9th November 2014, Sunday

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

MTP Act Amendment Update

The recent proposed amendments by the Health Ministry, Government of India are retrograde in nature and not in the interest of the public. The proposed amendments allow Homeopaths, Ayurveda doctors, Unani doctors, nurses and ANMs to carry out both medical and surgical abortions.

The proposed amendments are based on a study conducted by Population Council in which it has been shown that nurses, ANMs and AYUSH doctors can safely perform MTP. The very study is illegal as under the existing laws, such study could not have taken place as MTPs are not allowed to be done by these people. IMA has already written to MCI Ethics Committee and called for all the papers regarding trial and do inquiry against the concerned people.

The IMA has also written to the President FOGSI who, supposedly, has given a recommendation and consent for the government’s move of expanding the scope of MTP to AYUSH doctors. Gynecologists members of IMA have confirmed that no such resolution was passed by Annual General Meeting of FOGSI. Personal opinion of the office of FOGSI does not constitute an official document. Allowing AYUSH doctors to carry out medical and surgical abortions will increase the maternal mortality rate and it will amount to quackery as these doctors are not trained in allopathic drugs or surgical techniques.

No doubt the origin of surgery may have been in Sushruta Samhita or Charak Samhita, there are no surgical centres in AYUSH medical colleges. Even till today AYUSH does not have medical abortion drugs in their pathy nor do they have AYUSH anesthetist or AYUSH antibiotics.

Increasing abortion limit to 20-24 weeks and simultaneously allowing AYUSH doctors to perform abortion will increase the maternal mortality rate.

AYUSH doctors, ANMs and nurses have no knowledge about the confirmation of pregnancy test and about the modern scientific way of interpretation of level 1 and level 2 ultrasounds in pregnancy.

It is difficult to understand why the current Health Minister, who himself happens to be a doctor, has allowed these amendments to go public for opinion.

IMA is pro-AYUSH as it feels that AYUSH branches are scientific and have lot of role in prevention. Instead of promoting AYUSH pathies, if one starts giving them powers to prescribe allopathic medicines and make them backdoor allopaths, it will be the worst thing that will happen to Indian System of medicines which will get eradicated over a period of time by this move.

In fact both AYUSH and allopathic systems of medicines should work together, complementary to each other, especially in chronic diseases and many life-threatening disease where scientifically combining AYUSH philosophy with modern drugs and technology can make it possible to shorten the duration and dose of drugs in various treatments.

IMA is launching a project “Minimal Hospital Maximum Safety” in which AYUSH can play a big role provided both AYUSH and modern system of medicine work in symphony with each other and do not take over each other’s domain.

News Around The Globe

  • Obese patients who had two connected saline–filled balloons temporarily implanted in their stomachs — to induce satiety and jump-start weight loss — shed more pounds than those who underwent a sham procedure. The balloon insertion also appeared to have an acceptable safety profile. The balloon device was implanted endoscopically and then removed after 6 months. Dr Jaime Ponce, medical director of the bariatric-surgery program at Hamilton Medical Center, Dalton, Georgia presented their findings at Obesity Week 2014.
  • Bariatric surgery reduced the risk of developing type 2 diabetes by 80% among patients in a new UK study with up to 7 years of follow-up. Results from the retrospective review of 2167 bariatric-surgery patients and the same number of matched controls from the UK primary-care database were published online November 3 in Lancet Diabetes & Endocrinology by Helen Booth (King's College London, United Kingdom) and colleagues.
  • A US Food and Drug Administration (FDA) advisory committee voted 8 to 3 to recommend marketing approval of soluble ferric pyrophosphate as a parenteral iron agent to treat iron loss or iron deficiency and to maintain hemoglobin levels in adults with hemodialysis-dependent chronic kidney disease.
  • Pregnant women living in high-stress situations may benefit from supplements of the omega-3 fatty acid DHA (docosahexaenoic acid), suggests a randomized controlled trial published online November 5 and in the December issue of Obstetrics & Gynecology.
  • A panel of serum metabolites could predict the presence of non-small cell lung cancer, suggested a new study presented at CHEST 2014. Researchers noted that in patients with adenocarcinoma, the concentrations of 65 metabolites were significantly different from those in control subjects; in patients with squamous cell carcinoma, the concentrations of 50 metabolites were different.

Dr KK Spiritual Blog

The Science behind Training and Development

Training in any field requires gaining knowledge, skills and positive mental attitude towards the object of learning.

The knowledge is everything about what and why. In Yoga, it correlates with the Gyan (Gnana) Marg. The skill is all about how to do it and correlates with Karma Marg.

The positive mental attitude is linked to willingness to do any work or in other words one’s Astha in that action. In Yoga, it is synonymous with Bhakti Marg.

In Bhagwad Gita, Lord Krishna talks about all the principles of management including how to train and develop an individual.

The development teaches and increases one’s intelligence quotient (IQ), physical quotient (PQ), emotional quotient (EQ) and moral quotient (MQ).

Inspirational Story

Remember the Small Things

Some of my sisters work in Australia. On a reservation, among the Aborigines, there was an elderly man. I can assure you that you have never seen a situation as difficult as that poor old man's. He was completely ignored by everyone. His home was disordered and dirty.

I told him, "Please, let me clean your house, wash your clothes, and make your bed."

He answered, "I'm okay like this. Let it be." I said again, "You will be still better if you allow me to do it."

He finally agreed. So I was able to clean his house and wash his clothes. I discovered a beautiful lamp, covered with dust. Only God knows how many years had passed since he last lit it.

I said to him, "Don't you light your lamp? Don't you ever use it?" He answered, "No. No one comes to see me. I have no need to light it. Who would I light it for?"

I asked, "Would you light it every night if the sisters came?" He replied, "Of course."

From that day on the sisters committed themselves to visiting him every evening. We cleaned the lamp and the sisters would light it every evening.

Two years passed. I had completely forgotten that man. He sent this message: "Tell my friend that the light she lit in my life continues to shine still."

I thought it was a very small thing. We often neglect small things.

Rabies News (Dr A K Gupta)

What is "furious form" of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.

Cardiology eMedinewS

  • The European Medicines Agency (EMA), following a review by the Pharmacovigilance Risk Assessment Committee (PRAC), is making new recommendations on the use ivabradine for the treatment of patients with symptoms of angina or heart failure. The review is based on surprising data from the SIGNIFY trial.
  • Subcutaneous icatibant in the emergency department can eliminate the need for invasive airway management in patients with life-threatening angioedema due to cardiac medications, suggests a new study presented at the American College of Emergency Physicians 2014 Scientific Assembly.

Pediatrics eMedinewS

  • Childhood behavioral conditions such as attention deficit hyperactivity disorder and conduct disorder are linked with an increased risk of being convicted of a felony later in life, with heavy drinking and educational failure contributing to this link, suggests a new study published in Criminal Behaviour and Mental Health.
  • Researchers have taken the first steps towards developing a so-called "smart bomb" to attack the most common and deadly form of childhood cancer - the B-lineage acute lymphoblastic leukemia (ALL). In a November study published in EBioMedicine, researchers describe how this approach could prove lifesaving for children who have relapsed after initial chemotherapy and face a less than 20% chance of long-term survival.

Quote of the Day

  • Always remember that the future comes one day at a time. Dean Acheson

Wellness Blog

Cell Phone Elbow: A Disease of Mobile Era

Nintendo thumb, Guitar Hero wrist and now cell phone elbow are all diseases of the new gadget era. Cubital tunnel syndrome or cell phone elbow is numbness, tingling and pain in the forearm and hand caused by compression of the ulnar nerve, which passes along the bony bump on the inside of the elbow. Cubital tunnel syndrome results from prolonged flexing of the elbow.

In susceptible people, holding the bent-elbow position for extended periods can lead to decreased blood flow, inflammation and compression of the nerve. One of the causes of pressure on the ulnar nerve is excessive use of mobile phones.

Prolonged flexing of the elbow occurs when you hold a cell phone to your ear. The first symptom patients often notice include numbness, tingling or aching in the forearm and hand.
As symptoms progress, they can include a loss of muscle strength, coordination and mobility that can make writing and typing difficult. In chronic, untreated cases, the ring finger and pinky can become clawed. Evans and colleagues note in a report in the Cleveland Clinic Journal of Medicine that most people who get cubital tunnel syndrome are middle-aged or older. Women get cubital tunnel syndrome more often than men.

Other causes may include sleeping with the elbows bent and tucked up into the chest, sitting at a desk with the elbows flexed at an angle greater than 90 degrees and driving with your elbow propped on the window for extended periods.

In most cases, minor lifestyle changes can help alleviate symptoms, including using a hands-free headset for your cell phone. If sleep position is the problem, an elbow pad to keep the arm straighter at night can help.

As treatment, the occupational therapist may use ultrasound to loosen the scar tissue that can form around the nerve as a result of the inflammation, as well as stretching, deep massage and "nerve-gliding" exercises to reduce pressure on the nerve. Doctors may also use anti-inflammatory injections or surgery.

ePress Release

Diabetes is Preventable

Diabetes can be prevented, 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.

Type 2 diabetes is due to a faulty lifestyle due to insulin resistance and the same can be prevented by change in diet and regular exercise.

With proper risk factor management it is possible to get rid of both insulin and drugs in type 2 diabetes.

Tips to prevent diabetes

  • Do not eat white refined carbohydrates.
  • Eat less at a time.
  • Work out at least 30 minutes a day.
  • Eat plenty of green bitter vegetables
  • Eat a high fiber diet
  • Do not eat trans fats in food.
  • Eat jamun and kaith (Bel) fruit when available

eMedi Quiz

Beta-oxidation of odd-chain fatty acids produces:

1.Succinyl CoA.
2.Propionyl CoA.
3.Acetyl CoA.
4.Malonyl CoA.

Yesterday’s Mind Teaser: Injury to radial nerve in lower part of spiral groove:

1. Spares nerve supply to extensor carpi radialis longus.
2. Results in paralysis of anconeus muscle.
3. Leaves extension at elbow joint intact.
4. Weakens pronation movement.

Answer for yesterday’s Mind Teaser: 3. Leaves extension at elbow joint intact.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan.

Answer for 7th November Mind Teaser: 1. Transitional

Correct answers received from: Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Avtar Krishan.

Send your answer to email

Twitter of the Day

Dr KK Aggarwal: Do not take regularly sit in sunlight continuously to get educated level of Vitamin D
Dr Deepak Chopra: In the field of all possibilities time and space emerge. Learn more about The Akashic Field

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21st Perfect Health Mela 15th October 2014



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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

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Dr Good and Dr Bad

Situation: A patient with fever had headache.
Dr. Bad: It is meningitis unless proved otherwise.
Dr. Good: It can also be simple malaria.
Lesson: Fever with headache can be seen in meningitis, malaria, dengue and many viral infections.

Make Sure

Situation: A patient with dilated cardiomyopathy developed sudden cardiac arrest.
Reaction: Oh my God! Why was ICD (implantable cardioverter defibrillator) not given?
Lesson: Make sure that all patients with less than 35 years of age are considered for ICD therapy.

eMedinewS Humor

Rice Preference

The young woman really thought she'd been very patient, through a protracted period of dating with no talk of marriage.

One night her steady boyfriend took her to a Chinese restaurant. As he perused the menu, he casually asked her, "So . . . how do you like your rice? Boiled? Steamed? Or fried?"

Without missing a beat, she looked over her menu at him and replied clearly, "Thrown."

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Giving an opinion on phone has no legal liability

No legal liability will fall upon the doctor as there is no contract between him and the patient. For negligence to be proved there has to be a duty, breach of that duty and resultant damage. In this case there will no breach of duty. Only if the specialist has charged fee for his opinion from the patient (patient can sue) or from the physician (patient and doctor both can sue), he or she is liable. If the fee has been paid by the referring physician, it will be deemed to be paid by the patient.

medicolegal update
  1. Dear Sir, very informative newspaper. Regards: Dr Shagun

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