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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
 
  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 and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08c); 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

2nd May 2012, Wednesday

ACE inhibitors better ARBs in new meta–analysis in hypertensives

A new meta–analysis has shown that use of ACE inhibitors is associated with a 10% reduction in all–cause mortality over four years in hypertensive patients, compared with contemporary therapy that included blood–pressure lowering with drugs other than ACE inhibitors or angiotensin–receptor blockers (ARBs). In contrast, ARBs had a neutral effect on deaths.

(Dr Laura C van Vark at Erasmus Medical Center, Rotterdam, the Netherlands in April 17, 2012 European Heart Journal)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

ACE inhibitors better ARBs in new meta–analysis
in hypertensives

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

National Summit on "Stress Management" 2012

The Summit was organised by Heart Care Foundation of India in association with Bramkumaris. Large number of people attended the summit.

 
Dr K K Aggarwal
 
    National News

80% of medical colleges in south India: Azad

CHANDIGARH: Union health minister Ghulam Nabi Azad on Saturday expressed concern over a dearth of medical professionals in north, central and northeastern India while blaming concentration of medical colleges in the country’s southern and western regions for the "dismal state". "Almost 80% of India’s medical and nursing colleges are located in the south and the remaining in the remaining two–third portions of the country," said Azad while addressing Postgraduate Institute of Medical Education and Research (PGIMER)’s 32nd convocation in Chandigarh. He described inequitable distribution of medical professionals across north and south India as a "lopsided human resource situation". Azad said the government plans to address the situation by setting up more medical colleges in 2012. "Forty six new medical colleges have been established in last two years, raising the number to 335," he said. He described this as "an encouraging growth trajectory" while saying the number of MBBS seats have also gone up from 32,882 to 41,569. "There has been an 80% increase in the number of seats in the post–graduate courses in last three years. From 13,000 seats, the numbers have gone up to 22,194." (Source: TOI, April 29, 2012)

For Comments and archives

India to pump in Rs 2 lakh cr in 12th Plan to save climate

NEW DELHI: The fight against climate change will take a strategic jump in the 12th Five–Year Plan (2012–2017) with the government intending to plough in almost Rs 2 lakh crore through the various missions, the working group on climate of the 12th Five–Year Plan has said. The report seeks setting up of a dedicated structure of governance to oversee the different programmes under the 12th Plan with such large funds to be invested. The agriculture mission under the National Action Plan on Climate Change alone is to spend upwards of Rs 1 lakh crore over five years to make the primary sector more resilient to inevitable changes in climate change. The report pointed out that the government already spends 2.8% of its GDP on programmes that bring adaptation benefits to people. (Source: TOI, April 30, 2012)

For Comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Caffeine may relieve dry eye syndrome

Caffeine intake boosts a person’s ability to make tears and may help overcome dry eye syndrome, according to a small Japanese study published online February 15 in Ophthalmology. Dry eye, also known as keratoconjunctivitis sicca, is prevalent in older adults and involves malfunction of the rate and quality of tear production, as well as the rate of eye surface evaporation. Although symptoms such as gritty, scratching, or burning sensations; excessive tearing; and production of stringy mucus are mostly inconvenient, the condition can escalate into vision loss. (Source: Medscape)

For comments and archives

Many men older than 75 still PSA tested, contrary to guidelines

New data from a national health survey in the United States show that the guidelines for prostate cancer screening are being ignored. Many men 75 years and older are still undergoing prostate–specific antigen (PSA) testing, despite recommendations against this practice. These data are reported in a research letter published in the April 25 issue of JAMA. The US Preventative Services Task Force (USPSTF) issued a grade D recommendation against PSA screening in men 75 years or older in 2008. (Source: Medscape)

For comments and archives

Nomegestrol–estradiol OC effective with good cycle control

A combined oral contraceptive containing nomegestrol acetate and 17beta–estradiol (E2) taken in a 24–4–day regimen is somewhat more effective than an OC containing drospirenone and ethinyl E2 in a 21–7–day regimen, investigators report in the May issue of Obstetrics & Gynecology. "The high contraceptive efficacy of nomegestrol acetate and 17beta–E2 is consistent with the ovarian suppression previously observed and also may be related to the shorter hormone–free interval," the authors comment. The nomegestrol/17beta–E2 OC was approved as Zoely by the European Medicines Agency in 2011. (Source: Medscape)

For comments and archives

FDA: Don’t mix new HCV drug with HIV drugs

The FDA has issued a warning against using boceprevir (Victrelis) and anti–HIV drugs that contain the protease inhibitor ritonavir (Norvir) because of possibly dangerous drug interactions. But the agency cautioned that patients already taking boceprevir and one of the HIV regimens containing ritonavir should not stop their medications without consulting their doctors. Physicians with patients taking boceprevir and any HIV regimen containing ritonavir should monitor them carefully to ensure that: (Source: Medpage Today)

  • Hepatitis C treatment response – defined as no virus detected in the blood – continues.
  • Hepatitis C or HIV virologic rebound –– defined as either virus detected in the blood again after previously being undetectable –– does not occur.

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: #AJD Novel study in TN to know gestational diabetes effects For the first time in the country, 14,000 pregnant… http://fb.me/1TYeL7gtN

@DeepakChopra: When you realize a higher consciousness, how can you maintain the focus of it in your life?

 
    Spiritual Update

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

Low Self Esteem

Low self esteem is opposite of ego. Supportive psychotherapy is often used to treat depression by improving self esteem.

Low self–esteem always occurs when one compares one’s skill or knowledge with somebody else. We often forget that for passing marks, we only need 50%. One who passes with 50% is a good student.

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.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity Hospital, Gurgaon)

How much liver should be left behind with the donor?

At least 35% of the liver is left behind with the donor. CT volumetry is very important to calculate this volume.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

A Dream cannot be sold

Jehdi and Hassan were two merchants who were very close friends. Jehdi was a cheerful person, almost frivolous, whereas Hassan was very serious, perhaps too cautious and careful. But an unbreakable bond of friendship tied them together and this made their journey for business happy, for they never had any dispute.

One time they started together toward the city of Touria. They arrived at the outskirts of a forest where the big trees, moist rocks and cool shade invited them to take a well–deserved rest. Within a minute Jehdi fell asleep. Hassan looked at his friend with a sigh and told himself, "He sleeps peacefully in nature, as if he were in his own house. I am afraid of someone robbing me. Even though the thief might get very little, I am too apprehensive and I prefer to be cautious. After all, one never knows what might happen".

Hassan was ruminating over his anxiety when suddenly he saw a wasp coming out of Jehdi’s left nostril. Its enigmatic dance surprised him. It flew toward a single pine tree standing on a rock, circled the tree 3 times, and then returned to the sleeping Jehdi and disappeared into his right nostril.

Just at that moment Jehdi woke up, sat up laughing and said, "Hassan, you will never believe me. I just had a marvelous dream. Just imagine that there is big pine tree standing on a high rock, exactly like the one you see there. A wasp droned around the trunk and its wings buzzed as if to say, "You must dig in this place, you must dig in this place!" I started digging and I found a big pot full of gold coins. I have never in my life seen so much money…!"

"Yes, truly it is a strange dream," replied Hassan. "If I were in your place, I would have dug around the pine tree there." "My poor friend, how naive you are. I would never take a dream seriously. It is so hot here, to dig would be torture! Please, let us continue our journey."

But Hassan insisted, "Jehdi, a dream like this surely has a meaning. If you do not want to dig, I will try instead. Do you know what I propose to you? Sell your dream to me."

Jehdi began laughing loudly. "This is a good piece of business for me! How much will you pay?" "You have said that there is a big pile of gold coins. I am your friend and I do not want to wrong you. You tell me how much you estimate to be the price of your dream."

After a brief discussion, they agreed to the sum of 300 coins. "Never have I made such a business deal. So much money for a simple dream of no value. How gullible you are, Hassan!"

The 2 friends then went under the pine tree which the wasp had shown in the dream. Jehdi was amused to see Hassan perspiring profusely and breaking his back with the shovel. He continued on until the shovel made a dull sound as if it had struck something hard.

What a surprise for the 2 merchants when they uncovered an earthen pot full of gold coins! Before breaking it, Hassan noted an inscription near the handle: "the first of seven." "The first of 7. That means there should be 6 more pots buried," Jehdi understood, starting to regret the deal he had concluded too quickly.

This time both of them dug with energy and, sure enough, they found the 6 pots, one after another, each one filled to the brim with gold coins. Hassan built a huge inn in the city and named it The Bulging Pot. He lived as a rich and satisfied man until his death.

Jehdi often came to visit him and greeted his friend with the words, "Well, Hassan, how are you? I have come to see what has happened to my dream." And the 2 comrades patted each other on the back laughing. But every time Jehdi returned home sadder, for he knew that he could never buy back his dream.

For comments and archives

 
    Cardiology eMedinewS

ACE Inhibitors better ARBs in New Meta–Analysis in Hypertensives
Read More

PET/CT Helps Diagnose Cardiac Device Infection Read More

Atrial Fibrillation Should Be Surgically Treated When Performing Cardiac Surgery, Study Suggests Read More

 
    Pediatric eMedinewS

Use of CT for Pediatric Abdominal Pain Growing Rapidly Read More

Long–Term Negative Impact on Child IQ with Valproate Read More

CONFIRM: Second Positive Trial for BG–12 in MS Read More

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    IJCP Special

Dr Good Dr Bad

Situation: A patient presented with sub–clinical 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.

For comments and archives

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.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. I have a private hospital in Punjab. A woman was treated. A person claiming to be her husband has sent us an application under the RTI Act to get her treatment record. What should we do?

Ans.

  1. The applicability of RTI Act to private hospitals is doubtful, especially if the hospital has not taken any aid from the government. However, there is a Punjab judgment that RTI Act ia applicable to private hospitals.
  2. The treatment record of a patient is personal to him and cannot be revealed even to spouse or parents without his permission. If he sues you for breach of confidentiality, you will have no defence.
  3. According to a provision in the RTI Act, you should get a no objection certificate from the party concerned if a third party asks for record.
  4. SUMMARY—You should supply the record only to the patient or to someone authorised by her under her signature.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

The most valuable thing you can make is a mistake – you can’t learn anything from being perfect. Adam Osborne

 
  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Allergies are hypersensitivities, overreactions of the immune system to substances that do not cause reactions in most people.

Allergen specific IgE testing: Immunoassay and LINE BLOT TESTS are blood tests that are used to screen for type I allergen–specific IgE antibodies.

 
  Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity)

Management of accidental exposure to contaminated blood/OPIM

First step in management of accidental exposure to blood/OPIM is to determine the seriousness of the exposure, which will depend on type of exposure, disease status of source patient and duration of exposure. Second step is the immediate care of the site, third step is timely administration of post exposure prophylaxis (PEP) and fourth is lab testing to know the infection status of the healthcare workers (HCWs) at the time of exposure and finally to ensure that no transmission of blood–borne viruses has occurred after the accidental exposure to blood/OPIM. We will discuss these one at a time.

Types of accidental exposures amongst HCWs:

  • Needle stick injury
  • Cuts from other sharps
  • Contact of eye, nose, mouth or skin (intact/non–intact) with blood/OPIM

It is extremely important to keep in mind that most exposures do not result in infection and so do not require PEP. We need to determine whether the exposure is mild, moderate or severe taking into account the following factors:

  • Amount of blood involved in the exposure
  • Amount of virus in the patient’s blood
  • Duration of contact with blood/OPIM
  • Stage of disease (e. g. HIV–infection stage) and condition of the patient; and
  • Type of exposure (abrasion, penetration, injection, splash on skin/mucosal surface)

For comments and archives

 
    Mind Teaser

Read this…………………

What is a healthy blood–pressure level?

A. 110/70
B. 125/85
C. 135/90
D. 140/95
E. 150/95

Yesterday’s Mind Teaser: Which of the following is not a good approach to managing stress?

A. Talking directly to the person who is causing the stress.
B. Giving yourself a treat, like comfort food or a cocktail.
C. Accepting that there are things beyond your control.
D. Trying cognitive–behavioral therapy to learn new coping skills.
E. Working out regularly.

Answer for yesterday’s Mind Teaser: B. Giving yourself a treat, like comfort food or a cocktail.

Correct answers received from: Dr Prabha Sanghi, Kanta Jain, yJ Vasavada, Dr Sushma Chawla, Muthumperumal Thirumalpillai, Dr Sushma Chawla, Dr Chandresh Jardosh, Dr Jainendra Upadhyay,
Dr Valluri Ramarao, Dr Avtar Krishan.

Answer for 30th April Mind Teaser: E. All of the above and more.

Correct answers received from: Anil Bairaria, Bindu Bajaj, Dr Sushma Chawla.

Send your answer to ijcp12@gmail.com

For comments and archives

 
    Laugh a While

(Dr GM Singh)

Classes for women…

Training courses are now available for women on the following subjects:

  • Topic 1. Silence, the Final Frontier: Where No Woman Has Gone Before
  • Topic 2. The Undiscovered Side of Banking: Making Deposits
  • Topic 3. Parties: Going Without New Outfits
  • Topic 4. Bathroom Etiquette: Men Need Space in the Bathroom Cabinet Too
  • Topic 5. Communication Skills I: Tears – The Last Resort, not the First
  • Topic 6. Communication Skills II: Getting What you Want Without Nagging
  • Topic 7. Driving a Car Safely: A Skill You CAN Acquire
  • Topic 8. Telephone Skills: How to Hang Up
  • Topic 9. Advanced Parking: Backing Into a Space
  • Topic 10. Cooking III: How not to Inflict Your Diets on Other People
  • Topic 11. Classic Footwear: Wearing Shoes You Already Have
  • Topic 12. Oil and Petrol: Your Car Needs Both
 
    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)

World Asthma Day celebrated – All that wheezes is not Asthma

"All that wheezes is not asthma and all asthmatics do not wheeze", said Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India on the occasion of World Asthma Day falling on 1st May, 2012.

Dr. Aggarwal said that all asthmatics should keep their asthma under control to live a better quality of life. He said that two formulas can help in this regard:

  1. Formula of 2 tells whether a person needs continuous treatment or only when an asthma attack comes. As per formula of 2, if a person needs asthma drugs more than twice a week during day time, more than twice in a month during night or consumes more than two inhalers in a year, then the person requires treatment of asthma on continuous basis and is said to have persistent asthma otherwise a person can take asthma treatment on or as and when required basis.
  2. The second formula is – how a person speaks during asthma attack. This can decide the severity of asthma. If a person is able to speak full sentence during asthma attack, he is suffering from mild asthma and can be treated as an outpatient. But, if the person breaks a sentence during an attack of asthma then he is suffering from moderate asthma and requires hospitalization and aggressive treatment.

    On the contrary, if a person breaks every word which he speaks during an attack of asthma, he is suffering from severe asthma and invariably the patient requires hospitalization and intensive care.
 
    Readers Responses
  1. Sir, I am quite impressed by the new column started in emedinews How I treat… by Dr. Anupama Jaggia, Chairperson and Hony. Consultant, Dept. of Clinical Hematology, Sir Ganga Ram Hospital, New Delhi). I particularly want to point out one of the commonest problem of B12 deficiency seen in day to day practice but still is not treated well despite having acquired so much of knowledge. I think the knowledge should be distilled in Clinical wisdom as it has been done in the present column of ‘How I treat’ by avoiding too much medical jargon and un–necessary information. Thanks a lot. Keep publishing from various experts across all specialities. With regards, Dr Jitendra Ingole.
 
    Forthcoming Events
Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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    Our Contributors

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