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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 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 December, 2010, Monday

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

Revisiting 2000–2010

Top 10 Medical Advances of the Decade (2000-2010): ABC news 

  1. Decoding of the Human Genome
  2. Adoption of Information Technology
  3. Smoking significantly reduced
  4. Heart disease deaths reduced by 25%
  5. Stem cell research
  6. Targeted cancer therapy medicines
  7. Combination drug therapy extends Survival rates for HIV sufferers
  8. Micro surgical techniques that reduce invasion reduce surgery risk
  9. Heart, cancer risk discovered with hormone replacement therapy
  10. fMRI advances study of brain

Chlorine gas leak in haiderpur in Delhi

All about chlorine gas toxicity: Symptoms of hyperreactive airways (persistent dry cough and shortness of breath) may develop after a single large exposure to an irritant such as chlorine gas.  This is termed "reactive airways disease syndrome" or "RADs".

Chlorine is gas at room temperature. Chlorine is greenish-yellow and has a pungent smell. At high pulmonary exposures, they can cause death within 10 minutes.

Early symptoms from these agents are nose and throat irritation, cough, and chest pain. With lesser exposures, there may be a latent period of 24 hours, which is subsequently followed by shortness of breath and signs of pulmonary edema. Signs of acute lung injury that are seen within four hours of the exposure predict a low likelihood of survival. These agents burn and irritate the skin and the eyes.

Actions if exposed

• Leave the exposure area at once, and move to fresh air.

• Pulmonary agents are heavier than air, so do not lie down in the toxic area and do not go below ground level. Cover your nose and mouth with a wet cloth. Hold your breath if you can while escaping the toxic area. If you must breathe, take shallow breaths and as few as possible. Keep your eyes closed, if feasible, until away from the area of toxic release.

• Undergo decontamination. Remove clothing, begin a water shower, and in particular flush the eyes with water for about 10 minutes.

• Seek medical attention. Lung symptoms may be delayed for a few hours, but they can rapidly progress.

Medical management — The patient presents with acute respiratory distress, and the chest radiograph shows bilateral diffuse infiltrates.

Bronchospasm is treated with bronchodilators and corticosteroids.

Management of pulmonary failure with a ventilator may be required.

Bed rest is normally recommended until recovery is complete.

Eyes should be treated with a mydriatic followed by a topical antibiotic [13].

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

 
  HIV/AIDS Update

HIV– The Rule of 3

3 opportunistic infections
TB, TB and TB

3 strategies to manage opportunistic infections
1. Education
2. Vaccination (pneumonia)
3. Prevention (exposure, chemotherapy)

3 Universal public precautions to prevent HIV
1. WASH (hands, vegetables, fruits)
2. Consistent and continuous use of condom
3. Use of heating (boil it, cook it, heat it or forget it)

Septran DS once daily prophylaxis prevents 3 diseases
1. PCP (Pneumocystis carinii pneumonia)
2. Toxoplasmosis
3. Gastroenteritis

3 components of diet in diarrhea
1. Bread (toast)
2. Rice
3. Apple

Dose of Cifran DS
In patients with PCP is 3 tablets for a patient of 30 kg (add one tablet for 10 kg extra)

First 3 months of life
Although there may be no immediate physical signs of HIV infection at birth, signs of the infection might appear within 3 months after a child is born

3 most common causes of death in neonates born to HIV–positive mother
1. Diarrhea
2. Pneumonia
3. Malnutrition

3 Million
3 million children have died from AIDS since the epidemic began
3 million HIV–positive children worldwide

Progressors
1. Normal progressor
2. Rapid progresor
3. Slow progressor

 
  SMS of the Day

(By Dr GM Singh)

Self–confidence

You must find the best way to behave towards others. If you learn how to behave correctly, you will manage to conquer those people you want to, whatever the position. Through kindness, you will also gain a great deal from difficult and unpleasant people.

 
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Prof Dr Kiran Walia, Health Minister, Delhi State and Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal with the school students who participated in the drawing completion on the inauguration day of the 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

Keoladeo bags Best Asian wetland award

The Salim Ali Visitor Interpretation Centre, Keoladeo National Park, Bharatpur, India, has been conferred Best Asian Wetland Centre Award 2010 by Wetlands Links International (WLI). The network currently has over 100 members, and is an active committee of leading wetland professionals. The award was given in recognition of the role played by the Centre in conserving the national park, building awareness and stakeholdership amongst local communities and visitors for its preservation. (Source: The Pioneer, Dec 04, 2010)

 
    International News

(Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.fitnessequipmentnortheast.com/about-us/brands/international-sports-fitness-distribution/)

Interesting Fact

Today, health clubs serve more than 4.8 million members under the age of 18—including 1 million between 6 and 12 years old, and just over 3 million between 13 and 17. So health clubs have an important role to play in the fight against childhood obesity.

(Dr Monica and Brahm Vasudev)

Fenofibrate therapy may help slow progression of renal impairment in type 2 diabetes

According to a study published online in the journal Diabetologia, fenofibrate therapy may slow down the progression of albuminuria and glomerular filtration rate (GFR) impairment in patients with type 2 diabetes.

Fruits, vegetables slow kidney disease

The addition of fruits and vegetables to a diet can help offset acid imbalances and reduce the worsening of kidney disease among patients with hypertension. (American Society of Nephrology 43rd Annual Meeting).

Melatonin improve sleep in hemodialysis patients

Patients undergoing dialysis who have sleep disturbances showed significant improvements in their sleep patterns with the short–term treatment of daily exogenous melatonin; however, the improvements appeared to diminish after a year. (American Society of Nephrology 43rd Annual Meeting)

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is intracytoplasmic sperm injection?

ICSI involves the direct injection of a single spermatozoon into the cytoplasm of a human oocyte, usually obtained from follicles produced under controlled ovarian hyperstimulation. ICSI has revolutionized treatment and improved prognosis for fertility of men with very severe oligospermia, asthenospermia (low sperm motility), teratospermia (a higher rate of abnormal sperm morphology), and even azoospermia. It has also been successful in men with nonmosaic Klinefelter syndrome where spermatozoa are obtained from testicular biopsies.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

How common is lactose intolerance?

Lactose intolerance is quite common all over the world. Indians have one of the highest incidences of lactose intolerance. It is less common in the Caucasian population – one of the theories of this being that people who live in the tropics get ample sunlight and hence Vitamin D (and subsequently calcium) while those living in the temperate lands get less exposure to sun and hence less Vitamin D and less calcium. Dairy products are an important source of calcium.

 
    Books to read

Dr Jitendra Ingole, MD Internal Medicine, Asst Professor (Medicine), SKN Medical College, Pune

Why Zebras Don’t Get Ulcers (By: Robert M. Sapolsky)

Why you should read it:

Your body is a sophisticated machine. If it were an automobile, it would be a top–of–the–line, luxury–class vehicle with all of the latest options. There’s just one problem: Your body was designed for the savannas of Africa, not the streets and sidewalks of some urban metropolis. This is a major issue due to one of your body’s great fail–safe systems: the stress–response mechanism, also called the "fight–or–flight syndrome." This mechanism provides your body with its best chance to get away safely from sudden peril, such as when a lion attacks you. It immediately floods your muscles with robust energy. Thus strengthened, you are far more able to evade the hungry predator. Unfortunately, this same stress–response also kicks in during psychological stress. In much of modern city life (even without stalking lions), such stress is often chronic, making your stress–response mechanism work dangerously overtime, and putting your body at risk of numerous stress–related disorders and diseases. Robert M. Sapolsky, a leading neuroendocrinologist, explains it all in this lively and entertaining, yet highly informative book. He writes with delightful, ironic verve and dry, irrepressible wit. He details how chronic stress can undermine your health, and explains what you can do about it, even in the urban jungle.

 
    Medicolegal Update

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

How should the saliva sample be collected in a medicolegal case?

A saliva sample should be collected and preserved in cases of oral sex, rape/acquaintance rape/date rape, sodomy, sexual assault/drug–induced sexual assault such as molestation, inappropriate touching, Forced oral contact or kissing, child sex abuse, sexual torture or any other form of allegation where exchange of saliva is anticipated on medical examination by the examining doctor. A written or implied consent for examination and collection of evidences from the women alleging sexual assault must be obtained by the doctor as per Section 164A of CrPc. But, consent is not required under Section 53 CrPc of India for examination and collection of evidences from the alleged accused of sexual assault.

  • Dried saliva should be collected by the doctor with a swab of normal saline.
  • Saliva is collected in a test tube, diluted with an equal volume of normal saline and placed in a boiling water bath for about 10 minutes to destroy enzymes that inactivate blood group substances. It should be then allowed to cool and transferred to a clean, sterile and well–stoppered bottle, properly sealed and labeled.
  • Saliva tinged clothing must be preserved properly sealed and labeled for further investigation
 
   Legal Question of the Day

(Contributed by Dr. Ajay Limaye)

What is the medicolegal implication of diplomas through distance education?

  • Some DNB courses like Family Medicine, Maternal and Child Health etc. are also not included in the 1st schedule of MCI qualifications. I don’t think somebody would do DNB in these streams if he/she could not display that qualification. But certainly people are doing these courses and putting these qualifications, which I think is right. Like NBE is a parallel body to MCI, so is IGNOU. If NBE can start its own courses, so can IGNOU.
  • PGDGM, PGDMCH are IGNOU courses (School of Health Sciences) which are recognised by UGC. MCI is a body under UGC, and so is IGNOU. I don’t think UGC requires MCI permission in any case, or does it?
  • We see so many doctors obtaining MRCP, FRCS, FRCR degrees even today. Today, these degrees are not recognised by MCI. Then is it wrong to display these qualifications? If not, then why is it wrong to display other certificate courses?
  • MCI does not recognise any Fellowship from any institution from anywhere in the world, including India. However, you will see innumerable doctors flaunting fellowship degrees. What about that?
  • There are so many courses run by Annamalai University that are definitely not recognised by MCI. If one has to use only MCI recognised degrees, then how has MCI allowed a Deemed University like Annamalai to run these courses while not recognising them? Contradictory, isn't it?

In the ethics guidelines if you read carefully, MCI has not used the word "only MCI recognised qualifications" per se. The actual statement is as follows–

"1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification /achievements."

The "or" in the above sentence makes the statement non–specific.

"7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch."

The words in above sentence "special qualification"…it doesn’t say "MCI recognised qualification".

At the same time, it also mentions that
"(1A) The Central Government shall exempt any such existing/proposed non–teaching institutions or specialist institution or autonomous body owned and managed by the Central Government/State Government from fulfilling the prescribed provision of having an undergraduate teaching facility, and allow starting Postgraduate medical course."…Postgraduate Medical Education Regulations, 2000

Now, IGNOU is a body established by the act of parliament i.e. Union Government. Where is the question of MCI recognition?

  • The Distance Education Council is also an autonomous body. MCI has not laid any clear–cut guidelines regarding distance education in medicine.
  • If all of my above arguments are invalid and incorrect, then why is MCI turning a blind eye to all those who are fooling thousands of medical students and making money by conducting such courses? Is MCI not supposed to be a watchdog?

My confusion stems from all the above questions. I would be happy if someone could clarify the situation. Anyone…?

 
    Medilaw – Medicolegal Judgements

Can DMC take action against some one not registered with the DMC?

No, at least as per the order DMC/DC/F.14/Comp.724/2010/ 19th August, 2010 where DMC observed "On perusal of the representation, the Delhi Medical Council observed that since, as per records available in the office of Delhi Medical Council, Shri Syed Atif Hussain is not a medical practitioner registered with Delhi Medical Council, no action against him, can be considered in the Delhi Medical Council."

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum creatinine

Increase in serum creatinine is seen any renal functional impairment. Because of its insensitivity in detecting early renal failure, the creatinine clearance is significantly reduced before any rise in serum creatinine occurs. The renal impairment may be due to intrinsic renal lesions, decreased perfusion of the kidney, or obstruction of the lower urinary tract and nephrotoxic drugs and other chemicals.

 
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    Medi Finance Update

Understanding Mutual Funds

Money Market Finds

  • The rate of return of money market funds tends to be lower than that of funds that are managed for long–term gains, but they are a very low–risk investment.
  • Money market funds are ideal for parking your cash while you decide where to invest for the long haul, or for money you will need in the near future. Bond funds (also known as Income funds)
 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
Indication
DCI Approval Date
Sarpogrelate hydrochloride film coated Tablets 100mg. For the improvement of ischemic symptoms including ulcer, associated with chronic arterial occlusion 16–Jan–10
    IMSA Update

International Medical Science Academy (IMSA) Update

Combination MMRV vaccine

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends either MMR vaccine and varicella vaccine or MMRV vaccine for the first dose of measles, mumps, rubella, and varicella vaccines in children at age 12––47 months.

(Ref: Marin M, et al; Centers for Disease Control and Prevention (CDC). Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010;59(RR–3):1–12).

 
    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was on aerobic exercise protocol.
Dr Bad: Continue it.
Dr Good: Add resistance training also.
Lesson: According to a study published in the Nov. 24 issue of the Journal of the American Medical Association, people with diabetes should mix aerobics with weight training to get the best results in lowering blood sugar.

Make Sure

Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to remember that most painkillers (barring nimesulide) are not kidney–friendly drugs.

 
    Lighter Side of Reading

An Inspirational Story

(Contributed by Dr Prabha Sanghi)

Being a mother…

After 17 years of marriage, my wife wanted me to take another woman out to dinner and a movie. She said, ‘I love you, but I know this other woman loves you and would love to spend some time with you.’ The other woman that my wife wanted me to visit was my ‘mother’, who has been alone for 20 years, but the demands of my work and my two boys had made it possible to visit her only occasionally. That night I called to invite her to go out for dinner and a movie.

‘What’s wrong, aren’t you well,’ she asked? My mother is the type of woman who suspects that a late night call or a surprise invitation is a sign of bad news. ‘I thought it would be pleasant to spend some time with you,’ I responded. ‘Just the two of us.’ She thought about it for a moment, and then said, ‘I would like that very much.’ That Friday after work, as I drove over to pick her up I was a bit nervous. When I arrived at her house, I noticed that she, too, seemed to be nervous about our date. She waited in the door. She had curled her hair and was wearing the dress that she had worn to celebrate her last birthday on November 19th. She smiled from a face that was as radiant as an angel’s. ‘I told my friends that I was going to go out with my son, and they were impressed,’ she said, as she got into that new white van. ‘They can’t wait to hear about our date’.

We went to a restaurant that, although not elegant, was very nice and cozy. My mother took my arm as if she were the First Lady. After we sat down, I had to read the menu. Her eyes could only read large print. Half way through the entries, I lifted my eyes and saw Mom sitting there staring at me. A nostalgic smile was on her lips. ‘It was I who used to have to read the menu when you were small,’ she said. ‘Then it’s time that you relax and let me return the favor,’ I responded. During the dinner, we had an agreeable conversation, nothing extraordinary but catching up on recent events of each other’s life. We talked so much that we missed the movie. As we arrived at her house later, she said, ‘I’ll go out with you again, but only if you let me invite you.’ I agreed.

‘How was your dinner date?’ asked my wife when I got home. ‘Very nice. Much more so than I could have imagined,’ I answered.

A few days later, my mother died of a massive heart attack. It happened so suddenly that I didn’t have a chance to do anything for her.

Some time later, I received an envelope with a copy of a restaurant receipt from the same place mother and I had dined. An attached note said: ‘I paid this bill in advance. I wasn’t sure that I could be there; but nevertheless, I paid for two plates – one for you and the other for your wife. You will never know what that night meant for me. I love you, son.’

————————————

Mind Teaser

Read this…………………

minI’LL BE THEREute

Yesterday’s Mind Teaser: "sight love sight sight"
Answer for yesterday’s Mind Teaser: "Love at first sight."

Correct answers received from: Dr  Naorem Sharat, Dr Anurag Jain, Dr K Raju,  Dr K P Rajalakshmi, Dr Shirish Singhal, Dr Manjesha, Dr  Vinod Khetarpal, Dr S Upadhyaya, Dr Vishanji Karani, Dr A K Gupta, Dr Muthumperumal Thirumalpillai, Dr Neelam Nath, Dr Sudha Nayyar,

Answer for 4th December Mind Teaser: "Short notice"
Correct answers received from:  Dr Vijay Kansal, Dr G Padmanabhan, Dr Vikas Kumar, Dr Kalpana Mohan

Send your answer to ijcp12@gmail.com

————————————

Laugh a While
(Contributed by Dr G M Singh)

"Recently, while I was on a shopping trip in a department store, I heard a little five–year–old talking to his mother on the down escalator. He said, 'Mommy, what do they do when the basement gets full of steps?’"

 
    Readers Responses
  1. Dear Dr KK Aggarwal Sir, Tissue Doppler echo test is used to evaluate cardiac failure. Please elaborate.

    Secondly would it not be risky to carry out TMT test annually post bypass surgery if the heart functions were already low pre bypass surgery. Regards: Dr Neelam Nath

    eMedinews responds: 

    1. Tissue Doppler is doen to evaluate diastolic functions and diastolic heart failure
    2. EF is systolic functions
    3. E/E' ratio is for diastilic functions
    4. If the EF is low than TMT is done depending on diastolic functions and presence or absence of ischemia. If the effort tolerance is > 1 km TMT is safe.
    Dr KK Aggarwal
 
    Public Forum

(Press Release for use by the newspapers)

Alcohol: Benefits vs risk

There is consensus that non drinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India. People tend to consume more alcohol in winter and near the New Year.

  • Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.
  • The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.
  • For young to middle–aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).
  • Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.
  • Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.
  • Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 grams per day. Medically safe limits are 10 grams in one hour, 20 grams in a day and 70 grams in a week. (50% for the women).
 
    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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