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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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 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 December, 2010, Sunday

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

Revisiting 2010: Cardiology

Aspirin dose for patients with acute coronary syndrome undergoing PCI

In patients at high risk of bleeding, prescribe a daily dose of aspirin of 75 to 162 mg rather than higher doses beginning the day after PCI with either bare–metal or drug–eluting stents.

The CURRENT–OASIS 7 trial, randomly assigned over 25,000 patients with an acute coronary syndrome. With regard to the aspirin comparison, there was no significant difference in the primary outcome between those who were randomly assigned to 300–325 mg compared to those given 75–100 mg.1 While there was no significant difference in the rate of major bleeding, the rate of minor bleeding in the subgroup of patients who received PCI was significantly higher in those who received the higher dose of aspirin.2 Previous recommendations had been to treat such patients with aspirin at a dose of 162 to 325 mg/day for at least one month following placement of a bare metal stent, or three to six months following placement of a drug&ndeluting stent.

1.http://www.boehringer-ingelheim.com /news/ news_releases /press_releases/ 2010/ 27_october_2010_dabigatran.html.
2. The CURRENT–OASIS 7 Investigators; Mehta SR, Bassand JP, Chrolavicius S, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med 2010;363:930–42.  

Dr KK Aggarwal
Editor in Chief
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  HIV/AIDS Update

FAQs

1. What is the treatment approach at birth?
A: Give single dose of Nevirapine within 72 hours + Zidovidine 200 mg per hour for 7 days. If the mother has received <4 weeks treatment, then child should receive treatment for 6 weeks. Zidovidine can help to prevent the infant from becoming infected with HIV as a result of exposure to the mother’s blood during delivery. In infants whose mothers took an antiretroviral medication during pregnancy, the child may be considered HIV–negative if at least two HIV PCR tests are negative at >1 month and >4 months of age. If the HIV PCR is positive, it should be repeated to confirm that the child is HIV positive.

2. Can HIV positive mother breastfeed?
A: If top feeding is available, breastfeeding should not be allowed. HIV–infected women who continue to breastfeed can pass on the virus to the infant. The risk of transmitting HIV to the infant through breast milk is 7% for infants who breastfeed for one year and 10% for infants who breastfeed for up to two years.

3. Can an HIV–positive patient become a father?
Ans. It is possible to take sperms, process wash them and use.

4. What are the latest WHO guidelines?

  • Once CD4 cell count drops to 350. Currently, patients are put on ART when their CD4 cell count drops to 200.
  • To prevent mother to child transmission, all HIV–positive pregnant women should start using the drugs at 14 weeks of pregnancy instead of the previously recommended 28 weeks.

5. What is the importance of viral load?
A. Aim of treatment is to keep it < 50 copies /ml, if <1000 one can go for vaginal delivery and if > 1000 go for LSCS, if > 100,000 treat the patient irrespective of CD4b count.

6. What are the current indications of ART?
Indications of ARV in HIV–positive person WHO: Once CD4 cell count drops to 350. Currently, patients are put on ART when their CD4 cell count drops to 200.
d. To prevent mother to child transmission, all HIV positive pregnant women should start using the drugs at 14 weeks of pregnancy instead of the previously recommended 28 weeks.  

  • History of an AIDS defining illness
  • CD4 count of 350 to 500 cells/microL if the CD4 slope of decline exceeds 100 cells/microL/year or the baseline viral load exceeds 100,000 c/mL.
  • In patients with AIDS related neurocognitive disorders and HIV associated nephropathy.
  • In patients over the age of 50 years
  • Patients who need treatment for HBV related liver disease, but who do not need therapy for HIV, should be considered for early ART initiation with dual active agents against HBV and a fully suppressive regimen versus HIV.
  • In discordant monogamous couples to reduce transmission to the HIV–seronegative partner.

HIV– The Rule of 3

Post exposure prophylaxis
Whenever there is a needle stick injury a healthcare worker must receive post exposure prophylaxis (PEP) preferably within 3 hours but definitely before 3 days. The same is also true for PEP in a case with casual sex or victim of rape.

3 Steps of PEP
When there is needle stick injury
1. Wash the finger with soap and water, do not put finger into mouth
2. It is an emergency but do not panic.
3. Start PEP

Needle stick injury
The chance of HIV transmission through HIV infected needle is 0.3%.

3 routes of transmission of HIV from pregnant mothers to the child
1. Pre–partum
2. Intra–partum
3. Post–partum

Transmission
The chances of infection to the baby from an HIV-positive mother are highest when there is a premature rupture of membrane of > 3 hours duration or if the birth weight of the new born is < 3 kg.

3 strategies (for prevention of HIV from mother to child)
1. Start drugs (anti retro viral drugs)
2. Bypassing the vaginal delivery by choosing caesarean section
3. Advise about breastfeeding

Breastfeeding
It should be either avoided or it should be exclusive breast–feeding for not more than 3 months. Weaning should be abrupt.  

 
  Quote of the Day

(By Dr GM Singh)

"Tears are words the heart can’t express"

 
    Photo Feature (from the HCFI Photo Gallery)

Divya Jyoti 2010

Nurses from various nursing colleges took active part in competitions like Health Model Display during Divya Jyoti, an annual Festival for Nurses.

In the photo: Nurses explaining their model to a visitor in the 17th MTNL Perfect Health Mela

 
Dr K K Aggarwal
 
    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

Encephalitis claims two more lives, toll climbs to 516

Two people succumbed to encephalitis here, taking the toll in the viral infection in eastern Uttar Pradesh this year to 516. Health officials said on Saturday that the two died at the Baba Raghav Das Medical College Hospital here yesterday. The victims hailed from Gorakhpur and Sant Kabrinagar. "Nine patients suffering from encephalitis have been admitted to the hospital on Friday," Additional Director (Health) U K Srivastava said. (Source: The Hindustan Times, Dec 04, 2010)

Manipur has highest HIV infection prevalence: NACO

Even though the overall HIV infection prevalence rate has shown a 50 per cent decline during the past decade in India, among the States, Manipur continues to top the list with an adult prevalence of 1.40 per cent, followed by Andhra Pradesh (0.90 per cent), Mizoram (0.81 per cent) and Nagaland at (0.78 per cent). It is estimated that India had approximately 1.2 lakh new HIV infections in 2009 as against 2.7 lakh in 2000. (Source: The Hindu, Dec 04, 2010)

 
    International News

(Contributed by Dr GM Singh)

COPD: NICE Update

The 2010 update of the NICE guideline on COPD brings the guidance in line with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations.

  • COPD is a multisystem disease and severity should be assessed by a multi–dimensional assessment rather than by the severity of airflow obstruction alone.
  • A diagnosis of COPD should be made in the presence of characteristic signs and symptoms, and an obstructive spirometry characterized by a post–bronchodilator FEV1/FVC ratio of 0.7.
  • Initial choice of regular pharmacotherapy for persistent breathlessness is an inhaled long-acting beta–2 agonist (LABA) or long–acting anti–muscarinic agent (LAMA) where FEV1% predicted is = 50% and a LAMA or inhaled corticosteroid (ICS)/LABA combination where FEV1% predicted is < 50%.
  • Smoking cessation remains a key intervention and pulmonary rehabilitation should be offered to all patients who are functionally limited by COPD, including those who have had a recent hospitalization or exacerbation.

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

About half of America will have diabetes by 2020

A recent report by United Health Group’s Center for Health Reform and Modernization states that 52 percent of Americans will have diabetes by 2020, and the primary culprit will be obesity. It also states that inaction could cost the U.S. $ 3.35 trillion in health care spending over the next 10 years. The report, United States of Diabetes, makes a strong call to action for national lawmakers makers to adopt policies that increase prevention and management of the disease, through early detection and lifestyle interventions that reform the way Americans diet and exercise. "Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early and prevent this devastating disease before it's too late," said Deneen Vojta, M.D., senior vice president of the UnitedHealth Center for Health Reform & Modernization, in a press release.

(Dr Monica and Brahm Vasudev)

Clopidogrel, aspirin together may raise risk of hemorrhage

CDC researchers have found the combination treatment with clopidogrel and aspirin can also cause serious hemorrhages.

Surgical procedure destroying certain kidney nerves may reduce drug–resistant hypertension

A simple surgical procedure destroying certain nerves in the kidney can sharply reduce blood pressure in patients whose hypertension cannot be controlled with conventional medications, according to a study presented Nov. 17 at the American Heart Association meeting and simultaneously published online in The Lancet.

Kidney transplants may be safe for patients infected with HIV

According to a study published Nov. 18 in the New England Journal of Medicine, kidney transplants appear to be safe in patients with HIV.

 
    Infertility Update

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

How successful is ICSI?

The overall fertilization rate with ICSI is about 60% and the clinical pregnancy rate per cycle is about 20% while the multiple pregnancy rate is about 29–38%. The ICSI results are not influenced by either the cause of the azoospermia or the origin of the spermatozoa. This rate is similar to that of IVF in patients with tubal infertility and compares favorably with the 30% per cycle chance of successful pregnancy in a couple following natural intercourse.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

What are the common manifestations of lactose intolerance?

Lactose intolerance is a constellation of signs and symptoms that develop after ingesting a certain quantity of lactose or lactose containing food; this quantity can vary in different individuals depending upon the amount of lactase enzyme available to digest the lactose. For lactose to be absorbed into the body it has to be broken down into glucose and galactose. This breakdown occurs in the small intestine by an enzyme called lactase. Lactase enzyme is found in the intestinal epithelium mostly in the ‘tips’ of the villi. When the lactase enzyme is overwhelmed the lactose is not broken down and instead used by bacteria in the small and mostly large intestine to produce excessive gas and acid. Hence after the ingestion of lactose the symptoms don’t appear for some time and include abdominal pain, diarrhea, flatulence, bloating and even nausea. These symptoms begin within 1/2 hour to a few hours after ingestion of lactose, and usually resolve in a few hours. The hallmark of lactose intolerance is that in the absence of excessive lactose ingestion (not dairy exclusion), there are no symptoms. Clinical examination of the patient is normal. If the individual has recently ingested lactose, bloating and increased bowel sounds may be heard. Lactose intolerance can be present at any age.

 
    Medicolegal Update

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

Collection of blood sample in a medicolegal case

  • If the blood sample is collected to measure alcohol content, clean the site of injection with saline swab and not a spirit swab.
  • Draw about 3–4 ml of blood sample into chemically clean evacuated tubes of 5ml. Use labels with identification codes to mark the tubes. EDTA should be used as an anticoagulant. Tubes with liquid EDTA /fluoride reduce the risk of hemolysis that may change results.
  • Add 2ml of 5% aqueous solution of sodium citrate containing 0.2% w/v of formaldehyde or 0.5% w/v of formalin solution to prevent decomposition, which may alter results.
  • Plastic vacuum tubes/ Plastic vacuum gel tubes are preferred to glass tubes. If vacuum tubes are not available or tubes are opened for freely flowing samples, stoppers which do not react with blood constituents should be available.
  • Special boxes for tube transfer and storage, earmarked refrigerator/freezer must be available in hospital dealing with medicolegal cases.
  • Two, approximately 1cm x 1cm size, blood stains are formed on clean cotton cloth/gauze pieces and, after they are dry, they are transferred to a sterile 10ml injection vial. It should be properly dried, before packing to avoid decomposition and then sealed and labeled.
  • Bloodstains located on the body of an uninjured person are taken by rubbing with moistened clean cotton cloth pieces, it should be properly dried, before packing to avoid decomposition and then sealed and labeled.
 
    Legal Question of the Day

(Contributed by Dr M C Gupta, Advocate)

Q: My brother is in central government service, in Associate Professor Cadre. Due to personal ideological differences, he does not have good relations with his professional senior, the DG, who pressurizes him to do unwanted jobs and never gives him surgeries. His juniors are given more surgeries. Please let me know:

  • Should he start taking bribe/undue favours as per his senior?
  • Should he resign from the job?
  • What should be our next line of action?

A: These are personal decisions. I can give only the following guidelines as per my line of thinking:

  • He should not deviate from the straight and the principled path.
  • He should not resign his job without cool thought or out of frustration. Central government jobs are not easy to get. The boss or he may get transferred. He can try for a transfer. Resigning the job means losing pension benefits. If he has put in sufficient number of years, he may put in a few more and then take voluntary retirement with pension. He can change his career path by getting other qualifications by distance learning (MBA, LLB etc.) while continuing in service. He can apply for study leave and get admission to MCh.
  • If he is very keen on clinical career and has confidence and can get good offers from private hospitals, he can quit job and start a new path.
  • He can decide to take things easy and relax and get a good salary for not much work and spend time in whatever he likes—attending to family; writing books etc.; anything else.
  • If he wants to fight it out, he can contact a lawyer.
 
    Medilaw - Medicolegal Judgements

Can DMC look into PNDT cases?

DMC/DC/F.14/Comp.736/2010/ 4th August, 2010, DMC wrote to Directorate of Family Welfare that since the complaint pertains to allegation of violation of PNDT Act, the same is being forwarded to Directorate of Family Welfare for appropriate action. The attention was also invited to the provision of section 23(2) of PNDT Act: "The name of the registered medical practitioner shall be reported by the Appropriate Authority to the State Medical Council concerned for taking necessary action including suspension of the registration if the charges are framed by the Court and till the case is disposed of and on conviction for removal of his name from the register of the Council for a period of five years for the first offence and permanently for the subsequent offence."

 
    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

Serum urea nitrogen (BUN)

Serum urea nitrogen (BUN) is increased in acute and chronic intrinsic renal disease, in states characterized by decreased effective circulating blood volume with decreased renal perfusion, in postrenal obstruction of urine flow, and in high protein intake states.

 
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    Medi Finance Update

Understanding Mutual Funds

To understand what type of fund you are buying, first look at the asset class in which it is investing and then look at the specific investment categories within the fund.

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Levobetaxolol HCl Ophthalmic Suspension 0.5%

For lowering of intraocular pressure in patients with chronic open–angle glaucoma or ocular hypertension

16–Jan–10

 
    IMSA Update

International Medical Science Academy (IMSA) Update

MMRV vaccine and febrile seizure risk

Among 12– to 23–month–olds who received their first dose of measles-containing vaccine, fever and seizure were elevated 7 to 10 days after vaccination. Vaccination with MMRV results in 1 additional febrile seizure for every 2300 doses given instead of separate MMR + varicella vaccines.

(Ref: Klein NP, et al; Vaccine Safety Datalink. Measles–mumps–rubella–varicella combination vaccine and the risk of febrile seizures. Pediatrics 2010;126(1):e1–8).

 
    IJCP Special

Dr Good Dr Bad

Situation: A 36–year–old executive used to take 5 pegs of alcohol once a week.
Dr Bad: Continue it.
Dr Good: Take only one peg a day or stop it.
Lesson: The French habit of drinking wine almost daily is less taxing to the heart than the Irish custom of downing an equivalent amount of beer on one or two nights a week, according to a study published Nov. 23 in the British Medical Journal.

Make Sure

Situation: A 40–year–old hypertensive complains of head reeling in spite of being on antihypertensive.
Reaction: Oh my God! Her blood pressure is still high. Why didn’t you advise lifestyle modification?
Lesson: Make sure to first advise lifestyle modifications like exercise, low salt diet, high fiber diet, decreasing stress etc. before advising antihypertensive medication, in essential hypertensives.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Vasant Shenoy drvgshenoy@hotmail.com)

The Fern and the Bamboo (By Eric Garner)

One day I decided to quit…I quit my job, my relationship, my spirituality. I wanted to quit my life. I went to the forest to have one last talk with God. "God", I said. "Can you give me one good reason not to quit?" His answer surprised me. "Look around", He said. "Do you see the fern and the bamboo?" "Yes", I replied.

"When I planted the fern and the bamboo seeds, I took very good care of them. I gave them light. I gave them water. The fern quickly grew from the earth. Its brilliant green covered the floor. Yet nothing came from the bamboo seed. But I did not quit on the bamboo. In the second year the fern grew more vibrant and plentiful.

And again, nothing came from the bamboo seed. But I did not quit on the bamboo. "In year three there was still nothing from the bamboo seed. But I would not quit. The same in year fou……then in the fifth year, a tiny sprout emerged from the earth. Compared to the fern, it was seemingly small and insignificant. But just six months later, the bamboo rose to over 100 feet tall. It had spent the five years growing roots. Those roots made it strong and gave it what it needed to survive.

I would not give any of my creations a challenge it could not handle. "Did you know, my child, that all this time you have been struggling, you have actually been growing roots? I would not quit on the bamboo. I will never quit on you. "Don’t compare yourself to others." He said. "The bamboo had a different purpose than the fern. Yet they both make the forest beautiful."

"Your time will come", God said to me. "You will rise high" "How high should I rise?" I asked. "How high will the bamboo rise?" He asked in return. "As high as it can?" I questioned. "Yes." He said, "Give me glory by rising as high as you can." I left the forest, realizing that God will never give up on me. And He will never give up on you.

Never regret a day in your life. Good days give you happiness; Bad days give you experiences; both are essential to life.

— — — — — — — — — —

Mind Teaser

Read this…………………

sight love sight sight  

Yesterday’s Mind Teaser: "notic"
Answer for yesterday’s Mind Teaser:
"Short notice"

Correct answers received from: Dr Rashmi Chibber, Dr K P Rajalakshmi

Answer for 3rd December eQuiz: "Correct answers are C., D. and E."
Correct answers received from: Dr Anupama

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr G M Singh)

Doctor, Doctor I’ve lost my memory!
When did this happen?
When did what happen?

 
    Readers Responses
  1. Dear Sir, e-Medinews is coming out very well....and day by day it is becoming an addiction! It feels good to be one of the receivers of mail. Thank you and Congratulations once again. Regards: Dr. Mallikarjuna Swamy, DNB (Pediatrics) Fellow (Neonatology), Neonatologist, Alia International Hospital, Mahboula, Kuwait.

 
    Public Forum

(Press Release for use by the newspapers)

Can one drive after one peg of alcohol?

Several studies confirm that consuming one or two drinks leads to an increased risk of injury. No safe level of alcohol use exists for the use of potentially dangerous equipment, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

BACs of 0.02 to 0.05 percent impair the ability to operate motor vehicles; this level of blood alcohol can occur with even a single drink.Exposure to alcohol is measured in blood alcohol concentration (BAC) rather than drinks per day or week. The legal BAC limit for driving is 0.03 percent.

This corresponds to approximately four drinks for a 200 pound man, but only 2.5 drinks for a 150 pound woman.

  • The risk of involvement in a collision while driving doubles at a BAC of only 0.05 percent
  • Simulated driving ability is impaired with BACs as low as 0.02 percent.
  • The risk of driving accidents is greatest in the first two years of exposure to alcohol.
  • For pilots the BAC offense level is 0.04 percent.
  • Alcohol is involved in one–half to two–thirds of all homicides, at least one–half of serious assaults, and more than one–quarter of all rapes.

Pyramid Meditation on Monday morning

Pyramid meditation will be conducted by Dr. Aggarwal every Monday from 7 am to 8 am in the morning at Ahimsa Sadhna Pyramid Meditation Centre at C–599, Defence Colony. Giving the details, He said that the pyramid meditation is open to the public. Dr. Aggarwal is a qualified Meditation Teacher and has trained under the new age guru Dr. Deepak Chopra. People can walk in for meditation.

A pyramid is a three–dimensional polyhedron where the faces other than the base are triangular. Pyramids help to harmonize our environment and to charge crystals. In recent years, Pyramidology has experienced renaissance in fame. The pyramid shape itself is being considered as a supernatural source of power or energy of the Universe.

 
    Forthcoming Events

Hospital Infrastructure India (HII) 2010 opens doors on 7 – 9 December 2010 at Bombay Exhibition Centre, Goregaon East, Mumbai. More than 80 exhibitors will be showcasing the latest technologies, products, services and advancements in hospital sector.

  • Hospital planning and design from TAHPI (Australia), HKS (US), Burt Hill (US), AFL (UK)
  • Medical Imaging systems from Sony
  • Wall protection material from InPro Corporation (US). They will be introducing G2, the world’s greenest wall protection material
  • Hospital supplies, OT, LED solutions from Edifice Medical Systems & Dr Mach
  • Floor covering and disinfecting surface solutions from Graboplast, Hungary
  • Electrical safety solutions by Bender – Germany & RR – Eubiq – Singapore
  • Floors and ceilings by Armstrong World, Square Foot, CCIL, Gerflor
  • Clean Room Partitions from GMP Technical
  • Smart Networks International (SNI) – a global consortium of European companies, showcasing hospital infrastructure solutions
  • Hospital project management & consultancy from Medica Synergie
  • Engineering & Project consultancy from Ted Jacob (US), KJWW Engineering (US), ETS – Eastern Services Private Ltd.

Special Features
Exhibition: Leading companies from countries, besides host country India have confirmed their participation at HII 2010

Conference
Session themes include:
Hospital Building Design – Basic principles and insights into future trends
Departmental Planning 1 – HBOT, Laminar airflow in operation theatres
Departmental Planning 2 – Healthcare next: A view of next generation healthcare innovations amongst other topics
Developing Healthcare Infrastructure – Case study of PPP models from Australia, UK and India


Product Demonstration Area: A selection of the latest products and services from some of the key exhibitors participating at HII 2010 will be on display at the product demonstration area. There will be interactive workshops as well as detailed briefing on these products and services to help you keep updated on the trends as well as make informed buying decisions.

B2B Meetings: The event is designed to help you make the most of your time at HII 2010 by facilitating business meetings and networking opportunities.

eMedinewS Events: Register at 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, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

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

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