emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos ?

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

25th March 2013, Monday

You Can Reverse Heart Disease

Every cell in the body eventually dies and replaced by new cell. Every day is a new opportunity to build a new body. The entire body totally rebuilds itself in less than two years with 98% in less than one year.

  • Stomach lining rebuilds itself in five days.
  • Your skin rebuilds itself in one month.
  • Liver rebuilds itself in six weeks.
  • Your DNA rebuilds itself every two months.
  • Bone rebuilds the whole new skeleton in three months
  • Blood rebuilds itself in four months
  • Brain rebuilds itself in one year

You cannot swim in the same river twice. With every breath, we inhale 1022 atoms coming from all cells present in the universe. We share everything with everybody with every breath. Quadruplet atoms in the last three weeks have gone through our breath. Billion atoms out of them may have been those of Christ or Mohammad.

The very fact that our body rebuilds itself, it is possible to change the Dharma of the new cells and even prevent or even regress cancers and heart diseases.

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

Vowel chanting produces aspirin in my body

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

A symposium on prayer, faith, meditation and healing was organised by Heart Care Foundation of India jointly with Bhartiya Vidya Bhavan at Bhavan?s Auditorium. Speakers from various religions participated in the symposium.

 
Dr K K Aggarwal
    National News

Doctors log on to MCTS to keep track of mothers and children

ALLAHABAD: To offer suitable medical assistance to mothers and their children, officials of the health department have registered 1,19,147 women and 83,094 children in Allahabad region comprising Allahabad, Kaushambi, Pratapgarh and Fatehpur districts under Mother And Child Tracking System (MCTS) in the region for the year 2013-14. After the enrolment, every expectant mother will be receiving SMS regarding their next immunisation and check up dates. The programme is a part of National Rural Health Mission (NRHM) and the MCTS software also dispatches reminders to the Auxiliary Nursing Midwives (ANMs) or ASHAs on the various treatments to be availed by the expecting mothers having mobile phones. Once a mother receives her immunisation, ANMs have to send the details to the MCTS service through an SMS. MCTS is designed to collate information of all pregnant women and infants to ensure delivery of maternal and child health services from conception till 40 days after delivery in the case of pregnant women and up to five years for children. Additional director (health), Dr Ramesh Kumar Srivastava told TOI that the system is a name-based information tracking system about ante-natal check up, delivery and post-natal check up for pregnant women and immunisation record for the children. The complete details are being registered in MCTS website and health workers will be keeping a close watch as far as offering adequate health care is concerned. (Source: TOI, Mar 22, 2013)

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Working definition of child abuse

Physical abuse is inflicting physical injury upon a child. This may include hitting, shaking, kicking, beating, or otherwise harming a child physically.

For comments and archives

    Valvular Heart Disease Update

What is very severe aortic stenosis?

Very severe AS is defined as an aortic valve area of =0.75 cm2 (critical AS) accompanied by a peak aortic jet velocity = 4.5 m/sec or a mean transaortic pressure gradient =50 mmHg.

(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)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Energy drinks may put heart at risk

Energy drinks may raise blood pressure and interfere with the heart's electrical system, increasing the risk of sudden cardiac death, a meta-analysis found. (Source: Medpage Today)

Caries prevention: Three materials found equivalent

Silver diamine fluoride, resin-modified glass ionomer, and a resin-based sealant may be equally effective in preventing caries in primary molars, a new study suggests. Researchers from the Universidade Estadual de Maring?, Brazil, planned to present the study at the International Association for Dental Research (IADR) 91st General Session and Exhibition in Seattle, Washington. (Source: Medscape)

Laparoscopy for hernia repair of mixed benefit

Laparoscopic repair of incisional hernia offered some advantages compared with open surgical repair, but failed to reduce postoperative pain or improve other outcome measures, according to a randomized trial. (Source: Medpage Today)

Excess salt blamed for 2.3 million deaths from CVD worldwide in 2010

Researchers estimate that in 2010, adults in most parts of the world consumed about twice as much salt as recommended, and millions of CVD deaths worldwide were linked to excess sodium. These findings were presented at EPI-NPAM 2013, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions. (Source: Medscape)

No difference in IVF pregnancies with ring or gel delivery of vaginal progesterone

Pregnancy rates in women having 'fresh-cycle' in vitro fertilization (IVF) are the same whether vaginal progesterone is delivered via a new ring device or a gel, a study shows. (Source: Medscape)

 
  Twitter of the Day

@DrKKAggarwal: Dr A. Marthanda Pillai on Need for Speciality Chapter of IMA: http://youtu.be/yvdEO5v1muY?a via @YouTube

@DrKKAggarwal: How is one to deal with lack of enthusiasm? Please read my #askdeepak reply http://tinyurl.com/cgesr6x

 
    Spiritual Update

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

Hospitals must have a prayer room

The symposium was organised by Heart Care Foundation of India jointly with Bhartiya Vidya Bhawan at Bhawan?s Auditorium and was participated by speakers from various religions.

For comments and archives

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

A young couple married for last 4 months has visited infertility specialist for treatment. They are very stressed. How should we counsel them?

Firstly we have to ascertain that there are no gross medical problems in the couple. We have to ensure that there is no problem in performing regular intercourse. The lady?s menstrual cycle should be regular. Once this is ascertained the couple should be reassured that the chances of getting pregnant per month in a healthy couple are about 15-20%. The fertile period should be explained which is usually between day 12 and day 18 of a regular menstrual cycle. Infertility will only be defined once they are unable to conceive after trying for more than a year. The couple should be able to return in 6 months if conception does not occur. A basic semen analysis may also be done.

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

(Dr Sanjay Chaudhury, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre)

How is the tissue harvested from a donor?

Tissue is retrieved either through enucleation (whole eye ball removal) or corneal excision. Presently many eye banks in the country retrieve cornea by in situ corneal excision. This procedure involves removing just the cornea from the whole eye of the deceased/donor. During corneal excision, the cornea along with the white part of the eye known as the sclera is excised out. A 2?3mm scleral rim is excised 360 degrees. The procedure takes 20 to 30 minutes. The excised cornea is introduced into a preservative medium, the Mc Carey Kaufman medium (MK medium), which is prepared by the Rotary Club of Hyderabad, Cornea Preservation Center and distributed to all eye banks in the country and South East Asian countries. The MK medium allows preservation of the cornea for a period of 4 days.

For comments and archives

 
    An Inspirational Story

How elite people think?

Have you ever wondered how elite people think? Through a short, inspiring speech below, Jim Rohn leads us into the spirit world of highly successful entrepreneurs. Here to strengthen our spirit! Yes we can!!

An enterprising person is one who comes across a pile of scrap metal and sees the making of a wonderful sculpture. An enterprising person is one who drives through an old decrepit part of town and sees a new housing development. An enterprising person is one who sees opportunity in all areas of life.

To be enterprising is to keep your eyes open and your mind active. It?s to be skilled enough, confident enough, creative enough and disciplined enough to seize opportunities that present themselves? regardless of the economy.

A person with an enterprising attitude says, ?Find out what you can before action is taken.? Do your homework. Do the research. Be prepared. Be resourceful. Do all you can in preparation of what?s to come.

Enterprising people always see the future in the present. Enterprising people always find a way to take advantage of a situation, not be burdened by it. And enterprising people aren?t lazy. They don?t wait for opportunities to come to them, they go after the opportunities. Enterprise means always finding a way to keep yourself actively working toward your ambition.

Enterprise is two things. The first is creativity. You need creativity to see what?s out there and to shape it to your advantage. You need creativity to look at the world a little differently. You need creativity to take a different approach, to be different.

What goes hand-in-hand with the creativity of enterprise is the second requirement: the courage to be creative. You need courage to see things differently, courage to go against the crowd, courage to take a different approach, courage to stand alone if you have to, courage to choose activity over inactivity.

And lastly, being enterprising doesn?t just relate to the ability to make money. Being enterprising also means feeling good enough about yourself, having enough self worth to want to seek advantages and opportunities that will make a difference in your future. And by doing so you will increase your confidence, your courage, your creativity and your self-worth, your enterprising nature.

For comments and archives

 
  Cardiology eMedinewS

Promising new targets identified in early AD Read More

Mental illness not a barrier to weight loss Read More

 
  Pediatric eMedinewS

Childhood depression ups teens' cardiovascular risk Read More

Heliox for bronchiolitis works -- if given correctly 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)

What does post-exposure prophylaxis (PEP) include?

Post-exposure prophylaxis includes:

  • Categorization of animal bite wound(s)
  • Local treatment of wound(s)
  • Anti Rabies Vaccination (ARV)
  • Administration of Rabies Immunoglobulin (RIG)

In addition, Tetanus prophylaxis, analgesics and systemic antibiotics may be given.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with inflammation was being regularly followed up.
Dr. Bad: Do sequential ESR.
Dr Good: Do sequential CRP.
Lesson: As the patient?s condition worsens or improves the ESR changes relatively slowly but the CRP concentration changes rapidly.

Make Sure

Situation: A patient?s blood pressure was not responding on Arkamin.
Reaction: Oh My God! Why was the patient given Artamin?
Lesson: Make sure to clearly spell the drug name in the prescription.

 
  Quote of the Day (Dr GM Singh)

Friendship doubles our joy and divides our grief. Swedish Proverb

 
  Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. Registration of the centre was suspended under section 20(3) of the PCPNDT Act by the commissioner & MOH of Mahanagar Palika in his capacity of AA. The owner appealed to the District Collector. The AA objected, saying that appeal cannot lie with the District Collector who is at the same level as the commissioner & MOH of Mahanagar Palika/AA. He pleaded that the appeal must be made to the state AA. Where does the appeal lie?

Ans.

  1. There is apparent confusion as regards AAs and appeals as described in the Act and the Rules.
  2. Section 17(2) of the Act is reproduced below:

    ?(2). The State Government shall appoint, by notification in the Official Gazette, one or more Appropriate Authorities for the whole or part of the State for the purposes of this Act having regard to the intensity of the problem of pre-natal sex determination leading to female foeticide.?

    It appears from section 17 that the scheme of the Act does not provide for a hierarchy of AAs.
  3. Section 21 of the PCPNDT Act, 1994, reads as follows:

    ?21. Appeal. The Genetic Counselling Centre, Genetic Laboratory or Genetic Clinic may, within thirty days from the date of receipt of the order of suspension or cancellation of registration passed by the Appropriate Authority under section 20, prefer an appeal against such order to?

    (i) the Central Government, where the appeal is against the order of the Central Appropriate Authority; and

    (ii) the State Government, where the appeal is against the order of the State Appropriate Authority, in the prescribed manner.?

    It is clear that as per section 21, the appeal ultimately lies with the state government.
  4. Rule 19 is reproduced below:

    ?19. Appeals ?

    (1) Anybody aggrieved by the decision of the Appropriate Authority at sub-district level may appeal to the Appropriate Authority at district level within 30 days of the order of the sub-district level Appropriate Authority.
    (2) Anybody aggrieved by the decision of the Appropriate Authority at district level may appeal to the Appropriate Authority at State/UT level within 30 days of the order of the District level Appropriate Authority.
    (3) Each appeal shall be disposed of by the District Appropriate Authority or by the State/Union Territory Appropriate Authority, as the case may be, within 60 days of its receipt.
    (4) If an appeal is not made within the time as prescribed under sub-rule (1), (2) or (3), the Appropriate Authority under that sub-rule may condone the delay in case he/she is satisfied that appellant was prevented for sufficient cause from making such appeal.?

    The Rules are very clear that there is a hierarchy. Also, as per the Rules, the appeal ultimately lies with the state AA.
  5. The ground reality is that since there are very small states and UTs compared to very large states and UTs, sub-district level AAs may be present in some states and not in others. For example, there are no sub-district level AAs in Delhi while, in Punjab, by virtue of a gazette notification, SMO working in subdivision hospitals have been designated as subdistrict level appropriate authorities and CMOs have been designated as district level appropriate authorities.
  6. When anomalies occur then, as per the principles of legal interpretation, the different provisions of law have to be construed as per the doctrine of harmonious construction.
  7. The situation in this case appears to be that the commissioner & MOH of Mahanagar Palika was the district level AA. Hence, in terms of Rule 19, the appeal lies with the state AA.
 
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    Mind Teaser

Read this…………………

A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. She?s placed on trimethoprim-sulfamethoxazole to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed?

a. Nitrofurantoin
b. Ibuprofen (Motrin)
c. Acetaminophen with codeine
d. Phenazopyridine

Yesterday’s Mind Teaser: A male client with acute pyelonephritis receives a prescription for co-trimoxazole PO twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?

a. Urine output increases to 2,000 ml/day.
b. Flank and abdominal discomfort decrease.
c. Bacteria are absent on urine culture.
d. The red blood cell (RBC) count is normal.

Answer for Yesterday’s  Mind Teaser: c. Bacteria are absent on urine culture.

Correct answers received from: Dr. B.B. Gupta, Dr Pankaj Agarwal, Dr. Bharat Bhushan Aggarwal, Dr Jainendra Upadhyay, Dr Chandresh jardosh, Dr. Thakor Hitendrsinh G, DR P K SAHU, Dr V M Kartha, Dr Kanta Jain, Dr B K Agarwal, Muthumperumal Thirumalpillai

Answer for 23rd March Mind Teaser: b. Gonorrhea

Correct answers received from: Muthumperumal Thirumalpillai, Dr. B.B. Gupta, Dr K Raju, Dr PK Sahu, Dr Tukaram Pagad

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A woman marries a man expecting he will change, but he doesn't.
A man marries a woman expecting that she won't change, and she does.

 
    Medicolegal Update

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

Issuance of death Certificate by Doctor

Coma is a clinical symptom and not a cause of death

The certificate of death is always issued by doctor as an honor/respect to the deceased person without any fee. In accordance with the Registration of Births and Deaths Act 1969, the registration of deaths is now compulsory throughout India. The doctor must write his registration number in the Death Certificate and a register for such information should be maintained with his clinic/hospital and a copy/information of death must/mandatorily be sent immediately to the birth and death registration office. It is essential that the cause of death must be documented/determined before lawful disposal of the deceased body by the doctor. The death certificate also provides the exact cause of death for statistical purposes. The cause of death is recorded according to international conventions; the sequence being that adopted by the World Health Organization. Thus, the international medical Certificate of the Cause of Death consists of two parts:

  • Part I: Records (a) the immediate cause, and (b) the morbid conditions, if any, giving rise to the immediate cause. Thus (a) must be due to (b). When (b) is due to other causes, it should be mentioned in (c). The basic pathological condition is that on the lower?most line and this is the one that is used for statistical purposes.
  • Part II: records any other significant condition contributing to death, but not related to the immediate cause of death. The underlying cause of death is defined as the disease, which initiated the train of morbid events leading directly to death for instance; a patient may die primarily from myocardial infraction due to coronary artery disease. These should be placed in parts (a) and (b) of part I as the myocardial infraction due to coronary artery disease (or coronary insufficiency). Similarly, it can be certified that the patient died of cerebral hemorrhage due to hypertension.

However, if the patient also suffers from diabetes, it should be entered in part II as it does not have a direct contributing role to the immediate cause of death. It is incorrect to write ?heart failure ?or ?cardiac failure? or? cardiopulmonary arrest? without mentioning the underlying pathological cause, which might be? coronary artery disease? or ?rheumatic valve lesions? or? senile myocardial degeneration?. It should be remembered that everyone dies of ?cardiopulmonary arrest? or? heart failure? or ?cardiac failure?, which simply means cessation of circulation and respiration leading to somatic death.

The modes of death, e.g., cardiorespiratory failure, or asphyxia should not be recorded as the cause of death, unless qualified as explained here, for instance, ?coma? is a clinical symptom and not a cause of death. It should be used with proper cause such as crush injury of head or meningitis etc.

The terms like angina, cancer, tumor apoplexy congestion?,? debility?, ?asthenia,? organic disease toxemia, sepsis and hemorrhage are sign/symptoms of the disease and not a pathological condition. It is pertinent for medical professional to note that a death certificate requires the underlying pathological cause and not clinical manifestations or modes of death.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Spread the message of Holi: Communicate to remove mental impurities

Holi is a festival of love and joy and should be used as a medium of communication to remove the mental dirt and impurities and cleanse the mind, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

He said that Holi festival should not end up with quarrels, violence or eve teasing.

Unsafe Holi

  • Green and bluish green chemicals contain malachite green, which can be toxic to the eyes. Auramine, methyl violet, rhodamine and orange II are all phototoxic colours and can damage the skin.
  • Mica in Holi colours can damage the skin.
  • Instead of chemical dyes, one should use floral dyes. Flowers like Marigold, China rose, Butterfly Pea, Flame of the Forest etc. are used for the extraction of colours.
  • ?Bhang? or cannabis can precipitate acute abnormal mental behavior and psychosis. In the susceptible individuals, it can increase the heart rate and blood pressure. Pre treatment with a beta blocker can take away the bad effects of bhang.
  • Alcohol can impair judgment and make prone to accidents.
  • Balloons can cause blunt injuries to the eyes and precipitate head injuries.
  • Beware of date rape drugs. Do not play Holi with strangers.
  • Do not throw colour at sensitive parts of the body, such as eyes. If colour enters the eye, immediately wash it with a lot of water. If irritation persists, medical aid should be sought immediately.

Some tips

  • Use dental caps to protect teeth from staining.
  • Use sunglasses to keep eyes safe from the harmful chemicals of the colours.
  • Wear old and ragged clothes that may be discarded.
  • Wear full-sleeved T-shirts or shirts and leggings that fully cover the legs.
  • Wear socks.
  • Brightly coloured and dark coloured clothes should be preferred.
  • Keep your eyes and lips tightly closed, when colour is being applied on you.
  • Apply a thick layer of any oil on your body and hair till they glisten to make the skin slippery. This will help wash off colours easily later on.
  • While washing off the colour, use lukewarm water and keep eyes and lips tightly closed.
  • While traveling, keep the car windows tightly shut.
  • Use a hat, cap to protect the hair from being coloured with hard-to rinse dyes/colours.
  • If you venture out on the streets, avoid mob frenzy.
  • Do not bump into the frenzied group of mob if you take to streets. Cross the road to the sidewalk across. Or, simply stay at a safe distance.
  • Discourage children to play Holi with eggs, mud or gutter water.
  • Avoid use of abir as it has flakes of mica.
  • Stop children from forcibly applying colour on a hesitant neighbor.
  • Don?t walk alone on the streets on the day of Holi.
  • Use only natural colour and water.
  • Keep a big bucket of clean water handy for your children, so that they do not resort to gutter water and other unclean sources.

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 31330 people since 1st November 2012.

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

 
    Readers Response
  1. Dear Sir, Very informative news. Regards: Dr KP Mishra
 
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