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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); 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

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  Editorial …

30th May 2013, Thursday

Understanding child abuse

  1. Child maltreatment is defined as intentional harm or threat of harm to a child by a person who is acting in the role of a caretaker.
  2. Health care providers should care for children
  3. Four types of child maltreatment are described:
    • Physical abuse
    • Sexual abuse
    • Emotional abuse
    • Child neglect
  4. Child neglect is most prevalent form of child abuse accounting for more than 50% of cases. It is defined as failure to provide for a child’s basic, physical, emotional, educational and medical needs. The types are:
    • Physical neglect is failure to provide adequate cloth, food, hygiene, protection, inadequate supervision with risk of harm to the child.
    • Emotional neglect is failure to provide love, affection, security, emotional support and failure to provide a psychological care when needed, spouse abuse in presence of the child.
    • Educational neglect is failure to enroll a child in the school or ensure school attendance, home school, failure to address specific educational needs.
    • Medical neglect is refusal to seek or delay in seeking medical care resulting in damage or risk of child health.
  5. Emotional abuse is defined as a child abuse that results in impaired psychological growth and development. It is a repeated pattern of damaging interactions between the caregiver and the child that becomes typical of the relationship and conveys to the child that he is unheard or unwanted. Categories are rejecting (refusing to counsel), terrorizing (verbal assault or threat), ignoring (depriving essential interactions), corrupting (stimulating antisocial behavior), verbal assault (abusing or hammering), over pressuring (criticizing age-appropriate behaviors as inadequate).
  6. Physical abuse and sexual abuse: Physical abuse invariably involves injury or trauma. Sexual abuse is defined as attempted sexual touching of another person without their consent and includes sexual act (rape, sodomy – oral-genital and anal-genital contact) or fondling. The generally accepted definition is when one engages in sexual activity in which he cannot give consent, unprepared for apprehension or an activity that violates law or social taboos of society. This includes fondling and all forms of oral-genital, genital or anal contact with the child whether the child is clothed or unclothed as well as in touching abuses such as exhibitionism or voyeurism or involving the child in pornography.

Dr KK Aggarwal
Group Editor in Chief

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ACE inhibitors better ARBs in new meta–analysis in hypertensives

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    Photo Feature (from the HCFI Photo Gallery)

CPR 10 camp was organized by Heart Care Foundation of India at Police Training College, Najafgarh on 27th May 2013

Dr K K Aggarwal
    National News

Chewing tobacco riskier than smoking: Study

KOLKATA: Chewing tobacco poses a bigger threat than smoking, according to a study conducted by a group of city oncologists, reports TOI. Ahead of the No Tobacco Day on May 31, data compiled by the experts suggest that more than half of the city's tobacco-induced cancer patients are gutkha consumers, rather than smokers. Perhaps even more alarmingly, the average age of patients suffering from head-and-neck cancer - generally triggered by continuous tobacco use - has gone down to 25 years.

Conducted by Bengal Oncology, the study reveals that the share of head-and-neck cancer could drop to less than 20% from the present 45% of all cancer-affected people in Bengal if chewing tobacco could be prohibited. Even though gutkhas have been banned in the state, sale hasn't stopped. The figures also show that the number of tobacco-chewers is rising in the city faster than the number of smokers. "In terms of the number of patients who seek treatment in Kolkata hospitals, more chewers are falling prey to the disease than smokers. One reason could be the misconception that chewing is safe. This has led to a phenomenal rise in the number of gutkha and pan-masala users in Kolkata," said oncologist Subir Ganguly.

About one in two adult males in Bengal use tobacco. One in about five females is also a tobacco-addict. Till a decade ago, more than 90% of the head-and-neck cancer patients would be smokers. The trend started changing about seven years ago, according to oncologists. "We noticed a sharp rise in the number of gutkha-users being affected by cancer. Since 2006, the number has doubled and now more chewers are falling prey to the disease than smokers. The change has been dramatic," said Ashish Mukhopadhyay of the Netaji Subhas Cancer Research Institute.

Around 60% of all head-and-neck cancer patients in Kolkata are tobacco-chewers, said Ganguly. "It could not only lead to cancer in the oral cavity, but could also affect other organs that receive the tobacco juice. It is highly carcinogenic. Smoking, though, is equally harmful since many of the hydrocarbons produced by the burning of the cigarette paper are carcinogenic, too," explained Ganguly.

Easy availability, coupled with a complete lack of restriction on use, has drawn thousands of youngsters to gutkha, pointed out experts. "You can use it while travelling, in an auditorium or even at work. While we have restrictions on smoking, chewing remains easy. It can't be curbed unless we stop their sale," said Ganguly. The result has been quite distressing. More than 70% of the city's tobacco-chewers are believed to be aged below 35 years. A large number of them are falling prey to cancer even before turning 25.

In West Bengal, tobacco addicts are initiated into this habit at the ages of 18-19, and over half of them (55.7%) feel the compulsive urge to take their first fix of tobacco within the first half-hour of waking up. Although over 85% of adults believe that smoking and smokeless tobacco products cause serious diseases, it is a sad fact of life that most tobacco addicts are unable to quit as long as these products are freely available and aggressively marketed through advertisements, according to the Global Adult Tobacco Survey. (Source: TOI, May 29, 2013)

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, every Thursday 4:30 PM in DD India

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

Rheumatic heart disease (RHD) is the leading cause of heart disease in children and young adults under the age of 40 years.

(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)

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Screening for risk of child abuse and neglect. A practicable method?

Selective primary prevention programs for child abuse and neglect depend on risk screening instruments that have the goal of systematically identifying families who can profit most from early help. Based on a systematic review of longitudinal studies, a set of established risk factors for early child abuse and neglect is presented. Nearly half of the items included in screening instruments can be seen as validated. Available studies indicate a high sensitivity of risk screening instruments. Positive predictive values, however, are low. Overall, the use of risk screening instruments in the area of primary prevention for families at risk represents a feasible method, as long as stigmatizing effects can be avoided and participating families also benefit beyond preventing endangerment.

(Source: Kindler H: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Oct;53(10):1073-9)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

USPSTF favors gestational diabetes testing

All asymptomatic pregnant women should be screened for gestational diabetes after 24 weeks' gestation, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF). (Source: Medpage Today)

Surgery trumps proton pump inhibitors for acid reflux

Patients with gastroesophageal reflux disease (GERD) might benefit more from transoral incision less fundoplication than from continued treatment with proton-pump inhibitors (PPIs), according to results of a study presented at Digestive Disease Week 2013. (Source: Medscape)

Tobacco's role in movies falls, alcohol's rises

Tobacco and smoking were seen less frequently on movie screens from 1996 to 2009, but scenes with alcohol and drinking in movies aimed at youth have risen, researchers found. (Source: Medpage Today)

Device corrects inhaler technique for asthma patients

A simple handheld training device doubles the likelihood that patients with asthma will achieve the correct inspiratory flow when using their medication inhalers. (Source: Medscape)

CoQ10 promising for chronic heart failure

When added to conventional therapies, a supplement containing the antioxidant coenzyme Q10 (CoQ10) improved outcomes in patients with moderate-to-severe chronic heart failure, a small placebo-controlled trial showed. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Patients with acidity should avoid chocolates and peppermint http://bit.ly/12ZIRru #Health

@DrKKAggarwal: Medicine Keeps Changing But Not Well-Being. My article was written for SF Gate http://tinyurl.com/o9qjjcj

    Spiritual Update

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

Is it necessary to take a dip in Ganga to remove your sins?

Ganga, Jamuna and Saraswati, the trio sangam in Allahabad is believed to be the holiest place in the country, where if one takes a dip, you can wash off your past sins.

For Comments and archives…

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

How can assisted reproductive techniques help couples diagnosed with endometriosis?

According to western figures, couples diagnosed with endometriosis have success rates with assisted reproductive technology (ART) procedures such as in vitro fertilization and embryo transfer (IVF–ET) that are similar to those for couples with other causes of infertility. Success rates for ART procedures vary greatly depending on a woman’s age. Nationally, live birth rates for IVF–ET are approximately 30-35% for women under age 35, 25% from ages 35 to 37, 15–20% from ages 38 to 40, and about 10% between 41 and 42. IVF–ET is the most effective treatment for moderate or severe endometriosis, particularly if surgery fails to restore fertility.

    An Inspirational Story

A most important lesson

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions, until I read the last one: "What is the first name of the woman who cleans the school?"

Surely, this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark-haired and in her 50s, but how would I know her name? I handed in my paper, leaving the last question blank.

Just before class ended, one student asked if the last question would count toward our quiz grade."Absolutely," said the professor.

"In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say 'hello'."

I've never forgotten that lesson. I also learned her name was Dorothy.

For comments and archives

   Cardiology eMedinewS

Early results promising for new TAVI valve Read More

   Pedia News

Nature and nurture key for tots' sleep Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What are the common adverse reactions to HRIG?

In rare cases the following adverse reactions may occur:

  • Allergic reactions including fall in blood pressure, dyspnea, cutaneous reactions and, in isolated cases reaching as far as anaphylactic shock, even when the patient has shown no hypersensitivity to previous administration of immunoglobulins.
  • Generalized reactions such as chills, fever, headache, malaise, nausea, vomiting, arthralgia and moderate back pain
  • Cardiovascular reactions particularly if HRIG is inadvertently injected intravenously.

Local reactions such as local pain, tenderness or swelling at the injection site can be observed in rare cases.

    IJCP Special

Dr Good Dr Bad

Situation: A patient presented with subclinical hyper function of the thyroid.
Dr. Bad: No treatment is needed.
Dr. Good: You need to be on treatment.
Lesson: A study published in April 2012 in the journal Archives of Internal Medicine has shown that sub–clinical hyperthyroidism is associated with higher risks of overall mortality, cardiovascular mortality and arterial fibrillation.

Make Sure

Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on a sulfa drug?
Lesson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

  Quote of the Day (Dr GM Singh)

Any man's life will be filled with constant and unexpected encouragement. if he makes up his mind to do his level best each day. Booker T. Washington

    Mind Teaser

Read this…………………

The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to:

A. Develop a teaching plan
B. Facilitate psychologic adjustment
C. Maintain the present muscle strength
D. Prepare for the appearance of myasthenic crisis

Yesterday’s Mind Teaser: Jane, a 20- year old college student is admitted to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:

A. Brief exaggeration of symptoms
B. Prolonged symptomatic improvement
C. Rapid but brief symptomatic improvement
D. Symptomatic improvement of just the ptosis

Answer for Yesterday’s Mind Teaser: C. Rapid but brief symptomatic improvement

Correct answers received from: Dr KV Sarma, Dr Bharat Bhushan Aggarwal, Tukaram Pagad, Anil Kumar Dr BB Gupta, Rajeev Ardey, Dr Monica Gandhi,
Dr Arpan Gandhi, Dr K Raju, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Arundhati Malviya, Dr Gajveer Singh, Dr Bitaan & Dr Jayashree Sen, Dr Thakor Hitendrsinh G, Daivadheenam, Dr Chandresh Jardosh, Dr Kanta Jain, Muthumperumal Thirumalpillai.

Answer for 28th May Mind Teaser: c. Cerebral hyperemia

Correct answers received from: Dr Kanta Jain, Muthumperumal Thirumalpillai.

Send your answer to ijcp12@gmail.com

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Laugh a While (Dr Chandresh Jardosh)

The phone bill was exceptionally high. Man called a family meeting to discuss.

Dad: This is unacceptable. I don't use home phone, I use my work phone.

Mum: Me too. I hardly use home phone. I use my company phone.

Son: I use my office mobile, I never use the home phone.

All of them shocked and together look at the maid who's patiently listening to them.

Maid: "What? So we all use our work phones. What's the Big deal??

  Medicolegal Update

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

Abrasion injury in medicolegal cases

Mechanical momentum means mass with velocity discharged into the human body by a moving object or weapon or itself due to impact of moving body against a surface produces injuries over the body. In the first case, the counter force is provided by the body and in the second case, by the rigidity of the object/weapon/surface/wall against which the victim falls by himself or is forced to fall by external reason. In most cases it is seen that the mechanical injuries produced over the body are due to a combination of above two forces. Abrasion is one of the most superficial injuries and involves destruction of the superficial layers of the skin, caused by fall on a rough surface, or being dragged by a vehicle. Abrasions are of different types based on the pattern of the causative force viz. scratches, grazes, pressure, impact or imprint abrasions. A doctor can help legal investigation by his evaluation and documentation of abrasions as below.

  • They give an idea about the site of impact and direction of the force.
  • They may be the only external signs of a serious internal injury.
  • Patterned abrasions may help in relating the wound to the object which produced them.
  • The age of the injury can be determined, which helps to corroborate with the alleged time of assault.
  • Dirt, dust, grease, sand in the open wounds may connect the injuries to the scene of crime
  • Character and manner of the injury may be known from its distribution.
    • In throttling, crescent abrasions due to fingernails are found in the neck
    • In smothering, abrasions may be seen around the mouth or nose.
    • In sexual assaults, abrasions may be found on the breasts, genitals, inside of the thighs, and around the anus.
    • Abrasions on the face of the assailant indicate a struggle.
    • Abrasions on the victim may show whether the fingernails of the assailant were long, irregular or even broken.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

31st May is World No Tobacco Day: Twenty-six percent school girls say they will never marry a smoker

In a prospective survey, conducted by Heart Care Foundation of India among school going girls, 26% girls said that they would never marry a smoker. The survey included 195 school girls, belonging to class X-A, aged 15-16 years, from 16 Convent Schools in Delhi.

Speaking on the occasion, Padma Shri and Dr. B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India said that 72% girls answered that if they come to know that their would-be partner was a smoker, they would insist upon the partner to stop smoking before the marriage. Only 2% said that they would agree to marry as the fact that their partner smoked did not matter to them.

None of the girls smoked cigarettes or consumed tobacco products. However, 26% were exposed to passive smoking in their house. Of these, 80% had objected about it to their family members. The remaining 20% said that though they wanted to intervene but could not because of fear.

Fifty-eight percent girls agreed that they would object if someone was smoking in public in front of them. However, 38% girls said that instead of objecting they would rather remove themselves from the smoking area and move to a non-smoking place. Only 4% girls said that they did not care if somebody around them was smoking.

Ninety-five percent girls agreed that they would not begin to smoke on peer pressure from a friend or a boyfriend, even if they insisted on a single casual cigarette smoking. But, 5% girls said that they would be willing to do so to show their friends and their boyfriends that they too were modern.

Eighty-six percent participants were convinced that smoking is injurious to health. But, 14% girls felt that smoking helps in reducing depression. Also, 2% girls said that if they see doctors smoking in public, they would change their perception that smoking is bad for the health.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 54166 people since 1st November 2012.

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 10x10 i.e. 100 per minute.”

    Readers Response
  1. Surgery is required for infertility if there is history of infection or pain in abdomen and USG shows uterine adhesions or pelvic or ovarian mass, hysteroscopy and laparoscopy is recommended. Regards: Kochhar Mahinder.
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta