eMedinewS
3rd November 2014, Monday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

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

MTP (Amendment) Bill, 2014: A retrograde step by the ministry of health

Dr K K Aggarwal
Senior National Vice President and Honorary Secretary General Elect IMA; President Heart Care Foundation of India

Vide Notification No.12015/49/2008-MCH, dated the 29th October 2014, the government of India has published on its web site (http://www.mohfw.nic.in/showfile.php?lid=2986) the proposed amendment bill. The ministry of health has invited views/suggestions from the interested stakeholders and general public through email by 10th November 2014.
The amendment proposes to raise the limit of permitting MTP up to 24 weeks pregnancy from the current limit of 20 weeks. The bill proposes to replace the term “Registered medical practitioners” in section 2(d) of the MTP Act, 1971, by the term “Registered Health care providers” thus including vaids, hakims, Siddha practitioners, homeopaths as well as nurses and ANMs (Auxiliary nurse midwives) under the preview of the act.

Analysis of the government stand
· It does not look like that the draft has approval from the health minister who himself is a doctor. Also the move probably was taken without any Indian Medical association representative on the board.

· The proposed draft does not provide any rational for the amendments which is against the general precedence of issuing a statement regarding the background, need and objects of the proposed legislation whenever a bill or amendment is proposed by the government.

· The amendment allows persons to perform MTP who are so far not allowed by law to do so. Currently the Section 2(d) of MTP Act, 1971, defines who can do MTPS. "registered medical practitioner" means a medical practitioner who possesses any recognised medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956, (102 of 1956) whose name has been entered in a State Medical Register and who has such experience or training in gynaecology and obstetrics as may be prescribed by rules made under this Act.

· The current step by the government is against the interpretation given by the honorable Supreme Court of India in the Poonam Verma Vs. Ashwin Patel and Others (4 SCC 332, Kuldip Singh, S. Saghir Ahmad JJ, dated 10.05.1996,) where the court said “41. A person who does not have knowledge of a particular System of Medicine but practices in that System is a quack and a mere pretender to medical knowledge or skill, or to put it differently, a charlatan.”

· It also contradicts the Supreme court of India Judgment Dr. Mukhtiar Chand & Ors. Vs. State Of Punjab & Ors., (1998, 7 SCC 579, dated 8-1-1998 by judges K.T. Thomas and Syed Shah Mohammed Quadri) where the apex court further clarified the rights of non-allopaths as regards practicing allopathy as follows: " .............But after Sub-section (2) of Section 15 was inserted in the 1956 Act, with effect from 15.09.1964, which inter alia, provides that on person other than a medical practitioner enrolled on a 'State Medical Register' shall practise modern scientific medicine in any State, the right of non-allopathic doctors to prescribe drugs by virtue of the declaration issued under the said drugs Rules, by implication, got obliterated. However, this does not debar them from prescribing or administering allopathic drugs hold across the counter for common ailments.
The apex court also observed " ... A harmonious reading of Section 15 of 1956 Act and Section 17 of 1970 Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian medicine or Central Register of Indian Medicine to practise modern scientific medicine in any of its branches unless that person is also enrolled on a State Medical Register within the meaning of 1956 Act".

· Also under the clause (d) of sub-section (3) of section 17 of the Indian Medicine Central Council Act, 1970, the right to practise modern scientific medicine in all its branches is confined to only such persons who possess any qualification included in the Schedules to 1956 Act.

Further issues
· As per sources, if they are correct, the proposed amendments are based on a study by Population Council done in 2012 which showed that trained nurses and Ayurveda physicians provide medical abortion as safely as MBBS doctors. MTP Act 1971 was in place in 2012 and it does not allow anyone other than an MBBS doctor registered under the Act to conduct and abortions. If the study conducted by Population Council included abortions conducted by Ayurveda doctors, was it not a violation of MTP act. Who gave them the permission.

· On the other hand in one of the reports the population council mentions that even allopathic doctors require more training for performing the abortions. " There is lack of knowledge even among doctors ( allopathic) who provide abortion services about MTP and PCPNDT act as well as the different forms and registers that they have to maintain to comply with the procedures mentioned in the MTP and PCPNDT acts. Legal knowledge of what practices of theirs falls within which law and what forms they have to submit is gravely lacking. Training of health providers at all levels on the provisions of MTP act and PCPNDT act is necessary. Within the framework of law, who can provide medical abortion and what things should be kept in mind while providing medical abortion , what could be the possible complications with medical and other forms of abortion, how to identify complications and provide services and referrals are also important area of training for providers. Abortion providers need training in MVA (Manual vacuum aspiration), EVA (Manual vacuum aspiration ) and post abortion care. Practitioners are slow in adopting MVA either because of lack of equipments, training or both. "

(http://www.popcouncil.org/uploads/pdfs/2014STEPUP_IndiaCountryProfile.pdf)

So when the allopathic doctors require more retraining how can you expect non allopathic health care providers to start MTP procedures.
· Also under the proposed amendment MTP involves both medical and surgical abortions. Medical abortion means use of allopathic drugs not taught to health care providers of non allopathic system of medicine. Also in India nurses are not allowed to prescribe drugs. Medical abortion drugs are not over the counter drugs so cannot be prescribed by non allopathic health care providers as per above quoted apex court judgment.
As an today there are no homeopathic or Ayurveda drugs which can be used for medical abortion.
Also MTP surgery required allopathic anesthesia, sedation, sometimes antibiotics and often IV drips a domain of Allopathic practice. We do not have ayurvedic or homeopathic anesthesia as on today. How will they do MTPs.

· The proposed amendments will lead to a sudden uncontrollable increase in the incidence of unsafe MTPs with high mortality and morbidity. They will also end up with violation of the PC-PNDT Act, 1994 and a resultant fall in the sex ratio.

· Allowing abortion upto 24 weeks in the hand of non qualified healthcare providers will lead to more sex selective abortions. The move to increase the MTP weeks from 20 to 24 weeks is also a matter of concern, in fact any MTP after 12 weeks should have been allowed only by select recognized centers and under strict regulation to check selective sex selection abortions.

· It is also to be seen that how will non allopathic health care practitioners manage patients of pregnancy with other co morbid conditions like underlying heart or kidney diseases. It will end up with high morbidity and mortality. Patients with serious heart, liver, kidney problems, blood clotting disorders or HIV are contraindicated to take medical abortion pills.

· For any medical negligence or deficiency of service which council will register the case. All councils acts will need amendments. Also if anesthesia is given by allopath and abortion done by Ayurveda doctors which council will regulate such situation.

· How will the current drug controller act allow homeopaths or ayurveda doctors to prescribe medical abortion pills.
Finally the proposed amendments are not on merit and needs to be dropped.
(Note: Some of the inputs have been taken from Dr M C Gupta Blog)

News Around The Globe

  • Patients receiving chronic hemodialysis appear to be at a significantly higher risk for death if they are prescribed beta blockers with a high dialyzability (atenolol, acebutolol, or metoprolol) compared with beta blockers with a low dialyzability (bisoprolol or propranolol), suggests a retrospective cohort study published online October 30 in the Journal of the American Society of Nephrology.
  • A frailty index can successfully identify the patients least likely to survive a total joint replacement, suggests new research presented at the American College of Surgeons 2014 Clinical Congress.
  • Older people with strabismus seem to be about 27% more likely than people without the condition to be injured by a fall, reported a new study published online in JAMA Ophthalmology.
  • A new study published online in the American Journal of Gastroenterology has pointed that the location of diverticular disease in the colon may be a risk factor for irritable bowel syndrome (IBS). Researchers noted that patients with diverticular disease in the left-side colon and bilaterally were 2.6 to 3.1 times more likely to also have IBS.
  • Egg freezing is "an invaluable option" for female cancer patients who want to preserve their fertility before undergoing potentially sterilizing chemotherapy, suggests new research presented at the American Society for Reproductive Medicine (ASRM) 2014 Annual Meeting

Dr KK Spiritual Blog

Soul does not leave the body immediately after the death

According to Prashna Upanishad, at the time of death, the Prana Vayu (life force and respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body.

But this does not happen immediately after clinical death which is defined as stoppage of heart and respiration. Medically the term used for clinically dead patients is sudden cardiac arrest.

As per the modern medicine, in cardiac arrest, the brain does not die for the next 10 minutes and during this period, if the heart can be revived, life can be brought back.

The revival of patient during this period can be remembered by the formula of 10: Within 10 minutes of the stoppage of heart (cardiac arrest), if effective chest compressions are given for the next ten minutes with a speed of 100 per minutes (10X10), 80% of the cardiac arrest victims can be revived.

This period can be much longer in hypothermia state. If the temperature of the body is low, the soul does not leave the body till the temperature is brought back to normal. Today, this property of soul is also used as therapeutic measure where patients who cannot be revived in the first 10 minutes of clinical death are put in a freezing chamber and artificial hypothermia is produced and these patients can then be transported to an advance cardiac centre where even after 24 hours resuscitation measure can be applied after re-warming the body. Many people have been revived even after 24 hours of cardiac arrest with such a technology.

There are instances in literature where a newborn with hypothermia was declared dead but revived in the cremation ground when the environment heat brought his temperature to normal and the pressure of the wood worked like cardiac massage.

This aspect of “life after death” is a contribution of the modern science to the Vedic science. Though in Vedic literature, it was well known phenomenon as Savitri brought life back into Satyavan even after his clinical death.

Take home message is that one should not declare a patient dead in the first ten minutes give cardiac massage and try reviving him with chest compression cardio pulmonary resuscitation.

Inspirational Story

Our Time in History

The paradox of our time in history is that we have taller buildings, but shorter tempers; wider freeways, but narrower viewpoints. We spend more, but have less; we buy more, but enjoy it less. We have bigger houses and smaller families; more conveniences, but less time.

We have more degrees, but less sense; more knowledge, but less judgment; more experts, but less solutions; more medicine, but less wellness. We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.

We've learned how to make a living, but not a life. We've added years to life, not life to years. We've been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor. We've conquered outer space, but not inner space.

We've cleaned up the air, but polluted the soul. We've split the atom, but not our prejudice. We have higher incomes, but lower morals. We've become long on quantity, but short on quality.

These are the times of tall men, and short character; steep profits, and shallow relationships. These are the times of world peace, but domestic warfare; more leisure, but less fun; more kinds of food, but less nutrition.

These are days of two incomes, but more divorce; of fancier houses, but broken homes. It is a time when there is much in the show window and nothing in the stockroom.

Rabies News (Dr A K Gupta)

A person started with PVRV wants to change over to HDCV or PCECV or PDEV or vice versa. What should be done?

The currently available TCVs such as HDCV, PCECV, PVRV, and PDEV, are all equally good and WHO approved. All are interchangeable following non availability of one brand or due to allergy to one of the CCVs or PDEV. All are considered protective against different strains of rabies viruses in different parts of the world.

Cardiology eMedinewS

  • Aortic valve replacement (AVR) can safely be used to treat severe aortic stenosis in patients aged 90 years and older and is associated with a low risk of operative stroke and mortality, suggests a study published in The Annals of Thoracic Surgery.
  • Lyme carditis associated with Borrelia burgdorferi infection was uncommon but was linked to two previously unsuspected cases of sudden cardiac death, as reported in the October 31 issue of the CDC's Morbidity and Mortality Weekly Report.

Pediatrics eMedinewS

  • Children conceived with the help of assisted reproductive technologies are not at increased risk for common childhood cancers; however, the risk for rarer cancers remains unclear, suggests new research presented at the American Society for Reproductive Medicine 2014 Annual Meeting.
  • Drainage followed by urokinase instillation seems to be as effective as video-assisted thoracoscopic surgery (VATS) for treating septated parapneumonic empyema in children, suggests new study published online in Pediatrics.

Quote of the Day

  • Worry does not empty tomorrow of its sorrow; it empties today of its strength. Corrie Ten Boom

Wellness Blog

Guidelines about Eating

Malnutrition and wrong dietary habits have been identified as major risk factors for ill health, including heart attacks. Most people below the poverty line suffer from malnutrition due to lack of calories, proteins and vitamins in their food. In the affluent society, overeating or eating wrong food results in over nutrition, a form of malnutrition leading to heart blockages. Some guidelines include:

  • Eat only when you are hungry.
  • Do not eat for pleasure, social obligations or emotional satisfaction.
  • Eat at a slow pace
  • Eat less; dinner less than lunch.
  • Take small mouthfuls each time, chew each morsel well, swallow it and only then take the next morsel.
  • Do not eat while watching television, driving a car or watching sports events. The mind is absorbed in these activities and one does not know what and how much one has eaten.
  • Do not talk while eating and never enter into heated arguments. The stomach has ears and can listen to your conversation. It will accordingly send signals to the mind and heart.
  • Plan and decide in advance what and how much food you will be eating.
  • Use low fat or skimmed mild dairy products. For cooking, use oils which are liquid at room temperature.
  • Do not take red meat and if you are a non–vegetarian, you may take poultry meat or fish.

ePress Release

Rise and fall in share market can precipitate heart attack

Late winter immediate, post full moon and rise and fall in share market all are the risk factors for precipitation of acute blood pressure, paralysis, heart attack, sudden cardiac death and irregular heartbeats, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

All heart patients especially the ones who take risks in share market should have an extra checkup done from their cardiologist and get their dose of medicines adjusted. They may have to take more medicines during this period.

The rise and fall in share market can lead to acute anxiety or acute depression both can precipitate rupture of plaque causing blockage in the coronary artery and precipitate heart attack. People with small blockages of up to 50-60% are more prone to rupture than people with 90-95% blockages.

The early morning hours are more dangerous and that is the time one is reading the newspaper and gets a shock of his or her life seeing the share market report. Late winter according to Ayurveda is a vata predominant period during which there are fluctuations in the blood pressure readings. Sudden rise in blood pressure of more than 30 mmHg can be extra pressure and rupture the block.

eMedi Quiz

At the end of a balanced anesthesia technique with non-depolarizing muscle relaxant, a patient recovered spontaneously from the effect of muscle relaxant without any reversal. Which is the most probable relaxant the patient had received?

1.Pancuronium.
2.Gallamine.
3.Atracurium.
4.Vecuronium.

Yesterday’s Mind Teaser: An increase in which of the following parameters will shift the O2 dissociation curve to the left.

1. Temperature.
2. Partial pressure of CO2
3. 2,3 DPG concentration.
4. Oxygen affinity of haemoglobin.

Answer for yesterday’s Mind Teaser: 4. Oxygen affinity of haemoglobin.

Correct answers received from: Daivadheenam JellaDr.K.V.Sarma, Dr Avtar Krishan, Dr Jainendra Upadhyay,

Answer for 1st November Mind Teaser: 1.Criterion validity.

Correct answers received from:  Dr Jainendra Upadhyay, Dr Avtar Krishan, Tukaram Pagad

Send your answer to email

eMedinewS Humor

History of Telecommunication

After having dug to a depth of 10 feet last year, Italian scientists found traces of copper wire dating back 100 years and came to the conclusion, that their ancestors already had a telephone network more than 100 years ago.

Not to be outdone by the Italians, in the weeks that followed, a Chinese archaeologist dug to a depth of 20 feet, and shortly after, a story in the China Daily read: ‘Chinese archaeologists, finding traces of 200 year old copper wire, have concluded their ancestors already had an advanced high–tech communications network a hundred years earlier than the Italian’s.

One week later, the Punjab Times, a local newspaper in India, reported the following: After digging as deep as 30 feet in his pasture near Amritsar, in the Indian state of Punjab, Dugdeep Singh, a self–taught archaeologist, reported that he found absolutely nothing. Dugdeep has therefore concluded that 300 years ago, India had already gone wireless.

emedipicstoday emedipics

21st Perfect Health Mela 15th October 2014

Self-Assessment-Quiz

 

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press release

No Blood Tests for TB

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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 – 101090 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 came with diastolic heart failure was advised BNP test
Dr Bad: The test is not needed
Dr Good: It should be done
Lesson: In the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, patients with symptomatic heart failure, left ventricular ejection fraction of =45 percent with elevated natriuretic peptide levels .benefit from spironolactone therapy.

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.

Twitter of the Day

Dr KK Aggarwal: Eating transfat increases bad LDL cholesterol and reduces good HDL Cholesterol
Dr Deepak Chopra: Our body is the image we have of ourselves in consciousness

medicolegal update

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

Choosing the best option in the judgment of the doctor is not medical negligence

In the case of Charan Singh vs Healing Touch Hospital And Ors on 24 April, 2003 (III(2003) CPJ 62 (NC)), the National Consumer Disputes Redressal Commission observed “it is a settled law when two choices are available, exercise of one, which is the best in the judgment of the doctor and anything else is available to contradict this, doctor in such circumstances cannot be held negligent.

medicolegal update
  1. Dear Sir. I endorse your views about Dengue. Our blood banks are actively helping clinical friends on these lines that unnecessary transfusion of platelets should be avoided. Your timely advice will go a long way to check irrational use. Thanks and regards. Dr. N. K. Bhatia

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