Punishment to Rapist

1.       One needs to distinguish between Paraphiliac and non-paraphiliac rapists. Paraphiliac rapists have excessive sexual desire. Paraphiliac offenders commit sex offences because they are sexually aroused by the act. On the other hand, non-paraphiliac sex offenders are instigated by violations or ego-hurt or for taking revenge.

2.       False allegations of rapes can occur in situations like: if one of the partners in live-in relationship refuses to marry, if two consensual partners are caught in the sexual act by the society, someone exploits secrete of the other person.

3.       Under the influence of alcohol one loses intellect and may end up in raping somebody if instigated.

4.       Chemical castration is reversible and the effect of the injection lasts only 3-6 months. The injections are costly and need to be given by medical doctors.

5.       Chemical castration in the long run leads to thinning of the bone (osteoporosis), feminine characteristic and increased tendency for cardiovascular diseases.

6.       Chemical castration drugs are not safe and healthy.

7.     In long run influential people convicted for chemical castration will start paying bribes to doctors and get a water injection in place of chemical castration injection.

8.       Chemical castration does not mean dissolving the male organ with a chemical. It only means reducing the blood testosterone levels to that of pre-puberty levels.

9.        Non-injectible oral drugs which block the action of testosterone are costlier and need to be taken every day. Therefore, they cannot be a part of chemical castration as punishment.

10.       Surgical removal of testis will remove sexual desire permanently and the same can only be given as a punishment in patients who are spending life-term in the prison.

11. Depoprovera is another injection which can be given every three months to patients with paraphiliac sexual abnormality.

12. Deprivation of sex and non-fulfillment of sexual desires is one of the main causes of rapes.

13.   If female commercial sex workers are banned in the society, the incidents of rape will increase as sexually deprived people with strong sexual urges will end up raping the minors.

 14.  People under the influence of alcohol and drugs will keep raping the girls if not treated and counseled in time. 

 Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA

#AskDrKK: Can patient with high blood pressure take Viagra group of drugs?

#DrKKAnswers:
Viagra group of drugs are typically well tolerated with only minor reductions in blood pressure in patients taking conventional antihypertensive drugs (ACE inhibitors, AR blockers, calcium blockers, beta blockers, and diuretics), even when used in combination.
Source:
1. Sildenafil Study Group. Am J Hypertens 2001; 14:70.
2. Am J Hypertens 2004; 17:1135.

Bomb blast injuries are always hollow organ injuries; Delhi Blast Update

1.      Primary blast injuries are the injuries to the hollow gas-filled organs like the lungs, ear drum or intestines leading to their rupture. These occur as a direct result of the impact of the over pressurized blast wave on the body.

2.       Secondary blast injuries occur due to flying debris and bomb fragments leading to penetration or penetrating injuries such as to the eyes.

3.       Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures as a result of the fall.

4.       Quaternary blast injuries are due to direct effect of burn or crush injuries.

The most important triage to manage blast injuries is not to waste energies and resources on patients with non-serious injuries.  The first thing is to check for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non-serious injury.

All patients exposed to a blast must have eardrum examination as the first step. If the ear drums are intact, the patient can be discharged with first-aid treatment. If ear drum is ruptured, an X-ray chest should be done immediately. All such patients should be observed for eight hours as primary blast injuries are notorious for delayed presentation.

Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture. This is used as a screening procedure for admitting a patient. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

Half of all initial casualties seek medical care over first hour. Double this number after one hour and you will know the total casualties. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs.

Always expect upside down triage as the most severely injured arrive after the less injured who self-transport to the closest hospitals.

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Chairman Ethics Committee Delhi Medical Council, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association and Past Academic and Research Wing Heads IMA.

Thanks Krishan for not started smoking: Dr K K

This is an open letter from Padmashri Awardee Dr K K Aggarwal, President Heart Care Foundation of India and Senior Physician Cardiologist at Moolchand Medcity to Mr. Krishan Kumar who represents his own past in the Medical College as a medical student.

Dear Krishan,

I must congratulate and reward you for not indulging in smoking, drinking or taking drugs while you were at school, college or medical college. I know what hard times you had faced in your life. You were 7th out of 9 brothers and sisters and that to living in one room in the crowded old city of Delhi. Your father was handling accounts of a company and living a tight financial life.

You studied in a Government School (ASVJ) located at Darya Ganj. Later you did your first year from Deshbandu College of Delhi University. There all the times you were compared with convent students who used to humiliate you and pass comments at you.

Subsequently you went to MGIMS Sevagram for doing M.B.B.S. and M.D. Throughout your life you were under constant stress with financial crisis, not good in English, stigma of coming from a traditional Hindu Baniya family and from a Government School.

Heads off to you! Even then you did not indulge in any of the addictions. Now I recall what great favours you have done to me as how difficult it would have been for me to de-addict myself. In the last 28 years of my practice at Moolchand Hospital, I have seen people with addiction living a life full of miseries. I have seen people with tobacco chewing dying with oral cancers and smokers getting pre-mature deaths, severe heart attacks, paralysis at an early age and losing their memories in 40s and 50s. I saw one of my friends at age 40 suddenly dying of heart attack just because he could not stop smoking in time.

I even saw those who wanted to quit, how difficult it was for them to quit. I saw people drink and completely spoiling not only theirs but also their families’ health and financial status. I came across people consuming drugs and indulging into the illegal activities. One of my patients was an opium addict and was ridiculed by his wife and children for years and they even attempted to make him stay in a mental hospital.

One of my industrialist colleagues who is just two years younger to me practically ruined his industry, as he could not de-addict himself. He even went to Europe for a de-addiction course which gave him relief only for a few months.

I came across each and every type of cancer in smokers in the last two decades.

You were smart enough not to listen to your colleagues and did not get under pressure or got influenced by the Stars in the Indian Movies or the Politicians.

I now realize the importance as I see many of my colleagues continue to smoke as they have failed again and again after trying quitting.

We belong to a professional community who work late night and under constant pressure and are vulnerable to end up with addictions. The only answer is to say no to the first addictive instance that to when we are still in our youth and that was what you rightly did in time.

I am not only grateful to you myself but also on behalf of my family as if I would have been smoking there was no way I could have told them not to smoke.

Because of my non-addiction, I am today a successful preventive doctor who has received Dr B C Roy National Award and Padmashri.

You will agree with me that if I would have been smoking there was no way I could have asked my patients not to smoke. It is not that I belong to a family of non-smokers. I have seen my brothers smoking and one of them a chain smoker with all sorts of health problems.

Once again Thanks

Regards

Dr K K Aggarwal

#AskDrKK: Starting enteral nutrition in a patient on ventilator

#DrKKAnswers: Starting enteral nutrition with a low infusion rate improves tolerability, compared to initiation at the target rate. A randomized study of 200 mechanically ventilated patients showed that enteral feeding (at the target rate or at 10 mL/hr for six days before being incrementally increased to the target rate) showed no differences in mortality, ventilator-free days, or ICU-free days, but the group that began at the target rate had more episodes of elevated gastric residual volumes and a trend toward more diarrhea.
Source: Crit Care Med 2011; 39:967.

#AskDrKK: Ventilator induced Diaphragmatic atrophy

#DrKKAnswers: Controlled mechanical ventilation can lead to a very rapid type of disuse atrophy involving the diaphragmatic muscle fibers.
An observational study found that diaphragmatic strength decreased progressively during mechanical ventilation and that long-term (>24 hours) mechanical ventilation was associated with diaphragmatic muscle injury, atrophy, and proteolysis compared to short-term mechanical ventilation (2-3 hours)

Source: Am J Respir Crit Care Med 2011; 183:364.

HCFI Update: When not to ignore constipation

While most instances of constipation may not be serious, some cases of infrequent or difficult bowel movements need evaluation by a doctor said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, and MTNL Perfect Health Mela.

Constipation is one of the most common gastrointestinal complaints. Those reporting constipation most often are women and adults ages 65 and older. Pregnant women may have constipation, and it is a common problem following childbirth or surgery.

Constipation occurs when the large colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry.

Common causes of constipation are:

1. Not enough fiber in the diet
2. Lack of physical activity
3. Some drugs
4. Pregnancy
5. Elderly
6. Abuse of laxative
7. Ignoring the urge to have a bowel movement
8. Dehydration
9. Underlying cancer
10. Depression

Heart Care Foundation of India offers this list of warning signs:

a. You’re constipated for the first time
b. You’ have been treating with house hold remedies for constipation for three weeks with no improvement.
c. You have associated abdominal pain.
d. You have associated bloody stools.
e. You have associated unexplained weight loss.

Ganesha, the Stress Management Guru

If Lord Krishna was the first counselor who taught the principles of counseling, Lord Ganesha taught us the principles of stress management. We should worship Lord Ganesha and follow his principles whenever we face any difficulty or are stressed out.

The elephant head of Ganesha represents that when in difficulty, use your wisdom, intelligence and think differently. It can be equated to the Third Eye of Lord Shiva. Elephant is the most intelligent animal in the kingdom. Here wisdom implies to thinking before speaking. Lord Buddha had also defined that one should not speak unless it is necessary, is based on truth and is kind.

The big elephant ears of Lord Ganesha signify listening to everybody (taking opinions) when in difficulty. Elephant ears are known to hear long distances.

Elephant can also see a long distance and in terms of mythology the elephant eyes of Ganesha represent acquiring the quality of foreseeing when in difficulty. The elephant mouth of Ganesha represents speaking less so that more time can be given to ears to listen

The big tummy of Ganesha represents retaining and digesting all information gathered by hearing to people in difficulty.

The trunk represents to use one’s power of discrimination to scrutinize gathered information. It also indicates to do both smaller and bigger things by oneself. Elephant trunk can pick up a needle as well as break a tree.

The broken and unbroken tooth of Ganesha represent being in balance both in loss and gain. One should not get upset if the task is not accomplished and also not get excited if the task is accomplished.

In times of difficulty, Ganesha also teaches us not to lose strength and control one’s attachments, desires and greed. The four arms of Ganesha represent strength. Ropes in two hands indicate attachments, Laddu or Sweet in one hand represent desires and mouse represents greed. Riding over the mouse indicates controlling one’s greed.

Ganesha is worshiped either when one’s task is not getting accomplished or when a new work is initiated. In both situations, these principles of Lord Ganesha need to be inculcated in one’s habits.

HCFI Update: Risk of heart attack triples with pre-hypertension

A person with pre–hypertension, upper systolic blood pressure between 120–140 mmHg and lower diastolic pressure between 80–90 mmHg, is more than three times likely to have a heart attack and 1.7 times more likely to have heart disease than a person whose blood pressure is lower than 120/80 mmHg, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Normal blood pressure is lower than 120/80 mmHg and hypertension is a blood pressure more than 140/90 mmHg or higher.

If pre–hypertension is aggressively treated, 47% of all heart attacks can be prevented. Lifestyle modifications such as weight control, regular physical activity and changes in diet are recommended for people with pre–hypertension. The importance of pre–hypertension has been listed as one of the top 10 recent advances in cardiology. Every effort should be made to lower the blood pressure below 120/80 mmHg.

Emedinews:Makesure: A patient with fever and cough develops complications after he was given antibiotics.

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

Emedinews: Dr Good Dr Bad: A patient with metabolic syndrome was found to have impaired kidney functions.

Situation: A patient with metabolic syndrome was found to have impaired kidney functions.
Dr Bad: They are not related.
Dr Good: They are related.
Lesson: People with metabolic syndrome are at 55% increased risk for kidney disease (reduced kidney functions), according to a study to appear in the Clinical Journal of the American Society of Nephrology.

(Ref: Thomas G, et al. Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2011 Aug 18. Epub ahead of print)

Emedinews:Inspiration: The Rock

An old farmer had plowed around a large rock in one of his fields for years. He had broken several plowshares and a cultivator on it and had grown rather morbid about the rock. After breaking another plowshare one day, and remembering all the trouble the rock had caused him through the years, he finally decided to do something about it.

When he put the crowbar under the rock, he was surprised to discover that it was only about six inches thick and that he could break it up easily with a sledgehammer. As he was carting the pieces away he had to smile, remembering all the trouble that the rock had caused him over the years and how easy it would have been to get rid of it sooner.

(Dr Anupam Sethi Malhotra)

Emedinews: Linagliptin new DPP-IV inhibitor

It is used as an adjunct to diet and exercise in adults with type 2 diabetes mellitus. It can be used as monotherapy or in combination with other oral agents. It lowers A1C by o.5% (1-4). Adverse reactions were uncommon, but include nasopharyngitis, hyperlipidemia, cough, hypertriglyceridemia, and weight gain (5).

As it is eliminated via the enterohepatic system, no dose adjustment is necessary in patients with renal or hepatic impairment.

References
1. Diabetes Obes Metab 2011;13:65.
2. Diabetes Obes Metab 2011;13:258.
3. Scott LJ. Linagliptin: in type 2 diabetes mellitus. Drugs 2011;71:611.
4. Diabetes Obes Metab 2011.
5. http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf

HCFI Update: Do not ignore 2nd attack of dengue

If you have suffered from dengue in the past be more careful as the second attack of dengue may be more dangerous than the first attack, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

There are four different strains of dengue and one can, suffer with dengue four times during lifetime. Subsequent dengue infections are more likely to end up with deadly complications.

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.

In a dengue season nobody should take aspirin for fever as it can precipitate bleeding, he added.

In dengue most complications occur within two days of subsiding of fever and most people are careless 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 shift of blood volume and patient requires rapid infusion of oral or intravenous fluids in large quantity.

There is no need for giving platelets unless the counts have fallen lower than 2% of original platelet counts.

Emedinews:Insights on Medicolegal issues:Medical literature must exist in the public domain to serve as legitimate evidence in court

• To constitute valid medical testimony, the witness must be identified
• For a document to serve as legitimate evidence in a trial it must exist in the public domain and the degree to which a medical document/literature/book validates the point you are making depends upon the reliability of the document. The author of a document is a witness and you are calling upon to testify.
• Conventions for citing sources are somewhat dynamic. However, at a minimum you should identify the individual, institution, or publication that authored the document and the publication date.
• When it is not otherwise evident, you ought to make quick reference to the qualifications of the author to lend an air of credibility to the document. Although it is not necessary to read additional information into the records, you must be prepared to provide a complete bibliographic citation if called upon to do so by the court of law or cross lawyer.

(Contributed by Dr Sudhir Gupta)

Emedinews: Makesure: A patient with fever and cough developed complications after he was given antibiotics.

Situation: A patient with fever and cough developed complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

Emedinews: Dr Good Dr Bad: A patient at risk for stroke came for diet consult

Situation: A patient at risk for stroke came for diet consult
Dr Bad: Take normal diet
Dr Good: Take high potassium diet
Lesson: Individuals who eat a diet rich in potassium appear to have a lower risk for stroke than people with minimal potassium intake.

Source: Journal Stroke

Emedinews :Inspiration: The World is a Puzzle

There was a man who had a little boy that he loved very much. Everyday after work the man would come home and play with the little boy. He would always spend all of his extra time playing with the little boy. One night, while the man was at work, he realized that he had extra work to do for the evening, and that he wouldn’t be able to play with his little boy. But, he wanted to be able to give the boy something to keep him busy. So, looking around his office, he saw a magazine with a large map of the world on the cover. He got an idea. He removed the map, and then patiently tore it up into small pieces. Then he put all the pieces in his coat pocket.

When he got home, the little boy came running to him and was ready to play. The man explained that he had extra work to do and couldn’t play just now, but he led the little boy into the dining room, and taking out all the pieces of the map, he spread them on the table. He explained that it was a map of the world, and that by the time he could put it back together, his extra work would be finished, and they could both play. Surely this would keep the child busy for hours, he thought. About half an hour later the boy came to the man and said, "Okay, it’s finished. Can we play now?" The man was surprised, saying, "That’s impossible. Let’s go see." And sure enough, there was the picture of the world, all put together, every piece in its place.

The man said, "That’s amazing! How did you do that?" The boy said, "It was simple. On the back of the page was a picture of a man. When I put the man together the whole world fell into place."

(Contributed by Dr. Anupam Sethi Malhotra)

Emedinews : Metformin reduces A1C levels more than DPP-IV inhibitor monotherapy

Metformin as initial therapy is supported by a meta-analysis of 140 trials and 26 observational studies.

Older drugs (metformin and second generation sulfonylureas) had similar efficacy in reducing A1C values (1%) and other cardiovascular risk factors (blood pressure, lipids, body weight) compared with newer drugs (thiazolidinediones, meglitinides, and GLP-1 receptor agonists).

Source: Ann Intern Med 2011; 154:602.

Emedinews: Inspiration:A field mouse or an Osprey

Life offers two choices.

We can live scurrying for survival or soaring to the unlimited heights. The choices are modelled by two these two creatures.

A few months back while sitting in a boat fishing with a couple of friends, I noticed a field mouse on the river bank. He emerged out of his hole, darted in a couple of directions, and then scurried back. I thought of the existence of this little creature. His life is spent running around, frightened and frantic, following his nose. He darts here, scurries there, turns in circles, but never really sees much beyond his nose. He is trying to sniff his way to successful living, which defined, by a mouse's existence, is finding some daily morsel to consume, to sustain him, so that he can carry on for the rest of his life, frightened and frantic. Sound familiar.

A few minutes later I glanced up and noticed soaring high above was an Osprey.

Rather than a picture of a frightened and frantic existence, I saw a wide winged creature using the air currents to maneuver majestically in the unlimited heights. Rather than sniffing out a meager existence, this keen eyed hunter with a panoramic view of the river and lake beneath, was simply waiting for the appropriate time to swoop and capture his prey. The amazing creature, rather than return to some tiny hole in the river bank, glides toward a nest fashioned at the top of the tallest of trees.

The strength in his wings, the power in his talons, the amazing capacity of his vision, the effortless capacity to soar, It is the osprey, not the field mouse that models our human potential.

I don't know about you, but it is easy for me to decide which creature I want to exemplify my life. I want to soar. I want to explore. I want to see the big picture. I want to conquer. I want to climb higher, go farther, dive deeper, and experience more. I want my soul enlarged, my mind expanded, my heart enlivened and my spirit energized. I want the scurrying to stop. I want the frantic darting about following my nose, to end. I want new strength, fresh thinking, clear vision and resolved courage.

I want to be more and more like the osprey and less like the field mouse, for to live like this field mouse is to insult my creator and deny my true destiny.

(Contributed by Ms Ritu Sinha)