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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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

 

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eMedinewS Presents Audio News of the Day

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

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
    Dr KK Aggarwal on Social Media …

ASAR–Aamir Khan & Dr KK Aggarwal on Satyamev Jayate Watch Video
Docs vs Aamir Khan Headlines today 9th June 2012 7.30pm Watch Video
Aamir Khan Workshop with kids on dangerous areas Watch Video
DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan Watch Video

 
  Editorial …

26th June 2012, Tuesday

In a village hospital, doctors separate twins to script medical history

Pritha Chatterjee: Betul, Sun Jun 24 2012, 01:36 hrs: Indian Express: On June 20, six friends from the 1982 batch of Christian Medical College (CMC) in Vellore and their former professor operated in the same theatre, after nearly 30 years. In a small missionary hospital tucked away in a village in Betul district, 200 km from Bhopal, near the southern border of Madhya Pradesh, the doctors performed the first successful separation of conjoined twins in a rural setting in the country.

The twins Stuti and Aradhana—christened by the hospital staff—were delivered in Padhar Hospital in May 2011. The "shocked" parents, a couple from Chicholi block, 40 km from Betul, told hospital authorities they would not be able to take them home. Formal adoption procedures were initiated at the district collector’s office, and the babies were "donated" to the hospital.

Barely a month after their birth, Dr Rajiv Choudhrie, medical superintendent of the hospital and a general surgeon, contacted his friends, over the phone—Dr Sanjeeth Peter, cardiothoracic surgeon based in Nadiad in Gujarat, Dr Gordon Thomas, paediatric liver transplant surgeon in Sydney and Dr Anil Kuruvilla, head of the department of neonatology in CMC, Vellore.

"Back then, I did not know if separation was even possible, let alone in this remote hospital of ours. I simply sought their medical opinion on the state of the fusion, and asked them if any intervention was possible," Choudhrie recalls.

Over the next few weeks, Dr Deepa Choudhrie, Rajeev’s wife, and a radiologist at the hospital, prepared extensive reports—CT scans, MRIs and ECGs that were emailed to Peters and Thomas. Their examination brought good news. "It was a form of conjoinment known as thoraco–omphalophagus, i.e. the twins had two separate hearts in a common sack, that is called the pericardium sack, and is crucial for supplying blood to the heart. Secondly, their livers had separate blood supplies, but were joined by a bridge of the liver tissue—so it was a big joint mass of liver between them," Brown explained. The condition merited surgical intervention. "Luckily, the case was not very complicated, because both the organs, the hearts and the liver, were separate it was just that they were joined. We had to separate the hearts and make two sacks out of the existing one, and decided the proportions in which we would distribute the liver. We felt sure it could be done," Peter added. Dr Rebecca Jacob, a former professor of anaesthesia at CMC, was the first to come for a recce in the hospital, in November last year. "My students often contact me for advise if there are complications. My first reaction when I saw the hospital was to move the babies to another setting for surgery. They had one anaesthesia workstation to give the drugs, that too for adults, and one ventilator that was also for adults. It seemed impossible to me at first," Jacob recalls.

Choudhrie says he was bombarded with similar reactions—ranging from voices of concern to outright laughter—at his idea. Today, as people laud him for his resolute, almost obstinate, decision to do whatever it took to perform the surgery in the village, he says there was no bravado involved. "I did not decide right in the beginning that we would to do it here. But after I approached so many specialists and took in their opinions, somewhere along the way I decided I wanted to do this. It was a tempting idea to send the babies away—everything would be so much easier in a setting that had all the facilities, but I kept myself from falling for it," he explains.

There were offers—from reputed centres and specialists—including Dr. Devi Shetty, to move the kids, and take over the procedure. Instead of accepting the offers, the team worked towards overhauling the existing set–up—preparing the infrastructure and putting together a team to perform the surgery. Over the next eight months, more doctors were contacted. Thomas approached a paediatric surgeon in Sydney, Dr Albert Shun, who has operated on thee conjoined twins so far. "Clinically I have dealt with more complicated surgeries. But this one had so many more challenges, it was a team put together from across the world in a rural setting and we had to literally build the operation theatre and the ICU for post–surgical care. This was my first time in India, and I have never seen so much intricate planning anywhere else in the world," says Shun.

Jacob contacted a paediatric anaesthesiologist in Sydney, Dr David Baines, who also had experience in operating on conjoined twins. "It’s amazing how much fun we have had, though there were no commercial gains—even our travel here was not funded for. It was a huge challenge and we took it. Now it’s a statement to India and the world: such a procedure can be performed in this setting provided doctors care enough," Baines says.

Specialists in paediatric surgery were also roped in, from the country’s other CMC in Ludhiana. The doctors, after their individual visits to Betul spread over November–February, sent their requirements to Choudhrie. "I got these huge lists, and despite some donations, we had no money. It was like having Rs 10 in your pocket and going to buy stuff worth thousands of dollars," Choudhrie laughs. There were requests for two of everything—high–end paediatric ventilators, monitors, heart and lung machines, suction tubes, internal defibrillators, cardiac monitors, pericardial patches, syringe drivers, vacuum machines and infusion pumps. "These were impossible lists. We at Padhar Hospital use innovative desi methods. We make dressing materials out of kitchen elastic wraps that achieve the same results as the kinds produced by vacuum machines–except the latter machine will cost Rs 10 lakh. Each ventilator was worth Rs 15 lakh," Choudhrie adds. However, none of the doctors wanted to compromise on the requirements. "This was a huge risk we were all taking— we wanted the surgery to be a success so that it would be a milestone for other rural hospitals to follow. We did not want to leave any stone unturned," Dr. Anil Kuruvilla, in–charge of the post–surgical critical care management team said.

When buying equipment did not work out with the existing donations, doctors approached companies to "loan" the equipment. "It’s not a practice that companies follow routinely. But after a lot of cajoling, they agreed to transport their equipment here for some time, with their service engineers, just for the duration of the surgery, and in return we buy some cheaper equipment from them later," Choudhrie says. For example, the hospital has to return both the paediatric ventilators once the children are better. Meanwhile, the babies were growing up in a dedicated centre in the hospital’s neonatal ICU. Two ayahs were appointed to look after them. Their mother, Maya Yadav was visiting them, though she had forfeited her rights to them. It was at this stage that another CMC classmate, Dr. Prabhakar Thyagarajan, a psychiatrist now working at Apollo Chennai, was also called in to Betul, to counsel the parents on the public outcry, on ways to bring leaders of their Yadav community–the decision–makers for the couple—on board, and prepare for a possible reconciliation of the family, post–surgery.

The first deadline for the surgery, fixed in March, had to be postponed. "We wanted to wait for the babies to grow up a bit, so they were healthy enough to sustain the procedure. We were also delayed because of the refusal from many companies to provide us the necessary equipment," Peters says. Doctors themselves brought a lot of disposables, many of which they did not end up using at all in the surgery. "We wanted to be over–cautious. The nearest tertiary hospital is 200 km away, so we knew the buck stopped with us. There are lots of wirings, tubes and drugs that are still lying in boxes," Jacob says.

From the second week of June, a team of 23 doctors from India and Australia arrived at Padhar Hospital. The children were examined and re–examined, their reports checked. A day before the procedure, a three–hour dummy surgery was fixed. "We got two dolls and stuck a plaster between them and took them to the operation theatre with the entire team. We colour–coded the tubings and separated ourselves into teams—the red team and the green team—encoding the wirings of each twin. Everything was fixed—the positioning of the various equipments, where the doctors, technicians and nursing staff would stand, everything," Peters recalls.

Anaesthetists joked about that dummy rehearsal being their first "bloodless surgery." Now, after achieving what many termed as unrealistic—with Stuti already off the ventilator and Aradhana looking well on the way to recovery—the doctors say the marathon 12–hour procedure seems like a dream.

In the four–part surgery, doctors first separated the hearts from the single sack, and stitched two patches on the existing pericardium– to make two sacks, and inserted the separate hearts inside each twin.

Then the liver was separated—after the proportion for each liver was fixed, and finally the sternum was cut into two. "In the last stage, I was so focused on cutting the sternum bone, I did not notice the anticipation that had come towards the end of the surgery. But just as I finished, the entire theatre erupted in cheers. Everybody was clapping. I know, for as long as I live and as many procedures I perform, I will never forget that sight," says Peter.

A week after the surgery, against the backdrop of the greenery along the Nagpur Hyderabad highway, it’s reunion time for the former classmates—playful jokes, recollections of an old college play, and memories of their "wild gang" days. "We are a close–knit batch. Six out of 60 of us are here—that’s 10 per cent of the batch—and our professor in anaesthesia. Barring old friends, who else would agree to such an adventure, in this setting, where the nearest tertiary hospital is in Nagpur or Bhopal, both at least 200 km away?" jokes Peter.

Twins on road to recovery Betul: At 5 am on June 23, nearly 55 hours after the surgery was completed, one of the twins, Stuti, has been taken off the ventilator. Stuti is crying, moving and is likely to be started on food soon. Aradhana is still on the ventilator but has started moving her hands and feet. Doctors changed her pericardial patch on Friday evening, and estimate another 24 hours of assisted breathing before she can be taken off the ventilator. Aradhana will also need some reconstructive surgery to cover the wound in her chest, in another two weeks. "The twins are lying on their back for the first time. Since they were conjoined, they would always lie facing each other, sideways. This is bringing a postural change in their haemodyanamic system, and we are waiting for them to adjust to it," Dr Sanjeeth Peter, cardiothoracic surgeon who is part of monitoring team, says.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

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

In a village hospital, doctors separate twins to script medical history

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Bimaare Ek Ilaj Anek

All pathy consensus organized by Heart Care Foundation of India in association with All India Radio

 
Dr K K Aggarwal
 
    National News

Birth of another healing hand' in the capital city of India

(S Dwivedi, Dean/Principal, Professor of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research)

The Hamdard Institute of Medical Sciences and Research (HIMSR), Hamdard University has now been given go ahead from MCI for starting MBBS from this session. This was the dream project of Jamia Hamdard since long and has been possible because of the dynamic and visionary VC Dr. GN Qazi.

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 re build the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Mass screening smell test discovers early Parkinson’s cases

A 1–day mass public screening testing people’s ability to detect 5 different scents identified 3 potential cases of early Parkinson’s disease (PD). An olfactory deficit is an early symptom of PD. The screening also turned up a substantial number of people with hyposmia caused by a variety of other conditions. (Source: Medscape)

For Comments and archives…

Bridges can be more cost–effective than dentures

Older patients who have lost some of their teeth may fare better with bridges that supply only the essential teeth than with dentures, researchers reported at the International Association of Dental Research (IADR) 90th General Session and Exhibition, underway in Iguacu Falls, Brazil. (Source: Medscape)

For Comments and archives…

Subclinical PID associated with infertility

In women with or at risk for gonorrhea or chlamydia or with bacterial vaginosis, infertility may be in part a result of subclinical pelvic inflammatory disease (PID), and current therapies for treating sexually transmitted diseases may be inadequate for preventing infertility, new research suggests. Harold C. Wiesenfeld, MD, CM, from the University of Pittsburgh School of Medicine, in Pennsylvania, and colleagues reported their findings in the July 1 issue of Obstetrics and Gynecology. (Source: Medscape)

For Comments and archives…

No increase in miscarriage risk with nonprescription NSAIDs

Women who use nonsteroidal anti–inflammatory drugs during early pregnancy are at no increased risk for spontaneous abortion, according to findings from a prospective community–based cohort study of more than 2700 pregnancies. The study is published online June 21 and in the July print edition of Obstetrics & Gynecology. (Source: Medscape)

For Comments and archives…

Cockroaches essential to our planet for converting nitrogen into fertilizer

They are the most despised of all insects, but an Indian origin biologist has said that cockroaches are essential to the survival of our planet’s delicate ecosystem. According to Srini Kambhampati, professor and chair of the biology department at the University of Texas at Tyler, the disappearance of cockroaches would play havoc with the nitrogen cycle. "Most cockroaches feed on decaying organic matter, which traps a lot of nitrogen. Cockroach feeding has the effect of releasing that nitrogen (in their feces) which then gets into the soil and is used by plants," the Daily Mail quoted Professor Kambhampati, a leading expert on roaches, as telling the Huffington Post. "In other words, extinction of cockroaches would have a big impact on forest health and therefore indirectly on all the species that live there," she stated. The professor also warned that the Earth’s 5,000 to 10,000 cockroach species are also an important source of food for many birds and small mammals like mice and rats. In turn, these predators are themselves prey to many other species like cats, coyotes, wolves and reptiles, as well as eagles and other birds of prey. Thus, any cut to the number of roaches would have a cascading effect on the wellbeing of all these species that could have a devastating effect on wildlife across the world. (Source: The Indian Express, Jun 23 2012)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: Now, undergo bypass surgery while you're awake The Times of India, Hetal Vyas Bangalore: Guruswamy, a… http://fb.me/1aUNNz8CF

@DeepakChopra: Neuroplasticity: You can mend your brain by minding it

 
    Spiritual Update

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

Science behind the Shradh Ritual

Shradhs are observed by every family in Indian Hindu culture to seek forgiveness from the diseased person and our ancestors for their unfulfilled known or unknown desires.

For Comments and archives…

 
    4th Asia Pacific Vascular Intervention Course (APVIC)

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

The 4th Asia Pacific Vascular Interventional Course begins Read More

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

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

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

4th Asia pacific vascular intervention course Read More

4th Asia pacific vascular intervention course paper clippings Read More

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the risks and complications of HSG?

A hysterosalpingogram or HSG is considered a very safe procedure. Some complications occur in less than 1% of cases.

  • Infection: The most common serious problem with HSG is pelvic infection. This usually occurs in the presence of previous tubal disease. In rare cases, infection can damage the fallopian tubes or necessitate their removal.
  • Fainting: Rarely, the patient may get light–headed during or shortly after the procedure.
  • Radiation exposure: Radiation exposure from a HSG is very low, less than a kidney or bowel study, and there have been no demonstrated ill effects from this radiation, even if conception occurs later the same month.
  • Iodine allergy: Rarely, a patient may have an allergy to the iodine contrast used in an HSG. A patient should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Patients who are allergic to iodine may have a sonohysterogram performed instead of HSG since that procedure uses non–iodine containing ?uids.
  • Spotting: Spotting commonly occurs for one to two days after the HSG. A patient should notify her doctor if she experiences heavy bleeding after the HSG.

For Comments and archives…

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

(Dr. Neelam Mohan, Director, Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation , Medanta – The Medicity Hospital)

What’s life after liver transplantation?

Children who survive liver transplant will usually achieve a normal lifestyle despite the necessity for continuous monitoring of immunosuppressive drug levels. They attend normal school sports, activities etc.

Most studies from large pediatric liver transplant centres show a patient survival of 90% at 1 year and > 85% at 5–10 years. Usually there are no significant issues related to mortality after this. Patients usually lead a normal life. There are patients who have been operated as children/adolescents and have also produced children. Patients take part in sports, normal activities and there are examples of children who’ve climbed mountain peaks. Post liver transplant children have grown up into smart adults, married and produced children.

However, regular follow up with doctor is a must to monitor the organ functions and side effects of immunosuppression.

For Comments and archives…

 
    An Inspirational Story

(Ms Ritu Sinha)

Will you be a memorable mother?

Will you be a mother who’s remembered fondly by your children when they’re grown? Will you be a mother who affects their lives in ways they’ll recall with love and laughter?

A family can be close and create fond memories by sharing and doing things together. However, it’s often to the mother that the task falls of initiating family activities and pleasures her children will engage in with their children in future years.

Do you recall incidents and traditions from your childhood you want to share with your children and create a feeling of family continuity?

I realize now that Mother often must have had work to do. But she took time from her busy day as a farmwife for walks and picnics with us four children, doughnut making feasts, story sessions at bedtime, swimming in the brook in summer, and listening to us and talking with us when we had problems or secrets to share.

Looking back, I never remember her remarking, "No, I’m too busy," although she must have said it many times. The memorable times we shared together far overshadowed the times she had to refuse.

My daughter and I engaged in some of these activities as I shared with her my childhood experiences. It helps to bring continuity to the generations as a child realizes he/she’s sharing in a long line of family traditions.

Just possibly the enjoyment of these childhood activities and family highlights will be remembered by their children when they have families of their own. I’ve heard my daughter say to her son and daughter, "When I was little, I used to do this…just like Nanny and Great Grandma did."

As I look around the happy faces at my husband’s family reunions, I realize that it was mainly because of my mother–in–law’s efforts that the family now has many memories to bind them together.

Families need a sense of belonging, a sense of doing things together that makes them part of a long line of families. In these days, when the family unit is battered on all sides, it’s often the mother who can do so much to make for her family a haven at home, a place of happiness and security, a place which will stir fond memories as the children recall the incidents that formed their lives because of their memorable mother.

For Comments and archives…

 
   Cardiology eMedinewS

New recommendations on pneumococcal, influenza vaccines Read More

FDA turns down Xarelto for ACS patients Read More

 
   Pediatric eMedinewS

Breastfeeding moms’ exercise OK for infant growth Read More

First–line HIV drugs not equal for kids Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A man who was to be married was found to be HIV–positive.
Dr Bad: Keep the report secret.
Dr Good: I will inform the girl to–be married.
Lesson: Sections 269 and 270 of the Indian Penal Code provide as under: "269. Negligent act likely to spread infection of disease dangerous to life – whoever unlawfully or negligently does not act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

For comments and archives

Make Sure

Situation: A patient with gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure, to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

For comments and archives

 
    Fitness Update

(Rajat Bhatnagar, International Sports & Fitness Distribution, www.isfdistribution.com)

Travel with more than your toothbrush!

Many people who travel for work or pleasure find it hard to stay physically active while away from home. Plus, travel usually means eating out a lot, often resulting in excess portions and calories. But, with a little planning, travelers can maintain their activity routines – and keep burning calories – anywhere they land. Before you depart, make sure the following items are packed:

  • Active clothes – shorts/stretchy pants, t–shirts (short or long sleeve, depending on the weather), and athletic socks
  • Active shoes – sneakers or other comfortable walking shoes
  • Stretching strap
  • Jump rope. Elastic band/tubing and sample strength exercises
  • Portable audio player (iPod, MP3, CD or radio) – consider downloading a custom workout to your iPod or MP3 player (e.g., www.podfitness.com)

Whether it be a walk through a local town or 30 minutes in the hotel fitness center, staying active on the road will help burn extra calories from restaurant meals, reduce stress, improve your sleep and minimize the effects of jet lag.

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    Health News Bulletin

Not just baby fat

MINT, Sujata Kelkar Shetty

New Delhi: India’s overweight children are caught in a vicious cycle of ill health. Parents can help by being supportive and by leading by example. A 14–year–old–girl in class IX in New Delhi had her parents worried. She had a petite 5ft, 1–inch frame and weighed a whopping 74kg. She also had excessive facial hair, acne and irregular periods. She seemed uninterested in playing sports or engaging in extra–curricular activities. Her parents took her to the doctor and medical investigations revealed that she was clinically obese, and her insulin levels were dangerously high. When the doctor probed further he found that a large portion of the girl’s diet consisted of fried foods and aerated drinks. She was barely exercising. She spent her time outside of school on the computer or in front of the TV. After a detailed investigation by an endocrinologist, dietitian and psychologist, it was decided that she needed to change her diet and get both exercise and behavioral counseling. She and her parents were counseled on the health pitfalls that awaited her if she didn’t lose weight, and on the benefits of exercise. She was encouraged to eat right and to do a minimum of 45 minutes’ exercise a day. After six months, her weight was down to 56kg and her Body Mass Index (BMI—a measure of body fat derived from a person’s weight and height) was at a healthy 23. Her insulin levels were back to normal, her facial hair, acne and period irregularity were less severe and the doctor told her everything would be back to normal as long as she maintained her weight.

 
  Quote of the Day

(Dr GM Singh)

Next to trying and winning, the best thing is trying and failing. Lucy Maud Montgomery

 
  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum calcium

Hypocalcemia or low serum calcium level must be interpreted in relation to serum albumin concentration (Some laboratories report a "corrected calcium" or "adjusted calcium" which relate the calcium assay to a normal albumin. The normal albumin, and hence the calculation, varies from lab to lab). True decrease in the physiologically active ionized form of Ca++ occurs in many situations such as:

  • Hypoparathyroidism
  • Vitamin D deficiency
  • Chronic renal failure
  • Magnesium deficiency
  • Prolonged anticonvulsant therapy
  • Acute pancreatitis
  • Massive transfusion
  • Alcoholism
  • Drug–induced: Most diuretics, estrogens, fluorides, glucose, insulin, excessive laxatives, magnesium salts, methicillin and phosphates.
 
  Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. A PIL has been filed in Madhya Pradesh High Court at Jabalpur, challenging the legality of Medical Strike on 25 June 2012. What are your comments?

Ans.

  1. It is not clear what the PIL is about. I have not seen it. The news report about the PIL refers to the All–India medical bandh. The IMA web site refers to it as a strike. Different terms like Strike, Protest, Agitation, No work, Work to rule, Pen down strike, Bandh, Gherao, Chakka jam etc. different connotations. The news report about the PIL refers to violence associated with a bandh.
  2. It is expected that an organisation like the IMA would have foreseen this type of PILs and would have taken necessary legal advice to plan their strike in such a manner that it is not legally flawed.
  3. As regards employees, the employer has a right to take action as per law if the employees indulge in something, including strike that is against law and the rules of service. Employees need to be cautious about breaking law that might invite legal action.
  4. As regards private enterprise, including private practice, the state or the courts cannot regulate their private acts unless those acts contravene law. They may be amenable to state control if they have received assistance from the state, such as land etc. allotted to them at concessional rates.
  5. There is no general rule that doctors cannot strike work. However, they should do so in such a manner as is consistent with law and is not against public good.
  6. In practical terms, the PIL has been admitted by the HC. Notice has been issued to the state government. It is listed for hearing on 25th June at 10-30 a.m. Arguments will be heard and some order may be passed. IMA is not a party to the case. If the orders/directions need to be acted upon by the IMA/doctors, they will have to be conveyed to them. That may not be possible before evening. By that time, the strike may be largely over in the state of MP. As regards other states, this PIL will have no effect because the jurisdiction of the HC is limited to the state concerned.

For comments and archives

 
  Rabies Update

(Dr A K Gupta, Author of Rabies the worst death)

1. Can rabies be transmitted to doctor/assistants conducting postmortem of a person died of rabies?

Rabies cannot be transmitted to doctors/assistants conducting postmortem of a person died of rabies. This is because the virus dies within about 20–30 minutes in tropical conditions in a dead person.

2. What are the common animal reservoirs of Rabies?

Rabies exists in two forms:

(1) Urban rabies, propagated chiefly by unimmunized dogs.
(2) Sylvatic rabies, propagated by skunks, foxes, raccoons, mongooses, wolves and bats.

Worldwide, the most common cause of human rabies infection is dog bite. In the northern hemisphere, rabies in wildlife is the main problem. In eastern European countries, the Red Fox is the main reservoir for the disease.

In India, the animals commonly responsible for transmission of rabies are dogs and cats (97%) followed by wild animals like mongoose, foxes and jackals (2%) and occasionally by horses, donkeys, monkeys, cows, goats, sheep and pigs.

 
    Mind Teaser

Read this…………………

Following surgery, Mario complains of mild incisional pain while performing deep breathing and coughing exercises. The nurse’s best response would be:

A. Pain will become less each day.
B. This is a normal reaction after surgery.
C. With a pillow, apply pressure against the incision.
D. I will give you the pain medication the physician ordered.

Yesterday’s Mind Teaser: A client has undergone laryngectomy. The immediate nursing priority would be:

a. Keep trachea free of secretions
b. Monitor for signs of infection
c. Provide emotional support
d. Promote means of communication

Answer for Yesterday’s Mind Teaser: a. Keep trachea free of secretions

Correct answers received from: Niraj Gupta, Dr LC Dhoka, Yogindra Vasavada, Dr PC Das, Dr Kanta Jain, Dr Thakor Hitendrsinh G, Dr Jainendra Upadhyay , Dr Chandresh Jardosh, gopal shinde, Dr Avtar Krishan.

Answer for 23rd June Mind Teaser: b. 6 to 12 months
Correct answers received from: Dr B Rajammal, Dr Dinesh Mishra, Dr Sarita Badlani, Dr PC Das,
Dr Sushma Chawla.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

A man can succeed at almost anything for which he has unlimited ENTHUSIASM.

 
  Medicolegal Update

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

What is Forensic Thanatology?

Thanatology is the branch of science that deals with death in all its aspects. Shapiro, a well–known thanatologist defined death as the irreversible loss of the properties of living matter. However, it is difficult to appreciate his claim that this definition satisfies the practical requirements for death certification.

  • Black’s law dictionary (Black 1951) in United States defines death as "The Cessation of life, the ceasing to exit", defined by physicians as total stoppage of circulation and cessation of vital functions, thereupon such as respiration and pulsation
  • Section 46 IPC states that death denotes the death of a human being unless the contrary appears from the context.
  • Section 2 (b) of the Registration of Births and Deaths Act defines death as Permanent disappearance of all evidence of life at any time after live birth gas taken place.

(Ref: Dr. PC Dikshit, Head (MAMC) MD LLB, Concise Textbook of Forensic Medicine & Toxicology, Peepee Publishers)

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Panel discussion on Rog ek Elaaj Anek

1st July is observed as Doctors Day every year.

To ear mark the occasion, All India Radio along with Heart care Foundation of India and India Habitat Centre are jointly organizing a panel discussion on Rog ek Elaaj Anek on Thursday 28th July at Casurina Hall, India Habitat Center, Lodhi Road, New Delhi at 7 p.m.

The panel discussion will have experts from all pathies. The panel discussion will be moderated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal and President Heart Care Foundation of India. The panelists will include Dr Shikha Sharma (Wellness Expert), Dr Ishwar V Basavvadadde (Naturopath), Dr Praveen Bhatia (Obesity Surgeon), Dr S V Tripathi (Ayurveda) and Dr Mridula Pandey (Homeopathy).

The entry to the public is free.

Obesity is the new epidemic of the society and is responsible for increasing numbers of heart attacks, paralysis, diabetes and hypertension. It is a lifestyle disorder and completely preventable.

Unlike the west, obesity in India is more central and presents as pot belly obesity.

 
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  1. Dear Sir, eMedinews is very informative. Regards: Dr Shipra
 
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Dr K K Aggarwal


Dr K K Aggarwal


Dr K K Aggarwal


Dr K K Aggarwal

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
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Ph: +91.124.2223836, Mobile: +91.9811108230

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September 23, 2012 at 9:00 AM – 6:00 PM
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http://www.heartcarefoundation.org

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