March 18  2015, Wednesday
editorial
Healthy obesity does not exist
Dr KK AggarwalNew research published online in the Annals of Internal Medicine suggests that individuals cannot be simultaneously overweight and physically fit.

As BMI rose, so did blood pressure, waist circumference and insulin resistance. As BMI increased, levels of HDL cholesterol, thought to protect against heart attack and stroke, decreased.

While participants who were either overweight or obese "may not yet have reached the points that define metabolic illness, they appeared to be on that road as their weight" increased.
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CPR 10 Camp at Ex Serviceman Defence Association Ghaziabad on 7th December 2014
News
  • Army Hospital (Research & Referral), New Delhi, is organizing a CME “National Rheumatology Update- 2015”on 22 March 2015 (Sunday). Inauguration ceremony will be held at 10.45 am on 22nd Mar 2015. Dr KK Aggarwal will deliver the Keynote address as chairperson.
  • Getting on the scale every day may boost enthusiasm for healthy behaviors and lead to greater weight loss, suggests a new U.S. study published online in the Journal of the Academy of Nutrition and Dietetics.
  • Warming human monocytes to a febrile-range temperature, rather than normal body temperature, may reverse the effects of hypothermia, suggests a new study published online in Annals of Surgery.
  • Studies evaluating the performance of hybrid imaging using simultaneous PET/MRI for the staging of both primary and recurrent pelvic malignancies indicate that the integrated approach could be a valuable diagnostic modality in both settings, points new research presented at the European Congress of Radiology (ECR) 2015.
  • Cesarean section can be lifesaving for a pregnant woman in cardiac arrest and her baby, but only when done promptly and effectively, suggest UK researchers in a 24-step protocol published online in Emergency Medicine Journal.
  • A new study suggests that loneliness and social isolation seem to be risk factors for all ages for early mortality. The study is published online in Perspectives on Psychological Science.
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Dr KK Spiritual Blog
Values, Morals and Ethics

Values
  • Values are our fundamental beliefs. They are the principles we use to define that which is right, good and just.
  • Values provide guidance to determine the right versus the wrong, the good versus the bad.
  • They are our standards.
  • When we evaluate anything we compare it to a standard.
  • Typical values include: honesty, integrity, compassion, courage, honor, responsibility, patriotism, respect and fairness.
  • Ethics are universal.
Morals
  • Morals are values which we attribute to a system of beliefs, typically a religious system, but it could be a political system of some other set of beliefs.
  • These values get their authority from outside the individual– a higher being or higher authority (e.g. society).
  • Right as defined by a higher authority.
  • By that definition one could categorize the values listed above (honesty, integrity, compassion…) as "moral values" – values derived from a higher authority.
Ethics
  • Ethics is about our actions and decisions.
  • When one acts in ways that are consistent with our beliefs (whether secular or derived from a moral authority) we characterize that as acting ethically.
  • When one’s actions are not congruent with our values – our sense of right, good and just – we view that as acting unethically.
  • The ethics of our decisions and actions is defined socially, not individually.
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Cardiology eMedinewS
  • The High Value Care Task Force of the American College of Physicians (ACP) recommends against screening for coronary heart disease (CHD) in asymptomatic, low-risk adults with resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging. The statement was published online March 16 in the Annals of Internal Medicine.
  • Researchers from China have reported significantly positive results from folic-acid supplementation for prevention of cardiovascular events. The China Stroke Primary Prevention Trial (CSPPT) showed that daily treatment of 10-mg enalapril plus 0.8 mg of folic acid for 4.5 years in adults with hypertension but without a history of MI reduced the risk of first stroke (the primary outcome) by 21% compared with taking enalapril alone. The findings were presented at the American College of Cardiology (ACC) 2015 Scientific Sessions.
Pediatrics eMedinewS
  • Metabolic syndrome and insulin resistance appear to contribute to the pathogenesis of asthma in obese children and adolescents, suggests a cross-sectional study published online in the Journal of Allergy and Clinical Immunology.
  • Adding an electroencephalography (EEG)-based biomarker to standard clinician judgement may improve the accuracy of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and reduce the likelihood of overdiagnosis, suggests new research published online in Brain and Behavior.
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Events
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Inspirational Story
Where there is a will there is a way

A 72–year–old male came to Sameer Malik Heart Care Foundation Fund to get financial assistance for his heart condition. He was suffering from heart failure, which required biventricular pacing device to help him relieve his symptoms and live a better quality of life.

The private sector gave him an estimate of Rs. 7.50 lakhs. At AIIMS, the estimate was lowered to Rs. 2.25 lakhs for a reasonable device.

He approached Prime Minister’s Fund and was sanctioned an amount of Rs. 50000/– but the due six months passed as he could not raise further funds. Because of the large sum of money required, most of the family members refused to help him.

When he approached us, he had also sold his only buffalo for Rs 30000/–.

When we first met him, he was an enthusiastic elderly person and said, "Mein jeena chahta hoon" (I want to live) and these words impressed me immensely.

From Sameer Malik Heart Care Foundation Fund, we sanctioned an amount of Rs. 1 lakh towards his surgery and then talked to his family members and convinced them that when we are helping him all of them should also help.

His brother–in–law called us next day and said that he has arranged the balance amount of Rs 90000/–. Ultimately, a total amount of Rs 2.25 lakh was collected and deposited with AIIMS and his rightful surgery was done.

The message is very clear – "where there is a will there is a way."

He showed us his will to live by selling his only buffalo and that paved the way for his successful surgery.
Wellness Blog
CT not required in appendicitis

When a patient has all the signs of acute appendicitis, waiting to get a CT scan to confirm the diagnosis is not required. Compared with a straight–to–surgery approach, the CT strategy is linked to delayed surgery and increased risk of a burst appendix.

Pre–operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis. If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned. These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.
Make Sure
Situation: A 60–year–old male developed acute heart attack after consuming Viagra.

Reaction: Oh my God! Why was cardiac clearance not taken before?

Lesson: Make sure that all older patients get a cardiac clearance before they are given Viagra group of drugs.
Medicolegal
(Contributed by Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS)

What is the medicolegal importance of age up to 15 to 21 years?
  • 15 years of age: Even if a wife, a girl below 15 years of age cannot give valid consent for sexual intercourse.
  • 16 years of age: Any girl below 16 years of age cannot give valid consent for sexual intercourse. It will amount to rape even if sexual intercourse is done with consent.
  • Age 18–21 years:
    • In accordance with Indian Majority Act 1875, a person attains majority on completion of 18 years.
    • In accordance with Child Marriage Resistance Act, a female under 18 years and male under 21 years cannot contract marriage.
    • In accordance with Section 366 B of IPC, importation of any girl from Jammu & Kashmir or a foreign country under the age of 21 years for illicit intercourse is a criminal offence.
Dr Good Dr Bad
Situation: A patient with Mediclaim was advised MRI post discharge.

Dr. Bad: It will not be covered.

Dr. Good: It will be covered.

Lesson: Post hospitalization-related medical expenses incurred during period upto 60 days after hospitalization of disease/illness/injury sustained are covered as part of claim.

(Copyright IJCP)
IJCP Book of Medical Records
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eMedi Quiz
A 60-year-old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:

1. Thymoma

2. Lung cancer.

3. Hodgkin's lymphoma.

4. Superior vena caval obstruction.


Yesterday’s Mind Teaser: Which one of the following is a recognized X-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.

2. Sacroilitis.

3. Bone erosions.

4. Periarticular calcification.

Answer for yesterday’s Mind Teaser: 3. Bone erosions.

Correct Answers received from: Dr Avtar Krishan, Dr Jainendra Upadhyay.

Answer for 16th March Mind Teaser: 2. Interstitial lung disease.

Correct Answers receives: Daivadheenam Jella, Dr Avtar Krishan, Raju Kuppusamy, Dr Sushma Chawla, Dr Prateek.
Rabies News (Dr A K Gupta)
Can a vaccinated dog transmit rabies? How effective is dog vaccine?

If a potent veterinary vaccine is given correctly as per pre–exposure schedule, it will mostly prevent rabies in the vaccinated dog, unless the exposure is severe. Ideally, its sera should be tested for protective antibody titer level but this is rarely practicable due to scare facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:
  • 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history
  • 40% of dogs vaccinated only one time lost most of their immunity 4–6 months later.
  • Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs.
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
Indian Medical Association
Hospital Board of India
9th board meeting


Venue: Hotel Green Park Date : 21.03.15, saturday

Vadapalani, Chennai Time : 11 am

Agenda

10.30 am : coffee

Matter for discussion
  • Accreditation of health care institutions – NABH initiative.
  • Alignment and coordination with the state chapters.
  • Reconsideration of the fee structure.
  • New State Chapters.
Programme
1) IMA prayer
Dr Sridhar, Secretary NHB, IMA TNSB
2) Flag Salutation
Dr Ravikumar, Imm past Secretary NHB, IMA TNSB
3) Welcome address
Dr Anbarasu, Chairman NHB, IMA TNSB
4) Presidential address
Dr A Marthanda Pillai, National President, IMA
5) Address by
Dr L P Thangavel, National Vice President IMA
6) Chairman’s opening remarks
Dr R V Asokan, Chairman IMA HBI
7) Relevance and expectations from IMA HBI
Dr Arul Rhaj, Past National President IMA
 
Dr K VIjayakumar, Past National President IMA
8) Perspective of IMA TNSB
Dr R V S Surendran, State President IMA TNSB
 
Dr C N Raja, State Secretary IMA TNSB
9) Address by
Dr Zameer Pasha, Imm Past Chairman IMA HBI
10) Perspective of NHB, IMA TNSB
Dr Anbarasu, Chairman NHB, IMA TNSB
11) Perspective of IMA Kerala State Branch
Dr Sreejith N Kumar, State President IMA KSB
 
Dr A V Jayakrishnan, State Secretary, IMA KSB
12) Open discussion
 
13) Secretary’s report
Dr Raviwankhedkar, National Secretary IMA HBI
14) Financial status
Dr Shiv Kumar Utture, Treasurer IMA HBI
15) Hqs functioning
Dr Anil Pachnekar, Hqs Secretary IMA HBI
16) Self assessment software for accreditation
Dr Ruby Ammon, Director, Hope Hospitals
(1.00 pm to 1.30pm)
Lunch : 1. 30 pm
 
17) 2.00pm
Discussions with Dr K K Kalra CEO, NABH.
18) Any other matter with the permission of chair.
 
Vote of Thanks
Dr Raviwankhedkar, National Secretary IMA HBI
Tea
 
The meeting will be concluded by 4 pm.
 
 
Dr Raviwankhedkar
Secretary, IMA Hospital Board of India
Facts about Tuberculosis (TB)
Which age group is usually more affected by TB?
  • TB can occur at any age but is commonly seen in persons between 15-45 years of age, which is the economically productive age group.
  • Disease occurs in both the genders. However, males are affected more as compared to females.
IMA National Health Scheme
Not everyone with TB infection may suffer from the disease: IMA
The Hindu: “Only 10 per cent of those people living with tuberculosis infection may suffer from TB disease,’’ noted Indian Medical Association national president Dr. A.M. Pillai.
In most people, who breathe in the TB bacteria, the body’s immune system is able to fight it and stop it from multiplying. This is called TB infection. People who are infected with TB do not feel sick, do not have any symptoms and cannot spread TB, he added.
“However, if the infected person’s immune system cannot stop the bacteria from multiplying, the bacteria eventually cause symptoms of active TB, which is called the TB disease,” explained Dr. K.K. Aggarwal honorary secretary general Indian Medical Association.
Greater risk
He added that people with conditions including HIV, diabetes mellitus, malnutrition and those on treatment with immunosuppressant drugs (anti-cancer, corticosteroids, etc.) are at a greater risk of developing TB disease once infected. TB is spread through the air by a person suffering from it. A single patient can infect 10 or more people in a year.
Notification important
The Indian Medical Association has claimed that it has been able to notify over one lakh TB patients in the last one year, which has resulted prevention of at least ten lakh TB infections in the country.
Bar code on drug packaging to help track and trace authenticity
Sushmi Dey | 14 March 2015, 12:35 PM IST

NEW DELHI: To ensure medicines sold are genuine products, the health ministry has developed a `Track and Trace' mechanism which will enable consumers to check safety and authenticity of a drug through the internet.

Under the system, the primary, secondary and tertiary packs of medicines will carry a unique bar code, which will be allotted to each manufacturer. Consumers, buying medicines from retail pharmacy store, can use the bar code on the pack on internet to check information about the source of manufacturing of the product, whether it is an approved drug, it's date of expiry as well as price fixed by the government etc.

The move is significant because of the highly fragmented Indian pharmaceutical market, pegged at around Rs 89,000 crore annually. The huge size of the market makes it difficult for regulators and monitoring agencies to track medicines, mainly in rural areas and distant villages. This leads to a potential risk of spurious, inefficacious and low quality medicines being sold in the market.

The government is yet to finalize a date for launching the 'Track and Trace' system in the local market. "Rules for implementing the Track and Trace mechanism will be framed and will be operationalized after allowing a reasonable period for transition," Union health minister J P Nadda said. He added, compliance will be mandatory for all drug manufacturers.

Following allegations from some international markets that spurious medicines are making their way from India, the commerce ministry in 2012 had made it mandatory for pharmaceuticals exporters to have barcoding for secondary and tertiary packaging on their export consignments.

Now, the government is also working to create an integrated database with all details of a product, which will enable tracking and monitoring of these products.
'Government does not pay heed to our demands until we strike'
Ritwika Mitra

Doctors say strike is the last resort and often triggered by attacks on them

Doctors’ going on strike is not uncommon. But with OPD services paralysed and patients being turned away from the OPDs at short notice raises questions of ethics.

Most doctors claim that the administration turns a deaf ear to their demands till the time they go on strike. Seeking appointments with the officials in the Health Department to communicate their problems itself is a “major challenge”.

A strike, they say, is the last resort and often triggered by attacks on doctors.

“It may not be sound to go on strike from an ethical point of view. But the government does not pay heed to our demands. In a letter to Union Health Minister J P Nadda in February, we underlined our demands for better security measures and infrastructure in these hospitals. But nothing has changed so far,” says Dr Balwinder Singh, president, Federation of Resident Doctors Association (FORDA).

“Three Delhi Police personnel have been deployed in the premises of Safdarjung Hospital since the strike at GTB, which will not serve any purpose in case of an emergency,” says Dr Singh.

The situation remains the same across other hospitals as well, he added.

FORDA had given a two-week notice that if the situation did not improve they would go on strike from March 2.

The strike was, however, deferred after the government sought more time to put things in place.

“When resident doctors go on strike, they do not stop senior consultants from attending to patients. Also, a notice is served beforehand. So this is not unethical,” says Dr Shashank Pooniya, general secretary, Resident Doctors Association, AIIMS.

“We want the administration to address issues like doctors working for 48 hours at a stretch, extra pay for more work hours and better hostel facilities,” says Dr Pooniya.

With any number of attendants coming in along with patients, female doctors are often molested.

“Several cases have been reported from the state-run hospitals in which female doctors were abused and molested. The spate of assault cases on doctors are also on the rise. The apathy of the administration in taking corrective measures forces resident doctors to go on strike,” says Dr S K Poddar, Honorary State Secretary, Delhi Medical Association (DMA).

When doctors at GTB Hospital were on strike for five days, state Health Minister Satyendra Jain promised to deliver on their demands.

With a strike apparently being the only time when administration considers a dialogue, it is often seen by doctors as a “solution” to resolve their problems.

Resident doctors said they have been trying to highlight the issues faced by patients and doctors alike at the hospital for the past six months, but in vain.

During the recent strike, with other prominent hospitals joining in with a one-day strike, few hospitals managed to run basic OPD services and pressed the consultants into emergency services. Resident doctors are considered the backbone of government hospitals.

In cases where RDAs give notices to the administration, it is important that the hospitals plan ahead so that “services go on uninterrupted”.

“In a case where Safdarjung doctors had gone on strike, the Delhi Medical Council had issued an advisory that doctors should not resort to strikes. Cases of medical negligence reported due to doctors going on strike is not acceptable. There should be no impact of the strike on emergency services,” says Dr Girish Tyagi, Registrar, Delhi Medical Council (DMC).

People for Better Treatment, an NGO, had earlier filed a PIL seeking action against doctors in Safdarjung Hospital alleging that the strike had resulted in several cases of medical negligence.

The recent strike also attracted flak from within the doctors’ community with a section of resident doctors saying strikes would not help resolve the issues.

“In turn, it will bring the entire community a bad name,” says a resident doctor at a civic-body-run hospital.

According to Dr K K Aggarwal, Honorary General Secretary, Indian Medical Association, the resident doctors cannot be blamed alone.

“In case of any medical negligence, the medical superintendents and the senior consultants also will be held responsible. If doctors are giving a notice before going on strike, the onus is on the hospital administration to arrange for alternative options,” says Agarwal.

“The Medical Council of India ethics guidelines clearly state the patient should not suffer under any circumstances,” he adds.

The Union Ministry of Health and Family Welfare on Saturday issued a letter addressing the demands of the FORDA.

According to the letter, security services at hospitals will be improved and medical superintendents have been asked to resubmit the redevelopmemt plans of hostel infrastructure.

The issue of extra pay for additional work hours will be addressed too, it says.
Now, an app to book AIIMS appointment
Feb 17, 2015, 03.11AM IST TNN

NEW DELHI: The All India Institute of Medical Sciences (AIIMS) is going to launch a mobile application through which patients can book appointments and even check their lab reports.

The institute is already running an online facility and tele-service for this but officials said public response is not positive as yet.

"Only 20-25% of total appointments are being done through the online and tele-services system," said Dr Deepak Aggarwal, chairman of the computerization committee at AIIMS. He said the new app can be downloaded for free.

India's premier medical institute, which receives nearly 8,000 patients a day, believes the new facility will help reduce hassles in seeking appointments and cut down on corruption.

"All patients visiting AIIMS are given a Unique Health Identification (UHID) number. All they have to do to book an appointment is to fill up the UHID and select option to book appointment or check lab report on the app. Though the existing technology supports appointments only got follow-up cases, we may soon launch services for new patients also," said Dr Aggarwal
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IMA Videos
IMA Humor
‘X’ Marks the Spot

Paul and Jim decided to rent a boat on a lake for their favorite sport. After fishing for 4 hours at various places around the lake with no luck at all they decided to try one more spot before calling it quits.

Suddenly things started to happen, and they caught their limit inside of 20 minutes.

Paul said, "Hey, we should mark this spot, so next time we will know where to come."

Jim says, "Good idea," and he took out a can of spray paint and made a large X on the floor of the boat to mark the spot.

With that Paul says, "Why did you do that? Now anyone who rents this boat will know where to fish!"
Quote of the Day
Apology is a lovely perfume; it can transform the clumsiest moment into a gracious gift. Margaret Lee Runbeck
Reader Response
  1. Fruit salad observation / data is good, Dr Suresh Amin MD. IFCAP
  2. Dear Dr KK your spiritual blog was informative and inspiring. I wish that our medical fraternity starts praying for the patients under their care. By this we would treat our patients with love and compassion. Looking forward for more inspiring blogs from you. Regards, Dr Pankaj Khora
News on Maps
March 24 is World TB Day
Messages on Tuberculosis

Heart Care Foundation of India today released messages on TB for the forthcoming World TB day.

Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA said that TB is curable provided one knows the Formula of 3, which is ‘Do not ignore cough of more than 3 weeks and get 3 sputum TB tests done.’
  • India has the largest number of tuberculosis cases in the world.
  • Tuberculosis is a curable disease.
  • For complete recovery, full and adequate treatment of tuberculosis is important.
  • Most tuberculosis drugs are safe and have minimal side effects.
  • A minimum six months of treatment is required for a patient with tuberculosis.
  • DOTS is an effective way of controlling tuberculosis.
  • Tuberculosis is caused by bacilli spread through droplet infections.
  • Tuberculosis patients should dispose their sputum by burning, burying it in the soil or disinfecting them with a disinfectant.
  • All cases of tuberculosis are not contagious. Only sputum-positive TB patients are infectious to others.
  • Even contagious tuberculosis can become non-infectious within one week of effective treatment.
  • Tuberculosis can be of lungs (pulmonary) or outside the lungs (extra pulmonary). In 85% of cases, lungs are involved.
  • In tuberculosis of the lung, often an X-ray chest is the first investigation to be asked.
  • Tuberculosis can infect people of any age or sex.
  • Do not ignore a cough of more than 2 weeks.
  • Every cough with or without sputum is not TB.
  • Blood in sputum may be an indication of tuberculosis.
  • Even in pregnancy, tuberculosis requires full treatment.
  • Diagnostic tests for tuberculosis are available free of cost by the Govt.
  • Tuberculosis treatment is available free by Govt. of India.
  • TB infection and TB disease are not the same.
  • 90% of those infected may not develop TB in their life time.
  • 10% of HIV-positive patients will develop TB every year.
  • After 5 months of treatment if the patient has not responded, suspect a drug failure.
  • Relapse or re-infections can occur in a patient with TB.
  • TB drugs are often taken as single dose. Divided doses are not recommended.
  • Non-healing ulcer on the skin may be an indication of skin TB.
  • Drug resistant TB cases should be handled by a specialist.
  • Transient rise in liver enzyme reports are well-known in early weeks of TB treatment.
  • TB can occur any time in the course of HIV infection.
  • Doctors should not prescribe corticosteroids as a routine in the treatment of TB.
  • TB can cause collection of water around the heart or around the lungs.
  • TB of the intestine is a common occurrence in our country.
  • TB can be a common cause of infertility in women.
  • TB of the brain is the most life-threatening of all forms of TB.