emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
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


27th July, 2010, Tuesday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Can a pediatrician expected to treat an adult?

A private doctor was fined '3 lakhs for not attending to Mr. K.L. Guliyani, a Kargil fighter. The details of the cases were covered in national newspapers in front page or in the local city page. I remember, the case which happened when I was the President Elect of Delhi Medical Association and also I was a part of the DMC team which investigated the matter of Orchid Hospital.

As per the reports, Mr. Guliyani who was traveling in a DTC bus was robbed and stabbed by some pickpockets in Janakpuri just opposite the clinic of Dr. Manocha. He was bleeding profusely. Dr. Manocha is a consultant pediatrician. As per the newspaper reports, the bleeding patient was brought to his clinic by passerby. About 50 meters away from Dr. Manocha’s clinic is Orchid Hospital which has got indoor facilities. Dr. Manocha did not have any of these indoor facilities in his clinic and asked them to take the patient to the nearest Orchid hospital. When they (patient) reached the Orchid hospital, he was declared ‘brought in dead”.

We all understand the Supreme Court guidelines that every serious patient must be rendered medical help to save his life, but there are many points which this case raises:

  1. Consumer Rights starts once the patient pays for his or her services. In this case, no fee was paid to the doctor but still the case went to the Consumer Court.
  2. Is a private pediatrician consultant is expected and / qualified  to attend to adult cases in emergency? Are they required to remember how to treat adult patients?
  3. What is wrong if Dr. Manocha had asked to take the patient to the nearest nursing home/hospital which is only 50 meters away from his clinic as there was no way Dr. Manocha could have given any service to an adult patient in his clinic. If he would have attended the patient in his clinic, it would have been a waste of time. In that case, if the patient would have died, allegations would have been that why he was not shifted to the nearest hospital when the Doctor was not qualified to look after the adults.
  4. A patient who died within minutes could have died in his clinic also. There is nothing doctor can do without indoor facilities and emergency equipment facilities. 
  5. The only thing a doctor can offer is CPR which is usually not effective in road accident cases or in case of stab injuries. CPR is only effective if a patient dies of heart attack.
  6. The patient who was profusely bleeding required immediate IV fluid and blood transfusion the facility of which can only be provided in a hospital setting.

At the most, it can be a case of ‘error of judgment’ as the pediatrician thought at that moment that it was safer to send him to Orchid Hospital and did not attempt to treat him in his own clinic. I think, this is one matter IMA should look into and fight for doctor’s case and appeal to the High Court.

(With inputs from Dr. R.S. Bajaj, the Consultant Pediatrician, Rohini)

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 



Photo Feature (From HCFI file)

Heart Care Foundation of India (HCFI) organised an award  function in 1989 to recognize outstanding contributions of doctors from difference fields of medicine

IN the Photo: Gyani Jail Singh, Former President of India awarding Dr Samuel B Ritter for  his outstanding contribution in Fetal Color Doppler Echo

Dr k k Aggarwal

 

News and views

What the national dailies report
Worst dengue threat in 4 yrs (Hindustan Times)

Delhi is grappling with the biggest dengue outbreak since 2006. There have been 30 cases of dengue this year till July 26, according to MCD data, against only two cases till the same time last year. A survey of six private hospitals in the city indicated the number could be higher. “MCD does not accept a case as dengue until it gets a positive dengue serology report,” said Dr K.K. Aggarwal, chief physician at Moolchand Hospital. “People test positive only five days after the onset of fever, so many cases are missed.” Mosquito-breeding sites detected by the MCD have gone up threefold this year. The MCD has sent already legal notices to almost 34,000 homes and government departments against 14,000 last year. The situation is particularly alarming at the Commonwealth Games construction sites such as the Yamuna Sports Complex, the CWG village, Shivaji Stadium and the Indira Gandhi Stadium, where high mosquito breeding has been detected. “Delhi has been getting intermittent rains. The warm, humid weather is conducive to mosquito breeding,” said  Dr. N K Yadav, medical health officer, MCD.

International

Nano–sized efavirenz looks doable

Researchers have been successful in shrinking efavirenz into nano–sized particles in order to reduce dose and side effects of this mainstay antiretroviral drug without losing efficacy in HIV treatment. In vitro studies show that spray–drying technology can produce 211 nanometer–sized particles of the non–nucleoside reverse transcriptase inhibitor to be encased in polycaprolactone, which, in turn, can be packaged into capsules. Lebogang Katata, PhD, a research chemist at South Africa’s Council for Scientific and Industrial Research based in Pretoria said that these capsules will enable smaller doses of efavirenz that will be able to penetrate tissue better than current efavirenz products.

Obesity in young adults may predict later Psoriatic arthritis

Early adulthood obesity is an independent risk factor for the development of psoriatic arthritis. Razieh Soltani–Arabshahi, MD, and colleagues from the University of Utah in Salt Lake City observed in their case series of almost 1,000 patients with psoriasis, that those with a high body mass index (BMI) at age 18 years had an odds ratio for developing PsA of 1.06 (95% CI 1.02 to 1.10, P<0.01). Each unit increase in BMI at age 18 was associated with a 5.3% increase in risk. Those who were obese at that age were three times more likely to develop arthritis in the course of their psoriasis than were those of normal weight. The study findings are reported in the July Archives of Dermatology.

When can patients with heart disease fly?

In a new guideline published online in the journal Heart, patients with stable heart failure, angina, and arrhythmias including those with pacemakers and implantable cardioverter defibrillators (ICDs) can fly freely. The present recommendations were made by a working group of the British Cardiovascular Society after a 2007 House of Lords Science and Technology Committee report on the topic. Those who've had an acute coronary syndrome and appear to be at low risk can fly as early as three days later. Those with a medium risk can fly after 10 days, and those at highest risk should avoid doing so till a more stable situation is achieved.

Disrupted sleep patterns may contribute to risk of diabetes, obesity

According to a study published in the journal Nature, disrupted sleep patterns may add to the risk of obesity and diabetes.

 

Legal Column

Forensic Column: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Summon from court of law (Contd…)

  • The medical professional must keep in mind that the Criminal Courts have priority over Civil Courts. If a witness is summoned by two Courts on the same day, one of which is criminal and other civil, he should attend the Criminal Court and inform the Civil Court of his inability to attend, giving his reasons. Higher Courts have priority over the lower.

  • If he is summoned from two Courts of same status, he must attend the Court from where he received the summons first, informing the other Court about it. He can attend the second Court after finishing his evidence in the first Court.
 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

Dr. Neelam Mohan – Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity

Gastroesophageal Reflux Disease in Children (Contd…)

Management of GERD

Lifestyle changes

Positioning: There is some evidence which indicates that placing the child in a head–elevated prone position may result in both fewer and shorter episodes of reflux, but concerns regarding the association between prone positioning and sudden infant death syndrome (SIDS) required a reassessment of the benefits and risks of prone positioning for reflux management. It is recommended that infants be placed right–lateral for the first hour after feeding to promote gastric emptying and then switched to left– lateral thereafter to decrease reflux
.

Question of the Day

Can lupus occur in children without a malar rash? (Dr. Sujata Sawhney, New Delhi)

The classic example of a patient with lupus is one who has a frank malar rash, low platelets, skin vasculitis and moderate proteinuria. These patients are very easy to spot and the diagnosis of SLE is fairly straightforward. In pediatrics, such clinical situations are not very common and children who present with SLE often do not have facial rash. Thus, up to 30% of patients with SLE do not have a malar rash at disease onset. Fatigue, fever and multi system involvement are all pointers towards SLE.

Reference

  1. Petty RE, Laxer RM. Systemic lupus erythematosus; Elseiver Saunders. In: Text book of pediatric rheumatology. 5th edn., 2005:p342–406.
 

Public Forum (Press Release for use by the newspapers)

Diabetics should not smoke

The health hazards of cigarette smoking in the general population are well known. In patients with diabetes mellitus, smoking causes a substantial increase in risk for both macrovascular (cholesterol deposition) and microvascular (eye, kidney involvement) disease said  Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Smoking is an independent risk factor for all-cause mortality, due largely to cardiovascular disease.

There is a dose-response relationship between current smoking status and risk of coronary disease in women with diabetes. The risk is 1.7 and 2.68 for 1 to 14 and >15 cigarettes per day, respectively.The risk returns to baseline in those who had stopped smoking for more than 10 years.

The risk of mortality in diabetic women also increases with the number of cigarettes smoked per day. The risk is 1.4 and 2.1 for 1-14 and >35 cigarettes/day, respectively. The risk decreases substantially 10 years after quitting smoking (risk 1.1)

Smoking is associated with increases in the serum concentrations of total cholesterol and very-low-density lipoprotein cholesterol, a decrease in serum high-density-lipoprotein cholesterol concentrations, and a greater degree of insulin resistance.

Smokers, via an uncertain mechanism, have poorer glycemic control.
In patients with type 1 diabetes, smoking is independently associated with an increase in urinary albumin excretion and nonproliferative retinopathy; the degree of albuminuria falls to the level of nonsmokers if smoking is discontinued.

Smokers with either type 1 or type 2 diabetes are at increased risk for neuropathy, an effect that persists after adjusting for glycemic control.
Smoking is associated with an increased risk of end-stage renal disease and with decreased survival once dialysis is commenced.

 

Commonwealth Medical Association 

Dr. S. Arulrhaj, MD., FRCP (Glasg), President

Vision of the Commonwealth Foundation: "Commonwealth civil society contributing to national and international goals for democracy, sustainable development and cultural diversity for the benefit of all people"

 

An Inspirational Story (Dr Anupam Sethi Malhotra)

It was a busy morning, about 8.30, when an elderly gentleman, probably in his 80s, arrived to have stitches removed from his thumb. He said he was in a hurry as he had an appointment at 9:00 am.
I took his vital signs and had him take a seat, knowing it would be over an hour before someone would to able to see him.

I saw him looking at his watch and decided, since I was not busy with another patient, that I would evaluate his wound. On exam, it was well healed, so I talked to one of the doctors, got the needed supplies to remove his sutures and redress his wound.

While taking care of his wound, I asked him if he had another doctor's appointment this morning, as he was in such a hurry. The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife. I inquired as to her health. He told me that she had been there for a while and that she was a victim of Alzheimer’s disease.

As we talked, I asked if she would be upset if he was a bit late. He replied that she no longer knew who he was, that she had not recognized him for five years now.

I was surprised, and asked him, "And you still go every morning, even though she doesn’t know who you are?"

He smiled as he patted my hand and said,"She doesn’t know me, but I still know who she is."

I had to hold back tears as he left, I had goose bumps on my arm, and thought,
"That is the kind of love I want in my life."

True love is neither physical, nor romantic…It is an acceptance of all that is, has been, will be, and will not be.

IJCP
IJCP
ijcp
ijcpgroup
nuspera
Docconnect
IJCP
 

IJCP Special

Dr Good Dr Bad

Situation: A patient came with right heart failure.
Dr Bad: Take normal fluid intake.
Dr Good: You must restrict your fluid intake.
Lesson: In right heart failure, fluid inake should be restricted.

Make Sure

Situation: A hypertensive patient with microalbuminuria showed progression to CKD.
Reaction: Oh my God! Why was he not given the renoprotective telmisartan?
Lesson: Make sure that all patients with hypertension at risk for CKD are given the renoprotective telmisartan.

Quote of the Day

"Change your thought and Change your world." Norman Vincent Peale

Are you fit to fly?

Respiratory infection

  1. Patients with sore throat who cannot avoid flying may benefit from an oral decongestant
    (pseudoephedrine) and a nasal spray containing a vasoconstrictor used 30 minutes before descent.

  2. Patients should avoid alcoholic beverages and drink plenty of fluids to ensure hydration and to keep secretions thin and easier to clear.
 

International Medical Science Academy Update (IMSA)

Newborn screening

In January 2010, the United States Advisory Committee for Heritable Disorders in Newborns and Children recommended adding severe combined immunodeficiency (SCID) and other disorders with T cell deficiency to the uniform newborn screening panel using this screening method. Earlier diagnosis by newborn screening should prevent infections associated with live virus vaccines, especially those given in early infancy before the diagnosis of SCID is suspected clinically

Reference

  1. Patel NC, Hertel PM, Estes MK, et al. Vaccine–acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med 2010;362:314.
 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Oxymetazoline Hydrochloride
Nasal Spray 50mcg/0.05%w/w

Indicated for the relief of stuffy, running nose associated with colds and influenza, also post nasal drip, sinusitis.

19.08.2009

 

Medi Finance

Q: If any expenditure is incurred to keep the plant and machinery uptodate, then what will be its treatment?

Ans. Doctor can claim such expense as a deduction u/s. 37(1) against the profit for that year.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Blood tests for osteoporosis may include:

  • Blood calcium: Usually normal in osteoporosis but may be elevated with other bone diseases
  • Vitamin D: Deficiencies can lead to decreased calcium absorption
  • Thyroid tests (T4 and TSH): To screen for thyroid disease
  • Parathyroid hormone (PTH); To check for hyperparathyroidism
  • Follicle–stimulating hormone (FSH): To check for menopause
  • Testosterone: To check for deficiency in men
  • Protein electrophoresis: To identify abnormal proteins produced by a certain type of cancer (called multiple myeloma) that can break down bone
  • Alkaline phosphatase (ALP): Increased levels may suggest a bone disorder
 

Humor Section

Jokes

Patient: Doctor, I have a serious memory problem. I can’t remember anything!
Doctor: So, since when did you have this problem?
Patient: What problem?

Medical bloopers on medical charts!

The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.

 

Readers Responses

  1. Dear Dr, your efforts must be appreciated. Very good and day to day required newsletter.
    Must congratulate you Dr Sukhatme, Gynecologist, Nashik


  2. The so called RMPs who are termed as quacks by the constitution and prohibited by apex court rulings and penalized under IPC sections:
    vi.IPC: 416---- Cheating by impersonation.
    XVII.IPC:417---- Punishment for cheating.
    XVIII. IPC : 418- Cheating with knowledge.
    XIX. IPC : 419 Punishment for cheating.
    XX. IPC : 471- Using forged document as genuine as.
    XXI. IPC : 23,24,25 --Wrongful gain, dishonesty, fraudulency
    XXV. IPC: 44--Injury.
    XXVI. IPC: 269 , 270---Negligence act & malignant act (likely to spread infection of dangerous disease).
    XXVIII. IPC: 336,337,338- act endangering life or personal safety, causing hurt and causing grievous hurt.
    Dr. Srinivasa Raju, National Joint Secretary-IMA, Sri Sidhardh E.N.T.Hospital, ELURU-A.P


  3. Excellent coverage. Keep it up. Thanks. C V Raghuveer

  4. Dear Dr KK: Warning on treating MI with long–term clopidogrel makes an interesting study. It has certain pitfalls which need further clarification. Consensus amongst most interventional cardiologists is that once it is drug-eluting stent, clopidogrel needs to be given for many years, rather nobody advises to stop. Bare metal stent may be six months to one year. Size of vessel is critical. If it is < 3.5 mm, drug eluting stents are the only answer. Diabetic status and age more than 75 are also indication for drug-eluting stents and hence clopidogrel for much longer time. As you are a senior cardiologist and have plenty of personal experience, you may respond to clear these doubts. With regards. Satish Chugh
    eMedinews Responds: Platelets play a central role in the development of non-ST elevation ACS and antiplatelets improve clinical outcomes. The recommendation is daily use of aspirin indefinitely and thienopyridine for at least one year after non-ST elevation ACS.
    For patients who have not undergone stenting, use aspirin 75 to 162 mg/day. Use higher dose of aspirin (162 to 325 mg daily) for one month in patients with a bare metal stent, for three months for those who received a sirolimus-eluting stent, and for six months for those who received a paclitaxel-eluting stent.
    Clopidogrel (75 mg daily) and ticlopidine (250 mg twice daily) have equal efficacy to aspirin for long-term therapy and are alternatives in patients who cannot tolerate aspirin because of major gastrointestinal intolerance or hypersensitivity. Clopidogrel has better side effect profile.
    The duration of clopidogrel (75 mg/day) or prasugrel (10 mg for patients ≥60 kg or 5 mg for patients <60 kg) be at least one year in all patients with non-ST elevation ACS (Grade 1A).
    Continue clopidogrel indefinitely after DES if the patient is tolerating the medication without bleeding. If prasugrel is used, continue it for 15 months.


  5. Thanks for reminding Sawan ka mahina pawan kare sor.......DR KP Singh Cardiologist ESCORT NEW DELHI 110025


  6. YOU must watch, and spread it around!.  Anyone has an old bag to experiment on ?
    This is very educational! Don't leave your gold ingots and diamond necklaces in your zippered bags, okay? They don't have to open lots of bags. Only those with valuables, as told them by the X-ray machines! How they open and steal from your suitcase
    After you watch this, you will not leave anything valuable in your suitcase anymore.
    This is the way a bag is opened at the airport without your knowledge.. 
    Many people would have things missing from their baggage, even when they received them at the arrival port UNOPENED and UNTOUCHED!
    How did the thief (at the airport) do it? ..... just watch the video

Click Here to View the video                           

Click Here to Download the Video

 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.