eMedinewS
7th October 2014, Tuesday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

Running and cardiovascular risk

Most cardiologists recommend at least 30 minutes of moderate-intensity exercise 5 to 7 days per week.

In a prospective cohort study with a mean follow-up of over 15 years published in J Am Coll Cardiol 2014;64:472, over 55,000 adults (mean age 44 years) reported duration, distance, frequency, and speed of any running or jogging. Runners had significantly lower risks of all-cause and cardiovascular mortality compared to non-runners.

The derived mortality benefit was similar for all runners regardless of the total running time, including for those who ran less than 51 minutes per week.

The data support the concept that even small amounts of exercise are better than no exercise while at least 30 minutes of moderate-intensity exercise five to seven days per week remains a reasonable goal for most patients. (Uptodate)

News Around The Globe

  • Severe obstructive sleep apnea may interfere with blood pressure (BP)–lowering treatment in patients at high cardiovascular disease risk or with established cardiovascular disease, results of a multicenter clinical trial suggest by Harneet Walia, MD, from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
  • In June of 2014, the US Food and Drug Administration (FDA) approved a formulation of inhaled insulin (Afrezza) to improve glycemic control in adults with diabetes mellitus
  • The 23-valent pneumococcal polysaccharide vaccine has been recommended for many years in the United States for all adults ≥65 years of age. In September 2014, the United States Advisory Committee on Immunization Practices (ACIP) began also recommending the pneumococcal conjugate vaccine (PCV13) for all adults ≥65 years of age. Current recommendations for individuals ≥65 years of age who have not previously received either PCV13 or PPSV23 are to administer PCV13 followed 6 to 12 months later by PPSV23. In patients who have already received PPSV23, at least one year should elapse before they are given PCV13. The ACIP revision was prompted by results from the CAPiTA trial. This randomized placebo-controlled trial, including approximately 85,000 adults ≥65 years of age in the Netherlands, demonstrated the efficacy of PCV13 against vaccine–type pneumococcal pneumonia, vaccine-type nonbacteremic pneumococcal pneumonia, and vaccine–type invasive pneumococcal disease.
  • In May 2014, the World Health Organization issued poliovirus vaccination recommendations for all residents and long-term visitors (>4 weeks) exiting 10 poliovirus–affected countries in order to prevent further spread of the disease. The recommendations apply to Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, Pakistan, Somalia, and Syria. 
  • Some national polio vaccine programs utilize live attenuated oral polio vaccine (OPV) only. In 2014, the World Health Organization (WHO) recommended the addition of at least one dose of inactivated polio vaccine (IPV), to be given at ≥14 weeks of age, to the OPV series in such countries. IPV and OPV can be given concurrently. The purpose of the added IPV dose is to maintain immunity against type 2 poliovirus during and after the planned global switch in 2016 from trivalent OPV to bivalent OPV for routine immunization
  • An Italian toddler thought cured of HIV with early aggressive treatment following birth has suffered a relapse. The 3–year–old child's viral levels of HIV rebounded two weeks after doctors took him off antiretroviral medications, according to a case report published Oct. 4 in The Lancet. The child's HIV levels had been undetectable since he was 6 months old, thanks to aggressive drug therapy that doctors started within 12 hours of his birth, doctors said.

NATIONAL NEWS

Poverty can be a real ‘heartbreaker’

Monday, 06 October 2014 | Staff Reporter | New Delhi/ The Pioneer

But treating poverty works like medicine as HCFI announces fund for poor heart patients

Catering to the needs of the poor, the Heart Care Foundation of India (HCFI) recently came out with an initiative called the Sameer Malik Heart Care Foundation Fund, which will ensure that no person dies of a heart disease just because they cannot afford treatment. Any person irrespective of gender, religion or age can apply for the benefits of the fund by calling its helpline number 9958771177.

Research indicates that over 24 lakh people in India die due to heart disease every year and over 1.2 lakh children are born with a congenital heart defect. In Mumbai alone, 10 per cent to 14 per cent people above the age of 30 years suffer from heart disease. Several of the heart conditions are curable and death is preventable. However, not everyone can afford the treatment and hospital costs. Thus, this foundation fund is an attempt to bridge this disparity and provide individuals the ability to live a healthy and disease-free life.

The initiative was supported by well-known people like motivational guru and author Dr Deepak Chopra, vice president of the Indian Medical Association (IMA) Dr KK Aggarwal, chairman of Medanta Medicity Dr Naresh Trehan and chairman National Heart Institute Dr OP Yadava.

Speaking about the reversal of heart disease, Dr Chopra said, “Heart disease is becoming a global problem and its implications in a country like India where majority of the people cannot afford treatment, is huge. While preventive healthcare and what we call globally the concept of the reversal of disease is essential, often people become victims of the disease for no fault of theirs.”

An expert committee assesses all applications received by the Sameer Malik Heart Care Foundation Fund. Once sanctioned, the funds are directly deposited in the bank account of the medical establishments treating the patient. Heart Care Foundation of India provides surgery in association with leading hospitals such as Medanta and National Heart Institute for surgical treatments and also provides lodging facilities at concessional rates for outstation patients.

Dr KK Spiritual Blog

Namkaran Sanskar

In India, a person is identified by his/her name, which usually is a reflection of his/her own family. It may contain not only your maiden name but also the name of your father and your surname/caste. When you are born, you are usually given your special name, which you carry throughout your life unless it is changed for a specific purpose. For example, the surname may change after marriage or the in-laws may change your name, specifically, when you are a girl. Artists often change their names to those which may reflect their profession. A classical example is Rajesh Khanna, who changed his name from Jatin to Rajesh, which was easier for the public to recall. A name for a baby is chosen on any of the following grounds:

  • The priest, as per the horoscope, decides the sound present in the universe and that Akshar (Alphabet) is given to the family to choose a name beginning with that Akshar.
  • Sometimes, the name of the baby may be chosen depending upon the auspiciousness of the day he/she was born, e.g. a baby body born on Krishna Janmashtami, may be named ‘Krishna’ by the family after Lord Krishna.
  • If the parents have taken a vow or a Mannat to a deity, then they may name their child after one of the many names of that deity. For example, if parents have taken a Mannat from Vaishno Devi, their baby girl may be named as one of the forms of Goddess Durga or Parvati.
  • People may also choose similar names for their children, e.g. Ramesh, Mahesh and Suresh.
  • People may also keep the name of the child in the form of known pairs. If the name of the first child is Luv, the parents may like to name the second child as Kush, especially when the parents have twins. Other examples are Karan Arjun, Sita and Gita etc.
  • Sometimes, parents name their child after their favorite celebrity. For example, if someone is a big fan of Sachin Tendulkar, he may name his child Sachin. Sachin Tendulkar himself was named after the noted Hindi film music director Sachin Dev  Burman by his father, who was a great fan of SD Burman.

Name has a lot of significance as Akshar in Sanskrit has a vibration and if that positive vibration matches with the vibrations of universe at the time of your birth, it helps in healing.

Normally, it is expected that you live up to your name. For example, if your name is Durga, you are expected to know all about Maa Durga and try to adopt characteristics of Durga. 

Therefore, everyone is expected to know the literal meaning of his or her name and try to follow a lifestyle that is consistent with your name. For example, if you are named Ram, you are not expected to act like Ravana.

Namkaran Sanskar or the naming ceremony is a complete ceremony and is one of the 16 sanskars. It is both a social and legal necessity. As the naming process creates a bond between the child and the rest of the community, it is considered auspicious.

Some people name their child before he/she is born but a Namkaran Sanskar is usually performed on the 12th day after birth but it may vary from religion to religion and custom to custom.

The formal ritual involves a Namkaran puja, which is held at their home or a temple where the priest offers prayers to all the Gods, Navagrihas, five elements, Agni and the ancestors. The horoscope of a child is made and is placed in front of the idol of the deity for blessings. With the baby in the lap of the father, the chosen name of the child is whispered in the right ear.

Some people name the child on the 101st day of the birth, while some choose the first birthday to name their child.

The name of the child also entails certain etiquettes as it reflects a person. You cannot take the name of a person with disrespect. If you abuse a name it means you have abused a person.

Inspirational Story

It’s Never Too Late

It was an unusually busy day for the hospital staff on the sixth floor. Ten new patients were admitted and Nurse Susan spent the morning and afternoon checking them in. Her friend Sharron, an aide, prepared ten rooms for the patients and made sure they were comfortable. After they were finished she grabbed Sharron and said, “We deserve a break. Let’s go eat.”

Sitting across from each other in the noisy cafeteria, Susan noticed Sharron absently wiping the moisture off the outside of her glass with her thumbs. Her face reflected a weariness that came from more than just a busy day. “You’re pretty quiet. Are you tired, or is something wrong?” Susan asked.

Sharron hesitated. However, seeing the sincere concern in her friend’s face, she confessed, “I can’t do this the rest of my life, Susan. I have to find a higher-paying job to provide for my family. We barely get by. If it weren’t for my parents keeping my kids, well, we wouldn’t make it.”

Susan noticed the bruises on Sharron’s wrists peeking out from under her jacket. “What about your husband?” “We can’t count on him. He can’t seem to hold a job. He’s got . . . problems.” “Sharron, you’re so good with patients, and you love working here. Why don’t you go to school and become a nurse? There’s financial help available, and I’m sure your parents would agree to keep the kids while you are in class.”

“It’s too late for me, Susan; I’m too old for school. I’ve always wanted to be a nurse, that’s why I took this job as an aide; at least I get to care for patients.” “How old are you?” Susan asked. “Let’s just say I’m thirty-something.”

Susan pointed at the bruises on Sharron’s wrists. “I’m familiar with ‘problems’ like these. Honey, it’s never too late to become what you’ve dreamed of. Let me tell you how I know.” Susan began sharing a part of her life few knew about. It was something she normally didn’t talk about, only when it helped someone else.

“I first married when I was thirteen years old and in the eighth grade.” Sharron gasped. “My husband was twenty-two. I had no idea he was violently abusive. We were married six years and I had three sons. One night my husband beat me so savagely he knocked out all my front teeth. I grabbed the boys and left. “At the divorce settlement, the judge gave our sons to my husband because I was only nineteen and he felt I couldn’t provide for them. The shock of him taking my babies left me gasping for air. To make things worse, my ex took the boys and moved, cutting all contact I had with them.

“Just like the judge predicted, I struggled to make ends meet. I found work as a waitress, working for tips only. Many days my meals consisted of milk and crackers. The most difficult thing was the emptiness in my soul. I lived in a tiny one-room apartment and the loneliness would overwhelm me. I longed to play with my babies and hear them laugh.”

She paused. Even after four decades, the memory was still painful. Sharron’s eyes filled with tears as she reached out to comfort Susan. Now it didn’t matter if the bruises showed. Susan continued, “I soon discovered that waitresses with grim faces didn’t get tips, so I hid behind a smiling mask and pressed on. I remarried and had a daughter. She became my reason for living, until she went to college.

“Then I was back where I started, not knowing what to do with myself – until the day my mother had surgery. I watched the nurses care for her and thought: I can do that. The problem was, I only had an eighth-grade education. Going back to high school seemed like a huge mountain to conquer. I decided to take small steps toward my goal. The first step was to get my GED. My daughter used to laugh at how our roles reversed. Now I was burning the midnight oil and asking her questions.”

Susan paused and looked directly in Sharron’s eyes. “I received my diploma when I was forty-six years old.” Tears streamed down Sharron’s cheeks. Here was someone offering the key that might unlock the door in her dark life.

“The next step was to enroll in nursing school. For two long years I studied, cried and tried to quit. But my family wouldn’t let me. I remember calling my daughter and yelling, ‘Do you realize how many bones are in the human body, and I have to know them all! I can’t do this, I’m forty-six years old!’ But I did. Sharron, I can’t tell you how wonderful it felt when I received my cap and pin.”

Sharron’s lunch was cold, and the ice had melted in her tea by the time Susan finished talking. Reaching across the table and taking Sharron’s hands, Susan said, “You don’t have to put up with abuse. Don’t be a victim – take charge. You will be an excellent nurse. We will climb this mountain together.” Sharron wiped her mascara-stained face with her napkin. “I had no idea you suffered so much pain. You seem like someone who has always had it together.”

“I guess I’ve developed an appreciation for the hardships of my life,” Susan answered. “If I use them to help others, then I really haven’t lost a thing. Sharron, promise me that you will go to school and become a nurse. Then help others by sharing your experiences.” Sharron promised. In a few years she became a registered nurse and worked alongside her friend until Susan retired. Sharron never forgot her colleague or the rest of her promise.

Now Sharron sits across the table taking the hands of those who are bruised in body and soul, telling them, “It’s never too late. We will climb this mountain together.”

Rabies News (Dr A K Gupta)

Are pregnancy and lactation contraindications for IDRV?

Pregnancy and lactation are not contraindications for IDRV.

Cardiology eMedinewS

  • A new American Heart Association statement about enhancing radiation safety in cardiac imaging suggests that clinicians need to be better able to counsel patients about risks vs benefits, refer patients appropriately, and make sure patients' radiation doses are not too low or too high. The recommendations focus on three areas: education (of clinicians and patients), justification (that a particular cardiac imaging test with radiation is needed), and optimization of radiation exposure (choosing the smallest dose that provides high-quality images). The statement, which was published September 29, 2014 in Circulation, expands on a 2009 AHA science advisory.
  • Elevated levels of high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predicted heart failure in patients with chronic kidney disease followed for a median of close to 6 years, researchers reported. Compared with patients with the lowest blood levels of hsTnT, those with the highest had a nearly five-fold higher risk for developing heart failure and the risk was 10-fold higher in patients with the highest NT-proBNP levels compared with those with the lowest levels of the protein, researcher Nisha Bansal, MD, of the University of Washington in Seattle, and colleagues wrote online in the Journal of the American Society of Nephrology.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at SGSS Vidyalaya, Chirag Dehli on 22nd September 2014

mela_brochure
Self-Assessment-Quiz

 

expert_choice
Zee News – Health Wealth Shows

Alcohol

press release

FDA panel recommends first drug for HIV prevention

video of day video of day

Other Blogs

Video Library

MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

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 – 96458 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 patient with Mediclaim was advised MRI post discharge.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.

Lesson: Post hospitalization-related medical expenses incurred during period upto 60 days after hospitalization of disease/illness/injury sustained are covered as part of the claim.

 

Make Sure

Situation: A patient died after receiving IV isoprin stat.
Reaction: Oh my God! The order was for IV Isoptin.
Lesson: Make sure while ordering the drug to spell out the name of the medicine correctly and clearly.

eMedinewS Humor


No Exit

A person checks into a hotel for the first time in his life, and goes up to his room. Five minutes later he calls the desk and says, "You've given me a room with no exit. How do I leave?" 

The desk clerk says, "Sir, that's absurd. Have you looked for the door?" 
The person says, “Well, there's one door that leads to the bathroom. There's a second door that goes into the closet. And there's a door I haven't tried, but it has a 'do not disturb' sign on it." 

Twitter of the Day

Dr KK Aggarwal: Poor hygiene habits may lead to Typhoid fever


Dr Deepak Chopra: Awareness is a field in which minds, bodies & universes arise & subside like waves on an ocean

Pediatrics eMedinewS

  • Neonates who require positive pressure ventilation (PPV) at birth for as little as one minute still need close monitoring as part of their post resuscitation care, suggests new research published online in Pediatrics.
  • Low birth weight children are more vulnerable to environmental influences than infants born with normal weight and when brought up with a great deal of sensitivity, they will be able to catch up in school, but will not become better students than normal birth weight children, report novel findings published in the Journal of Child Psychology and Psychiatry.

Quote of the Day

Principles of Life

  • Whomsoever you encounter is the right one.
  • Whatever happened is the only thing that could have happened.
  • Each moment in which something begins is the right moment.
  • What is over, is over.

IMA NEWS

Jammu and Kashmir Health Crisis (World Medical Times)

A few days ago World Health Association wrote

“According to the information we have collected from various sources, in order to mitigate the impact on the functionality of certain major government hospitals due to the floods, 58 mobile health clinics have been set up in Srinagar and 4 mobile hospitals have been pressed into service. The maternity hospital in Srinagar has been functional and the bone and joint hospital has re-opened a week ago. Many district hospitals have been functioning. 106 medical teams of the army have been deployed in addition to 1 Base hospital and 4 Field hospitals. If the standard precautions are followed in all these facilities, patient safety may not be unduly compromised. To prevent /control public health exigencies 2 Central Public Health Teams have been posted – 1 each in Jammu and Srinagar for rapid health assessment and response by the Ministry of Health & Family Welfare. A 29-member clinical team comprising of physicians, pediatricians and gynecologists has also been positioned in Srinagar and all medicines and medical supplies that have been requested by the state government have been provided. Clean-up operations at hospitals in Srinagar have apparently started and once electricity and water supply is restored, these hospitals will also start taking on the patient load in an incremental manner” .

 In the meantime, doctors in Kashmir have challenged the conclusions of the WHO and requested urgent assistance.

This is a copy of their letter. Urgent appeal for intervention/assistance of WHO in Jammu and Kashmir

To: Dr. Margaret Chan
Director General, United Nations /World Health Organization -WHO, Geneva, Switzerland
October 4, 2014

Re: Urgent appeal for intervention/assistance of WHO in Jammu and Kashmir

Dr. Chan,

  1. We write to you today as concerned civil society representatives, including members of the medical fraternity, from Indian-administered Jammu and Kashmir.
  2. In the first week of September 2014, Jammu and Kashmir was affected by the worst floods in its recorded history. There are now an estimated 8, 00,000 internally displaced persons -IDPs in Jammu and Kashmir.
  3. 3. The extent of damage of the September 2014 floods, a disaster of international magnitude as stated by the Government of Jammu and Kashmir itself, has been compounded by Indian State policies of a complete lack of disaster management including in terms of preparedness, response, relief and rehabilitation. There has been a complete breakdown of an already overburdened healthcare system, which has been further aggravated by willful hindering/restriction of humanitarian work and aid. Government of India has sought to minimize the loss of life and property before the international community by misinforming the international community, including WHO. Various individuals and organizations internationally have expressed their willingness to provide financial aid, but Government of India has refused to accept aid and placed severe restrictions on voluntary donations.
  4. On 29 September 2014, WHO India submitted a one page response to six questions posed by a journalist. This response, attributed to Dr. Nata Menabde, WHO Representative to India is the official position of WHO India on the present health crisis in Jammu and Kashmir. The responses, apparently entirely based on Ministry of Health and Family Welfare, Government of India inputs, are factually incorrect, and a complete misrepresentation of the dire situation on ground. WHO India concludes by incorrectly stating that: “The government has been intervening to tackle the potential adverse public health consequence of this disaster especially as related to water and sanitation and control of communicable diseases”.
  5. 5. A point by point response of WHO India’s present position and findings is as follows: i. “58 mobile health clinics have been set up in Srinagar and 4 mobile hospitals have been pressed into service”: Firstly, reports from the ground suggest that the 4 mobile hospitals referred to do not exist. Further, while teams of doctors have been sent from India – and are perhaps part of the mobile health clinics referred to – it is clear that they are extremely few in number and with no effective reach on the ground. Secondly, there is no shortage of well-trained and skilled local medical man power on ground. The issue is that neither mobile health clinics nor mobile hospitals can be a substitute for permanent, well-equipped hospitals and a functional health care system.
    ii. “Maternity hospital in Srinagar has been functional and the bone and joint hospital has re-opened a week ago”: Lal Ded -LD Maternity Hospital, the only specialized maternity hospital in the Kashmir valley, was not functional as of 29 September 2014. A temporary arrangement was made with the Sanat Nagar Maternity home in the form of an Out Patient Department -OPD, with no in-patient or surgical facilities. LD Maternity Hospital only began functioning at a very minimal level on 3 October 2014. Even today, there is no continuous electrical supply and the blood bank and oxygen supply are extremely limited. Bone and Joint Hospital, Barzulla, the only specialized trauma and orthopedic centre, was barely functional as of 22 September 2014 -a week prior to the 29 September 2014 WHO response. There were acute shortages of medicine, blood, oxygen and surgical, medical equipment. Surgeries were being deferred. In fact, on 22 September 2014, 66 patients who had been stranded at the hospital were being sheltered in the Kashmir Nursing Home, Gupkar. To date, the functioning of Bone and Joint Hospital is extremely limited. Further, both LD Maternity Hospital and Bone and Joint Hospital have not been disinfected as per necessary standards.
    iii. “Many district hospitals have been functioning”: Firstly, the Kashmir Valley, a 70, 00,000 population, is entirely dependent on the government hospitals in Srinagar. The district hospitals are incapable of handling tertiary care. Tertiary care in the Kashmir valley is completely handled by Shri Maharaja Hari Singh Hospital -SMHS and associated hospitals and Sher-e-Kashmir Institute of Medical Sciences -SKIMS, Soura, of which, SMHS, the single largest facility is completely non-functional as of date. Secondly, specialist hospitals are only available in Srinagar city, for example, the GB Pant Childrens’ Hospital and the LD Maternity Hospital. Thirdly, many facilities, such as MRI facilities and a fully equipped oncology department, provided by SMHS, are not available at any district hospital. Fourthly, even the private hospitals in Srinagar city– which cannot be compared to the government hospitals in terms of infrastructure and expertise– were inundated by the floods. Lastly, the diagnostic centers have also been inundated in Srinagar city. Therefore, the district hospitals are not a replacement to the Srinagar city government hospitals.
    iv. “106 medical teams of the army have been deployed in addition to 1 Base hospital and 4 Field hospitals”: Firstly, information about medical teams or hospitals by the army have not been made public, strongly indicating the lack of any seriousness in providing access to common people. Secondly, there are confirmed reports from the ground that there has been no effective healthcare provided by the army. Only limited first-aid was provided in some instances. Lastly, given the long history of violence of the armed forces against the civilian population, and the recent discriminatory rescue efforts of the armed forces during the floods, the civilian population does not prefer approaching the army healthcare units.
    v. “2 Central Public Health Teams have been posted – 1 each in Jammu and Srinagar for rapid health assessment and response by the Ministry of Health & Family Welfare”: Firstly, if these teams have been posted, their reports must be made public. To date, there is no information about their assessment. Secondly, based on the abysmal situation on ground, it is clear that these teams have made no contribution whatsoever. The fact remains that even today the government is relying on local volunteers and donations for medical supplies.
    vi. “A 29-member clinical team comprising of physicians, pediatricians and gynecologists has also been positioned in Srinagar”: As stated above, there is no shortage of well-trained and skilled local medical man power on ground. The issue is that the hospitals are not functional, stocks and equipment have been destroyed, causing an acute healthcare crisis in Jammu and Kashmir.
    vii. “All medical supplies that have been requested by the state government have been provided”: This contention is refuted by the fact that local voluntary groups such as Athrout, Help Poor Voluntary Trust and others have been requested by government hospitals to arrange medicines as the government is unwilling to assist. Further, disturbing reports suggest that medicine that was provided by the army to SMHS recently was in fact expired. Confirmed reports suggest that as far as medical supplies are concerned, the hospitals are purely managing on voluntary contributions and supplies. These supplies are also in danger of being restricted by the government.
    viii. “Clean up operations at hospitals in Srinagar have apparently started and once electricity and water supply is restored, these hospitals will also start taking on the patient load in an incremental manner”: Firstly, this statement contradicts with the earlier statement of how LD Maternity Hospital and Bone and Joint Hospital, Barzulla are open. Secondly, all cleaning that has taken place has been done by voluntary groups and NGOs. Further, while some fumigation has been done by voluntary groups, it cannot be considered a substitute to a proper process followed by the concerned government department. No certification has been provided by the Infection Control Committees, present in each hospital, charged with granting a certificate that the hospital is in a state to begin work. Absolutely no care or concern has been shown by the government on whether the actual hospital buildings, inundated in floods for weeks, are structurally safe for use. This is particular alarming considering that Jammu and Kashmir is listed in the National Policy on Disaster Management, 2009, as being in Seismic Zone V -Very high damage risk zone. On 30 September 2014, it was reported in the media that while the Director, SKIMS, Bemina declared the hospital unsafe, the Public Works Department -Roads and Buildings of the government dismissed the same. The government, in its own interests of portraying normalcy, minimizing the crisis and excluding international intervention, is willing to place the lives of numerous patients and staff at risk.
  6. The healthcare system of Srinagar city is almost completely comprised of and dependent on SMHS hospital and associated hospitals, as SMHS and associated hospitals include of a majority of departments and provide treatment to approximately 10,000 patients per day, from across the Kashmir valley. SMHS was inundated from 7 September onwards. Further, the other major hospitals inundated by the floods catered to vital specialty areas: LD Maternity Hospital, GB Pant Childrens’ Hospital, and Bone and Joint Hospital, Barzulla. LD hospital is the only specialty maternity care hospital in the Kashmir valley. It is also the only maternal, obstetric, and gynecological referral centre across the Kashmir valley. Similarly, GB Pant Childrens’ hospital is the only specialized pediatric hospital in the valley. The only functioning major hospital, with tertiary care, following the flood is SKIMS, Soura, which is now overburdened by having to serve a population of 70, 00,000.
  7. None of these hospitals -or for that matter any of the government hospitals had in place any disaster management plan. Further, no warnings or evacuations were carried out by the government at these hospitals at any point before or during the floods.
  8. An illustrative example of the role of the government is that of SMHS hospital. The hospital premises were inundated from 4 September onwards. A boat had already been commissioned to ferry hospital staff and stock to the hospital. Yet, no emergency action was taken by the government until it was too late. When the water began to rise at 10/11:00 am, on 7 September in the hospital building, rather than evacuate SMHS, patients on the ground floor were moved to the first floor. This included critically ill patients in the Medical Intensive Care Unit. This led to the death of one patient. Further, at the same time, the oxygen plant, drug store, blood bank, electricity, telephone network, generator back up and hospital canteen stopped functioning, as they were all in the ground floor, which was flooded. Relief in the form of limited food and life saving drugs were also ferried into the hospitals by local volunteers on boats. As a result, local volunteers and hospital staff had to manage in extremely hazardous circumstances. There were a total of 13 deaths recorded at SMHS by the time patients could be evacuated, by local volunteers and hospital staff, out of the hospital on Monday evening. Reportedly, many patients died during the process of evacuation and shifting from SMHS. These deaths were all a direct result of the flooding and the lack of effective evacuation by government before the floods, and lack of any assistance in the final evacuation by government. The death toll would have been much higher if not for the work of the local volunteers and hospital staff. The government administration in charge of the hospitals, including the Chief Minister and Health Minister of Jammu and Kashmir should have, by the 7th, ordered evacuation of serious patients away from the hospitals in the low lying areas, such as SMHS, to SKIMS, Soura, the other tertiary care facility, which was not affected by the flood. Further, there were no rescues carried out by the government from any of the hospitals, including SMHS.
  9. The omissions and acts of the government have led to significant mortality and morbidity across the city hospitals. Out of this, there have been at least 14 neonatal deaths at GB Pant Hospital due to power and oxygen failure. The government has failed to provide any official record of loss of life at the hospitals. There has also been monumental damage across the government hospitals. The government figure of 250 odd crores -2.5 billion INR across SMHS and associated hospitals is a severe under-estimation considering the infrastructural damage to the hospitals. For example, at SMHS alone the following facilities have been destroyed: oncology department, oxygen plant, central blood bank, dialysis unit, ENT operation theatre, ENT emergency theatre, ophthalmology theatre, Medical Intensive Care Unit -along with all modern life saving equipment, echocardiography laboratory, neurology lab, radiology department with three CT scans, two MRI’s, USG machines, Doppler’s and x-ray plants.
  10. In reality, despite a passage of one month since the floods hit Srinagar city, neither Government of India, nor Government of Jammu and Kashmir, have made any efforts to rebuild the healthcare system. On the contrary, Government of India, and the Government of Jammu and Kashmir, took no steps to prevent, prepare for, or manage the floods. The role of Government of India and Government of Jammu and Kashmir has been of criminal negligence in not anticipating the floods, and a willful intent adverse to the people, coupled with acts and omissions, in the work of evacuation, rescue and relief. No warnings were issued. No evacuations were carried out. Almost negligible rescue of the people of Jammu and Kashmir by the Indian State rescue forces Indian army, Central Reserve Police Force and other units was carried out. Hospitals, the highest priority in the time of disaster, were completely ignored by the government. Reports have emerged of military airlifting of their own personnel from bunkers/camps located adjacent to hospitals, while ignoring the appeals of patients stranded on the roofs of the hospitals in obvious distress. Rather than assist in the re-building of the healthcare system, the government has repeatedly sought to suppress the seriousness of the situation.
  11. Jammu and Kashmir faces a dire healthcare crisis that Government of India and Government of Jammu and Kashmir are unwilling to address. Legal action in the form of public interest litigation before the Jammu and Kashmir High Court, and criminal complaints against the government administration have been initiated.
  12. In the present dire situation, the people of Jammu and Kashmir require the urgent intervention of the international community, particularly WHO, to: i. Put pressure on Government of India to allow an international WHO team to visit and perform an independent evaluation of the magnitude of the health crisis in Jammu and Kashmir.
    ii. Put pressure on Government of India to invite WHO to work in Jammu and Kashmir and serve as a coordinating and consulting body in the rebuilding of the healthcare system in Jammu and Kashmir.
    iii. Put pressure on Government of India that all restrictions to financial and other aid, particularly for the healthcare sector must be lifted, and the international community must be allowed to play a direct role in the rehabilitation of Jammu and Kashmir, particularly that of the healthcare system.
    iv. Seek the cooperation and assistance in the instant matter of the: Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and Independent Expert on the issue of human rights obligations relating to the enjoyment of a safe, clean, healthy and sustainable environment. Further, pressure must be put on Government of India to allow both the Special Rapporteur and Independent Expert to visit Jammu and Kashmir and assess the health crisis.

2. Doctors Association Kashmir (DAK), Resident Doctors Association of SMHS and Associated Hospitals (RDA), Kashmir Voluntary Doctors Organization (KVDO), Association of Pharmacy Graduates of Kashmir (APGK), Jammu and Kashmir Chemists and Druggists Association (JKCDA) and Jammu Kashmir Coalition of Civil Society (JKCCS)

3. IMA at work in Jammu and Kashmir
J&K IMA medical relief camp, Water & sewage sludge, Tent on pavement, Shortage of medicine, On Road tented clinic, Drinking water & food (supply), Vehicle submerged, Most tourist hotels are drowned, Main commercial area are drawn, Sludge water pulling out by pumps still ongoing, Destroyed roads & bridges, Shopping malls still submerged, People walked out of chest level water, Grain stores are destroyed, Government hospitals are collapsed

Rabiabaji 09419407577
(NGO affiliate with IMA's Disaster Management Chapter)
Camps done at:

23/9 Palpura Noorbagh 
24/9 Chanpura & Nalbal Nowshehra 
25/9 Madgam Khan shahb
26/9 Budgah 
27/9 Batpora

Wellness Blog

4 steps toward good posture

You can improve your posture — and head off back pain — by practicing some imagery and a few easy exercises.

  • Imagery. Think of a straight line passing through your body from ceiling to floor (your ears, shoulders, hips, knees, and ankles should be even and line up vertically). Now imagine that a strong cord attached to your breastbone is pulling your chest and rib cage upward, making you taller. Try to hold your pelvis level — don’t allow the lower back to sway. Think of stretching your head toward the ceiling, increasing the space between your rib cage and pelvis. Picture yourself as a ballerina or ice skater rather than a soldier at attention.
  • Shoulder blade squeeze. Sit up straight in a chair with your hands resting on your thighs. Keep your shoulders down and your chin level. Slowly draw your shoulders back and squeeze your shoulder blades together. Hold for a count of five; relax. Repeat three or four times.
  • Upper-body stretch. Stand facing a corner with your arms raised, hands flat against the walls, elbows at shoulder height. Place one foot ahead of the other. Bending your forward knee, exhale as you lean your body toward the corner. Keep your back straight and your chest and head up. You should feel a nice stretch across your chest. Hold this position for 20–30 seconds. Relax.
  • Arm-across-chest stretch. Raise your right arm to shoulder level in front of you and bend the arm at the elbow, keeping the forearm parallel to the floor. Grasp the right elbow with your left hand and gently pull it across your chest so that you feel a stretch in the upper arm and shoulder on the right side. Hold for 20 seconds; relax both arms. Repeat to the other side. Repeat three times on each side. (Source: Harvard News Letter)

ePress Release

Avoid unnecessary injections, finger prick blood tests

Over 200 diseases can be transmitted from exposure to blood; the most serious infections are hepatitis B virus, hepatitis C virus and HIV, 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.

  • HIV, Hepatitis B and Hepatitis C can be transmitted through blood and blood products and/or by sexual route. Though the prevalence of HIV is only 0.3% in the general population and the prevalence of hepatitis C is up to 5%.
  • The average risk of seroconversion after a needle stick injury is about 3 per 1000 with no prophylaxis. This risk is reduced by at least 80 percent when post exposure prophylaxis (started within 3 hours) is administered in a timely fashion.
  • Infection is high with hollow needles, high bore needles and if the needle is inserted in the artery or the vein.
  • Prior to the widespread use of hepatitis B vaccine among health care workers, the prevalence of hepatitis B virus markers was higher among healthcare workers than the general public. In 1991, the guidelines that all health care workers be offered hepatitis B vaccine were issued. This strategy has been highly successful in reducing hepatitis B virus infection among healthcare workers with a 95 percent decline in the incidence of hepatitis B infection among them.
  • About 30% of HIV-positive patients are also co-infected with the hepatitis C virus and 10% with chronic hepatitis B infection.
  • IV drug users acquire hepatitis C virus before HIV infection while men who have sex with men typically are infected with HIV before they acquire hepatitis C virus infection.
  • Hepatitis B virus is the most infectious of the three blood-borne viruses. It is transmitted by percutaneous and mucosal exposures and human bites.
  • Hepatitis B can be transmitted by fomites such as finger stick blood sugar check, multi dose medication vials, jet gun injectors and endoscopes.
  • Hepatitis B virus can survive on counter tops for 7 days and remain capable of causing infection.
  • The prevalence of HCV infection among healthcare worker is similar to that of the general population.
  • Testing of health care workers for hepatitis c virus (HCV) should be performed after needle sticks, sharp injuries, mucosal, or non intact exposure to hepatitis C virus positive blood.
  • The average incidence of seroconversion to hepatitis C virus after unintentional needle sticks or sharps exposures from a hepatitis C virus positive source is 1.8 percent (range, 0-7 percent).
  • Transmission of hepatitis C virus can occur from infected fluid splashes to the conjunctiva.
  • Hepatitis C virus can survive on environmental surfaces for up to 16 hours.
  • The first step after being exposed to blood or bodily fluids is to wash the area well with soap and water.  Expressing fluid by squeezing the wound will not reduce the risk of blood-borne infection.
  • Hepatitis B vaccine should be given to all unvaccinated persons after exposure to blood. If the exposed blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immunoglobulin is recommended.
  • The CDC does not recommend use of preventive post exposure HIV drugs when exposure occurred more than 72 hours prior or when intact skin was exposed or when the bodily fluid is urine, nasal secretions, saliva, sweat, or tears, and is not visibly contaminated with blood. Give 2 to 3 drugs for 4 weeks.
  • Precautions are important during the first three months after exposure, when most people who are infected with HIV become antibody positive.
  • Precautions include abstaining from sexual intercourse or using condoms every time.
  • Condoms reduce, but do not completely eliminate, the chances of transmitting hepatitis B, hepatitis C, or HIV infection to others.
  • Women exposed to blood or body fluids from a person known to be infected should avoid becoming pregnant during this time.
  • Individuals exposed to HIV infected fluids should not donate blood, plasma, organs, tissue, or semen during the follow up period.
  • Breastfeeding women should stop breastfeeding due to the risk of passing the infection to their child.

eMedi Quiz

Granulocytopenia, gingival hyperplasia and facial hirsutism are all possible side-effects of one of the following anticonvulsant drugs.

1. Phenytoin.
2. Valproate.
3. Carbamazepine.
4. Phenobarbitone.

Yesterday’s Mind Teaser:All of the following drugs act on cell membrane, except:

1. Nystatin.
2. Griseofulvin.
3. Amphotericin B
4. Polymyxin B.


Answer for yesterday’s Mind Teaser:2. Griseofulvin

Correct answers received from: Dr Poonam Chablani, Raju Kuppusamy, Dr Jainendra Upadhyay, Najib Khatee, Dr Avtar Krishan, Dr. Sushma Chawla

Answer for 5th Oct Mind Teaser: 2.Hypovolemia.


Correct answers received from:Dr Jainendra Upadhyay, Dr KV Sarma, Najib Khatee

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)

Can the court give compensation more than the amount asked?

A: Raj Rani & Ors. vs. Oriental Insurance Company Ltd. & Ors.  (2009 SCC 13, 654) in which the Apex Court has observed: “…..there is no restriction that compensation could be awarded only up to the amount claimed by the claimant.  In an appropriate case, where from the evidence brought on record if the Tribunal/court considers that the claimant is entitled to get more compensation than claimed, the Tribunal may pass such award (para 14).”

medicolegal update
  1. Dear Sir, emedinews is very informative newspaper. Regards: Dr Shreya

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