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; 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 15 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 …

29th January 2013, Tuesday

Dr Dog (Sniff): under which council will they be registered?

Dogs have an olfactory capacity that is more than 100 times that of humans, and that stool from patients with Clostridium difficile infection has a unique odor due to P-cresol, a phenolic compound fermented by the bacteria.

Some nurses, laboratory technicians, and physicians have been able to make a diagnosis of C. difficile infection on the basis of this odor.

The study by physicians in The Netherlands used a Beagle dog trained to recognize the unique odor of stool containing C. difficile toxin. Testing of stool samples showed recognition of positive tests in 30/30 (100% sensitivity) and negative tests in 270/270 (100% specificity).

These results are superior to all existing tests for C. difficile infection.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

   Constipation Update

Do not give phosphate enemas in the elderly

Sodium phosphate enemas should be avoided in the elderly. Sodium phosphate enemas, even in standard doses, may lead to severe metabolic disorders (hyperphosphatemia, severe hypocalcemia, hypernatremia, hypokalemia) and may cause acute renal failure and even death in elderly patients with constipation (Ori Y, Rozen-Zvi B, Chagnac A, et al. Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience. Arch Intern Med. 2012 Feb 13;172(3):263-5).

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

FDA OKs first drug-eluting stents for use in MI

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Hands-only CPR 10 camp at St. Froebel Public School, Paschim Vihar.
Over 1000 school children were trained on the spot during the camp.

 
Dr K K Aggarwal
    National News

Invite: Hands-only CPR 10 Camp

Heart Care Foundation of India will be organizing a Hands-only CPR 10 Camp on 31st January, 2013 at Lady Reading Nursing Institute, Near Delhi Gate. Over 150 nurses will be trained on how to survive a person within ten minutes of death.

Yesterday: What a great combination

Sunday (Sun)
Full moon (Moon)
Purnima (Salt and water retention, salt restricted diet, high tides)
Dry winter (More alpha activity, more upper blood pressure, more pulse rate)
Uttarayana (Positive state of mind)
Magh month (Time for vitamin D, increased fertility, marriages, eat sesame, sunbath)
Kalpwas month (Disciplined one month)
Allahabad sangam (Incubation period, away from routine stress, self confession).

This Sunday came after 148 years.

No insurance cover for organ donors

A housewife donated a part of her liver to her husband a few years ago. Even though she has no complications and is perfectly healthy, she was surprised to find that insurance companies rejected her application for comprehensive health cover, reports TOI. "Insurance companies don't ask if you have donated an organ. The application forms ask if there is a scar of the body and the reason for it. When you say you donated an organ, the application is rejected. The liver regenerates after donation and the donor is as normal as anyone else. Kidney and liver are the only two organs people can donate when they are alive.
Views: It’s unfortunate and not based on medical facts. I think the matter should be taken up by Indian Medical Association. Insurance companies cannot do that.

Medical mistakes in Indian movies

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

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

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

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

 
    Be Human Stop Child Abuse (Team IMA for CMAAO)

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

In US alone more than 60,000 children are sexually abused annually

For comments and archives

 
    Valvular Heart Disease Update

The bicuspid aortic valve is susceptible to infective endocarditis but routine endocarditis prophylaxis is not recommended.

(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)

For Comments and archives…

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

'Sticker Shock' is non-issue when ordering tests

Providing clinicians with information about the cost of the imaging tests they order failed to cut down on test utilization, a randomized study found. (Source: Medpage Today)

Omontys safety still a problem for nondialysis patients

The anemia drug peginesatide (Omontys) in chronic kidney disease patients not undergoing hemodialysis may carry an increased risk of cardiovascular events, results of two paired trials suggested. (Source: Medpage Today)

Surgery improves survival with GI stromal tumors

Imatinib therapy with surgical removal of residual tumors outperformed imatinib therapy alone among patients with recurrent and metastatic gastrointestinal stromal tumors, researchers reported at the Gastrointestinal Cancers Symposium. (Source: Medpage Today)

FDA approves new use for Exjade

The iron chelator drug deferasirox (Exjade) may be used to reduce iron overload in thalassemia patients 10 and older who do not require regular transfusions, the FDA has announced. Deferasirox was previously approved to treat the condition in transfusion-dependent thalassemia patients. The expanded indication covers nontransfusion-dependent patients with liver iron concentrations of at least 5 mg/g of dry liver tissue. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Can’t avoid anger: take aspirin http://bit.ly/TGfwkM #Health

@DrKKAggarwal: Just as a wave is a pattern of behavior of the ocean, our body/mind is a pattern of behavior of the total universe #CosmicConsciousness

 
    Spiritual Update

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

Were we more western in our mythological era?

The answer is ‘yes’.

India was much more advanced than today’s western culture in our mythological era. Following are the examples:

For Comments and archives…

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

What are the disadvantages of minimally invasive surgery?

Minimally invasive surgery is more risky for patients who are obese or who have had previous "open" surgery in the upper or lower part of their belly or other medical problems. Surgeons need special training and lots of practice before they can perform minimally invasive surgery; therefore, not all doctors are qualified to do these types of procedures. Also, not all hospitals have the special equipment necessary to do these kinds of surgeries.

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

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

What does pre transplant evaluation include?

a) Immunizations pre transplantation

Most units including ours consider live vaccines to be contraindicated after liver transplant because of the risk of dissemination secondary to immunosuppression. It is therefore better to complete normal immunizations before transplant. These include: BCG, DPT + Hib, Hepatitis B, Measles, MMR. It’s suggested to give even optional vaccine such as hepatitis A, typhoid, chickenpox, influenza rotavirus and pneumococcal vaccines. The vaccination schedule may be expedited and may differ from the normal recommendations.

b) Management of hepatic complications

It is important to ensure that specific hepatic complications are appropriately managed while the patient waits for transplant. These include portal hypertension, esophageal varices, ascites, hypoproteinemia etc.

c) Nutritional support

It has been demonstrated in several studies that nutritional status at liver transplant is an important prognostic factor in survival i.e. better outcome is seen in patients with good nutritional status. The patient needs to be on a high calorie diet (150- 200% calories good protein intake) with two times the RDA of multivitamins and in patients with cholestasis supplementation with fat-soluble vitamins like vitamin A,D,E,K is done. In patients with cholestasis, MCT oil as in coconut oil is used for cooking. If a child is not able to feed well orally then tube feed supplementation is done, which could be for overnight feeds or during the day as per the need.

For Comments and archives…

 
    An Inspirational Story

To love and to be loved

Once upon a time, a very poor man lived with his wife. One day, his wife, who had very long hair, asked him to buy her a comb for her hair to grow well and to be well-groomed.

The man felt very sorry and said no. He explained that he did not even have enough money to fix the strap of his watch he had just broken. She did not insist on her request.

The man went to work and passed by a watch shop, sold his damaged watch at a low price and went to buy a comb for his wife. He came home in the evening with the comb in his hand ready to give to his wife.

He was surprised when he saw his wife with a very short hair cut. She had sold her hair and was holding a new watch band. Tears flowed simultaneously from their eyes, not for the futility of their actions, but for the reciprocity of their love.

Moral of the story: To love is nothing, to be loved is something but to love and to be loved by the one you love, that is everything.

For comments and archives

 
   Cardiology eMedinewS

A likely link between stress and heart disease: Viral reactivation
Read More

The Good, the Bad - and the ugly cholesterol that causes heart disease
Read More

 
   Pedia News

Risk assessment can help beat child abuse Read More

Melamine from soup bowls found in urine Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A prediabetic with mild hypertension came with mild cognitive dysfunction.
Dr Bad: It’s unrelated to diabetes.
Dr Good: There is an association between the two.
Lesson: Cognitive dysfunction in type 2 diabetes is related to the cumulative effects of long–term exposure to hypertension, even in prediabetic stage. Patients with poor cognition had a 14–18 mmHg higher systolic blood pressure than patients with good cognition (Diabetes Metab Res Rev 2009;25(7):657–64).

Make Sure

Situation: A 50–year–old patient, highly stressed at work and a hypertensive as well, complained of acid eructations and indigestion.
Reaction: Oh my God! He has hyperacidity. Put him on magaldrate.
Lesson: Make sure that patients who are suffering from stress, diabetes and/or hypertension and who have hyperacidity/GERD/peptic ulcers are put on magaldrate, which is safe and effective as an antacid.

 
  Quote of the Day (Dr GM Singh)

One of the basic differences between GOD and humans is that, GOD gives and forgives and humans get, get and forget. Be thankful in life.

 
  Legal Question of the Day (Dr. M.C. Gupta)

Why should service tax be payable in relation to medical services?

Q. Why should service tax be payable by those providing medical services? Why should doctors have to shell it out from their pockets?

ANS.

  • Service tax is nothing new. Malaysia has a Service Tax Act, 1975. Service Tax was introduced in India through Finance Act, 1994. “Health services undertaken by Hospitals or Medical establishments” were brought under service tax w.e.f. 1-7-2010 as per

    http://www.servicetax.gov.in/st-proc-home.htm
  • The origin of service tax appears to be related to expenditure tax which has often been suggested but never imposed because of apparent practical difficulties. The demand for expenditure tax originated from the well- known fact that non-salaried persons making tons of unaccounted money through business and other transactions did not pay any income tax and lived lavishly while the law abiding salaried class had to pay income tax even on their meagre salaries. As a result of service tax, those spending crores on marriage functions etc. could be made to pay tax on consumption. (Service Tax was levied on services provided by the service provider who, in turn, charged it from the recipient of services. Thus, in simple terms, the person who paid for services paid tax also on such service. The service provider merely acted as the collecting agent).
  • The above scheme is quite rational and ingenious. It is very much within the provisions of law. If it were illegal, the concept of service tax would have been challenged in the courts.
  • Service tax, payable by the service provider, and recoverable from the service recipient at the option of the provider, serves dual purpose:
    • It meets the demand for expenditure tax in an indirect manner.
    • -It provides a data base to IT officials about those who spend lakhs and crores on BMWs and 5 star hotel banquets and frequent air travel etc. Such people can be checked to see if they are concealing income.
  • If a person spends 5 lakh on treatment in a corporate hospital, there is no reason why such payment should not be subject to service tax.
  • It is wrong to say that doctors paying service taxwould have to "shell it out from their pockets". They can add it to the patient's bill.
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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…………………

A patient received spinal anesthesia 4 hours ago during surgery. The patient has been on the unit for ½ hours and now reports severe incisional pain. The patient's blood pressure is 170/90 mm Hg, pulse is 108 beats/min, temperature is 99oF (37.2oC), and respirations are 30 breaths/min. The patient's skin is pale and the dressing is dry and intact. The most appropriate nursing intervention is to:

A. call the physician and report the findings.
B. medicate the patient for pain.
C. place the patient in a high Fowler position and administer oxygen.
D. place the patient in a reverse Trendelenburg position and open the IV line.

Yesterday’s Mind Teaser: An adult is receiving Total Parenteral Nutrition (TPN). Which of the following assessment is essential?

A. Evaluation of the peripheral IV site
B. Confirmation that the tube is in the stomach
C. Assess the bowel sound
D. Fluid and electrolyte monitoring

Answer for Yesterday’s Mind Teaser: D. Fluid and electrolyte monitoring

Correct answers received from: Dr Ajay Gandhi, Dr Thakor Hitendrsinh G, Dr KV Sarma, Dr Jella,
Dr Bharat Bhushan Aggarwal, Dr Pankaj Agarwal, Dr K Raju, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Bharat Bhushan Aggarwal.

Answer for 27th January Mind Teaser: C. Frequently observing for hoarseness, stridor, and dyspnea

Correct answers received from: Gracy Thomas, Dr PC Das, Dr Deepalichatterjee, Dr Bitan Sen &
Dr Jayashree Sen, Raghavendra Jayesh, Dr Pankaj Agarwal.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

Hospital regulations require a wheel chair for patients being discharged. However, while working as a student nurse, I found one elderly gentleman already dressed and sitting on the bed with a suitcase at his feet, who insisted he didn't need my help to leave the hospital.

After a chat about rules being rules, he reluctantly let me wheel him to the elevator.
On the way down I asked him if his wife was meeting him.

'I don't know,' he said. 'She's still upstairs in the bathroom changing out of her hospital gown.'

 
  Medicolegal Update

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

Instruments for shooting, stabbing, cutting are dangerous weapons

The doctor is not required to make speculations about the weapon of offence in a MLC case. According to the Section 324 of IPC, any instrument for shooting, stabbing, cutting or any instrument used as a weapon of offence likely to cause death or by means of fire or any heated substance or by means of poison or any corrosive substance or by means of any explosive or by means of any substance, which is deleterious to the human body to inhale, to swallow, or to receive into the blood or by means of any animal - are all considered as dangerous weapons.

The duty of the attending doctor is to record all the injuries, their dimensions as far as possible, and the body parts where the injuries are located, the nature of injury, whether simple or grievous, caused by sharp/blunt object, age or duration of injury along with the vital parameters like blood pressure, pulse, respiration and the mental status of the patient. When an investigating officer comes to the hospital, he needs some specific answers for his legal investigation and to book a case under law of the land.

  • Are the injuries self–inflicted or fabricated? If yes, please mention the forensic justification.
  • Is there any sign, symptom or smell of alcohol or any drug intoxication? If yes, please opine about his mental status due the influence of intoxication; also preserve a blood sample.
  • Please opine if the injured or intoxicated patient is fit to record his statement? If no, please give due reasons and an approximate time interval for medical evaluation for his/her fitness for statement.
  • Is the condition of patient is critical, severe or serious? If so, the dying declaration must be recorded by the attending doctor in the presence of one or two witnesses.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Paste the CPR 10 mantra in every notice board of schools

Conducting a Hands-only CPR 10 camp at St. Froebel Public School, Paschim Vihar, Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that origin of CPR in our country goes back to our mythology when Savitri saved Satyavan as the first person in the history of mankind.

Over 1000 school children were trained on the spot during the camp.

Dr. Aggarwal said that the CPR mantra “within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better – up to 25 minutes in adults and 35 minutes in children), compress the centre of the chest of the victim effectively and continuously with a speed of 10x10 i.e. 100 per minutes” should be pasted in every school and college wall. He said that all security persons, PCR vans should be taught Hands-only CPR because they are the first ones to arrive whenever there is a incidence of sudden death. Dr. Aggarwal said that CPR technique should be incorporated in the school syllabus.

 
    Readers Response
  1. It is good to read and see in TV about police. Have you ever seen and experienced a police behavior with a common man. It is far from civic. Vivek Kumar, Varanasi.
 
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