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Dr KK Aggarwal

From the Desk of Editor in Chief
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; Member 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


18th May, 2010, Tuesday

MCI Update 

Dear Colleague

Dr Desai seeks bail to see ailing mother

Former Medical Council of India President Dr Ketan Desai, arrested for allegedly taking a bribe, Monday approached the Delhi High Court for release on bail to see his ailing mother in Mumbai who is suffering from respiratory distress and is on bipep. Filing his application before Justice S.L.Bhayana, Dr Desai said his mother is in a critical condition. Appearing for Desai, Dr Desai's lawyers pleaded that Desai should be granted bail given the medical condition of his mother. At this, the court asked the CBI to verify the facts about Desai’s mother and file a reply by May 28. Dr Desai had earlier also moved a bail application before the court after he was arrested on corruption charges April 22. The court had asked the CBI to file its response by June 3.

Dr Desai had allegedly demanded and accepted a bribe of Rs.2 crore for granting recognition to a private medical college in Punjab which did not meet the norms of the Medical Council of India.

Dr Desai's defence in his petition
1. The bribe amount was neither recovered from his house nor from the premises belonging to him.
2. Recognition granted to any private college is done by a three-member team and he alone is not liable for this.
3. He is suffering from hypertension and severe sleep apnea disorders and has severe breathing trouble and is on auto CPAP every night.

Dr Desai was also suspended by the Gujarat government as professor of urology at the B.J. Medical College in Ahmedabad earlier this week. A city Patiala court also earlier rejected Desai’s bail plea, saying that the investigation is still in the initial stages.

The new panel to meet today

The new six members panel will meet today in the mCI office. Once taken charge initially they will divide the work among themselves and it is likely that one of them will be available every day by turn so that the office is on all working days.

What's in the mind of Prof Ranjit Rai Chaudhary, one of the panel members.

We are reproducing his thaughts he wrote to all the padma awardee doctors in the city about the health scenario on Monday 10th May before he ws inducted as a panel member MCI.

" Dear Dr Aggarwal: Thank you for sending me the set of pictures and the names of the participants of the first meeting of Padma Awardees. I believe it was a very good initiative and the whole evening was held in a very pleasant ambience. I believe that such meetings should continue. Unfortunately I go out of the country every summer and will miss the June meeting and will return on 11th July.
 
I THINK we could make an impact on the health scenario of the country if we start doing things which need to be done and is not being done for various reasons. The last thing we should announce is that we are going to advise the government on national policies. We can put our thoughts and recommendations in a series of papers which could be published. We will find that the Govt. will themselves come to us for advice the moment they are convinced that they will get mature objective advice. The great thing in this country is that technical advice is accepted without any political affiliation. In my own short stay in Delhi my advice was equally sought whether it was Dr Harsh Vardhan or Sushma Swaraj Ji or Dr Ramadas. That is the first point I want to make
 
There are several areas where mature seasoned advice would be welcome. Let me list a few areas crying out for leadership
1  The three and a half year course in Health 
2 Development of 18 month courses in Cardiology Nephrology Endocrinology and GI Diseases for MBBS
3  A Bsc course in Public Health          
4 The Public Private Partnership Health programme in U. P JUST ANNOUNCED WHICH HAS CREATED SUCH  A CONTROVERSY
5 Conflict of Interest--How can we deal with it
6 Traditional Systems of Medicine.  Could we help to define a complementary role
7 Entry of foreign Universities for Medical Education. Everyone would like to know what a group like this is thinking.

This IS JUST A SHORT LIST, I COULD DOUBLE  IT AND YET IT WOULD NOT BE COMPREHENSIVE. FOR EXAMPLE THIS IS THE 100TH YEAR OF THE fLEXNER REPORT  OUR GROUP SHOULD TAKE THE OPPORTUNITY TO WORK HARD AND BRING OUT TWO REPORTS ONE IN UNDERGRADUATE MEDICINE AND ONE ON POSTGRADUATE MEDICINE. A small group of three or four could get together and write it then bring it to the group who could modify it and then it goes out s a group initiative. Another activity could be for the group to select three or four areas and actually raise money and actually sponsor this work by providing the support and monitoring the study. This is something the Rhodes Scholars of India are doing.
 
Even if we do nothing more than meet once a month and organize one international meeting or national meeting every year it would be a worthwhile activity. I would suggest that it is on tne model of the Allahabad Annual Conferences of the Triple IITs where they get about 15 Nobel Laureates together with others and the students for three days
 
I believe there is a lot we can do without much fanfare. If we do that we would get our authority by the work we are doing and the quality of Recommendations and the Credibility of our members Pronouncements by NICE for example are never questioned .The doctors and the govt. and the pharmaceuticals all accept these because of the quality of the people making these pronouncements and the hard work that goes on to gather and assess evidence before making these pronouncements. All the very best and thanks for starting this off."  Yours sincerely. Padma Shri Awardee Prof. Ranjit Roy Chaudhury. M.B.B.S., D. Phil (Oxon), FRCP (Edin).

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file): Health awareness modules.

Laughter is the Best Medicine

Heart Care Foundation of India has regularly bagged the stardom of a film star and utilized the same for health campaigns and release of important health messages. Dr K K Aggarwal, announced dates of the Perfect Health Mela 1999 where Ms. Sridevi released the message "Laughter is the best medicine". Mr. Sandeep Marwah, also released a message stating the importance of Meditation.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Preoperative skin cleansing with chlorhexidine–alcohol is superior to providone–iodine; in a trial of 849 patients undergoing clean–contaminated surgery, the overall rate of surgical site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5 versus 16 percent). (Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical–site antisepsis. N Engl J Med 2010;362:18)

 

Mnemonics of the Day (Dr Prachi Garg)

NG tube removal post op (4Ps)

Peristalsis
Passage of flatus
Paucity of aspirate
Peckish patient

News and Views (Dr Brahma and Monica Vasudeva)

Some supplements may affect effectiveness of warfarin

Individuals using supplements containing gingko, garlic, and fish oil may have a higher risk of excessive bleeding or blood clots when taking the blood thinner warfarin, according to a study presented at the annual meeting of the Heart Rhythm Society.

New drug–eluting stents do better than old ones excepting diabetics

A new study finds that second–generation drug–eluting stents that released everolimus decreased stent thrombosis and restenosis rates as compared to paclitaxel–eluting stents. The trial reported in the May 6 New England Journal of Medicine involved more than 3000 patients to receive one or the other drug–eluting stent without routine follow-up angiography. Everolimus–eluting stents were notably better than paclitaxel–eluting ones on the composite endpoint of target–lesion failure (4.2% vs. 6.8% of patients; relative risk, 0.62, 95% CI, 0.46 to 0.82). The risk of ischemia–driven target–lesion revascularization, myocardial infarction (1.9% vs. 3.1%) and stent thrombosis (0.17% vs. 0.85%) also declined significantly with Everolimus–eluting stents. The newer stents showed no significant benefit in diabetics, which points out that the mechanism of restenosis and/or the response to antiproliferative agents may differ in diabetic patients. Hence, the paclitaxel–eluting stents may be more suitable in this patient group.

Curing atrial fibrillation with catheter ablation may prevent premature death, strokes and dementia

Curing atrial fibrillation with catheter ablation can prevent premature death, strokes and dementia for some patients. Six percent of ablation patients died within three years vs 23.5 % of medication–only patients and 9% of patients without heart disorder; 0.2 % of ablation patients developed Alzheimer’s –– lower than the 0.9 % of the medication-only heart patients and 0.5 % of non–heart patients who developed the disease. The study findings were presented at the Heart Rhythm Society’s annual scientific meeting.

That ‘spoonful’ of sugar actually works

Feeding sugar solutions to infants up to 12 months old helps reduce the pain of vaccinations, a systematic review showed. The effect appears to be weaker in older infants than newborns. This was reported by Denise Harrison, RN, PhD, of Royal Children’s Hospital in Melbourne, and colleagues online in Archives of Disease in Childhood.

Quote of the day (Paramjeet Chadha)

Never make the same mistake twice…
There are so many new ones…
Try a different one each day.

Question of the Day

What is the significance of H. pylori infection in patients taking long–term NSAID therapy? (Dr. Nageshwar Reddy, Hyderabad)

While NSAIDs are generally considered effective therapy for osteoarthritis and rheumatoid arthritis, significant morbidity and mortality are associated with their use. It is estimated that more than 100,000 hospitalizations and 10,000–20,000 deaths per year are attributed to NSAID–related GI toxicity. As many as 2% of all NSAID users per year experience a symptomatic ulcer as a result of treatment. This risk does not diminish over time, placing long–term NSAID users at significant risk of peptic ulceration.

H. pylori infection has been indisputably shown to cause peptic ulcer disease. Although many chronic NSAID users are infected with H. pylori, it is unclear how the infection affects the risk of NSAID–related symptoms, ulcers and ulcer complications. Risk of toxicity: Recent prospective data regarding the risk of GI complications in patients taking celecoxib and rofecoxib demonstrate that these antiinflammatories reduce the risk of both complicated and symptomatic ulcers by 50% or more. Risk factors have been identified for NSAID–induced ulcers and complications. These include age older than 60 years, concomitant corticosteroid therapy, previous ulcer disease, high–dose and/or multiple NSAID therapy (such as aspirin plus another agent), as well as concomitant anticoagulant use. Low doses of aspirin is associated with a significantly increased risk of bleeding ulcers. NSAID use and H. pylori infection may combine to influence ulcer formation and the risk of complication. They may have additive or even synergistic effect in increasing peptic ulcer risk. (Source: N Engl J Med 1999;340:1888–99.)

eMedinewS Try this it Works: Removing nasal foreign bodies

First administer 4 or 5 drops of adult–strength xylometazoline hydrochloride to the affected nostril and allow 5 minutes for vasoconstriction of the inferior turbinate and nasal mucosa. Then ask the child to take a deep breath through the mouth and exhale through the affected nostril while you occlude the contralateral nostril. This removes the foreign body about 30% of the time and at least moves it more anteriorly––for easier removal with bayonet forceps––in about half of cases.

Dr Good Dr Bad

Situation: A patient of COPD feeling better with oral steroids comes for a regular check–up.
Dr Bad: Continue the same.
Dr Good: Start inhaled steroids instead of oral.
Lesson: COPD patients who show improvement with oral prednisone, should be put on inhaled corticosteroids at a daily dose of about 1mg (20 puffs/day of beclomethasone; 10 puffs of triamcinolone, or 4 puffs of budesonide).

Make Sure

Situation: A 45–year–old HIV– positive patient presented with prolonged fever with night sweats and weight loss. Blood culture was positive for Mycobacterium avium.
Reaction: Oh my God! You should prescribe macrolides.
Lesson: Make sure to remember that the agents most active against MAC organisms are the macrolides (clarithromycin and azithromycin).

IMANDB Joke of the Day (Dr. Vandana Shiva)

Physicist and environmentalist awarded Sydney Peace Prize

I requested God, let all Ma dear ones be happy and healthy for ever
God sad – ok but 4 times only.
I said OK during spring, summer, autumn and winter.
He said no only 3 times
I said ok and yesterday, today and tomorrow
He said no only twice
I said ok day and night
He said no only once
And again I said ok everyday.
God laughed and said ok dear.

Formulae in clinical practice

QT interval (QTc ≤0.40 second)

Bazett’s formula: QTc = (QT)/Sq – root RR (in seconds)

Myth of the Day: Dr Gurinder Mohan Singh

Myth: Staring at a computer screen all day is bad for the eyes.

Fact: Although using a computer will not harm your eyes, staring at a computer screen all day will contribute to eyestrain or tired eyes. Adjust lighting so that it does not create a glare or harsh reflection on the screen. Also, when you’re working on a computer or doing other close work such as reading or needlepoint, it’s a good idea to rest your eyes briefly every hour or so to lessen eye fatigue. Finally, people who stare at a computer screen for long periods tend not to blink as often as usual, which can cause the eyes to feel dry and uncomfortable. Make a conscious effort to blink regularly so that the eyes stay well lubricated and do not dry out.

Milestones in Orthopedics

Jean–Andre Venel (1740–1791), known as ‘Father of Orthopedics’ established the first orthopedic institute in the world at Orbe, in Canton Waadt in 1780. This was the first true hospital that dealt specifically with the treatment for skeletal deformities in children. He recorded and published all his methods and for this was known as the first true orthopedist.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

ACE

Also known as: Serum Angiotensin Converting Enzyme; SACE To help diagnose and monitor sarcoidosis; to help differentiate this systemic condition from other disorders causing similar symptoms.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Surgical Sealant

Indicated for use in sealing suture lines along arterial and venous reconstructions.

26.03.09

 


 
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eMedinewS–Padma Con 2010

Will be organized at
Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

 
 

eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .

 

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Public Forum (Press Release for use by the newspapers)

Heat stroke guidelines released

Heart Care Foundation of India today released guidelines for heat stroke and common mistakes done either at the level of the patient or while managing the condition.

Releasing the guidelines, Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, said that there are two types of heat stroke. First, exertional heat stroke, which occurs in younger individuals who engage in strenuous physical activity for a prolonged period of time in hot environment. However, classical non–exertional heat stroke more commonly affects sedentary elderly individuals or persons who are chronically ill and/or younger children.

If not managed properly, hundreds of lives are lost in 72 hours post heat stroke. If therapy is delayed, the mortality is 80%. This figure can be reduced to 10%, if early and proper management is done and mistakes avoided.

Mistake No. 1

Missing Diagnosis: It is the rectal temperature, which is more important than axillary or oral temperature. The diagnosis of heat stroke may be missed if rectal temperature is not measured. Heat stroke is defined as when temperature exceeds 41°C (106 degree F) in absence of sweating and altered sensorium.

Mistake No. 2

Heat stroke mistaken for heat exhaustion: The two conditions can be differentiated, as there is no sweating in heat stroke.

Mistake No. 3

Continous lowering of temperature: The goal of treatment should be to reduce the temperature by atleast 0.20C/minute to approximately 390C (102 degree F)

Mistake No. 4

Continuing active external cooling beyond 390C: The cooling should be halted at 39°C to prevent over shooting cut–off point leading to hypothermia.

Mistake No. 5

Giving anti fever medicines: Anti fever medicines like paracetamol, aspirin and other non–steroidal anti–inflammatory agents have no role. They actually may be harmful if the patients have underlying liver, blood and kidney damage. They may also cause bleeding.

Mistake No. 6

Not checking temperature continuously: One should ideally place a flexible indwelling thermistor rectally to monitor temperature continuously.

Mistake No. 7

Not checking fever once temperature settles down: Thermal instability may persist for a few days after the onset of heat stroke. Therefore, temperature must be continuously monitored during this period.

Mistake No. 8

Not removing restrictive clothing: All clothes should be removed so that temperature can be lowered by evaporation.

Mistake No. 9

Giving phenytoin during seizure: Phenytoin is not effective in controlling seizures in heat stroke.

Mistake No. 10

Giving chlorpromazine to lower temperature: It was the mainstay of therapy earlier but is now avoided as it increases chances of seizures.

Mistake No. 11

Patients on anti cholinergic and anti histaminic drugs: In this season, self–treatment with anti allergic and anti nasal discharge drugs can be harmful. They lead to impaired heat loss and precipitate hypothermia.

Mistake No. 12

Heart patients not taking precautions: In elderly heart patients, cardiovascular drugs like beta–blockers, calcium channel blockers and diuretics may interfere with cardiovascular response to heat, heat loss and precipitate hyperthermia.

Mistake No. 13

Not realizing that the patient may be on substance abuse: Stimulant drugs, including cocaine and amphetamines can generate excessive amount of heat by increasing metabolism. They can worsen heat stroke.

Mistake No. 14

Ignoring mild temperature: One should remember that a high temperature would be found only if mild temperature is ignored. During peak summer, sudden onset of fever should be taken as heat stroke, unless proved otherwise.

Mistake No. 15

Not giving enough fluids: Remember the internal organs are on fire and the fires can only be extinguished with fluids. Such patients need liters of intravenous fluids to manage their internal fire.

Mistake No. 16

Carrying out sponging only on the head: Patients require continuous sponging of the body with tap water and not restricting to armpits or the head. Some doctors even try to immerse the patient in water. Ice massage should be avoided as it does not lower the internal core temperature.

Readers Responses

  1. High peripheral neutrophil counts correlated with excess cardiovascular (CV) risk in postmenopausal women with essential hypertension. Although neutrophil count added little to participants’ CV risk assessment using traditional risk factors, this simple, inexpensive measure might help a clinician when discussing a woman’s personal CV risk and the possible need for primary CV prevention with treatments such as statins or aspirin. (Published in Journal Watch Women’s Health April 29, 2010) (Dr G M Singh)

  2. Dear Sir, with the dissolution of MCI an era of corruption in MCI has ended. This is the time that one of the member should be elected from the DMC. Regards. Dr. Chandra Shekhar G Nath. Department of Neurosurgery, Post Graduate Institute of Medical Education & Research, Dr R.M.L. Hospital, New Delhi–110001
    eMedinewS Responds
    : Dr Rai Chaudhary is a past President of DMC.

  3. I appreciate the issue raised by Dr Kakar regarding medical ethics. I never charge any consultation from my colleages or their family.Till last year I was not charging any consultation whenever I visited any patient and found him dead. But over the period of time I realized that I was only called to declare the patient dead and I was not consulted in routine. So now I charge my consultation when I am called for home visit to declare a patient dead. Please give your opinion. I also seek views from fellow readers: Dr Jagjit Singh

  4. Dr Desai was taking everybody for a ride unhindered. Now that he is in the custody his stooges in IMA have started coming out, by supporting him. Who are the people in IMA HQ? These are all his men talking against Govt, who has taken a right decision in scrapping MCI. Don’t you watch TV like Samay, CNN IBN, which are giving startling and eye opening facts about the people in MCI. Opinion/resolutions have been passed by Southern State IMA branches supporting the PMO: Sanjay

  5. Good morning Dr Aggarwal. I am writing in relation to recent experience of Dr Kakar. It’s really an awful thing, these kind of acts tarnish image of medical profession. These matters should be taken seriously: Dr Neeraj Gupta