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

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

17th May 2012, Thursday

Love, affection of distant kin good enough for donation of organs: HC

In what could script new rules for organ donation between distant relatives, the Delhi High Court on Tuesday said that love and affection between the donor and recipient held top priority in such cases and a request could not be turned down simply because a family member had not stepped forward. Justice Vipin Sanghi made these observations while adjudicating a petition by Parveen Begum who was in dire need of a kidney. The Sir Ganga Ram Hospital’s authorisation committee had turned down her request to receive the organ from her niece. Her case was first reported by Newsline on April 24 when her family moved court against the hospital’s decision. Justice Sanghi said that a hospital’s authorisation committee, which examines cases of organ donation between distant relatives, could reject such a request only when there is ground to apprehend that the donation involved commercial transaction. “Merely because in a given case, a near relative may not be willing to donate his or her organ/tissue to the recipient, it is not ground to either raise suspicion of a commercial transaction, or to reject the case altogether. It is not the mandate of the authorisation committee to compel or drive the near relative of the recipient to donate their organ/tissue to the recipient," he said.

Justice Sanghi opted to interpret the term "payment" under the Transplantation of Human Organ and Tissues Act and noted that this would not cover a monetary transaction between a donor and recipient in the past when such a transplant was not required. "It refers to a monetary payment made by a donor on his or her behalf to a recipient as consideration for the donation of an organ. It does not refer to a contribution, gift or monetary support made or granted gratuitously in the past, when even the need for organ transplant was not in existence. The test is, whether the said payment would not have been made but for the donor agreeing to donate his or her organ," he said. Justice Sanghi noted that financial disparity between the donor and the recipient will also not come in the way of such donations unless the committee has something material on record indicating involvement of commercial elements. Going a step further, he said that a sense of love, affection and gratitude, once established, provided the impetus to donate one’s organ, and any financial help by the recipient’s family in future could not lead to a conclusion that a monetary deal was struck between them at the time of the donation. (Source: The Indian Express, May 16 2012)

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Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Love, affection of distant kin good enough for donation of organs: HC

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    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2012

Students of Delhi Public School presents a beautiful group song on the occasion of World Earth Day 2012. The event was jointly organised by Heart Care Foundation of India, Delhi Pulic School–Mathura Road and Ministry of Eart and Sciences

 
Dr K K Aggarwal
 
    National News

India faces chronic shortage of doctors, nurses

NEW DELHI: Analysts said the lack of human resources in health sector is a worrying trend for India, a country with a population of 1.2 billion people. With the population expected to grow to 1.7 billion by 2050, India is sorely lacking in doctors and nurses. There is now only one doctor for every 2,000 persons.The Health Minister recently revealed that 27 per cent of India’s registered doctors and over 60 per cent of nurses registered with the Medical Council of India (MCI) were no longer working. The recommended norm, according to the World Health Organization, is to have between 23 and 25 health workers per 10,000 people. India has only 19 health workers for every 10,000 people. Dr. K. K. Aggarwal, a member of Delhi Medical Council, said: "The Medical Council can only confirm that 23 per cent of (registered doctors). A lot of doctors are changing profession after doing MBBS. They are going into IAS (Indian Administrative Service), fashion, marketing, health administration and police force. A lot of doctors are going out (of the country) also. People are going to Gulf countries and they are all missing from our own country." There's also a shortage of women doctors. Two–thirds of all the health workers are men.The problem is worse in rural areas, where the ratio of women allopathic doctors is less than one to 10,000 people.

Analysts said under–representation of women in the field seriously impacts women’s health. Dr Aggarwal said: "In India, we know there is a shortage of doctors, nurses and paramedical workers. We need more and more doctors, but for that to happen, we need to change the policy."The data also highlighted disparity in terms of geographic and rural–urban divide.India has 270 medical schools and almost 60 per cent of these schools are located in India’s south–western states, where literacy levels are high. India's northern, central and north–eastern states lag behind in training and human resources in the health sector.
These figures once again stress on the need to increase public expenditure in training and research in health sector. India’s Prime Minister Manmohan Singh has promised to increase the expenditure to 2.5 per cent of GDP from 1.2 per cent during the course of the 12th Five Year Plan.– CNA/fa. (Asia Pacific News)

Doctors to keep records of HIV patients for three years

The Medical Council of India (MCI) has issued guidelines for all private medical practitioners across the country to keep records of HIV patients visiting them for treatment. The guideline comes after a significant rise in complaints related to negligence in treatment of HIV-positive patients in private establishments. The order (MCI–211(2) 2010/ethics/Gen 33690) states that if a request is made by relatives of an HIV–positive patient for medical records, the private practitioner is bound to provide them details within 72 hours. If he fails to do so, his registration will be cancelled under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. According to the circular, the private practitioner has to keep the medical records of an HIV–positive patient under his supervision for at least three years. (Source: The Indian Express, May 15 2012)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Changes in eye vessels signal heart troubles

Changes in diameter of the tiny blood vessels in the retina predicted the later development of cardiovascular disease in African Americans with type 1 diabetes, researchers found. (Source: Medpage Today)

For comments and archives

Nasal steroids not much help in acute sinusitis

Acute sinusitis improved slightly in patients treated with intranasal steroids, which appeared to work better at higher doses and longer treatment duration, results of meta-analysis suggested. (Source: Medpage Today)

For comments and archives

FDA staff flags false results of home HIV test

DA reviewers expressed concern over the risk of false negative and false positive results if the agency approved the first–ever over–the–counter at–home HIV test. The FDA’s Blood Products Advisory Committee will meet Tuesday to vote on whether the test, called the OraQuick In–Home HIV Test and manufactured by OraSure Technologies, should be marketed to the general public. (Source: Medpage Today)

For comments and archives

(Contributed by Dr S K Verma, Ophthalmologist, New Delhi)

Infrared light stops damage to eye

People with carriers that expose them to bright or strong artificial light, such as construction workers, fishermen, welders or actors are prone to develop cataract in the eye. They could be pretreated with infrared light to reduce vision damage. Researchers found that treating eye with gentle infrared light can help prevent damage caused by subsequent exposure to bright light. (Courtesy – TOI )

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: The One Skill That Can Make or Break a Doctors Career…
http://blog.kkaggarwal.com/2012/05/14/the–one–skill–that–can–make–or–break–a–doctors–career/

@DeepakChopra: Why compare yourself with others? No one in the entire world can do a better job of being you than you

 
    Spiritual Update

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

The one skill that can make or break a doctor’s career

One of the biggest components of patient–centered care is empathy. Empathy is the ability to put yourself in another person’s shoes. A lack of empathy can lead to a cold or rushed bedside manner, which makes patients uneasy.

1) Make empathy a priority: One often lose sense of priorities when working with a patient and shifts to "clinical" mode. Always give priority to empathy as you meet a patient.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are fertility enhancing treatments?

Fertility is enhanced in women with minimal or mild endometriosis by controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI). This treatment is also called superovulation with IUI. Without treatment, women with minimal/mild endometriosis–related infertility have spontaneous pregnancy rates of 2–4.5% per month. The monthly pregnancy rate with intrauterine insemination alone for endometriosis is approximately 5%, and it is approximately 4–7% per month for clomiphene citrate, human menopausal gonadotropin (HMG), or follicle stimulating hormone (FSH) injections, when used without intrauterine insemination. However, clomiphene + IUI improves the monthly pregnancy rates to approximately 9–10%, at least for the first four treatment cycles.

For comments and archives

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

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

PLASMA DERIVATIVES

HUMAN ALBUMIN SOLUTIONS

Description Prepared by fractionation or large pools of donated plasma

Preparations

  • Albumin 5%: contains 50 mg/ml of albumin
  • Albumin 20%: contains 200 mg/ml of albumin
  • Albumin 25%: contains 250 mg/ml of albumin
  • Stable plasma protein solution (SPPS) and plasma protein fraction (PPF): similar albumin content to albumin 5%

Infection risk No risk of transmission of viral infections if correctly manufactured

Indications

  • Replacement fluid in therapeutic plasma exchange: use albumin 5%
  • Treatment of diuretic–resistant oedema in hypoproteinaemic patients: e.g. nephrotic syndrome or ascites. Use albumin 20% with a diuretic
  • Although 5% human albumin is currently licensed for a wide range of indications (e.g. volume replacement, burns and hypoalbuminaemia), there is no evidence that it is superior to saline solution or other crystalloid replacement fluids for acute plasma volume replacement

Precautions Administration of 20% albumin may cause acute expansion of intravascular volume with risk of pulmonary oedema

Contraindications Do not use for IV nutrition: it is and expensive and inefficient source of essential amino acids

Administration

  • No compatibility testing required
  • No filter needed

For comments and archives

 
    An Inspirational Story

(Dr GM Singh)

Unique human flaws

An elderly Asian woman had two large pots, each hung on the end of a pole, which she carried across her neck.

One of the pots had a crack in it while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full.

For two years, this went on daily with the woman bringing home only one and a half pots of water. The perfect pot was proud of its accomplishments. The poor cracked pot was ashamed of its own imperfection and miserable that it could only do half of what it had been made to do.

After 2 years of what it perceived to be bitter failure, it spoke to the woman: "I am ashamed of myself because this crack in my side causes water to leak out all the way to your house."

The old woman smiled, "Did you notice that there are flowers on your side of the path, but not on the other pot’s side?"

"That’s because I have always known about your flaw so I planted flower seeds on your side of the path, and every day while we walk back, you water them. For two years I have been able to pick these beautiful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house."

Moral: Like the pots, we all have our own unique flaws. But it’s the cracks and flaws we each have that make our lives together so very interesting and rewarding.

For comments and archives

 
    Cardiology eMedinewS

RAAFT 2: Catheter Ablation Can Be First Line Of Defense Against Paroxysmal AF Read More

Bypass Moderate Left Coronary Lesions? Read More

 
    Pediatric eMedinewS

Bipolar Symptoms May Begin In Teen Years Read More

Binky, Sippy Cup Can Be Source Of Trip To The ER Read More

Detection of Fetal Aneuploidy by DNA Sequencing of Maternal Plasma
Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of asthma was put on tiotropium.
Dr. Bad: Stop it.
Dr. Good: Continue it.
Lesson: The addition on tiotropium to low–dose, inhaled steroids has been shown to improve asthma control in many studies.

For comments and archives

Make Sure

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. What is the legal validity of the requirement for a certain number of CME hours as a pre–requisite for re-registration every 5 years?

Ans.

  • Registration of medical practitioners is the function of the SMC. However, the SMC has to function as per the Act under which it has been established.
  • If the SMC Act states that re–registration on the basis of a certain number of CME hours is required, the SMC is authorised to insist upon such CME as a pre–requisite for re-registration.
  • An example of the above is section 13B of the Punjab Registration Act, 1916, reproduced below—

    "13–B. Every registered practitioner shall get his registration renewed after every five years within a period of two months from the date of the expiry of his previous registration on payment of the prescribed fee:

    Provided that before getting his registration renewed, the registered practitioner shall have to obtain a certificate from a State Medical Council or Medical Council of India or National or International Bodies to the effect that he had got fifty credited hours of Continuing Medical Education in every five years.

    Explanation:– For the purpose of this section, the expression "credited hours" shall mean the hours, accredited to the credit of registered practitioner by the aforesaid Council or bodies."
  • Some SMC’s have tried to introduce such a requirement without the backing of its Act/Rules by the mere device of issuing a circular or notice. Such circular or notice has no legal force and can be legally challenged.
  • An example of such challenge is seen in the WP decided by the Kerala HC on 12–1–2010. It is summarised below:
    • The Qualified Private Medical Practitioner’s Association and two other petitioners filed 3 WPs challenging a circular issued by the Travancore Cochin Medical Council making renewal of registration mandatory every five years on the basis of a certain hours of CME attended by the doctors. The WPs were decided by a common judgment dated 12–1–2010.
    • During the course of the proceedings, Respondent no. 4 Travancore Cochin Medical Council retracted its position. It filed an affidavit which says that "in the absence of statutory provisions for periodic renewal of Registration every five years with the pre-condition of compulsory attendance of CME, notice issued for renewal may be deferred……".
    • In the circumstances, the petitioners succeeded.
  • This case illustrates why it is necessary for doctors’ professional associations like the IMA to be alive to the issues that concern doctors in general. Such a WP should ideally have been filed by the IMA. At least, the IMA should have been a party to it. The QPMPA deserves to be commended for its pro-active stand in favour of doctors.

For comments and archives

 
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  Quote of the Day

(Dr GM Singh)

Once you have mastered time, you will understand how true it is that most people overestimate what they can accomplish in a year – and underestimate what they can achieve in a decade! Anthony Robbins

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum calcium

Hypercalcemia (or high serum calcium level) is seen in the following conditions:

  • Malignant neoplasms (with or without bone involvement)
  • Primary and tertiary hyperparathyroidism
  • Sarcoidosis
  • Vitamin D intoxication
  • Milk–alkali syndrome
  • Paget’s disease of bone (with immobilization)
  • Thyrotoxicosis
  • Acromegaly
  • Diuretic phase of renal acute tubular necrosis
  • Drugs: alkaline antacids, DES, diuretics (chronic administration), estrogens (including oral contraceptives) and progesterone

For given total calcium level, acidosis increases the physiologically active ionized form of calcium. Prolonged tourniquet pressure during venipuncture may spuriously increase total calcium.

 
    Mind Teaser

Read this…………………

The following are lipid abnormalities. Which of the following is a risk factor for the development of atherosclerosis and PVD?

a. High levels of low density lipid (LDL) cholesterol
b. High levels of high density lipid (HDL) cholesterol
c. Low concentration triglycerides
d. Low levels of LDL cholesterol

Yesterday’s Mind Teaser: Nurse Hazel teaches the client with angina about common expected side effects of nitroglycerin including:

a. High blood pressure
b. Stomach cramps
c. Headache
d. Shortness of breath

Answer for Yesterday’s Mind Teaser: c. Headache

Correct answers received from: Dr KV Sarma, Dr Avtar Krishan, Dr Ragavan Sivaramakrishnan Moudgalya, Dr kanta Jain, Dr Anjani, Dr Chandresh Jardosh, Mannalal Bhansali, Muthumperumal Thirumalpillai, Raju Kuppusamy, Anil Bairaria, Uma Gaur, Dr LC Dhoka.

Answer for 14th May Mind Teaser: a. Ineffective health maintenance

Correct answers received from:
Mannalal Bhansali, Muthumperumal Thirumalpillai, Raju Kuppusamy, Anil Bairaria, Uma Gaur, Dr LC Dhoka.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Simple Operation

A man was wheeling himself frantically down the hall of the hospital in his wheelchair, just before his operation. A nurse stopped him and asked, "What’s the matter?"

He said, "I heard the nurse say, ‘It’s a very simple operation, don’t worry, I’m sure it will be all right."

"She was just trying to comfort you, what’s so frightening about that?"

"She wasn’t talking to me. She was talking to the doctor!"

 
    Medicolegal Update

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

Facilitate cadaver organ retrieval for transplantation

  • The concept of ‘required request’ required to be introduced, wherein hospitals will be allowed to ask ICU patients, whether they would be willing to donate organs.
  • It should be made mandatory for hospital ICUs to declare all brain deaths and register them with an online central organ registry for better coordination of cadaver organ donation, retrieval and transplantation.
  • The hospitals equipped with ventilators and artificial life support system must make mandatory efforts to coordinate with organ bank and retrieve organs and the reason of failure must be documented for further review.
  • The World Medical Association also recommends that the physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.
  • These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Frequent urination in night: look for snoring

Frequent urination during night, a condition doctors call nocturia, is common among snorers (men with obstructive sleep apnea) said Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India. Nocturia was defined as needing to void two or more times each night.

In obstructive sleep apnea soft tissues in the back of throat temporarily collapse during sleep causing brief moments in which the patient stops breathing. The disorder can cause daytime sleepiness, and can be effectively treated with a breathing device that pushes air into the throat to prevent the tissues from collapsing called CPAP. Quoting a Japanese study published in the journal Urology by Dr. Yoji Moriyama, Dr Aggarwal said that nocturia was present in 41% of pateints with sleep apnea. The risk of nocturia was directly related to the severity of sleep apnea and the association was particularly strong in patients younger than 50 years of age.

 
    Readers Responses
  1. Dear all, There was a news item "Aishwarya Rai’s weight gain–––". It is true that a woman gains weight during pregnancy. Physiology has also described in brief why women gain weight during antenatal period. It would have been appropriate if scientific information would have also been given that breastfeeding makes mother lose weight and bring her weight to prepartum levels. Of course lifestyle synergizes reduction of weight. Dr MMA Faridi.
 
    Forthcoming Events
Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta