emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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 and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

 
    Health Videos …

Nobility of medical profession: Aamir Khan Controversy (Video 1 to Video 9)
Health and Religion: Bharatiya Vidya Bhavan and Heart Care Foundation of India(Video 1 to Video 7)
Take Care Holistically, DD India health series, Anchor Dr KK Aggarwal (Video 1–2)

 
  Editorial …

23rd July 2012, Monday

FDA approves new diet drug: Phentermine–Topiramate Combo

The US FDA has approved the weight–loss drug Qsymia which now joins lorcaserin as the first anti–obesity medications to enter the US market since 1999.

Qsymia, a controlled–release preparation of phentermine and topiramate in one capsule, is indicated for use in adults with a body mass index (BMI) >30 kg/m2 or adults with a BMI of >27 kg/m2 and at least one weight–related condition such as hypertension, type 2 diabetes, or dyslipidemia.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Intensive medical treatment prevents second stroke not intra cranial stenting

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Seminar on Health and Happiness

Rabbi Ezekiel Isaac Malekar was honoured at the recently concluded Seminar on Health and Happiness organised jointly by Heart Care Foundation of India and Bharatiya Vidya Bhavan at Bharatiya Vidya Bhavan on 05th July 2012

 
Dr K K Aggarwal
 
    National News

Live chat with Dr K K Aggarwal

Topic: Seasonal Disorders

Monday, 23rd July 2012, 2–3PM, @ www.itimes.com

Indore reports highest institutional deliveries among 8 EAG states: Survey

INDORE: While there are health parameters that have presented gloomy picture of the city, there is a reason to cheer. The city has reported the maximum number of institutional deliveries at 92.5% among eight Empowered Action Group (EAG) states of the country. The highest of 92.5% institutional deliveries have been reported from Indore district, says a survey by Census India. This is in contrast that nearly 170 out of 284 districts have reported less than 60% hospital deliveries. The least rate of 16.8% is reported from Balrampur district in Uttar Pradesh, if the recently released annual health survey conduced by Census India is to be believed.

Not only Indore, the state has faired well as compared to states like Chhattisgarh, Jharkhand, Uttar Pradesh, Bihar, Uttarakhand, Assam, Rajasthan and Odisha. While Madhya Pradesh has recorded 76.1% institutional deliveries, Chhattisgarh has reported the lowest at 34.9% among the states. According to the report, out of total institutional deliveries, 86% deliveries took place at government hospitals and private hospitals contributed only 13.8%. Elated with the performance of city along with the state, health department is now targeting to achieve millennium development goals set up by the United Nations. Apart from maximum number of institutional deliveries, Madhya Pradesh has performed better than other states in safe deliveries. Safe deliveries that are assisted by doctor, nurse and other support staffers. A maximum of 82.2% safe deliveries were recorded in the sample survey conduced by Census India while the minimum was found in Jharkhand. In Indore, a whopping 96.3% institutional deliveries were reported as safe. About one–fourth of the districts have reported less than 50% as far as the safe deliveries are concerned. Out of 14 districts reporting 90% and above safe deliveries, 10 belong to Madhya Pradesh. (Source: TOI, Jul 20, 2012)

For comments and archives

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Bevacizumab improves long–term visual outcome

Patients with inflammatory ocular neovascularization had significant visual improvement and foveal flattening after 3 years of bevacizumab treatment, according to the findings of a retrospective, multicenter, nonrandomized interventional study. Ahmad M. Mansour, MD, from the American University of Beirut in Lebanon, and colleagues published their findings in the June issue of the Canadian Journal of Ophthalmology. (Source: Medscape)

For comments and archives

Hip disorder common with sports–related inguinal hernias

Femoral acetabular impingement (FAI) is common among people with sports–related inguinal hernias, according to findings presented here at the American Orthopaedic Society for Sports Medicine (AOSSM) 2012 Annual Meeting. The study found evidence of FAI in 86% of patients who had undergone sports–related hernia repairs. (Source: Medscape)

For comments and archives

Changes in corpus callosum area indicate progression to MS

Changes in the area of the corpus callosum on magnetic resonance imaging (MRI) and T2 lesion volume are the most sensitive markers of the available MRI indicators for the risk for progression from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS), Dana Horakova, MD, PhD, told delegates during a presentation here at the 22nd Meeting of the European Neurological Society (ENS). She said quantitative MRI can help in monitoring treatment and is feasible in clinical practice. (Source: Medscape)

For comments and archives

Too much water bigger threat than too little

Hyperhydration, rather than dehydration, may pose a greater health risk to athletes, according to two articles in a British medical journal. (Source: Medpage Today)

For comments and archives

 
  Twitter of the Day

@DrKKAggarwal: Obesity Towards all Pathy consensus part 2
http://www.youtube.com/watch?v=Z1Wc58WWMwE

@DrKKAggarwal: Is it possible that the justices saved themselves as well as the Affordable Care Act? http://tinyurl.com/828qosu

 
    Spiritual Update

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

Anger in Mythology

The description of anger comes in mythology as one of the five vices which need to be controlled to acquire spirituality.

Anger is one of the gateways which takes us away from spiritual health. The description of anger in mythology is as under:

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)

4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More

The 4th Asia Pacific Vascular Interventional Course begins Read More

Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More

4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More

Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty
Read More

4th Asia pacific vascular intervention course Read More

4th Asia pacific vascular intervention course paper clippings Read More

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What can I do to ensure that I reduce the risk of multiple births?

During a fertility treatment cycle when fertility drugs are used with timed intercourse or insemination, your doctor will monitor your cycle very carefully. The use of fertility medications will make your body produce more eggs than usual. This makes it more likely that enough eggs will be produced so that one or more eggs will be fertilized. In vitro fertilization (IVF) means that your egg and your partner’s sperm are joined (fertilized) in the laboratory. Then the doctor places the fertilized eggs (embryos) in to your womb. It is less likely that you will become pregnant with triplets or more if only one or two embryos are placed in your womb. If three or more embryos implant inside your uterus, your doctor may suggest that you undergo a procedure called multifetal reduction. Multifetal reduction allows you and your doctor to reduce the number of implantations to one or two. Usually the procedure is done early in the pregnancy to increase the chance of a healthy and successful pregnancy.

For comments and archives

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

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

Blood Grouping systems & Principles, Blood Group Discrepancies & their possible solutions

Blood Group Antigens

Blood group antigens are:

  • Genetically encoded
  • Defined chemical structures of blood components
    • carbohydrate compounds or protein molecules
  • Present on the red cell surface (membrane)
  • They can elicit an immune response, after their introduction into an immunocompetent organism that does not possess these antigenic determinants and therefore recognizes them as foreign.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

A simple gesture

A little boy selling magazines for school walked up to a house that people rarely visited. The house was very old and run down and the owner hardly ever came out. When he did come out he would not say hello to neighbors or passersby but simply just glare at them.

The boy knocked on the door and waited, sweating from fear of the old man. The boy’s parents told him to stay away from the house, a lot of the other neighborhood children were told the same from their parents.

As he was ready to walk away, the door slowly opened. "What do you want?" the old man said. The little boy was very afraid but he had a quota to meet for school with selling the magazines.

"Uh, sir, I uh am selling these magazines and uh I was wondering if you would like to buy one." The old man just stared at the boy. The boy could see inside the old man’s house and saw that he had dog figurines on the fireplace mantle. "Do you collect dogs?" the little boy asked. "Yes, I have many collectibles in my house, they are my family here, and they are all I have." The boy then felt sorry for the man, as it seemed that he was a very lonely soul. "Well, I do have a magazine here for collectors, it is perfect for you, I also have one about dogs since you like dogs so much." The old man was ready to close the door on the boy and said, "No boy, I don’t need any magazines of any kind, now goodbye."

The little boy was sad that he was not going to make his quota with the sale. He was also sad for the old man being so alone in the big house that he owned. The boy went home and then had an idea. He had a little dog figure that he got some years ago from an aunt. The figurine did not mean nearly as much to him since he had a real live dog and a large family. The boy headed back down to the old man’s house with the figurine. He knocked on the door again and this time the old man came right to the door. "Boy, I thought I told you no magazines."

"No, sir I know that, I wanted to bring you a gift." The boy handed him the figurine and the old man’s face lit up. "It is a Golden Retriever, I have one at home, and this one is for you." The old man was simply stunned; no one had ever given him such a gift and shown him so much kindness. "Boy, you have a big heart, why are you doing this?" The boy smiled at the man and said, "Because you like dogs." From that day on the old man started coming out of the house and acknowledging people. He and the boy became friends; the boy even brought his dog to see the man weekly.

This simple gesture changed both of their lives forever.

For comments and archives

 
  Cardiology eMedinewS

Hospital Menus May Be High In Salt. Read More

Good Circulation Can Be A Disadvantage. Read More

 
  Pediatric eMedinewS

Dental Resins Linked To Mental Dysfunctions Read More

Pertussis Rates Raise Questions About Vaccine Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure needed a beta blocker.
Dr. Bad: Start any beta blocker.
Dr. Good: Start metoprolol succinate.
Lesson: Only carvedilol, bisoprolol and metoprolol succinate are approved for heart failure.

For comments and archives

Make Sure

Situation: A patient with suspected pneumonia and normal x–ray died 12 hours after admission.
Reaction: Oh my God! Why were antibiotics not started?
Lesson: Make sure that all patients with suspected pneumonia are given antibiotic at the first suspicion as x–ray can be normal in the first 24 hours.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

Whenever you want to know how rich you are?

Never count your currency, just try to drop a tear and count how many hands reach out to WIPE it. That is being truly rich.

 
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    Legal Question of the Day

(Dr MC Gupta)

Q. What is the summary of the judgment in IMA v. V.P. Shantha?

Ans.

  1. The judgment in IMA v. V.P. Shantha was given by a three judge bench on 13.11.1995.

    The question in this SLP was—
    "whether and, if so, in what circumstances, a medical practitioner can be regarded as rendering ‘service’ under Section 2(1)(o) of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’). Connected with this question is the question whether the service rendered at a hospital/nursing home can be regarded as ‘service’ under Section 2(1)(o) of the Act. These questions have been considered by various High Courts as well as by the National Consumer Disputes Redressal Commission (hereinafter referred to as ‘the National Commission’).

    (Para 2 of the judgment)
    Shri Harish Salve appeared for the Indian Medical Association.
  2. The case put up by the petitioner was that—

    "18. It has been contended that in law there is a distinction between a profession and an occupation and that while a person engaged in an occupation renders service which falls within the ambit of Section 2(1)(o), the service rendered by a person belonging to a profession does not fall within the ambit of the said provision and, therefore, medical practitioners who belong to the medical profession are not covered by the provisions of the Act. It has been urged that medical practitioners are governed by the provisions of the Indian Medical Council Act, 1956 and the Code of Medical Ethics made by the Medical Council of India, as approved by the Government of India under Section 3 of the Indian Medical Council Act, 1956 which regulates their conduct as members of the medical profession and provides for disciplinary action by the Medical Council of India and/or State Medical Councils against a person for professional misconduct." (Para 18)
  3. Since the case relates to the medical profession/medical negligence, the SC dwelt in detail about the characteristics of a profession in the following words:

    "19. While expressing his reluctance to propound a comprehensive definition of a ‘profession’, section L.J. has said ‘profession’ in the present use of language involves the idea of an occupation requiring either purely intellectual skill, or of manual skill controlled, as in painting and sculpture, or surgery, by the intellectual skill of the operator, as distinguished from an occupation which is substantially the production or sale or arrangement for the production or sale of commodities. The line of demarcation may vary from time to time. The word ‘profession’ used to be confined to the three learned professions, the Church, Medicine and Law. It has now, I think, a wider meaning." (See: IRC v. Maxse, KB at p. 657.)

    20. According to Rupert M. Jackson and John L. Powell, the occupations which are regarded as professions have four characteristics, viz.,

    (i) the nature of the work which is skilled and specialized and a substantial part is mental rather than manual;
    (ii) commitment to moral principles which go beyond the general duty of honesty and a wider duty to community which may transcend the duty to a particular client or patient;
    (iii) professional association which regulates admission and seeks to uphold the standards of the profession through professional codes on matters of conduct and ethics; and
    (iv) high status in the community.

    21. The learned authors have stated that during the twentieth century, an increasing number of occupations have been seeking and achieving 'professional' status and that this has led inevitably to some blurring of the features which traditionally distinguish the professions from other occupations. In the context of the law relating to Professional Negligence, the learned authors have accorded professional status to seven specific occupations, namely, (i) architects, engineers and quantity surveyors, (ii) surveyors, (iii) accountants, (iv) solicitors, (v) barristers, (vi) medical practitioners and (vii) insurance brokers. (See: Jackson & Powell on Professional Negligence, paras 1–01 and 1–03, 3rd Edn.)

    22. In the matter of professional liability professions differ from other occupations for the reason that professions operate in spheres where success cannot be achieved in every case and very often success or failure depends upon factors beyond the professional man’s control. In devising a rational approach to professional liability which must provide proper protection to the consumer while allowing for the factors mentioned above, the approach of the courts is to require that professional men should possess a certain minimum degree of competence and that they should exercise reasonable care in the discharge of their duties. In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services. (See: Jackson & Powell, paras 1–04, 1–05 and 1–56). Immunity from suit was enjoyed by certain professions on the grounds of public interest. The trend is towards narrowing of such immunity and it is no longer available to architects in respect of certificates negligently given and to mutual valuers. Earlier, barristers were enjoying complete immunity but now even for them the field is limited to work done in court and to a small category of pre–trial work which is directly related to what transpires in court. (See: Jackson & Powell, para 1–66; Saif Ali v. Sidney Mitchell & Co.; Rees v. Sinclair; Giannarelli v. Wealth.) Medical practitioners do not enjoy any immunity and they can be sued in contract or tort on the ground that they have failed to exercise reasonable skill and care." (Para 19, 20, 21, 22)
  4. Having discussed the characteristics of a profession, the SC concluded that the medical profession is not immune from a claim for damages on the ground of negligence. It observed as follows––

    "23. It would thus appear that medical practitioners, though belonging to the medical profession, are not immune from a claim for damages on the ground of negligence. The fact that they are governed by the Indian Medical Council Act and are subject to the disciplinary control of Medical Council of India and/or State Medical Councils is no solace to the person who has suffered due to their negligence and the right of such person to seek redress is not affected." (Para 23)

    "26. We are, therefore, unable to subscribe to the view that merely because medical practitioners belong to the medical profession they are outside the purview of the provisions of the Act and the services rendered by medical practitioners are not covered by Section 2(1)(o) of the Act." (Para 26)
  5. The IMA pleaded that the consumer courts don’t have medical expertise and hence are not competent to decide questions relating to medical negligence. The SC observed as follows:

    "33. Another contention that has been urged by learned counsel appearing for the medical profession to exclude medical practitioners from the ambit of the Act is that the composition of the District Forum, the State Commission and the National Commission is such that they cannot fully appreciate the complex issues which may arise for determination and further that the procedure that is followed by these bodies for determination of issues before them is not suitable for the determination of the complicated questions which arise in respect of claims for negligence in respect of the services rendered by medical practitioners…………………………………….

    34. Discussing the role of lay persons in decision–making, Professor White has referred to two divergent views. One view holds that lay adjudicators are superior to professional judges in the application of general standards of conduct, in their notions of reasonableness, fairness and good faith and that they act as "an antidote against excessive technicality" and "some guarantee that the law does not diverge too far from reality". The other view, however, is that since they are not experts, lay decision–makers present a very real danger that the dispute may not be resolved in accordance with the prescribed rules of law and the adjudication of claims may be based on whether the claimant is seen as deserving rather than on the legal rules of entitlement. Professor White has indicated his preference for a tribunal composed of a lawyer, as Chairman, and two lay members. Such a tribunal, according to Professor White, would present an opportunity to develop a model of adjudication that combines the merits of lay decision–making with legal competence and participation of lay members would lead to general public confidence in the fairness of the process and widen the social experience represented by the decision–makers. Professor White says that apart from their breadth of experience, the key role of lay members would be in ensuring that procedures do not become too full of mystery and ensure that litigants before them are not reduced to passive spectators in a process designed to resolve their disputes. (See: Professor Robin C.A. White: The Administration of Justice, 2nd Edn., p. 345.)" (Para 33, 34)
  6. On the question of whether medical service should be excluded, the SC observed as follows:

    "38. Keeping in view the wide amplitude of the definition of ‘service’ in the main part of Section 2(1)(o) as construed by this Court in Lucknow Development Authority, we find no plausible reason to cut down the width of that part so as to excludes the services rendered by a medical practitioner from the ambit of the main part of Section 2(1)(o)."
  7. One of the grounds taken by the IMA was that a physician renders service under a "contract of service". This was rebutted by the SC in the following words:

    "39. We may now proceed to consider the exclusionary part of the definition to see whether such service is excluded by the said part. The exclusionary part excludes from the main part service rendered (i) free of charge; or (ii) under a contract of personal service.

    40. Shri Salve has urged that the relationship between a medical practitioner and the patient is of trust and confidence and, therefore, it is in the nature of a contract of personal service and the service rendered by the medical practitioner to the patient is not ‘service’ under Section 2(1)(o) of the Act. This contention of Shri Salve ignores the well–recognised distinction between a "contract of service" and a "contract for services". (See: Halsbury’s Laws of England, 4th Edn., Vol. 16, para 501; Dharangadhara Chemical Works Ltd. v. State of Saurashtra at p. 157.) A "contract for services" implies a contract whereby one party undertakes to render services e.g. professional or technical services, to or for another in the performance of which he is not subject to detailed direction and control but exercises professional or technical skill and uses his own knowledge and discretion. (See: Oxford Companion to Law, p. 1134.) A "contract of service" implies relationship of master and servant and involves an obligation to obey orders in the work to be performed and as to its mode and manner of performance. (See: Stroud’s Judicial Dictionary, 5th Edn., p. 540; Simmons v. Heath Laundry Co.; and Dharangadhara Chemical Works at p. 159.) We entertain no doubt that Parliamentary draftsman was aware of this well–accepted distinction between "contract of service" and "contract for services" and has deliberately chosen the expression "contract of service" instead of the expression "contract for services", in the exclusionary part of the definition of 'service' in Section 2(1)(o)." (Para 39, 40)
  8. After detailed discussions, the SC concluded as follows:

    "55. On the basis of the above discussion, we arrive at the following conclusions:

    (1) Service rendered to a patient by a medical practitioner (except where the doctor renders service free of charge to every patient or under a contract of personal service), by way of consultation, diagnosis and treatment, both medicinal and surgical, would fall within the ambit of 'service' as defined in Section 2(1)(o) of the Act.

    (2) The fact that medical practitioners belong to the medical profession and are subject to the disciplinary control of the Medical Council of India and/or State Medical Councils constituted under the provisions of the Indian Medical Council Act would not exclude the services rendered by them from the ambit of the Act.

    (3) A "contract of personal service" has to be distinguished from a "contract for personal services". In the absence of a relationship of master and servant between the patient and medical practitioner, the service rendered by a medical practitioner to the patient cannot be regarded as service rendered under a 'contract of personal service'. Such service is service rendered under a "contract for personal services" and is not covered by exclusionary clause of the definition of 'service' contained in Section 2(1)(o) of the Act.

    (4) The expression "contract of personal service" in Section 2(1)(o) of the Act cannot be confined to contracts for employment of domestic servants only and the said expression would include the employment of a medical officer for the purpose of rendering medical service to the employer. The service rendered by a medical officer to his employer under the contract of employment would be outside the purview of 'service' as defined in Section 2(1)(o) of the Act.

    (5) Service rendered free of charge by a medical practitioner attached to a hospital/nursing home or a medical officer employed in a hospital/nursing home where such services are rendered free of charge to everybody, would not be 'service' as defined in Section 2(1)(o) of the Act. The payment of a token amount for registration purpose only at the hospital/nursing home would not alter the position.

    (6) Service rendered at a non-government hospital/nursing home where no charge whatsoever is made from any person availing of the service and all patients (rich and poor) are given free service - is outside the purview of the expression 'service' as defined in Section 2(1)(o) of the Act. The payment of a token amount for registration purpose only at the hospital/nursing home would not alter the position.

    (7) Service rendered at a non-government hospital/nursing home where charges are required to be paid by the persons availing of such services falls within the purview of the expression 'service' as defined in Section 2(1)(o) of the Act.

    (8) Service rendered at a non-government hospital/nursing home where charges are required to be paid by persons who are in a position to pay and persons who cannot afford to pay are rendered service free of charge would fall within the ambit of the expression 'service' as defined in Section 2(1)(o) of the Act irrespective of the fact that the service is rendered free of charge to persons who are not in a position to pay for such services. Free service, would also be 'service' and the recipient a 'consumer' under the Act.

    (9) Service rendered at a government hospital/health centre/dispensary where no charge whatsoever is made from any person availing of the services and all patients (rich and poor) are given free service - is outside the purview of the expression 'service' as defined in Section 2(1)(o) of the Act. The payment of a token amount for registration purpose only at the hospital/nursing home would not alter the position.

    (10) Service rendered at a government hospital/health centre/dispensary where services are rendered on payment of charges and also rendered free of charge to other persons availing of such services would fall within the ambit of the expression 'service' as defined in Section 2(1)(o) of the Act, irrespective of the fact that the service is rendered free of charge to persons who do not pay for such service. Free service would also be 'service' and the recipient a 'consumer' under the Act.

    (11) Service rendered by a medical practitioner or hospital/nursing home cannot be regarded as service rendered free of charge, if the person availing of the service has taken an insurance policy for medical care whereunder the charges for consultation, diagnosis and medical treatment are borne by the insurance company and such service would fall within the ambit of 'service' as defined in Section 2(1)(o) of the Act.

    (12) Similarly, where, as a part of the conditions of service, the employer bears the expenses of medical treatment of an employee and his family members dependent on him, the service rendered to such an employee and his family members by a medical practitioner or a hospital/nursing home would not be free of charge and would constitute 'service' under Section 2(1)(o) of the Act.” (Para 55)

For comments and archives

 
    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Serum human chorionic gonadotropin (hCG)

hCG is a protein produced in the placenta of a pregnant woman. A pregnancy test is a specific blood or urine test that can detect hCG and confirm pregnancy. This hormone can be detected 10 days after a missed menstrual period, the time period when the fertilized egg is implanted in the woman’s uterus.

During pregnancy, the production of hCG increases steadily during the first 10 weeks, peaking around the 10th week after the last menstrual cycle. The level then falls slowly during the rest of the pregnancy.

hCG is also produced by some germ cell tumors and increased levels are seen in trophoblastic disease. Qualitative hCG testing is routinely used to confirm pregnancy. It measures the actual amount of hCG present in the blood.

Abnormal findings

  • During early pregnancy, the hCG level in the blood doubles every 2 to 3 days. Ectopic pregnancies usually have a longer doubling time.
  • hCG is also used to check efficiency of treatment in patients with trophoblastic disease and to detect recurrent disease after treatment is complete.
  • Certain drugs such as diuretics and promethazine can also cause false–negative urine results.
  • Other drugs such as anticonvulsants, anti–Parkinson drugs, hypnotics and tranquilizers may cause false–positive results.
 
    Mind Teaser

Read this…………………

The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?

A. Fluid volume deficit
B. Decreased tissue perfusion
C. Impaired gas exchange
D. Risk for infection

Yesterday’s Mind Teaser: The nurse enters the room of a client with chronic obstructive pulmonary disease. The client’s nasal cannula oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9 per minute and shallow. What is the nurse’s best initial action?

A. Take heart rate and blood pressure
B. Call the physician
C. Lower the oxygen rate
D. Position the client in a Fowler’s position

Answer for Yesterday’s  Mind Teaser: C. Lower the oxygen rate

Correct answers received from: Anil Bairaria, Dr Mukesh K Bhandari, Dr. P. C. Das, Dr Kanta jain, Dr. Prabodh Kumar Gupta, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Raju Kuppusamy, Dr.Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr. Thakor Hitendrsinh G, Dr. P. C. Das, Dr. sandeep Sabharwal, dinesh yadav

Answer for 20th July Mind Teaser: A. Food and fluids will be withheld for at least 2 hours
Correct answers received from: Dr.Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr. P. C. Das, Dr. Sukla Das, Drshashi saini, Dr. sandeep Sabharwal, dinesh yadav, Yogindra Vasavada

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Diet Rules for Cheaters

  1. Movie related foods do not have additional calories because they are part of the entertainment package and not part of one’s personal fuel.
  2. Cookie pieces contain no fat–– the process of breaking causes fat leakage.
  3. Things licked off knives and spoons have no calories if you are in the process of preparing something. Examples are peanut butter on a knife making a sandwich and ice cream on a spoon making a sundae.
  4. Foods that have the same color have the same number of calories. Examples are: spinach and pistachio ice cream; mushrooms and white chocolate. NOTE: Chocolate is a universal color and may be substituted for any other food color.
  5. Foods that are frozen have no calories because calories are units of heat. Examples are ice cream, frozen pies and Popsicles.
 
  Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Chicken pox vaccine

Chicken pox vaccine is very safe. A few mild reactions like redness, stiffness and soreness at the injection site, as well as fever may occur. A few people may develop a mild rash which usually appears around the shot’s area. Very rarely, serious side effects like anaphylaxis, pneumonia and seizures may happen. Sometimes, mild form of chicken pox may develop after vaccination.

Contraindications to chicken pox vaccine

  • Individuals who have had life-threatening allergic reactions; who are allergic to gelatin, neomycin should not get the vaccine.
  • Pregnant woman should wait till after delivery.
  • Immunocompromised status due to any reason (HIV/AIDS, malignancy, treatment with anti–metabolites/radiation/chemotherapeutic agents).

Efficacy

Chicken pox vaccine is 70–90% effective for preventing varicella infection and > 95% effective for preventing severe disease. WHO reports regarding the duration of immunity after complete immunization that "After observation of study populations for periods of up to 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent persons who were vaccinated as children were still protected from varicella."

Chicken pox vaccine is not part of the EPI, India. However, it is worth the while to immunize our children with this vaccine to contain the complications which may happen in case chicken pox infection happens.

 
    Medicolegal Update

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

Delusion of persecution

  • Delusion of persecution is an unpleasant delusion.
  • The person is suspicious and apprehensive and leads a life of distress and pain. The sufferer believes that something bad is going to happen to him. He/she fears that he may be killed by somebody or his property may be robbed.
  • Such a person may feel himself so helpless that he may even commit suicide or may kill his own family members to "save" them from some imaginary danger. He may even kill some innocent person thinking him to be his enemy who is "out to destroy him, his family and his property."
  • In an insane person, delusion of grandeur may change to delusions of persecution. A man who wrongly believes that he possesses huge property, may at a time start to think wrongly that another person is out to kill him to inherit his property.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Stress management programs for heart patients a must

Drugs such as beta–blockers and psychosocial interventions can reduce the physiologic response to some forms of stress.

In patients with known coronary disease, the cardioprotective effect of beta blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic–induced endothelial damage and a rising of the threshold for ventricular fibrillation.

In patients at risk for cardiovascular events who are under increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India. In premature heart attack, the mean age is 53–54 yrs.

In general, the goal of a stress management program is to reduce the impact in the individual of stressful environmental events and to better regulate the stress response.

Interventions may be considered at several levels:

  • Removal or alteration of the stressor
  • Change in perception of the stressful event
  • Reduction in the physiologic sequelae of stress
  • Use of alternative coping strategies

Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity.

Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg.

Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.

 
    Readers Response
  1. To the Editor, My Profession My Concern" is a brbilliant opinion, and needs to be widely disseminated in the medical profession, through the print and the virtual media. IMA journal would be a good begining.
    Dr Rozario Menezes, GOA
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal


Dr K K Aggarwal

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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4. eMedinewS ebooks (This may take a few minutes to open)

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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