Do not be afraid...
Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt… William Shakespeare
"Doctor, doctor, my hair's coming out. Can you give me something to keep it in?
Certainly - how about a paper bag?"
Mistake to avoid
A 50-year-old male patient suffering from COPD was admitted in the ward. The patient was unable to sleep the Doctor on duty was informed who left the orders for the sister on duty that the patient should be given .25 mg alprazolam. The patient was given 25 mg of alprazolam.Two hours later the patient wasfound to have respiratory depression and hypotension.
This is a very common error. Drugs which have their dose in decimals, the decimal should always be preceded by a zero.
.25 mg was misread as 25 mg (instead of 0.25 mg) leading to alprazolam overdose. Such errors can very easily be prevented by uniform hospital instructions and problems of overdose can be totally avoided.
Funny clinical notes (Dr Minakshi)
On the second day the knee was better, and on the third day it disappeared.
Letter to the editor
1. Dear Dr Aggarwal, is there any research done which tells tea and coffee are not good for health? (Dr Pankaj Budhiraja)
Editors comments: People who drink lots of coffee and do not take healthy diet which is rich in whole grains, olive oil, fruits and vegetables and includes little red meat are more likely to have atrial fibrillation. A study has shown that patients with atrial fibrillation consumed more red meat and full fat dairy products. The heaviest coffee drinkers were also more likely to have atrial fibrillation than those who drank less.(European Society of Cardiology)
2. My dear Dr. K. K. Aggarwal: Heartiest congratulations on your very well deserved Acarya Sushil Muni Sadhna Jain Muni award for your contributions in social functions. You can speak on any subject be it related to medicine, religion, unity of faiths and believe firmly in dissemination of knowledge and for which purpose you daily get up so early Your life is your message and is based on the discipline that Seva to humanity is holier than the lips that pray. You are a real Karama Yogi. After attending your clinical meeting on Pneumonias, I wondered as for the senior citizens, above the age of 85 years who are suffering from diabetes, bronchial asthma, C.O.P.D, IHD, compensated heart failure etc and are in remission, as to how safe is it for them to attend meetings in multi specialty hospitals and how to safeguard himself against various hospital acquired infections, especially when they are very keen to attend such meetings. What precautions do you recommend that should be taken? Warm regards
Dr K. Kanwar
Emedinews comments: Thanks. The only answer is to get fully vaccinated against pneumonia, flu, and typhoid. (to be contd.....below)
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Letter to the editor contd.
3. Dear Dr. Aggarwal: Thanks for your regular updates which are really thought provoking and very much informative. I would appreciate a note on antibiotic policy in tertiary care hospital set up and how to prevent indiscriminate use of antibiotics, through your forum. Thanking you, Prof. S.K Bhattacharya, Deptt. of Pharmacology, UCMS >B Hospital, Delhi 110095,
Emedinews comments: will include them. Basics are rational use, avoid indiscriminate use, follow evidence based guidelines, follow hospital antibiogram policy, switch IV to oral early, emphasize on home IV antibiotics wherever possible etc. We must also learn the difference between community acquired infections, hospital acquired infections and health care associated infections as the antibiotic policed differ.
4. Respected Dr Aggarwal Ji, My sincere congratulations to you for your efforts. In context with your article entitled paracetamol may cause asthma; I would add for the knowledge of the esteemed readers of emedinews that it may cause exfoliative dermatitis. I do not think that many dermatologists even would have come across it. I have a publication in the year 1984 in Indian Journal of Dermatology, Veneorology and Leprology under my senior Dr. B. K. Girdhar published by me at Central JALMA Institute for Leprosy (now National Instt. for Research in Leprosy and other mycobacterial diseases, located at Tajganj, Agra). If somebody will be interested I may give further details of the paper. At the end, I once again thank you, Sir. With regards, Dr. A. K. Bagga
5. Respected Dr KK Aggarwal: Thanks so much for forcing me to read new things which I would otherwise, not do! Your effort is extremely appreciated. Can you please include the following topics if possible: importance of GPs in a society dominated by specialists, future of GPs in big cities of India, like Delhi and qualities of a good, successful GP.
Thank you so much in advance! DR YATISH SHARMA
Emedinews comments: Good GPs are lacking so are good physicians. They have a great future. In fact no specialist should see a case without a GP, this is how lawyers practice. The definition of a good GP is that he knows 10 things about 1000 conditions and specialist know 1000 things about 10 diseases. Its tea work of a good GP and a specialist which is required for a good care.
6. Respected sir, great topic on pioglitazone and vitamin E. But could you kindly comment on CHF effect induced by pioglitazone. Dr. Anshul.
Emedinews comments: I agree one must be careful. But its rosiglitazone (not pio) which, has been linked to heart failures.
7. Heartiest congratulation for another award, for serving the social cause. My best wishes. Dr O P Gupta, MGIMS Wardha.
8. Small tips of great clinical significance. Congrats on being felicitated. Dr. H.L. Kapoor