January 4 2016, Monday


Another illness by dengue mosquito 

The CDC has issued a warning to tourists traveling to Puerto Rico and other affected areas, asking them to protect themselves from the mosquitoes that spread the Zika virus -- especially pregnant women. 

The Aedes aegypti mosquito is the same mosquito that can carry yellow fever, dengue fever and chikungunya.

About the Zika virus

• Zika virus is a member of the flavivirus family (along with the viral etiologies of dengue fever, yellow fever, West Nile fever, and Japanese encephalitis) that is spread via mosquito bites. Countries with autochthonous circulation of Zika virus in the Americas include Brazil, Chile, Colombia, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Suriname, and Venezuela.

• In addition, outbreaks of Zika virus infection have occurred in Africa, Southeast Asia, and the Pacific Islands.

• Symptoms of Zika virus infection include fever, rash, joint pain and conjunctivitis.

• The illness is usually mild with symptoms lasting several days to a week; severe disease requiring hospitalization is uncommon.

• Asymptomatic infection is common, and only about 1 in 5 individuals who become infected with Zika virus become ill.

• Flavivirus infections are known to potentially cause premature birth, congenital defects and microcephaly.

• Till December 2015, more than 1000 cases of microcephaly were reported among newborns born to Brazilian mothers with Zika virus infection representing a 20-fold increase in microcephaly compared with previous years.

• An increase in the rate of Guillain-Barré syndrome has also been observed in association with Zika virus infection.

• A suspected case consists of a patient with rash or elevation of body temperature with one or more of the following symptoms (not explained by other medical conditions): arthralgia or myalgia, nonpurulent conjunctivitis or conjunctival hyperemia, and headache or malaise.

• A confirmed case is a suspected case with positive laboratory test result for detection of Zika virus.

• During the first five days after onset of symptoms, the diagnosis of Zika virus infection may be established via polymerase chain reaction (PCR) for detection of viral RNA; PCR for dengue should also be negative.

• Management consists of symptomatic treatment and supportive care



Safer polio vaccine strains developed for post-eradication era

Researchers have developed new polio vaccine strains that is particularly suitable for a post-eradication era as these strains appear both effective and unable to cause disease after accidental release. While the goal of polio virus eradication is in sight, there are concerns about post-eradication manufacturing and stockpiling vaccine stores containing live virus that could escape and repopulate the environment. The new strains are expected to allow for safe vaccine production in the post-eradication world. The findings of the study are published in the journal PLos Pathogens … (ET Healthworld)

NHRC to hear medical negligence cases in public

In the first-ever instance of National Human Rights Commission giving public hearing to medical negligence cases against both government and private hospitals, the panel has agreed to attend to such complaints at a two-day grievance redressal forum here. The event, assisted by Jan Swasthya Abhiyan (JSA), a network of civil society organisations, would be organised on January 6-7 at the Tata Institute of Social Sciences campus. Maharashtra Human Rights Commission chairman SR Bannurmath said, “We’ve chalked out the agenda and shortlisted the cases. They would be thoroughly discussed in the two-day event. This is a rare initiative to protect human rights.” Dr Leni Chaudhari, the event convener and member of the JSA also informed that about 125 complaints filed against erring hospitals have been shortlisted. “The grievances would be placed before human rights panels from four states — Maharshtra, Gujarat, Goa and Rajasthan. As many as 55 cases of medical negligence from Maharashtra, 30 each from Gujarat and Rajasthan and 10 from Goa would be heard and remedial action would be decided after the hearings”… (PTI, The Hindu)

FDA to create early warning system for medical devices

The US Food and Drug Administration (FDA) has proposed creating early warning system to inform the public about "emerging signals" of possible device risk before it determines whether the risk actually exists. The FDA historically has alerted the public about safety concerns that come up post-marketing, and usually after it has determined what to do about them. The FDA said, “Timely communication about emerging signals is intended to provide healthcare providers, patients, and consumers with access to the most current information concerning the potential benefits and risks of marketed devices, so that they can make informed treatment choices based on all available information. This may decrease the number of patients exposed to the potential risk while the issue is being further evaluated.” (Medscape)



  • Ad libitum early feeding after pyloromyotomy for hypertrophic pyloric stenosis is associated with shorter hospital stays than structured and delayed feeding, reported a meta-analysis published online December 30 in Pediatrics.
  • Most patients with dry eye disease report no progression, and some even report improvement with time, suggested a retrospective survey-based study of healthcare professionals having the condition, published online in Ophthalmology.
  • Results from the SUNBURST study have demonstrated that Burst stimulation from St. Jude Medical is superior to traditional tonic spinal cord stimulation (SCS) in relieving chronic pain. The findings were presented at the 19th annual meeting of the North American Neuromodulation Society (NANS).
  • In men treated for benign prostatic hyperplasia (BPH), the six most frequent adverse events (AEs) associated with doxazosin, finasteride, and combination therapy seem to make their initial appearance during the first year of treatment, suggests new research published online in the Journal of Urology.
  • A new meta-analysis, published online in the journal Clinical Gastroenterology and Hepatology, has found that the beneficial effects of psychological therapy for patients suffering from irritable bowel syndrome appear to last at least 6 to 12 months after the therapy has concluded.
  • For patients with cancer undergoing major surgery, the preoperative use of anticoagulants did not increase rates of major bleeding or the need for transfusions, suggested a new study published online in the Journal of the American College of Surgeons. Administration of an anticoagulant was also associated with a significant decrease in the rates of venous thromboembolism (VTE).
  • New research, published in Addiction Biology, noted significant differences in the brain connectivity of individuals with the most modern of psychological conditions, internet gaming disorder, in comparison with non-addicted people of equivalent age.
  • A study published in the New England Journal of Medicine that compared the risks of in-hospital and out-of-hospital births in Oregon finds the odds of infant death are more than two times higher for planned out-of-hospital births. These results contradict a recent study from Canada which found that newborn mortality rates were not higher among women who gave birth at home.


The spiritual prescription "I am sorry"

Two hardest words for a doctor to say: "I’m sorry." Most defense lawyers counsel doctors to not apologize to patients. Their view is that if you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened. In other words, you are pleading guilty. The complainant’s lawyers may use a doctor’s apology to the maximum extent possible to show the doctor knew what they did was wrong. The usual approach is deny and defend. But,

  • Apologizing after a medical error is the humane thing to do.
  • Patients often sue simply because it’s the only way to find out what went wrong.
  • Erecting a wall of silence is "enough to make someone very angry. And it’s awfully easy for an angry person to find a lawyer who will listen to them. At that point, it’s too late to say sorry.
  • Over 35 states in the USA have passed laws prohibiting doctors’ apologies from being used against them in court. (apology laws)
  • By promptly disclosing medical errors and offering earnest apologies and fair compensation one can hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

Apology the spiritual answer

  • The word ‘sorry’ is synonymous with apology.
  • To err is human, to admit one’s error is superhuman.
  • Sorry should be heart-felt and not ego-felt. You should not only say sorry but also appear as being genuinely sorry.
  • Tremendous courage is entailed to face the victim of our wrong doing and apologise.
  • It is generally seen that those who are in harmony with their life and consequently with themselves, find it easier to say ‘I’m sorry’. They are the positive, conscientious ones who are at peace only after making amends for their misdeeds.
  • The word ‘sorry’ in itself is imbued with so much potential and power. Within a fraction of a second, grave mistakes are diluted, tepid and estranged relations are brought alive, animosity and rancour are dissolved, misunderstandings resolved and tense situations ease out resulting in harmony and rapprochement.
  • To forgive and forget is a common spiritual saying.
  • Remember we all make mistakes and seek forgiveness form GOD every day.


Indian Medical Association vs VP Shantha & Ors on 13 November, 1995, 1996 AIR 550, 1995 SCC (6) 651 

“In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services.”


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Power morcellators come federal scrutiny

In September, the US Government Accountability Office (GAO) announced that it would launch an investigation into power morcellators. The controversial device shreds uterine fibroids for easy removal through laparoscopic incisions. Studies have long established that the use of power morcellators poses a high risk for spreading undiagnosed uterine cancer. In October, 12 members of Congress asked the GAO to find out why the FDA took so long to issue warnings. Last year in April, the FDA recommended that surgeons stop using power morcellators for fibroid removal... (Medscape)


Game-Changers in 2015: SERVE-HF upends ASV in sleep apnea

The SERVE-HF study, which alerted the sleep medicine and cardiovascular community to the dangers of adaptive servo-ventilation in sleep apnea patents with heart failure, was the most significant clinical finding of 2015 in sleep medicine. In September last year, the SERVE-HF researchers reported in the New England Journal of Medicine that "in patients with central sleep apnea and heart failure with a low ejection fraction (<45%) who used adaptive servo-ventilation (ASV) compared with similar subjects who did not use ASV, the risk of cardiovascular death was increased by 34%."… (Medpage Today)


 Prescribing Red Wine

  • There are thousands of studies of the risks and benefits of wine and its effect on health; nearly 200 recent ones are listed on the Boston University Scientific Forum site, with expert commentary.
  • Most evidence shows that the polyphenols in red wine provide additional cardiovascular and longevity benefits.
  • Modest daily consumption of red wine is an integral part of the Mediterranean diet, which is likely effective for secondary prevention after myocardial infarction and for primary prevention of cardiovascular disease.
  • Red wine becomes red only after crushed red grapes bathe for a day or two in their own juice. Anthocyanins leak out from the grape skins to color the pressed juice, which is otherwise nearly colorless.
  • Grape and wine phenolics, including anthocyanins, resveratrol, tannins, and other compounds, are complicated, fascinating molecules.
  • The concentration of phenolics in a finished wine varies by grape type and by how the wine is grown, made, and cellared. Even white wine, with little grape skin exposure, may have health benefits.
  • A glass of wine is 5 oz (150 mL) of 12% alcohol wine, one-fifth of a standard 750-mL bottle.
  • Mediterranean-style wines are characterized by lower alcohol levels, below 14%.
  • In some parts of the Mediterranean, it is traditional to drink water alongside wine. A sip of one and then the other serves both to dilute the alcohol level and to allow the glass of wine to last the length of the meal. Wine drunk slowly improves the enjoyment of the meal.
  • Physicians can prescribe alcohol as a competitive inhibitor for methanol poisoning and ethylene glycol poisoning. Alcohol has previously been prescribed for the treatment of delirium tremens and, during Prohibition, for "medicinal reasons.
  • People who want to sleep soundly should stop drinking at least 2 hours before bed.

A model prescription

Rx: Red wine of choice
Drink one 5-oz glass slowly, at night, no less than 2 hours before bed, preferably with food and at meal time, and with at least 10 oz of water, most nights prn.
Do not exceed or combine with other alcoholic beverages. May repeat x1. (Medscape Cardiology)


Culture-positive chorioamnionitis-exposed newborns may be asymptomatic at birth

A multicenter, prospective surveillance study for early-onset neonatal infections during 2006 to 2009 published in the journal Pediatrics found that some chorioamnionitis-exposed newborns with culture-confirmed, early-onset neonatal sepsis may be asymptomatic at birth and during the first 72 hours. These findings support current guidelines on prevention of perinatal group B streptococcal disease (GBS) that recommend diagnostic evaluation and empirical antibiotic therapy for well-appearing infants born to mothers with chorioamnionitis… (Medscape)


Triple therapy raises bleed risk vs DAPT post-PCI for MI

A secondary analysis of the TRANSLATE-ACS observational study reported in JACC: Cardiovascular Interventions suggests that combining an oral anticoagulant with dual-agent antiplatelet therapy (DAPT) after PCI performed for acute MI increases the risk of bleeding complications compared to DAPT alone, regardless of which P2Y12 receptor inhibitor—clopidogrel or prasugrel is added to aspirin. Six months after discharge patients on triple therapy with clopidogrel after PCl for MI had a significantly higher rate of bleeding (by Bleeding Academic Research Consortium [BARC] criteria) at 28.7% vs 19.7% for those discharged on DAPT with clopidogrel… (Medscape)


Drunken driving law in India

Dr K K Aggarwal

The Motor Vehicles Act, 1939, has a clause which states that "Driving by a drunken person shall be punishable at the first offence with imprisonment for a term which may extend to six months or with a fine which may extend to two thousand rupees or both; and for a second offence, if committed within three years of the previous similar offence, imprisonment for a term which may extend to three thousand rupees, or with both. According to this law, drinking and driving was not allowed to be mixed up, but after its amendment in 1994, an amount up to 30 mg per 100 ml of blood has been permitted to driver.





Parent’s dilemma in choosing sex of their intersex child

Smita N Deshpande 
Head, Dept. of Psychiatry, De–addiction Services 
PGIMER-Dr. Ram Manohar Lohia Hospital 
Park Street, New Delhi 

A and S have one child. The second, born three months ago, had indeterminate sexual genitalia. He doctor opines that the child will need one operation so that sex is clear. The operation can be done in the future once the child grows up and decides which sex s/he wants to belong to. They are worried because they feel that growing up with a confusing sexual identity will not be good for the child. Moreover the other sibling may face stigma. Finally the child does not even need to know about the operation. As their doctor what should you advise?

  1. What would you do, as a parent?
  2. Is such a surgery necessary at all? Can the child not go through life with indeterminate sex if s/he wants?
  3. What other social issues would such a child face?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):



Flu in children

  • The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestations of respiratory tract illness – sore throat, cough and nasal discharge.
  • All the above features may not be present in children.
  • Flu sometimes may last for more than a week in children.
  • Ear discharge, development into asthma and pneumonia are common complications in children.
  • Complicated pneumonia may be severe and rapidly fatal, especially if the bacterium is Staph.
  • During winter, a diagnosis of flu should be considered in all children with fever; children with fever and acute onset of respiratory illness; children with fever and exhilaration of underlying chest condition; children with pneumonia and children with fever of more than 100, with severe cough or sore throat.
  • Fever is present in over 95% of cases, often more than 39°C.
  • Cough is present in over 77% patients.
  • Nasal discharge is present in more than 78% patients.
  • Headache is present in more than 26% patients.
  • Muscle pain is present in more than 71 % patients.
  • Incubation period is 1–4 days with high transmissibility.
  • The treatment is often symptomatic.
  • Cough hygiene should be practiced.

WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi 

Click here to read the proposed changes


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Laughter is the Best Medicine

Many years ago, Norman Cousins was diagnosed as "terminally ill". He was given six months to live. His chance for recovery was 1 in 500. He could see the worry, depression and anger in his life contributed to, and perhaps helped cause, his disease. He wondered, "If illness can be caused by negativity, can wellness be created by positivity?" He decided to make an experiment of himself. Laughter was one of the most positive activities he knew. He rented all the funny movies he could find – Keaton, Chaplin, Fields, the Marx Brothers. (This was before VCRs, so he had to rent the actual films.) He read funny stories. He asked his friends to call him whenever they said, heard or did something funny. His pain was so great he could not sleep. Laughing for 10 solid minutes, he found, relieved the pain for several hours so he could sleep. He fully recovered from his illness and lived another 20 happy, healthy and productive years. (His journey is detailed in his book, Anatomy of an Illness.) He credits visualization, the love of his family and friends, and laughter for his recovery.

Some people think laughter is a waste of time. It is a luxury, they say, a frivolity, something to indulge in only every so often. Nothing could be further from the truth. Laughter is essential to our equilibrium, to our well–being, to our aliveness. If we’re not well, laughter helps us get well; if we are well, laughter helps us stay that way. Since Cousins’ ground–breaking subjective work, scientific studies have shown that laughter has a curative effect on the body, the mind and the emotions. So, if you like laughter, consider it sound medical advice to indulge in it as often as you can. If you don’t like laughter, then take your medicine – laugh anyway.

Use whatever makes you laugh – movies, sitcoms, records, books, New Yorker cartoons, jokes, friends. Give yourself permission to laugh – long and loud and out loud – whenever anything strikes you as funny. The people around you may think you’re strange, but sooner or later they’ll join in even if they don’t know what you’re laughing about.

Some diseases may be contagious, but none is as contagious as the cure… laughter.



Which one of the following is a recognized x-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Yesterday’s Mind Teaser:  High resolution computed tomography of the chest is the ideal modality for evaluating:

1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.

Answer for Yesterday’s Mind Teaser: 2. Interstitial lung disease.

Answers received from:Dr Jainendra Upadhyay. Dr Anil, Dr krishna

Answer for 1st January Mind Teaser: 4. Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionised in plasma.

Answers received from: Dr.K.Raju, Dr Avtar Krishan



Respected Dr Pillai, Dr KK Agrawal & Dr Alex Franklin, Thanks a lot for the great work during last one year.

Wishing all a very happy and prosperous new year. Regards: Dr Sanjay Deshpande.



Three Vampires Walk into a Bar

Three vampires walk into a bar and sit down at a table. The waitress comes over and asks the first vampire what he would like. The first vampire responds, "I vould like some blood." The waitress turns to the second vampire and asks what he would like. The vampire responds, "I vould like some blood." The waitress turns to the third vampire and asks what he would like. The vampire responds, "I vould like some plasma."

The waitress looks up and says, "Let me see if I have this order correct. You want two bloods and a blood light?"



Gift a healthy life to your elders this New Year
All you need to know about adult vaccinations

New Delhi, January 3, 2016: Everyone knows that children need regular vaccinations, but it's less well known that adults also need to get shots to live a healthy and long life. Vaccines can help protect a person from serious and sometimes deadly diseases and timely vaccination is extremely important especially for all those above the age of 65 years of age.

Speaking on the topic, Dr. S.S Agarwal– National President IMA and Padma Shri Awardee, Dr. KK Aggarwal – President HCFI and Honorary Secretary General IMA said, “We must always remember that our parents made sure during our childhood years that that we received all necessary vaccinations. Similarly, it is our duty to make sure that they receive their due vaccinations in their old age. Most adult vaccinations are administered through an intra muscular route on the shoulder muscle. With the onset of the new year, we must gift our elders the gift of good health.”

A few essential vaccinations and their administration guidelines include:

• It is recommended that all individuals above the age of 18 get a yearly flu vaccine. This becomes a crucial element especially for people who are above the age of 65 or have pre-existing lifestyle diseases such as diabetes & heart disease.

• Tetanus Toxoid vaccination should continue for life once ever 10 years and an extra dose to be given after five years.

• Elderly people after the age of 60 years may require a Herpes zoster vaccination.

• All elderly people above the age of 65 years require a pneumococcal pneumonia vaccination. It is recommended that this vaccine be taken once in five years.

• All adults irrespective of their age should be given a vaccine that provides full coverage against hepatitis B..

• Pneumonia and flu vaccines can be given in one single sitting.

• Most vaccination are safe to administer and cause only minor side effects.

• New data has shown that giving flu vaccination to heart and diabetes patients reduces morbidity and mortality drastically.