emedinews
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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 & 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

    Health Videos…

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

6th March 2013, Wednesday

Toddler 'functionally cured' of HIV infection, NIH

A two-year-old child born with HIV infection and treated with antiretroviral drugs beginning within 30 hours of life, no longer has detectable levels of virus using conventional testing despite not taking HIV medication for 10 months, according to findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta by Dr Deborah Persaud, associate professor of infectious diseases at the Johns Hopkins Children’s Center in Baltimore, and Dr Katherine Luzuriaga, professor of pediatrics and molecular medicine at the University of Massachusetts Medical School in Worcester.

This is the first well-documented case of an HIV-infected child functionally cured of HIV infection. Functional cure means no detectable levels of virus and no signs of disease in the absence of antiretroviral therapy.

The child was born prematurely in July 2010 in Mississippi at 35 weeks, to an HIV-infected mother who had received neither antiretroviral medication nor prenatal care. At 30 hours of age, the infant was started on liquid three anti-HIV drugs: zidovudine, lamivudine and nevirapine. The newborn’s HIV status was confirmed by PCR testing on the second day of life.

The baby was discharged at 1 week of age on a combination of zidovudine, lamivudine and co-formulated lopinavir-ritonavir.

Viral load tests performed over the first three weeks of life again indicated HIV infection. On Day 29, the infant’s viral load had fallen to less than 50 copies of HIV per milliliter of blood (copies/mL).

The baby remained on the prescribed drugs until 18 months of age when treatment was discontinued by the relations. However, when the child was again seen five months later, blood samples revealed undetectable HIV levels (less than 20 copies/mL) and no HIV-specific antibodies. Ultrasensitive viral RNA and DNA tests revealed extremely low viral levels. Presently the child is on no antiretroviral therapy with no identifiable levels of HIV.

The case suggests that providing antiretroviral therapy within the very first few days of life to infants infected with HIV through their mothers via pregnancy or delivery may achieve a cure.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Healthcare worker - fatigue and patient safety

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Multi-specialty camp in East Delhi

A multispecialty camp was organized by Heart Care Foundation of India in association with East Delhi Walkers’ Association on 17th February 2013.

 
Dr K K Aggarwal
    National News

Apex court lays down guidelines on foeticide

The Supreme Court on has laid down the guidelines for the strict implementation of the Pre-Natal Diagnostics Act (PNDT) and directed the central supervisory board and the state supervisory boards to hold a meeting once in six months to ensure the provisions of the Act are not breached.

“The decline in the female child ratio all over the country leads to an irresistible conclusion that the practice of eliminating female foetus by the use of pre-natal diagnostic techniques is widely prevalent in this country,” said a bench of Justice KS Radhakrishnan and Justice Dipak Misra while issuing the guidelines. The court gave all the states and Centre to file a status report within three months.

The advisory committees have been directed to seize records, seal machines and institute legal proceedings if they notice any violation of the Act. On confirming the breach, the advisory committees should inform state medical councils and seek cancellation of the errant doctor’s licence to practice and suspension of the registration of the ultrasound clinic.

“The authorities should ensure also that all genetic counselling centres, genetic laboratories and genetic clinics, infertility clinics, scan centres etc. using preconception and pre-natal diagnostic techniques and procedures should maintain all records and all forms, required to be maintained under the Act and the rules and the duplicate copies of the same be sent to the concerned district authorities, in accordance with Rule 9(8) of the Rules,” the bench ordered.

Advisory boards have also been directed to ensure that all manufacturers and sellers of ultra-sonography machines do not sell any machine to any unregistered centre and a list of persons to whom machines have been sold should be prepared on quarterly basis and sent to the respective state government and the Centre. (HT, March 04, 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)

(http://behumanstopchildabuse.emedinews.in/)

Victims who present within 72 hours of the incident needs urgent evaluation: they may have obvious forensic evidence on their clothes or bodies.

For comments and archives

    Valvular Heart Disease Update

What are the contraindications to surgery in aortic stenosis?

With certain high risk patient exceptions, valve replacement should not be performed for isolated severe AS in asymptomatic patients. The threshold for surgery may be lower in such "high–risk" patients with critical valve areas of <0.75 cm2 than in those with valve areas of <1.0 cm2 but =0.75.

(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)

HIV drugs ease inflammation in 'controllers'

Putting HIV controllers -- who ordinarily don't need therapy -- on highly active antiretroviral treatment (HAART) appeared to reduce markers of chronic inflammation, a researcher said at the Conference on Retroviruses and Opportunistic Infections. (Source: Medpage Today)

Treating hypertension may affect vision loss in glaucoma

Patients with normal-tension glaucoma have an increased risk for vision loss — and progressive worsening of their eye disease — if they are also being treated for systemic hypertension, according to a new study. (Source: Medscape)

PTSD often seen with breast cancer diagnosis

Nearly a quarter of women newly diagnosed with breast cancer experienced post-traumatic stress disorder (PTSD), with blacks, Asians, and women younger than 50 reporting distress more often, a study found. (Source: Medpage Today)

Colonoscopy may reduce late-stage colon cancer risk by 70%

Colonoscopy is associated with a 70% reduced risk for late-stage colorectal cancer (CRC) among people of average risk, and sigmoidoscopy is associated with reduced risk for cancers of the left colon, according to a study published online March 4 in the Annals of Internal Medicine. (Source: Medscape)

Diabetes: It is all about sugar

Increased availability of sugar may be the single most important driver of the worldwide diabetes epidemic, a population-based study suggested. (Source: Medpage Today)

 
    Twitter of the Day

@DrKKAggarwal: Ten ways to ease neck pain Dr K K Aggarwal 1. Don’t stay in one position for (cont) http://tl.gd/l77pp5

@DrKKAggarwal: Without unpredictability there is no creativity. The universe is creative but appears random to the limited mind #CosmicConsciousness

 
    Spiritual Update

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

How to improve your soul profile

1. What is my purpose of life?
2. What is my contribution going to be for my friends and family?

For comments and archives

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

What do you understand by Dilation and Curettage?

Dilatation and curettage (D&C) is a minor (short) surgical procedure that removes tissue from your uterus (womb). D&C also is done to remove pregnancy tissue remaining from a miscarriage or an abortion.

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

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

Transfusion with incompatible blood (mismatched blood)

The symptoms begin only after a few ml. of blood has been given:

  • Patient complains of shivering, restlessness, nausea, and vomiting. Precordial and lumbar pain.
  • Cold, clammy skin with cyanosis
  • Pulse rate and respiratory rate increase. Temperature rises to 38° to 40°C (101 to 105°F).
  • B P falls and patient passes into a state of shock.
  • Hemoglobinemia, hemoglobin urea (urine turns red), oliguria (urine becomes scanty or the urinary output is reduced) and anuria (total output of urine becomes 200 ml in a day)
  • Jaundice appears after a few hours and in some cases anuria persists and uremia develops. This may lead to death.

For comments and archives

 
    An Inspirational Story

Wooden bowls

A frail old man lived with his son, his daughter-in-law, and his four-year-old grandson. His eyes were blurry, his hands trembled, and his step faltered.

The family would eat together nightly at the dinner table. But the elderly grandfather's shaky hands and failing sight made eating rather difficult. Peas rolled off his spoon, drooping to the floor. When he grasped his glass of milk, it often spilled clumsily at the tablecloth.

With this happening almost every night, the son and daughter-in-law became irritated with the mess.

"We must do something about grandfather," said the son.

"I've had enough of his milk spilling, noisy eating and food on the floor," the daughter-in-law agreed.

So the couple set a small table at the corner.

There, grandfather ate alone while the rest of the family enjoyed their dinner at the dinner table. Since grandfather had broken a dish or two, his food was served in wooden bowls. Sometimes when the family glanced in grandfather's direction, he had a tear in his eye as he ate alone. Still, the only words the couple had for him were sharp admonitions when he dropped a fork or spilled food. The four-year-old watched it all in silence.

One evening, before supper, the father noticed his son playing with wood scraps on the floor. He asked the child sweetly: "What are you making?" Just as sweetly, the boy replied, "Oh, I'm making a little bowl for you and mama to eat your food from when I grow up." The four-year-old smiled and went back to work.

These words so struck the parents that they were speechless. Then tears streamed down their cheeks. Though no words were spoken, both knew what must be done. That evening, the husband took grandfather's hand and gently led him back to the family table.

For the remainder of his days, grandfather ate every meal with the family. And for some reason, neither husband nor wife seemed to care any longer when a fork was dropped, milk was spilled or the table cloth was soiled.

With very special thanks to Catherine Cruz for sharing this story.

For comments and archives

 
    Cardiology eMedinewS

Gastric bypass puts type 2 diabetes into remission Read More

Coronary calcium is stroke risk barometer Read More

 
    Pediatric eMedinewS

Kids' ADHD may continue into adulthood Read More

Screening for CAH will save girls' lives, too Read More

 
    Rabies Update

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

What are the initial (prodromal) symptoms of rabies?

  • Pain or paresthesiae at the site of the bite is well-known as a diagnostically useful prodromal symptom occurring in one-third to two-thirds of cases.
  • In Thailand, however, a specific type of paresthesiae-itching-was the earliest symptom in >40% of cases. Itching occurred at the site of the healed bite wound or involved the whole bitten limb and was sometimes so intense as to provoke frenzied scratching and excoriation of the skin. The explanation for local paresthesiae may be the multiplication of virus in the dorsal root ganglion of the sensory nerve supplying the area of the bite.
  • Pain behind the grafted eye was an early symptom in three of the four patients who developed rabies following corneal transplants.
  • Priapism with frequent spontaneous orgasms was the first symptom in one Thai patient.
  • Fever, malaise, nausea and vomiting.
  • The skin becomes sensitive to changes of temperature, especially air currents.
 
    IJCP Special

Dr Good Dr Bad

Situation: A CKD patient wanted to know if she should undergo brachial artery flow mediated test for arterial stiffness.
Dr Bad: It’s not needed.
Dr Good: Get it done.
Lesson: Increased arterial stiffness is noted in patients with CKD and end–stage renal disease, and is a possible risk factor for increased cardiovascular mortality.

Make Sure

Situation: A 28–year–old pregnant woman was advised erythromycin estolate for her upper respiratory tract infection. A week later she developed jaundice.
Reaction: Oh my God! You should have prescribed erythromycin stearate instead of estolate.
Lesson: Make sure to remember that higher incidence of hepatitis with cholestatic jaundice occur in pregnancy with erythromycin estolate.

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

 
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  Quote of the Day (Dr GM Singh)

A true friend is one who overlooks your failures and tolerates your success! Doug Larson

 
    Mind Teaser

Read this…………………

A 51-year-old female patient who has metastatic breast cancer is stabilized on oxycodone (OxyContin) for her pain. The patient exhausts her family medical leave act, is forced to leave her job, and, subsequently, loses her health insurance. What is the pain management nurse's best course of action for the patient?

a. Encouraging the patient to cut the pain tablets in half to make them last longer
b. Offering information to the patient about pharmaceutical assistance programs
c. Preparing the patient to be weaned off of oxycodone (OxyContin)
d. Providing the patient with information on the nearest free clinic

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: a. Additional time is needed for the patient to process the information.

Correct answers received from: Dr PC Das, Dr Bharat Bhushan Aggarwal, Dr Arpan Gandhi,
Dr KV Sarma, Dr (Maj. Gen.) Anil Bairaria, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Prabha Luhadia,
Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Kanta Jain, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 3rd March Mind Teaser: Clarify the patient's report by reviewing the patient's nonverbal behavior.

Correct answers received from: Dr K Raju, Dr KV Sarma.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Third son

In a class a teacher during his speech told a story.

"There was a father who gave 100 rupees each to his 3 sons and asked them to buy things and fill up a room completely.

The first son bought hay for Rs. 100 but couldn't fill the room entirely.

The second son bought cotton for Rs. 100 but couldn't fill the room entirely.

The third son bought a candle for Rs. 1 and lit it up and the room was completely filled with light."The teacher added "Our Principal is like the third son. Since the day he has taken charge, our school is filled with the bright light of prosperity"

A voice from the backbench asked: "Woh sab toh theek hai! But where are the remaining ninety nine rupees?"

 
    Medicolegal Update

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

How can snake bites be avoided?

Snake venom is a very complex mixture of proteins and toxins. Snakes use their venom to immobilize, and in some cases, digest their prey.

Snakes bite only when they are surprised by a sudden movement and cannot get away. Cobras and the Russel viper are responsible for as many as 20,000 snake bite deaths in India every year. Inland Taipan is the world’s most venomous land snake. Its bite is synonymous with death. Maximum survival time recorded after the bite of a Taipan snake is not more than few hours. Without prompt medical assistance its victim has rarest chance of recovery.

To avoid snake bite:

  • Do not sleep on the ground. You might roll over onto a snake while asleep, or a snake may move next to you to get warm.
  • Do wear shoes when walking outdoors. Tall leather boots give the best protection for walking in long grass or undergrowth.
  • Do learn about the poisonous snakes in your area. Learn what they look like and where they live. Most snakes live on the ground but some live in trees or bushes. Find out if there are any snakes that spit venom and how they attack.
  • Do take care at night because this is when many snakes are active. Tell children to wear shoes and use a torch when walking around at night. Teach them to leave snakes alone.
  • Do not go near snakes. Run away if you can. If you cannot run away, do not make sudden movements.
  • Do not touch a snake even if it looks dead. Some snakes pretend to be dead to avoid attack.
  • Do not turn over stones or logs, or put your hand or foot into a hole in the ground. Before stepping over a log look for snakes on the other side.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Promotion of hygiene as important as deworming tablet

It is just not enough to give children deworming tablets to reduce worm infestations, it is also important to improve hygiene and sanitation, says a study published in the February 2013 issue of the journal PLoS Neglected Tropical Diseases.

Elaborating on this, Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and National Vice President-Elect IMA said that deworming agents can easily treat intestinal worms; re-infection is common because of lack of adequate hygiene and sanitation to control re-exposure. Also, at times, the human body may not be capable of developing a protective response against re-infection by the intestinal worms.

According to the study, if infection persists, deworming agents should be given to children every year till hygiene and sanitation are improved so that re-infection does not occur.

The common intestinal worms are roundworms and hookworms. These are transmitted via contaminated soil.

Worm infestations impair the physical growth of children and affect their mental development. They also cause anemia, diarrhea and pain in abdomen.

All the common worm infections in school-age children can be treated effectively with deworming agents such as albendazole, mebendazole, which can be given as a single tablet to all children.

 
    Readers Responses
  1. Dear Sir, Strongly agree with you regarding MCI issues. Sarmishtha Bhattacharjee.
  2. Reference Comments on Prosthetic Valve Obstruction: Prosthetic valve thrombosis is the most common cause in our country due to inadequate anticoagulation follow-up. One dictum is that that you will be right 3 out of 4 times if you diagnose thrombus over pannus. This will then be supported by history of short onset of symptoms, progressive increase of symptoms, strongly related to inadequate anticoagulation. Trans-esophageal echo and fluoroscopy are important means of diagnosis by showing abnormal prosthetic valve motion. Even in case of some doubt, administering a rapidly-acting thrombolytic agent may be life-saving. Dr. Parashar.
 
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