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  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 and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

    Dr KK Aggarwal on Social Media …

DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan
ASAR–Aamir Khan And Dr KK Aggarwal on Satyamev Jayate

  Editorial …

11th June 2012, Monday

Confederation of Associations of Medical Specialties of India (CAMSI)

Confederation of Associations of Medical Specialties of India (CAMSI), at an emergency meeting held on 9th June, 2012 at New Delhi, discussed the impact of Star/ABP TV Programme - "Satyamev Jayate" – (Does Healthcare Need Healing?) telecast on Sunday 27-5-2012. It was unanimously resolved that:-

1. The programme was half baked, presenting one sided story based on superficial research and on distorted truths to tarnish the image of the medical profession. It has not only maligned the doctors but also raised the doubts & suspicion in the minds of the public at large, thus eroding the doctor-patient relationship which is based on utmost faith.

More than medical-men and various Associations of doctors/medical specialists, the programme has done dis-service to the society at large without realizing that crores of patients are attended every day by medical fraternity across the country and with unparalleled zeal, commitment & philanthropy giving the best results under all types of circumstances and relieving the pain and agony suffered by patients.

The meeting unanimously condemned the one sided projection & story telling and appeals to the responsible leaders of Media to project the other side of the coin also so that faith of the public in their doctor is not further eroded by such irresponsible programmes. (Dr.Mukesh Yadav)

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Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

New treatment for acute asthma in children

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th Asia Pacific Vascular Intervention Course

Inauguration of the 4th Asia Pacific Vascular Intervention Course

Dr K K Aggarwal
    National News

India shares highest preterm birth burden

NEW DELHI: Nearly 24%, or one in four children born prematurely across the globe in 2010 were from India. India recorded the highest number of births of preemies, or babies born before time, at 35.19 lakh children in 2010. Almost 13% of all children born in India were born too soon, while China ranked second, says a Lancet study to be published on Friday. However, China’s preterm birth rate was 7.8% of the global count, with 11.72 lakh children born preterm. Besides, China recorded 23 lakh fewer preterm births than India. Preterm birth (before 37 weeks gestation) remains the single biggest cause of neonatal death worldwide and is now the second most common cause of death among under–five children, and is responsible for 1.1 million deaths every year. Save the Children, which led the team producing the estimates for the World Health Organization published the report "Born Too Soon", to be announced by the British medical journal the Lancet on Friday, says preterm birth rate dropped in only three countries over past 20 years. The study says nearly 15 million babies were born prematurely in 2010 — more than one in 10 of all births. Sixty percent of these premature babies were born in south Asia and sub–Saharan Africa, but this is not just a problem of the poorest nations: the USA (517,000 preterm births) and Brazil (279,300) ranked among the top 10 countries with the highest number of premature births in 2010. (Source: TOI, Jun 8, 2012)

For comments and archives

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

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Heart disease, cancer top killers in U.S.

The two leading causes of death in the U.S. –– cancer and heart disease –– accounted for nearly half of all deaths in 2008, the latest year for which data are available, according to a CDC report. Heart disease accounted for 25% of all deaths, while cancer came in second at 23%, according to research by Melonie Heron, PhD, of the Department of Health and Human Services. The finalized statistics for 2008 show that, all together, the top 10 causes of death in the U.S. accounted for 76% of all U.S. mortalities, Heron reported in the National Vital Statistics Reports. (Source: Medpage Today)

For comments and archives

Standardized ethics framework needed for clinical guidelines

A standardized ethics framework could reduce concerns about financial conflicts of interest (FCOIs) creating bias in development of clinical practice guidelines (CPGs), according to a study of a gastroenterological CPG published in the June 5 issue of the Annals of Internal Medicine. (Source: Medscape)

For comments and archives

Toxic shock from Strep: a ‘lightning strike’

In rare cases, the bacteria responsible for causing strep throat –– group A Streptococcus –– can penetrate beyond the superficial surfaces of the body and lead to necrotizing fasciitis, toxic shock syndrome, and even death. (Source: Medpage Today)

For comments and archives

CDC: VTE toll remains high

More than half a million cases of venous thromboembolism occur each year in the U.S. and many that originate in the hospital can be prevented, according to a report from the CDC. (Source: Medpage Today)

For comments and archives

WHO: Gonorrhea drugs failing

Treatment options for gonorrhea are running out, the World Health Organization warned. In a new guidance, the agency said that several countries are reporting cases of resistance to cephalosporins – the last remaining drug class with activity against gonorrhea (Neisseria gonorrhoea). (Source: Medpage Today)

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  Twitter of the Day

@DrKKAggarwal: Thin line between ethical and unethical acts

@DrKKAggarwal: Each of us is a unique manifestation of the total universe.

    Spiritual Update

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

Rome was not built in a day

With ‘Abhyas’ or constant practice, one can conquer all the obstacles in life. The sutra "Rome was not built in a day" has a deep spiritual meaning. In the path for self–realization, regular practice is the principle behind all paths: Bhakti, Karma or the Gnana marg. Persistence is the key in any spiritual attainment.

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    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How can endometriosis be classified?

Endometriosis is classified into one of four stages, I–minimal, II–mild, III–moderate, and IV–severe, depending on the location, extent, and depth of endometriosis implants, the presence and severity of adhesions, and presence and size of ovarian endometriomas. Most women have minimal or mild endometriosis, which is characterized by superficial implants and mild adhesions.

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

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

Patient preparation

Patients who are aware of the steps involved in a transfusion experience less anxiety and are more comfortable with their treatment. The transfusionist should explain how the transfusion will be given, how long it will take, the expected outcome and what symptoms to report.

Venous access should be established, according to hospital policy, before the component is obtained. If a pre–existing line will be used, it should be checked for patency, for signs of infiltration or infection, and for compatibility of fluid with blood. Because a transfusion may take several hours, the recipient should be made as comfortable as possible before starting.

Premedication orders should be carefully timed with delivery of the unit. Patients with a history of allergic reactions may benefit from antihistamines given before transfusion. The routine use of antipyretics in patients with a history of simple febrile reactions is controversial, because preventing a rise in temperature may mask a significant symptom of hemolytic reactions. Antipyretics typically do not mask other symptoms of hemolysis, such as changes in blood pressure, pulse, or respiration.

The transfusionist should check the medical record for special instructions about administration and assemble all the necessary transfusion equipment before the unit arrives.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The Color of Friendship

Once upon a time the colors of the world started to quarrel. All claimed that they were the best. "The most important", "The most useful" and "The favorite".

Green said: "Clearly I am the most important. I am the sign of life and of hope. I was chosen for grass, trees and leaves. Without me, all animals would die. Look over the countryside and you will see that I am in the majority."

Blue interrupted: "You only think about the earth, but consider the sky and the sea. It is the water that is the basis of life and drawn up by the clouds from the deep sea. The sky gives space and peace and serenity. Without my peace, you would all be nothing."

Yellow chuckled: "You are all so serious. I bring laughter, gaiety, and warmth into the world. The sun is yellow, the moon is yellow, the stars are yellow. Every time you look at a sunflower, the whole world starts to smile. Without me there would be no fun."

Orange started next to blow her trumpet: "I am the color of health and strength. I may be scarce, but I am precious for I serve the needs of human life. I carry the most important vitamins. Think of carrots, pumpkins, oranges, mangoes, and papayas. I don’t hang around all the time, but when I fill the sky at sunrise or sunset, my beauty is so striking that no one gives another thought to any of you."

Red could stand it no longer he shouted out: "I am the ruler of all of you. I am blood – life’s blood! I am the color of danger and of bravery. I am willing to fight for a cause. I bring fire into the blood. Without me, the earth would be as empty as the moon. I am the color of passion and of love, the red rose, the poinsettia and the poppy."

Purple rose up to his full height: He was very tall and spoke with great pomp: "I am the color of royalty and power. Kings, chiefs, and bishops have always chosen me for I am the sign of authority and wisdom. People do not question me! They listen and obey."

Finally Indigo spoke, much more quietly than all the others, but with just as much determination: "Think of me. I am the color of silence. You hardly notice me, but without me you all become superficial. I represent thought and reflection, twilight and deep water. You need me for balance and contrast, for prayer and inner peace."

And so the colors went on boasting, each convinced of his or her own superiority. Their quarreling became louder and louder. Suddenly there was a startling flash of bright lightening thunder rolled and boomed. Rain started to pour down relentlessly. The colors crouched down in fear, drawing close to one another for comfort.

In the midst of the clamor, rain began to speak: "You foolish colors, fighting amongst yourselves, each trying to dominate the rest. Don’t you know that you were each made for a special purpose, unique and different? Join hands with one another and come to me."

Doing as they were told, the colors united and joined hands.

The rain continued: "From now on, when it rains, each of you will stretch across the sky in a great bow of color as a reminder that you can all live in peace. The Rainbow is a sign of hope for tomorrow." And so, whenever a good rain washes the world, and a Rainbow appears in the sky, let us remember to appreciate one another.

For comments and archives

  Cardiology eMedinewS

Stroke Risk Depends on What Prediabetes Is Read More

ADA update: Cancer Risk of Insulin Key Focus at ADA Read More

  Pediatric eMedinewS

Preschool-Based Anti-Obesity Program May Promote Healthy Behavior Changes Read More

Concern about Worse Leukemia Outcomes In Young Adults. Read More

Communication is Key In Conveying Vaccine Safety Message Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with recurrent headaches.
Dr. Bad: It is a sinus headache.
Dr. Good: This can be migraine.
Lesson: Sinus headache is commonly diagnosed by clinicians and self–diagnosed by patients, but acute or chronic sinusitis appears to be an uncommon cause of recurrent headaches, and many patients presenting with sinus headache turn out to have migraine or, less often, tension–type headache.

For comments and archives

Make Sure

Situation: A patient with blood in the sputum came back with massive bleeding.
Reaction: Oh my God! Why was the first bleeding ignored?
Lesson: Make sure that even minor bleeding in sputum is properly investigated.

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  Legal Question of the day

(Prof. M C Gupta Advocate & Medico–legal Consultant)

Q. What are your critical comments regarding the episode, ‘Every Life is Precious’, in the TV programme Satyamev Jayate, anchored by Aamir Khan?


  • It was a program meant to bring out in public the wrong doings in the medical profession. There is nothing wrong in this. Every citizen has a right, even duty, to search, bring out and spread the truth, whether it be pleasant or unpleasant.
  • Anybody who wants to appraise or evaluate a system has a duty to do so honestly, critically and in an unbiased manner and to present both sides of the coin in a fair and balanced manner. This duty lies all the more on the shoulders of the celebrities, whose every word and gesture may have a deep and lasting effect on the public. They must remember that nothing or nobody can be ideal or perfect. Even the moon has a spot. It is good to remember the following words—

    "There’s so much good in the worst of us
    And so much bad in the best of us,
    It’s hard to know which of us
    Ought to reform the rest of us.

    ––Ogden Nash
  • Aamir Khan failed to be fair and balanced. This is clear from the following:
    • He never made a firm or clear statement (which is a fact) that though there may be some doctors who are knowingly dishonest, a high percentage are still honest and sincere and such percentage is probably higher than that in various other professions or vocations. Thus his presentation was unbalanced and unfair and was biased against doctors.
    • There is a general principle that when a matter is in the court, it is best to avoid trial by the media. The example of Major Pankaj Rai, who even appeared on the TV and made a long statement, should have been best avoided or, at the most, given only a brief mention. The case is already in the court and programmes like this potentially vitiate the outcome of the court proceedings. IMA or some other agency needs even to explore the possibility of taking necessary legal action in this regard. The defendant doctor/hospital would be well advised to ask their lawyer to press this point in the pending court case. As a matter of fact, subsequent responses posted on the internet show that this case was investigated by the Karnataka Medical Council and no negligence was found on the part of the doctors.
    • The presentation of Shri VS Venkatesh’s case was imbalanced and unfair. He said his toes had been amputated by a surgeon to save him from infection. What is wrong with the approach taken by the doctors? Are doctors to be judged by patients’ perceptions? Why was a surgeon not asked to comment on the merits of the case. This was the Basic duty of the program organisers. If Shri V S Venkatesh felt so agitated to bring his case to every home in India through the TV, why did he not take his case to the court (Consumer court; medical council; police)?
  • Aamir Khan cannot and should not try to escape the above criticism by saying that he is merely an actor and the responsibility for any mistakes lies with the organisers and the research team. It is rumored that his fees for this show was somewhere around Rs. 3–4 crores (US dollars 600,000/– to 800,000/–). For practical purposes, it is his program and he needs to face the bouquets as well as the brickbats. He is not just an actor. The program revolves around his persona. He should have ensured that no one-sided views are presented. When patients, who are laymen, gave their versions, it was his duty to elicit the concerned point of view of the renowned doctors who were present. He should not have worn the mantle of a medical expert and indulged in the following behavior:
    • Telling the audience that patients on dialysis live up to 15–20 years. Even the 5–year survival rate of patients on dialysis is about 25–30 %.
    • Believing in the statement of a young girl in the audience and feeling aghast at her statement that 6 years ago, when she was probably in her early teens, her father went to a hospital for gastroenteritis but the hospital tried to force on him an emergency liver transplant surgery. This is almost an impossibility. That is not the way liver transplants are done or advised. Even today there are just ‘a handful’ of hospitals in India offering liver transplants. Aamir should have at least asked her the name of the hospital.
    • Expressing surprise that a diabetic patient had to lose a toe in the hands of a surgeon. Losing not only a toe but the entire limb is not an uncommon occurrence in case of diabetics despite best attention by the doctors.
  • The incidence of mass hysterectomies as described in relation to Kowdipally village of Medak district in Andhra Pradesh was alarming. It was found that many rural women were made to undergo hysterectomy. It is believed that in most of those cases, hysterectomy might not have been medically required. This is a case where the AP Medical Council should suo moto investigate this matter and inflict heavy punishment on those found guilty. The National Commission for Women should also take suo moto cognizance of this. Aamir Khan should have suggested the need for these statutory bodies to take necessary action. His word carries weight. In any case, an exhortation on a national channel made to these statutory bodies would have amounted to a complaint to them and they would have been forced to investigate the matter and take corrective action.
  • The data presented by the host about the British Medical Council was quite revealing in that the medical license of 42 doctors in 2008, 68 doctors in 2009 and 73 doctors in 2010, were cancelled permanently. In India, the number is zero. This cannot be otherwise considering the irresponsible and non-serious manner in which the MCI as well as the state Medical Councils work. Some examples are as follows:
    • Delhi Medical Council found nothing wrong with a doctor who injected the drug Lasix in a dose of 5000 mg. within a span of 10 minutes in a 70 years old person while the normal dose is 20–40 mg. He died of arrhythmia within 40 minutes of injection.
    • As informed in response to an RTI application, the MCI informed that it has no guidelines to match the punishment awarded to match the gravity of the crime.
    • The shameful record of WB Medical Council as regards Dr. Kunal Saha case is for all to see. The WBMC found nothing wrong in a doctor giving Depot Medrol injection twice a day over about a week leading ultimately to the death of the patient. The dose should have been not more than one injection a week. Dr. Saha had to go up to the Supreme Court to get justice.
  • Dr C M Gulhati, editor of Monthly Index of Medical Specialties, India, lamented that the increasing number of private medical colleges which charge hefty capitation fee. I do not share his views. My views are as follows:
    • There is nothing wrong with the concept of private medical colleges. Most of the medical schools in USA are private and are world renowned. Many medical institutions in UK are private.
    • The practice of capitation fee is illegal as per SC judgments. Everybody knows that this practice is there. All that is needed is recognition of these colleges being cancelled by the MCI. This is not done because the colleges are money machines owned by politicians.
  • Conclusion
    • It was, on the whole, a good program but was unbalanced and unfair and even misleading in many respects. It highlighted the deficiencies in the existing system related to medical ethics; pricing of drugs; medical education; and, in general, the functioning of the MCI. It would have been desirable for the program to include the following also:
      • Representation from IMA;
      • Representation from the legal community;
      • Representation from AYUSH department/practitioners, highlighting how quackery is rampantly committed by AYUSH practitioners and still left unpunished and the reasons for such non-punishment.
      • A statement that the case of Major Pankaj Rai is already in the court and the aim of the program is not to influence the outcome of that case by indulging in trial by media.
      • A statement that medical studies are highly technical, hard and time consuming and that patients and laymen and politicians often make the life harder for doctors by blaming them unnecessarily and continuously and even assaulting them physically.
      • A statement that patients having grievances against doctors can easily complain to the medical council or the consumer court or even to both of them at the same time.
      • Aamir Khan needs to retract his wrong statements at the next episode.
    • Aamir Khan drew comparisons between the medical care system in India and the West, depicting the Indian system and Indian doctors in bad light. Facts are not to be concealed. But if he chose to compare India with UK and USA etc., he should have known and referred to the following facts also:
      • Indian corporate hospitals follow the best medical practices at a fraction of the cost abroad. That is why the "medical tourism" industry is developing fast. Also, Indian doctors are given ridiculously low salaries compared to those in the West. Unlike in the West, quackery is not only rampant in India but is even promoted by the government.
      • The media, including TV, are full of irrational and false and misleading advertisements about increasing height; reducing weight; curing arthritis and diabetes and cancer etc. These are not sponsored by modern medicine doctors and are decidedly harmful to health and personal finances. Amitabh Bachchan even announces that a hair oil is full of medicinal properties!
    • The IMA has protested against Aamir’s partisan and defamatory attitude towards the medical profession. If they are serious, they should take legal opinion regarding the possibility of legally challenging the actor and the channel.

For comments and archives

  Quote of the Day

(Dr GM Singh)

It is a sign of strength, not of weakness, to admit that you don’t know all the answers. John P. Loughrane

    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Prostate–specific antigen (PSA) Velocity

PSA increases more rapidly in men with prostate cancer than in healthy men. Accurate measurement of PSA velocity requires 3 serial readings, ideally with the same assay, obtained over at least a 12– to 24–month period. In the Baltimore Longitudinal Study of Aging (BLSA), men with a PSA rate of change (PSA velocity) > 0.75 ng/mL/year were at increased risk of being diagnosed with prostate cancer and that PSA velocity was more specific than a 4.0 ng/mL PSA cutoff (90 vs 60 % specificity).

    Mind Teaser

Read this…………………

Which of these drugs has been shown to improve labyrinthine blood flow and to re–equilibrate central vestibular imbalance and is considered useful in treatment of patients with vascular disease of the vestibular system?

a. Propranolol
b. Amitriptyline
c. Cinnarizine
d. None of above

Yesterday’s Mind Teaser: Which of the following stage the carcinogen is irreversible?

a. Progression stage
b. Initiation stage
c. Regression stage
d. Promotion stage

Answer for Yesterday’s  Mind Teaser: a. Progression stage

Correct answers received from: Dr Uma Gaur,Dr Kanta Jain,Dr Jainendra Upadhyay,Dr Avtar Krishan,Muthumperumal Thirumalpillai, Dr. Thakor Hitendrsinh G,Anil Bairaria

Answer for 9th June Mind Teaser: d. Restlessness
Correct answers received from: Dr. Thakor Hitendrsinh G,Anil Bairaria

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

In a country of free speech, why are there phone bills?

    Medicolegal Update

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

How can a doctor assess the decision–making capacity of patient?

Assess the patient’s ability to reason and deliberate about treatments and their consequences. The patient should be able to express their goals and values and explain their choices by reference to these values and goals. Sometimes a patient is unable to give reasoning for his or her decision; this makes it difficult to consider the patient fully capacitated. In addition, the patient’s behavior should be consistent with his or her general character i.e. the decision should not be widely "out–of–character". There may be good reasons for a complete "change of heart" but at least preliminarily consistency with past preferences is a reasonable test.

If a patient is not able to fulfill these requirements, then his or her capacity to make health care decisions is questionable.

(Ref: Veatch RM, ed. Medical Ethics, 2nd ed, Jones and Bartlett, Boston 1997)

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Limit the dose of paracetamol to 3250 mg in patients consuming three or more alcoholic drinks a day

Paracetamol is the new suicide drug of the west. According to Consumer Education Campaign" by FDA although paracetamol is remarkably safe when taken at usual therapeutic doses, its overdose has been recognized to cause fatal and nonfatal liver damage said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India. Paracetamol in the US is available as Acetaminophen.

FDA has called for limiting the dosage to 3250 milligram for patients consuming three or more alcoholic drinks a day. It also recommends limiting tablet strength for immediate release formulation to maximum of 325 milligram and single adult dose to 650 milligram. FDA also mentioned that over–the–counter painkillers and fever reducers should carry a warning of liver damage and stomach bleeding.

Paracetamol in India is available in the market as 500 or 1000 mg tablets.

  • Repeated therapeutic or slightly excessive doses can be toxic to the liver in susceptible individuals, such as alcoholics.
  • Paracetamol poisoning is the most common cause of acute liver failure in the United States. In adults (over 12 years) the therapeutic dose is 10 to 15 mg/kg per dose or 325 to 1000 mg per dose in adults, given every 4 to 6 hours, with a maximum recommended daily dose of 4 g in adults.
  • Toxicity is unlikely to result from a single dose of less than 7.5 to 10 g for an adult (2 tablets four times a day of 1000 mg strength) but can occur with single ingestions greater than 250 mg/kg or those greater than 12 g over a 24–hour period (12 tablets of 1000 mg strength).
  • Virtually all patients who ingest doses in excess of 350 mg/kg develop severe liver toxicity (defined as peak SGOT or SGPT liver enzymes levels greater than 1000 IU/L) unless appropriately treated. (For 60 kg man it would mean 21 tablets of 1000g strength paracetamol)
  • In contrast to chronic alcoholics with an isolated ingestion, chronic alcoholics are at increased risk for liver toxicity following ingestion of multiple supratherapeutic doses (above the therapeutic dose of up to 4 g/day) of paracetamol. One report from George Washington University showed that 161 regular users of alcohol developed liver toxicity following paracetamol ingestion with therapeutic intent. In the report 54 percent had ingested 6 grams or less per day and 30 percent had taken less than 4 g/day of paracetamol, the overall mortality rate reached 20 percent. Delayed recognition of toxicity and continued use of the drug likely account for much of the morbidity in this patient population.
  • Following acute overdose, children younger than five years appear to be less susceptible to liver toxicity than older children and adults. The therapeutic dose of paracetamol for children younger than 12 years is 10 to 15 mg/kg per dose, every 4 to 6 hours, not to exceed five doses per 24–hour period (maximum daily dose 75 mg/kg). The minimal toxic dose for a single ingestion is 150 mg/kg for a child.
  • Toxicity is likely to occur with single ingestions greater than 250 mg/kg or ingestions of greater than 12 g in a 24–hour period. Virtually all children who ingest doses in excess of 350 mg/kg develop severe liver toxicity. In chronic ingestions (multiple supratherapeutic doses), the minimum toxic threshold for children appears to be 150 to 175 mg/kg over two to four days, particularly in the setting of a febrile illness and decreased oral intake. In both adults and children, paracetamol is rapidly and completely absorbed from the gastrointestinal tract, with peak serum concentrations reached from one–half to two hours after a therapeutic oral dose. Peak serum concentrations are reached within four hours following overdose of immediate-release preparations.
  • Concomitant use of other liver toxic drugs can cause liver damage in the absence of overt paracetamol overdose. The examples are anticonvulsants like carbamazepine, Phenobarbital, and anti–TB drugs like INH and rifampin. In addition, drugs like zidovudine (antiviral drug) may potentiate paracetamol liver toxicity. Herbal supplements may potentially amplify paracetamol induced injury. Patients should be questioned specifically about the use of herbal supplements since they are widely used, but often not mentioned during a routine medical interview.
  • Fasting or malnutrition predisposes to liver injury. Patients at greatest risk appear to be those who consume multiple excessive doses rather than a single overdose. This scenario is common among children suffering from an acute febrile illness, who may receive multiple doses or prolonged duration of paracetamol.
  • The outcome of paracetamol intoxication is nearly always good if the antidote, N-acetylcysteine (NAC), is administered in a timely fashion and given within 10 hours of ingestion.
  • Unlike most other causes of hepatitis, paracetamol-induced hepatitis is acute in onset, progresses rapidly, is characterized by marked elevation of plasma liver enzymes SGPT and SGOT (>3000 IU/L), and is associated with a rising prothrombin time in the blood.
  • Chronic paracetamol poisoning in the alcohol user is also characterized by markedly elevated liver enzymes (>3000 IU/L), combined with hypovolemia, jaundice, coagulopathy, low blood sugar, and acute kidney failure in greater than 50 percent of these patients.
    Readers Response
  1. Dear Kk Agarwalgi, it is very useful information based on science about the mood changes during newmoon,fullmoonand lunareclipse. Being a mental health professional i always get this information from patient"s relatives that during the above mentioned period there is behavioral changes.hats off to u sir, Dr.R.Mani
    Forthcoming Events


All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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