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  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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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  Editorial …

5th March 2013, Tuesday

Preventing malarial deaths in pregnancy

Dr K K Aggarwal and Dr Anita Kant

Pregnant travelers should defer travel to areas where risk of malaria is high until after delivery.

For non-immune pregnant women who cannot defer travel, chemoprophylaxis with chloroquine and mefloquine depending on travel to areas with chloroquine-sensitive or resistant malaria is recommended.

Pregnant women from endemic areas, who due to prolonged exposure to malaria, have developed natural immunity benefit from chemoprophylaxis.

  1. Continuous prophylaxis is not practical.
  2. One should go for Intermittent Preventive Treatment during pregnancy (IPTp) in areas with medium and high malaria transmission
    • WHO suggests IPTp with sulfadoxine pyrimethamine (SP) at each scheduled antenatal care visit in the second and third trimesters.
    • Four focused antenatal care visits as standard care: a first visit in the first trimester, a second visit at 24 to 26 weeks of gestation, a third visit at 32 weeks, and a fourth visit at 36 to 38 weeks)
    • Each dose suppresses or clears existing asymptomatic infections from the placenta and provides up to six weeks of prophylaxis.
    • The previous recommendation was for only two doses of SP one month apart.
    • In a systematic review and meta-analysis of trials =3 dose regimens resulted in fewer low birth weight infants, less placental malaria and less moderate to severe maternal anemia compared to two dose regimen.
    • For pregnant women who reside in areas of medium and high malaria transmission one should give treatment with three doses of sulfadoxine pyrimethamine as Intermittent Preventive Treatment (IPTp), rather than two doses.

(Source: Kayentao K, Garner P, van Eijk AM, et al. Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis. JAMA 2013; 309:594).

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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To Err is Human

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Dr KK Aggarwal with Dr Yogendra S Modi and Dr Kirti M Patel from National IMA National Social Security Scheme

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    National News

India budget-2013 (Prof. DR. S. ARULRHAJ, MD., FRCP(Glasg))

Budgetary allocation for Health has increased. Welcome mind set. But the allocation increase on GDP is only Marginal.

  • Our nearby developing countries allocate 2to 2.5 % of GDP to Health.
  • Still ours in less than 1%.
  • Developed Nations spend 8-10% of GDP on Health.
  • Concentrating on Medical education to overcome the Health workforce short fall is a Proactive move.
  • Primary Health care is the need of the hour.
  • Public Health & NCD are the next priority areas. These three segments are ignored.
  • We say Primary care & Rural Health but do nothing for it.
  • India today Private Health care offers 80% of Services. No Support till today for it.
  • Health is the only priority next to defence.
  • Health is still a Personal choice in our Nation not a responsibility of Government.
  • We say different ; mean different; do different
  • Long miles to reach to Health for All.

Pay for surgeries, costly treatment with EMIs soon

MUMBAI: Soon you will be able to finance the purchase of prescription medication. With healthcare costs going through the roof and exorbitantly-priced medicines making treatment inaccessible for many, companies are trying to reach out to patients and provide options of convenient monthly payments. These companies include patient financing start-ups which will provide options so patients don't delay expensive treatments and have access to medication through a customised repayment plan — an affordable alternative to personal loans and credit cards. Globally, patient financing companies like Springstone and Medicard bear the cost of a patient's treatment including surgeries, procedures and even pharma prescriptions, ranging from $2,000 to $40,000. Healthcare financing start-up Mya Health Credit will soon offer loans to patients for financing prescriptions. (Source: TOI, Mar 4, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Emotional abuse (also known as verbal abuse, mental abuse, and psychological maltreatment) includes acts or the failure to act by parents, caretakers, peers and others that have caused or could cause serious behavioral, cognitive, emotional, or mental distress/trauma.

For Comments and archives…

    Valvular Heart Disease Update

How is aortic stenosis evaluated?

When cardiac output is normal or near normal, the severity of aortic stenosis can be accurately assessed with echocardiography.

Cath should be reserved for patients in whom echocardiography is nondiagnostic or when clinical and echocardiographic data are discrepant.

More detailed evaluation is only needed in patients with low output aortic stenosis.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Solid midterm outcomes with transapical mitral valve-in-valve implants

Implanting another valve within a dysfunctional mitral prosthesis via a transapical approach has favorable midterm clinical outcomes, with more than 90% of patients alive after a median follow-up of two years. In addition, all patients who survived had improvements in various hemodynamic measurements as well as improvements in heart-failure symptoms. (Source: Medscape)

FDA Oks extended-release Abilify

The FDA has approved an extended-release injectable formulation of the antipsychotic drug aripiprazole (Abilify Maintena). The new formulation is the first dopamine D2 partial agonist approved as a once-monthly treatment via intramuscular injection, drug makers Otsuka and Lundbeck stated in a press release. (Source: Medpage Today)

Gastric bypass puts type 2 diabetes into remission

Bariatric surgery provides durable glycemic control out to 2 years compared with intensive medical therapy in moderately obese patients with type 2 diabetes, an extension of the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) study demonstrates. (Source: Medscape)

Coronary calcium is stroke risk barometer

Among individuals at low-to-intermediate cardiovascular risk, coronary artery calcification (CAC) score predicts the occurrence of stroke, even after accounting for traditional risk factors, researchers found. (Source: Medpage Today)

HIV cured in baby for the first time, scientists claim

CHICAGO: A baby girl in Mississippi who was born with HIV has been cured after very early treatment with standard HIV drugs, US researchers reported on Sunday, in a potentially ground-breaking case that could offer insights on how to eradicate HIV infection in its youngest victims. The child's story is the first account of an infant achieving a so-called functional cure, a rare event in which a person achieves remission without the need for drugs and standard blood tests show no signs that the virus is making copies of itself. More testing needs to be done to see if the treatment would have the same effect on other children, but the results could change the way high-risk babies are treated and possibly lead to a cure for children with HIV, the virus that causes AIDS. "This is a proof of concept that HIV can be potentially curable in infants," said Dr Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, who presented the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta. (Source: TOI, Mar 4, 2013)

    Twitter of the Day

@DrKKAggarwal: Aspirin Paracetamol combination can be dangerous # eMedinewS Taking a combination of aspirin with paracetamol can...http://fb.me/zXBovytJ

@DrKKAggarwal: Without unpredictability there is no creativity. The universe has a creative source that appears random to the limited mind #God #Atheism

    Spiritual Update

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

Mindfulness meditation

Sit on a straight-backed chair or cross-legged on the floor.

Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.

For Comments and archives…

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What happens in an egg donation cycle?

In an egg donation cycle, the donor receives fertility medications to stimulate the production of multiple eggs in her ovaries. At the same time, you are given hormone therapy to prepare your uterus to receive the fertilized eggs (embryos). After the eggs are obtained from the donor, they are fertilized in the laboratory with your partner’s sperm. Several days after fertilization, the embryos are transferred to your uterus. Any embryos which are not transferred may be frozen (cryopreserved) for a future cycle

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

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Do any diseases debar a donor from giving blood?

Yes, if the donor has suffered from any of the undermentioned diseases.

Fever: He should not have suffered from fever for the past 15 days.

Jaundice: A donor must not have his blood–tested positive for Australia antigen.

Blood transmitted diseases like syphilis, malaria, filaria, etc., debar a donor from donating blood till he is treated and is free from them.

Drug: If a donor is taking drugs like aspirin, anti–hypertensive, anti–diabetics, hormones, corticosteroids etc., he is unfit to donate blood.

AIDS: No person who is HIV–positive can be allowed to donate blood.

For Comments and archives…

    An Inspirational Story

Portrait of a friend

I can’t give solutions to all of life’s problems, doubts, or fears. But I can listen to you, and together we can seek answers. I can’t change your past with all its heartache and pain, or the future with its untold stories. But I can be there now when you need me to care.

I can’t keep your feet from stumbling. I can only offer my hand that you may grasp it and not fall. Your joys, triumphs, successes, and happiness are not mine; yet I can share in your laughter and joy. Your decisions in life are not mine to make, or to judge; I can only support you, encourage you, and help you when you ask.

I can’t give you boundaries which I have determined for you, but I can give you the room to change, room to grow, room to be yourself. I can’t keep your heart from breaking and hurting, but I can cry with you and help you pick up the pieces and put them back in place.

I can’t tell you who you are. I can only love you and be your friend.

For comments and archives

   Cardiology eMedinewS

Sitting less trims diabetes risk Read More

5 psych disorders have common genetics Read More

   Pedia News

Ocular complications after HSCT in children Read More

Heavy moms have babies with thick aortas Read More

    Stem Cell Update

(Dr S K Verma, Consultant Ophthalmologist, New Delhi)

  1. Paradoxes in biology are always interesting. One of them is the Peto’s Paradox, which states that cancer does not correspond to the number of cells in an organism. For e.g., humans get more cancer than large mammals like whales. This may be due to the fact that evolution of multicellularity required more cancer suppression.
  2. Among the weird gene names, a special mention is to be made to the ‘RING’ gene. The discoverers of this gene initially did not know the function of this gene in Drosophila is and hence named it “Really Interesting New Gene” (RING). (Courtesy: Journal of Stem Cell and Regenerative Medicine Vol. 4; Issue 3. 13th Feb 2013)
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Can we apply local antibiotics or antimicrobial agents on the site of bite?

After cleansing of the bite wounds, local antimicrobial agents can be applied. Discourage local wound applicants like turmeric, neem, red chili, lime, plant juices, coffee powder etc.

    IJCP Special

Dr Good Dr Bad

Situation: A patient wanted to know if he could buy Vigor–25 from the Internet.
Dr Bad: Go ahead.
Dr Good: It can be harmful.
Lesson: The US FDA has warned that Vigor–25, a product marketed as a natural dietary supplement to enhance male sexual performance, should not be purchased or used because it contains sildenafil which may interact with nitrates and can dangerously lower blood pressure. Vigor–25, distributed by Piston Corp., is sold on Internet sites.

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high?
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

  Quote of the Day (Dr GM Singh)

Life is full of beauty. Notice it. Notice the bumble bee, the small child, and the smiling faces. Smell the rain, and feel the wind. Live your life to the fullest potential, and fight for your dreams. Ashley Smith

    Mind Teaser

Read this…………………

When teaching a 65-year-old patient to use a pain scale, a pain management nurse anticipates that:

a. Additional time is needed for the patient to process the information.
b. Older adults are unable to use pain scales reliably.
c. The Pain Assessment in Advanced Dementia Scale is appropriate for the patient.
d. The patient's family is included in the education sessions.

Yesterday’s Mind Teaser: The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to:

a. Clarify the patient's report by reviewing the patient's nonverbal behavior.
b. Confronting the patient's denial of pain.
c. Obtaining an order for pain medication.
d. Supporting the patient's stoic behavior.

Answer for Yesterday’s Mind Teaser: Clarify the patient's report by reviewing the patient's nonverbal behavior.

Correct answers received from: Dr K Raju, Dr KV Sarma, Dr. Deepali Chatterjee, Dr Suresh Arora, Dr Arpan Gandhi, Dr PC Das, Anil Bairaria,
Dr Bharat Bhushan Aggarwal, Dr Pankaj Agarwal, Dr Jainendra Upadhyay,
Dr Chandresh Jardosh, Dr Shashi Saini, Dr Thakor Hitendrsinh G, Dr Kanta Jain, Muthumperumal Thirumalpillai, Dr Anupam Sethi Malhotra, Dr Bharat Bhushan Aggarwal, Dr Jella, Dr Jayashree Sen & Dr Bitan Sen.

Answer for 2nd March Mind Teaser: Providing demonstration and return demonstration

Correct answers received from: Dr PC Das, Anil Bairaria, Dr Kanta Jain,
Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Two difficult things

Two things are very difficult to achieve!!!

1. To plant your ideas in someone else's head.

2. To put someone else's money in your own pocket.

The one who succeeds in the first one is called a TEACHER. And the second is called a BUSINESSMAN.

The one who succeeds in both is called a WIFE.

The one who fails in both is called a HUSBAND!!!

  Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

How should biological samples and medical evidences be collected in a medicolegal case?

The analyst/doctor has a legal responsibility to retain untested biological specimen in legal cases so that another person can test it and come to an independent conclusion as to its origin.

The observation of scenes of crime, collection of human body fluids, weapons of the offence and medical examination of victim, accused, or both is required in any investigation of crime against human body such as injury, rape, murder.

The medical examination is carried out in emergency ward of hospitals and treatment of injured and dying patient remains the major focus of the treating doctor. But, in cases of crime against the human body, the medical examination and collection of biological sample/s, its documentation, packaging, and analysis have an important role and should be done by the doctor very meticulously with the high standards of science and the law in mind. These biological materials include: Blood, seminal stains, vaginal smears/slides gastric lavage, chemical substances, poison, hair, fiber, broken glasses, knives, blunt instruments/objects, fire arms, bullet, live and empty cartridge cases, wads, clothing etc. This scientific biological evidence becomes legal evidence in prosecution/acquittal of case if collected correctly.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Computer use can cause neck pains

Using computers for extended periods causes and aggravates neck pain, said Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Quoting a study published in the journal Cephalalgia, Dr Aggarwal said that neck pain is more common among students who spend more time on computers.

Sixteen percent of children who spend 5 or fewer hours using a computer each week have neck pain as against 48% who use 25 to 30 hours of computer a week.

The study enrolled grades 10 to 12 at schools in Western Cape, South Africa in 2006 and assessed duration of computer use and occurrence of neck pain among 1073 students (65 percent girls), who were 16 years old on average.

Correct computer posture and a few minutes break after every one hour can help, said Dr S Arulrhaj Past National President IMA.

Overuse of computer can also cause computer vision syndrome, added Dr Navin Sakhuja Senior Eye Specialist at Delhi.

    Readers Response
  1. Dear Dr KK Aggarwal, Thanks for your daily news letter. The first thing I do in morning is open up my mail and read your emedinews. It is very informative and with many of the latest information in medical field. Keep it up. With best wishes. Yours, Dr Neelam Kumar Bohra.
  2. An absolutely awesome n inspiring story. The words written below it are golden words. Life is truly a blessing if we live it with honesty towards ourselves and to others. Be thankful for what we have in life and keep smiling always and make others smile too!!!!!!!!! Nidhi Agarwal.
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