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IJCP July 2019.Pdf Indexed with IndMED ISSN 0971-0876 Indexed with MedIND RNI 50798/1990 Indian Citation Index (ICI) University Grants Commission 20737/15554 www.ijcpgroup.com A Multispecialty Journal Volume 30, Number 2 July 2019, Pages 101–200 Single Copy Rs. 300/- Peer Reviewed Journal y Original Research y Original Study y Review Article y Clinical Study y Case Report y Public Health y HCFI Consensus Statement y RTI Analysis y Expert’s View y Medifinance y Medical Voice for Policy Change y Conference Proceedings y Around the Globe y Spiritual Update y Inspirational Story y Lighter Reading Full text online: http://ebook.ijcpgroup.com/ijcp/ www.emedinexus.com IJCP Publications | https://goo.gl/j2nXQQ Online Submission IJCP Group of Publications A Multispecialty Journal Dr Sanjiv Chopra Volume 30, Number 2, July 2019 Group Consultant Editor FROM THE DESK OF THE GROUP editor-IN-CHIEF Dr Deepak Chopra 105 Bihar Children Deaths: Could Refeeding Syndrome Chief Editorial Advisor Precipitated by Litchis have Triggered the Deaths? KK Aggarwal Dr KK Aggarwal ORIGINAL RESEARCH Group Editor-in-Chief 107 Ambulance Services in Delhi Need an Ambulance Care Dr Veena Aggarwal KK Aggarwal, Ira Gupta Group Executive Editor ORIGINAL STUDY Mr Nilesh Aggarwal 110 Prevalence of Thyroid Dysfunction in Pregnancy CEO Ruchika Garg, Prabhat Agrawal, Vishy Agrawal, Urvashi, Saroj Singh Ms Naina Ahuja REVIEW ARTICLE COO 114 Management of Diabetic End-stage Renal Disease: Role of Hemodialysis Dr Anoop Misra H Sudarshan Ballal Group Advisor 120 Evaluation of the Infertile Female Garima Kachhawa, Anju Singh Editorial Advisors CLINICAL STUDY Obstetrics and Gynaecology 125 A Study of Corneal Thickness and Endothelial Dr Alka Kriplani Morphology in Type 2 Diabetes Mellitus Rajender Singh Chauhan, Ashok Rathi, JP Chugh, P Sharma, R Rajput, R Kumar Cardiology Dr Sameer Srivastava 130 Effect of Adjuvant Atorvastatin Therapy on Disease Activity in Active Rheumatoid Arthritis: A Tertiary Care Paediatrics Center Study in India Dr Swati Y Bhave H Singh, Rekha Mathur, A Singhania, Kiran B ENT CASE REPORT Dr Chanchal Pal 136 Gastroenterology Unusual Temporary Treatment for Mastoid Fistula Dr Ajay Kumar and Dr Rajiv Khosla Subramaniam Vinayak Easweran, Sarvesh Nayak, Arpana Hegde Dermatology 138 The Wide Clinical Spectrum of Raised Fetal Dr Anil Ganjoo Hemoglobin in Adults Pratik Vora, Sakshi Singh, Jemima Bhaskar, Manish Mehta, Ami Trivedi Oncology Dr PK Julka 141 Bilateral Single System Ectopic Ureters with Secondary Calculi in an Adult Anand Gopal Bhatnagar Editorial Anchor Gopi Kishore M, Suhasini G, Prasad PVGS, Sainadh AV Advisory Bodies PUBLIC HealtH Heart Care Foundation of India 146 Non-Resident Indians Chamber of Commerce & Industry 2013-2014 Investigation Findings of Unexplained Acute World Fellowship of Religions Neurologic Illness Outbreak, Muzaffarpur, Bihar – Brief Note This journal is indexed in IndMED (http://indmed.nic.in) HCFI CONSENSUS Statement and full-text of articles are included in medIND databases (http://mednic.in) hosted by National 154 Patient-Doctor Relationship Informatics Centre, New Delhi. KK Aggarwal, Amarinder Singh Malhi, Ankit Om, Girish Tyagi… 156 HCFI Round Table on Health and Wellness on the Published, Printed and Edited by Interpretation of the Word “Supplied By” in Clause 23 Dr KK Aggarwal, on behalf of of Schedule K of Drugs and Cosmetics Act/Rules IJCP Publications Ltd. and Published at KK Aggarwal, Anil Khaitan, Balbir Verma, Bejon Kumar Misra, BR Sikri… E - 219, Greater Kailash Part - 1 New Delhi - 110 048 158 HCFI Expert Round Table on Off-label Use of Drugs, E-mail: [email protected] Disposables and Devices Printed at KK Aggarwal, Manju Mani, Chander Prakash, Ahmed Quraishi, AK Grover… New Edge Communications Pvt. Ltd., New Delhi E-mail: [email protected] RTI Analysis Copyright 2019 IJCP Publications Ltd. 164 Lack of Coordination Amongst Various Departments of All rights reserved. Ministry of Health: Diseases are Notifiable but there is no The copyright for all the editorial material contained Vaccination Policy for Them in this journal, in the form of layout, content including images and design, is held by IJCP KK Aggarwal, Ira Gupta Publications Ltd. No part of this publication may be published in any form whatsoever without the prior EXPERT’S VIEW written permission of the publisher. 168 How can One Reduce Cardiovascular Mortality in Editorial Policies Patients with Hypertension? Nandini Mukherjee The purpose of IJCP Academy of CME is to serve the medical profession and provide MEDIFINANCE print continuing medical education as a part of their social commitment. The information and 170 Budget 2019-20 Highlights opinions presented in IJCP group publications reflect the views of the authors, not those of Arun Kishore the journal, unless so stated. Advertising is accepted only if judged to be in harmony with MEDICAL VOICE FOR POLICY CHANGE the purpose of the journal; however, IJCP group reserves the right to reject any advertising at its 172 Medtalks with Dr KK Aggarwal sole discretion. Neither acceptance nor rejection constitutes an endorsement by IJCP group of CONFERENCE PROCEEDINGS a particular policy, product or procedure. We believe that readers need to be aware of any 178 INDIA LIVE 2019 affiliation or financial relationship (employment, consultancies, stock ownership, honoraria, etc.) AROUND THE GLOBE between an author and any organization or entity that has a direct financial interest in the 182 News and Views subject matter or materials the author is writing about. We inform the reader of any pertinent SPIRITUAL Update relationships disclosed. A disclosure statement, 191 What is Charity? where appropriate, is published at the end of the relevant article. KK Aggarwal Note: Indian Journal of Clinical Practice does INSPIRATIONAL Story not guarantee, directly or indirectly, the quality or efficacy of any product or service described 192 The Mango Tree in the advertisements or other material which is commercial in nature in this issue. LIGHTER READING 194 Lighter Side of Medicine IJCP’s Editorial & BUSINESS OFFICES Delhi Mumbai Bangalore Chennai Hyderabad Dr Veena Aggarwal Mr Nilesh Aggarwal H Chandrashekar Chitra Mohan Venugopal 9811036687 9818421222 GM Sales & GM Sales & GM Sales & E - 219, Greater Unit No: 210, 2nd Floor, Marketing Marketing Marketing Kailash, Part - I, Shreepal Complex 9845232974 9841213823 9849083558 New Delhi - 110 048 Suren Road, Near Cine 11, 2nd Cross, 40A, Ganapathypuram H. No. Cont.: 011-40587513 Magic Cinema Nanjappa Garden Main Road 16-2-751/A/70 Radhanagar, Chromepet [email protected] Doddaiah Layout First Floor [email protected] Andheri (East) Chennai - 600 044 Babusapalya Karan Bagh Mumbai - 400 093 Cont.: 22650144 Subscription Kalyananagar Post Gaddiannaram [email protected] Dinesh: 9891272006 Bangalore - 560 043 [email protected] Dil Sukh Nagar [email protected] [email protected] Hyderabad - 500 059 [email protected] GM: General Manager FROM THE DESK OF THE GROUP EDITOR-IN-CHIEF Indian Journal of Clinical Practice, Vol. 30, No. 2, July 2019 Dr KK Aggarwal Group Editor-in-Chief, IJCP Group Bihar Children Deaths: Could Refeeding Syndrome Precipitated by Litchis have Triggered the Deaths? he recent mortality among children in Bihar due We have always been taught to never overfeed a to acute encephalopathy syndrome (AES) has malnourished child as the outcome may be an electrolyte Tgenerated speculations abound and raised many imbalance. Even the World Health Organization eyebrows. The illness has claimed more than 100 lives. (WHO) says that acute or severe malnutrition should be From blaming the government to identifying litchi as treated slowly over 10 days. Rapid treatment with large the cause of the condition, the hypotheses have been intake of litchi may have precipitated fatal electrolyte many. However, it is imperative at this juncture to imbalance. understand that litchi may not be the underlying cause Rapidly treating hypoglycemia with litchi, without of the symptoms and subsequent deaths, but only a managing phosphate levels, may be harmful. The best triggering factor. food in such a situation could have been sugarcane Most malnourished children below 10 years of age juice and not litchi. One must remember here that all experienced convulsions early in the morning without those who break a long-term fast, do so with sugarcane fever. Despite the fact that all of them had low sugar, juice. mortality still remained high even after infusing sugar. The risk of hypophosphatemia during refeeding This suggests that apart from sugar, there was some appears to be greater in patients who are more other metabolic factor in play. severely malnourished and at lower percent of ideal body weight. During episodes of starvation, the UNDERSTANDING THE REACTION phosphate stores in the body get depleted. When In significantly malnourished children, who have not nutritional replenishment starts and patients are fed consumed food in the last 24 hours, rapid carbohydrate carbohydrates, glucose causes release of insulin, which intake (in the form of litchi in this case, which has 10% triggers cellular uptake of phosphate (and potassium sugar) may have led to electrolyte and fluid shifts. and magnesium) and a decrease in serum phosphorous This may have in turn precipitated disabling or fatal levels. Insulin also causes the cells to produce a medical complications. This is also called the refeeding variety of depleted molecules that require phosphate syndrome and is marked by hypophosphatemia (this (adenosine triphosphate and 2,3-diphosphoglycerate), is the hallmark feature), hypokalemia, congestive heart which further depletes the body’s stores of the latter. failure, peripheral edema, rhabdomyolysis, seizures, The subsequent lack of phosphorylated intermediates fever and hemolysis. causes tissue hypoxia, myocardial dysfunction and IJCP SUTRA: "Lower your blood pressure (BP) levels as a high BP is one of the leading causes for stroke." 105 FROM THE DESK OF THE GROUP EDITOR-IN-CHIEF Indian Journal of Clinical Practice, Vol. 30, No. 2, July 2019 respiratory failure due to an inability of the diaphragm negative health outcomes. In the case of children in to contract, hemolysis, rhabdomyolysis and seizures.
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