eMedinewS
9th October 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Licenses needed by a 10-bedded hospital ⁄ nursing home with facility for cesarean ⁄ cholecystectomy under Clinical Establishment Act

  1. Registration under Nursing Home Act ⁄ Medical  Establishment Act
  2. Bio-medical Waste  Management Licenses, Authorization of HCO by  PCB MOU with Vendor
  3. AERB Licenses
  4. NOC from Fire Department
  5. Ambulance. Commercial Vehicle Permit, Commercial Driver License, Pollution Control Licenses
  6. Building Completion  Licenses
  7. Lift license for each lift
  8. DG Set Approval for Commissioning
  9. Diesel Storage Licenses
  10. Retail and bulk drug  license (pharmacy)
  11. Food Safety Licenses
  12. Narcotic Drug Licenses
  13. Medical Gases Licenses ⁄  Explosives Act
  14. Clinical Establishments  and Registration (if  applicable)
  15. Blood Bank Licenses
  16. Boilers Licenses
  17. MoU ⁄ agreement with outsourced human resource agencies as per labor laws
  18. Spirit License
  19. Electricity rules
  20. Provident fund⁄ESI Act
  21. MTP Act
  22. PNDT Act
  23. Sales Tax registration
  24. PAN
  25. No objection certificate under Pollution Control Act (Air⁄Water)
  26. Arms Act, 1950 (if guards )

Dr Neeraj Nagpal

News Around The Globe

  • The Department of Forensic Medicine of Tezpur Medical College, Tezpur and Assam is organizing the first National Conference cum CME of Medico legal society of Assam for the first time at Tezpur Medical College.
  • The patient exposed to Ebola admitted to the National Institutes of Health (NIH) Clinical Center in the US on September 28 for observation was discharged on October 7.
  • The liver is the principal site of the body's drug metabolism, so it isn't surprising that drug-induced liver injury (DILI) can occur. However, despite the common use of medications in today's society, DILI develops in only a small number of patients– approximately 1 in 10,000 to 19 in 100,000 people are affected. Antibiotics are a common cause of DILI in all age groups and are the drugs most frequently associated with childhood liver injury. Acetaminophen is a common cause of acute liver injury in adults. The American College of Gastroenterology (ACG) has recently published guidelines for the diagnosis and management of DILI.
  • Nearly half of kidney patients who received a late referral to a nephrologist may have shown signs that they needed specialized care well beforehand, according to a new study of the UK health care system by Ian Blunt, a senior research analyst at Nuffield Trust in London.
  • A recent population–based prospective study of Swedish men suggested almost four of five MIs in men could be preventable. Researchers from the Institute of Environmental Medicine in Stockholm, Sweden, followed 20 721 men from 1997 to 2009. They specifically asked about five modifiable lifestyle behaviors: a healthy diet, moderate alcohol consumption, no smoking, being physically active, and having no abdominal fat (waist circumference.) 
  • Researchers conducted a genome–wide analysis of regular coffee consumption among more than 120,000 people. They found 6 new regions of DNA that were significantly associated with coffee drinking behavior. Two of the new genes were linked to caffeine metabolism. Other regions were located near genes that potentially influence the effects of caffeine on the brain, others, near genes involved in glucose and lipid metabolism, which may influence responses to the stimulant.
  • If you are over 50 years of age, then your risk of developing one of four disorders that pose a threat to vision — cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy — increases as you grow older. Age is the main risk factor for these diseases. For example, half of all people between the ages of 65 and 74 have cataracts; after age 75, about 70% do. And glaucoma is most common in people over 60. 

Dr KK Spiritual Blog

The Right Action

Dharma is the path of righteousness and living one's life according to the codes of conduct as described by the Vedas and Upanishads. Its western equivalents might include morality, ethics, virtue, righteousness and purity. The term dharma can best be explained as the “law of being” without which things cannot exist.

The word dharma is derived from dhri, which means “to hold”. It literally means “that which holds” the people of this world and the whole creation. The same is described in the Vedic Text, in Atharva Veda as: Prithivim dharmana dhritam, i.e. “this world is upheld by dharma”.

In Hinduism, Dharma is the very foundation of life. Tulsidas, the author of Ramcharitmanas, defined the root of dharma as compassion. Buddha has also described this principle in his book Dhammapada. According to Hindu philosophy, it's GOD who holds us through “Truth” and/or “Love”. “Dharma prevails” or “truth prevails” is the essence of Hinduism.

In order to achieve good karma, Vedas teach that one should live according to dharma (the right action). This involves doing what is right for the individual, the family, the class or caste and also for the universe.

According to the Bhagavat Purana, righteous living or life on a dharmic path has four pillars: truthfulness (satya), austerity (tap), purity (shauch) and compassion (daya). It further adds that the adharmic or unrighteous life has three main vices: pride (ahankar), bad company (sangh), and intoxication (madya).

Manusmriti prescribes ten essential rules for the observance of dharma: Patience (dhriti), forgiveness (kshama), piety or self control (dama), honesty (asteya), sanctity (shauch), control of senses (indriya–nigrah), reason (dhi), knowledge or learning (vidya), truthfulness (satya) and absence of anger (krodha). Manu further writes, "Non-violence, truth, non–coveting, purity of body and mind, control of senses are the essence of dharma”.

In Bhagwad Gita, Lord Krishna says that in the society dharma is likely to fall from time to time, and to bring dharma back, a GOD representative is born from time to time.

The shloka “parithraanaaya saadhoonaam vinaasaaya cha dhushkr.thaam| dharma-samsthaapanaarthaaya sambhavaami yuge yuge” (Chapter IV – 8)” says that “For the protection of the virtuous, for the destruction of evil-doers, and for establishing the rule of righteousness (Dharma), I am born from age to age [in every age]”. Another shloka “yada yada hi dharmasya glanir bhavati bharata abhyutthanam adharmasya tadatmanam srjamy aham” means that O descendant of Bharata “Whenever and wherever there is a decline in religious practice, and a predominant rise of irreligion – at that time I descend Myself”.

Deepak Chopra in his book Seven Spiritual Laws of Success talks about the “Law of ‘Dharma’ or Purpose in Life’”. According to him, everybody should discover his or her divinity, find the unique talent and serve humanity with it. With this, one can generate all the wealth that one wants.

According to him, when your creative expressions match the needs of your fellow humans, then wealth will spontaneously flow from the un–manifest into the manifest, from the realm of spirit to the world of form.  In spiritual terms this is an attempt to find out whether one’s life is progressing as per the Laws of Dharma (Dharma in Sanskrit means ‘purpose in life’) which, according to the scriptures, is said to be the sole purpose for a human being to manifest in this physical form.

For one to achieve ‘DHARMA’ he suggests the following affirmative exercises:

  • Today I will lovingly nurture the god or goddess in embryo form that lies deep within my soul. I will pay attention to the spirit within me that animates both my body and my mind. I will awaken myself to this deep stillness within my heart. I will carry this consciousness of timeless, eternal being in the midst of time-bound experiences.
  • I will make a list of my unique talents. Then I will list all of the things I love to do while expressing my unique talents. When I express my unique talents and use them in the service of humanity, I lose track of time and create abundance in my life as well as in the lives of others.
  • I will ask myself daily, ‘How can I serve?’ and ‘How can I help?’ The answers to these questions will allow me to help and serve my fellow human beings with love.

Karma, dharma and samsara are three fundamental aspects of Hinduism. Buddhism, Jainism and Hinduism are all built on these aspects. Dharma is one’s appropriate role or attributes. Karma measures how well one performs one’s dharma, explains why one is born where he or she is, and why there is suffering and seeming injustices. Samsara is the continuous cycle of birth, death and rebirth, and the context for all experience.

Dharma sutras from Dharma Shãstras are the basic texts which talks about the morality of individuals and the society. Most Indian laws are made from these Shãstras.

In Jainism also, the wheel of Dharma (Chakra) with 24 spokes represents the religion preached by the 24 Tirthankaras consisting of nonviolence (Ahimsa) and other virtues.

The very first word of the Gita is “Dharma”. The Gita concludes with the word “Mama”. The whole of Bhagavad Gita is contained in the two words ‘Mama’ and ‘Dharma’. When you join these two words it becomes mamadharma, meaning ‘your true Dharma’. This is what the Gita teaches. ‘What is your Dharma?’

How to achieve your dharma?

  • Do unto others what you do unto yourself and satisfy your conscience. That is your Dharma.
  • The word ‘Living Dharma’ signifies right action in every moment of the life.
  • Do not follow the dictates of body, and do not indiscriminately follow the mind, for the mind is like a mad monkey. Hence, follow the conscience. 

Inspirational Story

Depend on Miracles

"You are never given a wish without also having been given the power to make it come true." Richard Bach.

One Sunday morning I heard my minister say if you want result from prayer, pray for thirty days without ceasing. I didn't know why it was thirty days, but I was willing to give it a try. The following became my daily prayer:

I am available, Lord, to be used by You each day. Guide me, precious Lord, and lead me in what I say and do. May my words and actions be a witness that You are living in me. To the one that is lonely, may I be a friend. To those with heavy burdens, help me to meet their needs. Lord, I do not want fame or fortune. My prayer is that You will use me to glorify your name. I know I don't have much to offer, but I will give You my all. Guide me to be what You want me to be. Amen

On the twenty–first day of this prayer, CPR took on a new meaning for me. I was working an extremely busy twelve–hour night shift in Labor and Delivery. I had just sat down for my first break when a phone call came from my friend working in the Emergency Room. I barely recognized her urgent voice. An eighteen–year–old boy had been brought to the ER for alcohol and drug overdose. The young man was very close to death and they had done all they could do to help him. The father of this boy was requesting a priest or minister and they were having difficulty locating one that could come to the ER quickly. My friend stated, "We know you're a Christian and we need you to come and try to comfort this father. Please help."

Reluctantly, I said I would come down. As I waited for the elevator my thoughts became very judgmental and frustration welled up inside me. Then I remembered the prayer I'd been praying. I walked into the ER and approached the father. Taking his hand, I silently led him to the chapel. Before I could even say, "I am not a minister," this six–foot, two–hundred–twenty–pound man sank into the chair and became a broken hearted child.

Through his non–stop sobbing he spoke, "Christian, pray for Raymond. I remember the first time I held my boy. I felt so proud and I just kept saying, 'I have a son.' As the years passed those tiny feet became bigger and walked away from his family's love and entered a strange, hardened, and destructive world. Tonight, too much alcohol and an overdose of drugs are taking his life.

It's as though he wants to rebel against everything his family stood for. He knew what he was doing was wrong. Sometimes he seemed so afraid, but he wouldn't stop. Now it is too late. Christian, you have to pray for Raymond." Those large hands trembled in mine and as I looked into his eyes, I mourned with him. Silence fell between us, as I searched for the words that would comfort this crumbling tower of a man. I felt so inadequate. I wanted to scream, "Lord it has only been twenty–one days since I began that prayer! I am not ready for this!"

Time was running out and I knew I couldn't stall any longer. I clutched his hands, now wet with tears, and began to pray. The words came easy, much to my surprise. I finished praying with him and went to Raymond's bedside. I took his cold, lifeless hand and once again began to pray. "Lord I am asking for a miracle and I know you can do it."
I stayed with them both until Raymond was taken to Intensive Care. I visited Raymond on a daily basis and continued to pray for him. Eight days passed with little improvement. On the ninth day I entered the ICU and a miracle had taken place. Raymond was awake and talking with his father. CPR had taken on a new meaning for me: "Christian Pray for Raymond". As I left the ICU with tears falling down my face, I realized, today is the 30th day of my prayer.

Now I not only believe in miracles, I depend on them.

Rabies News (Dr A K Gupta)

Can the vaccine be injected in gluteal region?

Rabies vaccine must not be administered in gluteal region as the gluteal fat may retard vaccine absorption resulting in delayed and lower seroconversion.

Cardiology eMedinewS

  • The discrepancy between the lower observed risk of atherosclerotic cardiovascular disease (ASCVD) vs the much higher predicted event rate using the new ACC/AHA cardiovascular risk calculator could not be explained by patients starting on statin therapy after their baseline assessment or having a coronary revascularization—two possible explanations for this gap, suggest the results of a new study published October 6 in JAMA: Internal Medicine. There is a considerable miscalibration between observed and predicted events even after accounting for statin use and coronary revascularizations.
  • Organizations, including the two largest US cardiology societies, have released a first-of-its-kind document with appropriate–use criteria (AUC) for transthoracic echocardiography (TTE) in the pediatric outpatient population with suspected heart disease. The report is published online in the Journal of the American College of Cardiology.

Pediatrics eMedinewS

  • Young kids exposed to Bisphenol A (BPA) before birth appear to be more likely than others to have a wheeze before age five, reported a new study. Researchers found no connection to BPA exposure after birth. The study is published online October 6 in JAMA Pediatrics.
  • Prenatal exposure to viruses may cause type 1 diabetes and other autoimmune diseases in children, suggests a study published in Diabetic Medicine. Researchers noted that women who contract a viral infection during pregnancy transmit viruses to their genetically susceptible fetuses, triggering the development of type 1 diabetes.

Quote of the Day

  • Most successful men have not achieved their distinction by having some new talent or opportunity presented to them. They have developed the opportunity that was at hand.   Bruce Barton

IMA NEWS

  • As part of its efforts to curb quackery in the national capital, the Delhi Medical Council, has filed FIRs against 13 illegal clinics operating in the city. These clinics were being run by doctors who do not have proper degree or diploma in medicine to dispense allopathic medicines and thus posed a grave threat to the health of people.  “The raids were conducted in Sangam Park and Sawan Park areas of northwest Delhi in a joint operation by Delhi Police and chief district medical officers (CDMOs) as a part of the anti-quackery fortnight being observed by DMC since October 1,” said Dr Girish Tyagi, Registrar, DMC.  The police says they do not know under which sections of the IPC they should take action when complained. As of now sections like 419 and 420 for cheating are being imposed in such cases.  The raids in the city are being conducted after the Delhi High Court directed the city police earlier this year to ensure that “no quacks are allowed to practice” in the national capital, saying that it affects the fundamental right to life of people. The fresh guidelines issued states that if the council receives a complaint, it has to complete the verification process in a maximum of 72 hours.  (Source PTI)
  • The executive committee of CSI Delhi Branch is again pleased to invite you to next Monthly Academic Meeting to be held at  India Habitat Centre, Lodhi  Road, New Delhi  form 7.30 PM onward followed by Cocktail & Dinner  on Saturday, the 25th Oct 2014. 
  • Report
                A team of doctors from Punjab under the banner of Crisis Response Committee of Indian Medical Association Punjab state branch organized serial medical relief camps from Sep 26th to 30th, 2014 for the flood affected people in the remote areas in Anantnag and Kulgam districts of Jammu & Kashmir. 
                Led by Dr Balbir Singh and Dr DS Bhullar, Chairman& Coordinator of the Committee, the team of doctors included an eye specialist, a medical specialist, a gynecologist, a child specialist, one orthopedic surgeon, a skin specialist along with eight general physicians.
                On the first day, more than 600 patients were examined with distribution of free medicines in the camp organized in Government High School of Khanabal town about one K.M. from Anatnag. On the second day, 1169 patients were examined in Gund village, 20 KM from Anantnag in Kulgam district by the team. Third day medical relief camp was organized in the Town Hall in Islamabad town adjoining Anatnag wherein the IMA team examined more than 1300 patients. On the last day of the camp, the team visited Veer and Danter villages in Anantnag district and examined more than 3500 patients.
                In all, about 7000 patients were examined by these doctors of Punjab with distribution of free medicines worth more than Rs. 5 lac. The IMA team also visited village Arigutnoo, one of the worst affected remote areas in District Kulgam to assess the situation after floods for possible aid by IMA Punjab including medicines and other urgently required relief material.
                As observed by the IMA team, although there is no immediate threat of flood related epidemic in the areas visited, but the post flood related ailments noted by the doctors included skin  and respiratory problems, fever, eye problems, pediatric ailments in common, gastrointestinal problems along with anxiety neurosis (AN) and depression possibly from huge losses after flood.
                On return, the team of doctors was received at Patiala by leaders of the local branch of IMA led by President Dr JPS Sodhi and Dr Chander Mohni Kansal including Patron of the Association Dr Janak Sachdeva, Dr Sudhir Verma, Dr Jatinder Kansal, Dr Rakesh Arora, Dr Bhagwant Singh, Dr Neelima Sodhi and other senior doctors.
                Dr Balbir Singh briefed about the medical relief camp and appreciated the services given by the team doctors.
  • Letter from IMA President Jammu and Kashmir

    Sir, contents of your letter are true & correct. The IMA Sect. Chairman disaster Dr Patel, President-elect Dr SS Agarwal, visited from the very start of the flood crisis.

    I took them to all the devastated areas, and the major hospitals of Government Medical College (GMC) and SKIMS Medical College that were drowned in the floods.  

    They handed over some drugs brought from Delhi to one NGO… Rabiaji, she bypassed the

    J &K IMA and went herself to decide as to whom these drugs would be given and which places they should be sent; she practically replaced me as the President, J & K IMA.

    I called up the secretary to at least inform me as to what aid was being delivered and who would be dealing with it. But, I got no reply, although Dr Saini had asked RABI JINGO, to decide in collaboration with IMA State president.

    Similarly, Dr SS Agrawal (Jaipur) visited thrice and also met me, but all the aid was distributed through different camps without my knowledge, except when I took him to PMC,GMC to handover the syringes that he had brought with him. The state presidents of Himachal Pradesh, Punjab, Gujarat and Rajasthan also visited and worked in camps that were NGO nominated/authorized by Secretary General HQ.

    The office bearers should hold an emergency meeting and call all these leaders to brief them and take immediate action at national/international level. After spending a week in various camps in Kashmir, Dr Mitra, General Secretary IDPD, Ex- President IMA Ludhiana gave a press conference to Tribune on 4th October, where he appealed to national and international bodies to help

    The Indian media totally ignored Kashmir and instead shifted their focus to New York to cover the Prime Minister’s visit to USA.

    The Prime Minister visited Kashmir twice but forgot it afterwards; the same is true for the Home Minister. Dr Harsh Vardhan visited every hospital on foot. I also met him at SKIMS Medical College and Hospital, Bemina and showed him the medical college hospital, which had been declared unfit for reuse by engineers. But till now nothing has been done.

    I get appeals from adm. for emergency drugs, fluids, vaccines, beddings, generators, new buildings, blood banks from NACO.

    The Indian media has shut its eyes as if this too were a political matter. Govt. does not allow NRIs to help us individually or as groups. WHO, Red Cross, Help from Govt. Institutions nowhere.

    I request our IMA Leaders to meet the Prime Minister, Home Minister, who are already aware of our conditions, but need to expedite their help or allow others to help us if the government is not interested e.g. allow Islamic bank to provide interest-free loans to our business class etc., construction of equipped trauma hospitals by the ministry; sanctioning of 10 smart cities by the PM.

    IMA should work like they did during the Gujarat earthquake; they even opened one medical college. I am greatly thankful to your human feelings. If the leadership of the country/state has left our people to die, we are here to do our best even with limited resources and face red tapism to carry on with our work.

    I am thankful to ASCOM Medical College and IDPD who on my request organized camps for district relief. I am told that the IMA sends lot of material, there is no information as to where this aid is sent.

    I asked the Secretary to donate cash to the administrators of various hospitals who are honest and accountable.

    Prof. GM Malik MD, Jammu & Kashmir IMA President, Member, cwc, c.c.

    National Vice President IDPD

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at N P CO-ED Sr Sec School, Laxmi Bai Nagar on 28th August 2014

mela_brochure
Self-Assessment-Quiz

 

expert_choice
Zee News – Health Wealth Shows

Alcohol

press release

Do not give citalopram more than 40mg

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: An elderly patient after IV ondansetron 16 mg dose developed irregular heart rhythm
Dr Bad: It cannot be due to the drug
Dr Good: It is due to the drug
Lesson:  ECG interval changes, including prolongation of the QTc interval, are a class effect of the first-generation serotonin antagonists, including ondansetron; potentially fatal cardiac arrhythmias may result. QTc prolongation occurs in a dose-dependent manner, and is expected to be greater with faster rate of infusion and larger doses for IV administration. The current recommendation is to limit single IV doses to no more than 16 mg. Canadian guidelines place additional dosing restrictions on IV ondansetron to mitigate the risk of QT prolongation, particularly in older adults, in whom the initial dose should not exceed 8 mg

(Source: healthycanadians.gc.ca/recall–alert-rappel-avis/hcsc/2014/39943a-eng.php (Accessed on June 16, 2014).

Make Sure

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue

eMedinewS Humor

No man can ever be satisfied with 4 things in life.

  • Mobile
  • Automobile
  • TV
  • Wife

Because there is always a better model in neighborhood…

Twitter of the Day

Dr KK Aggarwal: Travel more than doubles risk of blood clots
Dr Deepak Chopra: God dwells in us as existence, awareness, being.

Wellness Blog

Salt restriction increases efficacy of RAAS blockade

Eggs do not have an adverse effect on lipid levels in patients with type 2 diabetes. Researchers also found that an egg-rich diet for 3 months was associated with better appetite control and may provide greater satiety. "These findings suggest that a high egg diet can be included safely as part of the dietary management of patients with type 2 diabetes," remarked Nicholas Fuller, PhD, from the Boden Institute Clinical Trials Unit, University of Sydney, Australia.

ePress Release

Frequent urination in night: Look for snoring

Frequent urination during night, a condition doctors call nocturia, is common among snorers (men with obstructive sleep apnea) 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. Nocturia was defined as needing to void two or more times each night.

In obstructive sleep apnea, soft tissues in the back of throat temporarily collapse during sleep causing brief moments in which the patient stops breathing. The disorder can cause daytime sleepiness, and can be effectively treated with a breathing device that pushes air into the throat to prevent the tissues from collapsing called CPAP.

Quoting a Japanese study published in the journal Urology by Dr. Yoji Moriyama, Dr Aggarwal said that nocturia was present in 41% of patients with sleep apnea. The risk of nocturia was directly related to the severity of sleep apnea and the association was particularly strong in patients younger than 50 years of age.

Snorers at risk of sudden death

Dr Aggarwal said that the interrupted nighttime breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep, suggests that this risk is present among all people with obstructive sleep apnea. The study researcher Nathaniel Marshall, from Woolcock Institute of Medical Research in Sydney, said that the size of the increased mortality risk is surprisingly large. The study showed a six fold increase means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who don’t have sleep apnea.

For the study, Marshall's team collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition. People who have, or suspect that they have sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea.

eMedi Quiz

Which of the following is not true about papular pruritic eruption in HIV infection?

a. It is one of the earliest manifestations of HIV infection.
b. It is an HIV-specific cutaneous manifestation.
c. Arthopod bites have been postulated to be one of the causative factors.
d. It does not serve as a cutaneous marker of underlying immune status.

Yesterday’s Mind Teaser: All of the following are TRUE regarding HIV infection in children except:

a. Most of the children present with clinical symptoms during the neonatal period.
b. They usually present with non specific symptoms of immunodeficiency
c. Skin is one of the most commonly involved organs with HIV infections
d. Children may remain asymptomatic up to the age of 8-10 years

Answer for yesterday’s Mind Teaser: Most of the children present with clinical symptoms during the neonatal period.

Correct answers received from: Daivadheenam Jella,

Answer for 8th Oct Mind Teaser:1. Phenytoin.

Correct answers received from: Daivadheenam Jella

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)

Doctors are not liable to be punished for medical negligence if the sterilization procedure fails and someone conceives a child, the Delhi High Court has ruled.

"An unsuccessful sterilization procedure does not necessarily imply that the attending doctors were negligent," Justice Vibhu Bakhru said, rejecting the plea of a woman who sought Rs 60.5 lakh compensation for the doctors' negligence.

The woman moved the court seeking compensation to bring up her third child, who was alleged to have been born because of medical negligence on the part of the doctors in performing the sterilization operation on her.

The court remarked that the woman was fully conscious of the risks involved in sterilization and that she had signed the consent form in which she agreed not to seek compensation for maintenance of the child in case of failure.

Most sterilization surgeries are performed after the parties agree to the consent form which shields the doctor or the hospital from any sort of liability in case the procedure fails.

In view of her accepting the terms for the operation, the claim for bringing up the child or for compensation on account of failure of the procedure, cannot be entertained, the court said.

However, the judge said the woman was entitled to Rs.20,000 under the family planning insurance scheme of the government for maintenance of the child.

She contended that the sterilization procedure failed due to negligence of the doctors.
On the other hand, the hospital said there was no negligence on the part of the doctors and claimed that there was always a chance of a sterilization operation being unsuccessful.

The hospital also said that while signing the application for the operation, the woman was made aware of the chances of failure.

Accepting the submissions of the hospital, the judge said: "I am unable to accept the contention that the negligence of attending doctors is established in the given facts and circumstances of this case. There is no material on record which would justify the finding that the attending doctors were negligent in performing the sterilization operation on the woman."

medicolegal update
  1. Respected Sir, Today I got the opportunity to go through eMedicalnewS letter after long. I must appreciate the content on diverse issue of importance in the present practice of medicine. Some aspects on preventing Healthcare Associated Infections I am going to implement soon in Dr R P Centre. Regards Dr Shakti Gupta, AIIMS.

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