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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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 & 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 …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

27th January 2013, Sunday

IMA Suggestions for Health Budget 2013-2014 (Suggestions invited)

A meeting on the Health Budget for the year 2013-14 was held on 21st January, 2013 at IMA House. The following were present:-
Dr Narendra Saini, Hony Secretary General, IMA; Dr D R Rai, Sr. National Vice President, IMA; Dr K K Aggarwal, National Vice-President (Elect) IMA; Dr Atul Arora, Hony. Joint Secretary, IMA; Dr Nipun Choudhury, Apollo Hospital; Dr Atul Gandotra, Consultant Pharmaceutical; Dr S C Pandey, Central Govt. Hospital; Dr K K Kalra, NABH; Dr Chander Prakash, Sunder Lal Jain Hospital; Dr Girdhar Gyani, AHPI; Dr Vijay Aggarwal, PCH; Dr Zainab Zaidi, NABH; Dr B K Rana, NABH ; Dr Vijay Kohli, DMA; Dr R K Katharya, Hony Joint Secretary, IMA; Dr R K Gupta, Hony. Joint Secretary, IMACGP; Dr K K Kalra, NABH; Dr B K Rao, SGRM; Dr M K Singhal, IMA Rohini IMA; Dr Kalra, MS Hedgewar Hospital; Mr Atul Gandotra; Dr Himanshu Jain, HRH and Dr M Bakshi, HRH.

Basic issues
1. Food security, primary education, primary justice and primary healthcare are the minimum requirement of common man.
2. Health care needs coordinated effort of all healthcare workers.
3. The benchmark set for the standard health care: accessible, affordable and quality health care.
4. Current situation: Central Budgetary allocation of health- 0.9% of GDP; State expenditure on health- 5.5% of the budget; Central funding in the state for public health- 15%; 75-80% out of pocket expenditure; 70% of patients are managed by private sector and around 15 lakh doctors only 1.5 lakh in Govt.

IMA Recommendations
Healthcare Status
a. Health should be given infrastructure status and should be notified.
b. No commercial rates for electricity and water consumption for healthcare sector. It should be flat domestic rate without any slabs.
c. Upgrade districts hospitals to medical colleges or super- specialty hospitals.
d. Encourage PPP
e. Incentives for healthcare infrastructure providers: tax holidays, income tax rebates, provision of cheap medicine and instruments.
f. Easy Visa for patient who want to come for treatment from other countries.

Health budget allocation
a. Increase the budget for the Health to 2.5 % of GDP as envisaged in National Health Policy 2002.
b. No allocated funds for equipments, schemes, campaigns, projects should lapse. Accountability should be there.
c. Increased budgetary provisions for: drugs in govt. hospitals (at present only 15%); non communicable diseases; disease surveillance; safe drinking water; sanitation; mental health; child and maternal health; geriatric care; cancer.
d. Separate new fund provisions for reimbursements of emergency treatment given in private sector; for production of indigenous drugs, equipments and products.
e. More fund allocation for telemedicine and mobile units.
f. More fund allocation for new medical, nursing, dental and paramedical colleges.
g. Generic medicine should be available freely and their retail price should be properly monitored.

Taxes, custom Duty
a. Tax rebate on Preventive health check-up and health insurance at present is Rs.10,000 it should be increased to Rs. 25,000
b. Zero duty on medical equipments, drugs and reagents. Govt. get only Rs. 2 24 crore as duty through life saving equipment which is a meager amount.
c. Research and development should be given tax rebate. Special incentive should be provided for R & D.
d. No tax should be imposed on indigenous medicine and equipments.
e. Hospital should not be treated as “commercial venture” so property tax and land taxes should be charge as normal taxes.
f. Income tax free income for doctors willing to serve the rural areas.
g. Income tax reliefs for doctors who document 10% free service in their practice.

2. Insurance
a. Remove Service Tax on Medical Insurance.
b. Free insurance for the elderly
c. Soft loans for medical education and for opening of medical establishment.
d. Micro insurance (low premium for low income group) must be addressed

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Pain is a must to diagnose irritable bowel syndrome

According to the Rome III criteria, diagnosis of irritable bowel syndrome requires the presence of recurrent abdominal pain or discomfort (an uncomfortable sensation not described as pain) for at least 3 days a month in the past 3 months, associated with two or more of the following:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in form (appearance) of stool

These criteria should be fulfilled for the past 3 months with symptom onset at least 6 months before diagnosis.

(Spiller R, Aziz Q, Creed F, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 2007;56:1770–98).

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Monitoring LFT in a patient on statins

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions. Brig. (Dr.) AK Dhar received eMedinewS distinguished lecture Award

 
Dr K K Aggarwal
    Be Human Stop Child Abuse (Team IMA for CMAAO)

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

Children with emotional abuse may present with anxiety, depression, agitation, fearfulness, social withdrawal, running away from home, developmental delay, drug or alcohol abuse, anorexia nervosa bulimia.

For comments and archives

    National News

Health cover set to cost 25% more

Mayur Shetty, TNN | Jan 26, 2013, 01.24AM IST MUMBAI: Public sector non-life companies are set to revise health insurance rates by 20-25% with the regulator moving fast on approvals of new plans. A proposal to increase premium rates has been pending with theInsurance Regulatory and Development Authority (IRDA) for some time and the current schedule of rates has been in force for nearly five years now. State-owned insurers say that their combined ratio in health insurance is over 120%. In other words, the money they spend by way of claim payment and administration costs exceeds premium income by 20%. The regulator is in agreement that the ratio has to improve for the business to be solvent. However, while the PSU insurers say that rates should rise marginally every year to keep pace with medical inflation, the regulator wants them to have consistency in pricing for at least three years.
Since health insurance policies are annual contracts, companies do not charge 'level' premiums like in life insurance and instead calculate premium afresh every year based on the insured person's age. As a result, even without any revision in rate schedule, policyholders end up paying more as they move from one age bracket to another.
The last time insurers revised their schedule of rates five years ago, there were cases where individuals who moved into a higher age bracket got renewal notices for more than 100% of earlier premium. IRDA then issued a diktat stating that premium increases cannot exceed 75%.
PSU non-life insurers have been speaking about increasing rates for several months. TOI had twice reported the impending rise in rates in its November 22, 2012 and July 29, 2012 editions. Insurance officials said that even after the increase in rates, health insurance would not be a profitable business. According to insurers, the key to improving the pricing is to improve distribution and get more young policyholders. For this, it is necessary to keep premiums low.
Industry officials say that for a young buyer the cost of health insurance is around 2% of the sum insured and continues to be among the cheapest in the world. In the latest edition of IRDA's monthly journal, regulatory body's chairman J Harinarayan points out to the increased usage of health insurance by a section of the population. "It is also observed that most of the claims in the domain come from a concentrated group of policies, thereby necessitating a high incidence of cross-subsidization. While it would be ambitious to expect that there should be a very high uniformity in the claims occurrence, such a conspicuous skew is undesirable; and would be detrimental to the healthy growth of the industry in the long run," he said.
The regulator added that there is a need for studying and understanding the claims propensity of different cross-sections of policyholders; and take steps to even it out to the extent possible. "Such an analysis would also result in the identification and arresting of various frauds - either unintended or deliberate," he said. Although private health insurers are growing their portfolios, the individual business continued to be dominated by the four public sector companies - New India Assurance, National Insurance, Oriental Insurance and United India. "A cursory look at the business figures indicates that a major chunk of the business in this sector comes from just a handful of insurers, thereby indicating that a large number of players have either some hesitancy towards this line of activity; or that they are deliberately keeping away from the class, conscious of the tough demands associated with it. For a healthy growth of any class of business, it is essential that all the players play an equally important role and desist from the practice of choosing seemingly simple and profitable lines," Harinarayan said in the journal.


South India worst hit by diabetes

NEW DELHI: Diabetes and hypertension, traditionally seen as a rich man's disease, has made its way to the slums. Health ministry's fresh data shows one out of every four persons living in the urban slums of Chennai suffer from diabetes — which is three times higher than the national average of about 7%. In the slums of Bangalore the prevalence rate of diabetes was reported to be 14.77%, followed by 13.37% in Ahmedabad. Delhi had among the lowest rates of 5.02%. "The results of Chennai are shocking. I have asked the state health officials concerned to identify all positive cases and refer them to the nearest centre for treatment," said Dr Jagdish Prasad, the Director General of Health Services (DGHS). He said the union health ministry started targeted screening in urban slums in June 2011. "So far we have screened about 10 lakh people in Delhi, Bangalore, Chennai, Ahmedabad and Assam," said Prasad. Medical experts say poor eating habits and sedentary lifestyle is the main reason for the rise in diabetes among the urban poor. "It is a false belief that only those eating burgers and pizzas can get obese and develop diabetes. High consumption of fried items such as kachori, samosa and gulab jamun can also led to the onset of diabetes," said Dr H P S Sachdev, senior consultant pediatrics at Sitaram Institute of Science and Research. Sachdev said people living in urban slums generally did less physical activity than their rural counterparts. (Source: TOI, Jan 25, 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

    Valvular Heart Disease Update

Sudden death can occur in children with aortic stenosis due to a bicuspid aortic valve, especially during and immediately after exertion.

(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)

PET scan spots brain trauma in ex-athletes while alive

A new imaging technique has allowed detection of tau protein abnormalities in the concussed brains of living retired football players that are identical to the autopsy findings of chronic traumatic encephalopathy (CTE) in deceased athletes, researchers reported. (Source: Medpage Today)

No FDA approval yet for extended-release PD treatment

The US Food and Drug Administration (FDA) has issued a complete response letter on a New Drug Application (NDA) from Impax Pharmaceuticals for an extended-release capsule formulation of carbidopa-levodopa known as Rytary (IPX066) for the treatment of idiopathic Parkinson's disease (PD). (Source: Medscape)

ARDS numbers after trauma may be on the wane

The incidence of post-trauma acute respiratory distress syndrome (ARDS) declined over the course of a decade, researchers reported at the Society of Critical Care Medicine meeting. (Source: Medpage Today)

Folic acid supplementation not linked to cancer

Folic acid supplementation does not appear to increase or decrease the risk for site-specific or overall cancer in the first 5 years of treatment, according to the findings of a meta-analysis. Stein Emil Vollset, MD, from the University of Bergen in Norway, and colleagues published their findings online January 25 in the Lancet. (Source: Medscape)

Shorter wean time seen with tracheostomy

Using a tracheostomy collar enables earlier weaning from mechanical ventilation than pressure support in patients who need prolonged mechanical ventilation, researchers reported at the Society of Critical Care Medicine meeting. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Today's health question When we go for a fasting lipid test what does fasting means? Yesterdays question: (cont) http://tl.gd/kq59i5

@DeepakChopra: Starting my class soon at Columbia Business Schoolhttp://twitpic.com/bxlmkb

 
    Spiritual Update

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

Why different reactions to the same feeling?

If your son commits a mistake and sleeps with a girl, your approach is protective. You will never ask the son to leave the house. Similarly, if your daughter commits the same mistake, then also you never take action or take her out with all legal rights. In both the situations, you approach is protective.

For comments and archives

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

How early can endometriosis be identified?

Early endometriosis implants look like small, flat patches, blebs or flecks sprinkled on the pelvic surface. The flecks can be clear, white, brown, red, black or blue. Some women may have a few endometriosis implants on the surface of the pelvis, the peritoneum, or pelvic organs, or it may invade the peritoneum and grow as nodules.

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

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

What is the minimum amount of liver required for the recipient?

The recipient needs at least a liver volume of 0.7-0.8% of his body weight.

For comments and archives

 
    An Inspirational Story

A simple gesture

A little boy selling magazines for school walked up to a house that people rarely visited. The house was very old and run down and the owner hardly ever came out. When he did come out he would not say hello to neighbors or passersby but simply just glare at them.

The boy knocked on the door and waited, sweating from fear of the old man. The boy's parents told him to stay away from the house, a lot of the other neighborhood children were told the same from their parents.

As he was ready to walk away, the door slowly opened. "What do you want?" the old man said. The little boy was very afraid but he had a quota to meet for school with selling the magazines.

"Uh, sir, I uh am selling these magazines and uh I was wondering if you would like to buy one." The old man just stared at the boy. The boy could see inside the old man's house and saw that he had dog figurines on the fireplace mantle. "Do you collect dogs?" the little boy asked. "Yes, I have many collectibles in my house, they are my family here, they are all I have." The boy then felt sorry for the man, as it seemed that he was a very lonely soul. "Well, I do have a magazine here for collectors, it is perfect for you, I also have one about dogs since you like dogs so much." The old man was ready to close the door on the boy and said, "No boy, I don't need any magazines of any kind, now goodbye."

The little boy was sad that he was not going to make his quota with the sale. He was also sad for the old man being so alone in the big house that he owned. The boy went home and then had an idea. He had a little dog figure that he got some years ago from an aunt. The figurine did not mean nearly as much to him since he had a real live dog and a large family. The boy headed back down to the old man's house with the figurine. He knocked on the door again and this time the old man came right to the door. "Boy, I thought I told you no magazines."

"No, sir I know that, I wanted to bring you a gift." The boy handed him the figurine and the old man's face lit up. "It is a Golden Retriever, I have one at home, this one is for you." The old man was simply stunned; no one had ever given him such a gift and shown him so much kindness. "Boy, you have a big heart, why are you doing this?" The boy smiled at the man and said, "Because you like dogs."

From that day on the old man started coming out of the house and acknowledging people. He and the boy became friends; the boy even brought his dog to see the man weekly.

This simple gesture changed both of their lives forever.

For comments and archives

 
    Cardiology eMedinewS

Kidney disease is a powerful predictor of death in diabetes Read More

Liposomal vincristine 'appears to be a step forward' Read More

 
    Pediatric eMedinewS

Measles cases and deaths fall globally Read More

Newborn hearing tests not foolproof Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A type 1 diabetic came with A1c of 7.2%.
Dr Bad: Its ok.
Dr Good: You need better control.
Lesson: Blood sugar control can minimize risks for retinopathy, nephropathy and neuropathy in both type 1 and type 2 diabetes, and cardiovascular disease in type 1 diabetes.

Make Sure

Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

 
    Quote of the Day (Dr GM Singh)

Insan Kehta Hai Agar Paisa Ho To Mai Kuch Kar Ke Dikhau aur Paisa Kehta He Tu Kuch Kar Ke Dikha To Mai Aau .... Create Success....

 
    Legal Question of the Day (Dr. MC Gupta)

Q. I appeared as a faculty at the time of MCI inspection of college A. In September, I want to leave college A and join college B in the absence of relieving certificate from the previous college. Will you advise me to do so?

Ans.

  1. If you are leaving college A as per the terms and conditions of the contract of service, it is illegal on the part of college A to deny you relieving certificate. I have had 3-4 cases where my clients (faculty members) were denied the relieving certificate but the same was issued when legal notice was sent.
  2. Employers deny relieving certificate pursuant to certain vague directions of the MCI which have no legal force. In one case, a WP was filed in Delhi HC and MCI was also made a party. The WP was withdrawn because the HC felt it should be filed in the state where the college was situated. It could not be filed again because of miscellaneous reasons.
  3. I will not advise you to make the desired change on your own. You must do so in consultation with a lawyer. Lawyers know how to proceed so that legal complications are avoided and the desired result achieved.
 
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

 
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    Mind Teaser

Read this…………………

If a client has severe bums on the upper torso, which item would be a primary concern?

A. Debriding and covering the wounds
B. Administering antibiotics
C. Frequently observing for hoarseness, stridor and dyspnea
D. Establishing a patent IV line for fluid replacement

Yesterday’s Mind Teaser: After Billroth II Surgery, the client developed dumping syndrome. Which of the following should the nurse exclude in the plan of care?

A. Sit upright for at least 30 minutes after meals
B. Take only sips of H2O between bites of solid food
C. Eat small meals every 2-3 hours
D. Reduce the amount of simple carbohydrate in the diet

Answer for Yesterday’s Mind Teaser: (A) Sit upright for at least 30 minutes after meals

Correct answers received from:Pradip das, Raghavendra jayesh,Dr Avtar Krishan, Anil Balaria,

Answer for 25th January Mind Teaser: Medicate the patient for pain.Medicate the patient for pain.

Correct answers received from: Dr Jainendra Upadhyay, DR ARPAN GANDHI, Dr Pankaj Agarwal, Dr.K.V.Sarma, Muthumperumal Thirumalpillai, Dr. Thakor Hitendrsinh G, Dr Avtar Krishan, Dr B K Agarwal, Dr Avtar Krishan, DR P K SAHU,

Send your answer to ijcp12@gmail.com

 
   Laugh a While (Dr GM Singh)

Funny definitions

Inflation: Cutting money in half without damaging the paper.

 
    Medicolegal Update

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

Wisconsin appellate court stated

Perfection is a standard to which no profession can possibly adhere. Doctors are required to exercise reasonable care; they are not required to be perfect.

  • In order to establish medical malpractice, it must be shown by a preponderance of evidence that the injury complained of by the patient was caused by the doing of some particular thing that a physician of ordinary skill, care, and diligence would not have done under like or similar conditions or circumstances, or by the failure or omission to do some particular thing that such a physician would have done under like or similar conditions or circumstances…The standard of care for the physician…should be that of a reasonable doctor.
  • Illinois Supreme Court refined its opinions about standard of care which in common law is generally understood to mean a measure or rule against which a defendant’s conduct is to be measured.
  • The established standard of care for all professionals is stated as use of the same degree of knowledge, skill, and ability as an ordinarily careful professional would exercise under similar circumstances.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Can’t avoid anger: take aspirin

Emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute heart attack.

Episodes of anger are capable of triggering the onset of acute heart attack and aspirin can reduce this risk said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & National Vice President Elect IMA.

Angry people who can not control their anger should ask their doctors to consider taking aspirin.

Quoting a Harvard study Dr Aggarwal said that Doctors at the Deaconess Hospital, Harvard Medical School, Boston, interviewed 1623 patients (501 women) an average of 4 days after a heart attack.

The onset anger scale identified 39 patients with episodes of anger in the 2 hours before the onset of heart attack. The relative risk of heart attack in the 2 hours after an episode of anger was 23.

Regular users of aspirin had a significantly lower relative risk (1.4) than nonusers (2.9).

Anger in response to stress is also of particular importance for the development of premature heart attack in young men. An episode of anger may also trigger an acute heart attack in the next 2 hours.

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 25057 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 Responses
  1. Dear Sir, Thanks for the list of Padma Awardees. Regards: Dr Sudha
 
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