February 19  2015, Thursday
editorial
Smoking makes you 5 years older
Dr KK Aggarwal Men have a greater chance of dying then women, and smoking increases any adult’s risk of death just as if five years were suddenly added to their age.
  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.
eMedipics
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Health Check Up and CPR 10 Camp at Govt Boys Sr. Sec. School M.B Road, Pushp Vihar Sec-1 New Delhi on 1st December 2014
News Around the Globe
  • A diet that focuses solely on increasing fiber intake works about as well as a more complex American Heart Association (AHA)-compliant diet for promoting weight loss and improving risk profile among patients with metabolic syndrome, suggests a randomized trial published in the February 17 issue of the Annals of Internal Medicine.
  • About one-third of patients with locally advanced breast cancers who underwent mastectomy did not receive the recommended radiation therapy (RT) after surgery, reported a study of nearly 57,000 women. The findings are published online in the Journal of the American College of Surgeons.
  • Frequent vasomotor symptoms associated with menopause persist longer than had been thought previously, and the sooner they start, the longer they last, suggested a study published online in JAMA Internal Medicine. The median total duration of VMS was 7.4 years.
  • There may be no difference between antiplatelet and anticoagulant treatment for patients with cervical artery dissection in preventing stroke or death, reported a new study presented at the International Stroke Conference (ISC) 2015.
  • A new study helps guide the recent American Diabetes Association (ADA) recommendation to screen Asian Americans for type 2 diabetes starting at a body mass index (BMI) of 23 kg/m2 instead of 25 kg/m2. The study is published online in Diabetes Care.
Dr KK Spiritual Blog
Did all Gods suffer before death?

Most Gods and spiritual gurus had suffered in their last days. Lord Krishna had a nonhealing wound, Jesus Christ was crucified, Bhagwan Rajneesh had an infectious disease, Swami Chinmayanand had low functioning heart, Maharshi Mahesh Yogi had heart and pancreatic disease, Satya Sai Baba was put on a ventilator etc. When they were God–like personalities, why did they suffer in their last days?

The answer to this comes from Vedic knowledge within the concept of rebirth. Vedanta says that the very fact that we are born means that in the last birth we did not attain moksha or liberation. In other words, this means that there were some sufferings yet to be faced. You are born to face those sufferings. When you face the last suffering, there are high chances that this suffering might be your last suffering before liberation.

Most Gods or saints who died in a phase of suffering may mean that they did not attain liberation. A person who dies suddenly or unnaturally would mean that he would have to take rebirth to face more sufferings.

According to me, terminal sufferings are good from spiritual point of view.
Event
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Cardiology eMedinewS
  • Women in their late 50s who were at least moderately active a few days a week were less likely than their sedentary peers to have vascular disease—stroke, venous thromboembolism (VTE), or coronary heart disease (CHD)—when they were in their 60s or 70s, reported a study published online in Circulation.
  • Researchers at the University Department of Internal Medicine II at the MedUni Vienna (Clinical Department of Cardiology) have successfully demonstrated the advantages of an implanted defibrillator (ICD) as a means of prevention in patients with moderately restricted cardiac function, and that patients with the condition must be treated as carefully as patients with ischemic heart failure which has developed following a heart attack. The research is published in Circulation AE.
Pediatrics eMedinewS
  • Larry Gray, MD, assistant professor, section of behavioral and developmental pediatrics, Comer Children's Hospital, University of Chicago Medicine, and colleagues reported that babies who were placed under an infant warmer and given a sucrose solution cried and grimaced for 50% less time after receiving the hepatitis B vaccination than babies who were given sucrose alone (P<0.05, respectively).
  • Changes in the makeup of the infant gut microbiome precede the development of type 1 diabetes, suggests a new study published in the journal Cell Host & Microbe.
Make Sure
Situation: A patient with dengue fever developed shock.

Reaction: Oh my God! Why was the blood pressure of 90/80 ignored?

Lesson: Make sure that a pulse pressure of less than 20 is not ignored; it is an impending sign that the patient is going into shock.
Medicolegal
(Contributed by Dr MC Gupta, Advocate)

When a patient gets treatment at a hospital, he is the consumer of the services provided by the hospital. The consumer complaint should lie against the hospital, not the treating doctor. Why do the Consumer Courts allow the patient to file a consumer complaint against an individual doctor?


Many reasons can be given as to why the doctor should be made a party.
  • It has been held in court judgments that a doctor cannot be held guilty behind his back. He must be given a chance to defend himself. Courts have therefore directed that the treating doctor must be made a party.
  • The treatment to an individual is directly given by the doctor, not by the aggregate body called the hospital. If the doctor is protected by professional indemnity insurance, there is no reason why the compensation awarded should be paid by the hospital and not by the insurance company providing the cover to the doctor. The insurance company would pay only when there is a court judgment against the doctor.
  • Some hospitals may preferably employ those consultants who are covered by insurance. The insurance company would pay only when there is a court judgment against the doctor.
  • There may be confusion as to whether the hospital is the service provider or not while there may be no controversy regarding the role of the doctor as the service provider. The patient cannot be made to suffer in the legal procedural wrangle about determining the role and status of the hospital as service provider.
  • When the complainant alleges medical negligence, it is inevitable that even if the hospital alone is made the respondent, the hospital will have to ask the concerned doctor to explain his stand. The doctor may choose not to respond to the hospital’s request and, in the interest of justice, summons may have to be issued to the doctor to testify in the court. This will entail avoidable delay and also harassment to the doctor. At present, doctors have rarely to be present themselves in the consumer court.
  • The legal nature of the hospital as an entity may be unclear. Some are corporate hospitals; some are government hospitals; some are small hospitals that may not even be registered. Only a few states have nursing home acts or clinical establishment acts. The ownership and management etc. of a hospital may be unclear. All this may delay the legal process at the "service stage" itself. (Service here means the act of serving the court summons upon the opposite party.)
  • The same doctor may treat a patient partly as a hospital patient and partly as his private patient in his private clinic. When he alleges negligence in treatment, the treatment cannot be artificially separated into private clinic treatment and hospital treatment.
  • The consumer courts have been established to dispense speedy justice as summary proceedings by avoiding arguments and delays related to procedure. Justice would be speedy when the doctor is a party.
  • Please also note that till today, probably no treating doctor has pleaded as to why a case has been filed against him and not against the hospital alone. Your question is, hence, merely a hypothetical/theoretical question.
Dr Good Dr Bad
Situation: A patient wanted to know if the cost of the spectacles would be covered by Mediclaim after cataract surgery.

Dr. Bad: It will be covered.

Dr. Good: It will not be covered.

Lesson: Mediclaim does not cover the cost of spectacles, contact lenses, hearing aids.

(Copyright IJCP)
IJCP Book of Medical Records
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Wellness Blog
MR–Guided Focused Ultrasound for Knee Osteoarthritis

Local bone denervation by MR–guided focused ultrasound has been demonstrated as a promising tool for pain palliation of bone metastases. A study in BMC Musculoskelet Disord 2013;14(267) has shown the safety and efficacy of MR–guided focused ultrasound treatment in osteoarthritis. Significant increase of pressure pain thresholds on treated area showed successful denervation effect on the nociceptive nerve terminals. MR–guided focused ultrasound is a promising and innovative procedure for noninvasive pain management of knee OA.
Twitter of the Day
Dr KK Aggarwal: Eating refined sugar can cause diabetes http://youtu.be/NMIK16PyBrY?a via @YouTube

Dr Deepak Chopra: Why do you stay in prison When the door is so wide open –Rumi
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Is washing of animal bite wound(s) essential?

The risk of rabies reduces by about 50% by just washing of wounds and application of antiseptics.

The maximum benefit of the wound washing is obtained when the fresh wound is cleaned immediately. It is important to remove saliva containing rabies virus at the site of bite by physical or chemical means. This can be done by prompt and gentle thorough washing with ordinary soap or detergent and flushing the wound with running tap water for at least 15 minutes.

Washing of the wound must be done as long as the wound is raw irrespective of the time elapsed since the exposure. Care must be taken not to disturb the scab, if formed.

After washing with water and soap, disinfectants like Povidone Iodine or Surgical Spirit must be applied.

In extraneous circumstances, other alcoholic (>40%) preparations like Rum, Whisky or aftershave lotion may be applied on the wound. If soap or antiviral agent is not available, the wound should be thoroughly washed with water.
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
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
IMA NEWS
Sonal Namaste
CDC guidelines advise use of a plain (nonantimicrobial) soap with water for routine hand washing.
Swine flu kills 600-plus in India, refuses to die
Sushmi Dey, TNN | Feb 18, 2015, 06.35 AM IST

NEW DELHI: The mercury rising, yet the H1N1 influenza A virus seems to defy its survival limitations, worrying the health ministry and doctors.

This year, swine flu deaths have more than doubled compared to the previous year taking the toll to 624. A total of 9,311 people got infected, government data show. In February alone over 300 died across the country. In 2014, 218 swine flu deaths were reported from a total of 937 cases, pan-India.

"As it starts getting warmer, we expected cases to come down. This year the trend is different," says Dr Suranjit Chatterjee, senior consultant, internal medicine, at Indraprastha Apollo Hospitals.

Union health minister JP Nadda has held frequent review meetings. The ministry's directed pharma companies to expedite supply of antiviral medicines to state hospitals and licensed retail outlets. "We've asked companies to airlift stocks, if required. We'll monitor availability in the retail market," Union health secretary BP Sharma said. The government hopes cases will come down with awareness and precautionary measures, he said. The ministry has directed states to provide protective kits to health workers.

Although the cause is yet to be ascertained, doctors suspect a change in the strain behaviour — which generally happens in three to four years — resulting in the sudden spurt in cases. ICMR, though, has ruled out strain mutation, BP Sharma, secretary to the health ministry said.
Swine flu test rates rise in Delhi, labs minting money
Astha Saxena | Mail Today | New Delhi, February 18, 2015: Nearly 71 fresh cases of swine flu were reported in the Capital on Tuesday.

71 fresh cases of swine flu were reported in the Capital on Tuesday. With the scare of swine flu looming on the Capital, certain private laboratories and hospitals in the city are minting money.

These private laboratories and hospitals are charging the citizens any amount - ranging from Rs.3,500 to Rs.9,000 - for a simple swine flu test.

Absence of any guideline on the rate is allowing these organisations a free run. While the Delhi government's health department officials have promised action to counter the tendency of these private laboratories and hospitals, health experts have raised questions about the lack of uniformity in rates.

A random survey by MAIL TODAY of the 10 authorised laboratories of Delhi government revealed that the amount charged for a swine flu test varies from one private laboratory to another. While a simple test will cost Rs.9,000 in Dr Dangs Lab, the same test will cost Rs.3,500 at the Sequence Referral Lab in Janakpuri.

"These laboratories and hospitals are taking undue advantage of the situation. Last year, the trend was totally opposite as just one case of the influenza was reported from the city. But this year, more and more people are getting themselves tested for swine flu, even as a precautionary measure. With the scare looming, these private labs and the hospitals are making money," a health department official told MAIL TODAY.

While one doesn't have to pay for the swine flu test at the AIIMS or the National Centre for Disease Control or the Patel Chest Institute, health officials worry whether everyone can reach these government-managed institutions.

According to sources, the increase in the number of swine flu cases in 2015 has led to chaos in the health department of the Delhi government. Only 10 designated labs and hospitals can confirm the H1N1 influenza. Every day, these labs receive almost 70 to 80 samples for swine flu testing, out of which 50 per cent are tested positive. "The people are going to these notified labs. These labs are making money, whether or not one is tested positive for swine flu," another health official told MAIL TODAY. "The health department is simply trying to hide the figures, so that there is no scare among the people. A price control policy should be adopted by the health department," the official added.

Health experts too have red-flagged the lack of uniformity in the rates. "The question is not about the money. But why there is no uniformity in the rates? There should be a rate control in such a situation. The government should put a cap on the upper limit so that no one suffers. How can one expect a person with low income to shell more than Rs 5,000 for a test? The charges for such tests should be nominal," said Dr. K.K. Aggarwal of the Indian Medical Association.

When Mail Today raised the issue with the Delhi health department, they assured that stringent action will be taken against these labs. "This is totally unjustified that the charges are not uniform. We will call a meeting with all the authorised private labs on Wednesday and order them to charge nominal amount for the swine flu test," said Dr. Charan Singh, additional director, public health and waterborne diseases control, directorate of health services
Triad of swine flu prevention: Respiratory hygiene, cough etiquette, and hand hygiene
  • Median incubation period is 1.5 to 3 days.
  • Virus shedding begins the day prior to symptom onset and often persists for 5 to 7 days or longer in immunocompetent individuals. Even longer periods of shedding may occur in children, elderly adults, patients with chronic illnesses, and immunocompromised hosts
  • Respiratory transmission occurs mainly by droplets disseminated by unprotected coughs and sneezes.
  • Prevention lies in implementing respiratory hygiene, cough etiquette and hand hygiene.
  • Respiratory hygiene and cough etiquette apply to all patients and accompanying family or friends who have signs of respiratory illness such as cough, congestion, nasal discharge or increased volumes of respiratory secretions.
  • Maintain distance of 3-6 feet from a person who is coughing or sneezing, cover coughs and sneezes with disposable tissues and wash hands if soiled with respiratory secretions. Do not cough in the hands or cloth handkerchief. Use tissue paper or cough on the sides of your sleeves.
  • Frequent hand hygiene should be performed, including before and after every patient contact, contact with potentially infectious material, and before putting on and after taking off personal protective equipment, including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol-based hand rubs. If hands are visibly soiled, they should be washed with soap and water.
  • All doctors should take steps to minimize elective visits (telephone consultations for patients with mild respiratory illnesses).
  • In clinics all doctors should provide face masks to patients with signs and/or symptoms of respiratory infection and provide them space and encourage patients with respiratory symptoms to sit as far away from others as possible
  • Ask patients to avoid visiting crowded enclosed spaces.
 
Govt approves course on Bachelor of Science in Community Health
Abhay Anand, Source (Career 360 Education Hub)

The Government of India has approved introduction of a course namely, Bachelor of Science in Community Health. The duration of the course will be three years and is likely to commence from next academic session.

The main objective of the proposed course is to create mid-level health professionals who would possess the necessary public health and ambulatory care competencies to serve the rural population and will primarily be deployed at sub centres.

As per the Health Ministry, the curriculum of the course has been prepared after taking into consideration the views of various stakeholders.

The government has been planning to launch the course for past several years; however, the proposal was facing opposition from doctors on the ground that it will create two tiers of medical professionals.

The proposal for B. Sc. In Community Health has been prepared in consultation with Medical Council of India (MCI). The degree for the course will be awarded by the respective State Universities and it will be accredited by the National Board of Examinations (NBE) to ensure uniformity in the content and delivery of the course.
The course will be introduced only in those states which are willing to adopt it. The states may set up Rural Health Care Schools to impart the B.Sc. course. Central Government will provide assistance for the establishment of these centres to states under their State Programme Implementation Plans (SPIPs) under National Rural Health Mission (NRHM).

The Central Government, till now, has received willingness from the States of Jharkhand, Chhattisgarh and Assam. (Source Email Dr K V Babu)
57th Annual Award Presentation Ceremony
Delhi Medical Association is organizing its 57th Annual Award Presentation Ceremony on Sunday, 29th March 2015 at FICCI Auditorium, New Delhi from 6.00pm onwards. This will be followed by a gala Cultural Night and Annual Banquet.
Medscape Family Physician Lifestyle Report 2015
Where Do Family Physicians Lean on the Political Spectrum?

Instead of asking Medscape family physicians whether they are Democrat, Republican, or Independent, the survey focused on whether members considered themselves liberal or conservative in fiscal and social areas. Without clear definitions of these terms, the responses are very subjective; the aim was to get a sense of political biases rather than voting habits. Half of family physicians claim to be socially liberal, and about two thirds are fiscally conservative, regardless of burnout status. Political views have not changed in the 2 years since the previous report. Of interest, a 2007 study of medical students found them much more likely to be liberal than conservative and also more liberal than other young American adults. (Source: Medscape)
Media
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Inspirational Story
Four Burning Candles

In a room there were four candles burning. The ambiance was so soft you could hear them talking. The first one said, "I am PEACE, however nobody can keep me lit. I believe I will go out."

Its flame rapidly diminishes and goes out completely. The second one says, "I am FAITH. Most of all I am no longer indispensable, so it does not make any sense that I stay lit any longer." When it finished talking a breeze softly blew on it putting it out.

Sadly, the third candle spoke in its turn. "I am LOVE. I have not gotten the strength to stay lit. People put me aside and don’t understand my importance. They even forget to love those who are nearest to them." And waiting no longer it goes out.

Suddenly a child entered the room and saw three candles not burning. "Why are you not burning you are supposed to stay lit till the end." Saying this, the child began to cry. Then the fourth candle said, "Don’t be afraid, while I am still burning we can re–light the other candles, I am HOPE.”

With shining eyes, the child took the candle of Hope and lit the other candles. The flame of Hope should never go out from our life and that each of us can maintain HOPE, FAITH, PEACE and LOVE. Hope never abandons you. You abandon hope. Consult not your fears but your hopes and your dreams. Think not about your frustrations, but about your unfulfilled potential. Concern yourself not with what you tried and failed in, but with what it is still possible for you to do.
Quote of the Day
Failures are finger posts on the road to achievement. Charles F. Kettering
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Reader Response
 
  1. Wonderful content ....Happy reading this. Please keep posting Cheers: Dr H Jadeja.
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IMA Humor
A friend recently explained why he refuses to get to married. He says the wedding rings look like miniature handcuffs.
eMedi Quiz
A 31-year-old female patient complains of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows Type As curve and acoustic reflexes are absent. All constitute part of treatment, except:

1. Hearing aid.
2. Stapedectomy.
3. Sodium fluoride.
4. Gentamicin.

Yesterday’s Mind Teaser: Avascular necrosis can be a possible sequelae of fracture of all the following bones, except:

1. Femur neck
2. Scaphoid.
3. Talus.
4. Calcaneum.

Answer for yesterday’s Mind Teaser: 4. Calcaneum.
Correct Answers received from: Govind Purohit, Daivadheenam Jella, Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr K V Sarma, Dr K Raju.
Answer for 17th Feb Mind Teaser: 3. Haemophilia.
Correct Answers receives: Dr Pravar Passi, Dr Bharat Bhushan Aggarwal, Daivadheenam Jella.
Press Release of the Day
Give telephone consultations for patients with mild swine flu: IMA

Follow the triad of respiratory hygiene, cough etiquette and hand hygiene to prevent swine flu

The mean incubation period for flu is 1.5 to 3 days and shedding of the virus begins the day prior to onset of symptoms and often persists for 5 to 7 days or longer in immunocompetent individuals. Even longer periods of shedding may occur in children, elderly, patients with chronic illnesses and immunocompromised persons.

It is important to protect people from acquiring infections from each other. Mild flu does not require any investigations and treatment; therefore, doctors should avoid calling them in the clinics. Instead they should encourage phone consults. One can use smart phones like iphone, Skype or other media for communication, said Padma Shri Awardee Dr A M Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.

Dr Aggarwal said that respiratory transmission occurs mainly by droplets disseminated by unprotected coughs and sneezes and prevention lies in implementation of respiratory hygiene, cough etiquette, and hand hygiene.

Respiratory hygiene and cough etiquette applies to all patients as well as accompanying family or friends who have signs of respiratory illness such as cough, congestion, nasal discharge or increased volumes of respiratory secretions.

Maintain a distance of 3-6 feet from a person who is coughing or sneezing, cover coughs and sneezes with disposable tissues and wash hands if get soiled with respiratory secretions. Never cough in the hands or cloth handkerchief, instead use tissue paper or cough on the sides of your sleeves, Dr Aggarwal further cautioned.

Frequent hand hygiene should be performed, including before and after every patient contact, contact with potentially infectious material and before putting on and after taking off personal protective equipment, including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol-based hand rubs. If hands are visibly soiled, they should be washed with soap and water.

In clinics all doctors should provide face masks to patients with signs and/or symptoms of respiratory infection and provide them space and encourage patients with respiratory symptoms to sit as far away from others as possible.

Doctors should ask patients to avoid visiting crowded enclosed spaces.