eMedinewS
20th November 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Ebola in the semen

  • Ebola can be present in saliva, stool, semen, breast milk, tears, nasal blood and a skin swab.
  • A study published in the Journal of Infectious Diseases (J Infect Dis. 1999 Feb;179 Suppl 1:S28-35) evaluated if convalescent body fluids contain Ebola virus and if secondary transmission occurs during convalescence. Twenty-nine Ebola hemorrhagic fever convalescents and their 152 house hold contacts were monitored for up to 21 months. Blood specimens were obtained and symptom information was collected from convalescents and their house hold contacts. Other body fluid specimens were also obtained from convalescents. Joint and muscle pains were reported significantly more often by convalescents than house hold contacts. Evidence of Ebola virus was detected by reverse transcription-polymerase chain reaction in semen specimens up to 91 days after disease onset; however, these and all other non-blood body fluids tested negative by virus isolation. Among 81 initially antibody negative house hold contacts none became antibody positive. Blood specimens of 5 house hold contacts not identified as Ebola hemorrhagic fever patients were initially antibody positive. No direct evidence of convalescent-to- house hold contract transmission of Ebola fever was found, although the semen of convalescents may be infectious.

    The existence of initially antibody-positive house hold contacts suggests that mild cases of Ebola virus infection occurred.
  • Who is a high risk Ebola patient? Percutaneous (needle stick) or mucous membrane exposure to blood or body fluids (feces, saliva, sweat, urine, vomit, and semen) of a person with symptomatic Ebola virus disease and Exposure to the blood or body fluids (feces, saliva, sweat, urine, vomit, and semen) of a person with symptomatic Ebola virus disease without appropriate personal protective equipment (PPE). In both situations a person has to be symptomatic.
  • There is no identifiable risk when the contact is with an asymptomatic person who had contact with a person with Ebola and also contact with a person who is later diagnosed with Ebola virus disease, before the person developed symptoms.
  • Viral persistence: Virus can persist for some time in certain bodily fluids, such as semen and breast milk.
    • Follow-up studies of 40 survivors in the 1995 Kikwit, Democratic Republic of Congo outbreak showed that viral RNA sequences could be detected by RT-PCR in the semen of male patients for up to three months, and infectious virus was recovered from one individual 82 days after disease onset. (J Infect Dis. 1999;179 Suppl 1:S28.)
    • In only one known instance, during the 1967 Marburg outbreak has viral persistence in semen led to virus transmission through sexual contact. (Curr Top Microbiol Immunol. 1999;235:49, Trans R Soc Trop Med Hyg. 1969;63(3):295.)
    • A study of patient samples collected during the outbreak of Ebola Sudan virus disease in Gulu, Uganda in 2000 detected virus in the breast milk of a patient, even after virus was no longer detectable in the bloodstream. Two children who were breast-fed by Ebola-infected mothers died of the disease. (J Infect Dis. 2007 Nov;196 Suppl 2:S142-7.)
    • During the 2014 outbreak in West Africa, virus was cultured from a patient’s urine 12 days after the last positive culture was identified in plasma. (N Engl J Med. 2014 Oct)
  • The convalescent period of Ebola and Marburg virus disease is prolonged, and marked by weakness, fatigue, and failure to regain weight that was lost during illness. Extensive sloughing of skin and hair loss are commonly observed, possibly as a result of virus-induced necrosis of infected sweat glands and other dermal structures.
  • There is no evidence that asymptomatic persons still in the incubation period are infectious to others. But all symptomatic individuals should be assumed to have virus in the blood, and other body fluids, and appropriate safety precautions should be taken (Arch Virol Suppl. 1996;11:141).
  • Convalescence from Ebola Virus Disease is long and often associated with sequelae such as myelitis, recurrent hepatitis, psychosis, or uveitis. Data on the post-recovery viremic period are limited. As said above shedding of Ebola virus has been reported in breast milk and semen after the virus has been cleared from blood. Viable virus has been isolated from semen up to many weeks or months after recovery, and spermatogenic transmission of Marburg virus has been documented. There is a paucity of data on Ebola virus in human egg cells. The risk of Ebola transmission should be considered in connection with reproductive cell donations, both for ‘partner’ and ‘other than partner’ donations. However, the evidence that Ebola virus may persist for some time in the human body after recovery from Ebola fever is insufficient to define a specific deferral period for donors who have recovered from Ebola fever. The current guidance stipulates deferral for 12 months following recovery from a viral hemorrhagic fever and this recommendation also applies to donors who have recovered from Ebola fever. In addition, living or deceased donors of substances of human origin should be negative for Ebola virus by NAT testing.
  • A deferral of donation for two incubation periods will provide a reasonable margin of safety for asymptomatic donors returning from Ebola affected areas. The longest incubation period for Ebola disease has been 25 days. Thus, asymptomatic travelers or residents returning from Ebola virus affected areas should be temporarily deferred from donation of substance of human origin including blood for two months after leaving an area affected by Ebola virus.
  • Men who have recovered from the illness can still spread the virus to their partner through their semen for many months after recovery. For this reason, it is important for men to avoid sexual intercourse after recovery or to wear condoms if having sexual intercourse during this period after recovery.

News Around The Globe

  • A new study has found that smokers who were exposed to the smell of cigarettes along with an unpleasant odor during a single night of sleep reduced their smoking for days afterward. The study was presented at the Society for Neuroscience 2014 Annual Meeting.
  • The perioperative use of aspirin or clonidine does not prevent acute kidney injury in patients undergoing major surgery, and both drugs may even contribute to the risk, suggest new results from POISE-2 published online in JAMA.
  • Combination therapy with simvastatin and ezetimibe (Vytorin) reduced myocardial infarction and ischemic stroke in high-risk patients with acute coronary syndrome compared with simvastatin alone. The IMPROVE-IT (IM Proved Reduction of Outcomes: Vytorin Efficacy International Trial) study is the first to show clinical benefit of reducing LDL-C with a statin and ezetimibe. The randomized, controlled trial included 18,144 patients with a mean follow-up time of 6 years.
  • The first personalized spinal osteosynthesis rod has received 510(k) clearance from the US Food and Drug Administration (FDA) to be marketed in the United States for the treatment of spinal abnormalities, such as scoliosis and other deformities.
  • Enzyme replacement therapy with sebelipase alfa may reduce liver injury, liver fat, and dyslipidemia in patients with lysosomal acid lipase (LAL) deficiency, suggest results from a phase 3 randomized controlled trial presented at The Liver Meeting 2014.

66th Annual Conference of Cardiological Society of India (CSI) -2014

18th-Nov-CSI

IMA News

Commission to submit report in three months: Raipur, 14 November 2014: State Government has constituted single-member probe commission to investigate the case of sterilization surgery camps held at Sankri (Pendari), Gaurela, Pendra and Marwahi area of Bilaspur district in Chhattisgarh, where 13 women died and several fell critically ill after undergoing surgery. Considering the case on a serious note, Chief Minister Dr Raman Singh announced an unbiased and transparent judicial probe in the case yesterday. Taking immediate action on his announcement, General Administration Department (GAD) issued notification on yesterday evening from Mantralaya (Mahanadi Bhavan) regarding formation of the Commission.

Commission will investigation the case on following points of public importance:-

  1. Was the standard protocol followed in these camps?
  2. What circumstances led to this incident?
  3. Were the medicines used in these camps were of standard quality
  4. Who are the ones accountable for this incident?
  5. What measures can be taken to avoid recurrence of such incidences?
  6. Suggestions regarding Gender Equality in Family Welfare Programmes of state.
  7. Probing on the points, which Commission considers to be of public importance.

State Government has formed this Commission for special probe of public importance, by exercising its powers conferred under Section-3 of Judicial Commission Act (60 of 1952). Commission may take help from any organization/expert while investigating on technical subjects/points

Dr KK Spiritual Blog

You look at people the same way as you are

Honest people look at everybody as honest and dishonest people regard everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel everybody is honest. If you take bribe then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.

Never judge people with you personal experience. I recall one of the doctors saying that every doctor takes and gives bribe because he was running an imaging centre and every doctor who approached him asked for a bribe. But he did not take into consideration the doctors who did not approach him.

Inspirational Story

Reminiscing

Alas. It is good to reminisce. But how come when you reminisce, you can't help but to remember the not so good ones? How can you prevent the feeling from even entering your mind? You can never tell...

To reminisce is to understand. When you reminisce, you understand things you never understood before. To understand different thoughts and ideas, to understand the value of friendship and especially to understand the value of loyalty.

I have experienced reminiscing.. Now I ask myself, WHY? Does it have to do anything about me? Maybe God wants me to change something. To change things that is wrong. Quoted from Lion King III: "You won't change the past, so why worry?"

Again, why worry? Because it is our responsibility to change things we feel wrong. We have to make sure that everything is right in order to have a beautiful and peaceful life. But on the other side, we cannot remove the obstacles and trials in our lives. It is part of the tapestry of living and cannot be broken and scratched out by any means at all.

To reminisce is to remember good times. To remember the unforgettable days and wished you were back in time. Again, I say to myself over and over again, I cannot turn back time. I just can't. I also say to myself that it is not good to dwell in those memories forever because you have to move on. There is a big world waiting for you out there-waiting for you to change it, waiting for you to unfold and reveal its mysteries.

But then again, it is not good to reminisce forever. You must face and take the world in your hands and with the help of our Lord; you must overcome any trials and obstacles ahead for you to be worry-free in your life.

Rabies News (Dr A K Gupta)

If a person is on antimalarials or steroids or taking immunosuppressant drug, what is the schedule for rabies vaccine?

The vaccine on Day 0 (first injection) must be doubled and given at two sites (deltoids or thigh in young children). In category II exposures, it is recommended to administer even RIGs along with vaccine. Rest of the schedule is same as for any other patient.

Cardiology eMedinewS

  • Studies indicate that Losartan may be an effective treatment option for Marfan syndrome: Between 70 and 80 percent of patients with the connective tissue condition Marfan syndrome have aortic-root dilation, which happens when the aorta, the main blood vessel between the heart and body, becomes too large and tears. This condition can result in serious illness and sometimes death. A National Institutes of Health-funded study comparing treatment with widely used blood pressure medications atenolol or losartan in patients with Marfan syndrome who had an enlarged aortic root found no significant difference in the rate of aortic-root dilation between the two treatment groups over three years. The results of the Atenolol versus Losartan in Children and Young Adults with Marfan syndrome study, supported by NIH’s National Heart, Lung, and Blood Institute (NHLBI), were presented at the American Heart Association (AHA) Scientific Sessions in Chicago. The study was published simultaneously in the New England Journal of Medicine.
  • Mitral valve repair following heart attack may offer patients little to no benefit: Routinely adding mitral valve repair to coronary artery bypass graft surgery for heart attack patients may not be warranted in patients with moderate mitral valve damage, according to an NIH-funded study. Patients treated with both procedures versus the bypass graft alone showed no differences at one year in recovery from structural damage to the heart's left ventricle, nor in secondary measures such as heart failure, stroke, functional status or quality of life. The results of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation (IMR) study, supported by NIH’s National Heart, Lung, and Blood Institute (NHLBI), were presented at the American Heart Association Scientific Sessions in Chicago and published simultaneously in the New England Journal of Medicine.

Pediatrics eMedinewS

  • While noninvasive alternatives are increasingly available, liver biopsy still provides essential information in some children with liver disease, suggests a new position paper by the ESPGHAN Hepatology Committee published in the Journal of Pediatric Gastroenterology and Nutrition.
  • Teen's online behaviors may create real-life problems like relationship abuse and negative thoughts on body image, suggest two new studies published November 17 in Pediatrics.

Quote of the Day

  • Champions keep playing until they get it right. Billie Jean King

Wellness Blog

Don’t start if you do not drink; if you cannot stop, limit your intake

  • The definition of a standard drink differs in countries: US = 14–15 gm alcohol equivalent to 12 oz beer, 5 oz wine and 1.5 oz 80 proof liquor; UK 8 gm alcohol, Japan 19.75 gm alcohol and India 10 gm alcohol
  • A standard drink usually means a US drink.
  • Alcohol contents: Beer 5%; Malt liquor 7%; Table wine 12%; Fortified wine (sherry, port) 17%; Cordial liquor (aperitif) 24%; Brandy (single jigger) 40% and 80 proof gin, Vodka, whisky 40%
  • 10 ml of alcohol (hard liquor) = 0.8 gm of alcohol
  • 1oz = 30 ml
  • 12 oz of beer = 360 ml of beer (360×5% = 18 ml of alcohol = 14.4 gm of alcohol)
  • 18oz of beer = 8 to 9 oz of malt liquor = 5 oz of table wine = 3–4 oz of 45 wine = 2–3 oz of cordial liquor=1.5 oz of brandy=1.5 oz hard liquor
  • Binge drinking means 4 or more drinks at one time (women) or 5 or more at one time (men)
  • Heavy drinking means more than 7 drinks per week or 3 drinks per occasion (women) or more than 14 drinks per week or 4 drinks per occasion (men).
  • Moderate drinking means less than 2 drinks per day (women) and less than 3 drinks per day (men) and for people aged more than 65, less than two drinks per day
  • Safe limits: No level of alcohol compensation can be 100% safe for some people.
  • Contraindications: Pregnancy, present or strong family history of alcoholism, previous paralysis because of brain hemorrhage, liver disease, pancreas disease, running potentially dangerous equipment or machinery
  • Limit alcohol in acute gastritis, esophagitis, strong family history of breast cancer and pre cancerous GI lesions.
  • Ideal dose of alcohol = 6 gm per day
  • 10–15gm of ethanol is found in one glass of wine, one can or bottle of beer or one mixed drink.
  • One should not take more than two drinks (men), one drink daily (women).
  • Men under the age of 45 may experience more harm than benefit from alcohol consumption.
  • Alcohol benefits for the heart are only in 45+ people.

ePress Release

Padma Shri Awardee Dr. KK Aggarwal receives the Aacharya Sushil Muni Sarwa Dharma Shanti Award 2014

Felicitated for his outstanding contribution in the field of medicine and social work

Recognizing outstanding contribution in the field of social work and initiatives towards peace Aacharya Sushil Muni Memorial Trust felicitated Dr. KK Aggarwal with the Aacharya Sushil Muni Sarwa Dharma Shanti Award 2014 in New Delhi on Wednesday.

An eminent cardiologist, President of Heart Care Foundation of India and the Senior National Vice President of the Indian Medical Association, Dr. KK Aggarwal has played an active role in streamlining the procedure of handling medical negligence cases and creating guidelines which all doctors must follow through his books and writings. He has also worked extensively towards helping the lower sections of the society.

Commenting on the oration, Dr. K.K. Aggarwal, Sr. National Vice President of the Indian Medical Association and the President of the Heart Care Foundation of India said, “I am honored to receive such a prestigious award from the Aacharya Sushil Muni Memorial Trust. With the increase in the number of heart patients in the country and majority of them belonging to the economically backward sections of the society, I feel that it is very important to help those heart patients who cannot afford treatment. Every individual has a right to live a healthy life and keeping this mind I started the Heart Care Foundation of India and till date have continued to help many patients live a healthy and normal life. The trust recognized my efforts towards the society and it gives me immense happiness and encouragement to keep doing the same throughout life.”

Dr. KK Aggarwal is the recipient of three National Awards, namely the Padma Shri for brilliance in medicine and the Dr. BC Roy award for excellence in socio-medical awareness and DST National Award for Outstanding Efforts in Science & Technology Communication. Dr. KK Aggarwal has also served as a Director at IMA AKN Sinha Institute, Finance Secretary at IMA and Chairman at IMAAMS in the past.

A pioneer of leading health initiatives, Dr. KK Aggarwal has been instrumental in bringing treatments such as clot dissolving therapy for acute heart attacks and Colour Doppler Echocardiography in the country. In addition to this, he has also conceptualized and organized unique consumer driven health awareness platforms such as The Perfect Health Mela and the Run for your Heart as a part of his role as the President of The Heart Care Foundation of India. His most recent project within the NGO called the Sameer Malik Heart Care Foundation Fund is playing an instrumental role in providing heart care for all patients in need of treatment but do not have the financial or technical means to fund it.

Dr. KK Aggarwal’s other roles also include Dean of the Board of Medical Education Moolchand Medcity, Member Ethics Committee Medical Council of India, Chairman Ethics Committee Delhi Medical Council, Editor in Chief IJCP Group of Publications and eMedinewS and Chairman Legal Cell Indian Academy of Echocardiography.

emedipicstoday emedipics

Padma Shri Awardee Dr. KK Aggarwal receives the Aacharya Sushil Muni Sarwa Dharma Shanti Award 2014 Felicitated for his outstanding contribution in the field of medicine and social work

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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 +91 9958771177 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

Total CPR since 1st November 2012 – 101090 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Elderly man saved by Anuja

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IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and 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 and hearing aids.

Make Sure

Situation: A known epileptic child died of a seizure while swimming.
Reaction: Oh my God! Why was he allowed to swim?
Lesson: Make sure that patients with uncontrolled epilepsy are not allowed to swim.

eMedinewS Humor

I'll trust you that you paid

A man walks into a bar and has a couple of beers. Once he is done the bartender tells him he owes $9.00.

"But I paid, don't you remember?" says the customer.

"Okay," says the bartender, "If you said you paid, you did."

The man then goes outside and tells the first person he sees that the bartender can't keep track of whether his customers have paid.

The second man then rushes in, orders a beer and later pulls the same stunt.

The barkeep replies, "If you say you paid, I'll take your word for it."

Soon the customer goes into the street, sees an old friend, and tells him how to get free drinks.

The man hurries into the bar and begins to drink high-balls when, suddenly, the bartender leans over sand says, "You know, a funny thing happened in here tonight. Two men were drinking beer, neither paid and both claimed that they did. The next guy who tries that is going to get punched right in the nose."

"Don't bother me with your troubles," the final patron responds. "Just give me my change and I'll be on my way."

Twitter of the Day

Dr KK Aggarwal: Do not take Cheeni, Chawal, Maida
Dr Deepak Chopra: The Future of God is our evolution from a fragmented mind to a whole mind, from thought which is in time to Awareness which is not in time

eMedi Quiz

The following statements about meningococcal meningitis are true, except:

1. The source of infection is mainly clinical cases.
2. The disease is more common in the dry and cold months of the year.
3. Chemoprophylaxis of close contacts of cases is recommended.
4. The vaccine is not effective in children below 2 years of age.

Yesterday’s Mind Teaser: A measure of location which divides the distribution in the ratio of 3:1 is:

1. Median.
2. First quartile.
3. Third quartile.
4. Mode.

Answer for yesterday’s Mind Teaser: 3. Third quartile.

Correct answers received from: Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr.K.V.Sarma, Dr Avtar Krishan.

Answer for 18th November Mind Teaser: 3. Sound referral system.

Correct answers received from: Tukaram Pagad, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr Jayashree Sen & Dr Bitaan Sen, Dr Poonam Chablani.

Send your answer to email

medicolegal update

(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 be 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.
medicolegal update
  1. Dear Sir, Very informative news. Regards: Dr Deepak

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