HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com 

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)


Dear Colleague,                                                                                                            19th October

 Chronic Kidney Disease Rises While Most Unaware 

A growing number of Indians have chronic kidney disease, but most remain unaware of it, hampering efforts to prevent irreversible kidney failure requiring dialysis or a transplant. In the recently concluded MTNL Perfect Health Mela it was found that 87% people with mild CKD with kidney functions ranging between 40-60% did not know about the illness.  As per data in the USA about 13 percent of the population, now have chronic kidney disease. Increase in diabetes, hypertension, obesity, and the aging explain at least some of the increase in kidney diseases.
Kidney function can be estimated with a formula that considers the amount of creatinine in a blood sample, along with age and gender. Creatinine is a waste product created by normal breakdown of muscle cells during activity. When kidneys are ailing, creatinine builds up in the blood. Also damaged kidneys may persistently leak albumin from the blood into the urine, sometimes even when kidney function appears normal.
In a JAMA international study only 11.6 percent of men and 5.5 percent of women with moderate (stage 3) kidney disease knew it. Awareness increased to 22.8 percent among participants with stage 3 disease and albumin in the urine. Awareness was highest among people with severe (stage 4) kidney disease, only 42 percent of them knew that they had the condition. Stage 5 is kidney failure.
Kidney disease is often silent until late stages, but if we can find it early we can do a lot to prevent kidney failure. If you have diabetes, high blood pressure or a family history of kidney problems you are at risk and should be screened for kidney damage with routine blood and urine tests.
To help protect the kidneys' small blood vessels, carefully control high blood pressure, and blood sugar if you're diabetic, and ask your doctor if you should take an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. Kidney disease raises the risk of early death, heart attack, stroke, and high blood pressure; causes anemia, bone disease and malnutrition; and can lead to kidney failure.

MEDINEWS Doctor of the year awards

IJCP group will starting 10th Jan 2010 this year, every year on second Sunday of January, will award 20 medinews  Doctor of the Year Award to eminent doctors who have done outstanding work in the previous year (2009 for this year). The award will be distributed during a day long CME: MEDINEWS 2009 revisiting the year 2009. This will be a yearly event.  The award will carry a citation, shawl, coconut kalash, scenery and a memento.

Dr KK Aggarwal Gp Editor in Chief

 Does LAMA means a potential complaint?

Answer: Usually yes. In DMC/DC/F.14/Comp.571/2009 dated 2nd September, 2009, Delhi Medical Council examined a complaint of Shri Ram Saxena from Malviya Nagar, New Delhi, forwarded by Directorate of Health Services, alleging medical negligence on the part of doctors of Max Super Speciality Hospital, in the treatment administered to his wife late Sunita Saxena.   The Council perused the complaint, reply thereto of Dr. Sumit Marwah, Head Medical Services, Max Superspeciality Hospital, Saket, copy of medical records of Max Superspeciality Hospital, as provided by the office of Directorate of Health Services. 

The patient late Sunita Saxena, a 58 years old female, was admitted as a follow up case of multiple myeloma with stiff person syndrome with type II respiratory failure with septic shock with acute Oligoanuric ATN, in Max Superspeciality Hospital on 29th March, 2008.  She was treated conservatively with antibiotics and other supportive measures including the ventilator.  The patient went LAMA from Max Superspeciality Hospital on 22nd April, 2008 and as per the complaint, was admitted in AIIMS where she succumbed to her ailments on 25th April, 2008. 

It is observed that the patient was treated in accordance with the accepted professional practices in such cases by the doctors of Max Superspeciality Hospital.  The stiff person syndrome which is rare para-neoplastic syndrome associated with this disease, carries a high mortality rate.  It is also noted that prognosis of the patient was discussed with the attendants from time to time and efforts were made to wean of the patient from ventilator but since she failed to breathe comfortably without ventilator, she required on and off ventilator support.  Prima facie, no case of medical negligence is made out against the doctors of Max Superspeciality Hospital in the treatment administered to late Sunita Saxena.  Complaint stands disposed.

Do not give paracetamol to prevent vaccine induced fever
Fever after a vaccination is a normal and essential part of building an immune response, and giving children paracetamol after a shot could dampen that response. With some vaccines, transient fever means that a child's immune system is processing the immunization, providing them with the best protection, explained Dr. Robert T. Chen, a blood safety specialist at the U.S. Centers for Disease Control and Prevention. Therefore, unless a must do not administer fever-reducing medicines at the same time as vaccination to prevent the child from developing a fever as per Chen, who wrote an editorial accompanying a report in the Oct. 17 issue of The Lancet.

Now UV protecting cloths
Deep blue and red cotton fabrics are better than yellow at protecting skin against damaging ultraviolet (UV) radiation from the sun, according to Spanish scientists. The researchers dyed cotton fabrics in a wide range of red, blue and yellow shades and measured the ability of each to absorb UV light. Deep blue shades had the highest UV absorption, while yellow shades had the least. The results, scheduled to be published in the Nov. 4 issue of the journal Industrial & Engineering Chemistry Research, could be used by clothing makers to design more effective anti-sun clothing.

Air pollution tough on the obese
For those who are obese, exposure to air pollution further exacerbated systolic blood pressure and pulse pressure, said lead researcher Srimathi Kannan, an assistant professor at the School of Public Health and Health Sciences of the University of Massachusetts at Amherst. The report is published in the Oct. 16 online edition of the Journal of Epidemiology and Community Health.

When to call a child doctor
The Nemours Foundation offers these signs that it is time to call a pediatrician:

  1. When your infant aged 2 months or younger has a fever of 100.4 degrees Fahrenheit or higher.
  2. When your infant shows signs of dehydration, which may appear as crying with no tears, no urination for more than six hours, a sunken soft spot on the head or sunken eyes.
  3. When it's difficult to get your baby to wake up, or the baby has signs of no alertness, extreme inactivity, or severe drowsiness.
  4. When your infant has blood in the diaper, blood in the vomit, or frequent diarrhea.
  5. When your infant has rapid and labored breathing.
  6.  When your infant vomits frequently and forcefully (beyond spitting up).

Tips to prevent low backache
1. Get plenty of regular exercise, including aerobics and exercises to strengthen your back and abdominal muscles.
2. When carrying heavy objects, lift with your legs, not your back. Always bend at the knees with a straight back; don't bend over.
3. If you're overweight, lose those extra pounds to reduce stress on the lower back muscles.
4. Don't smoke. Smoking contributes to degeneration of the spine.
5. Maintain good posture, especially while sitting, lifting objects and standing.

Even doctors need six hours of sleep
Attending surgeons and obstetricians/gynecologists who get fewer than six hours of sleep between procedures risk increasing the rate of surgical complications, according to Harvard researchers.  A lot of attention has been paid to the long hours that residents and interns work and the increase in medical errors brought on by their fatigue, but the new study found the same problems among practicing physicians. Attending surgeons and obstetricians/gynecologists, like resident physicians and nurses, are vulnerable to the effects of fatigue and extended work shifts on performance and patient care, said Dr. Jeffrey M. Rothschild, a physician at Brigham and Women's Hospital in Boston. The risk of performing post-nighttime cases without sufficient rest may be especially important in hospitals without backup support or house staff physicians to assist a fatigued attending physician. The report is published in the Oct. 14 issue of the Journal of the American Medical Association.

Chlorhexidine dressings for catheters

Use of a chlorhexidine gluconate-impregnated sponge (CHGIS) in intravenous catheter dressings may reduce catheter-related infections [5]. Among 1636 patients with central venous or arterial catheters, use of a dressing incorporating a CHGIS was associated with a significant decrease in catheter-related bloodstream infection; the rates decreased from 1.3 to 0.4 per 1000 catheter-days. [JAMA 2009; 301:1231.] 


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