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Dr K K Aggarwal

Water Hygiene

By Dr K K Aggarwal
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Safe water is an essential commodity for prevention of most water and food-borne diseases like diarrhea, typhoid and jaundice. These diseases are 100% preventable. All of them can be lethal if not prevented, diagnosed or treated in time. Transmission of parasitic infections can also occur with contaminated water. Here are a few tips:

• Travelers should avoid consuming tap water.

• Avoid ice made from tap water.

• Avoid any food rinsed in tap water.

• Chlorination kills most bacterial and viral pathogens.

• Chlorination does not kill giardia or amoeba cysts.

• Chlorination does not kill Cryptosporidium.

• Boiled/Treated/Bottled water is safe.

• Carbonated drinks, wine and drinks made with boiled water are safe.

• Freezing does not kill organisms that cause diarrhea. Ice in drinks is not safe unless it has been made from adequately boiled or filtered water.

• Alcohol does not sterilize water or the ice. Mixed drinks may still be contaminated.

• Hot tea and coffee are the best alternates to boiled water.

• Bottled drinks should be requested without ice and should be drunk from the bottle with a straw rather than with a glass.

• Boiling water for 3 minutes followed by cooling to room temperature will kill bacterial parasites.

• Adding two drops of 5% sodium hydrochloride (bleach) to quarter of water (1 liter) will kill most bacteria in 30 minutes.

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Inaugurating a daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions, Dr. A.K. Agarwal, President, Delhi Medical Council, said that all doctors should document their medical records, carefully, punctually and timely. He said that doctors are for patient’s safety and medical records are for doctors’ safety. He said as far as possible, doctors and medical establishments should go for electronic records so that chances of mistakes are lower.

The conference was attended by over 1000 doctors from NCR. Briefing about the conference, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & Vice President Elect IMA, said that eminent faculty participated in the conference and listed the happenings in the year 2012.

The faculty included: Dr Brig A K Dhar, Dr. AS Bath, Dr Ambrish Mithal,Dr Anil Goel, Dr Ashish Jain, Dr Deepak Khurana, Dr Ganesh Mani, Dr IM Chugh, Dr. JPS Sawhney, Dr Kaberi Banerjee, Dr Kailash Singla, Dr Manju Gupta, Dr NK Bhatia, Dr Neeraj Jain,  Dr Praveen Chandra, Dr PC Joshi, Dr Praveen Bhatia, Dr Rajnish Malhotra,Dr SK Parashar, Dr Sanjay Chaudhary, Dr Sukhendy Roy, (Maj.Gen) Dr. SK Mittal, Dr Vivek Bhatia and Dr Yugal Mishra.

Following were the highlights:

1. It is now possible to give a blood transfusion to a person without getting in any blood transfusion reaction.

2. Nobody should suffer from pain and it is possible to get rid of painkillers in 2-3 months’ time.

3. It is now possible to do an aortic valve replacement without surgery using a catheter.

4. It is now possible to save 40 lives from a brain dead donor.

5. Intestinal transplant is now possible in the country.

6. If you have one ova and one sperm, fertility is now possible.

7. Midline incision in the chest is no more required for bypass surgery and for valvular surgery.

8. It is now possible to combine the bypass surgery with stent angioplasty in one sitting and give better results to the patients.

9. It is now possible to do cataract surgery practically without stitches and with near normal vision without spectacles.

10. It is now possible to do surgery in very high obesity using a robot both in adult and in children successfully.

11. With capsule endoscopy it is now possible to examine small intestine of a patient.

Doctor of the year awards were also distributed and the recipients included:

Dr. Ramesh Kumar Bapna, Dr. Harish Gupta, Dr. Narender Saini, Dr. (Maj. Gen.) AS Bath, Dr. JPS Sawhney, Dr. SM Chugh, Dr. Naveen Tuli, Dr KS Bhagotia, Dr Sukrit Sharma, Dr SK Mittal and Dr AK Bansal

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1. The word penis should not be used (use male sex organs) anywhere in the law

2. The work vagina, labia majora should not be used anywhere in the law (Female sex organs)

3. Under the influence of alcohol and drugs the punishment should be different and treatment added. For rarest of the rare case death sentence can be added. People with abnormal sexual urges should be treated.  

4. We must sensitize the parents, teachers and schools to identify red flag signals of an abnormal personality trait in children (present in up to 10% of children) so that they do not indulge in sexual offences later

5. Chemical castration is not acceptable to medical profession, is not safe, not health friendly is temporary and lead to corruption

6. Medical profession should help training all policemen in CPR and first aid

7. Every PCR van should be a mini ambulance also. One can post a paramedic in it for RTA and assault cases

8. Private hospital should be allowed to examine rape victims and guidelines should be pasted in every Emergency room

9. We need to define, issuing of medical bulletin, guidelines

10. Transfer to other country there should be a clear cut national policy and decide by a panel of treating doctors in consultation with Govt. health officials

 11. Sick RTA or assaulted patients should b shifted to a nearby hospital (govt. or private) so that medical services are available within ten minutes and stabilized within one hour.

12. Forensic examination lab should be strengthened and should give results in time bound manner.

13. Most sexual assault cases occur in slum areas. Efforts should be made to create awareness in these areas

14. All accused should be compulsorily be tested for sexually transmissible illnesses and victims be considered for STI, HIV and pregnancy prevention treatments

15. All health care professionals to have compulsorily short term training in counselling, empathy, communication, etiquette as part of medical education.

Drafted by Dr KK Aggarwal for National IMA and eMedinews based on proceedings of a seminar organised by IMA and inaugurated by National President IMA, Dr K Vijaykumar.

 

 

 

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Inaugurating the seminar on ‘Psyche Behind Rape: Treatment-cum-punishment’, Dr. K Vijaykumar, National President, IMA said that on one hand, IMA supports stringent punishment to the rape accused, on the other hand, IMA is for providing correct sex-education in the school at the right age and also educating the society, especially, the youth so that they do not end up in psyche, which provokes rape in the society.

Addressing the seminar, Dr. Narender Saini, Secretary General, IMA said that the IMA will come out with guidelines on “How a medical doctor should tackle a patient with suspected rape?”

Moderating the session, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, National Vice President (Elect.), IMA said that it is crucial for the doctor to examine both the rapist and the rape victim for HIV-AIDS, Hepatitis B and Hepatitis C, all which can be transmitted through sexual route. The rape victim as well as of the accused should be checked for these infections at baseline, then again at 6 weeks to 3 months. Post exposure HIV prophylaxis should be given to all rape victims.

The other faculty in the seminar included Dr Vinay Aggarwal Past President IMA;  Dr. D.R. Rai, Senior Vice President, IMA;  Mr. Ajay Kumar, Aaj Tak;  Dr. S K Pal and Dr Anil Goel (Andrologists); Ms Indu Malhotra (Senior Advocate); Dr. BB Rewari (NACO);  Dr. Jitender Nagpal (Psychiatrist); Dr Anita Kant (Gynecologist);  Dr. Ajay Gambhir (Pediatric and Finance Secretary, IMA), Ms Kalpana Kapoor (Educationist) and Dr Sarvesh Tandon (Finance Secretary IMA East Delhi Branch).

Following were the salient points of the seminar:

  • Right sex education should be started in school age. IMA will come out with suggestions regarding curriculum.
  • All doctors dealing with rape victims should ensure total confidentiality of the victim and examine them properly.
  • All rapists are also brought to medical doctors for examination which includes tests for their sexual potency. They should also be checked for presence of sexually transmitted diseases.
    • There has a suggestion from the Government that chemical castration can be one of the punishments to the rapist. The same cannot be done without involving the medical fraternity. The oral tablet for chemical castration given daily cannot be the punishment for rapist. One can only give injections which reduce testosterone levels but the same injection has to be given every 3-6 months and the effects are reversible.
    • Chemical castration injections are not safe and health-friendly. In the long run, they can cause thinning of bones and cardiovascular diseases.
    • Chemical castration injections will also promote corruption since influential people will force or bribe the police and the doctors to give a water injection and write anti-testosterone injection has been given.
    • A paraphiliac rapist has been differentiated from a non-paraphiliac rapist.
    • Sexual contact with a girl who is less than 16 years of age is a rape even if the sexual contact is with mutual consent.
    • The percentage of rapes is not reported. Majority of the rapes are reported from JJ Cluster areas.
    • False allegations may be made in the following situations:
  • Consensual live-in relationship where one refused to marry.
  • One is caught in an extramarital affair.
  • As a part of revenge
  • Under the influence of alcohol and drugs
  • In an atmosphere of pornographic movie
  • Date rapes and under the influence of date rape drugs
  • Presence of stepfather and stepbrother in the house.
  • Blackmailing a rich person after consensual relationship
  • Showing your supremacy of raping a girl in the society so that nobody speaks against the Dada.
  • To show off amongst your friends that you can do it and you did it.
  • Politically motivated
  • You plant a girl to somebody.
  • Examination of a rape victim
  • First and foremost make the woman/girl/child comfortable – she has been through physical and emotional trauma.
  • Take her to a room or corner with adequate privacy
  • A short recount of her trauma is necessary so that the doctor knows where all she has been violated.
  • All the surfaces – cheeks, ears, nose, breasts, arms, legs, thigh (inner parts), abdomen, locally the private parts, even anal opening should be examined for scratches, cuts,  bite marks, blood, dried white patches etc.
  • Examine the hair over vulva for blood or white discharge
  • Check the hymen for fresh/ old injuries
  • Examine the clothes of the victim e.g. underclothes or other clothes depending on how the victim has been violated; they should be collected in transparent bags and sealed to be sent for lab examination
  • After that swabs are taken from vagina (and other areas if relevant) to be tested in lab for sperms, PSA, DNA testing. Sometimes, blood or hair of the rapist can be picked up for DNA matching.
  • Medical treatment of the victim requires prevention of the following:
    Pregnancy – give i-pill; Sexually transmitted diseases (STDs) – fungal vaginitis, syphilis, HIV prophylaxis; The wound, if any, need to be cleaned, stitched, antibiotics, tetanus toxoid etc. to be given.; Psychological support is very important; preliminary blood test for HIV after consent and counseling, and subsequent follow up test is necessary

Types of rapes

Rape generally encompasses nonconsensual vaginal, anal, or oral penetration that involves force or threat of force (physical or psychological), lack of consent, or inability to provide consent because of age, intoxication, or mental status. Rape is categorized according to the relationship between the perpetrator and the victim.

  • Stranger rape describes nonconsensual sexual penetration between individuals who do not know each other before the sexual act
  • Acquaintance rape describes nonconsensual sexual penetration between individuals who know each other in some capacity before the sexual act
  • Date rape is a subset of acquaintance rape in which nonconsensual sexual penetration occurs between two people who are in a romantic relationship. Date rape can occur when the victim is alert and rational or irrational, semiconscious, or unable to respond due to alcohol or other drug use. Verbal coercion, threats or use of physical force, or the use of alcohol or illicit drugs may occur as precipitating events.
  • Pendency of Gang Rape Cases and Rape Cases in Delhi Alone: No. of cases file in court last year 568.
S. No. District Gang Rape Cases Rape Cases Total
1. Central 4 51 55
2. North 8 26 34
3. West 14 105 119
4. New Delhi - 5 5
5. South 11 106 117
6. South-East 18 107 125
7. East 13 62 75
8. North-East 15 137 152
9. North-West 23 131 154
10. Outer 23 79 102
11. South-West 21 75 96
  Grand Total 150 884 1034

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Cerebral (brain) venous thrombosis is uncommon occurring in 1/lac population

  1. It is more common in neonates and children than in adults. In adults it is more common in women than men.
  2. The mean age of onset is 39 years old.
  3. Thrombosis of cerebral veins or dural sinus leads to increased venous and capillary pressure, which in turn leads to brain swelling, venous hemorrhage, and/or ischemia with cytotoxic edema.
  4. Occlusion of dural sinus causes decreased brain cerebrospinal fluid absorption and elevated brain pressure.
  5. Risk factors are hypercoagulable states, oral contraceptives, pregnancy, cancer, infection and head injury.
  6. The onset can be acute, subacute, or chronic.
  7. Headache is the most frequent symptom, occurring in 90% cases
  8. Other symptoms are focal neurologic deficits, focal or generalized fits, altered mental status, stupor, or coma.
  9. Brain MRI with MR venography is diagnostic
  10. Head CTscan is normal in up to 30 percent of  cases
  11.  CT venography is a useful alternative to MR venography.
  12. There is complete recovery in 80 percent of patients.
  13. 5% die in acute illness and 10% die over a period of time
  14. The main cause of acute death is brain herniation.
  15. Recurrence rate is 2 to 4 percent.
  16. Treatment is blood thinners initially with subcutaneous low molecular weight heparin or intravenous heparin followed with oral warfarin for 3-12 months

 

 

 

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Indian government is envisaging compulsory treatment of some sex offenders with antiandrogenic drugs, commonly referred to as chemical castration.

Laws in several American states allow compulsory medical treatment of offenders who have committed serious sex offences. Chemical, as well as physical, castration of sex offenders takes place in psychiatric hospitals in theCzechRepublicunder the legal framework of “protective treatment.” Meanwhile, inEnglandthe Department of Health is supporting an initiative to facilitate the prescription of drugs on a voluntary basis for sex offenders in the criminal justice system.

Demand for the prescription of antiandrogens or physical castration for sex offenders is a common reaction by lawmakers and politicians when a high profile sexual crime is committed.

Whether medical or surgical, the procedure requires the participation of doctors. It also shifts the doctor’s focus from the best interests of the patient to one of public safety.

Antiandrogenic drugs and physical castration undoubtedly reduce sexual interest (libido) and sexual performance, and they reduce sexual reoffending.

Physical castration of sex offenders was carried out in several European countries in the first part of the 20th century.

Nowadays drugs are usually used alongside psychological treatment).

The main drugs used are cyproterone acetate (in the United Kingdom, Europe, and Canada); medroxyprogesterone (in the United States); and increasingly the more expensive but possibly more potent gonadotrophin releasing hormone agonists such as leuprolide, goserelin, and tryptorelin.

Although these drugs act in different ways, they all reduce serum testosterone concentrations in men to prepubertal values.

Castration, however—whether chemical or physical—is associated with serious side effects, including osteoporosis, cardiovascular disease, metabolic abnormalities, and gynaecomastia. Physical castration is mutilating and irreversible, and it carries the potential for serious psychological disturbance, although some offenders request it nonetheless.

Is there a clear medical rather than social reason for prescribing powerful drugs.

When the intensity or ability to control sexual arousal is the presenting feature—whether it manifests as frequent rumination and fantasy or strong and recurrent urges—then treatment directed towards the biological drive makes sense.

Treatment protocols can then be based on the medical indication (remembering that drugs other than the antiandrogens, such as selective serotonin reuptake inhibitors, can also be effective, particularly when sexual rumination is the presenting problem) rather than on risk.

When drugs work the clinical effect is often dramatic, with offenders reporting great benefit from no longer being preoccupied by sexual thoughts or dominated by sexual drive. These drugs can also allow offenders to participate in psychological treatment programmes where previously they may have been too distracted to take part. Given the transparency of benefits and risks, there is no obvious reason why an offender should not be able to make an informed choice about drugs. [Source BMJ, 2010]

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In a special Doctor’s day function being organized on 1st July at Maulana Azad Medical College, Delhi Medical Association will be honoring Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India with “Vishisht Chikitsa Ratan Award”.

The award would be given by Hon’ble Lt Governor of Delhi Mr. Tejendra Khanna.

Dr Aggarwal would be receiving this award for outstanding contribution to the medical profession and the society. Dr Aggarwal is known for his contribution to the society as an anchor, writer, columnist, public speaker and a campaigner. He is also known for his annual event Perfect Health Mela.

Read more

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ON 18 JUNE 2012

Indian Medical Association & Delhi Medical Association (DMA) in association with all its branches in Delhi, organizse a Massive Protest DHARNA on Monday, 18th June 2012 from 10.00 am to 2.00 pm at Jantar Mantar, New Delhi to protest against implementation of Clinical Establishment (Registration and Regulation) Act 2010 by the Government and Introduction of proposed National Council for Human Resources in Health (NCHRH) Bill-2011, said Dr. Harish Gupta, President, DMA,during the press conference held today at DMA House.

He said that the draconian Clinical Establishment Act which has been passed by Central Government was proposed to be adopted by Delhi Vidhan sabha for its implementation in Delhi, in its present form is unwarranted as when medical profession is already governed by number of acts and Government regulating bodies like Nursing homes Act, MCI etc. which monitor single Doctor Clinic to tertiary care Medical Establishment.

He further and said that implementation of this act will lead to-

- License and Inspector Raj.

- Very Harsh penalties on Medicos to be levied by Non-medicos.

- Allopathic medicine system giving more than 80% Health care facilities represented by just three members in National and

State Councils.

- Closure of single doctor clinics and small medical establishments.

- Medicare cost will increase exponentially directly affecting the public.

- Unemployment of doctors will increase as they will hesitate to start new centers.

- Incharge of companies and Heads of Dept in Govt hospitals would be held guilty without their involvement.

Dr. Vijay Kohli, Hony. State Secretary, DMA said that proposed National Council for Human Resources in Health (NCHRH) Bill-2011 is going to adversly affect the medical profession and medical education as the National Commission for Human Resources in Health (NCHRH) so formed will be a superarching body on all the Councils of medical profession, which clearly means that the powers of Medical Council of India, Dental Council, Pharmacist Council and Nursing Council etc. will be lost and all these will be governed by the proposed Commission which will be managed by the nominees of the Government and not by elected persons of the medical profession. Action taken by this National Commission won’t be challengeable in any Court of Law.

Dr. D.R. Rai, Hony Secretary General, IMA (Hqs) informed that to protest against these bills, a massive DHARNA is being organised by IMA and DMA at Jantar Mantar on Monday 18 June 2012 between 10-2 pm. He demanded that these bills should be introduced and adopted only after necessary amendments. He further said that this is only start of our agitation on these very important issues. It will be followed by Nation wide Medical Strike on 25th June 2012 in the whole country.

The proposed act has taken away the power of State Government on an important subject like health which has always been a State subject, damaging the federal structure of Indian constitution said Dr. K.K. Aggarwal President, Heart Care Foundation

Dr. A.K. Israni, Sr. Vice President, DMA this proposed act will adversely effect more than one lac doctors from Allopathy, Ayurveda, Homeopathy, Dental Doctors and other Doctors inDelhi alongwith more than 20 lacs Healthcare personnel associated with Medical Establishment in the city.

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