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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

21st April 2013, Sunday

The many dilemmas of a GP

General practitioners or family physicians are in a soup and may soon become an extinct species.

  1. The GPs are surrounded by quacks. Instead of quacks competing with them, they end up competing with quacks.
  2. There is no structural education program for GPs after they pass MBBS. They are not being allowed to grow.
  3. Patients are directly opting for specialists today. Unlike the legal system, specialists take up new cases without GP or family physician referrals.
  4. In the current system, a GP who charges Rs. 100 to 200/- as consultation fee cannot survive. He gets no exemptions for water electricity bills or other such expenses.
  5. With Clinical Establishment Act coming up, he will be bound by stricter regulations.
  6. If he dispenses drugs, the VAT department issues him notices.
  7. If he uses his residence as a clinic, the house tax department expects him to pay commercial tax on the area used.
  8. When the patient is not satisfied, he is liable under CPA and the amount of compensation awarded against him can be up to 1.7 crores.
  9. If he opens a collection center for lab services, he is charged for practicing unfair practice and booked for taking commissions,
  10. If he wants a radiologist to visit his center to do ultrasounds, the PNDT Act stops him from doing so.
  11. If he wants a cardiologist to visit his center to do Echo, the PNDT Act stops him from doing so.
  12. He has no means to update his knowledge and if he attends an education program organized by a pharma or equipment company, he is charged for having a nexus with that pharma company.
  13. If he believes in writing drugs from standard pharma companies, he is looked upon as a pharma agent.
  14. If he has confidence in a particular pathology or imaging lab, it is presumed that he is getting commissions from that lab.
  15. If he refers patients for admissions to a particular hospital, it is presumed that he is on incentive list.
  16. If he admits a patient in an establishment, the center deducts 25% of his fees.
  17. If he draws blood in his center he needs to pay Rs.1000/- every month to biomedical waste collection agency.
  18. If he ends up with a serious patient at 2 am in the night, he or she is expected to stabilize the patient and then transfer the patient without charging any fee.
  19. He is expected to attend to all emergencies and not charge any fee from them.
  20. If he visits a dying patient and spends 2 hours in reviving that patient, he gets one visit fee and if he is unsuccessful he is not expected to charge.
  21. He is expected to write only the generic names of drugs, which are not available in the market.
  22. He is expected to charge only nominal fee.
  23. If he wants to do a side business to earn more money, he is not permitted to do so.
  24. If he wants to open his own chemist or pharmacy shop, rules and regulations do not permit him to do so.
  25. He is not allowed to advertise.
  26. He is not expected to marry his patient without first severing any connection with her as a patient.
  27. He is not expected to pay for his admissions, investigations and drugs.
  28. He is not supposed to hire the services of doctors from other pathies.
  29. If he is registered with state council he can be fired, but if he is not he is not touched.
  30. If he gets a government job, he earns Rs. 60,000/- per month but in private practice he is offered only half of this.
  31. If he does double duty in two establishments, he is punished.
  32. If he is seen talking to a nurse while on duty, it is presumed that he is not working and giving the necessary patient care.
  33. He is expected to spend a few years in a village before he starts his practice.
  34. He has to pay crores to get his children admissions in MBBS or MD courses.
  35. If he becomes old, his own medical expenses are not covered.
  36. He is supposed to sacrifice at least 10 years of his life for others. Doctors die on an average 10 years earlier than non-doctors.
  37. He is supposed to maintain medical records for over five years.
  38. He is not allowed to promote his knowledge and skills.
  39. He is not supposed to have market promoters but hospitals are allowed to market, advertise and do PR activities.
  40. He is supposed to document all illnesses to corporations facing all hierarchies.

It is the black sheep doctors who should be punished and not an honest GP.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Obesity reduces life expectancy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

WHO Day Celebrated

Over 11459 people were trained in Hands Only Cardiopulmonary Resuscitation (CPR 10) in one day

 
Dr K K Aggarwal
    National News

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, every Thursday 4:30 PM in DD India

As appreciation pours in, Centre to study Chennai Declaration

NEW DELHI: With global appreciation pouring in for the Chennai Declaration on controlling antibiotic resistance, the Centre has decided to study and discuss the document. The Chennai Declaration, adopted last year, recommends urgent measure to formulate an effective national policy to control the rising trend of antimicrobial resistance, including a ban on over-the-counter sale of antibiotics, and changes in the medical education curriculum to include training on antibiotic usage and infection control. A meeting is expected soon to discuss the antibiotic policy and the role of Chennai Declaration, according to sources in the Ministry of Health and Family Welfare. Nine international medical journals have published reviews on the document. “Until recently international academic community was criticising India for not making any significant contribution towards tackling antimicrobial resistance efforts. Now the whole world is praising an Indian initiative,’’ Dr. Abdul Ghafur, coordinator, Chennai Declaration, told The Hindu. “Our image among the international community has definitely turned positive now. This is the time to consolidate this image by coming out with a national antibiotic policy incorporating the Chennai Declaration,” he said. The latest among the series of appreciation for the document has come from the World Alliance Against Antibiotic Resistance (WAAAR), a highly influential international collaboration aimed at tackling antibiotic resistance. Many prestigious medical societies are associated with the Alliance. In a letter, WAAAR group president Jean Carlet praised the initiative and supported the document. The World Health Organisation Team Lead, Antimicrobial Resistance, Carmem Lucia Pessoa-Silva, has appreciated also the move. “By spreading awareness to everyone, not just physicians, about antibiotic resistance and need to use antibiotics appropriately to preserve their utility hopefully multi drug resistance will remain treatable,’’ Laura JV Piddock, Director, Antibiotic Action, U.K. said. Similarly, the Chief Medical Officer of England advised the British government to recommend the Chennai Declaration to the Commonwealth countries. “Given the population flows between the U.K. and India, it can be seen that such initiatives can have a direct influence on U.K. health,’’ the Chief Medical Officer said, according to The Lancet. Arjun Sreenivasan of the Centre for Disease Control, U.S., is among those who have appreciated the move in addition to highly appreciative reviews in several journals like the Journal of Global Antimicrobial Resistance, British Medical Journal, Journal of Antimicrobial Chemotherapy, Antimicrobial Resistance and Infection Control Journal, Journal of American Medical Association and the Medical Journal of Australia. (Source: The Hindu, April 16, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Types of child neglect

  • Physical neglect is failure to provide adequate food, clothing, shelter, hygiene, protection and safety.
  • Emotional neglect is failure to provide love, affection, security and emotional support.
  • Educational neglect is failure to enroll the child in school.
  • Medical neglect is refusal to seek or delay in seeking medical care when required.

For comments and archives

    Valvular Heart Disease Update

What is transcatheter aortic valve replacement?

Transcatheter aortic valve replacement is a potential option for patients with severe symptomatic aortic stenosis who are considered inoperable for surgical aortic valve replacement.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

New biomarker identifies FTLD subtype in living patients

A newly identified cerebrospinal fluid (CSF) biomarker can accurately distinguish between 2 major subtypes of frontotemporal lobar degeneration (FTLD) in living patients, a finding investigators believe will pave the way for more intelligent treatment trials for this disease. (Source: Medscape)

FDA updates OxyContin label, blocks generics

The FDA has issued new labeling information for OxyContin -- on the same day the patent on the original formulation expired, thus blocking potential generic versions of the original that do not have abuse-deterrent properties. The new labeling indicates that the product "has physical and chemical properties that are expected to make abuse via injection difficult and to reduce abuse via the intranasal route," according to an FDA press release. (Source: Medpage Today)

Guides aim to cut readmission after acute coronary syndrome

As part of its Initiative on Acute Coronary Syndrome, the American College of Physicians (ACP) has developed a guide for patients, a practice guide for physicians, and 2 videos aimed at improving health outcomes after an initial event. The release of these materials was announced during a news conference at ACP Internal Medicine 2013 in San Francisco, California. (Source: Medscape)

Heart patients slow to make healthy choices

Roughly one in seven patients globally do not adopt healthy lifestyle changes after suffering a stroke or developing coronary heart disease, researchers found. (Source: Medpage Today)

Lymph-node dissection for papillary thyroid cancer questioned

Routine prophylactic central lymph node dissection (PCLND) following total thyroidectomy for low-risk papillary thyroid cancer (PTC) is not cost-effective unless the recurrence risk of the cancer is above a certain threshold, of around 11.6%, a new modeling study has found. (Source: Medscape)

 
    Twitter of the Day

@DrKKAggarwal: Heart disease starts in youth Autopsy studies of young people who died in accidents have shown that by the late... http://fb.me/22oV5by1m

@DeepakChopra: “A Conversation with Deepak Chopra and Eckhart Tolle” will be broadcasted live online. More info at http://tinyurl.com/d3phh8s

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Lotus the essence of the Gita

Bhagavad Gita again and again emphasizes that one should cultivate an attitude of non-attachment or detachment (detached attachment). One should live like water on a lotus leaf.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is hirsutism?

Hirsutism or the excessive growth of coarse dark hair on the face, chest, lower abdomen, back, upper arms, or upper legs of women, is a symptom of a medical disorder associated with the hormones called androgens. Polycystic ovarian syndrome (PCOS), in which the ovaries produce excessive amounts of androgens, is the most common cause of hirsutism.

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Blood Donation - Gift of Liquid Love

Blood is a double-edged weapon. On one hand, it is life saving; on the other hand, it is endowed with the dangers of transmitting deadly diseases. Fortunately, the public is becoming more and more aware about this danger.

For comments and archives

 
    An Inspirational Story

Are you blessed?

If you woke up this morning with more health than illness..........you are more blessed than the millions who will not survive this week.

If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture, or the pangs of starvation.......you are ahead of 500 million people in the world.

If you have food in the refrigerator, clothes on your back, a roof overhead and a place to sleep...you are richer than 75% of this world. If you have money in the bank, in your wallet, and spare change in a dish someplace....... you are among the top 8% of the worlds wealthy.

If your parents are still alive and still married........you are very rare, even in the United States.

If you hold up your head with a smile on your face and are truly thankful.....you are blessed because the majority can, but most do not.

If you prayed yesterday and today........you are in the minority because you believe God does hear and answer prayers.

If you can read now, you are more blessed than over two billion people in the world that cannot read at all.

For comments and archives

 
    Cardiology eMedinewS

CV risk factors seen more often at younger age Read More

 
    Pediatric eMedinewS

Child abuse more likely if mom sees baby as bad Read More

 
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What are the types of rabies?

There are mainly two types of rabies.

a) Two-third of rabies patients suffer from typical furious (encephalitic) type of rabies. The virus replicates in portions of the brain including the hippocampus, amygdala, anterior thalamic nuclei and limbic cortex. Furious rabies has three cardinal signs:

  • Fluctuating consciousness, episodes of excitement and hallucinations.
  • Phobic spasms – Aerophobia, hydrophobia and photophobia
  • Autonomic dysfunctions like increased salivation, excessive sweating, priapism and pupillary abnormalities.

It is typically believed that salivation and vomiting are linked, and contribute to the apparent hydrophobia (fear of water) in patients. These symptoms can last for few days, after which the patient may suffer from the second type of rabies, or may slip into a coma and die. It is when suffering from furious rabies that a person or animal is likely to attack those near them and spread the disease.

b) Dumb (paralytic) rabies, which is characterized by flaccid muscle weakness, constipation, urinary retention, stupor, coma. Hydrophobia is usually absent in these cases. This is a condition resembling Guillain Barre syndrome. Dumb rabies occurs as the result of the virus replicating in the brain’s neocortex. It is much harder for a doctor to diagnose rabies in its “dumb” form than it is in its “furious” form, because the symptoms are less indicative of a specific medical issue.

Both forms are progressive and will lead to death, usually within 7 days in patients with encephalitic rabies and 3 weeks in those with paralytic rabies.

 
    IJCP Special

Dr Good Dr Bad

Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in ventricles or cisterns.

Make Sure

Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that the macrolide, clarithromycin 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

 
    Quote of the Day (Dr GM Singh)

A total commitment is paramount to reaching the ultimate in performance. Tom Flores

 
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

 
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   Mind Teaser

Read this…………………

Nurse Jake is aware that most oral pediatric medications are administered:

a. With the night time formula
b. ½ hour after meals
c. On an empty stomach
d. With meals

Yesterday’s Mind Teaser: When caring for children who are sick, who have sustained traumas, or who are suffering from nutritional inadequacies, Nurse Ron should know the correct hemoglobin (Hb) values for children. Which of the following ranges would be inaccurate?

a. Neonates: 10.6 to 16.5 g/dl
b. 3 months: 10.6 to 16.5 g/dl
c. 3 years: 9.4 to 15.5 g/dl
d. 10 years: 10.7 to 15.5 g/dl

Answer for Yesterday’s  Mind Teaser: a. Neonates: 10.6 to 16.5 g/dl

Correct answers received from: DR P K SAHU, Dr.SaradhaJaganathan , Prabha Sanghi, rajeev ardey, DR ARPAN GANDHI, Dr. B.B. Gupta, Dr. P. C. Das, Dr Dinesh Yadav, dr. rakesh lavana, Dr.(Maj. Gen.) Anil Bairaria, DR AYYAVOO, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, DR Chandresh jardosh, Dr. Thakor Hitendrsinh G, Dr Avtar Krisha, Dr Avtar Krishan, Dr Kanta Jain, Muthumperumal Thirumalpillai, Tukaram Pagad, Dr. P. C. Das, Dr. Sukla Das, DR.JAYASHREE SEN & DR.BITAAN SEN

Answer for 19th April Mind Teaser: b. Elevating the neonate’s head and giving nothing by mouth

Correct answers received from: Dr. P. C. Das, Dr. Sukla Das, DR.JAYASHREE SEN & DR.BITAAN SEN

Send your answer to ijcp12@gmail.com

 
   Laugh a While (Dr GM Singh)

A lady was taking 2 dogs for a walk around the lake. A man approaches her.

HE: Ma'am, those are the two cutest dogs in the tri-state area.
SHE: Yes, I am aware of that and I love them very, very much.
HE: What would be their names, ma'am?
SHE: Timex and Rolex.
HE: Why would you name them after a couple of watch companies, ma'am?
SHE: Well.....they are WATCHDOGS...

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Immediate first aid may stop serious poisoning and may save life

If breathing and the heart stop, the person will die within a few minutes unless first aid is administered at once. Here is an action list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

  • Check if the patient is conscious. If not, try to wake up the patient. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
  • Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within 4 minutes. In an unconscious patient, the tongue may block the throat and the airway.
  • Make sure the airway is open and air can get down the throat. Place the patient on his/her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
  • Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient's breathe on your cheek. Listen for breath sounds. Put your ear close to the patient's mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Eating disorders are contagious

Quoting a study published in the International Journal of Eating Disorders, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA said that eating disorders are contagious.

According to the researchers, binge eating, fasting, use of diet pill and other eating disorder symptoms cluster amongst young adolescent females. In the study, it was found that a pair of students from the same state was 4 to 10% more likely to share an eating disordered behavior compared to pairs in which each person came from a different state.

Dr. Aggarwal said that most students try to copy the eating fads of one another. The study explains why people follow each other and attempt weight loss programmes even if they are not scientifically proven.

 
    Readers Responses
  1. Dear Sir, reading emedinews is very informative. Regards:Dr Shyam
 
    Forthcoming Events
Dr K K Aggarwal

 

Dr K K Aggarwal

WORLD EARTH DAY CELEBRATION

Date: 22nd and 23rd April

Programme brief:

22nd April, 2013 11 am onwards

Painting cum Slogan Writing competition

1 8.30 AM - 9.30 AM Special Assembly
2 9:40 AM - 10:10 AM A Symbolic Walk of ½ Km from the venue with all the participants carrying play-cards with one line environment protection slogans.
3 10.30 AM -11-00 AM Skit
4 11.00 AM onwards Hands only CPR TRAINING for teachers.
Dr K K Aggarwal
Dr K K Aggarwal
 
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  Dil Ki Batein

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Dr Usha K Baveja