and internal bleeding associated with the improper use of blood thinners and painkillers are life–threatening especially in the elderly. There are many reasons for these reactions and may include poor coordination of care, lack of time and knowledge among health professionals, and lack of patient education, according to Swedish researchers, who conducted a meta–analysis of 22 studies. Human error is inevitable, and therefore systems must be made to reduce the error. The study concluded that:

  • In outpatient setting, the frequency of preventable adverse drug reactions resulting in hospitalization or emergency treatment is 2%; of these 51 percent are preventable.
  • In the elderly, 71 percent of drug reactions are preventable.
  • In admitted patients the frequency of harmful drug reactions is 1.6 percent and 45 percent of them are preventable.
  • A third of preventable adverse drug reactions are life–threatening.

Inspirational Story

A Million Dollar Lesson

A cab driver taught me a million dollar lesson in customer satisfaction and expectation. Motivational speakers charge thousands of dollars to impart his kind of training to corporate executives and staff. It cost me a $12 taxi ride.

I had flown into Dallas for the sole purpose of calling on a client. Time was of the essence and my plan included a quick turnaround trip from and back to the airport. A spotless cab pulled up. The driver rushed to open the passenger door for me and made sure I was comfortably seated before he closed the door. As he got in the driver’s seat, he mentioned that the neatly folded Wall Street Journal next to me was for my use. He then showed me several tapes and asked me what type of music I would enjoy. Well! I looked around for a "Candid Camera!" Wouldn’t you? I could not believe the service I was receiving! I took the opportunity to say, "Obviously you take great pride in your work. You must have a story to tell."

"You bet," he replied, "I used to be in Corporate America. But I got tired of thinking my best would never be good enough. I decided to find my niche in life where I could feel proud of being the best I could be. I knew I would never be a rocket scientist, but I love driving cars, being of service and feeling like I have done a full day’s work and done it well. I evaluate my personal assets and… wham! I became a cab driver. One thing I know for sure, to be good in my business I could simply just meet the expectations of my passengers. But, to be GREAT in my business, I have to EXCEED the customer’s expectations! I like both the sound and the return of being ‘great’ better than just getting by on ‘average’"

ePress Release

Snorers at risk of sudden death

Interrupted night time breathing or sleep apnea increases the risk of dying said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association. Sleep apnea is a common problem wherein there are pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. An Australian study, published in edition of Sleep, suggests that the risk is present among all people with obstructive sleep apnea.

The study researcher Nathaniel Marshall, from Woolcock Institute of Medical Research in Sydney, said that the size of the increased mortality risk is surprisingly large. The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, Marshall’s team collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

Self-Assessment-Quiz

 

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Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

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CPR 10 Videos

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Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

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Health Check Up and CPR 10 Camp at NP CO–ED Sr Sec School, Tilak Marg on 8th August 2014

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Lifestyle change can reduce aging

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IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

eMedinewS Humor

Missing Homework

After teaching high school for nearly 20 years, I thought I’d heard every possible excuse for missing homework until one parent sent me this note: "Please excuse Lori for not having her algebra homework. The cat had kittens on it last night."

Quote of the Day

Families break up when people take hints you don’t intend and miss hints you do intend. Robert Frost

Twitter of the Day

Dr KK Aggarwal: Poly Diet and Poly Drugs by Dr k k Aggarwal http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: The greatest contradiction of common sense http://bit.ly/DC_Ananda #ananda

eMedi Quiz

A self practicing dermatological needs

a. Videoconference
b. Mobile teledermatology
c. Store and forward teledermatology
d. A combination of store and forward, online discussion group, and author–based second opinion teledermatology

Yesterday’s Mind Teaser: Holgene’s phenomenon is seen due to which component

a. Benzylpenicilloyl
b.Procaine
c.Crystalline
d.Benzathine penicillin

Answer for yesterday’s Mind Teaser: b. Procaine

Correct answers received from: Daivadheenam Jella, Raju Kuppusamy, Dr Avtar Krishan, Dr Prakash Khalap, Dr Chandresh Jardosh, Dr Poonam Chablani, Dr Bitaan Sen & Dr Jayashree Sen.

Answer for 13th August Mind Teaser: a. hemiplegia

Correct answers received from: Daivadheenam Jella, Raju Kuppusamy, Dr Avtar Krishan, Dr Prakash Khalap, Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com

medicolegal update

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  1. Dear Sir, Thanks for the information: Regards, Dr Kanishk
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