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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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 ...

5th, September, 2010, Sunday

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

Lord Krishna – The Great Teacher and Healer

Lord Krishna was a great teacher as well as a healer. For example, he gave just the right counseling to Arjuna when he was in a state of acute anxiety, confusion and indecisiveness, in other words, in a state of despondence. His supreme knowledge, skills and understanding of human relationship were responsible for convincing Arjuna that he had to perform his duty, regardless of who his opponents were.

There are four basic principles which one must learn from teachings of Bhagwad Gita to attain, if one desires, the right state of mental and physical strength.

The first principle is listen, listen and listen. In the first chapter of Bhagwad Gita, shlokas 20 to 46, the Lord only listens to Arjuna. Applying the same, the medical professionals must also learn to listen to patients if they want to heal them. Out of the 18 counseling sessions that Krishna took with Arjuna, one full session was devoted only to listening to Arjuna. The Lord did not speak even a word in the first Chapter. Fifty percent of the emotion of a person is released, once he has spoken to the Healer about his or her problems.

The second principle is to remain non–judgmental while listening. This is beautifully described in Chapter 2, shloka 10. While listening, Krishna did not show any signs of anger to Arjuna even during those extremely difficult moments. On the contrary, Krishna kept on smiling and listened patiently. This is another area where most healthcare workers fail in their relationship with the patients. We (doctors) sometimes become annoyed with the patients because they narrate unrelated details of their health problems. We need to understand and appreciate their predicaments.

The third principle is that every answer should be validated by reasoning. Throughout the 18 Chapters or 18 counseling sessions between Arjuna and Krishna incorporating 700 question and answers, Arjuna was given proper reasoning, either experiential or based on sound logic. Krishna never forced Arjuna to believe in what He was saying without Arjuna being convinced about it.

The fourth principle is that of reassurance. Krishna re–assures Arjuna on two occasions. Firstly, when he said that "I’ll appear whenever there is adharma" meaning thereby that whenever there is injustice someone will come and set it right. In terms of a Healer, the doctor should convincingly say "Wherever there is a disease I will be there". Again in Chapter 18, shloka 65, Krishna says that anyone who takes conscious decisions and interprets things with full devotion, there is no reason why he or she should not become happy or healthy. He again assures Arjuna that he is going to be successful.

Finally, the last shloka of Gita (18.78) summarizes the importance of a good doctor–patient (teacher–student) relationship where Sanjay says to Dhritharashtra that when there is a Healer like Krishna and a patient like Arjuna, there is no reason why there will not be a victory.

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

 eMedinewS Event 

Dr Sanjiv Chopra, Faculty Dean for Continuing Medical Education at Harvard Medical School talking on the issue of leadership amongst medical professionals. The function was organized by Heart Care Foundation of India in association with Maulana Azad Medical College

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Treatment of HIV and tuberculosis

In patients with pulmonary tuberculosis and HIV infection whose CD4 count is < 500 cells/mm3, prefer integrated treatment of TB and HIV infection compared with sequential therapy with antiretroviral medications after TB therapy is complete.

Reference

  1. Abdool Karim SS, Naidoo K, Grobler A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 2010;362:697–706.
  National News

 Now, a 'green candle' that does not pollute

A Punjab-based company, the country's largest producer, processor and exporter of honey, will soon launch candles from bee wax, a byproduct for bee-keepers. "These candles do not emit black smoke when blown out, unlike candles made of synthetic wax. These are environment-friendly. Right now, bee-wax candles are used only in Europe during Christmas in churches," says Shahzada Singh Kapoor, managing partner and son of Jagjeet Singh Kapoor, director of Kashmir Apiaries. The candles will be produced by Little Bee Impex, a subsidiary of Kashmir Apiaries. (The Times of India)

  International News

(Dr Monica and Brahma Vasudev)

Teriflunomide meets goal in late–stage MS study

An experimental oral medicine teriflunomide significantly reduced the relapse rate in multiple sclerosis patients, meeting the goal of a late– stage study. Data from the study will be presented at ECTRIMS (European Committee for Treatment and Research in Multiple Sclerosis) conference in Gothenburg, Sweden, on Oct. 15.

Potential bipolar depression treatment failed to meet mid–stage study’s key goals

Potential bipolar depression treatment cariprazine did not meet key goals in a midstage study.

Abdominal aortic aneurysm

A new study has suggested using additional criteria to expand routine screening for abdominal aortic aneurysm (AAA). The U.S. Preventive Services Task Force presently recommends screening in men 65 to 75 years of age who have a history of smoking. It does not recommend it in women or nonsmokers. Nonetheless, about 41% and 22% of AAA deaths, respectively, occur in the latter two groups. In the study, smoking was associated with AAA, as was excess weight. People who exercised at least once a week and incorporated nuts, fruits and vegetables into their diets at least three times a week were at lower risk, as were blacks, Hispanics and Asians compared with whites and Native Americans. Male sex, age, cardiovascular disease and family history were reaffirmed as known risk factors. The study results will be published in the September Journal of Vascular Surgery.

Annual PSA follow–ups not needed in low–risk cases

A study in the September 2010 Journal of Urology reports that patients with surgically treated low–risk prostate cancer may not need annual measurements of prostate–specific antigen (PSA), especially after three years of normal results. In the study, low risk was defined as preoperative PSA levels less than 10 ng/mL, pathological stage pT2c or less, Gleason score 6 or less, negative lymph nodes and negative surgical margins. Biochemical failure was defined as a PSA level above 0.4 ng/mL at any follow-up. PSA levels less than 0.15 ng/mL were defined as undetectable.

  Radiology Update

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

Is Oral Contrast necessary for most Abdominal CT scans?

Abdominal CT scans can be performed markedly faster and with no loss of accuracy by using intravenous contrast only, rather than the more conventional IV + oral contrast, according to two studies. Patient with abdominal pain tolerate oral contrast poorly. It takes them a long time to drink it – and all the while, they are occupying an emergency department (ED) bed and a nurse’s time, with corresponding delays in their diagnosis and treatment. The IV–only contrast imaging had 98.6% diagnostic sensitivity and 99.2% negative predictive value. Oral + IV contrast had 700 sensitivity and 700 negative predictive value.

  Infertility Update

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

Q: Is IVF the last option?

A. IVF is the option, which has the highest success rate and is most expensive. But, it is not the "end of the road". Many women have conceived naturally or with intrauterine insemination, even after IVF. However, for those with blocked tubes and very poor sperm counts, it is the only option.

  Vaccine Update: Question of the day

What are the indications of the use of Pneumococcal vaccine? Should it be given to all healthy children also? (Dr Harish Pemde)

This vaccine should be given to children with sickle cell disease, nephritic syndrome, and splenectomized children.

  • The older vaccine could not be used in children under 2 years of age where most of the morbidity (pneumonia and meningitis) is caused by pneumococcus. But, now with the availability of conjugated vaccine, it can be given to children below 2 years of age.
  • The latest 7 valent penumococcal vaccine is used for routine immuninzation of all healthy children in USA. But it covers only half of the serotypes of pneumococci which produce diseases in India and hence immunizing all the children with this vaccine may not be an very effective tool.
  Medicolegal Update

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

How can the direction of firearm be determined from the bullet track?

I have observed many surgeons to opine the direction of fire arm missile on the basis of the position of wound track. A bullet usually travels through the tissues in a straight line, so that the direction of fire may be determined from its track. But sometimes, a bullet may be deflected from its course; this occurs most commonly when it strikes a bone while passing through the tissues. It can also occur due to the inherent instability of a bullet as it penetrates tissues, and it may undergo changes of direction within the soft tissues in its track. This is illustrated by a case in which a man was struck by a bullet which went through tissues in the following order: gall bladder, hepatic flexure of colon, duodenum, pancreas, inferior vena cava, then passing medially through the bony part of the vertebral column, to strike the left kidney, spleen and pass through the diaphragm and pericardium, before coming to rest in the chest cavity. The only part of the track of bullet which was in a straight line was through the vertebral column, and sharp bends occurred in the soft tissue track before and after.

  Medi Finance Update

Life Insurance

The amount of insurance premium should not exceed 20% of actual capital sum assured (rebate is only upto 20%).

  Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Diclofenac 50mg + Chlorzoxazone 500mg Tablets

For the treatment of acute inflammatory conditions associated with spasm; in adults only

16/3/2010

  Lab Update

Mean Corpuscular Hemoglobin

MCH (pg/red cell) = Hemoglobin (in g/dL) × 10 / RBC count (in millions/μL)

MCH measures the average amount of hemoglobin per red blood cell.
Reference values are 27–30 pg

Interpretation: Value of 27 is normochromia; Value –27±3, indicates hypochromia

  IJCP Special

Dr Good Dr Bad

Situation: A patient with stroke was to be put on aspirin.
Dr. Bad: Start 150 mg.
Dr. Good: Start 75 mg.
Lesson: Higher doses of aspirin have no additional benefit but do increase risk of GI bleed.

Make Sure

Situation: A patient with UTI with culture report showing resistance to all bacteria developed sepsis.
Reaction: Oh my God! why was a cocktail of antibiotics not given?
Lesson: Make sure that all patients of UTI infected with resistant bacteria are treated with a cocktail of antibiotics.

Quote of the Day

Martin Luther King Jr …"The ultimate measure of a man is not, where he stands in moments of comfort and convenience, but where he stands at, times of challenge and controversy."
(Contributed by Dr Prachi)

Hypertension Alert

Hypertensive emergency means an acute, life–threatening situation associated with marked increases in blood pressure (BP), generally ≥180/120 mmHg.

There are two major clinical syndromes induced by the severe hypertension.

  • Malignant hypertension is marked rise in BP with retinal eye bleeding or hemorrhages, exudates, or papilledema (swelling of the internal eye). There may also be kidney involvement, called malignant nephrosclerosis (acute kidney, blood and proteins in urine, proteinuria). Although papilledema had been thought to represent a more severe lesion, it does not appear to connote a worse prognosis than hemorrhages and exudates alone (so–called accelerated hypertension). Thus, treatment is the same whether or not papilledema is present.
  • Hypertensive encephalopathy refers to the presence of signs of brain edema (swelling) caused by severe and sudden rises in blood pressure (insidious onset of headache, nausea, and vomiting, followed by non localizing neurologic symptoms such as restlessness, confusion, and, if the hypertension is not treated, seizures and coma)
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  Mind Teaser

Read this………………

faredce

The answer for yesterday’s Mind Teaser : "One foot in the grave"

Correct answers received from: Dr.K.V.Sarma, Dr.G.Padmanabhan, Dr Chandresh Jardosh, Dr.Anjani,  Dr Kalpana Mohan, Dr.A.K.Saxena, Dr Simran Singh, Dr Virender Prakash Gautam, Dr. Dinesh Kumar S

Correct answers for 3rd September is "Repeat after me"

Correct answers received  from: Dr Anurag Jain, Dr. Ashok Kumar, Dr Virender Prakash Gautam, Dr Aruna Tyagi,

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Contributed by Dr G M Singh)

A man goes to his doctor for a complete checkup. He hasn’t been feeling well and wants to find out if he's ill. After the checkup the doctor comes out with the results of the examination.
"I’m afraid I have some bad news. You’re dying and you don't have much time," the doctor says.
"Oh no, that’s terrible. How long have I got?" the man asks.
"10…" says the doctor.
"10? 10 what? Months? Weeks? What?!" he asks desperately.
"10…9…8…7…"

Funny One Liner (Dr G M Singh)

Conference Room: A place where everybody talks, nobody listens and everybody disagrees later on.

  An Inspirational Story

When One Door Closes, Another Door Opens

Becky Ellis was a loving, beautiful little girl, a third grader. She also had Cerebral Palsy, which is a disease that affects a person physically.
Becky had three sisters; Sara 14, Melissa 18, who suffered from mental retardation, and Laura who was 19. They were a loving family who lived with Christ in their hearts.
In the winter of ‘97 around Christmas time, they had gone up to the mountain, where they had a cabin, and rode snowmobiles in the snow. Becky, along with another woman, unfortunately lost control of their snowmobile and crashed right into a tree killing little Becky almost instantly.
Many people loved Becky; she was a very friendly, a bright little girl, and was missed by many. However that’s only the beginning of the story.
The family asked one of their close family friends to attend Becky’s funeral, a pastor. The pastor and his wife had been trying to have a baby for quite some years, and it just never happened. Two days before the funeral, the pastor’s wife discovered that she was pregnant. Not only had she finally become pregnant, but the baby was born later that year in October, on the same day of little Becky’s birthday.
That just shows you two things, The Lord does answer prayers, and that when one door closes, another door opens.

  Readers Responses
  1. 0N 5TH SEPT wish U a HAPPY BIRTH ANIVERSARY on ur bday. I want 2 vsh u a happy happy b'day n also want u 2 know tat u r loved by all of ur friends. Always take care. Dr K P Singh 9818110832
  2. Dear Dr. K. K. Aggarwal Ji Thank you very much for the E Medinews and am overwhelmed by reading the contents. It is very much informative and contains useful details. I would be obliged to receive it regularly. Meanwhile I am forwarding it to several contacts for their benefit. With Best Regards Ramesh Gugnani
  3. Dear Dr. Aggarwal, I wish to know about the safety profile of nimesulide in controlling fever. It is a drug that has been banned by many countries but is being used in ours. Is it safe to use it on a short duration basis e.g. 2-3 days and can it be used in patients suspected of having dengue?  Dr. Malini Kapoor
    eMedinews Responds: Nimesulide is as safe as paracetamol in dengue.  I am using it without any problem. It is not banned in any country. For example a drug not available in US does not mean it is banned. It’s a European drug and may not be available in US.
  Public Forum

(Press Release for use by the newspapers)

Dr. Naresh Trehan gets Acharya Sushil Muni Ahimsa Peace Award

The 2nd Acharya Sushil Muni Ahimsa Peace Award was received by Dr. Naresh Trehan, Chairman & Managing Director, Medanta Group. The award is given by Acharya Sushil Muni Ahimsa Peace Award Trust every year to a person of eminence nationally or internationally for his or her contribution in the field of peace, environment or health.
 
The recipient of the first award was His Holiness Dalai Lama Ji. Acharya Dr. Sadhvi Sadhna Ji Maharaj, Chairperson and Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal, Vice-chairman of the Award Trust said that anyone can apply for the award which carries a cash prize of Rs. 1 lakh. Chief Guest on the occasion, Shri Sriprakash Jaiswal, Ministry of Coal and Ministry of Statistics and Programme Implementation said that both inner peace, outer and environmental peace are interrelated. If 51% of the society is not at peace mentally, the result will be environmental distraction.

Viral Conjunctivitis Update

Monsoons, along with rain, also bring lots of diseases, which includes eye problems said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela and Dr Navin Sakhuja, Senior Eye Specialist, Moolchand Hospital. In a bid to educate the people about the problem, the specialists released the following information.

  1. Viral conjunctivitis is typically caused by the Adeno virus, which can also cause the common cold.
  2. The eye infection may be the only manifestation of the disease.
  3. Other symptoms may be a part of the common cold, enlargement of lymph glands, fever, sore throat and/or runny nose. 
  4. Viral conjunctivitis is highly contagious.  
  5. It spreads by contact with his or her eye secretions or contaminated objects and surfaces. 
  6. The most common symptoms are: redness, watery (serous) discharge, itchiness and a gritty feeling in one of the eyes.
  7. Sometimes, morning crusting (sticking together of eyelids) followed by watery discharge with some scanty mucus throughout the day may also occur.
  8. The second eye usually is involved within 24 to 48 hours.
  9. Unilateral eye involvement does not rule out viral eye flu.
  10. It is a self-limited disease.
  11. Clinical course compares with that of common cold.
  12. The total duration of illness is 2-3 weeks.
  13. Clinically, the eye may be better in first few days but usually symptoms worsen with very gradual resolution ever first two weeks.
  14. Treatment may reduce symptoms but does not alter the clinical course of the disease. 
  15. Drops should be put only in the affected eye and hands should be washed after that.
  16. There are no specific anti-viral drugs for viral conjunctivitis.
  17. Topical anti-allergic ointment or drops may help reduce the symptoms. 
  18. If one has to use lubricating agent, it should be non-antibiotic one. 
  19. Patients may feel better by using a topical lubricant that can be used often as hourly. 
  20. All patients must be told that they may get relief in 3-5 days but symptoms can persist for 3 weeks. 
  21. Frequent hand washing can prevent the infection from spreading.
  22. Adults or children who have viral conjunctivitis should NOT share their handkerchiefs, tissues, towels, or bed sheets/pillows with uninfected family or friends.
  Conference Calendar

The XXIX Annual European Society for Regional Anaesthesia Congress (ESRA 2010)

Date: September 8–11, 2010
Venue: Porto, Portugal
http://www.kenes.com/esra

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday– BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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