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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
 
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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

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

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

7th December 2012, Friday

Time for informed consent for CT scan

How much radiation is 1 mSv?

A typical CT of the thorax involves about 5 mSv, and CT of the abdomen 5-15 mSv.

Recent BEIR report suggests that for every 10 mSv of radiation, we in radiology are inducing 1 excess cancer for every 1000 patients.

The current recommendation is that 1 in 10,000 risks is something that should be the threshold for informed consent.

Some suggest that there should be verbal informed consent detailing medical radiation risks for all procedures of 1 millisievert (mSv) or greater.

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

When should enemas be used in a patient with constipation?

Enemas (tap water, sodium phosphate, soapsuds) should be used only as needed for constipation in the older adult, i.e., after several days of constipation in order to prevent fecal impaction. Adverse effects can include fluid and electrolyte abnormalities with phosphate enemas and rectal mucosal damage with soapsuds enemas. In elderly patients, sodium phosphate enemas should not be used for the treatment of constipation as they may lead to severe metabolic disorders associated with a high mortality and morbidity (Ori Y, Rozen-Zvi B, Chagnac A, et al. Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience. Arch Intern Med 2012 Feb 13;172(3):263-5).

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Obesity reduces life expectancy

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

64th Conference of the Cardiological Society of India and SAARC Cardiac Congress

Inauguration of the 64th Conference of the Cardiological Society of India and SAARC Cardiac Congress on 6t December 2012

 
Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

64th Conference of the Cardiological Society of India and SAARC Cardiac Congress

64th Conference of the Cardiological Society of India and SAARC Cardiac Congress begins today The Venue is hotel Ashok, located in pristine diplomatic area ofNew Delhi. The dates are from Dec 6 – 9, 2012

Medical mistakes in Indian movies

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

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

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

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

 
    Valvular Heart Disease Update

A high prevalence of mitral, tricuspid, and aortic regurgitation is observed in dialysis patients. The disappearance of regurgitant lesions with aggressive volume and blood pressure control suggests that most valvular insufficiency in dialysis patients is "functional" in origin and aggressive ultrafiltration to attain clinical dry weight and optimal blood pressure control should be therapeutic goals in dialysis patients.

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

For comments and archives

 
    International News

(64th Conference of the Cardiological Society of India and SAARC Cardiac Congress - Faculty Speaks)

Obesity paradox: Is weight loss indicated for patients with known CVDs? (by Dr Dharmendar Jain)

• Obesity may aid survival in patients with some chronic diseases, in what is called the obesity paradox. • Though obesity is a powerful risk factor for HT and LVH, obese hypertensives may paradoxically have a better prognosis.
• Obese patients with HF may have more metabolic reserve and have a better prognosis in advanced HF with greater tolerance for higher levels of cardioprotective medications.
• At least overweight and mild obesity do not seem to adversely affect prognosis in established CHD.
• Some say that purposeful weight loss may be detrimental in these patients; while, some state that losing body fat rather than lean mass carries lower mortality.
• Weight loss has potential adverse effects: prolonged QTc interval, increased risk of malignant dysrhythmias.
• Despite these controversies, however, the “weight” of current evidence strongly supports purposeful weight loss in overweight and obese patients with established CV diseases

Fixed Dose Combinations Of Antihypertensives (by Dr Harendra Kumar)

• More than one drug is often needed to control BP.
• Fixed dose combinations have several advantages.
• Components of combination should be decided on clinical situations like CAD, HT, ISH etc.
• Chlorthalidone is 1.5 to 2 times more potent than HCTZ in reducing BP. It reduces platelet aggregation. It is the best treatment of HT. The reduction in BP is large and it also prevents HT related morbidity and mortality. It should be combined with other classes of drugs.
• Aldosterone antagonists are underused. Their use may increase in near future.

Ambulatory BP monitoring (by Dr Soumitra Kumar )

“Treat those who need treatment and don’t treat those who don’t need treatment.”

• ABPM improves sensitivity and specificity of diagnosis vs clinic and home BP measurement. It records BP in the patient’s natural setting where they experience CV events.
• Several guidelines such as NICE have included ABPH in the work up of the patient.
• ABPM helps to diagnose WCH and masked HT. WCH may be overdiagnosed if referred only to clinic BP; while masked HT is underdiagnosed, if only clinic BP is relied upon.
• What to assess in ABPM: Range of BP in day, night and average.
• Nocturnal BP has the biggest correlation with adverse CV events.
• Early morning surge is related to MI, ischemia, stroke.
• Costs of ABPM are balanced by the counter costs of targeted treatment.

Assessment of ED by brachial artery flow mediated dilatation (by GS Sainani, Mumbai)

Presenting the results of a study on assessment of endothelial dysfunction by brachial artery flow mediated dilatation (FMD) in hypertensives with CAD and patients with CAD without HT conducted at Jaslok Hospital, Prof. Sainani commented that by a simple non-invasive procedure ultrasonography can help in identifying patients with HT or CAD who are at risk of future cardiovascular events. This would be particularly useful in low resource settings such as small towns and villages. FMD of <4.5 correlated prediction of CAD in hypertensive patients.

 
   Twitter of the Day

@DrKKAggarwal: Prof. Kiran Walia endorses hands only CPR In a special programme today, Prof. Kiran Walia, Minister of Educati http://twitpic.com/bjhk9f

@DeepakChopra: Please read "Why Bad Science Is Like Bad Religion" written by my friend Rupert Sheldrake http://tinyurl.com/a26nbqf

 
    Spiritual Update

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

Importance of Vitamin D in Mythology

Today it is a known fact that 80% of the India society is Vitamin D deficient. It was probably known to our Rishi Munis and they created rituals so that everybody gets enough Vitamin D from sunlight. Shahi snan in sunlight are mentioned in our Vedic literature.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Why do varicoceles cause fertility problems?

Varicoceles raise the temperature in the testicles, which may affect the production of sperm, as well as sperm movement and/or shape. It may also affect other aspects of sperm function.

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

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

In some type O adults, much of the anti-A & B and anti-AB (a cross reacting antibody, also called anti-C) isoagglutinins are of IgG class.

 
   An Inspirational Story

A Touching Story from a Father

My wife called, 'How long will you be with that newspaper? Will you come here and make your darling daughter eat her food?'

I tossed the paper away and rushed to the scene. My only daughter Sindu looked frightened.

Tears were welling up in her eyes. In front of her was a bowl filled to its brim with Curd Rice. Sindu is a nice child, quite intelligent for her age. She has just turned eight. She particularly detested Curd Rice. My mother and my wife are orthodox, and believe firmly in the 'cooling effects' of Curd Rice! I cleared my throat, and picked up the bowl.

'Sindu, darling,why don't you take a few mouthful of this Curd Rice? Just for Dad's sake, dear.

Sindu softened a bit, and wiped her tears with the back of her hands.

'OK, Dad. I will eat - not just a few mouthfuls, but the whole lot of this.

But, you should...' Sindu hesitated. 'Dad, if I eat this entire curd Rice, will you give me whatever I ask for?'....

Oh sure, darling'.... 'Promise?'......... 'Promise'.

I covered the pink soft hand extended by my daughter with mine, and clinched the deal.

'Ask Mom also to give a similar promise', my daughter insisted.

My wife put her hand on Sindu's, muttering 'Promise'. Now I became a bit anxious.

'Sindu dear, you shouldn't insist on getting a computer or any such expensive items. Dad does not have that kind of money right now. OK?'

'No, Dad. I do not want anything expensive'.

Slowly and painfully, she finished eating the whole quantity.

I was silently angry with my wife and my mother for forcing my child eat something that she detested. After the ordeal was through, Sindu came to me with her eyes wide with expectation. All our attention was on her.

'Dad, I want to have my head shaved off, this Sunday!' was her demand.

'Atrocious!' shouted my wife, 'A girl child having her head shaved off? Impossible!' 'Never in our family!' my mother rasped.

'She has been watching too much of television. Our culture is getting totally spoiled with these TV programs!'

Sindu darling, why don't you ask for something else? We will be sad seeing you with a clean-shaven head.'

'No, Dad. I do not want anything else', Sindu said with finality.

'Please, Sindu, why don't you try to understand our feelings?'

I tried to plead with her.

'Dad, you saw how difficult it was for me to eat that Curd Rice'.

Sindu was in tears. 'And you promised to grant me whatever I ask for.

Now, you are going back on your words. Was it not you who told me the story of King Harishchandra, and its moral that we should honor our promises no matter what?'

It was time for me to call the shots.

'Our promise must be kept.'

'Are you out your mind?' chorused my mother and wife.

'No. If we go back on our promises, she will never learn to honor her own.

Sindu, your wish will be fulfilled.'

With her head clean-shaven, Sindu had a round-face, and her eyes looked big and beautiful.

On Monday morning, I dropped her at her school. It was a sight to watch my hairless Sindu walking towards her classroom. She turned around and waved. I waved back with a smile. Just then, a boy alighted from a car, and shouted, 'Sinduja, please wait for me!'

What struck me was the hairless head of that boy.

'May be, that is the in-stuff', I thought. 'Sir, your daughter Sinduja is great indeed!' Without introducing herself, a lady got out of the car, and continued,' That boy who is walking along with your daughter is my son Harish. He is suffering from... ... leukemia.' She paused to muffle her sobs.

Harish could not attend the school for the whole of the last month. He lost all his hair due to the side effects of the chemotherapy. He refused to come back to school fearing the unintentional but cruel teasing of the schoolmates.

'Sinduja visited him last week, and promised him that she will take care of the teasing issue.

But, I never imagined she would sacrifice her lovely hair for the sake of my son! Sir, you and your wife are blessed to have such a noble soul as your daughter.'

I stood transfixed. And then, I wept. 'My little Angel, you are teaching me how self-less real love is!'

*The happiest people on this planet are not those who live on their own terms but are those who change their terms for the ones whom they love..*

Love Touch And Inspire your FRIENDS "The life is short, the vanities of world are transient but they alone live who live for others; the rest are more dead than alive.

By a Father

For comments and archives

 
   Cardiology eMedinewS

Coating on Buffered Aspirin May Hide Its Heart-Protective Effects Read More

New Patient-Friendly Way to Make Stem Cells for Fight Against Heart Disease
Read More

 
   Pediatric eMedinewS

Vitamin D Supplements May Reduce Risk For Dental Caries Read More

Embryo Screening For In Vitro Fertilization Improved Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have sarcopenia
Dr Bad: It is of no consequence
Dr Good: You are at risk of heart disease as well as diabetes
Lesson: A cross-sectional study of Japanese women concluded that the coexistence of sarcopenia and metabolic syndrome further increases the risks of cardiovascular diseases, such as type 2 diabetes mellitus, hypertension, arterial stiffness and hyperlipidemia even after adjustment of age and body composition. Eur J Clin Nutr 2012 May 9. -Epub ahead of print

Make Sure

Situation: A 40–year–old male developed acute heart attack after playing squash.
Reaction: Oh my God! Why was a cardiac test not done?
Lesson: Make sure that anybody going for anaerobic games after the age of 40 should first get a cardiac clearance.

 
    Legal Question of the Day

((Ex)Prof. M C Gupta, Advocate & Medico-legal Consultant)

Is there a need for a PCPNDT ultrasound clinic to have: a room of a particular size; separate examination and ultrasound rooms; an attached bathroom; separate room for each machine? Can the machine be moved within the hospital?

QUESTION: Please answer the following in the context of the PCPNDT Act / Rules:

a. Is there any requirement that the ultrasound clinic / room should have a particular size?

b. Is there any requirement that the ultrasound clinic should have an attached bath room or urinal?

c. Is it permissible to keep two ultrasound machines in the same room?

d. If the same doctor is carrying out both functions (examining gynae-obs cases and doing ultrasound test), is it permissible to have a combined room for both types of examinations?

e. Can the ultrasound machine in a hospital be moved to different wards / OT etc.?

ANSWER

The answers to the above are:

a. No. As per Rule 3(3)(1), the space should be adequate.

b. No

c. It should be permissible. There is nothing against it in the Act / Rules.

d. It should be permissible. There is nothing against it in the Act / Rules.

e. Yes.

 
  Quote of the Day (Dr GM Singh)

Life is something that makes you happy and proud at times and makes you feel so low at times that you say to yourself,

 
    Mind Teaser

Read this…………………

Which of the following would be inappropriate to include in a diabetic teaching plan?

A. Change position hourly to increase circulation
B. Inspect feet and legs daily for any changes
C. Keep legs elevated on 2 pillows while sleeping
D. Keep the insulin not in use in the refrigerator

Yesterday’s Mind Teaser: During the first 24 hours after thyroid surgery, the nurse should include in her care:

A. Checking the back and sides of the operative dressing
B. Supporting the head during mild range of motion exercise
C. Encouraging the client to ventilate her feelings about the surgery
D. Advising the client that she can resume her normal activities immediately

Answer for yesterday’s Mind Teaser: A. Checking the back and sides of the operative dressing

Correct answers received from: Dr.K.V.Sarma, Dr. B. B. Aggarwal, Dr. Thakor Hitendrsinh G, Dr prabha, Dr. P. C. Das, Dr Pankaj Agarwal, Dr.(Maj. Gen.) Anil Bairaria, Dr K P Chandra, DR ARPAN GANDHI, Dr Jainendra Upadhyay, DR Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta jain, Dr U Gaur, Dr prabha, Dr. P. C. Das

Answer for 5th December Mind Teaser: D. Cardiac glycoside

Correct answers received from: Dr Ashok Barat, Archna parwani, Dr prabha, Dr. P. C. Das

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A man walks into the toy store to get a Barbie doll for his daughter. So he asks the assistant, as you would, "How much is Barbie?" "Well," she says, "we have Barbie Goes to the Gym for $19.95, Barbie Goes to the Ball for $19.95, Barbie Goes Shopping for $19.95, Barbie Goes to the Beach for $19.95, Barbie Goes Nightclubbing for $19.95, and Divorced Barbie for $265.00." "Hey, hang on," the guy asks, "why is Divorced Barbie $265.00 when all the others are only $19.95?" "Yeah, well, it's like this....Divorced Barbie comes with Ken's house, Ken's car, Ken's boat, Ken's furniture..."

 
    Medicolegal Update

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

WMA declaration of Malta on hunger strikers – Guidelines for medical management

The doctor must assess the mental capacity of the individual. This involves verifying that an individual intending to fast does not have a mental impairment that would seriously undermine the person’s ability to make health care decisions. Individuals with seriously impaired mental capacity cannot be considered to be hunger strikers. They need to be given treatment for their mental health problems rather than allowed to fast in a manner that risks their health.

As early as possible, physicians should acquire a detailed and accurate medical history of the person who is intending to fast. The medical implications of any existing condition should be explained to the individual. Physicians should verify that hunger strikers understand the potential health consequences of fasting and forewarn them in plain language of the disadvantages. Physicians should also explain how damage to health can be minimized or delayed by, for example, increasing fluid intake. Since the person’s decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand.

For comments and archives

 
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