IMA View - Medical student who flung dog off rooftop arrested and later released on bail

IMA View - Medical student who flung dog off rooftop arrested and later released on bail IMA views 1. Such incidences and such people brings bad name to the profession 2. MCI or SMC can and should suspend them under MCI ethics regulation 8.5 pending investigations 3. If convicted their license should be suspended or deleted. 4. IMA condemns all such such acts of cruelty A day after the disturbing video of a dog being flung from the terrace of a four storey apartment triggered outrage, Chennai city police picked up the two suspects, both medical students, from their native towns on Tuesday night. On Wednesday morning, both of them were released on bail after judicial magistrate Judge Santhosam asked them to pay Rs 10,000 surety. According to college sources, both the students have been suspended. The accused students, Gowtham Sudharshan from Tirunelveli who threw the poor animal, and his friend Ashish Paul from Nagercoil who filmed the video, were tracked by the special teams. According to the sections of the Indian Penal Code under which the duo have been charged – Section 428 and 429 – carry a maximum prison sentence of two and five years respectively. Even if they are convicted in this case, it will not bar them from practising after completing their MBBS. Harming an innocent puppy is an indicator of psychopathy in its early stages, which is not to be taken lightly. Section 428 in The Indian Penal Code 428. Mischief by killing or maiming animal of the value of ten rupees.—Whoever commits mischief by killing, poisoning, maiming or rendering useless any animal or animals of the value of ten rupees or upwards, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both. Section 429 in The Indian Penal Code 429. Mischief by killing or maiming cattle, etc., of any value or any animal of the value of fifty rupees.—Whoever commits mischief by killing, poisoning, maiming or rendering useless, any elephant, camel, horse, mule, buffalo, bull, cow or ox, whatever may be the value thereof, or any other animal of the value of fifty rupees or upwards, shall be punished with imprisonment of either description for a term which may extend to five years, or with fine, or with both. MCI Ethics regulations: 7.5: Professional misconduct: 7.5 Conviction by Court of Law: Conviction by a Court of Law for offences involving moral turpitude / Criminal acts. 8.5 During the pendency of the complaint the appropriate Council may restrain the physician from performing the procedure or practice which is under scrutiny.

Monsoon and Dengue on the Door

Monsoon and Dengue on the Door New Delhi, July 06, 2016: "Bed netting is of little use in preventing dengue since the dengue mosquitoes are most active during the daytime," says Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. Staying indoors in well-screened or air-conditioned buildings during the day can reduce the risk of exposure. When outside, one should wear clothing that reduces the amount of exposed skin and should use an effective mosquito repellent, such as N, N–diethyl–metatoluamide(DEET). Dramatic plasma leakage can develop suddenly, and therefore, substantial attention has been given to early identification of patients at higher risk of shock and other complications. The following clinical features are of help in this regard. • Duration of illness: The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after the fever is over. • Alarm signs: Severe abdominal pain, persistent vomiting, abrupt change from fever to hypothermia, or abnormal mental status, such as disorientation, are noted in a minority of patients. • Hematocrit: An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required. • Platelet count: Severe thrombocytopenia (<100,000/mm3) is one of the clinical criteria for dengue hemorrhagic fever and usually precedes overt plasma leakage. • Serum aspartate transaminase (SGOT): Mild elevations in serum transaminases are common in both dengue fever and dengue hemorrhagic fever. However, levels are significantly higher in patients with dengue hemorrhagic fever and elevated SGOT levels are noted earlier in illness. Patients with suspected dengue with none of the above indicators can be safely managed on an outpatient basis as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count.
A patient may be hospitalized under the following conditions: • Blood pressure <90/60 mmHg • Hematocrit >50% • Platelet count <10,000/mm3 • Evidence of bleeding other than petechiae

New IDSA guidelines for the management of aspergillosis

New IDSA guidelines for the management of aspergillosis

Dr K K Aggarwal
Early diagnosis and treatment of the major forms of aspergillosis are the focus of a new practice guideline from the Infectious Diseases Society of America (IDSA). Some key recommendations are: • Hospitalized allogeneic hematopoietic stem cell transplant recipients should be placed in a protected environment to reduce mold exposure. These precautions can be reasonably applied to other highly immunocompromised patients at increased risk for invasive aspergillosis (IA), such as patients receiving induction/reinduction regimens for acute leukemia. • Until molecular tools are more widely used in clinical laboratories, tissue and fluid specimens be submitted in adequate quantities for simultaneous histopathologic/cytologic and culture examination. • Serum and BAL galactomannan (GM) is recommended as an accurate marker for the diagnosis of IA in adult and pediatric patients when used in certain patient subpopulations (hematologic malignancy, HSCT). • GM is not recommended for routine blood screening in patients receiving mold-active antifungal therapy or prophylaxis or for screening in solid organ transplant recipients or patients with chronic granulomatous disease (CGD) • A chest CT scan is recommended if there is clinical suspicion of invasive pulmonary aspergillosis (IPA). But routine use of contrast during CT chest is not recommended to screen for IPA. • Voriconazole is recommended for primary treatment of IPA; some high-risk patients may need combination therapy with voriconazole and echinocandin. Antifungal therapy for IPA should continue for at least 6 to 12 weeks. The new guidelines are published online June 29, 2016 in the journal Clinical Infectious Diseases.

Sedentary white-collar workers should consider walking meetings for better health

Sedentary white-collar workers should consider walking meetings for better health

Dr K K Aggarwal

Changing traditional seated meetings at work into a walking meeting increased the work-related physical activity levels of white-collar workers by 10 minutes, says a new study published in Preventing Chronic Disease, a journal of the Centres for Disease Control and Prevention (CDC).

The Walking Meeting (WaM) Pilot Study, Miami, 2015 examined opportunities to increase physical activity in the workplace among sedentary white-collar workers. Workers, mean age 39.8 years, who conducted weekly meetings in groups of 2 or 3 individuals from January 2015 to August 2015 were recruited for the study. The researchers developed a 7-item core component walking meeting protocol that included a safe 25- to 30-minute walking path on the university campus.

·         Set a time and place to meet before your WaM.

·         Create an agenda for your WaM.

·         To make the walk more comfortable, bring items such as water, sunglasses, and sunscreen. Wear comfortable shoes.

·         Have the group leader assign roles to each walking meeting group member. (i.e., time checker, note taker, path leader).

·         Follow the prescribed route.

·         Walk for 30 minutes minimum.

·         After the walking meeting, sit and conclude to wrap up meeting; take care of paperwork or other tasks that could not be accomplished during WaM.

Data analysis showed that walking meetings, a simple modification of traditional seated meetings, were not only well accepted by the study population, they were also easy to implement and feasible to conduct during regular working hours. Among the 8 participating groups, 7 completed both walking meetings. All groups walked from 30 to 40 minutes. The study found that the sit-and-conclude session and creating an agenda were the least frequently completed components.

The various health benefits of walking are well recognized. And, that a sedentary lifestyle has negative health effects is also well known. Physical activity is recommended for all ages.

White collar workers or people who have desk jobs spend most of their working hours sitting in chairs. Interventions such as this that encourage walking and physical activity in the workplace are needed to counter the negative health effects of sedentary behavior.

Red flags for intensive care in patients with asthma

Red flags for intensive care in patients with asthma

Dr K K Aggarwal
Illicit substance abuse and lower socioeconomic status indicate a higher risk for intensive care among patients hospitalized for asthma, says a new study published online June 18, 2016 in Respirology, the official journal of Asian Pacific Society of Respirology. Researchers from Australia investigated 482 asthma patients admitted to a tertiary metropolitan hospital with a primary diagnosis of asthma between January 2010 and January 2014. Of these, 39 required intensive care. Twenty-six percent patients admitted to intensive care were found to use illicit drugs compared with only 7% of those admitted to the ward. For illicit users, nonadherence to preventer therapy was associated with an even higher risk of ICU admission. Socioeconomic index was lower in the group requiring intensive care admission. According to Dr Eli Dabscheck, senior author of the study, illicit drug use can lead to poor self-management of asthma, and predispose to life-threatening asthma attacks. Prof. Mark Hew from The Alfred Hospital, Melbourne said that a smoking history is usually elicited in patients with asthma. But this study highlights the “need to also ask them whether they use illicit substances, and work with them to address these risky behaviors”. (Source: Medical News Today)

The body’s immunity reduces during the monsoon season

The body’s immunity reduces during the monsoon season New Delhi, July 4, 2016: After the hot summers, monsoons are welcomed by all. However, the monsoon season also means the onset of many diseases and reduced immunity. According to Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA, "The diseases associated with monsoon are malaria, dengue, Chikungunya, jaundice, and gastrointestinal infections like typhoid and cholera. Apart from these, viral infections like cold and cough are also common”.
Patients with Chikungunya typically have joint pain that is relieved by flexing the limbs. Dengue, if not adequately managed, can be fatal in 1% of the cases. Chikungunya, though not fatal, can cause chronic debilitating joint pains that can sometimes last for years. Management of dengue involves fluid resuscitation and not platelet resuscitation. If enough fluids are given, mortality can be reduced. The mortality period usually starts when the fever subsides. Misusing anti-fever medicines can precipitate bleeding in dengue patients.
The water that gets collected due to rain becomes a breeding ground for mosquitoes. As contamination of drinking water is common during monsoons, it is important to drink clean and pure water to prevent diarrhea and gastrointestinal infections.
Walking in dirty water during rainy season leads to numerous fungal infections, which affect the toes and nails. Diabetic patients should take special care of their feet and be aware of infections affecting the toes and nails. Feet should always be kept dry and clean. Avoid walking in dirty water. Keep shoes, socks, and raincoats dry and clean.
In the case of asthmatic patients, precautions should be taken to prevent dampness and growth of fungus (mould) in and around the house. Fumigation should also be avoided.
During this season, underground worms come to the surface and contaminate the surface vegetables. In the presence of weak digestive fire, this can cause gastric disturbances. It is because of this reason that community lunches and marriages are avoided in this season. It is better to eat light foods and consume barley, rice, and wheat. Water should be boiled before use. Eat warm food and add ginger and greens to your daily diet.

Dengue is preventable and manageable

Dengue is preventable and manageable New Delhi, July 02, 2016: India is believed to be the Dengue capital of the world with the most recorded cases of the disease. The monsoon season further increases its incidence owing to the innumerable potholes where water gets collected. This stagnant water acts as ideal breeding grounds for the Aedes mosquitoes, the vector responsible for spreading the illness. According to a recent report, over 58 lakh Indians are diagnosed with Dengue each year, a figure 282 times greater than the officially recorded number of 20,000 annual cases. However what most people are not aware of is that most dengue cases are preventable and manageable. Given this fact, it is extremely essential to educate the masses about its treatment, prevention and myths. The risk of complications is in less than 1% of dengue cases and if the public knows warning signals, all deaths from dengue can be avoided. The typical symptoms of dengue are fever, vomiting, headache, nausea, pain behind the eyes and severe joint and muscle pain. Most dengue virus infections in adults are symptomatic (86%) and in children under the age of 15 years are asymptomatic or minimally symptomatic. Classic dengue fever is an acute febrile illness accompanied by a headache, retro-orbital pain, and marked muscle and joint pains. Symptoms typically develop between 4 and seven days after the bite of an infected mosquito. The incubation period may range from 3 to 14 days. Fever typically lasts for five to seven days. The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults. Joint pain, body aches, and rash are more common in females. Because a virus causes dengue fever, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is directed toward relief of the symptoms. The acute phase of the illness with fever and myalgias lasts about one to two weeks. In dengue, most complications occur within two days of the fever subsiding and most people are casual during this period. Any abdominal pain, giddiness or weakness after the fever has subsided should be attended to, by a doctor. Dengue complications during this period are due to a shift of blood volume and patient requires a rapid infusion of oral or intravenous fluids in large quantities. Most complications of dengue occur after the fever is over. The two days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar. The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration. Giving fluids orally or by intravenous routes, if given at a proper time, can save fatal complications. Physicians should remember the ‘Formula of 20’ i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention. Speaking about the same Padma Shri Awardee Dr KK Aggarwal –President Heart Care Foundation of India & Honorary Secretary General IMA said “If a person has suffered from dengue in the past year, they must take additional precautions to prevent the disease because a second attack of dengue may be more dangerous than the first attack. There are four different types of dengue, and one can, therefore, suffer from dengue four times in his or her lifetime. The second or subsequent dengue infections tend to be more serious. A person with dengue can also simultaneously suffer from malaria. Malaria and dengue together can lower platelet counts to a dangerous level leading to complications. One must however always remember that platelet transfusion in dengue patients can cause more harm than good and must only be administered if a person’s platelet count is less than 10,000, and he has active bleeding”. It is a myth that all dengue patients require platelet transfusion. In fact unnecessary transfusion causes more harm and puts the patient at risk of complications such as sepsis, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), alloimmunization and allergic and anaphylactic transfusion reactions. Other risks of platelet transfusion include febrile non-hemolytic transfusion reactions (FNHTR), transfusion-associated graft-versus-host disease (ta-GVHD), and post-transfusion purpura (PTP). The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extravascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper, and lower blood pressure is over 40 mmHg or the patient passes adequate urine. This is all that is required to treat the patient. Giving unnecessary platelet transfusion can make the patient more unwell. It is always said that prevention is better than cure, and it applies to the case of dengue as well. What most people must remember while taking necessary precautions is that dengue mosquitos only bite during the day and breed in clean, fresh water. Often people remain unaware of these facts and protect themselves from bites during the nights by using mosquito nets and repellent creams. They also feel that they are the safest when in clean urban environments, not realizing that mosquitos could be breeding in the clean water filled bucket kept in their backyard. The dengue mosquito lays its eggs on the walls of water-filled containers in the house and patio. The eggs after they hatch can survive for months. Female mosquitoes lay dozens of eggs up to 5 times during their lifetime. The life cycle of the mosquito from egg to larvae, pupae, and to an adult mosquito is about eight days and occurs in water. Adult mosquitoes live for about one month and rest indoors in dark areas (closets, under beds, behind curtains). It is only the female mosquitoes, which bite humans.s The dengue mosquito can fly several hundred yards looking for water-filled containers to lay their eggs. A few mosquitoes per household can produce large dengue outbreaks. The dengue mosquito does not lay eggs in ditches, drainages, canals, wetlands, rivers or lakes; pouring chlorine into these habitats is useless. Chlorine is harmful to aquatic life. Remaining in well–screened or air–conditioned buildings during the day can reduce the risk of exposure. When outside during the day, one should wear clothing that reduces the amount of exposed skin and use an effective mosquito repellent, such as N, N–diethyl–metatoluamide (DEET). Checking the accumulation of clean water in and around the house, in flowerpots, dog bowls; water tanks and buckets can go a long way in preventing the mosquito from breeding