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

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eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

24th February 2013, Sunday

Pharma industry funds for IAP: IAP Annual Report 2012

Company Funds given in lakh Rs

Johnson and Johnson (118.4); Merck (98.6); Wyeth (13.3); Sanofi Pasteur (11.4); Zuventus (11); Glaxo SmithKline (5); X-ray Biocom (4.5); Serum Institute (3); Pfizer (2). Total (267.2)

Law Cited: 6.8.1 In dealing with Pharmaceutical and allied health sector industry, A MEDICAL PRACTITIONER shall follow and adhere to the stipulations given below:

a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives.
b) Travel facilities: A medical practitioner shall not accept any travel facility
c) Cash or monetary grants: A MEDICAL PRACTITIONER shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.

Issue

The Indian Academy of Pediatrics (IAP) has flouted Medical Council of India regulations

1. By accepting funding from the pharma industry
2. Violating code of ethics prohibiting endorsement or promotion of any brand.

Defense

1. MCI regulation is about individual doctors not accepting funds or gifts and not about associations.
2. Under 1860 societies act members of the association are not monitory beneficiary of the society funds.

What MCI says

It was illegal for the association of doctors to take funds from companies.

Conflict of interest

IAP is a member of the National Technical Advisory Group on Immunization (NTAGI) which decides immunization schedule and selection of vaccines to be included in the NIP.

Legal views

1. MCI 6.8.1 does not cover associations and trusts.
2. Unless the doctor is proven to be a beneficiary he cannot be implicated.
3. In charitable societies, members are not supposed to take monitory benefits.
4. Societies should not be funded or there activities sponsored by companies which they have conflict of interest with.
5. Endorsement issue in the High Court.

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 are the secondary causes of constipation?

Secondary causes for constipation include endocrine or metabolic disorders, neurologic disorders, myogenic disorders and medications.

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Rapid flu test more accurate when positive

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Sh P K Pradhan demonstrating CPR 10 mantra

 
Dr K K Aggarwal
    National News

Girl with brain TB gets MBBS degree in ICU

MUMBAI: Sporting a mortarboard and a black gown, 24-year-old Samidha Khandare stood out among other patients in Sion Hospital's ICU. Even though she has been battling miliary tuberculosis which has spread to all her vital organs, including the brain, Samidha's face was all lit up when the dean of Sion Hospital gave MBBS degree to her in the ICU on Wednesday. "As she was the only student who was going to miss her convocation, we decided to present the degree to her in the ICU," said Dr Suleiman Merchant, dean of Sion Hospital. Samidha, who was an intern at Sion, had contracted TB in the hospital. Samidha's brother Dr Shekhar Khandare said, "She was diagnosed with tuberculosis in early January this year. She spent a few weeks in the ICU and was subsequently discharged as she was doing fine. However, she complained of disorientation on February 12. An MRI scan showed TB infection in her brain. Doctors suspect that she may have multi-drug resistance TB and have started her treatment accordingly. She is responding well to the treatment." "Samidha is recovering well. We may shift her to the general TB ward in the next two days," said Dr Merchant. In November last year, TOI reported that 11 Sion Hospital doctors were suffering from tuberculosis. Sources within the hospital said that Samidha is the 13th doctor to contract the disease. "TB is still a problem in the hospital. We need better infrastructure, better working and living conditions and good hygiene to prevent the care-givers from contracting the disease. We have submitted a proposal for the same to civic authorities. Once that gets approved, we will be able to curb the spread of TB," said Dr Merchant. (Source: TOI, Feb 21, 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/)

All about child sexual abuse

  1. Children victims of sexual abuse should receive a thorough evaluation.
  2. Evaluation should include careful questioning and a complete physical examination.
  3. Evidence-collection procedures, and/or specialized examination techniques may be required.

For comments and archives

    Valvular Heart Disease Update

How common is MS in the elderly?

Mitral stenosis is relatively uncommon in elderly adults. Mitral annular calcification occasionally causes mitral obstruction. For patients with symptomatic mitral stenosis, percutaneous balloon valvotomy is the procedure of choice if valvular morphology is favorable but it is not indicated in patients with mitral obstruction due to mitral annular calcification.

(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 (Dr KK Aggarwal)

Prevention of abusive head trauma

Primary prevention

  • Large scale public education campaigns
  • Hospital-based education programs
  • Intensive education program describing the dangers of violent infant shaking and providing alternative responses to persistent infant crying

Secondary prevention

  • Programs directed toward a specific subset of the population at risk for child maltreatment
  • Prenatal and early childhood home visits
 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Potential cause of depression identified

A protein involved in synaptic structure has been identified as a potential cause of depression, a finding that according to researchers has "enormous therapeutic potential for the development of biomarkers and novel therapeutic agents." (Source: Medscape)

Antiplatelet switch still has bleeding risks

Switching high-risk patients to clopidogrel (Plavix) can help counteract the low platelet reactivity common with prasugrel (Effient), but doing so has risks of its own, a first-of-its-kind study found. (Source: Medpage Today)

Hip implants more likely to fail in women

Failure rates for hip implants were 29% higher for women than men in a large U.S. registry study after controlling for a variety of factors including device type, researchers said. (Source: Medpage Today)

CABG plus valve replacement tied to added risk

Doing aortic valve replacement and coronary artery bypass grafting (CABG) at the same time led to worse outcomes than valve replacement alone, but the difference was attributed to patient characteristics, researchers found. (Source: Medpage Today)

New form of misoprostol speeds up labor

A novel form of misoprostol (Cytotec) designed for induction of labor works faster than a similar vaginal insert of dinoprostone (Cervidil), a clinical trial showed. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Blast triage important by dr k k Aggarwal http://bit.ly/15CIkgP #Health

@DeepakChopra: How do we discover our purpose? Does anyone ever know what it is in this lifetime? My #askdeepak reply http://tinyurl.com/b7r3y9y

 
    Spiritual Update

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

A doctor is like honeybee and medical profession, the honey

In a seminar, Father Tomas compared all religious faiths to honey. He said that honey bees go from one flower to another and collect nectar and it is from this mix of the nectars from various flowers that honey is produced with its sweetness.

For comments and archives

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

What are the side effects of using gonadotropins?

  • Ovarian hyperstimulation syndrome (OHSS). OHSS is characterized by enlarged ovaries and fluid accumulation in the abdomen after ovulation or egg retrieval. It can be either mild or severe. The mild form occurs in 10-20% of cycles and results in some discomfort but almost always resolves without complications. When severe, it can result in blood clots, kidney dysfunction, twisting of an ovary (torsion), fluid collections in the chest and abdomen, and rarely even death. Most patients who are at high risk for severe OHSS are identified by closely monitoring ovulation induction cycles with the daily use of ultrasounds and/or serum estradiol levels. When serum estradiol levels are rising rapidly and/or are too high, or excessive numbers of ovarian follicles develop, one strategy for prevention of severe OHSS is to withhold further gonadotropin stimulation and delay hCG administration until estradiol levels plateau or decline.
  • Multiple gestation. Up to 30% of pregnancies, which result from cycles involving gonadotropin stimulation, are multiple, in contrast to a rate of 1% to 2% without fertility medications. The risk of multiple gestations is dependent upon the number of mature eggs released in an ovulation induction cycle and the number of embryos transferred in an IVF cycle. While most of these pregnancies are twins, a significant percentage (up to 5%) are triplets or higher. Twins and high order (>2) multiple gestation pregnancy are associated with an increased risk of pregnancy loss, premature delivery, infant abnormalities, handicap due to the consequences of very premature delivery, pregnancy-induced hypertension, hemorrhage, and other significant maternal complications.
 
    Tat Tvam Asi………and the Life Continues……

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

Whole blood

Definition: Whole blood contains 350 ml. of donor blood plus anticoagulants.

Volume: 350 ml.

Storage: Between 2° C to 6° C in approved Blood Bank refrigerator

Shelf Life: 35 days

For comments and archives

 
    An Inspirational Story

Keep on knocking, keep on asking, keep on seeking

When Colonel Harland Sanders retired at the age of 65, he had little to show for himself, except an old Caddie roadster, a $105 monthly pension check, and a recipe for chicken.

Knowing he couldn't live on his pension, he took his chicken recipe in hand, got behind the wheel of his van, and set out to make his fortune. His first plan was to sell his chicken recipe to restaurant owners, who would in turn give him a residual for every piece of chicken they sold--5 cents per chicken. The first restaurateur he called on turned him down.

So did the second. So did the third.

In fact, the first 1008 sales calls Colonel Sanders made ended in rejection. Still, he continued to call on owners as he traveled across the USA, sleeping in his car to save money. Prospect number 1009 gave him his first "yes."

After two years of making daily sales he had signed up a total of five restaurants. Still the Colonel pressed on, knowing that he had a great chicken recipe and that someday the idea would catch on. Of course, you know how the story ends. The idea DID catch on. By 1963 the Colonel had 600 restaurants across the country selling his secret recipe of Kentucky Fried Chicken (with 11 herbs and spices).

In 1964 he was bought out by future Kentucky governor John Brown. Even though the sale made him a multi-millionaire, he continued to represent and promote KFC until his death in 1990.

Colonel Sanders' story teaches an important lesson: it’s never too late to decide to never give up.

Earlier in his life the Colonel was involved in other business ventures--but they weren't successful. He had a gas station in the 30's, a restaurant in the 40's, and he gave up on both of them. At the age of 65, however, Harland Sanders decided his chicken idea was the right idea, and he refused to give up, even in spite of repeated rejection.

He knew that if he kept on knocking on doors, eventually someone would say "yes." This is how Jesus has commanded to approach life. He said, "Ask and it will be given to you; seek and you will find; knock and the door will be opened to you." (Luke 11:9)

This verse follows a story Jesus told emphasizing the importance of a "never-give-up" attitude in prayer. Jesus is saying, "Ask--not just once, but as many times as is necessary. Keep on knocking till the door is opened."

If you have made half-hearted attempts at doing God's will in your life...if you have given up too easily in the past...remember: It's never too late to become persistent. It's never too late to decide to never give up. Keep on knocking. Keep on asking. Keep on seeking.

For comments and archives

 
    Cardiology eMedinewS

Diabetes risk factor control improving, but far from ideal Read More

 
    Pediatric eMedinewS

Septic arthritis in children ruled out by new test Read More

End-tidal CO2 monitoring in delivery room won't reduce hyper-, hypocapnia 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)

How common are animal bites?

Animal bites are very common in India.

The annual incidence of animal bites is high, 1.7% and it was more in rural areas (1.8%), children (2.6%) and poor/low income group (75%). The main biting animal was dog (91.5%), mostly stray (63%), followed by cat (4.7%).

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and also stop low dose aspirin.
Lesson: In dengue, low dose aspirin should be discontinued.

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

 
    Quote of the Day (Dr GM Singh)

A man may fall many times, but he won't be a failure until he says that someone pushed him. Elmer G. Letterman

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

Q. My daughter has an MBBS degree and is registered with the medical council in India. She wants to get a postgraduate MD degree. Texila American University (TAU) in Guyana offers an MD degree. Should I send her to this university?

Ans.

  1. The web site of the university is www.tauedu.org. The program may be called an MD program but, as per the nomenclature in USA, it is a basic medical degree and not a postgraduate degree.
  2. I doubt whether degrees awarded by this university are recognised by the MCI.
  3. The Union Government, exercising powers conferred upon it by the provisions of the Indian Medical Council Act, 1956, has recognized Post Graduate medical qualifications being awarded in Australia, Canada, New Zealand, United Kingdom and United States of America, with the condition that these degrees should be recognized in the respective country for enrolment of medical practitioners in the concerned specialties. This recognition has been notified in the Official Gazette on 10th March 2008.
  4. The MD degree awarded by TAU will not be covered by the above gazette notification because it is not a PG degree and because Guyana is not included in the list of 6 countries mentioned.
  5. In the circumstances, it may not be advisable to send your daughter for the above course.

For comments and archives

 
    Mind Teaser

Read this…………………

Which nonpharmacologic intervention is difficult to use with older adults who are cognitively impaired?

1. Aromatherapy
2. Distraction
3. Guided imagery
4. Heat application

Yesterday’s Mind Teaser: An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for neuropathic pain. Which statement indicates the patient's need for additional education?

1. “I will chew sugarless gum and mints.”
2. “I will drink carbonated beverages.”
3. “I will take my medication at breakfast.”
4. “I will use a humidifier at bedtime.”

Answer for Yesterday’s Mind Teaser: c. I will take my medication at breakfast

Correct answers received from: Dr Jainendra Upadhyay, Dr Sarita Badlani, Dr Thakor Hitendrsinh G,
Dr Arpan Gandhi, Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Ajay Gandhi, Dr Kanta Jain.

Answer for 22nd February Mind Teaser: d. May be in conflict with the pain rating, and accepts the report of pain.

Correct answers received from: Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

 
   Laugh a While (Dr Vasant)

A teenage boy had just passed his driving test and inquired of his father as to when they could discuss his use of the car.

His father said he'd make a deal with his son: 'You bring your grades up from a C to a B average, study your Bible a little, and get your hair cut. Then we'll talk about the car.'

The boy thought about that for a moment, decided he'd settle for the offer, and they agreed on it.

After about six weeks his father said, 'Son, you've brought your grades up and I've observed that you have been studying your Bible, but I'm disappointed you haven't had your hair cut. The boy said, 'You know, Dad, I've been thinking about that, and I've noticed in my studies of the Bible that Samson had long hair, John the Baptist had long hair, Moses had long hair...and there's even strong evidence that Jesus had long hair.'

You're going to love the Dad's reply.

“Did you also notice they all walked everywhere they went?”

 
    Medicolegal Update

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

What is the vegetative state?

Complete absence of behavioral evidence for self or environmental awareness

  • The capacity for spontaneous or stimulus–induced arousal is preserved, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
  • They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
  • They cannot understand, communicate, speak, or have emotions and unaware of self and environment and have no interaction with voluntarily control passing of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
  • The following behaviors may be seen in the vegetative state: Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; Spontaneous blinking and roving eye movements; Produce sounds but no words; Visual pursuit following an object with her eyes; Grimacing to pain; changing facial expression; Yawning; chewing jaw movements Swallowing of her own spit No purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state was observed during the examination.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Laboratory testing in swine flu

Not all individuals with suspected pandemic H1N1 influenza A need to have the diagnosis confirmed, particularly if the illness is mild said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

The recommended test for suspected cases is real-time reverse transcriptase (RT)-PCR for influenza A, B, H1 and H3, which is generally performed at a state health department laboratory.

To establish the diagnosis of pandemic H1N1 influenza A, an upper respiratory sample (nasopharyngeal swab, nasal swab, throat swab, combined oropharyngeal/nasopharyngeal swab, or nasal aspirate) should be collected.

Whom to test — Testing for pandemic H1N1 influenza A should be considered in individuals with an acute febrile respiratory illness (a measured temperature of 100ºF or higher and recent onset of at least one of the following: rhinorrhea, nasal congestion, sore throat, or cough) or sepsis-like syndrome.

Priority for testing should be given to those who require hospitalization and those who are at high risk for severe complications.

Specimens — To establish the diagnosis of pandemic H1N1 influenza A, an upper respiratory sample (nasopharyngeal swab, nasal swab, throat swab, combined oropharyngeal/nasopharyngeal swab, or nasal aspirate) should be collected.

In intubated patients, an endotracheal aspirate should also be obtained.

Swabs with a synthetic tip (e.g., polyester or Dacron) and an aluminum or plastic shaft should be used. Swabs with cotton tips and wooden shafts are not recommended. Swabs made of calcium alginate are not acceptable. The collection vial in which the swab is placed should contain 1 to 3 mL of viral transport media. Specimens should be placed in viral transport media and placed on ice (4ºC) or refrigerated immediately for transportation to the laboratory. Once the samples arrive in the laboratory, they should be stored either in a refrigerator at 4ºC or in a -70ºC freezer. If a -70ºC freezer is not available, they should be kept refrigerated, preferably for =1 week. Specimens should be shipped on dry ice to the state public health laboratory.

Recommended tests

The recommended test to confirm the diagnosis of pandemic H1N1 influenza A virus is real-time reverse transcriptase (RT)-PCR for influenza A, B, H1, and H3.

Rapid antigen tests — Clinicians may consider using rapid influenza antigen tests as part of their evaluation of patients suspected of having pandemic H1N1 influenza A, but results should be interpreted with caution.

Confirmation of pandemic H1N1 influenza A infection can only be made by real-time reverse-transcriptase (RT)-PCR or culture.

Certain rapid influenza antigen tests that are commercially available can distinguish between influenza A and B viruses. Thus, a patient with only influenza B virus infection would not be suspected of having pandemic H1N1 influenza A virus infection. In contrast, a patient with a positive rapid antigen test for influenza A may be considered a probable case if he or she meets the other criteria. A negative rapid influenza test does not exclude infection.

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 29819 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.”

 
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