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 & 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

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  Editorial …

16th April 2013, Tuesday

IN THE HIGH COURT OF DELHI AT NEW DELHI

CONT.CAS(C) 137/2012

MEENAKSHI GAUTHAM ..... Petitioner Through: Mr. Pranav Sachdeva, Mr. Ramesh K. Mishra, Advocates vs PK PRADHAN and ANR ..... Respondent, Through: Mr. Rajeev Mehra, ASG with Mr. Neeraj Chaudhari, CGSC and Mr. Ravjyot Singh, Adv. for UOI and Mr. Ashish Kumar, Advocate for MCI.

CORAM: HON'BLE MR. JUSTICE RAJIV SHAKDHER ORDER: 13.12.2012


Mr. Mehra has referred me to an affidavit filed on 29th November, 2011 by Secretary, Ministry of Health and Family Welfare. In paragraph 5 of the said affidavit, the deponent has indicated the following tentative schedule: Sl. No./ Activity/ Expected time line

  1. Approval from Hon’ble Health and Family Welfare Minister on the Curriculum revised by Medical Council of India (MCI); 30.10.2012
  2. Constitution of a Task Force to frame the norms regarding requirements for introduction of the course: 01.11.2012
  3. Finalisation of the norms by the Task Force: 26.11.2012
  4. Consultation with MCI and Director General of Health Services (DGHS) regarding the norms framed by the Task Force: 14.12.2012
  5. Notification of regulations on Bachelor of Science (Community Health) by MCI: 31.12.2012
  6. Meeting with the State Governments to decide upon the introduction of the course: 15.01.2013
  7. Thereafter, commencement of the course in the States who agree to introduce it.

To be noted, insofar as the first two items are concerned, they stand liquidated as per the learned ASG. He states that approval of the Health Minister qua the revised curriculum submitted by MCI vis a vis the Bachelor of Science (Community Health) course has received the necessary approval of the Health Minster. The task force to frame the norms for introduction of the aforementioned course has also been constituted. For this purpose, learned ASG has drawn my attention to the order dated 6th November, 2012 issued by Government of India, Ministry of Health and Family Welfare.

Insofar as the remaining aspects are concerned (which are referred to in the table above), the learned ASG says that they shall be adhered to punctiliously. In case, any leeway is necessary, and that too for good reason, the Ministry of Health and Family Welfare, will approach this Court, with an application in that regard.

The steps taken, since the last date of hearing, at the behest of the learned ASG, by the concerned Ministry, are appreciated. Insofar as the petitioners are concerned, they have two outstanding concerns, which have been put to the learned ASG as well as to the Advocate for the MCI, Mr. Ashish Kumar.

These concerns being: first, that in the order of the Division, there is a submission made on behalf of the MCI, that the persons, who would undertake the aforementioned course, would be not only obliged to serve in the rural areas for a period of five years but thereafter would be required to undertake a bridge course of two years so that, they are put at par with a student who has taken a MBBS degree. The second concern is, with regard to the following recommendation of the MCI, which is contained in the curriculum submitted by them to the Government of India: The BSc (CH) graduates/CHOs shall not be eligible to provide private clinical services to any individual outside the government health system under any circumstances. They are trained only to provide certain limited tasks in specified public sector program settings under guidance and supervision of medical officers. Their main responsibility is public health.

The concern of the petitioner is that if the aforementioned recommendation of the MCI is to be implemented, it would virtually mean that the students who undertake the aforementioned course, would be left looking for a job in case they are not absorbed by the rural health centres run by the Central/State Governments.

Therefore, what flows from this submission is that the persons who undertake the aforementioned course should also be permitted, like any other professional, to undertake private practice. Both, the Central Government i.e. the Ministry of Health and Family Welfare as well MCI, will deliberate on the aforementioned issues, and return to the Court, with instructions on the next date of hearing.

Renotify on 21st February, 2013.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

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Monitoring LFT in a patient on statins

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    Photo Feature (from the HCFI Photo Gallery)

WHO Day Celebrated

The event was organised by Heart Care Foundation of India in association with Dept. of Education, Delhi Government with Dr. Sampoornanand Sarvodaya Kanya Vidyalaya, C-1 Yamuna Vihar as the host school to earmark World Health Day.

 
Dr K K Aggarwal
    National News

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

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

Departmental inquiry not sufficient for framing charges

New Delhi: In a case where the Delhi Police filed its charge-sheet entirely relying on a medical board inquiry report, indicting two doctors and three nurses of carelessness while treating a critically-ill tuberculosis patient, a Sessions court here has said that simply because they were proceeded against departmentally it does not “per-se make them liable for criminal negligence”.

The Sessions court was upholding a magisterial court order discharging the two doctors and three nurses of the Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (formerly RBTB Hospital) accused of collective gross negligence that led to the death of a patient in June 2002. The magistrate had discharged them as the evidence in the charge-sheet filed by the Mukherjee Nagar police was prima facie not sufficient to warrant framing of charge against them under Section 304A (causing death by negligence) of the Indian Penal Code. The State then moved a revision petition against the order.

Additional Sessions Judge Kamini Lau also noted in her order that the patient was brought to the hospital at a very late stage in his illness. “This being the background and there being material on record to prima facie show a gross degree of inadvertence or negligence or lack of adequate care or caution by the respondents simply because they have been proceeded against departmentally does not, per-se, make them liable for criminal negligence. The standard for both is totally different,” Ms. Lau said. The patient was suffering from a rare and highly contagious form of TB known as Pul-Koch’s disease. The Judge also noted that while the line of treatment the doctors adopted seemed to be a standard one, the investigating officer had not annexed with the charge-sheet, a medical expert’s opinion on an alternative line of treatment that should have been followed. The court said this would have helped to show whether there was any negligence by the hospital staff with regard to the treatment administered. “It is writ large that during the period of stay of the patient in the hospital, no complaint was made to the hospital management by the relatives of the deceased and the complaint in the present case had been filed after much delay on legal advice,” Ms. Lau said.

According to the prosecution, Attar Mohammed was admitted to the emergency ward of RBTB Hospital on June 26, 2002, in a critical condition. On June 27, he was shifted to another ward despite his condition being serious. On June 29, the patient was continuously administered glucose and he showed improvement. On the intervening night of June 29 and 30, there was allegedly no attendant, nurse or doctor on duty in the duty room nearby. The glucose bottle had allegedly gone empty and he started to bleed from where the needle was injected. Attar’s relatives allegedly tried to get a doctor or nurse to attend to him all night. A nurse came finally but despite repeated entreaties did not allegedly call a doctor till 4 p.m. The relatives allege a doctor examined the patient “half-heartedly” and a little later the patient fell unconscious and died around 4-45 p.m.

Ms. Lau said in her order: “It should not be forgotten that the service which medical professionals render to a human being is noblest to all. A doctor is often called upon to adopt the procedure involving higher element of risk where he honestly believes that such risk would provide greater chances to a patient before them…Simply because the patient has not responded favourably to a treatment given, the doctor cannot be held liable. It should not be forgotten that error of judgment by a professional is not negligence per-se and therefore, the obligation upon the court to ensure that doctors and medical practitioners are protected from frivolous and unjust prosecution and they be summoned only in cases of high degree of culpable criminal negligence.” (Source: The Hindu, April 15, 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/)

50% 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)

CV risk factors seen more often at younger age

Metabolic risks for cardiovascular disease, such as excess weight and hypertension, are becoming more prevalent at younger ages -- an ominous trend for health in the future, Dutch researchers warned. (Source: Medpage Today)

For Comments and archives…

'NOTES' cuts out appendectomy scar

Transgastric appendectomy may be a minimally invasive alternative to surgery for appendicitis, researchers found. (Source: Medpage Today)

For Comments and archives…

Strontium ranelate (Protelos/Osseor) restrictions recommended in EU

The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) has recommended restrictions in the use of strontium ranelate (Protelos/Osseor) to reduce the risk for adverse cardiac events in postmenopausal women. (Source: Medscape)

For Comments and archives…

Central fat has role in women's fracture risk

Older women with low abdominal fat stores were at substantially higher risk for fractures, particularly of the vertebrae, an Australian prospective study showed. (Source: Medpage Today)

For Comments and archives…

Appendicectomy via small navel incision gets high marks

Transgastric appendicectomy via a small incision at the navel may be a viable alternative to traditional laparoscopic surgery in uncomplicated cases, according to results from a preliminary study of 14 patients who underwent the procedure in Germany. The study was published online April 11 in the British Journal of Surgery. (Source: Medscape)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: Besan or gram flour has health benefits If you are in doubt that your food may be the cause of your illness, try... http://fb.me/24ltSZ7MT

@DrKKAggarwal: Super Brain With Dr. Rudy Tanzi | Alzheimer's Reading Room http://shar.es/GPrrm via @sharethis

 
    Spiritual Update

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

Understanding Yamraja

All these years, like others, I also regarded Yamraja as a negative personality whose name has been used for centuries to frighten people. Only recently, I started to analyze him after I starting to research Yamraja has a male buffalo (Bhainsa) as his vehicle (sawari).

For Comments and archives…

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

What precautions should be carried while carrying a multiple pregnancy?

Metabolic and nutritional considerations: There is an increased need for maternal nutrition in multiple pregnancies. An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. With multiples, weight gain of approximately 45 pounds is optimal for normal weight women. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.

Activity precautions: Women with multiple pregnancies are usually advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may increase birth weight up to 20%. Intercourse is generally discouraged when bed rest is recommended.

Monitoring a multiple pregnancy: Prenatal diagnosis by chorionic villus sampling can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities Amniocentesis is performed between 16 to 20 weeks. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation. Tocolytic agents are medications that may slow or stop premature labor. These medications are given in hospital “emergency” settings in an attempt to stop premature labor.

Cesarean section: Vaginal delivery of twins may be safe in some circumstances. Many twins can be delivered vaginally if the presenting infant is in the head first position. Most triplets will be delivered by Cesarean section. Appropriate anesthesia and neonatal support are essential, whether delivery is performed vaginally or requires Cesarean section.

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

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

Whole blood

Definition: Whole blood contains 350 ml. of donor blood plus anticoagulants.

Volume: 350 ml.

Storage: Between 2° C to 6° C in approved Blood Bank refrigerator

Shelf Life: 35 days

Indications

  1. Red cell replacement in acute blood loss with hypovolemia
  2. Exchange transfusion

Contraindications

  1. Chronic anemia
  2. Incipient cardiac failure

Dosage: One unit of whole blood increases hemoglobin by 0.75 to 1 gm/dl and hematocrit by 3–5%.

Administration

  • Must be ABO and RhD compatible with the recipient
  • Never add medications to the unit of blood
  • Complete transfusion within 4 hours of commencement

For Comments and archives…

 
    An Inspirational Story

Sometimes ignorance is bliss

My classmate, Susan, and I are in the middle of our thesis rewrites for Johns Hopkins University.

We only have two weeks left and we are both quite razzled at the prospect of doing more research in the remaining time.

Today Susan called me to say that she desperately needed more history about a small tribe of Native Americans that lives in the Grand Canyon. But there's only one telephone on the reservation and no one ever answers it.

As a matter of fact, the three times she visited the tribe's Visitor Center while she was on vacation, she said no one ever opened up the building.

Being a computer geek, I said, "Have you checked the Internet?"

She said, "No, what a great idea! Thanks."

I did a quick check using Excite while she used Yahoo and she was astounded at the information available about this little-known tribe.

She thanked me profusely for the tip and hung up.

Two hours later, she called me back sounding absolutely miserable.

"Susan," I said, "What's the matter?"

"Well," she said, "You're not going to believe it but they have their own Web page with all the information I could ever want about the tribe."

"That's great," I said. "What more could you ask for?"

"You don't understand," she said. "My article is about how isolated the tribe is and how their only path to the outside world is a little dirt trail up the side of the canyon!

On their Web page, they even have a scanned photo of the helicopter that brought the donated PC into the canyon."

Moral of the story: Sometimes ignorance is bliss -- especially when you're trying to finish a thesis on time.

For comments and archives

 
   Cardiology eMedinewS

New study questions carnitine heart risk Read More

 
   Pedia News

Childhood catatonia commonly missed, badly managed 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)

A previously immunized person is bitten again. What is the re-exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIGs are not required (WHO 2007). However, in laboratory confirmed rabies exposures, irrespective of past rabies immunization, full course of PEP and RIGs is recommended. In rabies, it is safer to over treat than under treat.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and also stop low dose aspirin.
Lesson: In dengue, low dose aspirin should be discontinued.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough lasting for 2 more weeks are investigated for TB.

 
  Quote of the Day (Dr GM Singh)

No power in society, no hardship in your condition can depress you, keep you down, in knowledge, power, virtue, influence, but by your own consent. William Ellery Channing

 
    Mind Teaser

Read this…………………

Nurse Wayne is aware that which finding would be least suggestive of necrotizing enterocolitis (NEC) in an infant?

a. Hepatomegaly
b. Distended abdomen
c. Gastric retention
d. Blood in the stool

Yesterday’s Mind Teaser: Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, Nurse Ernie detects dry mucous membranes and lethargy. What other finding suggests a fluid volume deficit?

a. A sunken fontanel
b. Decreased pulse rate
c. Increased blood pressure
d. Low urine specific gravity

Answer for Yesterday’s Mind Teaser: a. A sunken fontanel

Correct answers received from: Tukaram Pagad, Dr K Raju, Jayesh Sonvani, Rajiv Kohli, Dr KP Chandra, Dr Thakor Hitendrsinh G, Dr Prabha Luhadia,
Dr Suresh Arora, Prabha Sanghi, Dr PK Sahu, Dr PC Das, Dr Jella, Dr Rohini Dhillon, Dr BB Gupta, Dr (Brig) CH Gidvani, Dr (Maj. Gen.) Anil Bairaria,
Dr Anusha Sudhakar, Arundhati Malviya, Dr Pankaj Agarwal, Dr Arpan Gandhi, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Ayyavoo Erode, Yamini Alsi, Dr VM Kartha, Dr Gracy Thomas, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Jayant Navarange, Dr Kanta Jain, Dr K Raju, Dr Jainendra Upadhyay, Dr PK Sahu, Dr Avtar Krishan.

Answer for 14th April Mind Teaser: a. Comforting the child as quickly as possible

Correct answers received from: Dr Anusha Sudhakar, Arundhati Malviya,
Dr Pankaj Agarwal, Dr Arpan Gandhi, Dr Jainendra Upadhyay Dr Chandresh Jardosh, Dr Ayyavoo Erode, Yamini Alsi, Dr VM Kartha, Dr Avtar Krishan,
Dr Valluri Ramaro.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

A woman sat down on a park bench, glanced around and decided to stretch out her legs on the seat and relax. After a while, a beggar came up to her and said, "Hello, luv, how's about us going for a walk together?"
"How dare you," retorted the woman, "I'm not one of your cheap pickups!"
Well then," said the tramp, "what are you doing in my bed?"

 
  Medicolegal Update

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

Medical fasting

  • Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established
  • The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
  • Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
  • Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
  • In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Summer diarrhea treatment

One loose motion is equal to loss of one glass of ORS. Most summer diarrheas are watery, effortless and painless with no mucous or blood. They need no antibiotics. The only treatment is oral rehydration solution, said Padamshri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA. Citing an example:

Dr. Aggarwal said that if a patient has passed 10 loose motions he needs 10 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again.

A patient with up to 12 loose motions can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if more than 40, he needs intensive treatment.

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. One should maintain that the patient passes urine every 6-8 hours. If no urine is passed for eight hours, this may indicate threatening Kidney failure.

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 44488 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 Dr Aggarwal, Thanks for the comprehensive e-news.Dr Jayashree Joshi, Mahim, Mumbai
 
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