eMedinewS
2nd October 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Declare radiation risk to the patients

Cardiologists need to make sure that patients understand the radiation–related risks of heart imaging tests before sending them for such procedures, a new American Heart Association scientific statement says.

"With technological improvements, medical imaging has become an increasingly vital tool in diagnosing and treating patients with heart disease, but the rising use of the tests has led to increasing radiation exposure over the past two decades," Dr. Reza Fazel, chair of the statement writing committee and a cardiologist at Beth Israel Deaconess Medical Center in Boston said.

Heart imaging procedures account for almost 40 percent of the radiation exposure from medical imaging.

Before referring a patient for a heart imaging test, the cardiologists say, doctors need to address questions such as: how will the test help diagnose or treat the heart problem; are there alternatives that don’t use radiation and what are the levels of radiation exposure, how will it affect the risk of cancer later in life.

Doctors who order heart imaging tests need to understand when each type of test is appropriate, the typical average radiation dose and the potential risks, according to the statement published Sept. 29 in the journal Circulation.

News Around The Globe

  • Saxagliptin is safe to use in diabetes patients with heart failure, unless they have very advanced heart failure and concomitant renal insufficiency, experts say. The link between saxagliptin, a selective dipeptidyl peptidase 4 (DPP–4) inhibitor for the treatment of type 2 diabetes and heart failure was first reported a year ago, in the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus (SAVOR)–TIMI 53 trial.
  • A man in intensive care in Dallas is the first person to be diagnosed with Ebola in the US, the CDC said. The man, who flew from Liberia Sept. 19 and arrived in Dallas Sept. 20, is "critically ill" at Texas Health Presbyterian Hospital, according to CDC Director Tom Frieden, MD.
  • A study in the Journal of the American College of Cardiology looked at whether high–doses of fish oil can help reduce the recurrence of atrial fibrillation. The researchers randomly assigned 337 patients with AFib to take either 4 grams of fish oil a day or placebo. During the monitoring period, just about 64% of the people taking fish oil reported an irregular heartbeat lasting more than 30 seconds, compared to about 63% of the control group. The study concluded that high–dose fish oil does not stop AFib recurrence in patients who aren’t receiving traditional therapy.
  • Children who are given broad–spectrum antibiotics before the age of 2 may face a slightly higher risk of becoming obese during childhood, according to new research published in the Sept. 29 online edition of the journal JAMA Pediatrics. Broad–spectrum antibiotics target a larger number of organisms than narrow–spectrum ones
  • The US Diabetes Prevention Program results imply that you can give an at–risk person with pre–diabetes a 100% chance of using metformin with the goal of reducing by 31% their risk of developing a condition that might require them to use metformin, conclude Yudkin and Montori in BMJ. 2014;349:g4485.

National News

Apollo Hospitals today collaborated with Sanofi to provide diabetes care programmes through the Indian healthcare major's Apollo Sugar Clinics. The outlay of the company for the first 50 clinics that will be set up by the end of this year, is set to be Rs 200 crore, says Prathap Reddy, Chairman – Apollo Hospitals, adding that another 100 clinics will be set up in 2015. Through this partnership, Apollo and Sanofi plan to leverage their respective expertise in diabetes to provide patients with access to comprehensive educational resources, treatment and care programmes for better management. Apollo Hospitals is looking at investments for clinics from Sanofi too, adds Reddy in an interview with CNBC–TV18.

Under the proposed deal, Sanofi could acquire about 20% stake in ASCL, subject to approval from the FIPB (Foreign Investment Promotion Board). Competition Commission of India has already given its nod for the proposed stake buy by French pharmaceutical major.

eMedinewS Comments

  • Someone at the inauguration asked me this question: Can doctors working in a health care set up work in a project owned and co–managed by a pharma company?

    MCI Regulation: 6.8.g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always:
    (i) Ensure that his professional integrity and freedom are maintained.
    (ii) Ensure that patients’ interests are not compromised in any way.
    (iii) Ensure that such affiliations are within the law.
    (iv) Ensure that such affiliations/employments are fully transparent and disclosed.
  • Can a doctor in the clinic run by the pharma company write only products of that company?
    No. Answer is in 6.8.g(i) of Code of Medical Ethics Regulations, 2002, which states: "Ensure that his professional integrity and freedom are maintained".

Dr KK Spiritual Blog

On 8th Navratri Enjoy a purified mind

Maha Gauri is worshipped on the Eight Day of Navratri. SHE looks as white as moon and jasmine. White means purity of mind. She has three Eyes and four hands. SHE is dressed in a white sari.

SHE holds a drum and a trident and is often depicted riding a bull (control over the desires). Her upper left hand is in a fearless pose and she holds ‘Trishul’ in her lower left hand. Her upper right hand has tambourine and lower right hand is in a blessing Mudra.

Spiritual mantra on the 8th Navratri

By the 8th day of spiritual detoxification, one gets purity of mind.

Inspirational Story

Never Give Up

"You are never given a wish without also having been given the power to make it come true." Richard Bach.

What you need is patience, perseverance, and a burning desire that constantly needs to be fueled. The quest for the realization of your dreams is like waging a momentous battle during which you might encounter severe setbacks. But success comes to those who turn adversities into opportunities, overcome their limitations and bounce back with renewed vigor.

If you have fallen down, get up and brush the dust off your knees and move on. A temporary setback is not a defeat. For that matter, there’s no such thing as defeat. Nothing is impossible in this world. If you have the will to win, you can achieve anything. And always remember that the whole world will help you when you want to achieve something.

Just imagine a young girl who learned dancing when she was three–years old and whose greatest passion remains dancing. She loses one of her legs in an accident. Read on this true incident that took place almost 20 years ago and find out whether she gives up dancing or fights back to realize what she believes in:

Sudha Chandran, a classical dancer from India, was cut off in the prime of her career – quite literally – when her right leg had to be amputated after a car accident. Though the incident brought her bright career to a halt, she didn’t give up.

In the painful months that followed, she met a doctor who developed an artificial limb made from vulcanized rubber filled with sponge. So intense was her desire that she decided to go back to dancing after she had been fitted with an artificial leg. Sudha knew that she believed in herself and could fulfill her dream. She began her courageous journey back to the world of dancing – learning to balance, bend, stretch, walk, turn, twist, twirl and finally dance.

After every public recital, she would ask her Dad about her performance. "You still have a long way to go" was the answer she used to get in return.

In January 1984, Sudha made a historic comeback by giving a public recital in Bombay. She performed in such a marvelous manner that it moved everyone to tears while catapulting her to the number one position again. That evening when she asked the usual question her dad, he didn’t say anything. He just touched her feet as a tribute to a great artiste.

Sudha’s comeback was such heart–warming that a film producer was inspired to capture the incident into a celluloid box office hit, ‘Mayuri.’ When someone asked Sudha how she had managed to dance again, she said quite simply, "YOU DON’T NEED FEET TO DANCE."

Rabies News (Dr A K Gupta)

Can rabies be transmitted through sexual intercourse?

Rabies virus is present in the semen and to some extent in vaginal secretions. Priapism, increased sexual libido and indulgence are seen both in male and female rabies cases. Hence, in the exposed person, a full course of rabies post-exposure vaccination either by intramuscular (IM) or intradermal (ID) route should be given. If there is any doubt of category III exposures, i.e., abrasion on penis or in vagina, then RIG must also be given by IM route.

Cardiology eMedinewS

  • The 15–year survival and stroke rates among individuals undergoing aortic–valve replacement with a bioprosthetic or mechanical valve appear equivalent, suggest the results of a new study published in the October 1 issue of the Journal of the American Medical Association.
  • New results from high–risk patients treated with the Lotus transcatheter aortic valve from Boston Scientific outside of North America support the positive early results from this so–called "second–generation," fully retrievable and repositionable transcatheter device. The 12–month results for REPRISE II were reported at TCT 2014.

Pediatrics eMedinewS

  • Long–acting reversible contraceptives should be the first–line option for sexually active teenagers, suggest new guidelines on teenage pregnancy prevention from the American Academy of Pediatrics (AAP). The updated policy statement was published online September 29 in Pediatrics.
  • Children with attention–deficit/hyperactivity disorder (ADHD) perform well below their counterparts who do not have ADHD on multiple functional domains as early as grade 2, reported a new study published online September 29 in Pediatrics. Study authors noted that children with ADHD between 6 and 8 years of age were eleven times more likely to meet criteria for externalizing disorders than non–ADHD control children.

Quote of the Day

  • High achievers spot rich opportunities swiftly, make big decisions quickly and move into action immediately. Follow these principles and you can make your dreams come true. Robert H. Schuller
  • Most successful men have not achieved their distinction by having some new talent or opportunity presented to them. They have developed the opportunity that was at hand. Bruce Barton

IMA/MCI NEWS

Over 500 junior doctors from nine teaching hospitals affiliated to Osmania Medical College boycotted non–emergency duties on Monday in protest against mandatory rural service. Government is holding counselling for doctors for the rural stint on Oct 1. Led by Dr G Srinivasa, president of Telangana Junior Doctors' Association (TJUDA), the PG students sat on a dharna outside Osmania General Hospital superintendent Dr C G Raghuram’s chamber for a couple of hours before laying siege to the office of the director of medical education (DME). As a result of the protest, many patients slated to undergo surgeries on Monday were left high and dry.

Instead of a one-year compulsory rural stint, the TJUDA wants the government to replace it with a voluntary system. They also demanded introduction of residential system for students and faculty members and provision of special protection force inside the premises of teaching hospitals.

"Why are only PG medicos in Telangana and AP being singled out for compulsory rural service when other states have no such system? Even IIT and IIM graduates are never asked to undertake compulsory rural service though the Centre heavily subsidizes their education," said M Kiran, a TJUDA member.

While the stir did not impact emergency services in the teaching hospitals on Monday, the TJUDA members said they would boycott even emergency services if talks with the government failed. "When we gave a representation to DME Dr Putta Srinivas, seeking to withdraw the compulsory rural service, the latter promised to respond in a couple of days with the state government's answer," said Srinivasa.

Interestingly, Kiran, a PG second year student at Osmania Medical College, said that they would consider compulsory rural service if the government is ready to pay them salaries on par with assistant professors and civil assistant surgeons.

Junior doctors, who are mostly PG students of Gandhi Medical College and Kakatiya Medical College, also took out symbolic protests but did not boycott duties. (Times of India)

eMedinewS Comments: The government must see to it that it does not end up in total strike. The best solution is rural posting as a part of three-year PG training and not after or before that.

Wellness Blog

Salt restriction increases efficacy of RAAS blockade

In patients with nondiabetic CKD, sodium restriction on top of single and dual renin-angiotensin-aldosterone system (RAAS) blockade increases circulating levels of the anti-inflammatory and antifibrotic peptide N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP), according to a secondary analysis of a 46-patient randomized clinical trial in the Journal of Hypertension.

ePress Release

Heart Care Foundation of India’s flagship event - MTNL 21st Perfect Health Mela to get bigger and better with the inclusion of a SAIL Health Pavilion

Swach Bharat, Swasth Bharat to be the resonating mantra for the 5 day event scheduled to be held between October 15-19th at the Talkatora Indoor Stadium in New Delhi

October 1st, 2014, Ghaziabad: Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease free nation today announced the exciting additions to its annual flagship event, the MTNL Perfect Health Mela scheduled to be held from 15th -19th October 2014 at the Talkatora Indoor Stadium in New Delhi. In its 21st edition the Mela will feature a first of its kind SAIL Health and Heart Pavilion to provide a complete solution to a person’s overall healthcare needs. People will now not only be able to learn about preventive health measures through interactive entertainment modules but will also be able to seek treatment and consultation under one roof.

Started in 1993, the Perfect Health Mela is an annual mass health awareness module, which attracts over 2-3 lakh visitors every year. Catering to people from all age groups and walks of life, the Mela incorporates activities across categories such as health check up camps, entertainment programs, lifestyle exhibitions, workshops and competitions. This year’s Mela is being organized in association the NDMC, MCD, SAIL and MTNL and its theme is “Swach Baharat, Swasth Bharat”. The main philosophy behind this theme is that by improving the cleanliness of the country, several leading diseases such as dengue, typhoid, malaria, cholera can be eliminated.

Addressing the Press Conference Padma Shri, DST National Science and Communication and Dr. BC Roy National Awardee and the President of the Heart Care Foundation of India, Dr. KK Aggarwal said “It has been Heart Care Foundation of India’s constant endeavor to continuously develop engaging and consumer driven modules to educate the masses about the importance of preventive healthcare and the Perfect Health Mela has been one of the most successful examples. Now in its 21st year, the Mela will aim at not only educating the masses about the importance of being healthy through disease prevention but will also provide technical and financial assistance for those who need heart interventions and cannot afford treatment”

“Modi Ji has come to power and revolutionized governance and it gives us immense pride to support his campaign of Swach Bharat and combine it with something that’s the need of the hour, Swasth Bharat. I would like to thank all our supporters and partners for supporting us in this initiative and hope that we can continue making a substantial difference in the future as well” Dr. Aggarwal added.

The SAIL Health and Heart Pavilion at the 21st MTNL Perfect Health Mela will comprise of a one of a kind conclave of leading hospitals which will offer various health treatments under one roof. For the first time, video consultation facility will also be provided through which patients will be able to interact with and seek medical advice from leading doctors belonging to one of India’s leading multi-specialty hospital, Medanta – the Medicity. Keeping in mind the healthcare needs of the poor and needy and with a vision to ensure that no person dies of disease because they can’t afford treatment, special free of diagnostic facilities and cardiac interventions will be provided by the Sameer Malik Heart Care Foundation fund, which is a new initiative by HCFI.

Speaking on the occasion, Dr. S.K. Gupta Director Medical and Health Services SAIL said, “A country can only truly progress if its citizens are healthy. I congratulate the Heart Care Foundation of India for their constant efforts towards raising health awareness and providing effective health solutions for the marginalized sections of the society. I hope through the SAIL Health and Heart Pavilion at the Perfect Health Mela we can contribute towards making India a healthier nation”

For more information about the event please visit: www.perfecthealthmela.com. Entry to the Mela is free for all.

emedipicstoday emedipics

Heart Care Foundation of India’s flagship event – MTNL 21st Perfect Health Mela to get bigger and better with the inclusion of a SAIL Health Pavilion

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MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

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VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation: A patient with skin diseases needed circumcision and wanted to know whether mediclaim covers it or not.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Circumcision is excluded unless it is necessary for treatment of a disease.

 

Make Sure

Situation: A 40–year–old mild hypertensive complained of ED after a beta blocker.
Reaction: Oh my God! What was the need of starting the drug so early?
Lesson: Make sure that all mild hypertensives are first advised lifestyle modifications like exercise, low salt diet, high fiber diet, decreasing stress, etc. before advising anti hypertensive medications.

eMedinewS Humor

Another time, a man came running in the office and yelled,
"Doctor, doctor ! My son just swallowed a roll of film!"
The doctor calmly replied, "Well let’s just wait and see what develops."

Twitter of the Day

Dr KK Aggarwal: Birth defects linked to mother use of cold medicines. http://bit.ly/15ArAmM #Health
Dr Deepak Chopra: Nothing is not a system of thought but Robert thinks that if you don't understand nothing you don't understand consciousness.

eMedi Quiz

A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mmHg followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Yesterday’s Mind Teaser: A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Propriception on the ipsilateral side.

Answer for yesterday’s Mind Teaser: 3.Pain Sensation On The Contralateral Side.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr B K Agarwal, Dr Ayyavoo Erode, Dr Bitaan Sen, Dr Jayashree Sen, Dr Prakash Khalap.

Answer for 30th Sept Mind Teaser: 3.Lateral Rectus And Abducent Nerve.

Correct answers received from: Tripti Parmar, Dr Pankaj Agarwal, Dr K V Sarma, Dr Jainendra Upadhyay, Najib Khatee, Dr Poonam Chablani.

Send your answer to

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Can the Medical Council act against a doctor if the doctor does not appear repeatedly before the Ethics Committee?

Answer: In an appeal dated 13.07.2013 filed by Shri Padam Singh Gehlot from Jodhpur against an order dated 10.06.2013 passed by Rajasthan Medical Council in a meeting held on 24th & 25th April, 2014, the Ethics Committee of MCI decided as under:

" ..........4: The defendant doctor has also not appeared before the Ethics Committee Meeting in spite of repeated reminder.

5: Under its powers the Council can take an action if a Registered Medical Practitioner does not obey the Council in respect of the matters pertaining to Ethical issues.

6: The MCI, under section 8.5 of Code of Medical Ethics can also take action: “MCI 8.5: During the pendency of the complaint the appropriate council can restrain the physician from performing of procedures or practice which is under scrutiny.”

7: In view of the above, the Ethics Committee under clause 8.5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations decided to suspend the license of Dr Kapoor Choudhary and Dr Promod Sharma for a period of six months or till an appearance in the Committee, whichever is earlier.

medicolegal update
  1. Dear Sir, Thanks for the information. Regards: Dr Kalpesh

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