emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
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 (07–08); 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

  Editorial ...

2nd November 2010, Tuesday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

2011 Immunization Schedules: CDC panel recommends changes

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) has approved several changes in the 2011 immunization charts for both children and adults. The changes are scheduled to be published in the February issue of the CDC's Morbidity and Mortality Weekly Report (MMWR).

Children: Recommended changes
 
The 2011 schedule incorporates four changes for 0-6 year age group: 

  • Revision of wording regarding a sidebar: the sidebar currently states "recommended ranges for all children except certain high-risk groups." The words "except certain high-risk groups," were added by mistake and will be deleted from the 2011 child charts.
  • Added guidance on the hepatitis B vaccine schedule for children who did not receive a birth dose: such infants should receive 3 doses of HepB on a schedule of 0, 1, and 6 months; the final (3rd or 4th) dose in the HepB series should be administered no earlier than age 24 weeks. 
  • Added information on the use of 13-valent pneumococcal conjugate vaccine (PCV13), and
  • Guidance on administration of 1 or 2 doses of influenza vaccine based on the child's history of H1N1 influenza infection: children aged 6 months through 8 years who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010-2011 seasonal influenza vaccine.

The changes for ages 7 through 18 years would be similar to those for 0 through 6 years age group; it would also include the addition of the word "female" (already included in the adult chart) to the human papillomavirus (HPV) vaccine recommendation
 
Adults: Recommended changes
 
For adults, the modifications include inclusion of the universal influenza vaccination recommendation as a footnote, a reordered list of vaccines so that all universally recommended vaccines are listed together (i.e., influenza, Td/Tdap, varicella, HPV, and herpes zoster), and a revised Td/Tdap row denoting new expanded age recommendation.
 
Many changes have been done in existing footnotes, including removing language regarding the interval between Td and Tdap vaccinations and use of Tdap in people older than 65 years, clarification of language regarding revaccination with PPSV ("ages 19-64 years" added), consolidated language regarding measles, mumps, rubella (MMR) vaccination, and a description of the meningococcal vaccine as being quadrivalent.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

 Medico Masti Infotainment 

Medico Masti an inter college festival of the Perfect Health Mela is a great hit with the public and students each year.

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Screening for lung cancer

In a randomized trial involving over 3,000 individuals at high risk for lung cancer, the cumulative probability of a false positive finding after two rounds of annual screening by low–dose CT was 33 percent and after two annual chest x–rays was 15 percent. Seven percent of CT screening participants underwent at least one invasive procedure (usually bronchoscopy) as a result of a false positive finding.

(Ref: Croswell JM, et al. Cumulative incidence of false–positive test results in lung cancer screening: a randomized trial. Ann Intern Med 2010;152:505).

  National News

Certificate courses in 2D and 3D Echocardiography/ Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

NCDC to become apex institute

The National Centre for Disease Control (NCDC)—formerly known as the National Institute of Communicable Diseases (NICD) – is all set to become the apex institute for communicable diseases on a par with the Centers for Disease Control and Prevention (CDC), Atlanta, U.S. The Rs. 382.41–crore proposal has received inter-ministerial approval and the Ministry of Health and Family Welfare has prepared a note for Cabinet approval. The revamped institute will be able to tackle threats of bio–terrorism and respond to public health emergencies of international concern. (Source: The Hindu)

India to get its first AC double–decker train

India’s first air–conditioned double–decker train is expected to be launched on the Howrah–Dhanbad sector before the Diwali celebrations. While a few old double–decker coaches are still operational on the Mumbai–Surat route currently, the new coaches that are built with a "crashworthy design" will also have state–of–the–art facilities for passenger comfort. Developed at the Rail Coach Factory in Kapurthala, eight double–decker coaches were recently brought to Howrah for conducting trial runs before the official flagging-off ceremony. (Source: The Hindu)

Jabalpur Obs/Gyn Society dedicates 31st Oct as FETUS DAY

Jabalpur ob/gy society dedicated 31st Oct as ‘Fetus Day’ with an objective to reduce fetal genetic defects and to treat fetus as a separate patient. This is an appeal to all to always celebrate this day as a Fetus Day. Dr Swaraj Naik, President Jabalpur ob/gy society.

Spurt in chikungunya cases in Delhi

Chikungunya cases are on a rise in the city with health agencies reporting more than 1000 cases in the last 20 days. "Our records show only 33 cases of Chikunguya as most hospitals are not reporting such cases. But after talking to doctors and hospitals on a regular basis we can say that more than  1000 cases have been reported in the past 20 days," V K Monga, MCD's Public Health Committee Chairman, said. Chikungunya is spread by the the Aedes aegypti mosquito. The symptoms of chikungunya are almost like dengue -high fever, rashes, drop in platelets - but the distinguishing symptom is acute joint pain. "There are no vaccines for the disease and it is treated with painkillers and fluids," Monga said. (Source: The Hindustan Times)

Tiger losing way in jungle of dubious economic development

Sometime this November, the Government is expected to release the new tiger population figure. With the apprehension that it could be lower than the currently adopted official number of 1,411 tigers — in itself arrived at following an estimation way back in 2006-07 by the Wildlife Institute of India — experts believe the official campaign to save the striped cats has been hit in recent years. This is primarily due to a shift in focus from habitat recovery and strengthening ground protection forces to questionable eco-development activities within the forest areas. Except in the first few years after the Central Government launched Project Tiger in the early 70s, when the tiger number went up to more than 3,000 from a low of 1,200 or so, the tiger population has consistently plunged despite various efforts taken to address the issue. (Source: The Pioneer)

  International News

(Dr Monica and Brahm Vasudev)

Extending zoledronic acid regimen maintains bone density

Findings from a study of more than 1000 patients show that those who continued annual treatment with zoledronic acid for 6 years had significantly better bone mineral density and fewer morphometric vertebral fractures as compared to patients who received treatment for 3 years and then stopped taking the drug. The treatment was also safe. The study was presented by Dennis M. Black, Ph.D., professor of epidemiology and biostatistics at the University of California, San Francisco at the annual meeting of the American Society for Bone and Mineral Research.

ACIP adds meningococcal vaccine booster dose at age 16 years

A booster dose of meningococcal conjugate vaccine should be given to adolescents at 16 years old if they received a first dose at age 11–12 years, and a booster should be given 5 years after the first dose – up to age 21 years — to those who first received the vaccine at age 13-15 years. That was the vote of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention on Oct. 27th, but it was not unanimous. The panel was split 6 to 5, with 3 abstentions. Following that vote, ACIP also voted to include the booster dose under the federal Vaccines for Children program. The CDC usually adopts the ACIP’s recommendations but is not obligated to do so.

In 2007, quadrivalent meningococcal conjugate vaccine (MCV4), was recommended for 11– to 12–year–olds at the established preteen visit, and to 13– to 18–year–olds who had not been previously vaccinated. Recent data however suggest that immunity from the vaccine wanes within 5 years after vaccination, thereby possibly failing to protect those at highest risk, particularly college students living in dorms, according to Dr. Amanda Cohn of the CDC's National Center for Immunization and Respiratory Diseases (NCIRD).

Legius syndrome may be incorrectly identified as neurofibromatosis type 1

Legius syndrome can be easily misdiagnosed as neurofibromatosis type 1 (NF1). First described only 3 years ago, by Dr. Eric Legius and coworkers at the Catholic University of Leuven (Belgium), the hallmarks of Legius syndrome include multiple café au lait macules, axillary freckling, and autosomal dominant transmission, all of which are also among the NF1 diagnostic criteria established by the National Institutes of Health. However, bone lesions, plexiform or cutaneous neurofibromas, Lisch nodules in the iris, and nervous system tumors, which are the other typical lesions of NF1 are not found in patients with Legius syndrome. Legius syndrome, unlike NF1, does not carry an increased cancer risk. (Dr. Sirkku Peltonen at Annual Congress of the European Academy of Dermatology and Venereology).

Elderly more likely to die from H1N1 influenza

According to the results of a retrospective analysis, mortality rates from H1N1 influenza show a J–shaped curve, with those aged 70 years and older having the greatest risk for death. The study is published online November 12 in The Lancet.

  Gastro Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

What is the significance of ANCA and ASCA antibodies?

Perinuclear anti–neutrophil cytoplasmic(ANCA) antibody is positively associated with UC and anti–Saccharomyces cerevisiae (ASCA) antibody with CD, but the diagnostic sensitivity of these serological markers only ranges between 60% and 80%, so they are of limited clinical use.

  Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How do fertility treatment and the resulting birth of a child affect the possibility of conceiving again, either, with or without treatment?

I don’t identify the answer to this, but I visualize it depends on what the initial analysis was. If the original problem was blocked tubes that were repaired, chances are they will be fine the next time around. However, if the cause was male factor that required ICSI, chances are ICSI will be required the next time around, too.

(For queries contact: banerjee.kaberi@gmail.com)

  Interesting Website to know

Dr Jitendra Ingole, MD Internal Medicine, Asst Professor (Medicine), SKN Medical College, Pune

JagoInvestor

www.jagoinvestor.com
Web site providing personal financial articles in very simple language and busting many of our common myths… Giving self–explanatory details with real life examples for good understanding—it covers almost all aspects of personal finance.

  Medicolegal Update

Dr Sudhir Gupta, Asso. Professor, Forensic Medicine & Toxicology, AIIMS

What are ethanol and isopropanol?

Ethanol is ethyl alcohol or grain alcohol and isopropanol is isopropyl alcohol or rubbing alcohol.

  • When people talk about alcohol it usually means ethanol. Alcoholic drinks beers, wines and spirits contain ethanol. Methylated spirit and surgical spirit contain mainly ethanol, with a small amount of methanol. Ethanol is also an ingredient of some liquid medicines, mouthwashes, antiseptics, disinfectants, and cosmetics such as aftershaves, perfumes, and colognes. Alcohol abuse is common and chronic abuse can lead to dependence. People who try to poison themselves by taking large doses of medicine often take alcohol at the same time. Ethanol content of drinks and other products: Distilled spirits 40–50%; Wines 10–20%; Beers 2–10%; Mouthwashes up to 75% and Colognes 40–60%.
  • Isopropanol is used as a sterilizing agent and as rubbing alcohol, and is added to some antifreeze, car windscreen washes, window cleaners, aftershaves and disinfectants. Car windscreen washes may also contain methanol.
  Medi Finance Update

Exclusions

Convalescence, general debility, ‘Run–down’ condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional selfinjury and use of intoxicating drugs/alcohol.
1.9 All expenses arising out of any condition directly/indirectly caused to/associated with human T–cell lymph tropic virus type III (HTD–III) or lymphadinopathy associated virus (LAV) or the mutant’s derivative or the mutants derivative or variations deficiency syndrome or any (HTBB–III) syndrome or condition of similar kind commonly referred to as AIDS.

  Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combination of any anthelmintic with cathartic/purgative except for piperazine/Santonim

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Cardiolipin Antibodies (IgG and IgM)

  • To help determine the cause of an unexplained thrombotic episode, recurrent miscarriage, or thrombocytopenia
  • To help investigate the cause of a prolonged PTT (activated partial thromboplastin time), along with lupus anticoagulant testing, especially if clinical findings suggest that the patient may have SLE or another autoimmune disorder
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  IJCP Special

Dr Good Dr Bad

Situation: A patient with painful diabetic neuropathy came with postural hypotension.
Dr Bad: The two are unrelated conditions.
Dr Good: It is due to autonomic dysfunction.
Lesson: Painful diabetic neuropathy is associated with significantly greater autonomic dysfunction than painless diabetic neuropathy. The greater autonomic dysfunction seen in painful diabetic peripheral neuropathy (DPN) may reflect more predominant small fiber involvement and also adds to the growing evidence of its role in the pathophysiology of painful DPN.

Make Sure

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necrosis at injection site.
Reaction: Oh my God! Why didn't you observe the IV site carefully?
Lesson: Make sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasations of calcium can produce severe interstitial necrosis.

Quote of the Day (Dr Jitendra Ingole)

"Time decides whom we meet in life. Our heart decides whom we want in life. But our behaviour decides who will stay in our life."

Mind Teaser

Read this…………………

hahandnd  

Answer for yesterday’s Mind Teaser: "Out in the middle of nowhere"

Correct answers received from: Dr  Muthumperumal Thirumalpillai, Col (Dr) Narendra Kotwal, Dr Sudha Nayyar,  Dr.Susheela Gupta, Dr. Suman Kumar Sinha.

Answer for 1st November Mind Teaser: "Splitting headache"
Correct answers received from: Dr Virender Prakash Gautam, Dr.G.Padmanabhan, Dr. Vishanji Karani, Dr U Gaur, Dr S. Upadhyaya., Dr. Naorem Sharat, Dr Ajmer Singh, Dr MK Bhandari, Dr.KP Rajalakshmi, Dr Aditya Rattan, Dr.RK Goel.

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)

A waiter suddenly became ill and was rushed to the hospital emergency room. He was lying on the operation table in great pain when he saw an intern walk by. "Doctor, you have to help me," the waiter pleaded. "Sorry," the intern said. "This isn’t my table."

An Inspirational Story

Admitting Flaws

In the mid–1980’s researchers at Cleveland State University made a startling discovery.
They conducted an experiment by creating two fictitious job candidates David and John. The candidates had identical resumes and letters of reference. The only difference was that John’s letter included the sentence "Sometimes, John can be difficult to get along with". They showed the resumes to a number of personnel directors. Which candidate did the personnel directors overwhelmingly prefer? Difficult to get along with, John.
The researchers concluded the criticism of John made praise of John more believable. Admitting John’s wart actually helped sell John. Admitting flaws gives you more credibility. A key to selling.

  Readers Responses
  1. Dearest brother Dr. KK, splendid Effort and achievement for holding SUCH A GREAT SHOW…God bless you. I always feel PROUD of you. Regards: Dr. NK Bhatia, President, Mission Jan Jagriti (An NGO for Empowerment of Youth)  & Medical Director, Rotary Noida Blood Bank, Noida
  2. FAST Scan vs Peritoneal Lavage: In Blunt Trauma cases, FAST (Focused Assessment by Sonology in Trauma) scan for abdomen is the gold investigation and is being practiced by many emergency physicians across India for last five years.
    It is better and highly sensitive for picking up free fluid like blood without being invasive like peritoneal lavage and thus harmless.  Only if your setup is not having an ultrasound machine or lack of expertise (which is now getting unacceptable in the developed world) one shall consider the peritoneal lavage.One can learn FAST scan in just one day course. Dr Vivek Chhabra, Faculty & Instructor ATLS, Specialty Emergency Physician, James Paget University Hospital, Gr Yarmouth, Norfolk, UK.
  Public Forum

(Press Release for use by the newspapers)

Level of awareness on rise in Delhi

Over the last decade, the health awareness level of people has increased by over 100%. These were the findings of a health survey conducted by Heart Care Foundation of India during the recently concluded 17th MTNL Perfect Health Mela. Giving the details, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India said that over a period of ten days, 30-40.people were interviewed every day randomly from across the visitors visiting the health Mela, total 377 persons.

Seventeen years back, when the 1st PHM level of awareness was less than 10%, the same varied from 50-80% in the current Mela. Following were the results:

a. 80% people rightly answered that fruits are better than fruit juices.
b. 75% people knew that trans fats are bad for the heart.
c. 67% people knew that foods which are bitter in taste and green have anti-diabetic properties.
d. 64% people knew that foods of plant in origin have no cholesterol.
e. 62% people knew that soya has no cholesterol.
f. 62%  people knew that proteins provide 4 calorie/gram.
g. 61% people knew that unsaturated fat is liquid at room temperature.
h. 46% people knew that saturated food is solid at room temperature.
i. 56% people knew that fats provide 9 calories/gm.
j  50% people knew that carbohydrates provide 4 cal/gm

Though the level of awareness has increased but the implementation was still less than 50%. Most were aware that fruits were better than fruit juices but when given an option, they still opted for fruit
juices.

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

November 29, 2010, Monday, 9 AM – 1PM, Moolchand Medcity – “Update on Kidney Transplant”. No Fee. Entry by Invitation.  Contact: emedinews@gmail.com
 
eMedinewS Revisiting 2010

The 2nd eMedinewS  - revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08-09, 2011.

January 08, 2011, Saturday, 6PM – 9PM – Grand Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6PM – 2nd eMedinewS revisiting 2010, A Medical Update

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