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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 ...

6th October 2010, Wednesday

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

ART now reportable

In Writ Petition (C) No. 535 of 1998 of Sahara House versus Union of India and others, the Honourable Supreme Court of India during its hearing on 1 October 2010 has directed that all Private Practitioners, Hospitals and Clinics, should report information about patients receiving Anti–Retroviral Therapy (ART) in their care. They have to report in the Quarterly Reporting Format available at the link below within a period of two weeks from 1 October 2010.
http:// nacoonline.org/ Divisions/ CST/ Urgent_Reporting__of_Patients_on_ART_In_private_Sector/

The report can be sent to the National AIDS Control Organisation (NACO) as a hard copy, or in the Quarterly Reporting format excel sheet available at the link given above by email to artreports.private@gmail.com

(with inputs from Dr B. B. Rewari, NACO)

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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  Photo Feature (from the HCFI Photo Gallery)

Perfect health Mela

Since 1993 Perfect health Mela has been generating awareness about all aspects of health incorporating all pathies, among people from all strata and walks of life using infotainment modules under one roof.
In the photo: Shri Atal Bihari Vajpayee, former prime minister of India, Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI and Mr Mahesh Khandelwal.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Vitamin D

A randomized trial in women age 70 and older found an increase in the risk of falls and fracture with administration of 500,000 units of cholecalciferol orally given once annually, compared to placebo. The incidence of falls was highest in the first three months following supplementation

(Reference: Sanders KM, et al. Annual high–dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010;303:1815).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

City turns pink to create breast cancer awareness

Hyderabad: In a rare show, the city was lit pink on Sunday evening to show solidarity in creating breast cancer awareness. An integral part of the ‘Pink Ribbon’ campaign, prominent buildings of the city including the US Consulate General, the historic Charminar and the Buddha statue at the Hussainsagar among others were lit pink to make people aware of breast cancer. The campaign kicked off with a symbolic Pink Ribbon walk on Sunday morning at KBR Park. Nearly 3,000 people, including breast cancer survivors, their families as also men and women from different walks of life came together to be a part of this walk. A joint initiative of Ushalakshmi Breast Foundation and the US Consulate General, actor Akkineni Nageshwara Rao flagged off the walk at the venue. (Source: The Times of India)

‘Dengue strain milder this time’

In the wake of reports that an official attached with Indian Lawn bowls team in the Games Village has been admitted to a hospital with dengue symptoms, the DMA on Sunday said there was nothing to worry and came out with a ‘Do’s and Don’ts’ list for the participants. "In every place in the world, there are certain seasonal diseases which are more prevalent at that time. At present in Delhi, besides dengue, few cases of malaria, typhoid, seasonal viral and chikungunya cases are seen," Narender Saini, President, Delhi Medical Association, said. "Luckily this time the dengue strain is much milder in form. More over our hospital are well equipped with all kind of drugs and other modalities required to treat the disease," he said. The DMA also issued a list of precautionary measures for the benefit of tourists and participants:–

  1. The participants and visitors of the CWG are advised to use full–sleeved clothes and mosquito–repellent creams, mats and coil.
  2. Do not leave the doors and windows open during day time.
  3. Do not shake hands or hug in greeting to avoid the spread of H1N1.
  4. In case of irritation/redness/discharge in the eyes wash your eyes with clean water and visit the nearest health centre.
  5. Use only bottled water/juice/cold drinks and make sure that seal is not broken.
  6. Wash your hands frequently with soap and water or with hand rub.
  7. Preferably, eat food only which has been served hot.
  8. In case of fever don't panic, and don’t take medicine of your own.
  9. Always carry your health records and continuation of any medicine intake. (Source: The Times of India)
  International News

(Dr Monica and Brahm Vasudev)

New research in mice shows ageing can be reversed by stem cells

That mixing blood of old people with the blood of young people, the young blood cells can rejuvenate old blood cells has been demonstrated by The Havar Stem Cell Institute in a recently published study on Mice. In the study when blood from young mice bone marrow was injected in old mice, these blood cells after entering into bone marrow of old mice revitalized the blood stem cells present in bone marrow. Usually in old mice, bone marrow produces that type of blood stem cells which generate more myeloid series. After the injection of young blood cells even old mice started producing lymphoid stem cells that induces repair. The study is yet to be done in humans. (Dr. D R Nakipuria)

Home dialysis as good as hemodialysis at centers

Patients with end–stage kidney disease who have dialysis at home fare just as well as their counterparts who do hemodialysis, which is traditionally performed in a hospital or dialysis center. According to Dr. Rajnish Mehrotra, lead author of the study, not only was there no difference, the improvements in survival have been greater for patients who do dialysis at home. The study is published online Sept. 27 in the Archives of Internal Medicine.

Increases in 5–, 10– Year survival at every stage of breast cancer

A review of 60 years of patient records at The University of Texas MD Anderson Cancer Center shows that advances in screening for disease detection, better surgical techniques available to more women, and an increased number of therapies that reduce the risk of relapse in patients with both locally advanced and early stage disease, have together led to a striking improvement in survival rates of patients with breast cancer.

  Hepatology Update

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

What is the role of imaging studies in neonatal cholestasis?

Role of USG

USG is the most useful initial imaging modality for providing information about the liver structure, size and composition.
  • It can detect choledochal cyst, gall bladder size, dilated common bile duct (CBD), anomalies of viscera or portal hypertension.
  • A normal gall bladder on fasting (for 4 hrs) contracts normally on feeding, which virtually rules out biliary atresia. Reverse is not true for neonatal hepatitis.
  • A triangular cord (TC) representing a fibrous cone of tissue at porta hepatis is seen in 80% of patients with EHBA (extrahepatic biliary atresia). Use of 4 mm thickness as the criterion for TC sign gives a sensitivity of 80%, and specificity of 98% and positive and negative predictive value of 94% for the diagnosis of biliary atresia. The sensitivity and specificity of small and absent gall bladder in detecting biliary atresia varies from 73–100% and 67–100% respectively.
  Infertility Update

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

I’m worried that my cancer treatment means I won’t be able to have children.

Some cancer treatments can have an impact on future fertility, and it is worth discussing this with your doctor before your treatment begins. Men can, for example, freeze their sperm and women can consider creating embryos with their partner (if they have one). Egg and ovarian tissue cryopreservation is also possible, but it is still not very effective.

  ENT Update

Dr. Aru Handa MS, DNB (Department Co–ordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

What are the effects of noise exposure?

The effect of noise on ears is initially temporary. If given rest from noise, the temporary shift in hearing threshold can come back to normal within 24 to 48 hours. But prolonged exposure over a long period of time leads to permanent shift of hearing thresholds which initially affect higher frequencies and thus may go unnoticed. The hearing frequencies i.e. 500, 1000, 2000Hz are affected later. Tinnitus may be a presenting symptom in many patients of noise induced hearing loss.

  Medicolegal Update

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

What was the Dr. Sam Sheppard Murder Case?

American re–trial of the Century in 1966

Facing two different juries, twelve years apart, Sam Sheppard was found guilty by one jury, not guilty by the next. Even over the past decade, partisans continued the debate.

The most significant difference between the trial of 1954 in which he was found guilty and prosecuted and 1966 trials wherein he was acquitted was that Sam Sheppard did not testify in the 1966 trial.

In the closing argument, it has been told to the jurors that the real killer was not in the courtroom: "Someone was angry, angry enough to kill, someone who didn’t have the strength in her arm that Sam Sheppard had, for indeed he would have crushed that skull like an eggshell…" Despite his earlier hints about a possible motive, it has been found that the case still left many questions unanswered. "Why was that person so angry? What had happened? What had Marilyn done to anger that person? We will never really know? The first vote was 8 to 4 for acquittal, but by the evening the minority had come around. Sam Sheppard was a free man and he returned to his surgical practice, but with deteriorated skills and a serious drinking problem, he botched two operations killing both patients On April 6, 1970, Sam Sheppard collapsed vomiting blood and died. The death of Sam Sheppard did not mean an end to the continuing mystery surrounding the murder of Marilyn Sheppard. A third jury in 2000, asked to consider awarding the Sheppard family damages for wrongful imprisonment, sided with county prosecutors. In 2001, a book on the Sheppard case concluded that Sam was clearly innocent.

  Medi Finance Update

Goals of the Mutual fund

If you need the funds to generate income either because you have retired, are saving to buy a house or are unable to work, you need to look at funds that will not only grow over time, but will also provide you with an income. For example, dividend funds are designed to pay you dividends on a quarterly or annual basis.

  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combinations of Sodium Bromide/chloral hydrate with other drugs

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Lab diagnosis of rheumatoid arthritis is based on clinical evaluation with lab investigations of CBC with ESR, CRP, RA factor and anti CCP.

Perfect Health Mela 2010
IMA Elections
  IJCP Special

Dr Good Dr Bad

Situation: A 25-year-old patient was brought to the medical emergency with kerosene ingestion.
Dr.Bad: Do Ryle’s Tube aspiration and lavage.
Dr.Good: Refrain from doing Ryle’s tube lavage. Get a CXR done to check for lipid pneumonia.
Lesson: Never attempt Ryle’s tube insertion and lavage in kerosene poisoning as it can cause perforation. Instead chemical pneumonitis should be suspected and an X-ray chest should be ordered for confirmation.

Make Sure

Situation: A patient with Chikungunya had persistent joint pain.
Reaction: Oh my God! Why was Hydroxychloroquine not given?
Lesson: Make sure that all patients with post Chikungunya persistent arthritis are treated with Hydroxychloroquine

Quote of the Day (Dr. GM Singh)

"A ship ought not to be held by one anchor, nor life by a singe hope." Epictetus

  Mind Teaser

Read this…………………

      strike your

Answer for yesterday’s Mind Teaser: "The aftermath".

Correct answers received from: Dr GM Singh, Dr Prachi, Dr Anupam, Dr. K. P. Rajalakshmi, Dr. Dinesh Kumar S, Dr Aditya Rattan

Answer for 4th October Mind Teaser is: Who’s in "charge"

Correct answers received from:Dr S. Upadhyaya, Dr Anurag Jain, Dr. Manjesh, Dr Virender Prakash Gautam, Dr. Gautam Roy

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr. G.M. Singh)

An angry wife was complaining about her husband spending so much of his free time in the local bar, so one night he took her along with him. "What’ll you have?" he asked. "Oh, I don’t know. The same as you I suppose," she replied. So, the husband ordered a couple of Jack Daniels and threw his down in one shot.
His wife watched him, then took a sip from her glass and immediately spit it out. "Yuck, that’s TERRIBLE!" she spluttered. "I don’t know how you can drink this stuff!"
"Well, there you go," cried the husband. "And you think I’m out enjoying myself every night!"

You are an Indian if you (Anuj Goel)
You name your children in rhythms (For example, Sita & Gita, Ram & Shyam, Kamini & Shamini…)

  An Inspirational Story

Sleeping Through the Storm
A young man applied for a job as a farmhand. When the farmer asked for his qualifications, he said, "I can sleep when the wind blows."

This puzzled the farmer. But he liked the young man, and hired him. A few days later, the farmer and his wife were awakened in the night by a violent storm. They quickly began to check things out to see if all was secure. They found that the shutters of the farmhouse had been securely fastened. A good supply of logs had been set next to the fireplace.
The young man slept soundly.The farmer and his wife then inspected their property. They found that the farm tools had been placed in the storage shed, safe from the elements. The tractor had been moved into the garage. The barn was properly locked. Even the animals were calm. All was well.
The farmer then understood the meaning of the young man's words, "I can sleep when the wind blows." Because the farmhand did his work loyally and faithfully when the skies were clear, he was prepared for the storm when it broke. So when the wind blew, he was not afraid. He could sleep in peace.

  Readers Responses
  1. Respected Sir, Good question by Ashish. The CHADS2 score of pt E is maximum ie 3 thus he is the best candidate for Antocoagulation. However, any person of 1 or more CHADS2 score requires anticoagulation, thus I will prescribe antocoaguants to other patients too except the first(A), provided the A.f is persistent. Rgds Dr Varesh Nagrath.
  2. Sir, in your last edition - Dr.Good recommends for a bioprosthetic valve (instead of a mechanical valve) for a patient from a village. I would like to contradict this. The cheapest mechanical heart valve is the TTK - CHITRA Tilting disc valve - The only valve manufactured indigenously in India, which would cost just 1/4th to 1/3rd of the cost of a bioprosthetic valve.Costs of most of the tissue valves are too high for the reach of a poor man (The cost of a single valve varies from Rs. 70,000 to more than 1 lakh.). Hence, mechanical valves can be used for patients from village; the rest of the money can be utilized for anticoagulants. Even village people, if properly explained about the anticoagulation schedule and follow up, to our surprise (contradictory to popular belief) follow our advice assiduously. The main problem in most centres is that at the time of discharge, patients are not well-informed and instructed due to busy schedule of the doctors in the cardiothoracic Surgery wards, this is the major setback instead of blaming the patient's non-compliance. This is purely based on my personal experience - as I practice in the centre where majority (>2/3rd) patients are from villages - all done with mechanical prosthetic valves. They do come regularly for follow up.  Moreover, the longevity of the mechanical valves is well proven and time-tested.  In my personal experience, I am still observing patients with mechanical valve replaced even 15 - 20 years ago without any major complications.
    Dr. B.V. Sai Chandran, Consultant, Dept. of Cardiothoracic & Vascular Surgery, JIPMER, Puducherry.
  3. Dear Dr Aggarwal, you had very correctly put the spiritual and scientific aspects of 'Pitra Paksha'. This prompted me to put few lines for parents; described here as below: Regards: Dr. Shridhar Dwivedi, 5th September, 2010-10- 10, 12th day of Pitrapaksha, Vikram Samvat 2067. Pitra Paksha (Parent’s Fortnight) -My Take, I am grateful to my parents, because they conceived me, Gave me good genes, inculcated healthy habits,Made me learn basics of human life, Early to bed and early to rise, Gave vegetarian food and drinks, Abhorred tobacco and alcohol, Sown good work culture, Suffered a lot, Sacrificed their pleasure and time, Molding me to become professional, helpful and sublime,Remembering Almighty always, be it hay or shine Making me proud of my land, country and culture
  4. Dear KK, Will u pl congratulate the IMA Kerala Chapter on my behalf, or give me their contact number/s? I, being one of the first few to oppose whole heatedly the idea of BRMS, am really delighted to know developments on this issue.
    Dr K K Arora  
  Public Forum

(Press Release for use by the newspapers)

Heritage: Dance Competition at MTNL Perfect Health Mela

Heritage a special Dance competition will be held during the forthcoming MTNL Perfect Health Mela which is being organised by Heart Care Foundation of India jointly with various Departments of Delhi Government, NGOs and public sector undertakings from 23rd to 31st October at NDMC Grounds Laxmi Bai Nagar, New Delhi.

The competitions will include traditional dance forms of India like Odisi, Bharatnatyam and Kathak. The participants will be both from junior and senior groups. Over 20 dance schools will participate in the event.

Giving the details, Padma Shri and Dr BC Roy National Awardee Dr. K K Aggarwal, President, Heart Care Foundation of India and noted Kathak dance exponents Ms Nalini and Ms Kamalini said that dancing is good for health and classical dance is a mix of exercise and meditation. It is a known fact that dancers do not end up with serious lifestyle disorders.

  Forthcoming Events

CPLD 2010: Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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