eMedinewS
23rd December 2014, Tuesday

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

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Not reporting TB a violation of MCI ethics regulation 7.14

Vide letter number Z-28015/2/2012-TB, the Government of India, Ministry of Health and Family Welfare on 7th May 2012 declared TB as a notifiable disease. According to the circular

“TB continues to be a major public health problem accounting for substantial morbidity and mortality in the country. Early diagnosis and complete treatment of TB is the corner-stone of TB prevention and control strategy. Inappropriate diagnosis and irregular/incomplete treatment with anti-TB drugs may contribute to complications, disease spread and emergence of drug-resistant TB.

In order to ensure proper TB diagnosis and case management, reduce TB transmission and address the problems of emergence and spread of drug-resistant TB, it is essential to have complete information of all TB cases. Therefore, the healthcare providers shall notify every TB case to local authorities i.e. District Health Officer/Chief Medical Officer of a district and Municipal health Officer of a Municipal Corporation/Municipality every month in a given format.

For the purpose of case notification, a TB case is defined as follows: A patient diagnosed with at least one sputum specimen positive for acid fast bacilli, or culture positive for Mycobacterium tuberculosis, or RNTCP endorsed Rapid Diagnostic molecular test positive for tuberculosis or a patient diagnosed clinically as a case of tuberculosis, without microbiologic confirmation, and initiated on anti-TB drugs.
For the purpose of this notification, healthcare providers will include clinical establishments run or managed by the Government (including local authorities), private or NGO sectors and/or individual practitioners.

For more detailed information, the concerned State TB Officers/District TB Officers, whose details are available on www.tbcindia.nic.in, may be contacted.

(Manoj Sinha)
Under Secretary to the Government of India"

A copy of this circular was sent to all Principal Secretaries/Secretaries of Health of States/UTs With the request to kindly immediately; All Directors of Health Services of bring this order to the notice of all States/UTs concerned for compliance, in their respective State/UT; All State TB Officers of States/UTs; PS to Union Minister HFW/Union Minister of HRD & CIT/MOS (HFW); PPS to Union Secretary HFW/DGHS/Union Secretary AYUSH/Union Secretary HR (DG-ICMR)/union Secretary — NACO/DG-NIC; All Addl. Secretaries & Joint Secretaries in MOHFW/GOI All Dy. Director General/DteGHS/MOHFW/GOI; Director (Media) MOHFW/Got; All Regional Directors (HFW/GOI) — with request to facilitate wide dissemination of this Govt. Order, for compliance, in respective states/UTs; Websites of MOHFW/GOI (www.mohfw.nic.in) and Central TB Division (www.tbcindia.nic.in); DDG (NIC) & Sr. Technical Director (NIC)/MOHFW/GOI.

The above circular was not sent to Medical Council of India for reasons only known to them. Not reporting a notifiable disease is a violation of Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 under regulation 7.14: "The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his/her profession except –

  1. in a court of law under orders of the Presiding Judge;
  2. in circumstances where there is a serious and identified risk to a specific person and/or community; and notifiable diseases.

In case of communicable/notifiable diseases, concerned public health authorities should be informed immediately.

Under the regulation the word used is 'SHOULD' but under the notification the word used is 'SHALL.' This means that it is mandatory to report but for the violation the MCI may take a lenient view if it is the first violation.

In most municipal corporation Acts, for example, Delhi Municipal Corporation Act, TB is defined as a dangerous disease under 2 (9) "dangerous disease" means— (a) Cholera, plague, chicken-pox, small-pox, tuberculosis, leprosy, enteric fever, cerebrospinal meningitis and diphtheria; and (b) any other epidemic, endemic or infectious disease which the Commissioner may, by notification in the Official Gazette, declare to be a dangerous disease for the purposes of this Act; Prevention of dangerous diseases.
The DMC act also mandates reporting under section 371. “Obligation to give information of dangerous disease: Any person being in charge of, or in attendance, whether as a medical practitioner or otherwise, upon any person whom he knows or has reason to believe to be suffering from a dangerous disease, or being the owner, lessee, or occupier of any building in which he knows that any such person is so suffering shall forthwith give information respecting the existence of such disease to the Municipal Health Officer.

News Around The Globe

  • The first-in-class drug olaparib has been approved in the United States for the treatment of advanced ovarian cancer with BRCA mutations.
  • Younger patients and those with better baseline visual acuity (VA) have better two-year outcomes after ranibizumab treatment for polypoidal choroidal vasculopathy (PCV) as suggested by new findings published online in the British Journal of Ophthalmology.
  • Individuals whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as compared to those with no family history of knee surgery, suggests a new study published online in the Annals of the Rheumatic Diseases.
  • Prompt use of a small stent to retrieve a stroke-causing blood clot seems safe and helps most patients who suffer a severe stroke recover faster and better, suggests a new study published in the New England Journal of Medicine.
  • A new study suggests that older people with hearing loss may have improved balance when they use hearing aids. The finding suggests that improving hearing in older people with hearing loss may reduce their risk of falls. The study is published in The Laryngoscope.

Dr KK Spiritual Blog

Definition of Health

Health is not mere absence of disease; it is a state of physical, mental, social, spiritual, environmental and financial well-being. All aspects of health are not defined in Allopathy.

During MBBS, medical students are taught more about physical health. Social and mental healthcare is covered only in few lectures. Community health is a separate subject but is never given its due importance. Spiritual health is not defined at all and financial health is hardly covered.

Yet, in day-to-day practice, it is the social, financial, spiritual and community health, which is the most important during patient-doctor communication. It is incorporated in the four basic purposes: dharma, artha, kama and moksha.

Dharma and artha together form the basis of karma, which is righteous earning. You are what your deep rooted desires are. Most of the diseases today can be traced to a particular emotion, positive or negative. Anger and jealously are related with heart attack, fear with blood pressure, greed and possessiveness with heart failure. Unless the mind is healthy, one cannot be free of diseases.

The best description of health comes from Ayurveda. In Sanskrit, health means swasthya, which means establishment in the self. One is established in the self when there is a union of mind, body and soul. Most symbols of health are established around a shaft with two snakes and two wings. The shaft represents the body, two snakes represent the duality of mind and the two wings represent the freedom of soul.

Sushrut Samhita in Chapter 15 shloka 10 defines the Ayurvedic person as under:

Samadosha, samagnischa,
Samadhatumalkriyah,
Prasannatmendriyamanah,
Swastha iti abhidhiyate


From Ayurvedic point of view, for a person to be healthy, he/she must have balanced doshas, balanced agni, balanced dhatus, normal functioning of malkriyas and mind, body, spirit and indriyas full of bliss and happiness.

Human body is made up of structures (Kapha), which have two basic functions to perform; firstly, metabolism (pitta) and movement (vata). Vata, pitta and kapha are called doshas in Ayurveda. Samana dosha means imbalance of structures, metabolism and movement functions in the body. Agni in Ayurveda is said to be in balance when a person has normal tejas and a good appetite.

Ayurveda describes seven dhatus: rasa, rakta, mamsa, medha, asthi, majja, shukra and they are required to be in balance. They are equivalent to various tissues in the human body.

Ayurveda necessitates proper functioning of natural urges like urination, stool, sweating and breathing and that is what balance in malakriya means.

Ayurveda says for a person to be healthy he/she has to be mentally and spiritually healthy, which will only be possible when his or her indriyas are cheerful, full of bliss and devoid of any negativities. For indriyas to be in balance, one has to learn to control over lust and desires, greed and ego. This can be done by learning regular pranayama, learning the dos and don’ts in life, living in a disciplined atmosphere and learn to live in the present.

Regular pranayama shifts one from sympathetic to parasympathetic mode, balances the mind and thoughts and helps in removing negative thoughts from the mind. For living a disabled life one can follow the yama and niyama of yoga sutras of Patanjali or dos and don’ts taught by various religious gurus, leaders and principles of naturopathy.

Living in the present means conscious or meditative living. This involves either learning meditation 20 minutes twice-daily or learning subtle mental exercises like mind-body relaxation, yogic shavasana, self-hypnotic exercises, etc.

According to Yoga Sutras of Patanjali, a person who eats thrice a day is a rogi, twice a day is a bhogi and once a day is yogi. The take home message is: to live more one should eat less.

Swar yoga defines the importance of respiration and longevity. According to this yoga shastra, everybody has a fixed number of breaths to be taken during the life span. Fewer the breaths a person takes in a minute, more is the life. It also forms the basis of pranayama, which is nothing but longer and deeper breathing with reduced respiratory rate.

To be healthy one should follow the principle of moderation and variety in diet and exercise, regular pranayama and meditation and positive thinking.

Inspirational Story

Some Thing You Keep

Some things you keep; like good teeth, warm coats and bald husbands. They're good for you, reliable and practical and so sublime that to throw them away would make the garbage man a thief. So you hang on, because something old is sometimes better than something new, and what you know often better than a stranger.

These are my thoughts. They make me sound old; old and tame and dull at a time when everybody else is risky and racy and flashing all that's new and improved in their lives. New spouses, new careers, new thighs, new lips.

The world is dizzy with trade-ins. I could keep track, but I don't think I want to. I grew up in the fifties with practical parents - a mother, God bless her who washed aluminum foil after she cooked in it, then re-used it- and still does. A father who was happier getting old shoes fixed than buying new ones.

They weren't poor, my parents, they were just satisfied. Their marriage was good, their dreams focused. Their best friends lived barely a wave away.
I can see them now; Fifties couples in Bermuda shorts and Banlon sweaters, lawn mower in one hand, tools in the other. The tools were for fixing things - a curtain rod, the kitchen radio, screen door, the oven door, and the hem in a dress. Things you keep.

It was a way of life, and sometimes it made me crazy. All that re-fixing, re-heating, renewing, I wanted just once to be wasteful. Waste meant affluence. Throwing things away meant there'd always be more.

But then my father died, and on that clear autumn night, in the chill of the hospital room, I was struck with the pain of learning that sometimes there isn't any 'more'. Sometimes what you care about most gets all used up and goes away, never to return.

So, while you have it, it's best to love it and care for it and fix it when it's broken and heal it when it's sick. That's true for marriage and old cars and children with bad report cards and dogs with bad hips. You keep them because they're worth it, because you're worth it. Some things you keep.

Rabies News (Dr A K Gupta)

Can rabies be transmitted to a dog that has eaten the flesh of a dead rabid cow or buffalo?

Yes. The rabies virus after multiplying in the brain spreads to other organs of the body like the heart, muscles, skin, etc. So the dog can definitely get infected because the virus can spread through oral mucous membrane.

Cardiology eMedinewS

  • Androgen deprivation therapy (ADT) for prostate cancer is associated with an increased risk of cardiovascular disease (CVD), suggested a new meta-analysis published online in European Urology.
  • A new report suggests that people with high levels of fitness are less likely to develop high blood pressure. The report is published in the Journal of the American Heart Association.

Pediatrics eMedinewS

  • Children who skip main meals are more likely to have excess body fat and an increased cardiometabolic risk already at the age of 6 to 8 years, suggests a new study published in European Journal of Clinical Nutrition, International Journal of Obesity and European Journal of Nutrition.
  • Researchers have identified a possible therapy to treat neurofibromatosis type 1 or NF1, a childhood neurological disease characterized by learning deficits and autism caused by inherited mutations in the gene encoding a protein called neurofibromin. The anatomical defects in the cerebellum, caused by the loss of neurofibromin, could be reversed by treating with a molecule that counteracts the loss of the protein. The findings are published in the journal Genes and Development.

Quote of the Day

Men for the sake of getting a living forget to live. Margaret Fuller

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at GB S School, Khan Pur, New Delhi, on 27th November 2014

video of day
press release

Obesity reduces life expectancy

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 trained

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

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

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

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

 

Dr Good and Dr Bad

Situation: A diabetic patient was found unconscious.
Dr Bad: He has suffered a stroke.
Dr Good: First rule out hypoglycemia.
Lesson: In diabetics, sudden loss of consciousness is hypoglycemia unless proved otherwise.

Make Sure

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh my God! Why were antibiotics not given when the meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

eMedinewS Humor

Dumb and dumber

Friend 1: Is it true that your wife talks to herself when she is alone?

Friend 2: I don’t know. I wasn’t with her when she was alone.

Twitter of the Day

Dr KK Aggarwal: Caloric restriction may prevent disease increase life span
Dr Deepak Chopra: Every event including an imagined event occurs in the present moment The thread of memory creates the illusion of time

Wellness Blog

CT not required in appendicitis

When a patient has all the signs of acute appendicitis, waiting to get a CT scan to confirm the diagnosis is not required.

Compared with a straight-to-surgery approach, the CT strategy is linked to delayed surgery and increased risk of a burst appendix.

Pre-operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis. If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned. These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.

ePress Release

Have Leg Artery Blockages? Walk on a Treadmill

A planned program of walking is good for people with blockage of leg blood vessels called peripheral arterial disease (PAD) said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

Normally when there is pain in the calf muscles in the leg on walking the general tendency is to rest and not walk. A study published in JAMA of 156 people with PAD showed that regular six-minute walks on a treadmill improved their endurance and quality of life.

The study examined patients with symptoms and without symptoms. Over the six months of the study, the participants who did their regular six-minute treadmill walks increased their walking distance by about 69 feet, while those who did not walk regularly saw a decrease of 49 feet.

There is the potential for greater oxygen extraction from the blood under maximum exercise conditions. The muscles can make better use of blood flow and the oxygen release that comes from it.

Such exercise leads to improvement in "collateral circulation" -- growth in the number of blood vessels supplying the legs. Clinicians should urge all PAD patients, whether or not they have symptoms, to engage in a regular, supervised exercise program.

Walking is a standard recommendation for people with PAD. A recommended regimen is a 40-minute walk three times a week for at least six months.

Persistent leg pain is an indication that help is needed. In the absence of that symptom, physicians can test for PAD by measuring the difference in blood pressure between an ankle and an arm.

eMedi Quiz

Which of the following is present intracellularly in muscle cells?

1. Insulin
2. Corticosteroid
3. Epinephrine
4. Glucagon

Yesterday’s Mind Teaser: The buffering capacity of a buffer is maximum at pH equal to:

1. 0.5pKa.
2. pKa
3. pKa+1
4. 2pKa

Answer for yesterday’s Mind Teaser: 2. pKa.

Correct answers received from: Dr KV Sarma, Dr Avtar Krishan, Dr Rakesh Sharma Nohar.

Answer for 21st December Mind Teaser: 4.Vertebral venous plexus.

Correct answers received from: Dr K Raju, Dr Jainendra Upadhyay, Dr Rakesh Sharma, Dr Avtar Krishan, Manoj Bhatt, Dr Jainendra Upadhyay.

Send your answer to email

medicolegal update
  1. Thanks for such informative & beautiful mail, with Regards, Dr Bharat Gadhvi.

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