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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

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  Editorial …

29th November 2012, Thursday

Parliamentary Committee Rejects NCHRH Bill

  • The Committee takes note of the fact that even though it is more than sixty years since India attained independence, affordable healthcare and health education have been a distant dream for the common people of the country. Even though concerted efforts have been made by the Government, but due to substantial socio-economic and geographical inequalities, those efforts have not made the desired impact. The Committee expresses its concern over the acute shortage of qualified health workers including doctors in the country. It is constraining to note that as per 2001 Census, the estimated density of all the health workers (qualified and unqualified) in India is about 20 per cent less than the WHO norm of 2.5 workers (doctors, nurses and midwives) per thousand population. This shows the substantial shortage of qualified health workers in the country. The Committee also notes the disparities between the rural and urban areas in respect of the availability of health infrastructure. Even though there is a steep increase in the number of medical colleges in the country, the cause of the concern for the Committee is that a number of colleges that have been opened are not evenly distributed. This has resulted in distorted distribution of the country’s production capacity of health workers. The Committee also takes cognizance of the fact that the other health professions such as nursing, pharmacy, etc., are not in a promising state. The nursing education is also in a poor condition resulting in poor quality of the nursing professionals. Similarly, the nurses-doctors ratio in the country is only 0.8:1 as against the ideal ratio of 3:1. Adding to these woes is the criticism being made against some of the National Health Councils, leading to judicial censure on several occasions. The Committee, therefore, takes note of this background in which the Bill has been brought forward by the Government in the Parliament.
  • Taking note of the importance of the Bill and its likely impact on the availability of health professionals, health infrastructure and ultimately healthcare delivery for the common people of the country, the Committee took the views of a cross-section of the society and various stakeholders. The Committee feels that the need for reforms in health sector is long overdue so as to invigorate the health sector. But several stakeholders have raised serious apprehensions on various provisions of the Bill and effectiveness of various bodies that are proposed to be established under the Bill. In view of the apprehensions expressed by various stakeholders, the Committee, in its meeting held on 17 August, 2012, felt that the Bill, in the present form, cannot be recommended. The Committee, therefore, decided not to go in for clauseby- clause consideration of the Bill and to recommend to the Government to consider all shades of opinion and all the suggestions and bring forward a revised comprehensive Bill before the Parliament.
  • The Committee, however, makes the following general observations/recommendations to enable the Government to take necessary action at the time of revisiting the Bill:
    • The National Commission for Human Resources for Health, as proposed in the Bill, is mandated to take measures to determine, maintain and coordinate the minimum standards of and promote the human resources, in the disciplines of health education and training, commensurate with the requirement of such resources in different States and Union Territories. The Committee is aware that ‘Health’ is a State subject whereas ‘Health Education’ figures in the Concurrent List of the Constitution. However, the composition of the Commission gives no representation to the States. The Committee agrees with the viewpoint put forth by the State representatives that the States play a vital role in delivery of healthcare and medical education. States are well versed with existing medical education capacity and know their future requirements better. The Secretary, Department of Health and Family Welfare, during the course of his deposition before the Committee stated that he was open to giving greater representation to the States in the National Commission, the National Board and the National Evaluation and Assessment Committee. It is, in this context, that the Committee is of the considered view that a substantive role should be mandated for the States in the Commission. The Committee, therefore, recommends to revisit the institutions of National Commission, National Board and National Evaluation and Assessment Committee and give adequate representation to the States. Cooperation and coordination of the States is very essential for better provision of healthcare and health education in the country. Discussions may be held with all the State Governments before revising the Bill. Necessary modifications may, accordingly, be made in the Bill.
    • Some stakeholders favoured strengthening of the existing Councils rather than overarching body as proposed in the Bill. They felt that sufficient safeguards should be provided in the present Councils to ensure their transparent functioning and accountability to the Central Government and the Parliament. The Committee also took note of their concern that the present National Councils have been relegated to maintaining the Central Register only, in the Bill. There was also a mention that in the National Commission, National Board and National Evaluation and Assessment Committee, the representation of several professions has not been indicated. The Committee notes the concern expressed by the Councils that their autonomy and democratic set-up have been taken over under the Bill. The Committee feels that these apprehensions need to be appropriately addressed by the Government in the Bill. There is a need for clarifying all these concerns. The democratic functioning of the National Councils should be appropriately protected, even if they are brought under the overarching body. As regards the existing functions of the Councils, the Committee suggests that Councils may be given the powers to consider all the proposals as per the existing functions and after their due consideration, the three bodies proposed under the Bill i.e the Commission, the Board and the Assessment Committee may be given the power to take final decision in the respective matters. Besides, adequate representation should be given to all the professions in the proposed Commission, Board and Committee.
    • Some of the stakeholders expressed their apprehensions that there is no element of election in the composition of the Commission, Board and the Assessment Committee. The Bill provides only for the appointment by the Central Government on the recommendations of the Selection Committees. In fact, this has been objected by the State Governments also. The Committee desires, that the apprehensions of stakeholders may be considered by the Government while revising the Bill.
    • The Selection Committees proposed to be set up for recommending persons for nominations to the Commission, Board and the Assessment Committee have been questioned by some of the stakeholders. They felt that the selection process for the Selection Committees has been made very ambiguous stating that the Chairperson and Members shall be appointed in such manner as may be prescribed. The Committee agrees that this would lead to doubts in the minds of the people and this needs to be clearly spelt out. The Committee, in this regard, takes note of the Higher Education and Research Bill, 2011 in which composition of the Selection Committee has been clearly spelt out. The Committee recommends that a procedure on the similar lines be spelt out at the time of revising the Bill. The Committee also feels that the members of Selection Committee should be persons of eminence, preferably from the medical field. Besides, the Committee also recommends that there should be only one Selection Committee for all the three bodies.
    • The Bill provides that the Chairperson or a Member of the National Commission/National Board/National Evaluation and Assessment Committee can be removed by the Central Government at its pleasure which is very ambiguous provision and susceptible to misuse whereas the Higher Education and Research Bill, 2011 provides that the Chairperson or a Member of the National Commission for Higher Education and Research can be removed by the President. The Committee feels that a similar provision may be incorporated in the present Bill. The Committee recommends that adequate safeguards may be provided in the Bill so that the Chairperson and other Members of the Commission, Board, and the Assessment Committee are able to discharge their duties and responsibilities in a fair and objective manner.
    • It has been brought to the notice of the Committee that though the Bill seeks to abolish the National Board of Examinations (NBE), it fails to define how the existing streams of health education run by the NBE are to be preserved and promoted within the ambit of the Bill. The Committee is given to understand that the NBE has provided standardized examination for post-graduate courses across the country and public sector hospitals like Railway Hospitals, Armed Forces Hospitals and some private sector hospitals like Sir Ganga Ram Hospital, Shankar Netralaya, etc. are participating for the post graduation courses. It has been impressed upon the Committee that India is very short of specialists and the NBE provides an opportunity beyond the medical colleges to train the specialists of higher order. The Committee agrees that the NBE performs very important functions and the post-graduate medical education of the highest order is being standardized by it, and if this stream disappears, it is going to affect the specialists, who have been awarded degrees so far. The Committee, therefore, recommends that the above apprehensions be adequately addressed and precise and explicit provisions be made while revising the Bill to protect the existing streams of PG education run by the NBE.
    • The Committee also takes note of the apprehensions expressed before it about a potential conflict of powers between the Commission, the Board and the Assessment Committee due to lack of clarity regarding the powers of the three bodies. One of the apprehensions was that the Commission gives permission for new courses under Clause 17 of the Bill whereas Clause 30 gives an impression that the Board is fully empowered to recognize new courses and give accreditation to new courses. Similarly, it was also apprehended that there is conflict between Board and Committee regarding accreditation of Health Educational Institutes under Clauses 30 (2) (t) and 37 (1) respectively. The Committee strongly feels that there is a need to clearly demarcate the respective jurisdictions of the three bodies under the Bill.
    • The Committee also takes note of the apprehensions expressed by some of the professional associations like physiotherapy, dental hygienists, optometrists, occupational therapists etc. They expressed the desire to have separate Council for each of the professions. For example, Dental Hygienists Association felt that they are always relegated to the background and they do not get sufficient prominence. They also felt that their profession has not been appropriately represented in the Bill. The Committee feels that many new fields have emerged in the health profession but the new fields are yet to be granted the status of separate Council so as to ensure their better growth, regulation and standards. The Committee, therefore, recommends that their grievances may also be taken care of and separate Councils may be provided for them, wherever feasible.
    • The Committee takes note of the provision in Clause 17 (6) which provides that where no order on establishment of institution for imparting health education or a new course of study has been given by the Commission for a period of one year, the same shall be deemed to have been approved by the Commission in the form in which it has been submitted. The Committee expresses its serious doubts on this open-ended clause. The Committee feels that this clause is susceptible to misuse by allowing backdoor entry of health institutions or a new course of study by stalling the decision for one year, which would automatically be treated as approval. The Committee recommends that this provision may be made more stringent and sufficient riders and safeguards may be provided in the clause.
    • The Committee is also of the view that there is no mention about the Medical Research in the preamble, powers and functions of the Commission nor has been defined under the definition in Clause 2. It has only been mentioned in Clause 30(1)(a) under the powers and functions of the National Board of Examination stating that it is one of the functions of the Board to maintain standards of Health Education and Research. Health Research is covered under the Higher Education and Research Bill, 2011 also. The Committee has noted that in the Higher Education Bill, 2011, Agricultural Education and Research has been kept out of its purview. A comparative perusal of contents of the provisions pertaining to jurisdiction and functions of the Commissions proposed under both the Bills reveals that both the Bills have identical jurisdiction and functions on various aspects of Medical Education and Research. Under such circumstances overlap and conflict of jurisdiction is inevitable. Wherever there is overlap and conflict of jurisdiction between more than one agency on a particular subject, the ultimate sufferer would be its objective i.e. development of medical education and medical research. The Committee is not in agreement with the Ministry’s contention that Health Research requires a forum like National Commission on Higher Education. There is a separate department for Medical Research mandated with the responsibility of development of various aspects of Medical Research and coordination between various National and International Agencies engaged in Medical Research. In the given circumstances, the Committee is of the opinion that it would not be appropriate to keep Medical Education and Medical Research under the jurisdiction of more than one Agency and Ministry. It would not serve any purpose and rather it would hamper its development. The Committee, therefore, strongly recommends that both Medical Education and Medical Research should be brought under the purview of the proposed National Commission envisaged in the Bill. The Ministry may appropriately address this issue while revising the Bill.
    • The Committee notes that the medical education and healthcare under AYUSH has not been brought under the Bill. The Committee, therefore, heard the views of the Secretaries of Departments of Health and Family Welfare and AYUSH. Both the Departments of Health and Family Welfare and Department of AYUSH desired to keep the Indian Systems of Medicine and Homoeopathy out of the ambit of the present Bill on the ground that the Allopathy and the Indian Systems of Medicine and Homoeopathy are completely different and the latter needs focussed attention for proper development. It was, therefore, proposed to be kept on a separate footing due to the apprehensions that if they were brought under one Commission, the focussed attention of the AYUSH may be lost. It was also brought to the notice of the Committee that a separate Department was created in 1995 for Indian Systems of Medicine and Homoeopathy to give focussed attention and later it was named as Department of AYUSH in 2003. A separate policy known as ‘National Policy on Indian Systems of Medicine and Homoeopathy’ was also formulated in 2002. The Committee cannot understand the rationale behind having two separate overarching bodies for two different systems of medicine within the country. The Committee is of the view that there should be only one overarching body and all the health/medical professions should be brought under one single umbrella though with separate Councils. The Committee, therefore, recommends that the Indian Systems of Medicine and Homoeopathy may also be brought under the jurisdiction of the National Commission for Human Resources for Health. The representatives of the Councils of the Indian Systems of Medicine and Homoeopathy may also be given representation in all the bodies, i.e., the Commission, the Board as well as the Assessment Committee so that their interests are well taken care of.
    • The Committee notes that though Health Educational Institutions, Health Institutions and Health Education have been mentioned in the Bill, but Health Education has not been defined while Health Educational Institution or Health Institutes have been defined. The Committee desires that this may be amply clarified. The Committee also desires that health education should be replaced by medical education because it is not the Health Educational Institution, it is Medical Educational Institution which imparts various kinds of medical education. The Committee, therefore, recommends that Health Education, Health Education Institutions/Health Insitution may be replaced by Medical Education/Medical Educational Institutions/Medical Institutions whereever they appear and Medical Education may be appropriately defined.
    • Similarly, distance education system as has been mentioned in Clause 2(r) is also not acceptable to the Committee. The Committee feels that Medical Education should not be imparted through distance education mode and it should be a regular course.
  • The Committee has received several suggestions from various stakeholders in the form of written representations, written submissions as well as oral evidence. The Committee has dealt with some important suggestions made by various stakeholders and appended all the memoranda/written submissions to the Report. The memoranda/written submissions received from various persons/bodies have been sent to the Ministry for comments. The issues raised by various persons/bodies in the memoranda and the written submissions and the comments of the Ministry are appended. Some of the stakeholders have proposed amendments to various provisions of the Bill. The Committee recommends that the Ministry of Health and Family Welfare may carefully examine all the suggestions made by various stakeholders in the written memoranda, written submissions and oral evidence and also the recommendations made by this Committee while revising the Bill. All the apprehensions made by various stakeholders may be appropriately addressed. If need be, the Ministry may hold another round of discussions with all the stakeholders before finalizing the fresh Bill.
  • The Committee, accordingly, recommends that the Ministry may withdraw this Bill and bring forward a fresh Bill after sufficiently addressing all the views, suggestions and the concerns expressed. Before finalising the fresh Bill, the Ministry may hold discussions with all the stakeholders including the State Governments.

    Kindly visit the link for the details of the rejection of the NCHRH Bill –


For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

In patients over the age of 70 years being treated with enemas for constipation give warm water enemas rather than sodium phosphate enemas. The use of sodium phosphate enemas in older adults has been associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure and EKG changes (prolonged QT interval).

For Comments and archives…

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

AHA - ACS update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela 2012

Large number of Nursing students actively participated in the 19th MTNL Perfect Health Mela

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

Soon, mental health atlas from Nimhans

BANGALORE: If this premier institute has its way, a model mental health atlas to help in formulation of research and policy making in the country will be ready soon. National Institute of Mental Health and Neurosciences (Nimhans) is all set to adopt a district in Karnataka with over 2 million people to seek community-based data on mental health disorders. In probably the first-of-its-kind project likely to begin early next year, the institute will gather data related to the mental health condition of people in that district. The statistics generated can be used for research and policy making. The announcement was made by Dr P Satishchandra, director and vice-chancellor, Nimhans, on Tuesday at the launch of the 'Centre for Public Health'. The centre, which has come up at the department of epidemiology, Nimhans, will focus on bringing out solutions for mental health disorders. Explaining the need for district-based, Satishchandra said: "We see 4.5 lakh patients suffering from various mental disorders every year. The Centre for Public Health will help us in evidence-based research. In India, we have to depend on hospital-specific evidence for research, which has its own biases and limitations. To overcome this, we've decided to adopt a district and follow-community observation. Community-based work will help in generating genuine data which will be useful for research and policy-making decisions." Under the National Mental Health Program, 123 districts of India will be given special mental healthcare assistance. Four Karnataka districts -- Kolar, Gulbarga, Raichur and Chitradurga -- have been included. "We have a vision to cover the entire country in the 12th Five Year Plan if the central government provides funds," he added. Dr Shekhar Saxena, director, department of mental health and substance abuse, WHO, said: "WHO would like to provide required support system for this centre. We will discuss the priorities and start the process of designating it as a WHO-support centre." (Source: TOI, Nov 28, 2012)

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

What are the most common causes of significant mitral regurgitation in the elderly?

The causes are mitral valve prolapse and ischemic heart disease. Surgery for severe chronic mitral regurgitation is recommended for young asymptomatic patients with early evidence of left ventricular dysfunction but the same is not indicated in patients over age 80 to proceed with surgery unless symptomatic.

(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)

Sleep apnea linked with AF recurrence postablation

Individuals with obstructive sleep apnea (OSA) are at a higher risk of atrial fibrillation (AF) recurrence following radiofrequency catheter ablation, according to the results of a small study. Concomitant OSA was associated with a more than twofold increased risk of AF recurrence following ablation compared with individuals without sleep-disordered breathing, while the use of continuous positive airway pressure (CPAP) reduced the risk of redeveloping the arrhythmia. (Source: Medscape)

Warfarin for six months should be norm for bioprosthetic aortic valves

Patients who have had a bioprosthetic aortic valve implanted should receive anticoagulation with warfarin for six months after surgery, new epidemiological data suggest. The findings should inform current guidelines on this issue, which are muddled due to a lack of randomized trials in this area, say Dr Charlotte Mérie (Copenhagen University Hospital Gentofte, Denmark) and colleagues in their paper in the November 28, 2012 issue of the Journal of the American Medical Association. (Source: Medscape)

Transplant pioneer Murray dies at 93

Joseph Murray, MD, who performed the first successful human organ transplant in 1954, died Monday at the age of 93 from complications of a stroke suffered last week. In the groundbreaking procedure, Murray performed a kidney transplant between 23-year-old identical twins. He won the Nobel Prize for physiology or medicine in 1990. Murray died at Brigham and Women's Hospital in Boston, where he had spent his career after leaving the Army following World War II. In addition to developing some of the first procedures for organ transplants, Murray was also well known for his work in reconstructive plastic surgery. (Source: Medscape)

Obesity adds to OR time for lung surgery

Heftier patients take a little longer in the operating room for lung cancer resection, although with an effect that appears limited to costs rather than outcomes, researchers found. (Source: Medpage Today)

Moderate activity may be key to saving knees

Too much exercise led to early degenerative cartilage changes in the knee in healthy people and in those at risk for osteoarthritis, according to an MRI-based study. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Asthma patients should check with their doctor before going for holiday People with chronic obstructive lung... http://fb.me/CLIQn7da

@DeepakChopra: You are capable of making a quantum leap in how you use your brain. http://tinyurl.com/adwt7hy

    Spiritual Update

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

Why spirituality is happiness-friendly?

  1. What you believe in can have a big impact on health and longevity. People with high levels of religious beliefs or spirituality have lower cortisol responses. Cortisol is a hormone the body releases in response to stress.
  2. Positive thinking produces nearly a 30 percent drop in perception of pain.

For comments and archives

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

Why is infertility stressful?

Most couples are used to planning their lives. They may believe that if they work hard at something, they can achieve it. So when it's hard to get pregnant, they feel as if they don't have control of their bodies or of their goal of becoming parents. Infertility tests and treatments can be physically, emotionally, and financially stressful. Infertility can cause a couple to grow apart, which increases stress levels.

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

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

ABO system

The fetal immunoglobulin production is low, so the plasma contains very little of anti-A and B agglutinins.

    An Inspirational Story

Angel Rescued sick girl – True story!

This incident happened in Charlotte, North Carolina, USA, in September 2008. 14-year-old Chelsea Barton was born five weeks prematurely which resulted in developmental disabilities and serious health problems all her life.

Chelsea got sick very easily and going back and forth to the hospital very often. In 2008, she caught pneumonia and was eventually put on life support at Presbyterian Hospital in Charlotte, North Carolina. Doctors told Chelsea’s mother that there was no hope for young Chelsea’s recovery.

The family gathered one last time in Chelsea’s hospital room to say their goodbyes and the order was giving to disconnect her from the life support system and “just let nature take its course.” It appeared that Chelsea had another visitor just after the life support was disconnected!

As her mother waited for the girl to take her last breath, an image of bright light appeared on the hospital’s security monitor screen. Within an hour, the dying girl began a recovery that doctors were at a loss to explain.

The mother and other workers noticed an image of an angel in light on the security surveillance monitor near the hospital room door and the mother managed to capture the image with her cell phone camera.

The mother told that at first she thought that it was the angel-of-death coming to take her daughter but shortly afterwards Chelsea started showing signs of improvement. It would be another two months before Chelsea finally left the hospital to return home but her mother is so convinced that Chelsea was saved by divine intervention.

God is real and does care for us!

Source: http://academictips.org/blogs/angel-rescued-sick-girl-true-story/

For comments and archives

    Cardiology eMedinewS

Low serum magnesium linked with AF Read More

Afib linked to sudden cardiac death, too Read More

    Pediatric eMedinewS

TB risk for kids has global reach Read More

AAP: Teach teens about emergency contraception Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with dengue hemorrhagic shock.
Dr. Bad: Give platelet transfusion.
Dr. Good: Give initial bolus of 5% dextrose in saline or Ringer Lactate 20ml/kg body weight infused over 15 minutes.
Lesson: In hemorrhagic shock, fluid resuscitation is more important. Bolus should be followed by continuous infusion of 10–20 ml/kg body weight fluids until urine output normalizes. (World Health Organization, Geneva 2009, p. 1)

Make Sure

Situation: A patient who had multiple blunt traumas on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt traumas to exclude peritoneal hemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

    Lab Update (arpangandhi@gmail.com)


Hypoalbuminemia or decreased albumin: Cystic fibrosis, chronic glomerulonephritis, alcoholic cirrhosis, Hodgkin's disease, malnutrition, nephrotic syndrome, multiple myeloma, inflammatory bowel disease, leukemia and collagen-vascular diseases

  Quote of the Day (Dr GM Singh)

Betrayal is about learning not to idealize external sources. Linda Talley

    Mind Teaser

Read this…………………

In dealing with a dying client who is in the denial stage of grief, the best nursing approach is to:

A. Agree with and encourage the client’s denial
B. Reassure the client that everything will be okay
C. Allow the denial but be available to discuss death
D. Leave the client alone to discuss the loss

Yesterday’s Mind Teaser: Nurse Maureen is aware that a client who has been diagnosed with chronic renal failure recognizes an adequate amount of high-biologic-value protein when the food the client selected from the menu was:

a. Raw carrots
b. Apple juice
c. Whole wheat bread
d. Cottage cheese

Answer for Yesterday’s Mind Teaser: d. Cottage cheese

Correct answers received from: Dr KV Sarma, Dr K Raju, Dr PC Das, Sunil Parwani, Dr pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr (Maj. Gen.) Anil Bairaria, Dr U Gaur, Dr Kanta jain, Dr Suresh Arora.

Answer for 27th November Mind Teaser: (C) A hemolytic transfusion reaction

Correct answers received from: Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Kanta Jain, Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

New Teeth

Our local minister had all of his remaining teeth pulled and new dentures made a few weeks ago.

The first Sunday, his sermon lasted 10 minutes. The second Sunday, he preached only 20 minutes. But, on the third Sunday, he preached for an hour and a half.

I asked him about this. He then told me "well, John, that first Sunday, my gums were so sore it hurt to talk. The second Sunday, my dentures were still hurting a lot. Now the third Sunday, I accidentally grabbed my wife's dentures AND I COULDN'T STOP TALKING!"

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    Medicolegal Update

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

What is postmortem discoloration?

The bluish color of postmortem discoloration does not have the same connotation as cyanosis produced during life

  • There is a gravitational pooling of blood in the veins and capillary beds of the dependent parts of the body occur since after death the body remains lying in a position and cessation of the circulation. The postmortem coloration helps a doctor to estimate the time since death.
  • The skin of deceased may show dark purple discoloration due to accumulated blood. The process begins immediately after the circulation stops, and in a person dying slowly with circulatory failure, it may be pronounced very shortly after death. Lividity is present in all bodies, although it may be inconspicuous in some and thus escape notice.
  • Postmortem lividity is first apparent about 20–30 minutes after death as dull red patches or blotches, which deepen in intensity and coalesce over the succeeding hours to form extensive areas.
  • Postmortem lividity is usually well marked in the earlobes and in the fingernail beds. In a supine corpse, there may be isolated areas of lividity over the front and sides of the neck resulting from incomplete emptying of superficial veins. If the head is slightly flexed on the neck, then lividity may have a linear distribution corresponding to the skin folds.
  • Fading of the primary pattern of lividity and development of a secondary pattern of lividity will be quicker and more complete if the body is moved.
  • Cyanide poisoning results in lividity which is described by different authors as pink, bright scarlet, and violet.
    Public Forum

(Press Release for use by the newspapers)

Children and adolescents with congenital heart disease should avoid body piercing

Children and teenagers with congenital heart disease should be strongly discouraged from getting a tattoo or piercing their ears or other body parts, because it could lead to a potentially deadly infection of the heart called endocarditis, said Padma Shri and Dr BC Roy National Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India.

Infective endocarditis occurs when bacteria or fungi attaches and begins to grow on the valves of the heart. If left untreated, it can lead to a fatal destruction of heart muscle.

Most people are not aware that they should talk to their doctor before tattooing or piercing their body.

Body art in the form of tattoos and piercing has become increasingly popular among children and teenagers.

Most experts today strongly discourage all forms of body art. For those who cannot be dissuaded, the recommendation is to give antibiotics prior to tattooing or piercing, “with strong advice for prompt treatment of any signs of subsequent infection”.

    Readers Responses
  1. Dear Sir, Nice reading emedinews. Regards: Dr Ratan
    Forthcoming Events
Dr K K Aggarwal

Seminar on "Mind and Body in Health and Harmony in Asian Systems of Medicine"

Date: December 11-13, 2012
Venue: India International Centre, New Delhi
Themes of the Workshop: Anatomy, Philosophy, Diagnostics and imbalances, Therapeutics and treatments, Understanding Mind-Body relationships and Preventive and Promotive aspects in the traditional systems of medicine

4th eMedinews Revisiting 2012

(a day long single hall medical conference on 2012 happenings, followed by doctors of the year 2012 awards)

Sunday 20th January 2013, Maulana Azad Medical College Auditorium

Dilli Gate Delhi


Dr KK Aggarwal
Padmashri and Dr B C ROY National Awardee President

Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman

Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

4th eMedinewS Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Register at: www.emedinews.in/


4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

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

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Activities eBooks



  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    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