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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); 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

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  Editorial …

15th May 2013, Wednesday

Edible insects

  1. As per UN, edible insects fight hunger, boost nutrition and reduce pollution.
  2. Entomophagy is the consumption of insects as food. Insects are eaten by many animals, but the term is generally used to refer to human consumption of insects; animals that eat insects are known as insectivores. There are also some species of carnivorous plants that derive nutrients from insects. Over 1,000 species of insects are known to be eaten in 80% of the world's nations.
  3. Some of the more popular insects and arachnids eaten around the world include crickets, cicadas, grasshoppers, ants, various beetle grubs (such as meal worms), the larvae of the darkling beetle or rhinoceros beetle, various species of caterpillar (such as bamboo worms, mopani worms, silkworms and waxworms), scorpions and tarantulas. Entomophagy is sometimes defined broadly to include the practice of eating arthropods that are not insects, such as arachnids (tarantulas mainly) and myriapods (centipedes mainly). There are 1,417 known species of arthropods, including arachnids that are edible to humans. The term is not used for the consumption of other arthropods, specifically crustaceans like crabs, lobsters and shrimps
  4. In practice, it is not possible to eliminate pest insects from the human food chain. Insects are present in many foods, especially grains. Food laws in many countries do not prohibit insect parts in food, but rather, they limit the quantity. People in rice-eating regions, for example, typically ingest significant numbers of rice weevil (Sitophilus oryzae) larvae, and this has been suggested as an important source of vitamins. The Food and Agricultural Organisation specifies in the Codex Alimentarius standard for wheat (Codex Standard 152-1985 : Codex Standard for Wheat Flour) that : wheat flour shall be free from filth (impurities of animal origin, including dead insects) in amounts which may represent a hazard to human health. Contamination on the average of less than 150 insect fragments per 100 grams of wheat flour poses no health hazard.
  5. As per US FDA likes of grasshoppers, ants and other members of the insect world are an underutilized food for people, livestock and pets.
  6. About 2 billion people worldwide already have supplemented their diets with insects, which are high in protein and minerals, and have environmental benefits.
  7. Insects are 'extremely efficient' in converting feed into edible meat. On average, they can convert 2 kilograms (4.4 pounds) of feed into 1 kilogram (2.2 pounds) of insect mass. In comparison, cattle require 8 kilograms (17.6 pounds) of feed to produce a kilo of meat.
  8. Most insects are likely to produce fewer environmentally harmful greenhouse gases, and also feed on human and food waste, compost and animal slurry, with the products being used for agricultural feed.
  9. Currently, most edible insects are gathered in forests and what insect farming does take place is often family-run and serves niche markets.
  10. Insects are everywhere and they reproduce quickly.
  11. They provide high-quality protein and nutrients when compared with meat and fish.
  12. Insects can also be rich in copper, iron, magnesium, manganese, phosphorus, selenium and zinc, and are a source of fiber.
  13. The Edible Insect Program is also examining the potential of arachnids, such as spiders and scorpions, although they are not strictly speaking insects.
  14. Some of them, such as certain beetles, ants, crickets and grasshoppers, come close to lean red meat or broiled fish in terms of protein per gram (ounce).
  15. Some caterpillars in southern Africa and weaver ant eggs in Southeast Asia are considered delicacies and command high prices. (Source: TOI)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

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Monitoring LFT in a patient on statins

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Dr KK Aggarwal conducts a lecture on World Laughter Day on 5th May 2013 in Rohini

 
Dr K K Aggarwal
    National News

MCI bill: Govt to seek ordinance

May 10, 2013 - TEENA THACKER | Asian Age Correspondent | New Delhi With the government failing to get through Indian Medical Council (Amendment) Bill in this session of the Parliament-that proposed to reconstitute the elected body of the Medical Council of India (MCI), the government is now left with an option to bring in an ordinance to govern the regulatory body.

It is learnt that the government is mooting with the idea to bring in an ordinance of the same bill soon. The proposed bill was introduced in the Rajya Sabha in March 2013 with an intention to initiate election process and restore the elected body of the MCI. However, the matter could not be taken up in the Parliament, it is expected that the government will bring an ordinance by Monday.

Sources said that government will continue with the arrangement of Board of Governors (BoG) for manning the regulatory body as section 3 A (a) proposes “present arrangement of BoG to constitute till the body is reconstituted.” The government may however make some changes in the present board headed by Dr K.K. Talwar.

The government had earlier superseded the MCI by issuing an ordinance in May 2010 after the then MCI president was caught by the CBI for allegedly taking bribe. Since then the health ministry has been seeking extension of the tenure of BoG governing MCI. The tenure of the current BoGs, which is running its second term, will end on May 13.

The Indian Medical Council (Amendment) Bill, 2013, sought to bring about such changes requiring the government to act in case of serious charges against MCI office-bearers. The proposed bill proposes to fix the tenure of the president of the elected-body of MCI to a maximum period of four years and restricting it to two continuous terms only.

For comments and archives

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, every Thursday 4:30 PM in DD India

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/)

Fifty percent of school children do not reveal sexual assault to anyone.

    Valvular Heart Disease Update

Bicuspid aortic valve can be associated with ventricular or atrial septal defect, hypoplastic left heart syndrome, patent ductus arteriosus, bicuspid pulmonic valve and Ebstein’s anomaly.

(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)

Hospitalizations due to urinary catheters on the rise

Hospital admissions from indwelling catheters are mushrooming, costing lives and money, a new study shows. Dr. Colli presented results from a study of hospitalizations here at the American Urological Association 2013 Annual Scientific Meeting. (Source: Medscape)

For comments and archives

If job stress mounts, healthy living may be lifesaver

A handful of studies have suggested that high stress work environments are bad for the heart, but some of the job-related risk may be reduced by avoiding a quartet of known lifestyle risk factors: smoking, obesity, physical inactivity, and heavy drinking, researchers report. (Source: Medpage Today)

For comments and archives

Single-embryo screening equal birth rate, better outcomes

Single-embryo transfer with aneuploidy screening is not only as successful as double-embryo transfer, but results in healthier babies, report researchers, who say a paradigm shift is in the works in the field of in vitro fertilization (IVF). (Source: Medscape)

For comments and archives

New guidance for inherited arrhythmias

A redefinition of Brugada syndrome diagnosis based on ECG alone, and a new look at short QT syndrome and repolarization are featured in new consensus guidelines on inherited arrhythmias. The recommendations call for evaluation of all patients with such conditions and their first-degree relatives in a dedicated clinic with appropriately trained staff. (Source: Medpage Today)

For comments and archives

End-of-life care guidelines updated

The Hastings Center has updated and expanded its landmark 1987 consensus guidelines for ethical care of terminally ill patients. Oxford University Press published this second edition of The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life. (Source: Medscape)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: Lifestyle counseling can reduce heart disease http://bit.ly/12wK5Jc #Health

@DrKKAggarwal: What is the true meaning of surrender? My #askdeepak reply http://tinyurl.com/cbora38

 
    Spiritual Update

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

Akshaya Tritiya ( Akshaya Teej, Akha Teej)

1. Akshay Tritiya is one day which is never "absent" from the lunar calendar.
2. It is one of the most pious festivals in Hinduism. It is the beginning of 'Treta Yuga'.
3. Akshaya means imperishable. Japa, worship, purification of body, donations etc. done on this day remain imperishable.

For comments and archives

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

How are the sexual dysfunction and infertility inter-related?

Sexual dysfunction may cause problems getting pregnant (infertility). The right time for sexual activity is when the egg is released from the ovary (ovulation). Determine the time of ovulation by your partner's menstrual history or by the use of a urine test that becomes positive when the hormone that triggers the egg to be released can be detected. If you cannot or do not have sex near that time, the woman is less likely to get pregnant. If you only have sex once in a while because of low sexual desire or pain during sex, you may miss that important time for pregnancy. Men who have erectile dysfunction or ejaculatory dysfunction will not be able to get their partner pregnant.

 
    An Inspirational Story

The evil you do remains with you

Once upon a time in the little countryside, there was a mother who would bake loaves of bread for her family every day. She would always bake an extra loaf of bread and keep it at the doorstep for any poor passer by or beggar or for any individual who wished to take it.

This lady lived with her husband and son in a small cottage and her son would go into the city to earn money. He would return after many days and come home to give his parents the money he had earned. Every day when the lady would leave a loaf of bread at her doorstep, this old man with a hunchback would come and take it. Not once would he thank her or show her some gratitude. Instead he would always mutter to himself, " the evil you do remains with you; the good you do comes back to you." This went on day after day and frankly the woman was getting very angry that not once did the old hunchback ever show any gratitude.

So one day she decided to get rid of the old man and she decided to put poison in the loaf of bread that she would keep outside the house for him. After she prepared the bread and filled it with poison, she began to feel guilty and think about what the old man had said. She wondered if there was any truth in what he had said and she immediately threw away the poisoned loaf in the fire and prepared a new fresh and clean loaf and placed it outside the house.

That night her son was due to return from the city. Later that evening, the old hunchback came and after he took the loaf of bread, he uttered the same words. Late at night, there was a knock at the house. When the lady opened the door, she was startled to see her son there. He looked tired and pale and miserable. His clothes were torn and he had bruises on his body. The son said, “Mother it is a miracle how I got here. When I was on my way home, some goons robbed me and I had to walk all the way home. I would have died had it not been for some old hunchback man I saw a mile away who took pity on me and gave me some bread to eat. Although it was his dinner, he still parted with it and gave it to me." The lady was shocked and her hand immediately flew to her mouth to cover her shame. Had she given the old man the poisoned loaf, she would have killed her own son in the bargain.

It was then that she realized the significance of the words: “The evil you do remains with you: The good you do, comes back to you!” Do good and don’t ever stop doing good, even if it is not appreciated at that time.

For comments and archives

 
    Cardiology eMedinewS

Racial, ethnic variation seen in BP control Read More

 
    Pediatric eMedinewS

One in three preschoolers not screened for vision 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 is the potency requirement of IDRV?

Only three countries are practicing IDRV in regular patients attending regular anti-rabies clinics (ARCs) for more than 10 years. These countries are Thailand, Philippines and Sri Lanka.

In Thailand and Sri Lanka, the potency requirement is 0.7 IU/ID dose and in Philippines it is 0.5 IU/ID dose.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came with an eGFR of 15.
Dr. Bad: Go for immediate dialysis.
Dr. Good: Hold till proper investigations are done.
Lesson: A study published in the Canada Medical Association Journal shows that starting dialysis too soon may increase the risk of death.

Make Sure

Situation: A patient with rheumatoid arthritis was not responding.
Reaction: Oh my God! Why was smoking not stopped?
Lesson: Make sure that all patients of RA stop smoking. It is a major preventable factor contributing to the development of antibody–positive rheumatoid arthritis in genetically susceptible individuals.

 
  Quote of the Day (Dr GM Singh)

Idleness is an inlet to disorder, and makes way for licentiousness. People that have nothing to do are quickly tired of their own company. Jeremy Collier

 
    Legal Question of the Day (Dr MC Gupta)

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

Q. Is it legally necessary for a physician to display his registration no.? If so, why?

Ans.

  1. Regulation 1.41 of the MCI Code of Ethics Regulations, 2002, reads: “1.4.1 Every physician shall display the registration number accorded to him by the State Medical Council/Medical Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients.”

    It is obvious that the above direction is mandatory.
  2. Regulation 7.3 provides that it is professional misconduct

    “If he/she does not display the registration number accorded to him/her by the State Medical Council or the Medical Council of India in his clinic, prescriptions and certificates etc. issued by him or violates the provisions of regulation 1.4.2.”
  3. The Hindu dated 26-3-2013 carried a news item titled—“Doctors to be made to show registration”.

    http://www.thehindu.com/todays-paper/tp-national/doctors-to-be-made-to-show-registration/article4549571.ece

    It is given below:

    “The Kerala State Consumer Disputes Redressal Commission has directed the Travancore-Cochin Medical Councils-Kerala (TCMC-K) to instruct doctors to display their medical council registration numbers on their signboards. It has also asked doctors to quote the register numbers in all prescriptions and all case sheets. In their decision on a petition by a woman patient who had sought Rs.1 crore compensation for a faulty surgery at a Thiruvananthapuram hospital, commission presiding member M.K. Abdulla Sona and A. Radha, directed the TCMC-K to give strict instructions to its members on the registration number. The Travancore-Cochin Council for Modern Medicine, one of the wings of the TCMC-K is the agency that issues registration numbers to medical doctors. The commission pointed out that using the registration number in the doctors’ prescriptions, case-sheets and signboards would help patients to get information about the whereabouts of the doctor and also to check if the doctor had the competency and possessed the required qualifications. This would also be useful for other members of the healthcare profession. The commission also noted that the patient has the right to information about all the doctors attending on him/her. “The patient/consumer has the right to know the details of each doctor who accompanied the leader of the surgical team, including the anaesthesiologist,” the commission ruled. Any denial of this would be considered a deficiency of service and an unfair trade practice under the provisions of the Consumer Protection Act.

    The commission made the directive on the faulty surgery case in which there was dispute over who attended on the patient apart from the gynaecologist.

    Wrong practice

    It is pointed out that many private hospitals in Kerala employ young medical practitioners who do not possess the required medical council registration. Many of them are doctors who had graduated out of Russian or Chinese medical colleges. Such doctors need to get a licence from the Medical Council of India to practice in India. However, the licence test is pretty tough and those who cannot pass the test often opt for working at private hospitals at much lower salaries. Since these doctors cannot register themselves with the TCMC-K, they skip the registration details in their prescriptions, and other documents as well as their signboards.”
  4. The National Consumer Commission has observed as follows:

    “We feel it is high time that hospital authorities realize that the practice of employing non-medical practitioners such as Doctors specialized in Unani system and who do not possess the required skill and competence to give allopathic treatment and to let an emergency patient be treated in their hands is a gross negligence.” (In: Prof. P.N. Thakur v. Hans Charitable Hospital, decided on 16 Aug. 2007, where the hospital was held negligent in employing a BUMS doctor) --http://ncdrc.nic.in/OP21497.HTML
  5. Delhi Medical Council has written to the Directorate of health Services, NCT of Delhi, on 18-6-2009 and 13-5-2010 to direct the hospitals/nursing homes established and functioning in the NCT of Delhi to seek verification of registration of the doctors engaged in the practice of modern system of medicine in view of the fact that the registration and regulation of the nursing homes/hospitals includes the aspect of employment of unregistered doctors.
  6. In view of the above, it is clear that it is legally necessary for a physician to display his registration number. The purpose of this legal binding is to minimise the possibility of quackery. It is the duty of doctors to abide by law and not to violate this mandatory regulation.
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    Mind Teaser

Read this…………………

Nurse Claudine is reviewing a client’s fluid intake and output record. Fluid intake and urine output should relate in which way?

a. Fluid intake should be double the urine output.
b. Fluid intake should be approximately equal to the urine output.
c. Fluid intake should be half the urine output.
d. Fluid intake should be inversely proportional to the urine output.

Yesterday’s Mind Teaser: A male client with acute pyelonephritis receives a prescription for co-trimoxazole PO twice-daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?

a. Urine output increases to 2,000 ml/day.
b. Flank and abdominal discomfort decrease.
c. Bacteria are absent on urine culture.
d. The red blood cell (RBC) count is normal.

Answer for yesterday’s Mind Teaser: c. Bacteria are absent on urine culture.

Correct answers received from: Dr valluri Ramarao, Dr Nimai, Dr Kanta Jain, Dr Bharat Bhushan Aggarwal Tukaram Pagad, Dr BB Gupta, Dr PC Das & Dr Mrs. S Das, Dr Arpan Gandhi, Dr Pankaj Agarwal, Dr KV Sarma, Dr Jainendra Upadhyay, Dr Thakor Hitendrsinh G, Raju Kuppusamy, Muthumperumal Thirumalpillai, Dr Jayant Shah, Dr Avtar Krishan, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 12th May Mind Teaser: Providing demonstration and return demonstration

Correct answers received from: Raju Kuppusamy, Muthumperumal Thirumalpillai, Dr Jayant Shah,
Dr Avtar Krishan, Dr Jayashree Sen & Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A true friend is one who overlooks your failures and tolerates your success! Doug Larson

 
    Medicolegal Update

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

What is somatic death?

For many years it was accepted that death occurred if respiration and circulation ceased for more than 10 minutes. Now it is possible to stop the heart and respiration for an hour or longer and restart them again at will by methods such as cooling the whole body to 15°C or 59°F or less. During this period, ECG and EEG show no electrical activity and body looks like a corpse. This leads to the view that it is not the cessation of the respiration or circulation but it is their failure to return that indicates death. Thus we are driven from a positive to negative approach. Therefore, the doctor while taking decision must satisfy himself that not only respiration and circulation have stopped, but their failure has persisted to such a period that under no circumstances it is possible for the person to come to life again.

  • Death is said to have occurred when a final expiration is followed by continuous immobility of the chest, loss of pulse and alteration of the features. These changes indicate that respiration and circulation have been stopped and the brain will stop functioning if it has not been so.
  • Residual heart movement is not of practical importance as they are insufficient to maintain the circulation.
  • Somatic death can be detected by ECG that will stop within minutes.

(Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of Forensic Medicine, Peepee Publishers)

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

International Family Day

Every year, May 15 is observed as International Day of Families. This year the theme is ‘Advancing Social Integration and Inter-Generational Solidarity.’

Inter-generation solidarity relates to reciprocal care, support and exchange of material and non-material resources in families typically between younger and older generations. It is often defined as bonding between and among individuals in multi-generational family network and among different age cohorts in the larger community.

Speaking on the occasion, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Vice President (Elect) Indian Medical Association said that grandparents can play a major role in family bonding. They often take care of their grandchildren and can even act as near custodial grandparents when the parents migrate in search of jobs.

Dr. Aggarwal said that our parents look after us till the age of 20 years and so it becomes our duty to look after them during the last 20 years of their life with equal care and concern.

We must plan our old age and be able to look after our health through continued Mediclaim policy and know everything about financial management including reverse mortgage where we can mortgage our houses and take regular money from bank. One should also plan one’s will in time and the will must contain all aspects of Dharma, Artha, Kama and Moksha.

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 50338 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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  1. Dear Sir, Emedinews is very informative. Regards: Dr Sapna
 
    Forthcoming Events
Dr K K Aggarwal

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Name
Date
Time
Place
Duration
Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

 
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