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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

4th October 2012, Thursday

How to prevent arthritis from slowing you down

Keep moving

  • Avoid holding one position for long.
  • While working get up and stretch every 15 minutes.

Discover your strength

  • Put the strongest joints and muscles to work.
  • Push open heavy doors with the side of the arm or shoulder. It will protect finger and wrist joints.
  • While climbing up let the strong leg lead you and while going down let the weaker leg lead you. It will reduce hip or knee stress.

Plan ahead

  • Simplify and organize your routines so you minimize movements that are difficult or painful.
  • Keep items you need for cooking, cleaning, or hobbies near where they are needed
  • Have multiple sets of cleaning supplies, one for the kitchen and one for the bathroom

Make use of labor-saving devices and adaptive aids.

  • Long-handled grippers can be designed to grasp and retrieve out-of-reach objects.
  • Rubber grips can help one get a better handle on faucets, pens, toothbrushes, and silverware.

Ask for help.

  • Only a very small percentage of people with arthritis become severely disabled and get dependent on others.
  • Educate family members and friends about how arthritis affects you.
  • Don’t be afraid to ask for help when you need it.

(Source Harvard Healthbeat)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Levocarnitine Update

How does L-carnitine deficiency occur?

Several factors can influence L-carnitine levels in the body and can lead to deficiency states. Carnitine deficiency may be primary or secondary. Although primary deficiency is rare, deficiency due to secondary causes can occur. Primary carnitine deficiency (PCD) is a rare autosomal recessive disorder of fatty acid oxidation caused by deficiency of plasma membrane carnitine transport resulting from impairment in the plasma membrane OCTN2 carnitine transporter.

The secondary causes of L-carnitine deficiency are:

  • Carnitine deficiency can be caused by inborn errors of metabolism.
  • Vegetarians have low levels of carnitine because a vegetarian diet is not only low in L-carnitine but also in the precursors to synthesize L-carnitine in the body.
  • Chronic conditions such as cirrhosis, chronic renal failure (dialysis), diabetes mellitus, heart failure, Alzheimer disease, intestinal infections, severe infections, drugs (valproate, zidovudine) may also cause carnitine deficiency.

Preterm neonates develop carnitine deficiency due to impaired re-absorption of carnitine in the proximal renal tubule carnitine and immature carnitine biosynthesis.

For Comments and archives…

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Vegatable and fuits lower chances of getting some cancers

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th Dil Ka Darbar

The Darbar was organized by Heart Care Foundation of India in association with Indian Oil, Central Bank of India Department of AYUSH and various Departments under Health Ministry, Government of Delhi on Sunday 23rd September 2012 at Talkatora Stadium.

 
Dr K K Aggarwal
    National News

For universal health coverage, Plan Panel to train quacks

New Delhi: The Planning Commission has proposed to train registered medical practitioners, commonly referred to as quacks, to ensure universal health coverage reaches even the remote populations. “Affordability, accessibility and quality are three pillars of UHC. The challenge is to fill the gaps especially in rural areas where there is a problem of trained manpower. We would like to train traditional midwives and RMPs — some people call them jholawala doctors or quacks — to be used because they have been providing services in remote areas all these years. It is important to respect and use what we have. The XIIth plan document talks about this need,” Syeda Hameed, a member of the commission, told The Indian Express. India, according to the commission, had 26,329 doctors in the public sector in March 2011 against a requirement of 1,09,484, a massive shortage of nearly 76 per cent despite the fact that every year some 43,740 students are awarded MBBS. A Health Ministry plan to train rural healthcare workers as “half-way doctors” through a course prescribed and managed by the Medical Council of India had raised hackles of the doctor lobby which claimed it would amount to leaving the rural population in the hands of semi-doctors.

Now, the ministry has renewed efforts to push it through with a different name. Sources said the idea of using quacks as first-line health workers wasn’t received with much enthusiasm in the Plan Panel’s meetings. It was, in fact, seen as a move that would derail states’ efforts to crack down on quackery. Hameed admitted that the idea was greeted with a certain amount of “professional arrogance” by the Health Ministry and anticipates stiff resistance from doctors as well. She, however, added: “Supplementing the public sector is important and since they themselves will not go and work in boondocks, we need to weigh all options.” Hameeda said there is a proposal to make states institute a special cadre of officers to deal solely with public health, and added that there is a need to use cheap technological innovations to make healthcare more accessible and affordable. States, she added, would be required to invest in a management information system so that health data is easily accessed. “Though we tried to give states greater flexibility in the XIIth plan... there is a need to evolve a formula where laggard states like Bihar and Uttar Pradesh get extra funds. Right now the system is such that states like Tamil Nadu and Kerala, which have good healthcare systems in place, get most of the money,” she said. (Source: Indian Express, Oct 3, 2012)

For comments and archives

My Profession My Concern

Include this in your practice

Treatment for latent tuberculosis

For treatment of latent tuberculosis infection (LTBI) in HIV-negative adults start three months of weekly isoniazid and rifapentine (given by direct observation). The Centers for Disease Control and Prevention (CDC) recommends either the three month regimen of isoniazid and rifapentine (directly observed therapy) or the nine month regimen of isoniazid as equal alternatives for treatment of LTBI in otherwise healthy patients aged =12 years with risk for TB reactivation. Rifapentine is a rifamycin derivative with a long half-life and greater potency against M. tuberculosis than rifampin. Important drug interactions with rifamycins, including with warfarin, oral contraceptives, methadone, and the protease-inhibitor class of antiretroviral drugs.

(Ref: Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep 2011;60:1650)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

Bicuspid aortic valve

  • Congenital left ventricular outflow lesions can occur at valvular, subvalvular and supravalvular levels. The most common lesion is bicuspid aortic valve. A congenitally bicuspid aortic valve is present in about 1-2% of the population
  • Bicuspid valve function may be normal at birth but evolves with age. In young adults, aortic regurgitation is more common that aortic stenosis (AS). Progressive fibrocalcific stenosis requiring surgery eventually occurs in over 75% of patients with bicuspid aortic valve. The peak incidence of symptoms of AS occurs between the ages of 40 and 60.
  • Bicuspid aortic valve is a genetic condition with autosomal dominant inheritance. Echocardiographic screening of first degree relatives of patients with bicuspid aortic valve and a positive family history and in those with a dilated aorta is recommended.
  • Bicuspid aortic valve is associated with dilation of the ascending aorta in some patients which occasionally progresses to aortic aneurysm and less frequently to aortic dissection.
  • Bicuspid aortic valve is also associated with coarctation of the aorta. Lesions less commonly associated with bicuspid aortic valve include ventricular or atrial septal defect, hypoplastic left heart syndrome, patent ductus arteriosus (PDA), bicuspid pulmonic valve and Ebstein’s anomaly.
  • Symptoms of AS include dizziness or syncope, chest pain that may be typical angina, and dyspnea due to heart failure. The onset of these symptoms is associated with a poor prognosis; as a result, intervention is recommended for symptomatic AS.
  • Sudden death can occur in children with AS due to a bicuspid aortic valve, especially during and immediately after exertion.
  • In older adults with a bicuspid valve, the risk of sudden death is related to the presence of severe AS.
  • The bicuspid aortic valve is susceptible to infective endocarditis but routine endocarditis prophylaxis is not recommended.

(Experts: Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Statins cut glaucoma risk in older eyes

Older individuals who take statins are at decreased risk for developing open-angle glaucoma or for having progression of the disease, a large retrospective study found. (Source: Medpage Today)

For comments and archives

Upping physical activity slashes CV events, deaths in type 2 diabetics

Not surprisingly, higher levels of leisure-time physical activity cut the risk of cardiovascular and all-cause mortality in people with type 2 diabetes, a new analysis from the Swedish National Diabetes Register (NDR) shows. But in an important additional finding, researchers report that among diabetics who did little or no exercise at baseline, those who managed to substantially increase their leisure-time physical-activity levels over approximately five years cut their risk of death by almost two-thirds. Dr Björn Zethelius (Uppsala University, Sweden) presented the study findings here at the European Association for the Study of Diabetes (EASD) 2012 Meeting. (Source: Medscape)

For comments and archives

2 drugs beat 1 for metastatic melanoma

A two-drug combination bested monotherapy for metastatic melanoma, resulting in a 60% reduction in the odds of progression, according to a study reported at the European Society for Medical Oncology meeting and published simultaneously online in the New England Journal of Medicine. (Source: Medpage Today)

For comments and archives

First look at mitral valve-in-valve data from global registry

The implantation of a transcatheter valve, the Edwards Sapien, inside a failing surgically implanted mitral valve or mitral ring--a so-called valve-in-valve or valve-in-ring procedure--is clinically effective, with one-year results comparable to native transcatheter aortic-valve implantation (TAVI). However, there are some major safety concerns in this, the first-ever report of a large series of almost 100 such patients, Dr Danny Dvir (Washington Hospital Center, DC and Rabin Medical Center, Israel) told the PCR London Valves 2012 meeting. (Source: Medscape)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: 5 Ways to Stop A–Salting Your Kidneyhttp://blog.kkaggarwal.com/2012/10/5-ways-to-stop-a%e2%80%93salting-your-kidney/

@DeepakChopra: All of us including #atheists are God. In every act of perception we convert invisible photons into a universe.

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

The Science behind Shradhs

Shradhs are observed every year in Dakshinayana during Chaturmas in the Krishna Paksha of Ashwin month. Many rituals are performed to satisfy the unfulfilled desires of our three generations of our ancestors.

The Vedas say that every individual has three debts to be paid off, firstly, of the Devtas (Dev Rin), secondly of Guru and teachers (Rishi Rin) and, thirdly, of Ancestors (Pitra Rin). Devtas here from scientific point of view will represent the people with Daivik qualities; teachers the ones who have taught us and Pitra will include three generations of ancestors. ‘Rin’ from scientific point of view would mean unfinished desires or tasks.

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is pelvic adhesion?

Adhesions in and around the pelvic cavity may form if you have endometriosis, a pelvic infection, surgery on your pelvis, a cyst on an ovary, or have had surgery on your pelvis. Scar tissue causes organs that normally are separate from each other to become attached.

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Blood Donation - Gift of Liquid Love

  • The dependence of human source for the reagents will also be reduced if the hybridoma technology is applied for preparation of reagents.
    • Recent advances in medical knowledge have significantly increased the volume and complexity of the work of the hospital blood bank.

For comments and archives

 
    Liver Abscess Update

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

When should CT be done in liver abscess?

CT is done in cases of”

  • Small and multiple abscesses. It is more sensitive in detecting even small abscesses anywhere in liver. In one study, the sensitivity was 95-100%.
  • Large abscess, if the extent is not clear

For comments and archives

 
    An Inspirational Story

Hospital Window

Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room’s only window. The other man had to spend all his time flat on his back. The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation.

Every afternoon when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and color of the world outside.

The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every color and a fine view of the city skyline could be seen in the distance. As the man by the window described all this in exquisite detail, the man on the other side of the room would close his eyes and imagine the picturesque scene.

One warm afternoon the man by the window described a parade passing by. Although the other man couldn’t hear the band – he could see it. In his mind’s eye as the gentleman by the window portrayed it with descriptive words.

Days and weeks passed.

One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away.

As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone. Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside. He strained to slowly turn to look out the window beside the bed.

It faced a blank wall. The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window. The nurse responded that the man was blind and could not even see the wall. She said, “Perhaps he just wanted to encourage you.”

Source: http://academictips.org/blogs/moral-tale-hospital-window/

For comments and archives

 
    Cardiology eMedinewS

Under-the-skin ICD gets FDA green light Read More

Ticagrelor mortality profile gets good grades Read More

 
    Pediatric eMedinewS

Intellectual disability likely not inherited Read More

Virus fights acne Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A 63–year–old male with pneumonia had blood urea of 44 mg/dL.
Dr Good: This can be treated as an outpatient case.
Dr Bad: He needs ICU care.
Lesson: Patients with a CURB–65 score of 0 to 1 could probably be treated as outpatients, those with a score of 2 should be admitted to the hospital, and those with a score of 3 or more should be assessed for ICU care, particularly if the score was 4 or 5 (Thorax 2003;58:377–82).

For comments and archives

Make Sure

Situation: A diabetic patient’s wound was not healing.
Reaction: Oh my God! Why is his A1c still more than 8?
Lesson: Make sure to control diabetes in such cases. Every 1% increase in hemoglobin A1c was associated with almost a 0.03 cm2 reduction in daily rate of wound resolution.

For comments and archives

 
    Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. What are your comments about the news that the health ministry plans to bring in a legislation to make it mandatory for doctors to prescribe generic medicines?

Ans. My comments are as follows:

  • The news item, briefly, is as follows:
    “A bill is already being drafted to push low-cost medicine, along with an ambitious plan to provide free medicine to all. The out-of-pocket expense on healthcare is too high. Generic medicine will ensure that it is affordable. The bill will make sure that a list of generic medicines and combination drugs are available in all districts, and it is prescribed by doctors. The government has a list of nearly 350 medicines for which generic varieties will be made available. The Out-of-pocket expenditure for healthcare is 78 per cent of total expenditure on healthcare. Generic medicine would reduce the burden on the common man”.
  • This is what happens when doctors fail to self- regulate themselves. Neither the MCI nor the IMA have ever done anything in this regard.
  • The MCI Regulations, 2002, clearly as follows:

    “Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.”---Regulation 1.5
    “Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.”—Regulation 6.3.

    The two regulations are reproduced below:

    “1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.”

    “6.3 Running an open shop (Dispensing of Drugs and Appliances by Physicians): - A physician should not run an open shop for sale of medicine for dispensing prescriptions prescribed by doctors other than himself or for sale of medical or surgical appliances. It is not unethical for a physician to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.”
  • The MCI or the state medical councils have never punished till date a physician for violating the above regulations. I have complained against physicians quoting Regulation 1.5. Medical councils have always ignored such complaint. I do not know of any IMA initiative in encouraging or helping the doctors to follow these regulations.
  • When doctors do not follow a mild law, it is natural that tougher laws may be proposed even though the medical community is likely to protest that the government is trying to place restrictions upon their professional freedom.
  • It is an irony that even though India is one of the world’s largest exporters of generic drugs, its domestic market for generic drugs is small. It may be mentioned that India exports to over 200 countries, including the highly regulated markets of the US, Europe, Japan and Australia.
  • The reasons why domestic market for generic drugs is small in India are as follows:
    • There is no punishment for using brand names in place of generic names. Likewise, there is no reward for prescribing by generic names.
    • Prescribing by brand names is an effortless job. Brand names are brief, catchy, though often misleading. They need not be remembered. Sales agents drum them into the physicians’ ears constantly.
    • Prescribing by brand names carries rewards from the pharma companies in various forms.
    • It is easy to confuse a patient into thinking that a new and better medicine is being prescribed when, in fact, only the brand is changed.
    • Generic drugs are cheaper and hence their use is less beneficial for all concerned (the physician; the retailing chemist; the manufacturing pharma company etc.), except for the patient who has to make the payment.
    • Even the government/politicians gain from brand drugs. FIRSTLY, the DCGI stands to gain by having the power to grant permission for a brand name; SECONDLY, the government stands to gain by way of fees for granting permission; THIRDLY, the political party in power stands to gain in donations from the pharma companies concerned.
  • Generic drugs are cheaper than branded drugs. For example, common medicines like paracetamol costs Rs 10 per strip of 10 tablets when branded, while the generic variety costs around Rs 2.45 per strip. One of the reasons for lesser cost of generic drugs is that there are no R&D costs (Research and development costs). After the patent of the original company expires, any company can manufacture and sell the drug under a generic name. An example is ibuprofen.
  • The disadvantages of prescribing by brand names are as follows:
    • Brand drugs are more costly. For example, in October 2010, generic simvastatin (20mg) cost £1.12 for a pack of 28, compared with approximately £30 for a pack of 28 of the branded version.
    • Brand drugs produced by shady companies are likely to be spurious or of low quality but yet some doctors are prone to prescribe them for ulterior motives.
    • Brand names can be similar and confusing. It is not uncommon for the same generic drug to have 30, 40 or even 100 brand names from different companies. Confusion can lead to prescription errors (wrong drug being prescribed or supplied by the chemist or the dispenser). Prescription errors are a well known cause of risk to patient.
    • Brand drugs are often undesirable combinations of two or more generic drugs. It is a safer and better medical practice to minimize the use of combination drugs.
 
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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Serum calcium

Hypocalcemia (or low serum calcium level) must be interpreted in relation to serum albumin concentration (Some laboratories report a "corrected calcium" or "adjusted calcium" which relate the calcium assay to a normal albumin. The normal albumin, and hence the calculation, varies from lab to lab). True decrease in the physiologically active ionized form of Ca++ occurs in many situations:

  • Hypoparathyroidism
  • Vitamin D deficiency
  • Chronic renal failure
  • Magnesium deficiency
  • Prolonged anticonvulsant therapy
  • Acute pancreatitis
  • Massive transfusion
  • Alcoholism

Drugs causing hypocalcemia include most diuretics, estrogens, fluorides, glucose, insulin, excessive laxatives, magnesium salts, methicillin, and phosphates.

 
  Quote of the Day (BK Sapna)

Where there is determination there is success.

Think of all that you wanted to achieve in the past few days. Now check if you have achieved it or are still trying for it. Check if you have left anything midway. Pick out one of the things that you wanted to achieve or create an aim for yourself and think, "I am the one who is victorious and I will achieve whatever I set out to. I will not leave any task unfinished."

 
    Mind Teaser

Read this…………………

A post-operative complication of mastectomy is lymphedema. This can be prevented by

A. ensuring patency of wound drainage tube
B. placing the arm on the affected side in a dependent position
C. restricting movement of the affected arm
D. frequently elevating the arm of the affected side above the level of the heart.

Yesterday’s Mind Teaser: Which of the following is true about glycemic control in diabetes?

1. Improved glycemic control can retard or prevent the development of the earliest glomerular lesions of diabetic nephropathy in this patient population.
2. Improved glycemic control can slow progression of diabetic nephropathy even when patient has documented microalbuminuria.
3. Regression of established diabetic glomerular lesions may result from prolonged normoglycemia that may result after pancreatic transplantation.
4. All of the above.
5. None of the above.

Answer for Yesterday’s Mind Teaser: All of the above.

Correct answers received from: Dr Ajay Gandhi, Dr (Maj. Gen.) Anil Bairaria, Dr Chandresh Jardosh,
Dr Pankaj Agarwal, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr K Raju, Jayaraman, Dr B K Agarwal.

Answer for 2nd October Mind Teaser: Drop in the bucket

Correct answers received from:
Sagar Tucker, Dr Sudipto Samaddar, Avula Ramadevi, Dr KV Sarma,
Dr PC Das.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Flustered

As an instructor in driver education at the local area High School, I’ve learned that even the brightest students can become flustered behind the wheel. One day I had three beginners in the car, each scheduled to drive for 30 minutes. When the first student had completed his time, I asked him to change places with one of the others. Gripping the wheel tightly and staring straight ahead, he asked in a shaky voice, "Should I stop the car first?"

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Should a doctor perform CPR in already injured chest patient?

When a person needs CPR or cardiopulmonary resuscitation, this means that he/she is unconscious, not moving and not breathing normally. If this is the case, the person is presumably in cardiac arrest or in a state that justifies cardiopulmonary resuscitation.

  • If the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and further complicate the victim’s injuries.
  • As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services would be contacted and CPR would be initiated regardless of the injuries of the patient.
  • If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death.
  • This is why, regardless of the chest injury, if the person is "dead" or in need of CPR, compressions are to be given per the American Heart Association (AHA) guidelines even if the complications could include those of punctured lungs, lacerated organs, or bruised/punctured heart muscle. These injuries must be recorded in clinical sheet.
  • This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Diabetes is a progressive disease

Diabetes is a progressive disease, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Dr Aggarwal said that an analysis from the United Kingdom Prospective Diabetes Study (UKPDS) has shown that 50 percent of patients originally controlled with a single drug required the addition of a second drug after three years. By nine years, 75 percent of patients need multiple therapies to achieve the target hemoglobin A1c (HbA1c) level. After a successful initial response to oral therapy, patients fail to maintain target A1c levels (<7 percent) at a rate of 5 to 10 percent per year.

That means that all diabetic patients start with one drug and will invariably end up with three drugs with or without the addition of insulin within 10 years.

A1c should be done every three months until it is less than 7 percent and then at least every 6 months and should be preferred over the fasting sugar levels. It represents the average blood sugar of the last three months and the value should be kept lower than 7%. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes for blood glucose concentrations is to rise gradually with time. Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients and insulin may be indicated for initial treatment for some.

In the absence of contraindications, metformin is usually the initial therapy for most patients with type 2 diabetes.

 
    Readers Responses
  1. Dear Sir, I have been enjoying your very useful, informative, educative and very regular eMedinewS for the past several months. Thank you very much for the uninterrupted mailing of the same. Thank you once again. With regards: Dr. Manjesha
 
    Forthcoming Events
Dr K K Aggarwal

19th MTNL Perfect Health Mela

Heart Care Foundation of India and Depts. of Health & Family Welfare, Govt. of Delhi in association with World Fellowship of Religions, NDMC, MCD are organizing 19th MTNL Perfect Health Mela at Constitution Club of India Rafi Marg, New Delhi from 7th-11th November 2012 (8am-8pm). The focus this year will be Prevention of Non Communicable Diseases.

 
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes 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)

HCFI
Activities eBooks

  DIET BOOK

  HCFI

  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

 
    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta