March 5  2015, Thursday
Flu in children
Dr KK Aggarwal
  • The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestation of respiratory tract illness – sore throat, sough 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.
Mega Heart checkup camp at Sagar,Madhya Pradesh 23rd February 2014
  • The vast majority of asymptomatic, benign thyroid nodules show no significant growth over a 5-year follow-up, thus indicating that existing guidelines on follow-up of such tumors can safely be relaxed, reported a new study published in the March 3 issue of the Journal of the American Medical Association.
  • Intralymphatic injections of standard grass-pollen extract are well tolerated and could serve as a new and convenient option for treating grass-pollen allergy, suggests new research presented at the American Academy of Allergy, Asthma & Immunology 2015.
  • Compared with healthy controls, women with multiple sclerosis (MS) have lower levels of folate, magnesium, vitamin E, and other nutrients that may have important anti-inflammatory or antioxidant properties, reports a new study that will be presented at the upcoming 67th American Academy of Neurology (AAN) Annual Meeting.
  • Low serum vitamin D levels are more closely associated with diabetes than obesity is, thus pointing towards a link between vitamin D deficiency and an increased risk for type 2 diabetes, suggests new research published online in the Journal of Clinical Endocrinology & Metabolism.
  • The American College of Physicians (ACP) has released updated recommendations for preventing and treating pressure ulcers, or bedsores, in two evidence-based clinical guidelines published March 3 in the Annals of Internal Medicine.
Dr KK Spiritual Blog
The spiritual prescription "I am1 sorry"

Two hardest words for a doctor to say: "I’m sorry."

Most defense lawyers counsels doctors not to 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.

  1. Apologizing after a medical error is the humane thing to do.
  2. Patients often sue simply because it’s the only way to find out what went wrong.
  3. 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 for sorry.
  4. Over 35 states in the USA have passed laws prohibiting doctors’ apologies from being used against them in court. (apology laws)
  5. 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 you should 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.
Cardiology eMedinewS
  • An update of the guidelines for the management of patients with atrial fibrillation (AF) significantly increases the number of patients eligible for oral anticoagulant therapy, suggest the results of a new analysis published March 2 in JAMA: Internal Medicine. Researchers noted that the overall proportion of patients recommended for oral anticoagulation increased from 71.8% under the 2011 AHA/ACC/HRS guidelines to 90.8% with the 2014 AHA/ACC/HRS clinical recommendations.
  • A new study suggests that drinking 3 to 5 cups of coffee a day reduces the risk of clogged arteries and heart attacks. The study is published in the journal Heart.
Pediatrics eMedinewS
  • There seems to be a strong link between body mass index in teenagers and blood pressure, suggests a new large study published in the American Journal of Hypertension.
  • A team of researchers from Weill Cornell Medical College and New York-Presbyterian/Weill Cornell Medical Center has improved a non-surgical procedure that safely and effectively corrects newborn ear deformities in just two weeks. In the study, published in the Journal of Plastic and Reconstructive Surgery, the researchers demonstrate how a rigid plastic mold can be used to reshape deformed ears.
Make Sure

Situation: A patient with gross ascites presented with complaints of difficulty in breathing on lying down.

Reaction: Oh my God! Why did you drain so much ascitic fluid?

Lesson: Make sure, to evaluate the patient thoroughly and only moderately tap the ascitic fluid since overenthusiastic tapping can be life-threatening.

Dr Sudhir Gupta, Prof & Head, Forensic Medicine & Toxicology, AIIMS

When can pregnancies be terminated by Registered Medical Practitioners?

A Registered Medical Practitioner shall not be guilty of any offence under that code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with MTP Act
  • where the length of the pregnancy does not exceed twelve weeks, if such medical practitioner is, or
  • where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two medical practitioners are of the opinion, formed by doctor in good faith that – the continuance of pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health, or there is a substantial risk that the child, if born, would suffer from such physical and mental abnormalities as to be seriously handicapped.
  • 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.
  • Where any pregnancy results as a result of failure of any device or method used by any woman or her husband for the purpose of limiting the number of children, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.
  • In determining whether the continuance of a pregnancy would involve such risk of injury to the health as is mentioned in sub–section (2), account may be taken of the pregnant women’s actual or reasonably foreseeable environment.
  • No pregnancy of a woman, who has not attained the age of 18 years, or, who, having attained the age of 18 years is a mentally ill person (substituted for "lunatic" by Amendment Act, 2002), shall be terminated except with the consent in writing of her guardian.
Inspirational Story
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, Monty Python, 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.
Wellness Blog
Drinking coffee prevents Parkinson’s disease

Nicotine present in the tobacco has been used for its medicinal value for quite some time for diseases like Parkinson’s disease and ulcerative colitis. A study from University of Miami School of Medicine, USA, now has shown that people from families prone to Parkinson’s disease are less likely to develop the disease if they drink coffee on a regular basis.

Both coffee and nicotine have a link with dopamine in the brain. Dopamine is a chemical that decreases in patients with Parkinson’s disease.

It is possible that people who will develop Parkinson’s disease have lower levels of dopamine. Those with low levels of dopamine may be more likely to enjoy caffeine.

Parkinson’s disease is caused when brain cells that produce dopamine die. The disease is progressive, affecting about one percent of people older than 65.

Symptoms start out with shaking and can progress to paralysis. There is no cure, although a number of drugs can make symptoms better for a time.
Dr Good Dr Bad
Situation: A 50–year–old male came with early morning onset of acidity.

Dr. Bad: Take an antacid.

Dr. Good: Get an ECG done.

Lesson: Onset of acidity after the age of 40 unless proved otherwise is acute coronary event.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
eMedi Quiz
Brocq's phenomenon is analogous to which clinical sign in psoriasis?

a. Olfleck's phenomenon

b. Auspitz sign

c. Salmon patch

d. Candle wax scales

Yesterday’s Mind Teaser: Epidermodysplasia veruniciformis is caused by which of the following HPV serotypes:





Answer for yesterday’s Mind Teaser: c.5

Correct Answers received from: Dr Virendra Kharpate, Dr Shangarpawar, Dr Poonam Chablani, Dr Avtar Krishan, Dr KV Sarma, Raju Kuppusamy.

Answer for 3rd March Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct Answers receives: Dr KV Sarma, Dr Poonam Chablani, Raju Kuppusamy, Dr Jainendra Upadhyay.
Rabies News (Dr A K Gupta)
Is there a need to alter the dose or schedule of any concomitant medication during IDRV?

There is no need to alter the dose or schedule of any concomitant medication during IDRV.
eMedinewS Humor
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?"
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
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 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
Suggestions for Medical Emblem Received So Far
Child Sexual Abuse: Prevention & Response

The purpose of Grooming
  • To reduce the likelihood of disclosure
  • To reduce the likelihood of child being believed
  • To reduce the likelihood of being detected
  • To manipulate the perceptions of other adults around the child
Dr DS Bhullar
Ayush doctors may get nod to do abortions
Sushmi Dey, TNN | Mar 4, 2015, 02.39 AM IST

NEW DELHI: Here's something ayurveda gurus like Charak and Sushruta may not have imagined. Modern ayurvedacharayas, homoeopaths and other Ayush doctors may soon be allowed to conduct non-invasive abortions.

The health ministry has worked out changes to the Medical Termination of Pregnancy (MTP) Amendment Bill. The revised bill proposes to allow Ayush doctors to conduct non-invasive procedures on women seeking to terminate pregnancy. The draft bill will soon be sent to the Cabinet.

"We have made revisions to the earlier draft and proposed that Ayush doctors who are registered healthcare specialists be allowed to carry out non-invasive procedure, which would mean prescribing medicines etc," a senior health ministry official told TOI.

Another key amendment seeks to increase the period for abortion to 24 weeks from the present 20 weeks.

The government's proposal, originally formulated taking a cue from a study conducted by Population Council, is aimed at increasing access to safe abortion by expanding the number of healthcare providers.

Estimates show around 7 million abortions are conducted in India every year and over 50% of them are said to be illegal.

Initially, the government had decided to allow midwives and Ayush doctors to do even invasive procedures for abortion, but dropped it following mounting objections from allopathic practitioners, particularly Indian Medical Association (IMA) and Federation of Obstetric and Gynaecological Societies of India (FOGSI).

IMA, a pan India voluntary organization with a membership of 2.5 lakh allopathic practitioners, said even the latest move can put patients at risk as well as allow unethical practices and sex selective abortions.

"MTP is a procedure meant to be conducted by an allopathic doctor only. It is not possible to allow restricted practice. How will the government monitor whether a person is conducting abortion through medicine or doing invasive procedures," says IMA secretary general Dr KK Aggarwal.

According to Dr Aggarwal, abortions by a non-MBBS doctor can lead to critical medical conditions arising out of excessive bleeding or incomplete abortions, which can be difficult to handle.

Ministry officials say FOGSI members were part of the consultations and initially supported the amendments. However, FOGSI has maintained that it changed its position after a thorough discussion.

"Expanding the number and type of providers able to legally perform abortion services, including manual vacuum aspiration (MVA) and medical abortion (MA), could greatly expand women's access to safe abortion and save many lives each year," Population Council said in a note on the issue.

The World Health Organisation (WHO) also seems to endorse the government's proposal. A technical and policy guidance for health systems by WHO released in 2012 states, "Abortion care can be safely provided by any properly trained health-care provider, including mid-level providers....(e.g. midwives, nurse practitioners, clinical officers, physician assistants, family welfare visitors, and others) who are trained to provide basic clinical procedures related to reproductive health..."

Traditionally, mid-wives have played a key role in catering to urgent medical needs, especially attending to pregnant women for child delivery or even for abortion, in rural areas and villages that lacked medical facilities. Though with time government health centres and private players reached many such villages, mid-wives continue to exist and attend to many emergencies even today.

The government's proposal to involve Ayush doctors has also found support from the women and child development ministry, National Commission for Women and other women's groups.
IMA writes to Kejriwal over Delhi Medical Council
New Delhi, Mar 3, 2015 (PTI)

The Indian Medical Association (IMA) has written to Delhi Chief Minister Arvind Kejriwal, urging him to clear the files approved by the Lieutenant Governor last year for Gazette Notification of the nominated members of the Delhi Medical Council (DMC).

The IMA raised concern over the DMC being without a democratically-elected body and carrying out its functions despite its term having expired on December 20 last.

"The medical fraternity respects your movement against corruption and is of the opinion that your government will ensure that any regulatory body is honest.

"DMC was constituted in 2009 and its term completed on December 20, 2014. The elections for the new council were held between November 16 and December 2. After completion of the elections, Lt Governor also cleared all the elected and nominated members," said the letter written by IMA Secretary General K K Aggarwal.

"It is a matter of concern that still the Gazette notification has not taken place. It reflects poor on the part of government. IMA requests you to kindly intervene in the matter so that the State of Delhi is not without any regulatory body," the letter, dated February 27, stated.

There are 23 members in DMC, and of them eight were elected on November 16 and another member was elected on November 22.

Lieutenant Governor Najeeb Jung, who was heading the administration of Delhi then, had nominated four members on December 22, and eight elected members from various medical colleges were elected before December 20. Two are Director Health Services and Dean Universities as ex-officio members.

"Since January 22, the file cleared by the Lt Governor for Gazette Notification is still pending with the new AAP Government. We want the Delhi government to intervene into the matter and resolve the issue," Dr Anil Goyal, President of Delhi Medical Association (DMA), said.
Check blood availability status online soon
Mar 3, 2015, 11.25AM IST TNN

Jaipur: The health department has started linking all blood banks through an internet network to allow all those who need blood check the availability of any particular blood group online.

A health official said the work of networking blood banks has started. But, due to certain initial problems, the stock entry of blood has not been begun yet. Soon, that will also be done for the benefit of patients.

The proposal to network blood banks was pending for a long time. Under the project, all the blood banks in the state would be connected online. This will save time for all those patients who looking for a particular blood group for transfusion.

There are 44 government blood banks and 39 private blood banks in the state. A total of 87 blood banks are operational in the state. The health official said every year they provide more than 5.5 lakh units of blood.

Since, the requirement of blood is constantly increasing as the numbers of surgeries are on the rise in hospitals and also due to increasing road accidents and population growth, there is a need to increase voluntary blood donation. According to the health department figures, the voluntary blood donation is constantly increasing every year. It was 78% in 2013-14 and has increased to 85% in 2014-15.

On Sunday, various blood bank officials of the city and health officials met to discuss how the voluntary blood donation could be increased. The blood banks demand replacement of blood for providing a particular group of blood to the patients. They claimed that as the voluntary blood donation increases, it will reduce demand of replacement of blood.

During the workshop, Indian Medical Association (IMA) president Dr S S Agarwal said measures should be taken to discourage replacement and encourage voluntary blood donation. For the purpose, the government agencies, private blood banks and also NGOs should work in close coordination, he added.

Besides, he pointed out that often blood expires when it is not used for a particular period of time after its collection. To avoid this stage there should be coordination between blood banks and excess blood in a particular blood bank should be transferred to other blood banks so that neither there is unavailability anywhere nor does a unit of blood goes waste.

The government officials present in the workshop said for transfer of blood from one bank to another, change in law is required. They asked the blood bank officials to prepare the proposal for it and send it to the government.
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Quote of the Day
The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference bet ween reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened. Johann Wolfgang von Goethe
Reader Response
Dear Sir, very nice initiative! eagerly waiting every morning about this email. Again, it was great. One small suggestion about diabetes related comment. Now a days we measure blood glucose not sugar. Best regards Good Luck! Dr Sanjay Kumar Bhadada
News on Maps
Burn your internal Holika and play a safe Holi: IMA
Addressing a Press Conference Padma Shri Awardee, Dr K K Aggarwal, Hony. Secretary General, IMA and President Heart Care Foundation of India said that in the first 6 months of Uttarayan, Holi is the only major festival.

Uttarayan is the phase of a positive state of mind, which helps build friendships and turn your enemies into your friends. Holashtak, a period of 8 days before Holi is meant for this purpose. It takes up to 8 days to purify the mind and clear ego-based negativity from one’s own mind as well as that of our enemies or those with disputes. Once the negativity of the mind is removed, the day of Holi is played in friendship.

Dr A Marthanda Pillai National President IMA and Dr K K Aggarwal Honorary Secretary General IMA released the following guidelines for Holi.
  • Water filled balloons can causes head/eye injury.
  • Green Holi colours contain malachite green, which can be dangerous to the eyes.
  • Most Holi colours may contain artificial colours or dyes and/or lead. These chemicals are harmful to the body and skin. Shiny colours may contain ground glass or mica, which again are harmful.
  • Use haldi/turmeric and flower-based colours to play Holi.
  • Avoid eating adulterated sweets.
  • Avoid Bhang and alcohol.
  • Date rape drugs can be mixed with Bhang and Thandai by boys to sexually harass young girls. According to POCSO Act, any girl below age of 18 years if harassed with sexual intent even in the pretext of Holi celebrations is a criminal offence and punishable with imprisonment. Under the POSCO Act, any person touching the chest of a female younger than 18 years of age, can amount to imprisonment.
  • Patients with cough and fever should be careful during Holi celebrations as Swine Flu can infect others who are in the vicinity of 3 feet from the patient. Because of untimely rain and lowering of temperature, the effect of Swine Flu will continue for a few more days. According to IMA, people suffering from Swine Flu should not be allowed to gather in Holi crowds.

    The dignity of women must be preserved when playing Holi and this should be our message for the coming International Women's Day falling on 8th march.