eMedinewS31st January 2014, Friday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; 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

USICON 2014

How to defend yourself in the court

Check if the allegation falls into "medical accident" as this is not negligence.

The Supreme Court of India has observed in a case: "Mere accident is not evidence of negligence."1 The order also clarifies that difference of opinion or error of judgment cannot be termed negligence. Likewise adverse reactions or medical accidents cannot be classified under medical negligence

Reference

1. Jacob Mathew v. State of Punjab SC⁄0457⁄2005: (2005) 6 SCC 1.

Check if the allegation falls into "error of judgment"as this is not negligence.

In one of the cases Supreme Court of India has observed: "An error of judgment on the part of a professional is not negligence per se."

Reference

1. Jacob Mathew v. State of Punjab SC⁄0457⁄2005: (2005) 6 SCC 1 (iii). Check if the allegation falls into "deviation from medical practice" as this is not negligence. The Supreme Court of India has observed in a case: "Deviation from normal practice is not necessarily evidence of negligence. To establish liability on that basis, it must be shown: 1. that there is a usual and normal practice; 2. that the defendant has not adopted it; and 3. that the course in fact adopted is one no professional man of ordinary knowledge skill would have taken had he been acting with ordinary care."

Reference

1. Jacob Mathew v. State of Punjab SC⁄0457⁄2005:(2005)6SCC 1.

Check if the allegation falls into "not getting cured" as this is not negligence.

The Supreme Court of India has observed in a case: "Simply because a patient has not favourably responded to a treatment given by a physician or a surgery has failed, the doctor cannot be held liable per se by applying the doctrine of res ipsa loquitur."

Reference

1. Jacob Mathew v. State of Punjab SC⁄0457⁄2005 : (2005) 6 SCC 1 (iv).

Congratulations New Feathers to Dr K K Aggarwal’s Cap

To receive DST National Award

Dr Aggarwal will be awarded National Award for Outstanding Efforts in Science & Technology Communication in general for the year 2013. The award consists of Rs. 2 lakh, a memento and a citation. It would be presented on Feb 28 at DST Auditorium as part of National Science Day. The award is given by the Dept. of Science and Technology Govt. of India (Ministry of Science and Technology).

To receive Harpal S Buttar Oration

Dr. Aggarwal, will be awarded Harpal S Buttar Oration Award at the 6th International conference of International Academy for Cardiovascular Sciences today by International Academy of Cardiovascular Sciences India. The award consists of a memento and a cash prize of Rs. 10000⁄–. The Oration will be given to him for his outstanding contribution for heart care and other achievements in cardiovascular sciences.

Dr Aggarwal is already recipient of two National Awards: Dr BC Roy National Award and the Padma Shri.

The 6th International Conference of IACS ON "Recent Advances in Cardiovascular Sciences"

The 6th International Conference of IACS ON "Recent Advances in Cardiovascular Sciences" is being held in New Delhi at DIPPSAR, Pushp Vihar, New Delhi Date: January 31st and 1st February 2014

Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

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 mantra
VIP’s on CPR 10 Mantra Video
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

An empty mind is the devil’s house

sprritual blog

It is an old saying that "Khali dimag shaitan ka ghar".

Empty mind means when you are doing nothing and Shaitan means negative thoughts. In terms of Vedic Sciences, negative thoughts mean absence of positive thoughts and they are often equated to darkness which is absence of light.

Positive thoughts always need efforts and exertions while negative thoughts are spontaneous and without exertion. It is recommended that one should think differently and positive otherwise there will be spontaneous appearance of negative thoughts.

Darkness is spontaneous and naturally present and to bring light one has to make efforts by switching on the light or the nature has to ask the Sun to come and give the light.

cardiology news

Always remember those who serve

In the days when an ice cream sundae cost much less, a 10 year old boy entered a hotel coffee shop and sat at a table. A waitress put a glass of water in front of him.

"How much is an ice cream sundae?" "Fifty cents," replied the waitress.

The little boy pulled his hand out of his pocket and studied a number of coins in it. "How much is a dish of plain ice cream?" he inquired. Some people were now waiting for a table and the waitress was a bit impatient.

"Thirty–five cents," she said brusquely. The little boy again counted the coins. "I’ll have the plain ice cream," he said.

The waitress brought the ice cream, put the bill on the table and walked away. The boy finished the ice cream, paid the cashier and departed.

When the waitress came back, she began wiping down the table and then swallowed hard at what she saw. There, placed neatly beside the empty dish, were two nickels and five pennies – her tip.

News Around The Globe

USICON 2014:

Uplift Men’s Health
Prof. (Dr) Rajeev Sood, Organizing Secretary ,USICON 2014

Dear Friends,
Men’s health is one another section of medicine which has often got neglected with no concerted efforts being currently undertaken by the health care system for its promotion on the national front. Again as urologists we can contribute immensely to the endorsement of this cause as we frequently deal with problems of men in the geriatric and adolescent age group. Erectile dysfunction often heralds to the more ominous cardiovascular accidents. Psychiatric disorders, hypogonadism, metabolic problems, drug and alcohol abuse, smoking, cancers are all common male gender specific problems for which the treating physicians and the patients alike need to be sensitized. The interplay of these among themselves, ultimately leading to the health havoc, needs to be severed to be able to achieve anything concrete in terms of improving the overall life expectancy of the male, which currently trails from that of females by several years all across the globe, including India. To add to the gloomy scenario of men’s health many policymakers and the general public simply do not see the need for men’s health efforts even though it is likely to directly impact the economic health of the country and also have a scientifically proven direct negative impact on the medical, social and economic health of women and children as well. Surprisingly it is reasoned not to take up this important cause on national front, given the inability to have achieved targets with other national programs. To overcome these psyche impediments at all levels, the cause has to be projected at a much larger scale.

Recently ‘Men’s Health society of India’ was launched successfully in an effort to create awareness about this cause and also to bring forth the collective wisdom and efforts from all interested quarters for the uplift of the overall male health. This society stands affiliated as the official arm of the ‘International Society of Men’s Health’. The earlier program about prostatic diseases titled ‘Prostatic Disease Awareness Program’ was another lead effort in this regard which was heartily imbibed by the USI for greater impact and implementation all across India. The fruits of all such efforts have already started appearing and shall improve in the near future.

Today, we can use this large national platform of the USICON, to further the goal of Men’s Health in India and help making it move from dreams to reality.

The State of Men’s Health in India:Dr Narmada P Gupta, Medanta, Gurgaon

Men’s Health deals with physical, mental and social wellbeing of men throughout their life cycle from boyhood to elderly age. India has the second largest population in the World after China with current population in 2013 being 1.24 billion. As per 2011 census the sex ratio is 940 females per 1000 males, life expectancy at birth for males is 65.77 years and for females is 67.95 years. Men have shorter life span due to their risk taking habits like smoking, chewing tobacco, drinking alcohol, higher suicidal tendency, drugs intake, rash driving, unsafe sex and health hazards at work places. There are certain diseases which occur in both sexes but are more common in men like metabolic syndrome, Coronary Artery Disease, Diabetes Mellitus, Hepatitis, Athlete’s foot, Urination and Bladder problems, Chronic kidney diseases. In India 34.6% of adults consume tobacco out of which 47.9% are male and 20.3% are female. Among the total smoking habits, 73% is in the form of Bidi and 27% in the form of Cigarettes. Bidi smoking poses a very high risk for lung cancer even more than that of cigarette smoking. Chewing tobacco⁄Gutka is common. 33% adult Indian males and 18.4% adult Indian females use smokeless tobacco. This all results in to cardiac diseases, diabetes mellitus and metabolic syndrome. A new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington has revealed that between 1980 and 2012, smoking prevalence among Indian men decreased from 33.8 percent to 23 percent. Alcohol consumption is more common in males than females resulting in alcohol related complications and death. Rash driving resulting to death is more common in men. Suicidal tendency is more common in males.

The gender specific diseases in men are diseases of prostate, testicular problems, epididymitis, varicocele, Androgen Deficiency in Aging Ma le (ADAM) , and Male infertility. The elderly population is increasing in India due to increased longevity of life and better health care. Prostatic diseases occur in aging male. The common diseases are benign enlargement of the prostate and cancer prostate. Cancer Prostate is now becoming 2nd most common cancer in men next to oral cancer. Sex related problems like erectile dysfunction, premature ejaculation and hypogonadism is also increasing. In infertile couples, the male factors are responsible in about 50 % cases. It is important to recognize these factors and educate doctors and public at large to minimize health related problems in males and to improve their quality of life and longevity.

Men have shorter life span due to their risk taking habits like smoking, chewing tobacco, drinking alcohol, higher suicidal tendency, drug intake, rash driving, unsafe sex and health hazards at work places. Life expectancy at birth for males is 65.77 years and for females is 67.95 years. Men have shorter life span due to their risk taking habits like smoking, chewing tobacco, drinking alcohol, higher suicidal tendency, drug intake, rash driving, unsafe sex and health hazards at work places. Life expectancy at birth for males is 65.77 years and for females is 67.95 years.

Prof (Dr) RM Meyyaapan: President, Urological Society of India

As President of the USI, I would like to say that this conference held on the auspices of the USI, has been held in New Delhi after 31 years. Almost 2000 delegates have gathered for the annual conference. The aim of this conference is ‘academic excellence’ in par with international standards. The postgraduates have access to the Trace Centre with new technologies that are useful in urology. The conference is spread over 4 days and, over the last 2 days, has covered several aspects related to urology such as stone disease, prostatic disease, cancer prostate etc. among several others. Men’s health is another significant focus in this conference. Various subspecialties are discussed. Eminent faculty, both national and international, have assembled to give their oration in different fields. The live operative workshop held yesterday would have been very useful to all especially the postgraduate students. This year too, the USI–AUA Instructional Course would serve as an Education Bridge for the young urologists in particular, giving them an excellent opportunity to interact with an international academic organization. My take home message for the delegates is –To get oriented the newer technology in the management of Urological Problems thereby the community is benefitted. I hope you enjoy this academic feast…

Dr Ranjith Ramasamy, New York: Varicocele surgery

A varicocele is a dilatation of the pampiniform venous plexus and the internal spermatic vein. It is important to differentiate between clinical and non clinical varicocele. Clinical is palpable varicocele and subclinical varicocele is non palpable.

Varicocele: Clinical classification

Clinical (palpable)

Subclinical (non palpable):

Grade III (large): easily visible
Grade II (medium): Palpable at rest (without valsalva
maneuver), invisible Grade I (small): Palpable with valsalva maneuver only

Vein larger than 3mm on ultrasound; Doppler reflux on valsalva maneuver

Indications of varicocelectomy

  • Palpable varicocele
  • Documented infertility in the couple.
  • The female has normal fertility or potentially correctable infertility
  • The male partner has one or more abnormal semen parameters.

Varicocelectomy is superior to observation in infertile men with palpable varicoceles and impaired semen quality, with increased odds of spontaneous pregnancy; 32.9% (treatment) vs 13.9 % (control) and improvements in semen characteristics within 1–year of follow–up. (Eur Urol. 2011 Mar;59(3):455–6)

Varicocelectomy improves clinical pregnancy and live birth rates by intracytoplasmic sperm injection in infertile couples in which the male partner has clinical varicocele. (J Urol. 2010 Oct;184(4):1442-6)

  • Postoperative improvement, sperm count (14 → 35 m), motile sperm (6.7 → 15.4 m)
  • Improved live birth rate: 37 vs 51%
  • Improved clinical pregnancy rate: 48 vs 73%

Methods to treat varicocele: Embolization, laparoscopic varicocelectomy, microsurgical varicocelectomy (inguinal vs subinguinal) Sperm parameters improve by 3 months after varicocele repair and then do not improve further. This finding should allow physicians to decide quickly if varicocelectomy has been effective and, then, if required, plan on the use of other therapies to manage the couples' infertility. (J Urol. 2012 Jan;187(1):227–31)

 Key points

  • Men with male factor infertility need evaluation beyond presenting condition.
  • Varicocelectomy can improve both natural conception and ART outcomes
  • Microsurgical approach – lower recurrence and side effects.

Azoospermia: Step by step –Dr Rajeev Kumar: New Delhi

To me, azoospermia is completely different from few dead immotile sperms seen. Questions to be answered in such cases include:
· Is the male contributory? Semen analysis – azoospermia
· Why? Causes
· What can we do about it? Reversible or not, surgery ⁄drugs, IVF or not

Step 1: Confirm azoospermia
 ‘0’ sperms – azoospermia; repeat

Step 2: Causes
·  Obstructive (May be treatable): vasectomy, trauma, surgery, epididymal obstruction, absent vas, ejaculatory duct obstruction
·  Non obstructive (will need ART) : Testicular failure

Step 3: Check volume
· Is it low? 0.5–1 ml; few drops vs spoonful
· If yes, then look for presence of vas clinically
If few drops, the causes may be absent vas or blocked ejaculatory ducts

Step 4: Check production
Look for testes size and secondary sexual characteristics
Obstructive
· Normal testes, normal FSH
· FNAC; confirm spermatogenesis before surgery

Vaso–epididymal anastomosis

Step 5: Non obstructive azoospermia
· These patients will not benefit from surgery unless huge varicocele
·  No investigations
·  Will need ART
·  Investigations are done to facilitate ART (IVF)
Non obstructive
· Small testis, raised FSH
· FSH <2x: FNAC to confirm, genetic studies prior to ICSI
·  FSH >3x: Poor sperm retrieval

Genetic screening
· Diagnostic: Severe OATS⁄NOA
· Prognostic: Prior to ICSI
· Yq microdeletions: Present in 9% NOA men in India, poor implantation, increased incidence of congenital malformations (2.7%).Varicocele cases with Yq microdeletion do not show improvement in semen parameters post–varicocelectomy. Detection of Yq microdeletion determines prognosis and future management in such cases. (Indian J Med Sci. 2007 Sep;61(9):505-10)

The Children’s Hospital of Philadelphia (CHOP): Douglas Canning

Transitioning urology patients to adult providers
Transition is a process, not an event!!!
There are more than 9000 youth aged 13-18 years with complex chronic medical conditions and more than 2000 adults older than 18 years with chronic issues at CHOP.

Barriers impacting transition of care (TOC)
· Upper age limits for care at pediatric hospitals: 18–21 years
· Insurance coverage and reimbursement
· Availability and interest of specialty care
· Practice differences: adult vs pediatric (organization of care, communication, involvement of family)

JA Binks barriers to transition (Arch Phys Med Rehabil. 2007 Aug;88(8):1064-73)
· Inability of child-centered health care professionals to let go of their long standing relationships  with patients and their distrust of adult centered health services.
· Little incentive for youth to move on to adult providers from pediatric providers who have supported them very well for a very long period of time.
· Parents inability to relinquish control over their child’s health and healthcare decisions
· Adult centered physicians may have limited training in childhood diseases  and therefore have limited knowledge and interest in caring for these patients.

As adults with chronic GU health issues age, they have a higher incidence of overall mental health issues, poor body image from psychosexual perspective, depression, and suicidal ideation.
To address these barriers, it is important to identify good adult providers, get a patient feedback and most importantly, prepare the patients early, so that transition is not a surprise … “we thought we could stay at CHOP forever”

CHOP intranet: A lot of resources about transition on CHOP intranet is available for provider, parent or caregiver and patient: http://intranet.chop.edu/sites/pfe/45 –transition–to–adulthood.html

The first thing we do at CHOP is to identify adult providers who are capable and willing to accept care of our adult patients. Then we review the list of identified adult providers, get a feedback for either addition or removal of providers & dot phrases…
Adolescents and their families should be involved in all healthcare decision. The parents and caregivers can be of help to facilitate change.

TOC works best when pediatric providers prepare their patients and families

Transition: A work in progress
· Know your patient
· Communicate to the hand off physician
· Work out the payment issues
· Stay in contact: continue to be available to the patient, physician
· Continue to refine the process

Tips for providers
·    Encourage progressive responsibility for patient
·    Ask them about future goals or plans
·    Ask them about social concerns
·    Patient privacy at age 18
·    Meet with the patient alone for part of the visit

The State of Men’s Health in India:Dr Narmada P Gupta, Medanta, Gurgaon

Men’s Health deals with physical, mental and social wellbeing of men throughout their life cycle from boyhood to elderly age. India has the second largest population in the World after China with current population in 2013 being 1.24 billion. As per 2011 census the sex ratio.

++++++++++++++++++

The State of Men’s Health in India:Dr Narmada P Gupta, Medanta, Gurgaon

Men’s Health deals with physical, mental and social wellbeing of men throughout their life cycle from boyhood to elderly age. India has the second largest population in the World after China with current population in 2013 being 1.24 billion. As per 2011 census the sex ratio.

++++++++++++++++++

The State of Men’s Health in India:Dr Narmada P Gupta, Medanta, Gurgaon

Men’s Health deals with physical, mental and social wellbeing of men throughout their life cycle from boyhood to elderly age. India has the second largest population in the World after China with current population in 2013 being 1.24 billion. As per 2011 census the sex ratio.

++++++++++++++++++

The State of Men’s Health in India:Dr Narmada P Gupta, Medanta, Gurgaon

Men’s Health deals with physical, mental and social wellbeing of men throughout their life cycle from boyhood to elderly age. India has the second largest population in the World after China with current population in 2013 being 1.24 billion. As per 2011 census the sex ratio.

++++++++++++++++++

Dr Rajesh Taneja: Apollo, New Delhi
Indian men suffer from a peculiar pre marital anxiety. Many of these young men have been exposed to fallacious ideas and suggestions which are in fact detrimental to their psyche and resultant sexual dysfunction. These men end up feeling guilty about past sexual practices and thus result in psychogenic ED.

++++++++++++++++++

Dr Manu Gupta: New Delhi
Men’s health is an often neglected topic. It has to be emphasized that men’s health is not only about erectile dysfunction and infertility. Patients deserve a multimodal approach to management with involvement of physicians, psychiatrists, dermatologists, and dieticians working together with urologists.

Use of high power holmium laser in stone management: Dr Pankaj N Maheshwari

Dr Pankaj N Maheshwari is Senior Consultant & Chief of Urology at Fortis Hospital, Mulund, Mumbai. His special areas of interest include Endo-Urology, Lithotripsy & Holmium laser. He has pioneered the use of Holmium laser in urology in India. He has performed over 350-holmium laser enucleation of prostate for management of BPH and managed more than 6000 patients with urinary calculus disease. He has performed more than 1000 PCNLs, 1500 ureteroscopies and a large number of lower tract endourological procedures. Dr Maheshwari has performed few unusual surgical procedures were done for the first time in India namely laparoscopy assisted PCNL for large calculi in pelvic kidney (3 cases) and laparoscopic repair of spontaneous bladder perforation.

Does high power holmium laser have a role in management of urinary stones?

High power holmium laser has established a place in management of urinary calculus disease. PCNL, URS and RIRS have increased its indications and safety with the availability of high power holmium laser.

How does holmium laser work?

Holmium laser works by a combination of photothermal and photoacoustic mechanism.

What are the advantages of using holmium laser?

Due to its photothermal effect, almost all types of calculi can get fragmented. There is very less risk of pushback of calculi. With high power holmium laser, you can modulate the frequency and energy to choose whether you want to fragment or to powder the stone.

How does holmium laser compare with ESWL?

These are two different modalities. ESWL is extracorporeal, while high power holmium laser is intracorporeal lithotripsy.

What have been the results of using high power holmium laser in terms of patient outcome and satisfaction?

Stones at all locations, whether in urinary bladder or ureter or kidney can be fragmented with the high power holmium laser.  The size of the stone is also not a concern as largest bladder and renal stones can be fragmented and removed with use of high power holmium laser. The access could be through the cystoscope, ureteroscope or nephroscope. The fiber can be passed through both rigid and flexible scopes. As the fiber is very small, we can access the stone through mini and micro instruments.

What according to you is the biggest advantage of high power holmium laser?

The biggest advantage of high power holmium laser is the ability to choose the frequency and energy of the laser. With low energy and high frequency the stones are powdered while with high energy the stones are fragmented. Associated anatomical problems like diverticular calculi, pelviureteral junction obstruction, ureteral strictures, ureteroceles can be treated with same energy source. Patients with obstructing prostate and vesical calculi can be managed with high power holmium laser in single session. The machine does not need much maintenance and also the recurrent per patient cost is very less.

OATs: Evaluation and Management: Dr Ravimohan S Mavuduru

Global sperm quality abnormalities involving counts, motility and morphology are described with the term OAT or oligoasthenoteratospermia.
Evaluation
·  Missing points in history: Occupationa; sedentary vs non sedentary lifestyle; Smoking and tobacco; Any major illness; Drug history
· Examination
o   General examination for 2nd degree sexual characters
o   External genitalia: penis, testis, and epididymis
o   Varicocele, bilateral vas
o   PR for inflammatory disease, SV status
Semen analysis
Asthenospermia (1%)
·  Iatrogenic (delayed processing in the lab)
·  Idiopathic
·  Varicocele: the only thing which can be treated with urologist.
·  Genital tract infections
·  Ultrasttructural cilia abnormalities, such as immotile cilia syndrome
·         Immunologic infertility with antisperm antibodies
Teratospermia is a common finding
Etiology of OAT: Hormonal, immunological, inflammatory, varicocele, genetic, idiopathic
Hormonal profile includes: LH,FSH, testosterone, prolactin, estrogen
1. Endocrine abnormalities (15%)
·  Hypogonadotrophic hypogonadism
o   Detailed evaluation is required
o   hCG 1500-2000 IU 2-3⁄week for 4–6 months followed by hMG 75 IU 2 –3 ⁄week and recombinant FSH 37.5-75IU 3⁄week.
o   Pulsatile GnRH
o   Clomiphene citrate
A word of caution about gonadotropins – injudicious use can actually reduce fertility.
·         Androgen excess: anabolic steroids
o   Hyperprolactinemia (>18 ng⁄dl): Aromatase inhibitors

2. Inflammatory (5-10%)
·  Leukocytospermia
·  Semen culture (Chlamydia & gonococcal infection)
·  Empirical antibiotic therapy for 4–6 weeks

3. Idiopathic OAT (30–40%)
Cause may be oxidative stress (ROS and antioxidation). Clinical trials using antioxidants in vivo and in vitro have resulted in major debate. Various combinations of neutraceuticals are available.
Under investigation: The role of SERMs in idiopathic infertility, ACE inhibitors improves sperm motility, role of environmental factors, occupation and electronic devices
  Key messages
· Careful examination and evaluation essential
·  Further research is required before one can be optimistic about a role of antioxidants in the treatment of infertile man
·  Optimal values of semen parameters, ROS & TAC needs to be defined.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

What are the common animal reservoirs of rabies?

Rabies exists in two forms:

  • Urban Rabies, propagated chiefly by unimmunized dogs.
  • Sylvatic rabies, propagated by skunks, foxes, raccoons, mongooses, wolves, bats etc.

Worldwide, the most common cause by far of human rabies infection is dog bite. The host animals of the rabies virus differ among regions, even though almost every mammal is capable of contracting rabies. The main vectors are foxes in Europe and Canada, raccoons, skunks, and fruit-eating and insectivorous bats in the United States, dogs in Asia, mongooses, jackals, and dogs in Africa, and dogs and vampire bats in Latin America.

In India, the animals commonly responsible for transmission of rabies are dogs and cats (97%) followed by wild animals like mongoose, foxes and jackals (2%) and occasionally by horses, donkeys, monkeys, cows, goats, sheep and pigs.

cardiology news

Food poisoning with rice dishes

Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit

  • B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic–type food poisoning associated with B. cereus
  • The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating such as stir frying
  • Two distinct types of toxin–mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.
  • The emetic syndrome is caused by direct ingestion of the toxin.
  • The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.
  • Cereulide is heat stable and resistant to gastric conditions.
  • The ingested toxin itself may therefore cause disease despite sufficient heating to kill B cereus.
  • The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one-third of individuals. Symptom onset is usually within one to five hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice–based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.
  • The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.
cardiology news

Total CPR since 1st November 2012 – 84500 trained

Media advocacy through Web Media

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press release

Vitamin D

In a discussion organized by Zee Media and moderated by Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President, Heart Care Foundation of India, Dr. Ambrish Mithal from Medanta, Dr. Rajesh Malhotra and Dr. P C Khadgawat from AIIMS in a joint statement said that the sunlight is the main source of Vitamin D and 40% of the body should be exposed for 40 minutes, 40 days in a year to get adequate Vitamin D.

In our Vedic science, it is mentioned that for one month continuously one should take a bath at the sunrise in the month of Magh, Vaishakh or Kartik. These traditional rituals probably were made so that people get enough exposure of sunlight and get adequate vitamin D. The rishi-munis probably knew that Indians are more prone to get deficient in Vitamin D.

Today, upto 80% of all Indians are Vitamin D deficient which can present with bone pains, and is also linked with heart disease, dementia and other known bone problems.

The experts said that it should be compulsory for schools to have children play for one full period in sunlight and those who believe in Yoga should prefer Surya Namaskar to be done in sunlight.

Since Vitamin D fortified milk and foods are not available in India, those who are prone should take monthly Vitamin D granules to cover the deficiency.

emedipicstoday emedipics

Inaguartion of USICON 2014

press release

Weight loss may improve sexual health of obese diabetes

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

Heat labile instruments for use in surgical procedures can be best sterilized by:

1. Absolute alcohol.
2. Ultra violet rays.
3. Cholorine releasing compounds.
4. Ethylene oxide gas.

Yesterday’s Mind Teaser: Which one of the following conditions may lead to exudative pleural effusion

1. Cirrhosis.
2. Nephrotic syndrome.
3. Congestive heart failure.
4. Bronchogenic carcinoma.

Answer for yesterday’s Mind Teaser: 4. Bronchogenic carcinoma.

Correct answers received from: DR. ANITA RAJORHIA, Abhay Naik, Tukaram Pagad, Dr Ajay Gandhi, Dr. P. C. Das, Dr pawan Mehta, drjella, Dr Jainendra Upadhyay, Dr. Pankaj Agarwal, Dr. Anil Bairaria, Dr.Chandresh Jardosh, Dr Prajakta Sambarey, Dr. Avtar Krishna, Dr shashi saini, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Prabodh K Gupta,

Answer for 29th January Mind Teaser:2. Giardia lamblia

Correct answers received from:DR.A.K.GAJJAR, Dr.Bitaan Sen & Dr.Jayashree Sen

Send your answer to ijcp12@gmail.com

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Work Wisdom

– Kauffman’s Paradox of the Corporation: The less important you are to the corporation, the more your tardiness or absence is noticed.

–The Salary Axiom: The pay raise is just large enough to increase your taxes and just small enough to have no effect on your take–home pay.

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medicolegal update

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Reaction: Oh My God! Why was acetazolamide not started before the journey?
Lesson: Make sure all high risk patients are given acetazolamide before they travel to mountains.

medicolegal update

Love is the strongest force the world possesses, and yet it is the humblest imaginable. Mahatma Gandhi

medicolegal update

Dr KK Aggarwal: The very purpose of life is to face sufferings…According to Hinduism, the very fact http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: : Intention is the active partner of attention; it is the way we convert our automatic processes into conscious ones.

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  1. Dear Sir, Thnaks for the information about USICON. Regards

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