eMedinewS
4th November 2014, Tuesday

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

Heart Attack Symptoms in Women and elderly are Different

Winter is the month for heart attacks and the symptoms in women and the elderly may be different,

  • Chest pain is still the most common sign of a heart attack for most women but women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart pain. In a study published in Archives of Internal Medicine researchers examined 35 years of research that yielded 69 studies and found that, between 30 and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 to 27 percent of men did not experience chest discomfort.
  • Older people are also more likely to have heart attack without chest discomfort. Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays.
  • Women are also more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with acute coronary syndrome (ACS). They are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.
  • Women are, on an average, nearly a decade older than men at the time of their initial heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.

News Around The Globe

  • The US Food and Drug Administration (FDA) has approved a once-daily combination of dapagliflozin and metformin hydrochloride extended-release for the treatment of adults with type 2 diabetes. The once-daily oral tablet is the first in the United States to combine the sodium glucose cotransporter-2 inhibitor dapagliflozin with the biguanide extended-release (XR) metformin hydrochloride. It is indicated for use as an adjunct to diet and exercise in adults in whom treatment with both dapagliflozin and metformin is appropriate
  • Withdrawing inhaled corticosteroids (ICS) from patients with severe chronic obstructive pulmonary disease (COPD) does not lead to an increased rate of exacerbations, suggests a new study presented at CHEST 2014. Based on their findings, the authors suggest that ICS may be successfully withdrawn in patients receiving dual bronchodilator therapy with a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA).
  • Moderately suppressing thyroid-stimulating hormone (TSH) after treatment for differentiated thyroid cancer may be the best strategy, suggest new findings presented at the American Thyroid Association meeting. Moderate TSH suppression was associated with better overall survival and disease-free survival vs aggressive suppression.
  • The drug D-cycloserine appears to be no more effective than placebo when used with a computer-based cognitive training program for relieving persistent ear ringing in patients with tinnitus in a small clinical study, but patients did report fewer cognitive difficulties. The study is published online in the journal JAMA Otolaryngology-Head & Neck Surgery.
  • Scratching an itch causes the brain to release the mood-regulating and pain-controlling neurotransmitter serotonin which has the effect of intensifying the itch sensation, suggests a new study published online in Neuron.

National News

Government of India
Ministry of Health & Family Welfare
Maternal Health Division
****
Notification
No. 12015/49/2008-MCH

New Delhi, the 29th of October, 2014



Ministry of Health & Family Welfare, Government of India is proposing to bring amendments in some provisions of The Medical Termination of Pregnancy Act, 1971. A copy of the draft MTP (amendment) Bill is enclosed herewith to solicit the views/suggestions from the interested stakeholders and general public and the same may be sent through email on saurabh.mittal89@nic.in on or before 10th November, 2014.
(D.N. Sahoo)
Under Secretary to the Govt. of India

Department of Health and Family Welfare
DRAFT MEDICAL TERMINATION OF PREGNANCY (AMENDMENT) BILL, 2014

 

THE MEDICAL TERMINATION of PREGNANCY (AMENDMENT) Bill, 2014

 
 

A BILL

 
 

further to amend the Medical Termination of Pregnancy Act. 1971.

 
 

Be it enacted by Parliament in the Sixty-fifth Year of the Republic of India as follows:-

 
 

1. (1) 'This Act may be called the Medical Termination of Pregnancy (Amendment) Act, 2014.

Short title and commencement.

 

(2) It shall come into force on such date as the Central Government may, by notification in the Official Gazette, appoint.

 

34 of 1971.

2. In the Medical Termination of Pregnancy Act, 1971(hereinafter referred to as the principal Act), in the long title, for the words "by registered medical practitioners", the words "by registered health care providers" shall be substituted.

Amendment or long title.

Department of Health and Family Welfare
DRAFT MEDICAL TERMINATION OF PREGNANCY (AMENDMENT) BILL, 2014

 

3. In section 2 of the principal Act, for clause (d), the following clauses shall be substituted, namely:- '(d) "registered health care provider" means – (I) a medical practitioner who possesses any recognised medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act. 1956, whose name has been entered in a Indian Medical Register or State Medical Register, or

Amendment of section 2.

102 of 1956

 

(II)a practitioner who possesses –

(i) any recognised medical qualification of Ayurveda, Unani or Siddha as defined in clause (h) of section 2 of the Indian Medicine Central Council Act, 1970, whose name has been entered in the Central Register or State Register of Indian medicine; or

(ii) any recognised medical qualification of Homoeopathy as defined in clause (g) of section 2 of the Homoeopathy Central Council Act, 1973, whose name has been entered in the Central Register or State Register of Homoeopathy; or

(III) a nurse or auxiliary nurse midwife who possesses any recognised qualification in general nursing or auxiliary nurse midwifery as defined in section 10 of the Indian Nursing Council Act, 1947 and who has been enrolled as a nurse or auxiliary nurse midwife in the Indian Nurses Register or the State Register,

(e) "prescribed" means prescribed by rules made under this Act;

(f) "termination of pregnancy" means a procedure to terminate a pregnancy by using medical or surgical methods.'

4. In section 3 of the principal Act, -

(i) for the words "registered medical practitioners", wherever they occur, the words "registered health care providers" shall be substituted;

(ii) for sub-section (2), the following sub-section shall be substituted, namely: -
"(2) Subject to the provisions of sub-section (4), a

48 of 1970


























59 of 1973













48 of 1947


Amendment of section 3.

Winter is the month for heart attacks and the symptoms in women and the elderly may be different,

 

pregnancy may be terminated by a registered health care provider.-
(a) on request of a woman. where the length of the pregnancy does not exceed twelve weeks;
(b) (i) where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks; or
(ii) where the length of the pregnancy exceeds twenty weeks but does not exceed twenty-four weeks and the woman falls in one of the categories, as may be prescribed,
if such health care provider is of the opinion, formed in good faith, that –
(A) the continuance of the pregnancy would involve a risk to the lift of the pregnant woman or of grave injury to her physical or mental health; or
(B) there is a substantial risk that if the child were born, it would suffer from serious physical or mental abnormalities;
Explanation- For the purposes of this clause,-
(i) where any pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman;
(ii) where any pregnancy occurs as a result of failure of any device or method used by any woman or her partner for the purpose of limiting the number of children or preventing pregnancy, the anguish caused by such pregnancy may be presumed to constitute a grave injury to the mental health of the pregnant woman.
(C) the provisions of sub-section (2) of section 3 as relate to the length of the pregnancy shall not apply to the termination of a pregnancy by a registered health care provider where the termination of such pregnancy is necessitated by the diagnosis of any of the substantial foetal abnormalities as may be prescribed.".

 
 

5. After section 3 of the principal Act, the following section shall be inserted, namely:-

"3A. (I) For the purposes of clause (d) of section 2, the training, experience and the methods to be adopted by the registered health care providers who are qualified to terminate the pregnancy, shall be such, as may be prescribed.

(2) For the purpose of sub-section (I), the place where the pregnancy may be terminated, the modalities of diagnosis, record keeping and other matters, in addition to the provisions of section 4, shall be such, as may be .prescribed."

Insertion of new section 3A.

 

6. For section 5, the following sections shall be substituted, namely:-
"5. The provisions of section 4, and so much of the provisions of sub-section (2) of section 3 as relate to the length of the pregnancy and the opinion of a registered health care provider shall not apply to the termination of a pregnancy by a registered health care provider in case where he is of the opinion, formed in good faith, that the termination of such pregnancy is immediately necessary to save the life of the pregnant woman."

Section 3 and 4 When not to apply.

Qualification, training, experience, etc of registered health care providers.

5A. 'No registered health care provider shall reveal the name and other particulars of a woman whose pregnancy has been terminated under this Act.

Protection of privacy of a woman.

Substitution

6. For section 5, the following sections shall be substituted, namely:-
"5. The provisions of section 4, and so much of the provisions of sub-section (2) of section 3 as relate to the length of the pregnancy and the opinion of a registered health care provider shall not apply to the termination of a pregnancy by a registered health care provider in case where he is of the opinion, formed in good faith, that the termination of such pregnancy is immediately necessary to save the life of the pregnant woman."

Offences and penalties

 

5A. 'No registered health care provider shall reveal the name and other particulars of a woman whose pregnancy has been terminated under this Act.

 

45 of 1860

5B. (I) Notwithstanding anything contained in the Indian Penal Code, the termination of pregnancy by a person who is not a registered health care provider shall be an offence punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years.

 
 

(2) Whoever terminates any pregnancy in a place other than a place mentioned in section 4, shall be punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years.

 
 

(3) Any person being the owner of a place, which is not approved under clause (b) of section 4, shall be punishable with rigorous imprisonment for a term which shall not be less than two years but which may extend to seven years.

 
 

Explanation.- For the purposes of this sub-section, the expression "owner", in relation to a place, means any person who is the administrative head or otherwise responsible for the working or maintenance of a hospital or place, by whatever name called, where the pregnancy may be terminated under this Act.

 
 

(4) Whoever contravenes the provisions of section 9 shall be punishable with imprisonment which may extend to one year, or with fine, or with both."

 

Amendment of Section 6.

7. In section 6 of the principal Act, in sub-section (2),-
(I) in clause (a), for the words "registered medical practitioner", the words "health care provider" shall be substituted;
(ii) after clause (a), the following clauses shall be inserted, namely:-
"(aa) the categories of woman under sub-clause (ii) of clause (b) of sub-section (2) of section 3;

 
 

(ab) the categories of registered health care providers who are qualified to terminate the pregnancy, the training and experience of such registered health care providers and the methods to be adopted by them in terminating the pregnancy under sub-section 3A;
(ac) the place where the pregnancy may be terminated, keeping of records and other matters under sub-section (2) of section 3A;
(ad) the categories of substantial foetal abnormalities under sub-section (2) of section 5."

 

Amendment of section 7

8. In section 7 of the principal Act, in sub-section (1),-
(i) in clause (a), for the words "the registered medical practitioner", the words "the registered health care provider" shall be substituted;
(ii) in clause (b), for the words "registered medical practitioner", the words "registered health care provide’' shall be substituted.

 

Amendment of section 8.

9. In section 8 of the principal Act, for the words section 8. "registered medical practitioner", the words "registered health care provider" shall be substituted.

 
emedipicstoday emedipics

21st Perfect Health Mela 15th October 2014

Self-Assessment-Quiz

 

expert_choice
press release

Strenuous exercise may increase risk of cardiac disorder

video of day video of day

Other Blogs

Video Library

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 :

 

Dr Good and Dr Bad

Situation: A 39–year–old male with community–acquired pneumonia came for OPD treatment.
Dr Bad: You need admission for IV ceftriaxone therapy.
Dr Good: Take Levofloxacin 500 mg orally.
Lesson: A prospective, randomized, multicenter trial of 599 adults with community-acquired pneumonia who could be treated as an outpatient or in the hospital compared the efficacy of levofloxacin (500 mg IV or orally daily) to ceftriaxone (1 to 2 g IV once or twice daily) and/or cefuroxime (500 mg orally twice daily) with or without erythromycin or doxycycline. Clinical success at 5 to 7 days after treatment was superior with levofloxacin (96%) compared with either cephalosporin arm (90%) (Antimicrob Agents Chemother 1997;41(9):1965–72)

Make Sure

Situation: A patient with 3 hour of developing chest pain went into acute cardiac arrest.
Reaction: Oh my God! Why was water–soluble aspirin not given at the time of chest pain?
Lesson: Make sure that all patients with suspected MI are given water–soluble aspirin to reduce chances of death.

eMedinewS Humor

A Friendly Honest Neighbor

A man received the following text from his neighbor:

I am so sorry Bob. I've been riddled with guilt and I have to confess.

I have been tapping your wife, day and night when you're not around.

In fact, more than you.

I'm not getting it at home, but that's no excuse.

I can no longer live with the guilt and I hope you will accept my sincerest apology with my promise that it won't happen again.

Bob, anguished and betrayed, went into his bedroom, grabbed his gun, and without a word, shot his wife and killed her.

A few moments later, a second text came in: Damn autocorrect. I meant "wifi", not "wife".

Twitter of the Day

Dr KK Aggarwal: Keep your BP lower than 120/80 mmHg
Dr Deepak Chopra: Knowing God consists of many experiences acquired over a lifetime, a slow-motion epiphany

Dr KK Spiritual Blog

You look at people the same way as you are

Honest people look everybody as honest and dishonest people look everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel everybody is honest. If you take bribe then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.

Never judge people with your personal experience. I recall a doctor saying that every doctor takes and gives bribe because he was running an imaging centre and every doctor who approached him asked for a bribe. But he had not taken into consideration the doctors who did not approach him.

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)

Is hydrophobia a sign of rabies in dogs?

Hydrophobia is not a sign of rabies in dogs. Rabid dogs can drink water and even swim in water. If a rabid dog is not able to drink water, it is because of paralysis of jaw muscles and not due to hydrophobia.

Cardiology eMedinewS

APHRS 2014

MicroRNAs as regulators for cardiac conduction

Rajesh Katare,
New Zealand

  • Sudden cardiac death due to fatal ventricular arrhythmias kills more than 400,000 people every year.
  • Alterations at the molecular level occur much earlier before the onset of clinical arrhythmias.
  • microRNAs are the key regulators of molecular changes and importantly released into the circulation from early stage of molecular alterations
  • Our clinical findings suggest higher incidence of cardiac arrhythmias in patients with marked increased in microRNA
  • Simple blood test to measure the circulating levels of microRNA could be used to identify those at the risk of developing fatal arrhythmias, thereby helping in providing quality management of the disease

Left atrial diverticula in AF ablation

Roberto De Ponti,
Italy

  • Left atrial diverticula are found in about 30% of the general population undergoing CT scan for various reasons; they are muscular structures projecting from the heart cavity outside the plane of the left atrial wall and are also called left atrial aneurysms or accessory appendages.
  • For their morphology and electrical properties, it has been hypothesized that left atrial diverticula might compromise safety and efficacy of catheter ablation of AF. However, their potential role as extrapulmonary vein source of AF is not confirmed by intracavitary mapping and follow-up data. Moreover, the comparable prevalence of left atrial diverticula in patients with and without AF seems to exclude a role in the pathophysiology of this arrhythmia
  • In a patient population with a low CHADS2 score undergoing catheter ablation of AF, the presence of left atrial diverticula does not increase the risk of cerebrovascular events
  • Although perforation of left atrial diverticula by radiofrequency energy delivery during ablation of AF is possible, this seems extremely rare and favored by peculiar circumstances.

Pediatrics eMedinewS

  • Omega 3 and 6 fatty acids supplementation can help children and adolescents who have the inattentive subtype of ADHD called ADD, suggest researchers at the Sahlgrenska Academy, University of Gothenburg, Sweden.
  • Binge drinking during adolescence can have lasting effects on brain function, suggests a new study published in The Journal of Neuroscience.

Quote of the Day

  • Enthusiasm releases the drive to carry you over obstacles and adds significance to all you do. Norman Vincent Peale

Wellness Blog

Yesterday: What a great combination

Sunday (sun)
Full moon (Moon)
Purnima (salt and water retention, salt restricted diet, high tides)
Dry winter (more alpha activity, more upper blood pressure, more pulse rate)
Uttarayana (positive state of mind)
Magh month (time for vitamin D, increased fertility, marriages, eat sesame, sunbath)
Kalpwas month (disciplined one month)
Allahabad sangam (incubation period, away from routine stress, self confession).

This Sunday came after 148 years.

ePress Release

Dengue is preventable and manageable

Dengue has once again made its appearance in the capital, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

Dengue is both preventable and manageable. The risk of complications is in less than 1% of dengue cases. If warning signals are known to the public, all deaths from dengue can be avoided.

A platelet transfusion is not needed if the platelet counts are more than 10,000. Unnecessary platelet transfusion can cause more harm.

Most complications of dengue occur after the fever is over. The two days after the last episode of fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar. The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration. Giving fluids orally or by intravenous routes, at a proper time, can save fatal complications.

Physicians should remember the ‘Formula of 20’ i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high risk situation and the person needs immediate medical attention.

The onus of preventing dengue lies with the public and not with the Government authorities. The dengue mosquitoes are found only in fresh water collected outside the house and not in dirty water in the drains or ‘nallas’, flowing all over the country.

In dengue, one should NOT use aspirin for fever as aspirin also has antiplatelet effects.

eMedi Quiz

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

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

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: 3.Atracurium.

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

Answer for 2nd November Mind Teaser: 4. Oxygen affinity of haemoglobin.

Correct answers received from: Daivadheenam Jella, Dr KV Sarma, Dr Avtar Krishan, Dr Jainendra Upadhyay.

Send your answer to email

medicolegal update

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

Not disclosing the names of doctors in the surgical team may be deficiency of service

Recently, the Kerala State Consumer Disputes Redressal Commission presiding members M.K. Abdulla Sona and A. Radha directed the Travancore-Cochin Medical Councils-Kerala (TCMC-K) to instruct all doctors to display their medical council registration numbers on their signboards and quote the register numbers in all prescriptions and all case sheets. The commission said that using the registration number in the doctors’ prescriptions, case-sheets and signboards would help patients to get all information about the doctor including their competency and possessed the required qualifications.

The commission said that the patient/consumer has the right to know the details of each doctor who accompanied the leader of the surgical team, including the anaesthesiologist. Any denial of this would be considered a deficiency of service and an unfair trade practice under the provisions of the Consumer Protection Act.

medicolegal update
  1. Dear Dr. Aggarwal, Please accept my sincere congratulations for sharing such an important piece of information. I fully agree with your view and will definitely like to provide my input on the MOH website.

    I feel there should be separate criteria and rules for doing abortions before and after 12 weeks of pregnancy. I feel only Gynecologist (MD/MS) should have right to perform MTP after 12 weeks and only MBBS with training before 12 weeks. Some may argue about availability of these types of doctors in the interiors/countryside but this cannot be an excuse to every thing. Does this mean if we do not have trained people to perform surgeries in very part of country, would Govt. allow alternative medicine doctors to perform surgeries. with kind regards, Dr. Ashutosh Aggarwal

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