eMedinewS
3rd January 2015, Saturday

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

Tackling obesity in children

More than 30% people of the society including children have potbelly abdominal obesity. India is witnessing an epidemic of metabolic syndrome, which is characterized by abdominal obesity, high triglyceride, low good cholesterol, high blood pressure and high sugar.

Abdominal girth of more than 90 cm in men and 80 cm in women indicates that the person is vulnerable to future heart attack.

Normal weight obesity is the new epidemic of the society. A person could be obese even if his/her body weight was within the normal range. An extra inch of fat around the abdomen increases the chances of heart disease by 1.5 times.

Normally once the height stops growing, most organs will also stop growing. The weight of the heart, liver of kidney cannot increase after that. Only muscles can build up to some extent. The only thing, after that stage, which can increase the weight of the body, is deposition of fat. Therefore any weight gain after puberty is invariably due to fat. Though the overall weight can be in the acceptable normal range but any weight gain within that range will be abnormal for that person. One should not gain weight of more than 5 kg after the age of 20 years in males and 18 years in females. After the age of 50, the weight should reduce and not increase.

Potbelly obesity is linked to eating refined carbohydrates and not animal fats. General obesity is linked to eating animal fats.

Refined carbohydrate includes white rice, white maida and white sugar. Brown sugar is better than white sugar. Refined carbohydrates are called bad carbohydrates and animal fat is called bad fat.

Trans fat or vanaspati is bad for health. Trans fats increase the levels of bad cholesterol and reduce good cholesterol in the body.

Reduction in weight can reduce snoring, pain of arthritis, blood pressure and control uncontrolled diabetes.

Some key points

  1. Skip carbohydrates once in a week.
  2. Combine a sweet food with bitter food (prefer aloo methi over aloo matar).
  3. Walk, walk and walk…
  4. Consume green bitter items in foods such as karela, methi, palak, bhindi etc.
  5. Do not eat trans fats (vanaspati).
  6. Do not consume more than 80 ml of soft drink in a day.
  7. Do not consume sweets with more than 30% sugar.
  8. Avoid maida, rice and white sugar.

IMA NEWS

Team IMA meets on 3rd Jan 2015

  • SMS sent to 13416 IMA members in Northern States and leaders + 9000 Delhi Doctors regarding Cultural fest and Chaat party on Jan. 3, 2015 at AIIMS Gymkhana, Pool side, New Delhi
  • E mail invite sent to over 1.6 lakh doctors

IMA UNESCO Initiative

As a follow up of a meeting of the conclave of UNESCO Indian Bioethics program at SRM University, IMA is in process of tying up with UNESCO- Indian Program of the UNESCO chair in Bioethics for developing the modern bioethics curriculum of medical undergraduate training; developing bioethics curriculum for postgraduate medical training and developing training modules jointly for professional development of existing medical practitioners. A MOU, a joint IMA – UNESCO chair bioethics task force and the terms of reference is on the way.

Minutes of the meeting of IMA Padma Forum Initiative

A meeting of the Padma Awardees was held on 28th December, 2014 at IMA House, New Delhi. The following Padma Awardees and office bearers of IMA were present:

Padma Awardees: Dr. Madan Mohan, Dr. D K Bhargava, Dr. K K Sethi, Dr. Arvind Lal, Dr. Kalyan Banerjee, Dr. G K Mani, Dr. K K Aggarwal, Dr. Prem Kakkar

IMA Office bearers: Dr. Vinay Aggarwal, Dr. R. N. Tandon, Dr. Anil Goyal, Dr. Harish Gupta, Dr. Ramesh Dutta, Dr. Manjul Mehta, Dr Rajiv Ardey, Dr. Ravi Malik, Dr. B B Wadhwa

The following concerns and issues were shortlisted where both IMA and Padma Awardee Forum will work together:

  1. To analyze and go into the root cause as to why medical professionals indulge into cuts, commissions and corruption.
  2. To jointly raise the issues with CGHS regarding consultation fee of Rs.150/- and also irrational approved rates for various medical and surgical procedures.
  3. As lawyers are designated as advocates and Sr. advocates; in government departments also medical professionals are graded differently. A uniform grading of specialists in private sector should also be created by IMA with or without clearance from MCI. In this way, Sr. doctors will be able to differentiate themselves from others. The fee structure for them may also be uniformly different at a national level where they charged individually or through medi-claim/CGHS/Public sector).
  4. No target should be given to doctors whether in Govt. or Private sector. The forum was concerned after seeing a few documents on Bilaspur where targets of doing 100-250 sterilizations surgeries in one day were issued by CMO to Govt. doctors. Similarly, monthly targets are given in private sectors to doctors for number of interventions. Targets often lead to compromise in safety and quality.
  5. It was decided to debate the process of re-registration in medical profession. On the contrary, emphasis should be done on making education available to every doctor after he has passed his MBBS. RE-registration, in any case, should not be linked to paying registration fee again or completing the number of CME hours.
  6. The joint forum will also look into the problems faced by doctors in terms of requirement of multiple registrations in running a clinic
  7. The joint forum also raised concern about the Govt. Policy where the foreigners cannot undergo corneal transplantation, unless there is NOC from the govt. based eye centers.
  8. The joint forum also raised the issue about the pay scales of doctors of Jr./Sr./Specialist doctors, which should be revised. The pay scales & privileges of Professors should be the same as that of a High Court Judge and Secretary, Govt. of India.
  9. The joint forum wanted IMA to be in every Policy making.
  10. The joint forum said that efforts should be made to take PC PNDT out of the purview of doctors, who are not practicing Obs. Ultrasounds.
  11. There is a Nodal officer for identifying BPL patients in various Pvt. Hospitals. Similarly, there should be a Nodal Officer to identify all notifiable diseases.
  12. The Generic Vs. Brand Drugs controversy should be solved for once and doctors should be instructed to write quality, safe and cheapest drugs to the community.
  13. IMA & Specialized associations should work together for the interest of the community.
  14. Non MBBS doctors should not be allowed to sign the lab/imaging reports.
  15. The CGHS charges criteria of LI-L5 etc should not be the criteria for deciding the prices.

IMA will not tolerate unrealistic targets for surgeries in a camp

IMA has been informed that at State Level, targets are given to doctors by CMOs to conduct a specific number of surgeries in a camp in a day. As per documents available with IMA a target of 100-250 had been given to doctors for performing sterilization surgeries in one day. As per IMA guidelines which are also consistent with Govt. guidelines, in one day, more than 30 such surgeries should not be done. IMA has written to Shri Lov Verma, Health Secretary, Deptt. of H&FW, to ensure that no unrealistic targets are given to member of any Association in any State.

IMA Central Council Decisions (27th December 2014)

  1. Directions are being given to hospitals and doctors not to appoint Ayush Doctors as RMO/Assistant. Strong action should be taken against those violating the directions.
  2. Hon’ble Supreme Court has said in one of the judgments that although it is unethical for doctors to resort to strike but the Supreme Court cannot put a stay to any such strike. IMA central council resolved that though strike is a right but should be the last resort.
  3. IMA has asked for defined protocols for medical professionals for organizing medical and surgical camps. IMA is against any unrealistic targets given to government doctors.
  4. IMA condemned cut commissions and corrupt practices any of the IMA member. IMA will not support any member indulging in corrupt practices. IMA will ask all its members hospitals to display declaration Code of Ethics for Health Care Providers at the Reception of their hospitals.
  5. IMA will come out with a White paper on “When not to use Antibiotics”.
  6. IMA will come out with a White paper on “What is not unethical in terms of Doctor – Industry Relationship”.
  7. IMA wants Consumer Protection Act should be amended/empowering councils to award compensation/establishing to separate Medical Tribunal for such cases.
  8. IMA wants a cap on the compensation awarded in medical negligence. Even in cases of a plane crash, there is a cap. Also IMA wants the awarding formula not to be based on the income of a person. If that is so then the poor will not get the same treatment as the rich will get.

    Dr K K Aggarwal
    Hony Secretary General

IMA in the news

IMA moots protection for docs treating accident victims: TOI Ahmedabad

News around the Globe

  • A breast biopsy that results in a diagnosis of atypical hyperplasia is considered a benign finding, but that description obscures the riskiness of the condition, according to a special report published in the January 1, 2015, issue of the New England Journal of Medicine. Dr Hartmann and coauthors from the Mayo Clinic in Rochester, Minnesota, have reported a cumulative incidence of breast cancer of almost 30% at 25 years of follow-up in their 698-patient cohort of women with atypical hyperplasia.
  • In latest guidance, the National Institute for Health and Care Excellence (NICE) recommends dabigatran as an option for treating and preventing recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE) in adults.
  • According to a new study in the Journal of Clinical Endocrinology and Metabolism, rituximab offers a number of advantages for Graves' orbitopathy compared to IV methylprednisolone. It was found that Graves' orbitopathy after rituximab therapy does not relapse, when compared to a relapse rate of about 20-25% after standard treatment with steroids, observed after discontinuation of intravenous methylprednisolone.
  • A self-directed exercise program can improve the symptoms of arthritis, according to a study by Sara Wilcox, PhD, from the Dept. of Exercise Science, University of South Carolina, Columbia, and colleagues published in 2015 issue of the American Journal of Preventive Medicine
  • Removal of the fallopian tubes may help prevent ovarian cancer, according to an opinion written by the American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice and published in the January 2015 issue of Obstetrics & Gynecology. The committee made the following recommendations:
    • In women at population risk for ovarian cancer, surgeons should discuss the potential benefits of salpingectomy.
    • In women considering laparoscopic sterilization, physicians can discuss the fact that bilateral salpingectomy provides effective contraception, while pointing out that this procedure eliminates the option of tubal reversal.
    • Prophylactic salpingectomy may prevent ovarian cancer in some patients.
    • More randomized controlled trials are needed to support the use of salpingectomy in reducing ovarian cancer.
  • A combination of a cephalosporin and a beta-lactamase inhibitor in an intravenous formulation has been approved for treating complicated intra-abdominal infections and complicated urinary tract infections in adults, the Food and Drug Administration announced on Dec. 19. The cephalosporin is ceftolozane and the beta-lactamase inhibitor is tazobactam; it will be marketed as Zerbaxa by Cubist Pharmaceuticals. This is the fourth antibacterial drug product approved by the FDA in 2014 and was designated as a Qualified Infectious Disease Product (QIDP) and was given priority review.

Dr KK Spiritual Blog

Negative Thoughts are Absence of Positive Thoughts

Darkness cannot be removed physically; it can only be removed by switching on the light or going into sunlight or lighting a fire. Similarly, negative thoughts are absence of positive thoughts.

In Bhagavad Gita, it has been said that in the period of Uttarayana with longer days, the first half at full moon, in the presence of light or agni, one acquires more positive thoughts as compared to in Dakshinayana, before Amavasya or no moon or in absence of light.

Bhagavad Gita also says that whatever you think the whole life, you think at the time of death and if the time at the time of death you have positive thoughts, you are likely to get Moksha. That may be the reason why in Hindu mythology it is said that just before the death, we should light a diya or chant in front of agni (fire) so that dying person’s thoughts become positive.

In computer language, it is explained that when you open a file repeatedly, it becomes a priority file and comes in search engine on priority as compared to other files.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at G B S.S.School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014

video of day
press release

Five Things Physicians and Patients should question

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

cpr 10 mantra
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 :

 

Make Sure

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum.
Reaction: Oh my God! Why was TB not suspected earlier?
Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

eMedinewS Humor

Embarrassing Traffic Stop

A police car pulled me over near the high school where I teach. As the officer asked for my license and registration, my students began to drive past. Some honked their horns, others hooted, and still others stopped to admonish me for speeding. Finally the officer asked me if I was a teacher at the school, and I told him I was. "I think you’ve paid your debt to society," he said with a smile, and left without giving me a ticket

Twitter of the Day

Dr KK Aggarwal: Women should quit smoking to lower their risk of heart disease
Dr Deepak Chopra: If the brain produces the experience of the world it is a hallucination If the world is real how does it fit inside the brain

Inspirational Story

The Comfort Zone

I used to have a comfort zone where I knew I wouldn't fail. The same four walls and busy work were really more like jail. I longed so much to do the things I'd never done before, but stayed inside my comfort zone and paced the same old floor.

I said it didn't matter that I wasn't doing much. I said I didn't care for things like commission checks and such. I claimed to be so busy with things inside my zone, but deep inside I longed for something special of my own.

couldn't let my life go by just watching others win. I held my breath; I stepped outside and let the change begin. I took a step and with new strength I'd never felt before, I kissed my comfort zone goodbye and closed and locked the door.

If you're in a comfort zone, afraid to venture out, Remember that all winners were at one time filled with doubt. A step or two and words of praise can make your dreams come true. Reach for your future with a smile; Success is there for you!

Rabies News (Dr A K Gupta)

Is there carrier state of rabies in dogs?

A carrier state of rabies in dogs/cats has not yet been conclusively proven and established.

Cardiology eMedinewS

  • A randomized trial in N Engl J Med. 2015 Jan;372(1):11-20 reports that intra-arterial treatment plus usual care within 6 hours of stroke onset was safe and effective in patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion of the anterior circulation. This finding is in contrast to results of other recent randomized controlled trials that did not report a benefit of intra-arterial treatment.
  • A third-generation transcatheter heart valve, Sapien 3 transcatheter valve, addresses issues with earlier valves and was associated with improved ease of use, accuracy of positioning and paravalvular sealing, according to a new report published in J Am Coll Cardiol. 2014;64:2235-2243. The rates of mortality and stroke with transfemoral access are among the lowest reported and support further evaluation as an alternative to open surgery in intermediate-risk patients.

Pediatrics eMedinewS

  • Preschoolers who drink three or more cups of milk a day may get a small height boost, but they're also more likely to be overweight or obese, according to a new US study. The results, based on nearly 9,000 children, support current recommendations that preschoolers consume two servings of milk a day, with one serving equal to one cup.
  • Artemisinin-naphthoquine drug-combo should be considered for the treatment of children with uncomplicated malaria in settings where multiple parasite species cause malaria, according to Tim Davis from the University of Western Australia. The study compared the current recommended therapy for uncomplicated malaria in children in Papua New Guinea, artemether-lumefantrine, with a different combination therapy, artemisinin-naphthoquine and found that it was more effective than the former for treating Plasmodium vivax.

Quote of the Day

Act with kindness, but do not expect gratitude. Confucius

Wellness Blog

Nitrate-Rich Diet Good for the Heart

Do not heat leafy vegetables twice

Nitrates in foods such as spinach, beet root and lettuce stimulate the production of nitric oxide in the body. Nitric oxide relaxes blood vessels. Ingested nitrate is reduced by oral, commensal, bacteria to nitrite, which can further be reduced to nitric oxide.

Vegetables are a major source of dietary nitrate. Green leafy and root vegetables, such as spinach and carrots, provide more than 85 percent of dietary nitrate. Foods in which nitrite are present are bacon, fermented sausage, hot dogs, bologna, salami, corned beef, ham and other products such as smoked or cured meat, fish and poultry. The conversion of dietary nitrate to nitrite has antimicrobial benefits in the mouth and stomach. Some epidemiological studies show a reduced rate of gastric and intestinal cancer in groups with a high vegetable-based nitrate intake. Nitrate is totally harmless; however, it can be converted to nitrite and some portion of nitrite to nitrosamines, some of which are known to be carcinogenic. Heating increases the conversion rate. The longer the heat treatment, the more nitrosamines will be formed. Hence, the recommendation not to heat leafy vegetables twice. Adding lemon juice to vegetables will reduce the formation of nitrosamines. It contains vitamin C, which also reacts with nitrite, thereby preventing the nitrosamine formation.

ePress Release

Most school children do not know how to prevent swine flu

Prevention of Swine Flu mainly involve implementation of the respiratory hygiene, cough etiquette and hand hygiene, said Padma Shri Awardee, Dr K K Aggarwal, Honorary Secretary General IMA and President Heart Care Foundation of India.

Respiratory hygiene involves maintaining a distance of at least 3 feet from the person who is coughing and sneezing.

Cough etiquette involves covering the mouth and nose with a tissue when you cough and sneeze and put the used tissue in a waste basket. If one does not have a tissue, then one should cough and sneeze into the upper sleeves and not hands or handkerchief.

Frequent hand hygiene should be observed before and after every patient contact; contact with potential infectious material and before putting on and after taking of personal protective equipment including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol based hand rubs. If hands are visibly soiled, then they should be washed with soap and water.

In a recent study conducted by Heart Care Foundation of India, involving 63 schools (both Public and Govt.) and 6047 students (2817 girls and 3230 boys), 76% of the students (4576) did not know about the role of cough etiquette in preventing flu. They answered that the best way to cough was either in the hands or in the handkerchief.

The need of the hour is to educate the schools, added Dr Aggarwal.

Flu is diagnosed when a person suffers from cough and cold. Only sore throat is not a sign of flu. Flu patients do not require antibiotics. Unless cough and cold is associated with breathlessness, it does not require admission.

eMedi Quiz

Formation of antibody against acetyl choline receptor in pemphigus can be explained by

a. Desmoglein compensation theory
b. Antibody excess prozone phenomenon
c. Anti idiotypic
d. Epitope spreading phenomenon

Yesterday’s Mind Teaser: The exaggerated lepromin test seen in cases of Lucio phenomenon is called as

a. Mitsuda's reactionion
b. Medina-Ramirez reaction
c. Fischer's test
d. Fernandez reaction

Answer for yesterday’s Mind Teaser: b. Medina-Ramirez reaction

Correct answers received from: Dr Avtar Krishan, Daivadheenam Jella.

Answer for 1st January Mind Teaser: Herpes genitalis

Correct answers received from: Anil Kumar, K P Bansal, Kartik Krishna.

Send your answer to email

medicolegal update

Click on the image to enlarge

medical query

medicolegal update

Click on the image to enlarge

medicolegal update

medicolegal update
  1. Dear Editor, Very Happy to receive this medical News on my Email. I always wait for the same daily. Happy and prosperous New Year 2015…Thanking you again. Dr. Suresh, Kalambi. Mumbai.
  2. Dear President Sir, Greetings & Happy New Year , I am delighted to learn that our Union Govt has decided to bring Right to Health Act and I have gone through the National Health Policy released the day before yesterday. It is open to suggestions till 28th Feb. You will be glad to know that there would be increased Health Spending. i.e. 2.5% of GDP, which IMA has been demanding for long. In addition to Right to Health Act, issues like health insurance, bringing changes in the MBBS Curriculum & Universal Health Coverage, Combating Malnutrition, Health & Law, Trauma Care and various other avenues of Health, IMA should collaborate with Govt. I suggest preparation of IMA Health Policy Document in line with National Health Policy & Present to the Govt and see that our demands are met. With Kind Regards: Dr KM Abul Hasan, Imm. Past Secretary, CGP IMA HQ

eMedinewS Special

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

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

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

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