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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 April 2013, Thursday

Over 40044 never events in US annually

Never-events are the kind of medical mistakes that should simply not occur. Despite this, such events occur more often than people believe, according to a recent study by patient safety researchers at John Hopkins University School of Medicine in Baltimore, Maryland published in the April issue of the journal Surgery.

As per the study "a surgeon in the United States leaves a foreign object such as a sponge or towel inside a patient's body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week, and operates on the wrong body site 20 times a week." 4044 never-events occur in the United States each year.

Surgeons between the ages of 40 and 49 years are responsible for more than one third of the events, whereas surgeons older than 60 years are responsible for 14.4%.

Six in 10 of the surgeons involved in a never-event are named in more than 1 separate malpractice report, and more than 1 in 10 are involved in at least 1 separate surgical never-event.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Depression linked to paralysis

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2013

Heart Care Foundation of India and World Fellowship of Religions in association with Ministry of Earth Sciences Govt. of India and Delhi Public School Mathura Road observed World Earth Day 2013.

 
Dr K K Aggarwal
    National News

Post stringent norms, clinical trials in India plummet

New Delhi, April 21, 2013: Clinical trials of drugs in India have seen a drastic fall this year after toughened norms were introduced following Supreme Court directives as reported in The Hindu. Not only have the number of trial approvals in the country reduced, there has also been a significant reduction in the number of sponsoring pharma firms applying for such approvals. Official Health Ministry data shows that until January 31 this year, only six trials had been approved. Even these pertained to older applications where the Drug Controller General of India had asked the applying firms to make some amendments.

Sources say until April, only around 12 approvals have been granted by the DCGI for trials of drugs in India. Pending applications for trials as of today are just 70. This is in sharp contrast to the past when the number of Global Clinical Trials (GCTs) approved for conduct in India was in hundreds. Though in 2008 the DCGI had granted just 65 approvals for trials, the number in 2009 rose sharply to 391. The trend continued with a whopping 500 GCTs being allowed in 2010 and 325 in 2011 followed by 262 approvals in 2012.

Admitting that there has been a drastic fall in fresh applications for conduct of global clinical trials of drugs in the country, DCGI GN Singh told PTI, “The safety and well being of Indian subjects participating in clinical trials is the foremost in our minds.

“This is why the Government has tightened the norms putting the onus of safety of participants on firms conducting the trials. It is for the first time that such norms have been put in place.” As many as 2,262 people died in these trials during the past five years, leading to a public outcry and Supreme Court intervention for stricter norms for holding drug trials. The apex court had rapped the Health Ministry for allowing Indians to be used as “guinea pigs” in the conduct of drug trials. Also before the new rules were put in place, the average compensation awarded per death was a meagre Rs 2.2 lakh as per Health Ministry data.

The Government recently notified new rules for the conduct of drug trials in India, making it mandatory for investigators and sponsors to address issues of serious adverse events such as death of subjects involved in trials and fixing a formula for grant of adequate compensation in such cases. Pharma firms, the sources say, have been discouraged to apply for new trials due to recent stringent norms which the Government has notified as a precondition for grant of approvals. The new rules which came into force this year, for the first time, propose a formula for minimum compensation to be paid by the sponsoring firm in case of serious adverse events such as death or injury of the trial participant.

New rules also require the setting up of independent ethics committees under medical institutes to monitor ongoing drug trials. These committees must now be registered with the DCGI prior before the conduct of clinical drug trials. In the older system, pharma company hosting the trial could set up its own committee and have its own investigators for inquiring into serious adverse events. Currently pegged at USD 500 million, India’s clinical research market was projected to more than double and cross USD one billion mark by 2016 driven by a large and easy-to-access population with much lower cost than in the developed world.

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, every Thursday 4:30 PM in DD India

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/)

A total of 63 infanticide case were reported in India in the year 2011

The incidence decreased in the year 2011 (63 cases) from 100 cases in the year 2010. A total of 132 cases of feticide were reported in the country in the year 2011 as compared to total 111 cases in the year 2010. 0.222% children presenting in emergency care are victims of child abuse.

In the United States alone, up to 2500 children die of inflicted injuries annual with children under one year of age affected disproportionately. Higher rates of child abuse are reported from minority children.

For comments and archives

 
    Valvular Heart Disease Update

Bicuspid aortic valve can be associated with ventricular or atrial septal defect, hypoplastic left heart syndrome, patent ductus arteriosus, bicuspid pulmonic valve and Ebstein’s anomaly.

(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)

CV screening does not prevent disease over long term

According to a trial, cardiovascular screening may benefit individuals but was not powerful enough to have a long-term impact on the general population (European Association for Cardiovascular Prevention and Rehabilitation's EuroPRevent meeting). (Source: Medpage Today)

CDC releases food-borne illness report card

The Centers for Disease Control and Prevention (CDC) has released a report on the Foodborne Diseases Active Surveillance Network (FoodNet) results for 1996 through 2012. The findings suggest that there has not been a significant change in the overall incidence of selected monitored infections, though Campylobacter and Vibrio infections have increased. (Source: Medscape)

Light drinking in pregnancy seems safe

A recent study found that light drinking during pregnancy was not associated with development problems for children – at least up to the age of 7 years. (Source: Medpage Today)

Adequate vitamin D decreases risk of uterine fibroids

Women with adequate vitamin D levels may be about a third less likely to develop uterine fibroids, noncancerous tumors that are the leading cause of hysterectomy. (Source: Medscape)

Cortisol in hair may indicate CV risk

A new study reported that cortisol levels in the hair that remained elevated over time are a sign of increased risk of cardiovascular disease. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Why is laughter called a Yoga? Dr K K Aggarwal The word ‘yoga’ comes from the word ‘yolk’ which means to (cont) http://tl.gd/n_1rjuaju

@Dr Deepak Chopra: Why Does God Allow Evil? Please read my article published by @SFGate http://tinyurl.com/bpfmqgs

 
    Spiritual Update

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

Birth of Hanumana: was it a case of sperm donation?

When Lord Shiva spurted semen on seeing Vishnu in the form of the celestial enchantress Mohini (semen donation after getting excited), sages collected this semen (semen bank) and gave it to the wind-god Vayu (centrifugation to select the best of the sperms) who poured it into the ‘ear’ (mythical metaphor for the womb) of Anjani, who gave birth to Hanuman.

For comments and archives

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

What are the side effects of gonadotrophins?

Despite intensive monitoring, up to 30% of gonadotropin-stimulated pregnancies are multiple. Of the multiple pregnancies, about two-thirds are twins and one-third are triplets or more. Premature delivery is a known risk for multiple pregnancies. The greater the number of fetuses in the uterus, the greater the risk of premature deliveries. Premature delivery can subject the newborn to complications such as severe respiratory distress, intracranial hemorrhage, infection, cerebral palsy, and death. Some patients pregnant with triplets or more choose to undergo a procedure known as multifetal pregnancy reduction in an effort to decrease these risks. The most serious side effect of gonadotropin therapy is ovarian hyperstimulation syndrome (OHSS), in which the ovaries become swollen and painful. Careful monitoring of ovulation induction cycles with the use of ultrasound and/or measurement of serum estradiol levels, in conjunction with daily adjustment of gonadotropin dosage, will enable the physician to identify risk factors and prevent most cases of severe OHSS.

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

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

Blood transfusion

Blood transfusion is a broadly based discipline that overlaps and intersects many other medical, scientific and managerial fields, including hematology, immunology, genetics, histocompatibility, cellular function and metabolism protein structure and function, cryobiology, disposable equipment, bioengineering, statistics, data-processing, public relations, logistics and standardization.

For comments and archives

 
    An Inspirational Story

Perception

The situation

In Washington, DC, at a Metro Station, on a cold January morning in 2007, this man with a violin played six Bach pieces for about 45 minutes. During that time, approximately 2,000 people went through the station, most of them on their way to work. After about 3 minutes, a middle-aged man noticed that there was a musician playing. He slowed his pace and stopped for a few seconds, and then he hurried on to meet his schedule.

About 4 minutes later: The violinist received his first dollar. A woman threw money in the hat and, without stopping, continued to walk.

At 6 minutes: A young man leaned against the wall to listen to him, then looked at his watch and started to walk again.

At 10 minutes: A 3-year old boy stopped, but his mother tugged him along hurriedly. The kid stopped to look at the violinist again, but the mother pushed hard and the child continued to walk, turning his head the whole time. This action was repeated by several other children, but every parent - without exception - forced their children to move on quickly.

At 45 minutes: The musician played continuously. Only 6 people stopped and listened for a short while. About 20 gave money but continued to walk at their normal pace. The man collected a total of $32.

After 1 hour: He finished playing and silence took over. No one noticed and no one applauded. There was no recognition at all.

No one knew this, but the violinist was Joshua Bell, one of the greatest musicians in the world. He played one of the most intricate pieces ever written, with a violin worth $3.5 million dollars. Two days before, Joshua Bell sold-out a theater in Boston where the seats averaged $100 each to sit and listen to him play the same music.

This is a true story. Joshua Bell, playing incognito in the D.C. Metro Station, was organized by the Washington Post as part of a social experiment about perception, taste and people's priorities.

This experiment raised several questions:

  • In a common-place environment, at an inappropriate hour, do we perceive beauty?
  • If so, do we stop to appreciate it?
  • Do we recognize talent in an unexpected context?

One possible conclusion reached from this experiment could be this: If we do not have a moment to stop and listen to one of the best musicians in the world, playing some of the finest music ever written, with one of the most beautiful instruments ever made, then how many other things are we missing as we rush through life?

(Courtesy: Maj GenVinay Malhotra and Vasudha Seth)

For comments and archives

 
    Cardiology eMedinewS

Digital anatomical library created by scientists scanning the human heart Read More

 
    Pediatric eMedinewS

Lullabies and other music may help sick preemies 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)

The IM dose of Verorab (PVRV) and Abhayrab (PVRV) is 0.5mL; that of Rabipur (PCEC) and PVRV (Coonoor) is 1mL. Is the ID dosage of all vaccines uniformly 0.1mL?

The ID dosage of all approved vaccines is uniformly 0.1 mL per ID site irrespective of their IM dosage.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with diabetes was found to have aortic stiffness.
Dr. Bad: It is normal in diabetes.
Dr. Good: It is associated with albuminuria in the urine.
Lesson: Aortic stiffness is associated with incident albuminuria and the rate of decline in glomerular filtration rate in type 2 diabetic patients (Diabetes Care 2011 Dec;34(12):2570-5).

Make Sure

Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI.
Reaction: Oh my God! Why was a statin not started earlier?
Lesson: Make sure that all patients with even normal cholesterol are considered for statins if the hsCRP is high.

 
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

 
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  Quote of the Day (Dr GM Singh)

Adapt yourself to the life you have been given and truly love the people with whom destiny has surrounded you. Marcus Aurelius

 
    Mind Teaser

Read this…………………

Nurse Lei is aware that one of the following is an early sign of heart failure in an infant with a congenital heart defect?

a. Tachypnea
b. Tachycardia
c. Poor weight gain
d. Pulmonary edema

Yesterday’s Mind Teaser: An infant is hospitalized for treatment of inorganic failure to thrive. Nurse Faith is aware that the nursing action is most appropriate for this child?

a. Encouraging the infant to hold a bottle
b. Keeping the infant on bed rest to conserve energy
c. Rotating caregivers to provide more stimulation
d. Maintaining a consistent, structured environment

Answer for Yesterday’s Mind Teaser: d. Maintaining a consistent, structured environment

Correct answers: Dr Deepali Chatterjee, Dr BB Gupta, Anil Bairaria, Dr KV Sarma, Dr Pankaj Agarwal,
Dr Jainendra Upadhyay, Dr U Gaur, Dr Ayyavoo ERODE, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr K Raju, Dr pawan Mehta, Dr Avtar Krishan, Dr Kanta Jain, Tukaram Pagad,
Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 23rd April Mind Teaser: b. 1 week to 1 year, peaking at 2 to 4 months

Correct answers received from: Dr Jayashree Sen & Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

 
    Legal Question of the Day

(Dr. M C Gupta, Advocate & Medico-legal Consultant)

Q. What is the legal position regarding PG qualifications awarded by the CPS?

Ans.

  • The College of Physicians & Surgeons (CPS) of Mumbai is an examining body like Royal College of Surgeons, England, and was established around 1913, almost 100 years ago. It awards Fellowships and Diplomas.
  • Students wishing to join courses/examinations/Qualifications awarded by the CPS need to carefully checked beforehand with the MCI and the state medical councils as regards recognition.
  • Some of the available information regarding recognition is given below but this information needs to be further checked before relying/taking crucial decisions.
    • As stated in Dr. Nupur Vishnu Dhankani v. UOI & Ors, Bombay HC, decided on 5-1-2012, — “On 2 December 2009, the Union Government derecognized the Post-graduate Degree and Diploma Courses of the College of Physicians and surgeons”. http://bombayhighcourt.nic.in/data/judgements/2012/OSWP212311.pdf
    • Even though de-recognised vide Govt. Notification F.No.C.18018/3/2009-ME(P-II), dated 02/12/2009 the Cent. Govt. vide F.No.C.18018/3/2009-ME(P-II) dated 24.8.2011 clarified that the student who got admission before 02.12.2009 shall stand recognised.
    • It appears that the FCPS awarded by the CPS is recognized by Maharashtra Medical Council from March 15, 2010 and by Gujarat Medical Council from August 26, 2011.
  • As regards government service, persons whose qualifications are not recognised cannot get employment on the basis of such qualifications.
  • As regards working or practicing in the private sector, the persons having such qualifications and practicing the speciality concerned should be careful about the application of the following or other similar laws: i) Medical Council Act and the concerned state medical council act. ii) CPA iii) CEA or a similar Act if applicable in the state.
  • If a complaint is made under CPA alleging medical negligence, the court would mainly consider whether there was such negligence. If there is negligence, even a recognised PG degree holder can’t escape. If there is no proven negligence, the court is not likely to hold him guilty just because his CPS diploma is recognised in one state and not by the MCI.
  • If a complaint is made under CPA alleging wrong information to the consumer that the doctor said he was a specialist while he was not so as per the MCI, the consumer court is unlikely to hold the doctor guilty as long he does not make an open declaration in a manner which suggests that his specialist qualification is recognised by the MCI. I suggest that such a doctor should hold out on his prescription letter-head as follows: “Dr.XYZ, MBBS, DGO(College of Physicians & Surgeons, Mumbai)”
  • Medical Council Act/MCI Code of ethics Regulations, 2002—There is no clear legal provision under which they can take action. Regulation 7.20 reads—“A Physician shall not claim to be specialist unless he has a special qualification in that branch”. It does not specifically say—“ a special qualification in that branch recognised by the MCI”. If the medical council takes adverse action, it can be legally challenged.
  • Logic and common sense say that if a person is judged competent to treat patients as a specialist in Maharashtra, he should be judged competent to treat patients outside Maharashtra also.
 
    Laugh a While (Dr GM Singh)

Murphy's Laws for Humor

If at first you don't succeed, destroy all evidence that you ever tried.

 
    Medicolegal Update

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

Medicolegal cases & injury, assault and hurt in Indian law

The words injury, assault and hurt are invariably used by doctors in hospital practice and are used as synonyms. But all three have a different meaning as per law. It is defined by the Indian Penal Code as below:

  • Injury: Section 44 of IPC defines injury as any harm whatever illegally caused to any person in body, mind, reputation or property.
  • Assault: Section 351 of IPC defines assault as an offer or threat or attempt to apply force on body of another in a hostile manner. It may be a common/simple assault or an intention to murder.
  • Hurt: Section 319 of IPC defines hurt as whoever causes bodily pain, disease or infirmity to any person is said to cause hurt.

When we as doctors deal with cases of hurt/body injury, it means bodily pain, wound, disease or infirmity voluntarily caused to any person in medicolegal cases. These would include abrasions, contusions, lacerations, stab wounds, electric shock, firearm or ligatures etc. resulting in injury to the human body. The doctor who is certifying an injury report should keep in mind the Penal provisions (as below) required by police to book the case.

  • Simple injury: IPC Section 323
  • Simple injury caused by dangerous weapons: IPC Section 324
  • Grievous injury: IPC Section 325
  • Grievous injury caused by dangerous weapons: IPC Section 326
  • Dangerous injury: IPC Section 307
  • Injury likely to cause death: IPC Section 304
  • Injury sufficient to cause death: IPC Section 302
  • Causing hurt by means of poison: IPC Section 328

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Gums bacteria can cause preterm delivery

Proper dental care can prevent heart attacks, heart blockages, asthma and COPD. This was stated by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA. Bacteria present in the gums have been linked to many diseases in the past.

Periodontal treatment should be included in prenatal care programs, as per a study published in the Journal of Periodontology, which has shown that treating gum disease in pregnant women may prevent preterm birth.

The study has shown that while pregnant women, in whom the periodontal disease was treated, were no more likely to deliver their babies prematurely than women with no gum disease. Those who did not get treatment had a nearly 90-fold increased risk of premature delivery.

Another study found that the more bacteria women with periodontal disease had in their gums during and after pregnancy, the more likely they were to deliver their infants prematurely.

 
    Readers Responses
  1. Dear Sir, emedinews is very useful. Regards: Dr Tripti
 
    Forthcoming Events
Dr K K Aggarwal

10th National Summit on Stress Management and
Workshop on How to be Happy and Healthy

TENTATIVE PROGRAMME

Saturday 27th April 2013

2.00pm – 4.00pm                                      : Registration
4.00pm – 4.30pm                                      : TEA
4.30pm – 5.30pm                                      : Dr. K.K.Aggarwal
5.30pm–6.30pm                                        : Inauguration
6.30pm–8.00pm                                        : Brahma Kumaris
8.00pm – 8.30pm                                      : DINNER
8.30pm – 10.00pm                                    : Dr. K K Aggarwal Sunday

28th April 2013

7.00am–8.30am                                      : Meditation Session
8.30am–9.00am                                      : BREAKFAST
9.00am–11.00am                                    : Dr. K.K.Aggarwal
11.00am–11.30am                                   : TEA BREAK
11.30am–1.00pm                                    : Brahma Kumaris
1.00pm–1.30pm                                      : Prasad and Blessings
1.30pm–2.00pm                                      : LUNCH Farewell for a New Beginning

Dr K K Aggarwal
 
    eMedinewS Special

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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