emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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

    Health Videos…

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial…

22nd February 2013, Friday

Spurious drugs

The spurious drugs trade is believed to be 30-40% of total market as focused by the media. However, according to the official reports from the Government of India, the spurious drugs amount to only 0.3 to 0.4% of the total market.

Spurious drugs are mainly the products which are deliberately and fraudulently mislabeled and manufactured to mislead and misrepresent the patients by concealing their identity, source of manufacture and its content to profiteer on the popularity of fast moving branded or generic medicines. It may or may not contain the active ingredients in the manner mentioned on the label.

Law: Drug shall seem to be spurious if it falls within the definition as per Chapter IV, Sec. 17B of the D&C Act:

  • If it is manufactured under a name which belongs to another drug; or
  • If it is imitation of or is a substitute for another drug or resembles another drug in a manner likely to deceive or bears upon it or upon its label or container the name of another drug unless it is plainly and conspicuously marked so as to reveal its true character and its lack of identity with such other drug; or
  • If the label or container bears the name of an individual or company purporting to be manufacturer of the drug; which individual or company is fictitious or does not exist; or
  • If it has been substituted wholly or in part by another drug or substance; or
  • If it purports to be the product of a manufacturer of whom it is not truly a product.

*About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA (blog.kkaggarwal.com)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What is the role of colonoscopy in constipation?

A colonoscopy allows for direct visualization of the colon to exclude mucosal lesions (e.g., solitary rectal ulcer syndrome, inflammation, malignancy) and should be performed in patients if they have alarm symptoms and also as indicated for colorectal cancer screening.

For comments and archives

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Proton–pump inhibitors to carry warning about C

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

Dr. Anil Goel, DMA President-Elect being felicitated at DMA

 
Dr K K Aggarwal
    National News

National urban health mission likely to get Cabinet nod

NEW DELHI: UPA's ambitious plan for an urban health initiative focusing on primary health care for the poor living in cities and towns is expected to be cleared by the Union Cabinet on Thursday. As similar health initiative for rural areas — National Rural Health Mission ( NRHM) — is under implementation and it is proposed to set up a National Urban Health Mission (NUHM) as part of the overarching National Health Mission (NHM). The National Health Mission is expected to be part of budget 2013-14. The NUHM proposal, costing Rs 20,000 crore, has been cleared by the finance ministry's expenditure finance committee (EFC). The urban mission, aimed at providing a dedicated public health delivery system to address medicare challenges in town and cities, will focus on the nine crore urban poor living in slums. The NUHM will focus on specific health requirements of the urban poor population. The mission is expected to cover 779 cities and towns with over 50,000 population, including metros such as Delhi, Mumbai, Kolkata, Chennai, Bangalore, Hyderabad and Ahmedabad. (Source: TOI, Feb 20, 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/)

The differential diagnosis includes other types of genital injury, infection, dermatologic conditions, congenital conditions affecting the perineum, and conditions affecting the urethra or anus.

For comments and archives

 
    Valvular Heart Disease Update

What is the indication of surgery in a valve patient with atrial fibrillation?

Atrial fibrillation is not an absolute indication for surgery in an asymptomatic patient with preserved left ventricular function but the burden of this arrhythmia in a patient with borderline left ventricular function (LVEF 55–60%) may be considered as an indication for surgery, especially if the risk of surgery is low and the valve appears to be amenable to repair.

(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)

 
    From the Desk of Vice President (Elect) IMA

Why is health insurance necessary?

Dr K K Aggarwal

Driving a car or any other vehicle without insurance is a crime. Unfortunately, there is no law in India that mandates an insurance of the human body, which is the costliest vehicle available in the world. Getting everybody insured is the best way to make sure that health services reach trans India with uniform standards of care. As per the current recommendations, the magnitude of care may differ but the standards of care should be the same in all health care centers irrespective of whether a person is treated in village or a city.

Insurance companies usually can decide their reimbursement policy so that there is also a uniformity of charges for the services rendered. The population of India today is 1241491960. If everybody pays less than Rs. 3/- per day premium or for the purpose of calculation, Rs. 1,000/- per person per annum, insurance premium, the total amount that the insurance company will be getting will be equivalent to 124000 crores. One can imagine how many healthcare centers and hospitals can be opened with just this insurance premium money.

People who cannot afford Rs. 1000/- per person per annum, this money should be paid by the government. Getting insurance done should be the responsibility of the employer. Villagers can pay in terms of their dhan.

Medical treatment today is getting costlier day by day and a time will come when an ordinary man will not be able to afford medical treatment without insurance. For higher claims and premiums one can introduce the scheme of ‘co-pay’ so that malpractices are kept under control. OPD insurance should also be brought under the purview and the insurance must continue till death. No age should be a bar to start insurance.

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA (blog.kkaggarwal.com)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Diabetes risk factor control improving, but far from ideal

People with diabetes are increasingly achieving recommended targets for blood sugar, blood pressure, and lipid control, but less than 20% are achieving all 3, according to new data from an ongoing national health survey. The findings were published online February 15 in Diabetes Care. (Source: Medscape)

No IBD risk seen with acne drug

The acne drug isotretinoin doesn't boost risk of inflammatory bowel disease (IBD), a large observational study in young women affirmed. (Source: Medpage Today)

Acupuncture for allergic rhinitis: Role remains questionable

Acupuncture may improve the symptoms of seasonal allergic rhinitis (SAR), but "the clinical significance of the findings is uncertain," the authors of a new study write in an article published online February 18 in the Annals of Internal Medicine. (Source: Medscape)

Magnetic collar slows GERD

A string of magnetic beads placed around the esophageal sphincter helped most patients reduce acid reflux and cut back on medications for the condition, results of a small, uncontrolled trial indicated. (Source: Medpage Today)

Virtual therapist promising for MDD in young adults

Computerized avatars — virtual 3D images of a healthcare provider — may help reduce depressive symptoms in young adults, preliminary research suggests. A pilot study conducted by investigators at Case Western Reserve University in Cleveland, Ohio, showed that the use of an avatar healthcare provider in depressed patients aged 18 to 25 years was feasible and reduced depressive symptoms over time. Known as the Electronic Self-Management Resource Training for Mental Health (eSMART-MH), this novel approach "demonstrated initial efficacy and is a promising developmentally appropriate depression self-management intervention for young adults," the authors, led by Melissa D. Pinto, PhD, RN, write. (Source: Medscape)

 
   Twitter of the Day

@DrKKAggarwal: Persist in your efforts and you will be successful Dr K K Aggarwal All success stories are stories of great (cont) http://tl.gd/l3sjlr

@DeepakChopra: The source of thought is also the source of the universe#CosmicConsciousness

 
    Spiritual Update

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

Why do we regard trees and plants as being sacred?

The upper part of the plants, the leaves, flowers and fruits are worshipped as sacred and offered to God. As per the Bhagwad Gita, these have satvik properties. Roots of any plant are tamsik and not offered in pooja or eaten during pooja days. The same is true for the stems of plants, which have rajsik properties.

For comments and archives

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

What is the process of insemination?

Inseminations may be timed based on a woman’s natural cycle or in conjunction with an ovulation induction cycle and should occur close to the time of ovulation. The woman is positioned on the examination table as if in preparation for a pelvic examination. The physician or nurse then places the speculum into the vagina to visualize the cervix. The semen sample is drawn up into an insemination catheter attached to a syringe. For intracervical inseminations (ICI), the thawed semen sample is injected into the cervical opening and the sample bathes the cervix. After an ICI, the patient is instructed to lie supine for a few minutes. Some providers may choose to place a cervical cap or sponge into the vagina to hold the semen near the cervix for four to six hours after the insemination, after which time the cap or sponge may be removed. This enables a higher concentration of sperm to reach the uterine cavity and fallopian tubes where fertilization occurs.

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

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

What are the functions of the components of blood?

  • Plasma: acts as a vehicle to carry many substances like glucose, fats, and proteins, enzymes, and hormones etc., in addition to the blood cells.
  • Red blood cells: carry oxygen from lungs to various body tissues and take back carbon dioxide from the cells and tissues to be thrown out of body in the form of exhaled air.
  • White blood cells: mainly act as body scavengers and guards. They help in the immune system of the body and act as defense forces of the body killing the bacteria or any other organisms that enters the body.
  • Platelets: help in the clotting and coagulation of blood. We all have experienced that whenever we get injured, the bleeding stops after a few minutes. This is brought about by a mechanism called clotting of blood in which platelets play a very vital role.

For comments and archives

 
   An Inspirational Story

Glass of milk

One day, a poor boy who was selling goods from door to door to pay his way through school, found he had only one thin dime left, and he was hungry.

He decided he would ask for a meal at the next house. However, he lost his nerve when a lovely young woman opened the door.

Instead of a meal he asked for a drink of water! She thought he looked hungry so brought him a large glass of milk. He drank it so slowly, and then asked, “How much do I owe you?”

“You don't owe me anything,” she replied. “Mother has taught us never to accept pay for a kindness.”

He said ... “Then I thank you from my heart.”

As Howard Kelly left that house, he not only felt stronger physically, but his faith in God and man was strong also. He had been ready to give up and quit.

Many years later that same young woman became critically ill. The local doctors were baffled. They finally sent her to the big city, where they called in specialists to study her rare disease.

Dr. Howard Kelly was called in for the consultation. When he heard the name of the town she came from, a strange light filled his eyes.

Immediately he rose and went down the hall of the hospital to her room. Dressed in his doctor's gown he went in to see her. He recognized her at once.

He went back to the consultation room determined to do his best to save her life. From that day he gave special attention to her case.

After a long struggle, the battle was won.

Dr. Kelly requested the business office to pass the final bill to him for approval. He looked at it, and then wrote something on the edge, and the bill was sent to her room. She feared to open it, for she was sure it would take the rest of her life to pay for it all. Finally she looked, and something caught her attention on the side of the bill. She read these words..."Paid in full with one glass of milk"

(Signed) Dr. Howard Kelly.

Tears of joy flooded her eyes as her happy heart prayed: "Thank You, God, that Your love has spread broad through human hearts and hands."

There's a saying which goes something like this: Bread cast on the water comes back to you. The good deed you do today may benefit you or someone you love at the least expected time. If you never see the deed again at least you will have made the world a better place - And, after all, isn't that what life is all about?

For comments and archives

 
   Cardiology eMedinewS

Pollution linked to increased risk of death among heart attack patients
Read More

Determining heart attack risk in suspected coronary artery disease
Read More

 
   Pediatric eMedinewS

Tysabri may be option for kids with MS Read More

Obesity may increase risk for brain abnormality in newborns 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)

Name the rabies-free countries.

There are about 59 countries that do not report rabies. Few countries are free of rabies as a result of their privileged geographical situation & strict application of stringent legislation.

According to Centers for Disease Control and Prevention, countries and political units that reported no indigenous cases of rabies during 2009 are:-

Region Countries
Africa Cape Verde, Libya, Mauritius, Réunion, São Tomé and Príncipe, and Seychelles
Americas North: Bermuda, St. Pierre and Miquelon
Caribbean: Antigua and Barbuda, Aruba, The Bahamas, Barbados, Cayman Islands, Dominica, Guadeloupe, Jamaica, Martinique, Montserrat, Netherlands Antilles, Saint Kitts (Saint Christopher) and Nevis, Saint Lucia, Saint Martin, Saint Vincent and Grenadines, Turks and Caicos, and Virgin Islands (UK and US)
Asia and the Middle East Hong Kong, Japan, Kuwait, Lebanon, Malaysia (Sabah), Qatar, Singapore, United Arab Emirates
Europe Austria, Belgium, Cyprus, Czech Republic,2 Denmark,2 Finland, Gibraltar, Greece, Iceland, Ireland, Isle of Man, Luxemburg, Netherlands,2 Norway, Portugal, Spain2 (except Ceuta and Melilla), Sweden, Switzerland.
Oceania3 Cook Islands, Fiji, French Polynesia, Guam, Hawaii, Kiribati, Micronesia, New Caledonia, New Zealand, Northern Mariana Islands, Palau, Papua New Guinea, Samoa, and Vanuatu

1Bat rabies may exist in some areas that are reportedly free of rabies in other mammals.
2Bat lyssaviruses are known to exist in these areas that are reportedly free of rabies in other mammals.
3Most of Pacific Oceania is reportedly "rabies-free."
In India the islands of Andaman and Nicobar and Lakshadweep are free of rabies.

 
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    IJCP Special

Dr Good Dr Bad

Situation: A diabetic with A1c 6% had a BP of 130/88 mmHg.
Dr Bad: This is very good control of diabetes.
Dr Good: This is very good control but we also need to control BP.
Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL <100 mg/dL) and aspirin (75–150 mg/day) in patients with or at high risk for cardiovascular disease.

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure a patient with fever and cough is not given antibiotics as presence of cough is mostly due to viral infection.

 
  Quote of the Day (Dr GM Singh)

Buddha was asked, "What have you gained from meditation?"
He replied "Nothing!"

"However, Buddha said "let me tell you what I lost: Anger; Anxiety; Depression; Insecurity and Fear of Old Age and Death."

 
    Legal Question of the Day (((Ex)Prof. M C Gupta, Advocate & Medico-legal Consultant))

Q. A father has an 8-yearold son who is suffering from a serious disease. The father is against allopathy and believes only in naturopathy/sun therapy and continues with the same. The son is critically ill and is on the verge of death. They call a physician. He comes and advises urgent treatment to save life. The father withholds consent. What should the physician do?

Ans.

  1. It is a basic principle that the duty of a doctor is to save life. However, such duty is subject to the principle that a doctor cannot force treatment on anybody.
  2. In the present case, the doctor has been called by neighbors acting as guardians of the child. Hence, consent is very much there. The doctor should go ahead with treatment.
  3. The treatment may fail and the child may die. The father may file both civil and criminal complaints against the doctor. The father himself may have criminal/foul reasons for withholding treatment. In such a background, the doctor would be well advised to:
    1. Keep proper, well documented records including consent from neighbors in their capacity as guardians.
    2. Inform the police at his discretion.
 
    Mind Teaser

Read this…………………

A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior:

1. Is an emotional reaction to the anticipated pain.
2. Is in anticipation of future pain.
3. Is more indicative of the need for pain medication than the pain rating.
4. May be in conflict with the pain rating, and accepts the report of pain.

Yesterday’s Mind Teaser: The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by:

Adding bulk fiber to the diet
Giving the patient enemas as needed
Increasing fluids and exercise
Using a bowel stimulant and stool softener

Answer for yesterday’s Mind Teaser: d. Using a bowel stimulant and stool softener

Correct answers received from: Dr K Raju, Dr Kanta Jain, Dr PC Das, Br Bharat Bhushan Aggarwal, Tukaram Pagad, Dr Arpan Gandhi, Dr Shashi Saini, Dr KV Sarma, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Thakor Hitendrsinh G, Dr Ayyavoo, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 20th February Mind Teaser: All of the above and more.

Correct answers received from: Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr Jayashree Sen & Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A women’s lib speaker was addressing a large group and said, “Where would man be today if it were not for woman?”

She paused a moment and looked around the room. “I repeat, where would man be today if it were not for woman?”

From the back of the room came a voice, “He’d be in the Garden of Eden eating strawberries.”

 
    Medicolegal Update

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

World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

  • Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.
  • In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
  • In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.
  • When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.
  • In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.
  • The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

6% of young Indians suffer from heart disease
Mean Median age of first heart attack in Indians: 53 years
5-10% of heart attacks occur in Indian men and women younger than 40 years

According to the Global Burden of Disease Study, the developing countries contributed 3.5 million of the 6.2 million global deaths from CAD in 1990 writes Dr. Kannan and Colleagues from Dept. of Pharmacy Practice at Sri Ramachandra University, Porur, Chennai in the January Edition of Indian Journal of Clinical Practice

Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle harden and narrow.

He prevalence of CAD in India has more than doubled in the past two decades, said Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal, Editor in Chief IJCP and Vice President Elect National IMA.

India topped the world with 1,531,534 cardiovascular disease-related deaths in 2002, and based on WHO report, 2009, CAD currently occupies the first place in cause of death.

It is estimated that 9.2 million productive years of life were lost in India in 2000, with an expected increase to 17.9 million years in 2030.

Salient features of the CAD epidemic in India:

  • Incidence of CAD in young Indians is about 12-16%, which is higher than any other ethnic group
  • Age-standardized estimates for disability-adjusted life years (DALYs) lost due to CAD per 1,000 population in India are three times higher than in developed countries
  • About 5-10% of heart attacks occur in Indian men and women younger than 40 years
  • Median age of first heart attack in Indians is 53 years
  • 1,55,88,000 DALYs (WHO, 2009).

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 29780 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

 
    Readers Response
  1. Coming back to India and rural area posting of doctors are two different things. Doctors from abroad will surely join Medanta, Vedanta or Apollo. The point is rural heath; it will improve only when infrastructure facilities are looked after like roads, school and law and order in rural areas. Vivek Kumar,Varanasi.
 
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