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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 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

  Editorial …

29th December, 2010, Wednesday                                 eMedinewS Present Audio News of the Day

2nd eMedinewS – revisiting 2010 at http://www.docconnect.com/ on 9th January 2011

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

AHA Top 10 Advances in Cardiovascular Research in 2010 (Part 1)

  1. Tailoring treatment for people with diabetes to reduce their risk of cardiovascular disease
    Heart disease death rates are 2 to 4 times higher for diabetics compared to people without diabetes. New research from the ACCORD Study Group offers insight into specific treatments that can reduce their risk of cardiovascular disease. The first study found that aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD. In a second study, a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD. However, the combination lipid therapy may be successful in reducing CVD risk in those type 2 diabetes patients who had low HDL cholesterol and low triglycerides. (The ACCORD Study Group – N Engl J Med 2010 March 14;362:1575–85; N Engl J Med 2010;362:1563–74)
  2. New advances for patients who aren’t candidates for conventional valve surgery
    Many patients with severe aortic blockage have other medical conditions that make it risky for them to have conventional surgery to replace the blocked aortic valve. Transcatheter aortic valve implantation is an emerging alternative therapy to open–heart surgery in these high–risk patients. Two new studies support the evidence that TAVI can improve symptoms and outcomes – including quality of life – even over the course of several years. While there are some risks associated with TAVI, including strokes and other major cardiovascular events, the catheter-based procedure offers significant progress in this area. (PARTNER Trial Investigators – N Engl J Med 2010 Sept. 22;363(17):1597–607; Ye, et al – J Thorac Cardiovasc Surg 2010 May 1;139:1107–1113)
  3. Improving the way we reverse sudden cardiac arrest
    More than 300,000 people suffer out–of–hospital sudden cardiac arrest each year. Many die because the people around them didn’t know how to or were uncomfortable performing cardiopulmonary respiration (CPR). Significant studies now report that chest compression only, or ‘Hands Only CPR’ for adults by bystander lay rescuers improves survival outcome. Public awareness campaigns resulted in increased use of hands only CPR, as well as improved survival rates. While the new procedure appears successful in adults, it is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest. In October, the American Heart Association issued updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science, reflecting new advances in this field. (Bobrow, et al – JAMA Oct. 6 2010;304(13):1447–54; Rea, et al – N Engl J Med 2010 July 29;363(5):423–33; Field, et al – Circulation 2010 Oct. 18;122 (suppl 3):S640 –S656)
  4. More options for reducing stroke risk in atrial fibrillation
    For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). AF is a major risk factor for stroke and affects more than 2 million people over the age of 65. Warfarin (Coumadin) has long been the standard anti–clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin and are simpler for patients to take offering an important advance in this field. In October 2010, following further positive findings from the RE–LY trial, the U.S. FDA approved dabigatran for stroke prevention in AF patients. The ROCKET–AF trial presented at the American Heart Association’s Scientific Sessions 2010. Rivaroxiban, apixiban, edoxaban and other oral anticoagulants are being or have been studied in AF and may show future promise. (RE–LY– Lancet. 2010 Sep 18;376(9745):975–83; ROCKET–AF – American Heart Association Scientific Sessions 2010, Abstract 21839. AVERROES – European Society of Cardiology Congress 2010)
  5. Adjusting pacing therapies can improve outcomes for heart failure patients
    Many heart failure patients experience abnormal heart rhythms, known as arrhythmia. There are a number of devices available to treat arrhythmia, including implantable cardioverter difibrillators (ICDs) which can shock the heart beat back into a normal rhythm. New studies show that adding additional resynchronization pacing to ICD therapy can lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices. (MADIT–CRT Trial Investigators – N Engl J Med 2009 Sept. 1;361(14) 1329–1338; RAFT Investigators – American Heart Association Scientific Sessions 2010, Abstract 21768; New England Journal of Medicine, Nov. 14, 2010. Bardy, et al – May 12, 2010; N Engl J Med 2010 May 12;363:36–44)
Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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  eMedinewS Audio PostCard

  Topic: eMedinewS Top 10 Health Stories of 2010

  Diabetes Diagnosis

Audio PostCard
  Quote of the Day

(By Dr. GM Singh)

"Reading makes a full man, meditation a profound man, discourse a clear man."

Benjamin Franklin

    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Students from various schools across Delhi and NCR participated in collage making competition in the Eco Fest – School Eco club Festival.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

December trend: Sneezing and wheezing cases are on the rise

CHENNAI: With increasing air pollution levels due to vehicular pollution, construction debris, industrial waste and burning of municipal waste, the city is seeing a huge rise in cases of respiratory diseases and pulmonary disorders. Doctors say pollution is one of the main triggers for asthma, particularly during the months of December and January. Hospitals across the city have recorded an increase in the number of asthma cases this month. A random survey by the Asthma and Allergy Resource Centre, Mylapore, found that at least 18% of people were prone to asthma. "In the urban areas, the figures go up to 25%. Many won’t admit that. But when we put them on nebulizers and aerosols, they feel better," said Dr R Sridharan, who heads the centre. (Source: The Times of India, Dec 27, 2010)

    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC http://www.isfdistribution.com)

High level of physical activity leads to less middle age weight gain

Our body’s metabolism slows as we age, but moderate to vigorous exercise can counteract this decline by lessening weight gain. According to a study published December 14 in the Journal of the American Medical Association, people who begin moderate to vigorous physical activity in their 20s and continue through middle age gain less weight. Women particularly benefitted from 20 years of high activity, gaining on average 13 pounds less than those with low activity, says the study. Men who engaged in comparable exercise over the same time period gained about 6 pounds less than those with low activity.

The study of 1,800 women and nearly 1,700 men is a part of The Coronary Artery Risk Development in Young Adults, a prospective longitudinal study done over 20 years. The active group in the study comprised 12 percent of the participants. Lower levels of activity had a negligible effect on weight gain. 

(Dr Monica and Brahm Vasudev)

Medtronic system for atrial fibrillation receives FDA approval

FDA approved Arctic Front Cardiac CryoAblation Catheter system to treat a form of atrial fibrillation in patients who do not respond to drug therapy.

Experts excited at prospect of drug that may raise HDL, lower LDL

A new drug, anacetrapib, developed by Merck, has experts excited at the prospect of raising HDL, or ‘good’ cholesterol, while lowering bad LDL, even as remarkably effective statins gradually go generic, lowering costs significantly.

A new oral triple antihypertensive drug combination gets FDA green signal

The FDA has approaved a new oral triple antihypertensive drug combination. This new drug includes a direct renin inhibitor, a calcium channel blocker, and a diuretic. Amturnide, the new product combines aliskiren, amlodipine, and hydrochlorothiazide. It is indicated in patients who have failed treatment with any two of the following drug types: aliskiren, dihydropyridine calcium channel blockers, and thiazide diuretics.

Elective single embryo transfer vs double embryo transfer improves probability of term singleton live birth

Results of a one–stage meta–analysis reported in the December 21 issue of the British Medical Journal state that elective single embryo transfer vs double embryo transfer increases the chances of delivering a term singleton live birth by nearly 5–folds.

    Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What are the causes of infertility in men?

Male infertility could be erectile problems or problem in the sperm count. The causes of sperm production problems can exist from birth or develop later as a result of severe medical illnesses, including mumps and some sexually transmitted diseases, or from a severe testicle injury, tumor, or other problem. Inability to ejaculate normally can prevent conception, too, and can be caused by many factors, including diabetes, surgery of the prostate gland or urethra, blood pressure medication, or impotence.

For queries contact: banerjee.kaberi@gmail.com

    Hepatology Update

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

What are the common causes of acute liver failure in a child?

The common causes of ALF in a child in India are Infective Hepatitis (Hepatitis A is more than Hepatitis E; Hepatitis B), metabolic causes, Wilson’s disease, autoimmune hepatitis and drug–induced (ATT, Valproate etc). In newborn period, the common infectious causes of ALF are herpes virus, adenovirus, hepatitis B, Echovirus etc. Metabolic liver diseases are Hereditary fructose intolerance, galactosemia, tyrosinemia and neonatal hemachromatosis.

    Medicolegal Update

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

What is negligence?

A simple lack of care, an error of judgment or an accident is not a proof of negligence on the part of medical professional

Negligence is a breach of duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the contract of human affairs would do which a prudent and reasonable man would not do. Medical negligence is clearly defined as want of reasonable degree of care and skill or willful negligence on the part of medical practitioner in the treatment of patient with whom a relationship of professional attendance is established so as to lead to bodily injuries or as to loss of life.

  • The components of negligence are duty, breach and resulting damage. Definition above is mainly in purview of negligence as tort. But in relation to tort and crime, in tort it is an amount of damage which is an issue but in criminal law it is the amount of degree of negligence that determines the liability.
  • The ingredient of mens rea exist where there is a charge of criminal negligence. Criminal negligence is gross and culpable neglect or failure to exercise reasonable and proper care to guard against injury when it was the imperative duty of the accused person to adopt.
  • A negligence carried by a professional is highly criticized. A professional should not lag behind other members of his profession in knowledge of new advances. He should be alert to the hazard and risk in any professional task he undertakes. He need not posses highest nor a very low degree of care and competence. A person is not liable because someone of greater skill, knowledge would have done something different or in terms of doctors, would have prescribed different treatment or operated in a different way.
  • Negligence in the context of medical negligence necessarily calls for a treatment with a difference.
    ENT Update

Dr. Aru Handa MS, DNB (Department Co–coordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

Can sinusitis recur after surgery?

If surgery is done for the right indication and with good postoperative follow up, sinusitis does not recur. However, for certain diseases like allergic polyposis or allergic fungal sinusitis, not responding to medical treatment alone, the treatment is combined surgery and medical treatment. If these conditions are not followed up after surgery with proper medication they tend to recur. Surgery in these conditions helps to open up the passages and also in better delivery of local nasal sprays.

    Men’s health: Preventing your top 10 threats (Mayo Clinic)

Type 2 diabetes

What are the symptoms of unsafe type of ear infection?

Type 2 diabetes, the most common type of diabetes affects the way the body uses blood sugar (glucose). The possible complications of type 2 diabetes include heart disease, blindness, nerve damage and kidney damage. To prevent type 2 diabetes:

  • Lose excess pounds, if you're overweight.
  • Eat a healthy diet rich in fruits, vegetables and low–fat foods.
  • Include physical activity in your daily routine.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

What should a doctor do when:

  • A victim of sexual assault/rape victim voluntarily comes for treatment to the hospital after the incidence but she (or her guardian) does not want that the matter may be reported to the police?
  • A child is brought for treatment by the mother and the doctor suspects that it is a victim of sexual abuse by a near relative but the mother does not want to report the matter to the police?

What is the applicability of section 39, CrPC, section 174, CrPC and section 202, IPC in such cases?


  • When anybody comes to know that a crime has been committed, it is part of his responsibility and duty toward the public that he should report the same to the appropriate authorities.
  • A doctor has to deal with medicolegal cases. I would classify medicolegal cases into the following categories:
  • Those cases that are brought to the doctor by the police;
  • Those cases that have to be mandatorily informed to police under section 39 CrPC;
  • Those cases where the doctor suspects foul play (such as rape; child abuse; stab wound etc.)
  • Those cases where the injury or death appears to be accidental but is likely to be a subject of litigation in future (such as a roadside accident).

    A sexual offence belongs to the above category ‘c’. The doctor should ordinarily report such cases to the police but should not do so when the person concerned specifically withholds consent to do so and requests professional confidentiality.
  • Some offences have to be mandatorily reported to the authorities as per the provisions of Section 39 of the Code of Criminal Procedure, 1973, titled "Public to give information of certain Offences". The section is reproduced below:
    "(1) Every person, aware of the Commission of , or of the intention of any other person to commit any offence punishable under any of the following sections of the Indian Penal Code ( 45 of 1860 ), namely:

    shall, in the absence of any reasonable excuse, the burden of proving which excuse shall lie upon the person so aware, forthwith give information to the nearest Magistrate or Police officer of such Commission or Intention."
  • Section 174 of Cr.P.C., titled "Police to inquire and report on suicide etc." refers only to cases where death has been caused by suicide, animal, machinery or accident etc.
  • Section 202, IPC, is titled "Intentional omission to give information of offence by person bound to inform" and reads:
    “Whoever, knowing or having reason to believe that an offence has been committed, intentionally omits to give any information respecting that offence which he is legally bound to give, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both."
    It is clear that the words "which he is legally bound to give" refer to section 39, CrPC.
  • The offences of sexual assault mentioned in the question do not fall within the purview of Section 39 CrPC. Hence there is no mandatory requirement that a doctor should report the same to the police.
  • The doctor concerned may face the following situations and he/she should act accordingly as indicated below:
    a. When the patient/victim/guardian has no objection to the crime being reported to the police—The doctor should inform the police.

    b. When the patient/victim/guardian expressly states (in writing, under signature, with a witness) that he/she does not want a police report,—The doctor should not inform the police. However, it is likely that some time in future, the police may ask the doctor about the particular incident. Hence it is important that the doctor should keep the record of the patient in sufficient detail in safe custody because it may be the subject of litigation in future.
  • When a patient comes to a doctor, the latter is bound by the principle of professional secrecy which demands that anything regarding the patient that comes to his knowledge during the course of professional services is privileged information for the divulgence of which, without permission or legal necessity, he would be liable in law. In situation ‘b’ above, the doctor can be sued by the patient/victim for breaching the principle of privileged communication. The only exceptions to this principle may be when there is a legal necessity to disclose (such as a demand by an authorised investigating agency; court orders; and specific legal provisions for mandatory disclosure as per Section 39 CrPC).
    Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

Can MCI stay the action of DMC or does one need to go to the High Court?

A: IN THE HIGH COURT OF DELHI: Writ Petition (C) No.1735/2008/3rd March: Dr PB vs DMC, Justice Gita Mittal.

  1. This writ petition has been filed by the petitioner who has submitted that he is a radiologist and has been wrongly found guilty of medical negligence by the DMC vide an order dated 4th February, 2008 in respect of the alleged examination which he never conducted. It is an admitted position that the petitioner has assailed the order passed by the DMC by way of an appeal filed before MCI.
  2. Ms. PMS learned counsel for the MCI submits that it is a fact that the petitioner has filed an appeal. I find that there is also no dispute that the appeal accompanied by an application seeking interim stay, has been filed. However, as on date, no interim order has been passed and the impugned order passed by the DMC dated 4th February, 2008, takes effect from 4th March, 2008. According to the petitioner, the respondent has taken a stand that there is no statutory power with MCI to entertain or pass interim order. This writ petition seeks grant of the interim orders during the pendency of the appeal.
  3. DMC has directed removal of the petitioner’s name from the State Medical Register for a period of three months as well as penalty. It is pointed out that the same would abrogate not only the petitioner’s right to practice medicine in Delhi but also in the entire country and would severely impact his professional reputation.
  4. I have heard the parties who are present. So far as the merits of the petitioner’s appeal is concerned, the same is pending consideration before MCI which would take a considered view after hearing the parties before this court. However, it cannot be denied that removal of the name from the medical register would irreparably impact the petitioner’s right as well as the reputation and standing in the medical profession. In case the appeal is decided in favour of the petitioner, there is substance in the petitioner’s contention that restitution may not be possible. The regulations under the appeal which has been filed, are statutory. The petitioner has invoked this statutory remedy in accordance with law. On a consideration of the matter, in order to balance equities and meet the ends of justice, in my view, it would be appropriate if the execution of the order remains stayed till consideration and adjudication upon the appeal filed by the petitioner. Accordingly, this writ petition is allowed. The execution of the DMC order shall remain stayed during the pendency of the appeal which has been filed by the petitioner before the MCI herein, assailing this order. (Supreme Court of India: Samira Kohli Vs. Dr. Prabha Manchanda. Ref: 2008 vol2 SCC @ pg1)
   Ethical earning   

What is reimbursable to a doctor?

One can charge differently for minor versus major dressing

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Polymerase Chain Reaction (PCR) Technique

PCR is a technique in molecular biology to amplify a single or few copies of a piece of DNA across several orders of magnitude, generating thousands to millions of copies of a particular DNA sequence.

  • The method relies on thermal cycling, consisting of cycles of repeated heating and cooling of the reaction for DNA melting and enzymatic replication of the DNA.
  • Primers (short DNA fragments) containing sequences complementary to the target region along with a DNA polymerase (after which the method is named) are key components to enable selective and repeated amplification. As PCR progresses, the DNA generated is itself used as a template for replication, setting in motion a chain reaction in which the DNA template is exponentially amplified.
  • PCR can be extensively modified to perform a wide array of genetic manipulations.
Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Medi Finance Update

Q. Are trusts required to file return of income?

Ans. Trusts are also required to file return of income, if the voluntary contributions or other income exceeds the exemption limit.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Sertaconazole 2% w/v+ Zinc Pyrithione 1% w/v Shampoo For the treatment in adults patients with dandruff/seborrheic dermatitis of the scalp
    IMSA Update

International Medical Science Academy (IMSA) Update

Clinical and prognostic subforms of new daily–persistent headache

Clinical and laboratory features used to assess neurologic prognosis after cardiac arrest may not be reliable in early evaluations in the setting of induced hypothermia therapy. (Ann Neurol 2010; 67:301, Neurology 2010;74:965).

    IJCP Special

Dr Good Dr Bad

Situation: A patient wanted to know whether drinking sugar lemonade could prevent his hot temper.
Dr. Bad: There is no role.
Dr. Good: Try it.
Lesson: A spoonful of sugar is enough to cool a hot temper. People who drink lemon with sugar act less aggressively towards strangers than people who consume lemonade with sugar substitutes.

Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Charu Aggarwal)

Breakfast at McDonald’s

This is a good story and is true, please read it all the way through until the end! (After the story, there are some very interesting facts!):

I am a mother of three (ages 14, 12, 3) and have recently completed my college degree. The last class I had to take was Sociology. The teacher was absolutely inspiring with the qualities that I wish every human being had been graced with. Her last project of the term was called, ‘Smile.’ The class was asked to go out and smile at three people and document their reactions. I am a very friendly person and always smile at everyone and say hello anyway. So, I thought this would be a piece of cake, Literally.

Soon after we were assigned the project, my husband, youngest son, and I went out to McDonald’s one crisp March morning. It was just our way of sharing special playtime with our son. We were standing in line, waiting to be served, when all of a sudden everyone around us began to back away, and then even my husband did. I did not move an inch… An overwhelming feeling of panic welled up inside of me as I turned to see why they had moved. As I turned around I smelled a horrible ‘dirty body’ smell, and there standing behind me were two poor homeless men.

As I looked down at the short gentleman, close to me, he was ‘smiling.’ His beautiful sky blue eyes were full of God’s Light as he searched for acceptance…… He said, ‘Good day’ as he counted the few coins he had been clutching. The second man fumbled with his hands as he stood behind his friend. I realized the second man was mentally challenged and the blue–eyed gentleman was his salvation. I held my tears as I stood there with them. The young lady at the counter asked him what they wanted. He said, ‘Coffee is all Miss’ because that was all they could afford. (If they wanted to sit in the restaurant and warm up, they had to buy something. He just wanted to be warm). Then I really felt it – the compulsion was so great I almost reached out and embraced the little man with the blue eyes. That is when I noticed all eyes in the Restaurant were set on me, judging my every action.

I smiled and asked the young lady behind the counter to give me two more breakfast meals on a separate tray.

I then walked around the corner to the table that the men had chosen as a resting spot. I put the tray on the table and laid my hand on the blue–eyed gentleman’s cold hand. He looked up at me, with tears in his eyes, and said, ‘Thank you.’ I leaned over, began to pat his hand and said, ‘I did not do this for you. God is here working through me to give you hope.’ I started to cry as I walked away to join my husband and son… When I sat down my husband smiled at me and said, ‘That is why God gave you to me, Honey, to give me hope…’ We held hands for a moment and at that time, we knew that only because of the Grace that we had been given were we able to give.

We are not church goers, but we are believers. That day showed me the pure Light of God’s sweet love.
I returned to college, on the last evening of class, with this story in hand. I turned in ‘my project’ and the instructor read it. Then she looked up at me and said, ‘Can I share this?’ I slowly nodded as she got the attention of the class. She began to read and that is when I knew that we as human beings and being part of God share this need to heal people and to be healed. In my own way I had touched the people at McDonald’s, my son, the instructor, and every soul that shared the classroom on the last night I spent as a college student. I graduated with one of the biggest lessons I would ever learn: unconditional acceptance.
Much love and compassion is sent to each and every person who may read this and learn how to

Love people and use things – not love things and use people.


Mind Teaser

Read this…………………

legal legal

Yesterday’s Mind Teaser: "age minus story"
Answer for yesterday’s Mind Teaser: ageless story

Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr. Rajiv Dhir, Dr Satish Gunawant, Dr K.Raju, Dr Susheela Gupta

Answer for 27 December Mind Teaser: "Gross injustice"
Correct answers received from: Dr Prabha Sanghi, Dr Anurag Jain, Dr Rajiv Dhir  

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr GM Singh)

Once Jhatka was walking. He had a glove only on one hand . So the man asked him why he did so. He replied that the weather forecast announced that on one hand it would be cold and on the other hand it would be hot.

    Readers Responses

Letter to Editor

To: Dr K K Aggarwal

Subject: Padma Awardee Meet

Reference your e–mail dated 20th October, 2010 on the above subject. I being out of station was unable to attend the meeting. I greatly appreciate the various issues discussed and decisions taken. I, however, have some comments and suggestions for the consideration of the group.

Item No. 12:– Bachelor of Rural Health: We need to seriously debate on the issue of creating such service cadres I personally am not in favor of such a course. It is like introducing a half baked Licentiate course (LSMF) in medicine. If at all such manpower is needed, we should re-introduce Licentiate course. The Govt. needs to make cast iron rules for such cadres which should form part of the prospectus. What will be the future career prospects of Bachelor of Rural Health BRH (a trained person)? He will not be allowed to suffix Dr. with his name whereas quacks write ‘Doctor’ with their names and Govt./MCI has no control on them.

Under the National Programme for the Control of Blindness (NPCB), we started an Ophthalmic Assistant Training course of 2 years duration in 1982 to produce required manpower to assist the PHC doctors and Ophthalmologists in the hospitals. We called the course training as ‘Para Medical Ophthalmic Assistants (PMOA)’. 37 Medical colleges conducted this training programme in different parts of the country. 800 to 1000 PMOA were produced each year to meet the needs of the NPCB. Now, 25 years later, the PMOA are all in arms asking for designation as ‘Ophthalmic Officers’ and demand higher training opportunity for diploma and degree courses in Ophthalmic Sciences with a lateral entry to degree courses and establishment of a council for Ophthalmic Assistants.

Item No.14: MCI will soon make credit hours compulsory before re-registration: I do not support the proposal. My comments are as follows.

Though it is a very laudable objective but is not likely to succeed for the following reasons. It will not be easy to enforce and will introduce ‘License Raj’. The situation in India is not conducive at present. Great majority of doctors, particularly the elder ones, working in small towns and rural areas can hardly afford to go to big cities where CME are conducted to earn required credit hours. Hardly 20–25% of doctors attend CMEs at present. We need to motivate the rest; it should be made voluntary and not compulsory. They should be encouraged to update themselves for which incentives should be given for credit hours and certificate of proficiency should be awarded. Re–registration should be considered after 10 years and in any case, there should be no re–registration fee.

There are other professional regulatory bodies: judicial academy such as Bar Council, Press Council, Council of Charted Accountants. Do they prescribe compulsory credit hours and re–registration? Supposing a large percentage of doctors does not collect credits and does not apply for re-registration. What action can be taken against them, when quacks practice freely in this country? We should simultaneously eliminate quackery in the next 10 years.

In my opinion the objective of Padma Awardee Doctors group should be promotive and not punitive. We should act as thinktank for upholding the dignity of profession and welfare of the Professionals and not just endorse what the Govt. or the MCI desires or plans. I would like discussion on the following issues in future meetings of the Padam Awardees:

  • How to uphold the dignity of the medical profession.
  • How to improve the unwarranted decline of the image of Doctors
  • How to help regulate the practice of medicine in India.
  • How to grade Hospitals, Nursing Homes/Clinics depending on the location, infrastructure, qualification and experience of the consultants on the same lines as grading of Hotels.

Who fixes the tariffs of Hotels or fees of the Lawyers or Arbitrators, Architects, Chartered Accountants and other consultants? No attempt should be allowed to curb freedom of the doctors to practice the profession. Interference of TPAs in medical practice is undesirable. Are there any such agencies who try to fix the professional fees of Lawyers, Charted Accountants, and Business Consultants etc? Laws should strictly be enforced to curb quackery and sale of drugs by the chemists, without an authentic prescription. There should be an agency, which should be promotive and protective, to improve the quality of life of the medical Professionals who work under undue stress in this country.

I will appreciate receiving views of the other members of the Padma group on the issues mentioned above to have a healthy discussion.

With regards, Prof. (Dr.) Madan Mohan

    Public Forum

(Press Release for use by the newspapers)

Heart failure and snoring not a welcome combination

Two types of sleep–disordered breathing are common among patients with heart failure: snoring–related obstructive sleep apnea–hypopnea (OSAH) and snoring unrelated Cheyne–Stokes breathing (CSB). They are collectively referred to as sleep–disordered breathing (SDB), said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

OSAH is characterized by reductions or cessations of airflow during sleep, despite ongoing respiratory effort. It is due to upper airway obstruction and clinically is associated with snoring.

CSB is characterized by cyclic crescendo–decrescendo respiratory effort and airflow during wakefulness or sleep, without upper airway obstruction. The decrescendo effort may be accompanied by cessation of respiration during sleep (central sleep apnea syndrome).

Patients who have heart failure and SDB can be asymptomatic or symptomatic. When OSAH is the predominant type of SDB, snoring and symptoms related to poor sleep quality (eg. fatigue) are common. When CSB is the predominant type of SDB, symptoms due to CSB may be subtle or indistinguishable from those due to the underlying heart failure.

Night time angina and recurrent refractory arrhythmias (irregular heart beats) may occur with either type of SDB. The evaluation of patients with heart failure should include questions about potential SDB symptoms.

Patients who report snoring, excessive daytime fatigue, or poor sleep quality may benefit from assessment via sleep lab. Sleep testing should also be considered in patients with heart failure who have night angina, recurrent arrhythmias, or refractory heart failure symptoms.

Patients who have heart failure and SDB are likely to have a poorer prognosis than patients who have heart failure without SDB. Optimization of the medical management of heart failure is the primary therapy for patients whose heart failure is complicated by SDB because it improves heart failure–related outcomes and may improve SDB. For patients who have heart failure complicated by SDB positive airway pressure with CPAP machine improve cardiac function, blood pressure, exercise capacity, and quality of life.

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Dear Colleague, The Second eMedinews Doctor of the Year Award function will be held on 9th January, 2011 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2010, send his/her biodata: Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee.

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