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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 ...

3rd November 2010, Wednesday

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

All about Forgetfulness

How can one tell whether the memory lapses are within the scope of normal aging or are a symptom of something more serious? Unless memory loss is extreme and persistent — it is not considered indicator of Alzheimer’s or other memory-impairing illnesses. Seven normal memory problems as reported by HEALTHbeat (Harvard)

  1. Transience: This is the tendency to forget facts or events over time. One is most likely to forget information soon learning. Memory has a use-it-or-lose-it quality: memories that are called up and used frequently are least likely to be forgotten. Brain scientists regard it as beneficial as it clears the brain of unused memories, making way for newer, more useful ones.
  2. Absentmindedness: This occurs when one does not pay close enough attention. One forgets where one has just put the pen because one does not focus on where one put it in the first place. One is thinking of something else so the brain didn’t encode the information securely. Absentmindedness also involves forgetting to do something at a prescribed time, like taking the medicine or keeping an appointment.
  3. Blocking: Someone asks a question and the answer is right on the tip of your tongue - you know that you know it, but you just can’t think of it. This is perhaps the most familiar example of blocking, the temporary inability to retrieve a memory. A common example is calling your older son by your younger son’s name, or vice versa. Research shows that people are able to retrieve about half of the blocked memories within just a minute.
  4. Misattribution: Misattribution occurs when you remember something accurately in part, but misattribute some detail, like the time, place, or person involved. Another kind of misattribution occurs when you believe a thought you had was totally original when, in fact, it came from something you had previously read or heard but had forgotten about. This sort of misattribution explains cases of unintentional plagiarism, in which a writer passes off some information as original when he or she actually read it somewhere before. Misattribution becomes more common with age. As you age, you absorb fewer details when acquiring information because you have somewhat more trouble concentrating and processing information rapidly. Also as you grow older, your memories grow older as well. And old memories are especially prone to misattribution.
  5. Suggestibility: Suggestibility is the vulnerability of the memory to the power of suggestion - information that you learn about an occurrence after the fact becomes incorporated into your memory of the incident, even though you did not experience these details.
  6. Bias: Even the sharpest memory isn’t a flawless snapshot of reality. In your memory, your perceptions are filtered by your personal biases — experiences, beliefs, prior knowledge, and even your mood at the moment. Your biases affect your perceptions and experiences when they’re being encoded in your brain. And when you retrieve a memory, your mood and other biases at that moment can influence what information you actually recall.
  7. Persistence: Most people worry about forgetting things. But in some cases people are tormented by memories they wish they could forget, but can’t. The persistence of memories of traumatic events, negative feelings, and ongoing fears is another form of memory problem. People suffering from depression are particularly prone to having persistent, disturbing memories. So are people with post-traumatic stress disorder (PTSD). PTSD can result from many different forms of traumatic exposure; for example, sexual abuse or wartime experiences. Flashbacks, which are persistent, intrusive memories of the traumatic event, are a core feature of PTSD.
Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

 Heritage – Festival of Classical Dances

Students from Dancing Schools from Delhi and NCR participated in large numbers in Bharatnatayam group competition organized in the 17th MTNL Perfect Health Mela 2010.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Goal blood pressure in diabetes and CVD

The new target blood pressure goal is 140/90 mmHg in patients with diabetes mellitus and/or cardiovascular disease.

  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

Ketamine to be sold only with prescription

Anesthetic drug Ketamine will no longer be available ‘over the counter’ in India and can be obtained only with a prescription in duplicate. Chemists will have to retain the duplicate prescription for two years. In a drug consultative committee meeting last week, the Drug Controller General of India (DCGI) shifted Ketamine from Schedule H to Schedule X, for which special control measures will have to be taken. (Source: Indian Express)

DCGI go-ahead for stem cell trials

The Indian Spinal Injuries Centre has got a go–ahead from the government to carry human trials using bone marrow transplantation in patients suffering from acute spinal cord injury. "We have received the nod of the Drug Controller General of India (DCGI) to carry out phase II trials using autologous bone marrow transplant in acute spinal cord injury patients," said Dr HS Chabbra, chief of spine surgeries and medical director at ISIC. Stem cells are taken from the patient and harvested outside the body and then infused into the spinal cord. The patient gets his stem cells back. "We will carry out the study on 30 patients, who have been divided into three groups," he said. For the first group, researchers will inject the cells harvested from the bone marrow in the fluid around the spine, in the second, they will inject the cells into the spine and third will be the control group. (Source: The Hindustan Times)

  International News

(Dr Monica and Brahm Vasudev)

Gene variants tied to poor outcomes with heart drug

Heart patients taking clopidogrel are at increased risk for serious cardiovascular problems if they have 1 or 2 copies of a common gene variant. The clot-busting clopidogrel is often prescribed for people at risk for heart attack or stroke. The drug is also used to prevent clot-related complications after coronary stenting. Recent studies suggest that it's less effective in people who have specific variants of the CYP2C19 gene.

A new injectable antibiotic for bacterial infections

FDA has given its nod to Ceftaroline fosamil (Teflaro), an injectable cephalosporin antibiotic to treat adults with community–acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI), including methicillin–resistant Staphylococcus aureus (MRSA). Teflaro is a cephalosporin antibiotic, which acts by interfering with the bacterial cell wall.

Serum potassium may independently predict incident type 2 diabetes

Results from the Atherosclerosis Risk in Communities (ARIC) Study state that serum potassium level is an independent predictor of incident type 2 diabetes mellitus. According to Ranee Chatterjee, MD, MPH, from the Johns Hopkins University in Baltimore, Maryland, and coreserachers, serum potassium levels affect insulin secretion by pancreatic β–cells, and hypokalemia associated with diuretic use has been associated with dysglycemia. The study is reported in the October 25 issue of the Archives of Internal Medicine. ARIC is an ongoing, prospective cohort study initiated in 1986. The investigators analyzed data from 12,209 participants enrolled in ARIC who had 9 years of in–person follow–up and 17 years of telephone follow–up.

Waist–to–height ratio may predict cardiometabolic risk in normal–weight children

The waist–to–height ratio (WHtR) may foretell cardiometabolic risk in normal–weight and in overweight/obese children, according to results from the Bogalusa Heart Study reported in the October 11 issue of BMC Pediatrics. The Bogalusa Heart Study is a biracial (black and white), community–based study of the natural history of cardiovascular disease from childhood.

Sandoz recalls methotrexate vials that may contain glass flakes

Sandoz has announced that it is withdrawing a total of 24 lots of 50 mg/2 mL and 250 mg/10 mL methotrexate injection sold under the Sandoz and Parenta brands after discovering glass flakes in some vials of the product. Depending on the type of parenteral injection different types of adverse events, some life-threatening, may occur if glass–contaminated methotrexate was used for a patient.

  • Intravenous administration: Risk of local damage to blood vessels in the lungs, localized swelling, and the development of granulomas.
  • Intramuscular administration: Foreign–body inflammatory reaction may occur, with local pain, swelling, and possible long–term granuloma formulation.
  • Intrathecal administration: Neurologic damage.
  • Intra-arterial administration: Glass–contaminated methotrexate could damage blood vessels in distal extremities or organs.
  Gastro Update

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

How is a case of IBD diagnosed?

Role of Upper GI Endoscopy and Colonoscopy

  • Ideally, all children suspected of having IBD should have upper and lower GI endoscopy preferably with intubation of terminal ileum and multiple biopsies from all of the segments in the upper (oesophagus, stomach, duodenum) and lower intestinal tract (ileum, cecum, ascending colon, transverse colon, descending colon, sigmoid, and rectum) for histological diagnosis.
  • Barium meal and follow–through should be performed in all children who may have Crohn’s disease to evaluate involvement of the small bowel.
  • A full colonoscopy is advisable as unlike adults, > 90% of children with ulcerative colitis (UC) have a pancolitis.
  • Sigmoidoscopy does not have a role except in severe UC where the risk of bowel perforation is higher. Histology of terminal ileal biopsies may help to exclude other diagnoses (e.g, TB, Behcet syndrome, lymphoma, vasculitis) as well as assess the extent of IBD, and in children from a population at high risk for TB, tissue should be sent for TB culture.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What advice do you have for young women to prevent possible future fertility problems?

Sexually transmitted diseases (STDs) can be a major cause of future infertility; therefore young women should ALWAYS have protected sex. Also, women should consult with their Ob/Gyns if they have irregular menstrual cycles or have painful periods or ovulation. If your doctor is dismissive and does not offer to find a cause and solution to your problems, find a physician who will. Unfortunately, the biggest barrier to conception for many couples is an Ob/gyn who is unfamiliar with the latest technology to treat the causes of infertility even though the woman may not presently be trying to conceive.

  Pediatric Update: Question of the day

For how long a patient with Henoch Schonlein purpura should be followed up? (Dr Sujata Sawhney)

Henoch Schonlein purpura is the most common vasculitis of childhood. It is characterized by a triad of non–thrombocytopenic purpura, abdominal pain and arthritis. It occurs most frequently between the ages 3–15 years and is rare in children below two years of age. Renal involvement can occur in up to one–third children but it is serious and life threatening only in 10%. The renal disease may not occur at onset but can occur up to a month after the rash is first seen. Age of onset of HSP more than seven years, persistent purpura and severe abdominal symptoms are risk factors for developing nephritis. The initial three months are critical in determining the eventual extent of the disease. In two–thirds of children, HSP runs it entire course within four weeks of the disease onset. One third of children may have a recurrence within six weeks or rarely up to two years.

Children with a single episode of HSP must have careful urine examination and clinical review for three months from the onset of disease. If the disease recurs, then the follow up would need to be done on an individual basis.

  Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is ethanol and isopropanol poisoning?

The effect of a dose of ethanol depends on how much alcohol a person regularly drinks

The effect of a dose of ethanol depends on how much alcohol a person regularly drinks. Someone who does not usually drink much alcohol may be badly affected by an amount that would otherwise have very little effect on a person who regularly drinks large amounts. Children may suffer severe poisoning after drinking just a mouthful of aftershave, mouthwash or perfume. Isopropanol is more poisonous than ethanol. Serious poisoning can be caused by using isopropanol as rubbing alcohol, if large amounts are rubbed on the skin and absorbed into the body. Both ethanol and isopropanol slow down the brain, causing unconsciousness and shallow breathing. Isopropanol vapor is irritant to eyes, nose and throat and poisonous, if inhaled. Regularly drinking large amounts of ethanol causes chronic poisoning, resulting in many changes in the body, particularly in the brain, the liver, and the heart.

Signs and symptoms of acute poisoning if swallowed:

  • The patient’s clothes and breath may smell of alcohol; patients who have swallowed isopropanol smell of acetone
  • Slurred speech – difficulty in performing simple tasks, staggering walk, – nausea, vomiting, and abdominal pain which are more severe after swallowing isopropanol – drowsiness– blurred or double vision– unconsciousness – fits
  Medi Finance Update

Money Market Funds

Bond funds typically invest in bonds issued by governments and large companies. Bond fund returns are based on a combination of interest payments and price changes of the bonds in the fund.
The market value of bonds is affected by prevailing interest rates. When interest rates fall, existing bonds will generally rise in value; when interest rates rise, bonds will generally fall in value. Overall, bond funds are affected in the same way.

  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 Salbutamol or any other drug having primarily bronchodilatory activity with centrally–acting anti–tussive and/or antihistamine.

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Antidiuretic hormone

  • To help detect, diagnose, and determine the cause of antidiuretic hormone (ADH) deficiency or excess
  • To investigate low blood sodium levels (hyponatremia)
  • To distinguish between the two types of diabetes insipidus
  IJCP Special

Dr Good Dr Bad

Situation: A female with rheumatoid arthritis became pregnant while taking Leflunomide.
Dr. Bad: You can continue to take it.
Dr. Good: Stop it immediately.
Lesson: In women with rheumatoid arthritis who become pregnant while taking leflunomide, healthy pregnancy outcomes usually occur, if the drug is discontinued at the earliest and a cholestyramine drug elimination procedure is done. (Arthritis Rheum 2010;62:1494)

Make Sure

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengue.

Quote of the Day (Dr GM Singh)

"Real glory springs from the silent conquest of ourselves." Joseph P. Thompson

Mind Teaser

Read this…………………


Answer for yesterday’s Mind Teaser: "Hand in hand"

Correct answers received from: Dr. Joshi Sachin, Dr. Sudipto Samaddar, Dr. Supadhyaya, Dr. Susheela Gupta, Dr. Rohini, Dr. RK Goel, Dr. Kalpana Mohan, Dr. Chandresh Jardosh, Dr. Virender Prakash Gautam, Dr. Mamta Sharma, Dr. KP Rajalakshmi, Dr. Neelam Nath, Dr. Muthumperumal Thirumalpillai, Dr Deepti Katyal Uppal, Dr K Raju, Dr Manjesha, Dr Ajmer Singh, Dr Rashmi Chhibber, Dr Neena Sablok, Dr. Suman Kumar Sinha, Dr K V Sarma, Dr Avdhesh Shukla, Dr Prashant Bharadwaj, Dr Prabha Sanghi.

Answer for 1st November Mind Teaser: "Out in the middle of nowhere"
Correct answers received from: Dr. Neelam Nath, Dr. Sukanta Sen, Dr. Vijay Kansal, Dr. Virender Prakash Gautam, Dr. K Raju, Dr. Marak, Dr. Satish Gunawant

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)

A newly married husband saved his wife's mobile number on his mobile as "My life"
After one year of marriage he changed the number to "My Wife"
After 2 years of marriage he changed the number to "Home"
After 5 years of marriage he changed the number to "Hitler"
After 10 years of marriage he changed the number to "Wrong Number"

An Inspirational Story

(For Soul Dr Muthumperumal Thirumalpillai)

A Jury to be proud of

I arrived at the address where someone had requested a taxi. I honked but no one came out. I honked again, nothing. So I walked to the door and knocked. 'Just a minute', answered a frail, elderly voice. I could hear something being dragged across the floor.

After a long pause, the door opened. A small woman in her 90s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, any knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware. 'Would you carry my bag out to the car?' she said. I took the suitcase to the cab, and then returned to assist the woman. She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness. 'It's nothing', I told her. 'I just try to treat my passengers the way I would want my mother treated'. 'Oh, you're such a good boy', she said. When we got in the cab, she gave me an address, and then asked, 'Could you drive through downtown?'

'It's not the shortest way,' I answered quickly. 'Oh, I don't mind,' she said. 'I'm in no hurry. I'm on my way to a hospice'. I looked in the rear-view mirror. Her eyes were glistening. 'I don't have any family left,' she continued. 'The doctor says I don't have very long.' I quietly reached over and shut off the meter. 'What route would you like me to take?' I asked. For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator.

We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl. Sometimes she'd ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing.

As the first hint of sun was creasing the horizon, she suddenly said, 'I'm tired. Let's go now. We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair. 'How much do I owe you?' she asked, reaching into her purse. 'Nothing,' I said. 'You have to make a living,' she answered. There are other passengers,' I responded. Almost without thinking, I bent and gave her a hug. She held onto me tightly. 'You gave an old woman a little moment of joy,' she said. 'Thank you.'

I squeezed her hand, and then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life. I didn't pick up any more passengers that shift. I drove aimlessly lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?

On a quick review, I don't think that I have done anything more important in my life. We're conditioned to think that our lives revolve around great moments. But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

People may not remember exactly what you did, or what you said, But they will always remember how you made them feel.

  Readers Responses
  1. This is context to MAKE SURE. In a blunt injury/trauma, we prefer an ultrasound abdomen as it gives the slightest fluid if present in paracolic gutters, pelvis & Morrison’s pouch. A moderate or massive fluid is always aspirated there and then to confirm hemorrhage. This is a time saving, non-invasive procedure without any complications. Regards: Dr. Dibendujoy Verma, Director, Sooryavansham Consulting Solutions, Express Lane, Suite H6170, Sarasota, FL 34238, USA.www.sooryavansham.org, Corporate E-mail:sooryavansham@sooryavansham.org
  Public Forum

(Press Release for use by the newspapers)

Diwali crackers can cause blindness

Bursting fire crackers and sparklers on Diwali can cause chemical injuries in the eyes especially in the case of small children unless adequate precautions are taken. These burn injuries can lead to blindness said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Here are some tips from Heart Care Foundation of India to prevent injury to the eye.

  1. Do not look up at the sky to watch the lighted crackers. The unburned particles can fall on the eye and cause burns.
  2. Do not go near the unburnt firecrackers; they can still blast. Also, do not try to re-light a firecracker that has not burnt properly.
  3. It is dangerous to ignite crackers in bare hands; stay at a safe distance while lighting firecrackers.
  4. Do not wear clothes, which can cause fire. Prefer cotton clothes.
  5. Do not light more than one firecracker at a time.
  6. Small children should be restrained form bursting firecrackers.
  7. Keep the windows closed. The sparkling cracker may enter the house and cause fire.
  8. Never rub the eyes when an injury is suspected. Immediately wash the eyes with running water and keep on washing till the burning disappears. If an open injury has occurred, keep sterile pad on the eyes and report to the nearest medical facility.
  9. Do not store fire crackers near lighting candles or other inflammable materials.
  10. The whistling ‘citi’ can be dangerous, avoid it. 

The Foundation also warned the general public and parents to avoid late nights, gambling and excessive alcohol consumption. These can make one prone to accidents.

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 – 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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