emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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 (07–08); 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 …

5th June 2011, Sunday                                 eMedinewS Presents Audio News of the Day

Anti Tobacco Day Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Today is World Environment Day

India on high alert against deadly "Super Toxic Bug” E Coli strain- H4 0104 that causes kidney failure

  1. India is on high alert against the deadly strain of Shiga toxin-producing E coli (STEC 0104: H4).
  2. This strain has infected over 1823 cases across 12 European nations (Austria, Czech Republic, Denmark, France, Netherlands, Norway, Spain, Sweden, Switzerland, Britain and the United States) including 520 cases of hemolytic uremic syndrome (HUS). Twelve HUS cases were fatal, and 6 deaths were reported among non-HUS cases. (17 deaths in Germany and 1 in Sweden).
  3. The Food Safety and Standards Authority of India has informed its officials to watch out for all food items, especially fruits and vegetables, coming in from Europe.
  4. The FOOD source is organic Spanish cucumbers. Cucumbers, tomatoes, and lettuce are top suspects.
  5. E coli is a common bacteria in the GI tract and part of the normal bacterial flora. However, some E coli strains produce a toxin that could produce serious infection. The infection is acquired by consuming contaminated food or water.
  6. The incubation period is 3-4 days in conventional strain but in the STEC 0104: H4 strain it is 7-12 days. Most patients' symptoms resolve within 5 to 7 days. However, HUS STEC 0104: H4 can develop a week after diarrhea begins.
  7. Symptoms range from mild to severe bloody diarrhea, mostly without fever. The strain STEC 0104: H4 is causing severe symptoms, including stomach cramps, bloody diarrhea, vomiting, and fever. However, fever is not usually high.
  8. As per WHO, this STEC 0104:H4 strain of E coli "is a unique strain that has never been isolated from patients before" and there may be "various characteristics that make it more virulent and toxin-producing".
  9. The hemolytic-uremic syndrome (HUS) is characterized by the simultaneous occurrence of a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury.
  10. Microangiopathic hemolytic anemia: Hemoglobin levels are usually less than 8 g/dL. The Coomb's test is negative and the peripheral blood smear is characterized by the large number of schistocytes and helmet cells. There is no correlation between the severity of the anemia and the severity of the renal disease.
  11. Thrombocytopenia: Platelet counts are generally around 40,000/mm3. There is no correlation between the degree of thrombocytopenia and the severity of the renal disease.
  12. Acute renal injury: The severity of renal involvement ranges from hematuria and proteinuria to severe renal failure and oligoanuria, which occur in one-half of cases. Hypertension is also frequently observed. Although as many as 50 percent of those with HUS require dialysis during the acute phase, the prognosis for recovery of renal function is generally favorable.
  13. Up to 10% of patients with this latest infection with STEC 0104: H4 strain may develop HUS, with a case-fatality rate ranging from 3% to 5%.
  14. Normally HUS is the most common cause of acute renal failure in young children but this strain (STEC 0104: H4) is affecting female adults above the age of 20.
  15. It can cause neurological complications like seizure, stroke and coma in 25% of HUS patients and chronic renal sequelae, usually mild, in around 50% of survivors.
  16. Usually HUS can be typical HUS or atypical HUS. Typical HUS is Shiga-like toxin (Stx)-associated HUS and atypical HUS is non-shiga toxin (NStx)-associated HUS.
  17. Typical Stx HUS occurs after a prodromal episode of bloody diarrhea. It normally affects children under the age of five years. On the other hand, atypical non-shiga toxin associated (NStx) HUS is a heterogeneous disorder distinguished clinically by the absence of diarrhea or Shiga toxin-producing E. coli infection, but with microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury.
  18. Typical HUS primarily follows an infection with Shiga toxin producing strains of E coli. The most common serotype is O157:H7, which is found in 70 percent of cases. The annual incidence is 2 to 3 per 100,000 children less than five years of age. The current strain is different Shiga toxin–producing E coli O104:H4.
  19. This disorder is commonly observed during the summer.
  20. The differential diagnosis includes: Other enteric infections, Henoch-Schönlein purpura, systemic vasculitis, sepsis and disseminated intravascular coagulation.
  21. There is no known effective therapy to prevent progression from the bloody diarrheal phase (acute infectious phase) to the post diarrheal phase of HUS.
  22. Therapy is supportive. One can give antibiotics but NOT anti-motility agents. Some research has shown that administering antibiotics may in fact increase their risk of developing HUS, but the CDC recommends that clinicians ultimately determine treatment according to each individual patient. There may be indications for antibiotics in patients with severe intestinal inflammation if perforation is of concern. Of note, isolates of STEC O104:H4 from patients in Germany have demonstrated resistance to multiple antibiotics.
  23. Patients may require red blood cell transfusions when the hemoglobin is below 6 g/dL.
  24. Platelets are transfused when there is active bleeding or prior to a required invasive procedure in patients with platelet counts less than 30,000/mm3.
  25. Dehydration is corrected as per requirement.
  26. Dialysis is done as per standard indications.
  27. Hypertension is managed by fluid restriction, antihypertensive agents, and dialysis if needed. Nifedipine is the drug of choice in initial phase to be substituted with ACE inhibitors later.
  28. Parenteral diazepam, phenytoin, and fosphenytoin are used for seizures.
  29. One can try plasma exchange in cases with significant neurological symptoms.
  30. Do not use anti-thrombotic agents or oral Shiga toxin-binding agent.
  31. In general, prognosis is excellent with mortality rates below 5%. Around 5% of patients will have significant long-term sequelae of either stroke or end-stage renal failure. In patients who require renal transplantation, recurrence of HUS is rare.
  32. All stools submitted for testing from patients with acute community-acquired diarrhea should be cultured for STEC O157:H7. These stools should be simultaneously assayed for non-O157 STEC with a test that detects the Shiga toxins or the genes encoding these toxins
  33. It is often difficult to isolate STEC in stool by the time a patient presents with HUS.
  34. WHO does not recommend any trade restrictions related to this outbreak.

Dr KK Aggarwal
Editor in Chief
Blogs.kkaggarwal.com Dr K K Aggarwal on blogs
drkkaggarwal.blogspot.comDr K K Aggarwal on blogs
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

 
    Changing Practice – Evidence which has changed practice in last one year

Artesunate for severe malaria

For treatment of nonpregnant adults and children with severe falciparum malaria, start IV artesunate. (Lancet 2010;376:1647)

 
    eMedinewS Audio PostCard

Rheumatoid arthritis Update

Dr Neelam Mohan Speaks on
‘Hepatitis B disease progression’

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

WORLD ENVIRONMENT DAY

‘Save Tree Save Environment’ and ‘Plant Saplings & Preserve Old Trees’ were the message spread via different tableaus from Heart Care Foundation of India on World Environment Day in 2010.

 
Dr K K Aggarwal
 
    National News

Workshop with Dr KK Aggarwal June 5th, 8 am at Moolchand Hospital on ‘E Coli bloody diarrhea causing kidney failure, new threat to India’ as per WHO.

Finance Ministry nod for National Health Portal

NEW DELHI: To establish a national database for the medical records of all the citizens from birth to death, the Centre will soon come out with the launch of a National Health Portal. The Expenditure Finance Committee of the Finance Ministry has given its nod to the Health Ministry’s proposal to set up the portal, which will now go to the Union Cabinet for approval, according to MoS for Health and Family Welfare Dinesh Trivedi. The portal, recommended by the National Knowledge Commission, will make the optimum use of technology for establishing a database for the medical records of all citizens and other health–related issues. The portal will put information on standardisation and protocols in the public domain. The effort will also be to ensure that the medical records of all citizens are electronically stored for ease of access by pathologists and doctors for diagnosis and treatment of patients. (Source: Express Buzz, June 3, 2011)

India on high alert against deadly E. coli strain that causes kidney failure

NEW DELHI: India is on high alert against the deadly strain of Shiga toxin–producing E coli, that has infected over 1,700 people across 12 European nations. The deadly food–borne bacteria is causing haemolytic uremic syndrome (HUS) or kidney failure. The Food Safety and Standards Authority of India (FSSAI) has informed its officials posted in the five major ports and four airports which receive imports, to watch out for all food items, especially fruits and vegetables, coming in from Europe. All such items will first be tested in FSSAI labs before being allowed into the country. (Source: TOI, June 4, 2011)

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 Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Exercise decreases pain in fibromyalgia sufferers

Fibromyalgia is a condition characterized by chronic dull musculoskeletal pain and often accompanied by fatigue, sleep problems, and mood swings. People who suffer from the disorder often complain of amplified pain sensations and increased pain sensitivity. Exercise is typically prescribed to relieve symptoms of fibromyalgia, yet it is not always adhered to as physical activity can be very painful.

In a study, twenty–two women in their forties who suffered from acute pain caused by fibromyalgia were randomized into two groups. One group performed a 20–minute cycling session at a prescribed intensity while the other group of women selected their own pace and intensity. Researchers measured heart rate, intensity and participants’ perceived exhaustion and muscle pain every five minutes during the sessions. Additionally, a pain questionnaire was given to all participants before and at different intervals after the sessions. Results showed that exercise significantly lowered pain for three days after the sessions. The group that selected their own pace exercised at a lower intensity but reaped the same benefits as the other group. There were no significant differences between the groups, leading researchers to conclude that low intensity exercise should be prescribed. Better yet, patients should decide on their own pace.

(Dr Monica and Brahm Vasudev)

Does eating less salt lead to heart disease? New JAMA study is more wishful thinking than a diet changer

A new study from Europe published in the May 4 Journal of the American Medical Association shows that taking in less salt may increase the risk of heart disease and has little effect on the development of high blood pressure. The findings contradict results of many other studies showing that less salt prevents heart disease. Flaws in the new study, from the young age of the participants to the small number of heart attacks, strokes, and other cardiovascular problems that occurred over the course of the study, suggest that it is not a game changer. If you are leery about the low–salt message for whatever reason, there are other ways to keep your blood pressure in check, like more exercise, weight loss, and following a diet like the DASH diet.

(Dr GM Singh)

Definitions associated with opioid use and abuse

Misuse

Use of a medication for a medical purpose other than as directed or as indicated, whether willful or unintentional, and whether harm results or not.

Abuse

Any use of an illegal drug; the intentional self–administration of a medication for a nonmedical purpose such as altering one’s state of consciousness (e.g., getting high).

Tolerance

A physiologic state resulting from the regular use of an opioid where increased doses are needed to maintain the same effects. In analgesic tolerance, increased opioid doses are needed to maintain pain relief.

Physical dependence

A physiologic state characterized by abstinence syndrome (withdrawal) if an opioid is stopped or decreased abruptly or if an opioid antagonist is administered. It is an expected result of opioid therapy and does not, by itself, equal addiction.

 
    Twitter of the Day

@DrKKAggarwal:Listen well instead of advising. A sympathetic ear is a wonderful thing.

@DeepakChopra:#vmdhealthblog Please read my health blog post about the power of meditation and RT if you like it: http://bit.ly/Dpak_Medit

 
   Spiritual Update

Hanuman Chalisa

Anta Kaal Raghubar Pur Jai
Jahan Janma Hari Bhakta Kahai


Meaning: After death he enters the eternal abode of Sri Ram and remains a devotee of him, whenever, taking new birth on earth.

Spiritual Significance: At the time of death, Prana Vayu merges with the Udana Vayu and consciousness and stays there till one takes a rebirth.

 
    An Inspirational Story

(Dr G M Singh)

11 ways to comfort someone who’s grieving

If you have a friend or relative who is grieving, it can be hard to know how to console him or her. If it seems that nothing you can do or say helps, don’t give up. You can’t take the pain away, but your presence is more important than it seems. Accept that you can’t fix the situation or make your friend or relative feel better. Instead just be present and offer hope and a positive outlook toward the future. Accept that the person’s grieving will be a gradual process.

It is sometimes difficult to know what to say to a bereaved person. If you find yourself tongue–tied or uncertain of what to do in the face of someone’s loss, here are some steps you might try.

  1. Name names. Don’t be afraid to mention the deceased. It won’t make your friend any sadder, although it may prompt tears. It’s terrible to feel that someone you love must forever be expunged from memory and conversation. (This suggestion does not apply in cultures in which mentioning the dead is taboo or bad luck, however.)
  2. Offer hope. People who have gone through grieving often remember that it is the person who offered reassuring hope, the certainty that things will get better, who helped them make the gradual passage from pain to a renewed sense of life.
  3. Make phone calls. Call to express your sympathy. Try to steer clear of such phrases as "It’s God’s will" or "It’s for the best" unless the bereaved person says this first. Your friend or relative may need you even more after the first few weeks and months, when other people may stop calling.
  4. Write a note. If you had a relationship with the deceased, try to include a warm, caring, or funny anecdote that shows how important to you he or she was. If you didn’t know the deceased, offer your sympathy and assure the bereaved that he or she is in your thoughts or prayers.
  5. Help out. Be specific when offering help. Volunteer to shop or do laundry, bring dinner, pass on information about funeral arrangements, or answer the phone. Pitch in to clean up the kitchen. A lawyer might volunteer to help with the estate. A handy person might button up the house as winter approaches.
  6. Be sensitive to differences. People mourn and grieve in different ways. Religion plays a big role in how death is treated; so do ethnic, cultural, and family backgrounds. Avoid criticizing the funeral arrangements or memorial service. Also, try not to impose your beliefs about death on your friend.
  7. Make a date. Ask your friend to join you for a walk or meal once a week. Be aware that weekends are often very difficult, and suggest an activity. Low–stress activities may be best: watch a video at home together versus going out to a movie. Sometimes just being there without saying much is enough — it may even be exactly what your friend wants.
  8. Listen well instead of advising. A sympathetic ear is a wonderful thing. A friend who listens even when the same story is told with little variation is even better. Often, people work through grief and trauma by telling their story over and over. Unless you are asked for your advice, don’t be quick to offer it.
  9. Express your feelings. If you share your friend’s sorrow, say so. It’s even all right to blurt out that you don’t know what to say. Most likely, nothing you say will turn the tide, but your sympathetic presence may make your friend feel slightly less alone. (One caveat: try not to express your feelings so emphatically that your friend has to take care of you.)
  10. Handle anger gently. People who are grieving sometimes direct angry feelings toward the closest target. If that happens to be you, try to be understanding. That is, wait until well after the person has cooled down before raising your concern in a nonthreatening way.

Keep your promises. If you offer to do anything, follow through. This is especially important where promises to children are involved. Losing a loved one is abandonment enough.

Our Social
Network sites
… Stay Connected

        FaceBook
  > Dr K K Aggarwal
  > eMedinewS
  > Hcfi NGO
  > IJCP Group

        Twitter
  > Dr K K Aggarwal
  > eMedinewS
  > HCFI-NGO
  > IJCP Group

        Blog
  > Dr K K Aggarwal
  > eMedinewS
  > HCFI-NGO
  > IJCP Group

        You Tube
  > Dr K K Aggarwal
  > eMedinewS

Docconnect
Docconnect
 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with CKD (chronic kidney disease) was prescribed a soup made from goat intestine.
Dr Bad: Stop it.
Dr Good: It is prescribed in Ayurveda.
Lesson: Different pathies have different treatments.

Make Sure

Situation: A patient who had blood in the urine one month back was found to have large bladder cancer.
Reaction: Oh my God! Why was a cystoscopy not done at that time?
Lesson: Make sure that all patients of painless bleeding in urine are investigated for cancer at the first diagnosis.

 
  SMS of the Day

(Dr GM Singh)

Where there is movement, there is improvement.

 
    Medicolegal Update

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

Sudden death due to cardiac origin-autopsy

Right coronary artery supplies the blood to the electrical area of heart

The most common cause of sudden cardiac death in adults over the age of 40 was found to be coronary artery atheroma seen in postmortem examination in approximately 100 cases that were randomly selected by me in AIIMS mortuary.

  • The most common finding at postmortem examination is chronic high–grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
  • A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
  • In 75 cases out of hundreds the clots were seen in right coronary artery supplying the electrical area of heart.
  • Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall which induces an ventricular arrhythmia/fibrillation and no changes in the myocardium is seen during postmortem examination.
  • The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
  • Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
  • Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.
 
  Vitamins—Open Secrets revealed

(Dr Jitendra Ingole, MD Internal Medicine)

Supplement recommendations for chronic fatigue syndrome

Dr. Melvyn Werbach, MD of the UCLA School of Medicine has just published a thorough review of nutritional deficiencies involved in chronic fatigue syndrome (CFS). These include deficiencies in vitamin C, coenzyme Q10, magnesium, zinc, sodium, l–tryptophan, l–carnitine, essential fatty acids, and various B vitamins. He points out that there is some evidence that the deficiencies are caused by the disease itself rather than by an inadequate diet. He suggests that the deficiencies not only contribute to the symptoms of CFS but also impair the healing process. Although the results of supplementation trials involving CFS patients have been inconclusive so far Dr. Werbach nevertheless recommends that CFS patients be given large doses of certain supplements for at least a trial period to see if their symptoms improve. His recommendations are:

  • Folic acid: 1–10 mg/day for 3 months
  • Vitamin B12: 6–70 mg (intramuscular injection) per week for 3 weeks
  • Vitamin C: 10–15 grams/day
  • Magnesium: 600 mg/day + 2400 mg/day of malic acid for 8 weeks
  • Zinc: 135 mg/day for 15 days
  • 5–hydroxytryptophan: 100 mg three times daily for 3 months (if fibromyalgia is present)
  • L–carnitine: 1–2 grams three times daily for 3 months
  • Coenzyme Q10: 100 mg/day for 3 months
  • Essential fatty acids: 280 mg GLA and 135 mg EPA daily for 3 months

The supplements should be administered with medical supervision and accompanied by a high–potency vitamin/mineral supplement for the duration of the trial.

(Ref: Werbac MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev 2000;5(2):93–108).

 
    Mind Teaser

Read this…………………
(Dr GM Singh)

A 37–year old, previously healthy postal worker in New Jersey is evaluated because of an enlarging sore on his right arm for 10 days. He denies trauma to the arm. The sore began as a painless, itchy papule that enlarged over one to two days, with small blisters forming on top of the papule that filled with clear fluid. As the blisters enlarged, extensive swelling developed around the sore. The blister broke down, forming a painless ulcer covered by a black scab. His symptoms include low–grade fever and malaise. He has not traveled outside of the mid–Atlantic area.

On physical examination the patient is not in any obvious distress. Temperature is 99°F (37.2°C). There is a 3 cm ulcer located on the upper, outer aspect of the right arm. A black, adherent eschar covers the ulcer. The ulcer and eschar are surrounded by extensive non–pitting edema. Lymphadenopathy is present in the right axilla. Which of the following is the most likely diagnosis?

A. Cutaneous anthrax
B. Cat–scratch disease
C. Tularemia
D. Herpes simplex infection
E. Streptoccocal adenitis

Yesterday’s Mind Teaser: MEREPEAT
                                    

Answer for yesterday’s Mind Teaser:
Repeat after me

Correct answers received from: Dr Pramod M Kulkarni, Dr HL Kapoor, Dr T Samraj, Dr D Chatterjee, Dr Doraisami Sundaram, Dr Muthumperumal Thirumalpillai, Dr (Maj. Gen.) Anil Bairaria, Dr Rashmi Chhibber, Dr Neelam Nath, Dr Chandresh Jardosh.

Answer for 3rd June Mind Teaser: 2. Serum creatinine
Correct answers received from: Dr BB Aggarwal, Dr BN Ganagdhar, Dr KV Sarma, Dr Prashant Bharadwaj, Dr Maneesh Gupta, Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com

 
    Medi Finance Update

Fixed Maturity Income Plan

Where to invest in rising interest rate scenario?

Fixed Maturity Plans (FMPs) provide investors with a good alternative to fixed deposits given that they are more tax efficient. This is especially so during volatile times when investors are likely to be more risk–averse. These schemes are close–ended debt schemes with an objective to seek to generate reasonable returns and reduce interest rate volatility primarily through investment in money market and short–term debt instruments with a maturity profile generally in line with the duration of the Plan.

 
    Laugh a While

(Dr. GM Singh)

Wilson’s Law of Commercial Marketing Strategy: As soon as you find a product that you really like, they will stop making it.

 
    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name

Indication

DCI Approval Date

Levocloperastine (as Fendizoate) Suspension eq. to Levocloperastine HCl 20mg/5ml.

For the treatment of non productive cough in adult patients

29.09.10

 
  Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Understanding Laparoscopic Sleeve Gastrectomy

What is the preoperative preperation for LSG?

After a one–on–one consultation with the surgeon, the patients make an informed decision to have LSG and informed consent is obtained. All patients are required to have psychological screening, routine labs, electrocardiogram, upper gastrointestinal X–rays, pulmonary function studies, and a medical evaluation. All patients receive intravenous antibiotics, subcutaneous unfractionated heparin and sequential compression devices preoperatively.

 
    IMSA Update

International Medical Science Academy (IMSA) Update

Children with mild to moderate asthma

A meta–analysis of randomized trials found that children with mild to moderate persistent asthma who were treated with inhaled glucocorticoids had better pulmonary function and asthma control than those treated with montelukast.

 
    Public Forum

(Press Release for use by the newspapers )

World Environment Day

Lead exposure can cause brain damage: Spices may have high lead contents

Repeated exposure to lead can cause cognitive damage and behavioral changes in children. About two-thirds cases occur when young children lick or ingest lead-containing paint as it peels or chips off the walls.

Researchers at Children's Hospital in Boston and the Harvard School of Public Health visited 15 Indian specialty stores in Boston and analyzed 71 cultural powders and 86 spices and food products. About 25% of the food items, including spices such as cardamom, fenugreek and chilli powder, contained more than 1 microgram of lead per gram of product. About 65% of the ceremonial powders, including sindoor, contained the same amount, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

In India, leaded gasoline is still commonly used in cars and the lead from car exhaust can seep into the ground, saturating the soil in which food plants, including those that are dried and ground into spices are grown. Such environmental exposure is the most likely source of lead in these products.

In addition, exposure to lead can occur in numerous work settings, such as manufacturing or use of batteries, pigments, solder, ammunitions, paint, car radiators, cable and wires, some cosmetics, ceramic ware with lead glazes, and tin cans.

An additional source of lead exposure has been identified as lead dust deposited on radiographs stored in lead-lined boxes said Dr Nikhil, Sr Radiologist, Moolchand Medcity.

In some parts of the world, illegally distilled alcohol ("moonshine") is an important source of lead exposure.

Lead poisoning has occurred in those taking adulterated Ayurvedic ‘bhasma’ medications and in those cooking or eating off lead-glazed tableware and cookware.

It has been shown that women use herbal supplements have blood lead levels 10 percent higher than non-users, said Dr Anita Kant, Chief Gynecologist, Asian Institute of Medical Sciences.

Blood lead levels were about 20 percent higher for those women reporting use of adulterated Ayurvedic and/or traditional Chinese medicine herbs, as well as St. John's Wort, compared to non-users.

 
    Readers Responses
  1. Sir, It is quiet interesting to know about the updates in our field on a daily basis. I think we all should raise our voice against the murder of a Doctor on duty in prison by some inmates. Something needs to be done against this to avoid such things in future. It’s admission time in colleges and parents are rushing to get a proper course for their children. Army College Of Medical Sciences announced its admissions for MBBS 2011 courses, & as usual the form filling, Demand Draft purchase & arrangements for travel to the exam venue and all hardships were taken and some of the candidates cleared the stage I exam and again started booking for stage II exam conducted by Guru Gobind Singh University, New Delhi. One day prior to the final exam, the Army Medical College announces cancellation of Admissions for this year. Can’t they do it before advertising, avoiding anxiety to candidates and parents? Dr K Shakila.
 
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

HCFI
Activities eBooks

  HCFI

  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

 
    Forthcoming Events

National Conference on "Insight on Medico Legal Issues"
Date: Sunday, 10th July, 2011
Venue: Auditorium, Chinmaya Mission, 89, Lodhi Road, New Delhi – 10003

eMedinewS and Heart Care Foundation of India are jointly organizing the first ever National Conference on "Insight on Medico Legal Issues" to commemorate "Doctors’ Day".
The one-day conference will provide total insight into all the medicolegal and ethical issues concerning the practicing doctors. Both medical and legal experts will interact with the delegates on important issues.
You are requested to kindly register in advance as seats are limited. There will be no registration fee. You can register by sending your request at rekhapapola@gmail.com or at 9899974439.

Programme

Session: Ethical Issues in Medical Research (8 am – 8.30am)
Chairpersons: Dr T K Joshi
Moderators: Dr K K Aggarwal and Dr. Girish Tyagi
Topic        -        Speaker          -               Time
Rights of a patient in medical trial - Ajay Agrawal (Sr Advocate) - 8 am - 8.10 am
Ethical Issues in a medical trial - Dr Ranjit Roy Chaudhury 8.10 am – 8.20 am
Statutory permits required for conducting trials - Ms Priya Hingorani (Sr Advocate) - 8.20 am – 8.30 am

Session: Medical ethics and organ donations (8.30 – 9.00 am)
Chairpersons: Dr N V Kamat and Dr Anil Bansal
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Ethical issues in IVF practice - 8.30 am-8.37 am
100% voluntary blood donation - Dr N K Bhatia - 8.37 am-8.44 am 
Need for do not resuscitate laws in India - Dr Rajesh Chawla- 8.44 am-8.51am 
Ethical issues in organ transplantation Dr Neelam Mohan 8.51 am-8.58 am 

Session: Handling cases of death (9 am - 9.30 am)
Chairpersons: Mr S K Saggar and Dr Arvind Chopra
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
How to declare the death? Dr Ambrish Mithal  9.00 am-9.10 am
Spiritual considerations in a dying patient Dr S C Tewari  9.10 am-9.20 am
Medico legal and ethical issues in post mortem Dr G.K. Sharma 9.20 am-9.30 am

Session: Medical Insurance (9.30-10 am)
Chairpersons: Mr Vibhu Talwar, Dr H K Chopra and Dr Vinod Khetrapal
Moderators: Dr K K Aggarwal
Indemnity Insurance 9.30 am-9.40 am
Engaging a lawyer  Ms Meenakshi Lekhi (Sr Advocate)  9.40 am-9.50 am
Understanding various court procedures Maninder Acharya (Sr Advocate) 9.50 am – 10.00 am 

Session: How to handle medico legal cases? (10-10.30 am)
Chairpersons: Dr Anil Goyal and Dr Rajiv Ahuja
Moderators: Dr K K Aggarwal and Dr. Girish Tyagi
When to do the MLC? Dr M C Gupta (Sr Advocate) 10.00 am-10.10 am 
Checklist of MLC case Dr Sudhir Gupta 10.10 am-10.20 am 
Medico legal record keeping Mr Siddarth Luthra (Sr Advocate) 10.20 am –10.30 am

Session: Medical Consent (10.30-11 am)
Chairpersons: Dr Vinay Aggarwal and Dr P K Dave
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic Time Speaker
Types of consent Ms Indu Malhotra (Sr Advocate) 10.30 am-10.40 am 
Ideal consent Dr Manoj Singh 10.40 am-10.50 am

Session: Fallacies in acts applicable to medical profession (11-11.30 am)
Chairpersons: Dr Anup Sarya and Dr Sanjiv Malik
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
MTP, PNDT Dr Kaberi Banerjee  Act 11.00 -11.10 am
Organ Transplant Act Dr Anupam Sibbal  11.10-11.20 am
State Medical Councils and Medical Council of India Dr DK Diwan  11.20 –11.30 am

Session: Inauguration: 11.30 am to 12.00 noon
Invited Guests: Justice Vipin Sanghi, Dr KK Talwar, Dr Shiv Sarin and Dr A K Agarwal

Session: Professional misconduct and professional ethics (12.00 – 1.00 PM)
Chairpersons: Dr A K Agarwal, Dr. D S Rana and Dr H S Rissam
Moderators: Dr K K Aggarwal and Dr Girish Tyagi
Topic Time Speaker
Doctor-pharma relationship 12.00 -12.10 pm
Advertisement and medical practice Dr P Lal  12.10 pm-12.20 pm
Rights of a patient Dr Navin Dang 12.20 pm –12.30 pm
Rights of a doctor Dr Ajay Gambhir 12.30 pm-12.40 pm 
Kickbacks, touts and commercialization in medical practice Dr Ashok Seth 12.40 pm- 12.50 pm 
Complaints of a doctor against doctor 12.50 pm – 01.00 pm

Session: When it is not negligence?
Timings: 1.00 pm to 2.00 pm
Chairpersons: Dr Prem Kakkar and Dr S K Sama
Moderators: Dr K K Aggarwal and Dr. Girish Tyagi
What is medical negligence? Dr Girish Tyagi 1.00 pm-1.10 pm 
Medical accidents Dr Vijay Aggarwal  1.10 pm – 1.20 pm
Professional Misconduct Mr Mukul Rohatgi (Sr Advocate) 1.20 pm – 1.30 pm 
How to defend a complaint? Dr K K Aggarwal 1.30 pm- 1.40 pm 
Out of court settlement 1.40 pm – 1.50 pm
Compensation Vs Cancellation of License Dr O P Kalra 1.50 pm – 2.00 pm

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com

………………………………………………………………

Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at
medifilmfestinhealthmela@gmail.com

………………………………………………………………

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

   Dr K K Aggarwal on blogs    Dr K K Aggarwal on blogs     Dr K
K
Aggarwal
on Twitter    Dr k k Aggarwal on Facebook    You Tube
 
    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 Naveen Dang, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta