emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL 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; 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 1–7
DD Take Care Holistically Video 1–4 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

28th August 2012, Tuesday

Dr Prakash Detroja arrested in a case of death due to medical negligence
(TOI, IE)

  • The Crime Branch on Tuesday 21st August in Rajkot arrested Dr Prakash Detroja in connection with the death of an eight-year-old girl Drishti who died on the operation table in the city on June 4.
  • Drishti had a small boil on her tongue and was brought to Dr Detroja’s hospital, where he advised a minor operation.
  • However, Drishti’s condition deteriorated soon after anesthesia was administered and she died on the operation table.
  • The forensic report, which arrived on Tuesday, said the girl died after an anesthesia overdose.
  • According to the crime branch official V B Jadeja, efforts are on to nab the anesthetist Dr Anil Patel.

Source (Dr. Harkanwaljit Singh Saini, Hoshiarpur)

Lessons

  1. Over the past several decades, anesthesia related mortality rates have reduced from two deaths per 10,000 anesthetic administered to one death per 200,000 to 300,000 anesthetics administered.
  2. Complications are much more likely to occur in patients with preexisting disease states.
  3. The relative risk of serious perioperative complications is 2.2 and 4.4 for ASA patient status III and IV, respectively, illustrating that increasing serious co-morbidities increases perioperative morbidity
  4. Proper consent is a must.
  5. OT table details should be reported to police by ourselves.

American Society of Anesthesiologists physical status scale

ASA class
Physical status
Functional status
Examples
Risk status
1
Healthy, no disease outside surgical process
Can walk up one flight of stairs or two level city blocks without distress Little or no anxiety
Little or no risk Green flag for treatment
2 Mild to moderate systemic disease, medically well controlled, with no functional limitation Can walk up one flight of stairs or two level city blocks but will have to stop after completion of the exercise because of distress ASA I with extreme anxiety and fear, a respiratory condition, pregnancy or active allergies Well controlled disease states including diabetes, hypertension, obesity, epilepsy, asthma or thyroid conditions Minimal risk Yellow flag for treatment
3 Severe systemic disease that results in functional limitation Can walk up one flight of stairs or two level city blocks but will have to stop enroute because of distress History of angina pectoris, MI, CVA; HF >six months ago, COPD, diabetes with vascular complications, poorly controlled HTN, morbid obesity Yellow flag for treatment
4 Severe incapacitating disease process that is a constant threat to life Unable to walk up one flight of stairs or two level city blocks. Distress is present even at rest. History of unstable angina, MI or CVA within last six months; severe HF, severe COPD; uncontrolled diabetes, HTN, epilepsy or thyroid condition Advanced pulmonary, renal or hepatic dysfunction The risk may be too great for elective surgical procedure Medical consultation needed for emergency treatment Red flag for treatment
5 Moribund patient not expected to survive 24 hours without an operation Ruptured abdominal aneurysm, pulmonary embolus, head injury with increased intracranial pressure Elective treatment is contraindicated; however, emergency surgery may be necessary Red flag for treatment
6 A declared brain-dead patient being maintained for harvesting of organs
E Suffix to indicate emergency surgery for any class Any patient in whom an emergency operation is required Otherwise healthy young woman requiring D&C for persistent vaginal bleeding

MI: Myocardial infarction; CVA: Cerebrovascular accident; HF: Heart failure; HTN: Hypertension; D&C: Dilation and curettage.

Medical Emergencies in the Dental Office, Sixth Edition, Mosby Elsevier, St Louis 2007

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

Treat GAD for one year instead of six months

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Doctor’s Day 2012

Doctor’s Day celebrations organised by Heart Care Foundation of India and eMedinewS

 
Dr K K Aggarwal
 
    National News

AIIMS pioneers computer-aided hip replacement

NEW DELHI: For patients requiring hip replacement surgery, there is good news. The All India Institute of Medical Sciences (AIIMS) has become the first centre in the country to introduce computer assisted total hip replacement which, doctors claim, is more accurate than the conventional surgery and reduces the risk of any complexities in future, for example the risk of dislocation. "Primary osteoarthritis, road traffic accidents, loss of blood supply to hip mostly due to alcohol or steroids use and ankylosing spondylitis - all culprits for hip joint damage can be handled better using the new technique," said Dr Rajesh Malhotra, professor, department of orthopedics at AIIMS. He said that the first live surgery will be conducted on Saturday. "In this technique, special instruments with trackers fitted over them are used. The tracker - which is like a small metal ball - is connected to the computer and it guides the operating surgeon to conduct procedures at precise angles," he said.

Experts from Germany, he added, have arrived to oversee the demonstration and training. More than 65,000 total hip replacement procedures are performed annually in India. Doctors say most of the patients needing hip replacement in India are young with the great risk of one or more revision surgeries in future. "It is absolutely mandatory in these patients that joint replacement be performed most accurately (and hence the use of computer navigation) and should spare soft tissues and bone and preserve them in case of a need for revision in future," said another senior orthopedic surgeon at the institute. AIIMS has been using computer assisted navigation technique for total knee replacement, spine surgery and trauma cases. (Source: TOI, Apr 27, 2012)

For Comments and archives…

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Healthy lifestyle factors and diet linked with income: PURE

Data from the Prospective Urban Rural Epidemiology (PURE) study highlight the disparity between healthy diet and lifestyle behaviors among affluent and underdeveloped nations. The consumption of fruits and vegetables increased among nations with a higher gross domestic product (GDP) and wealth index, but this was offset by an increase in the amount of energy obtained from total and saturated fats, as well as from protein. (Source: Medscape)

For Comments and archives…

Delayed CMV Tx may work best in new kidney

Waiting to treat cytomegalovirus (CMV) in kidney transplant patients may deliver better long-term outcomes than blanket preventive drugs, researchers found. (Source: Medpage Today)

For Comments and archives…

New European STEMI guidelines emphasize care coordination

Authors of the new European Society of Cardiology (ESC) guidelines for the management of patients with acute ST-elevation MI (STEMI) hope their recommendations spur efforts to improve the speed and efficiency of STEMI care in Europe. The new guidelines were announced here today at the European Society of Cardiology 2012 Congress by Dr Gabriel Steg (Hôpitaux de Paris, France), chair of the task force that wrote the new recommendations. The new document, also published in the European Heart Journal, supplants the guidelines released in 2008 and complements the non-STEMI treatment guidelines released at last year's ESC congress. The new guidelines "emphasize the need to have geographic networks to care for patients so that the decisions and protocols are not simply coordinated at one site or one department, but across geographic regions between the various stakeholders," Steg told heartwire. (Source: Medscape)

For Comments and archives…

Low vitamin D, Epstein-Barr, linked to later MS

Low levels of vitamin D and exposure to the Epstein-Barr virus (EBV) have been linked to the development of multiple sclerosis (MS), new research shows. (Source: Medscape)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: Add PCI to Drugs in Stable CAD: for symptomatic relief with no reduction in MI rates Adding PCI to optimal... http://fb.me/1hfan14wJ

@DeepakChopra: Much of this "awakening" is somewhat confusing. What does it mean to be fully conscious?

 
    Spiritual Update

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

Meditation

Meditation forms can be classified as concentrative or non-concentrative:

  1. Concentrative techniques limit stimuli input by instructing the patient to focus attention on a single unchanging or repetitive stimulus (sound, breathing, focal point). If the patient's attention wanders, he or she is directed to bring the attention gently back to the focal object.
  2. Non-concentrative techniques expand the patients' attention to include the observation, in a non-judgmental way, of one's mental activities and thoughts.

Benefits associated with meditation include:

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)

How is the donor prepared for the egg retrieval process?

In order to retrieve multiple eggs from the donor’s ovaries, the donor must be given a combination of hormonal medications to stimulate the development of multiple eggs within the ovary. This technique is called ovulation induction. Development of eggs is monitored by ultrasound and measurement of hormones in blood. When the eggs are mature, ovulation is triggered by an injection of human chorionic gonadotropin (hCG). The eggs are harvested from the ovary approximately 34-36 hours after hCG through a process called transvaginal ultrasound aspiration. This is done by placing a transvaginal ultrasound probe, which has a needle guide, into the vagina. A needle is placed into this guide, through the vaginal wall and into the ovary.

For Comments and archives…

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

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

Transfusion practices in pediatrics

  • As with adults, transfusion should not be administered to pediatric patients without consideration of risk-to-benefit ratio.
  • As with all patients, indications for transfusion must be individualized.

For Comments and archives…

 
    An Inspirational Story (Dr GM Singh)

Have lunch with God – bring chips!

A little boy wanted to meet God. He knew it was a long trip to where God lived, so he packed his suitcase with a bag of potato chips and a six-pack of cola and started his journey. When he had gone about three blocks, he met an old woman. She was sitting in the park, staring at some pigeons. The boy sat down next to her and opened his suitcase.

He was about to take a drink from his cola when he noticed that the old lady looked hungry, so he offered her some chips. She gratefully accepted it and smiled at him.
Her smile was so pretty that the boy wanted to see it again, so he offered her a cola . Again, she smiled at him. The boy was delighted! They sat there all afternoon eating and smiling, but they never said a word.

As twilight approached, the boy realized how tired he was and he got up to leave… but before he had gone more than a few steps, he turned around, ran back to the old woman, and gave her a hug. She gave him her biggest smile ever. When the boy opened the door to his own house a short time later, his mother was surprised by the look of joy on his face.

She asked him, "What did you do today that made you so happy?"

He replied, "I had lunch with God." But before his mother could respond, he added, "You know what? She's got the most beautiful smile I've ever seen!"

Meanwhile, the old woman, also radiant with joy, returned to her home.

Her son was stunned by the look of peace on her face and he asked, "Mother, what did you do today that made you so happy?"

She replied, "I ate potato chips in the park with God." However, before her son responded, she added, "You know, he's much younger than I expected."

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. People come into our lives for a reason, a season, or a lifetime. Embrace all equally!

Have lunch with God… bring chips!

For comments and archives

 
   Cardiology eMedinewS

Patterns of muscle synergies identified in stroke patients Read More

Bariatric Tx seems to stymie type 2 diabetes Read More

 
   Pediatric eMedinewS

Pain dosing hit or miss for heavy kids Read More

Uninfected infants may carry maternal HIV antibodies beyond 18 months Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim wanted angiography.
Dr. Bad: Get admitted for 24 hours.
Dr. Good: You can go after six hours.
Lesson: If you can justify that due to technological advances, hospitalization is required for less than 24 hours, Mediclaim will be applicable.

For comments and archives

Make Sure

Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to avoid painkillers in renal failure as most painkillers (barring nimesulide, paracetamol) are not kidney–friendly drugs.

For comments and archives

 
  Quote of the Day (Dr Prabha Sanghi)

What God gives never exhausts. What man gives never lasts.

 
  Legal Question of the Day (Dr MC Gupta)

Q. According to a recent news related to drug trials in India, “It is shocking that only over 3 per cent of cases have been compensated”. What are your comments?

Ans.

  1. You are obviously referring to the following news—

    http://www.thehindu.com/news/states/other-states/article3792082.ece

    The summary of this news item is as follows:

    “As per information provided by the office of the Drug Controller General (India) under the RTI, 438 people died during 2011 due to Serious Adverse Events (SAEs) during drug trials in India but drug companies provided compensation, totalling Rs. 34.88 lakh, in only 16 such cases. The year-wise break-up of the deaths are: 132 (2007), 288 (2008), 637 (2009), 688 (2010), 438 (2011) and 30 (January, 2012). However, compensation was only provided to 22 victims in 2010 and 16 in 2011. “It is shocking that only over 3 per cent of cases have been compensated. It is a mockery of the human rights of trial subjects in India. But sadly, the CDSCO's new draft guidelines on financial compensation only address part of the problem,” says Dr. Rai, who obtained the information under the Right to Information Act. At present, financial compensation is not mandated by law in India and is only mentioned as a Good Clinical Practice (GCP) in para 2.4.7 of the Indian Council of Medical Research's GCP Guidelines for Clinical Trials in India. The Central Drugs Standard Control Organization's (CDSCO) new draft guidelines for financial compensation seek to fill this major gap in the existing Drugs and Cosmetic Act, 1940.”
  2. The above news item may not reflect the truth and may unnecessarily sensationalize the issue. As per law, compensation can be granted only for negligence, the onus for proving which lies upon the complainant. Death during a drug trial does not automatically mean that compensation should be paid unless there is a law to this effect. Anybody who alleges negligence during a drug trial is free to file complaints with the medical council, the consumer court and the police as is done so often by patients now-a-days. It is not revealed in respect of how many of the 438 deaths such complaints were filed. If no claim for compensation is filed in a court alleging negligence, no amount is payable as per law.
  3. It is true that drug trials are often conducted in a careless manner because the patients are poor and ignorant and not in a position to engage lawyers; the drug companies are rich; and, the doctors may tend to be unscrupulous when paid attractive fees for conducting a trial. It is possible that if I (or some other lawyer with medical background) were engaged as an advocate to sue the doctors and the drug companies for negligence, favorable judgments might have been obtained in at least 100 of the 438 cases.

For comments and archives

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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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  Lab Update (Dr Arpan Gandhi and Dr Navin Dang)

Porphyrin Test: Indications

When a patient has symptoms that suggest an acute neurologic/psychiatric porphyria, such as abdominal pain, tingling in hands or feet, and/or confusion or hallucinations, or that suggest a cutaneous porphyria, such as reddening, blistering, or scarring on sun–exposed skin.

 
    Mind Teaser

Read this…………………

Mr. Valdez has undergone surgical repair of his inguinal hernia. Discharge teaching should include:

A. Telling him to avoid heavy lifting for 4 to 6 weeks
B. Instructing him to have a soft bland diet for two weeks
C. Telling him to resume his previous daily activities without limitations
D. Recommending him to drink eight glasses of water daily

Yesterday’s Mind Teaser: Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the

A. left lower quadrant
B. left upper quadrant
C. right lower quadrant
D. right upper quadrant

Answer for Yesterday’s Mind Teaser: C. right lower quadrant

Correct answers received from: Dr KV Sarma, Prabha Sanghi, Dr BB Aggarwal, YJ Vasavada, Anil Bairaria, Dr PC Das, Dr K Raju, Dr Thakor Hitendrsinh G, Dr Jainendra Upadhyay, Dr Kanta Jain, Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Avtar Krishan.

Answer for 26th August Mind Teaser: D. He will be pain free.
Correct answers received from: Dr AK Kela.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

An elderly gentleman had serious hearing problems for a number of years. He went to the doctor and the doctor was able to have him fitted for a set of hearing aids that allowed the gentleman to hear 100%. The elderly gentleman went back in a month to the doctor and the doctor said, 'Your hearing is perfect.. Your family must be really pleased that you can hear again.'

The gentleman replied, 'Oh, I haven't told my family yet. I just sit around and listen to the conversations. I've changed my will three times!'

 
  Medicolegal Update

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

Sudden death – Autopsy

Left ventricular hypertrophy is the second leading cause of sudden cardiac death in adults in India

  • Longstanding raised high blood pressure causes secondary damage to the wall of the left ventricle, the main pumping chamber of the heart. Hypertrophy is associated with cardiac arrhythmias.
  • The mechanism of death in a majority of patients dying of sudden cardiac death is ventricular fibrillation and as a consequence there may be no prodromal symptoms associated with the death. These patients may be going about their daily business and suddenly collapse without the typical features of myocardial infarction such as chest pain and shortness of breath. There are a number of cases in which patients feel the effect of myocardial ischemia. (Myocardial ischemia is associated with referred pain, classically to the front of the chest, the left arm and the jaw. Patients may feel generally unwell, with nausea, dizziness and vomiting).
  • These symptoms may precede the death for any length of time between a few minutes and several hours.

I have conducted the postmortem examination of four cases who were found dead in toilet during daily pursuits; these were cases of left ventricular hypertrophy that led to sudden death.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Debunking Diabetes Myths

If you’ve just been diagnosed with diabetes, it may be difficult to separate fact from fiction, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Heart Care Foundation of India debunks some popular myths about diabetes.

  • Diabetes is not contagious and one cannot get diabetes from someone else.
  • Diabetics can eat desserts, but with caution. While eating too many sugary foods is a bad idea, one can have an occasional dessert, especially if one exercises and otherwise eats healthy.
  • Eating too much sugar cannot "cause" diabetes. The disease stems from genetic and lifestyle factors. But consuming too much white sugar can cause insulin resistance and future diabetes. The healthy sugar is brown sugar or jaggery.
  • Diabetics aren’t more susceptible to colds and other illnesses but may have more complications of flu.
  • Taking insulin doesn’t cause hardening of the arteries or high blood pressure.
  • Fruit, while healthy, can’t be consumed in huge amounts, since it contains carbohydrates
 
    Readers Response
  1. Superb quote: “I want happiness "Remove I (i.e., ego) and want (i.e., desire) and happiness will be yours. Dr.G.Sampath Kumar "
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal
Dr K K Aggarwal


Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org

TOGETHER WE CAN

RELAX *RECREATE* REJUVENATE

Weekend Retreat for Doctors on
Mind – Body – Medicine

8 (Sat) – 9 (Sun) September 2012 At Brahma Kumaris Om Shanti Retreat Centre NH–8, Bhorakalan, Pataudi Road, Bilaspur Chowk, Distt.-Gurgaon

There is NO REGISTRATION FEE but REGISTRATION is MUST
Visit us at: www.togetherwecan.in
Contact: BK Sister Sapna – M – 9650692204
E–mail: bksapna108@gmail.com

 
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

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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