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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 ...

7th December, 2010, Tuesday

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

Revisiting 2010: Pertussis vaccination

DPT vaccine (reduced dipththeria toxoid, acellular pertussis, and tetanus) is approved since 2006 for booster vaccination in individuals aged 10 to 64 years.

The Advisory Committee on Immunization Practices has now recommended that a single dose of DPT vaccine may be given in place of DT for adults aged 65 years and older who have not previously received DPT. The addition of the pertussis component to tetanus/diphtheria booster immunization reduces the incidence of pertussis infection in both vaccine recipients and, more importantly, their infant contacts. The ACIP also recommended that a single dose of DPT vaccine may be given in place of Td for adults = 65 years who have not received DPT. 1,2

References

  1. http://www.cdc.gov/vaccines/recs/acip/slides–oct10.htm (Accessed on November 10, 2010).
  2. http://www.reuters.com/article/idUSTRE69Q5UL20101027 (Accessed on November 15, 2010).
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

TB HIV link
3% TB cases are HIV–positive

Sputum positive
3% of HIV–positive cases may be sputum–positive despite normal chest x–ray

Hospital waste
1. Routine waste
2. Infected waste
3. Sharp waste

3 colors of Waste management
1. Black
2. Red
3. Yellow

3 High risk behaviors
1. Unprotected sex
2. MSM
3. IV drug users

3 heterosexual high–risk groups
1. CSW
2. Truckers
3. Migrants

3 phases of HIV spread
1. High risk population
2. Bridge population
3. General population

3 vaccinations
1. Flu
2. Pneumonia
3. Hepatitis B vaccine

3 phases of HIV–AIDS
1. HIV
2. AIDS
3. Complications

3 steps of Counseling
1. Pre test counseling
2. Informed consent
3. Post test counseling

Follow ups
Every 3 months

3 Cs of prevention
1. Correct
2. Consistent
3. Condom

Safe disposal
1. Heat it
2. Bury it
3. Chemical it

3 phases of AIDS illnesses
1. Window period
2. Serious illness
3. Terminal illness

HIV test results
1. False negative
2. False positive
3. Positive

3 treatment modalities
1. ARV
2. TB
3. Prophylaxis

3 common transplants that can cause HIV
1. Kidney
2. Eye
3. Liver

No treatment
If no treatment is given most HIV–AIDS would die in 3 years

 
  Quote of the Day

(By Dr GM Singh)

"The true art of memory is the art of alteration."

Samuel Johnson

 
    Photo Feature (From the Net)

(Contributed by Dr Mukul Tiwari)

Weird X–rays

X–rays are one of the most useful medical advancements in history. But they can also reveal some of the most gruesome and bizarre results. This X–ray shows a bullet (conical object at centre left) embedded in the chest of a patient.

 
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

Haryana to have world’s first global centre for N–energy

The world’s first global centre for nuclear energy partnership to benefit people in various fields would be set up in Haryana’s Jhajjar district, Sri Kumar Banerjee, chairman of the Indian Atomic Energy Commission said. "The centre would be set up in at village Kheri Jassaur near Bahadurgarh and would have four schools — School of Advanced Nuclear Energy System Studies, School of Excellence in Nuclear Security, School of Excellence in Radiation Safety and School for Applications of Radioisotopes and Radiation Technology," he said. (Source: The Pioneer, Dec 04, 2010)

 
    International News

(Contributed by Dr GM Singh)

Heart and Stroke Groups update stroke prevention guidelines

Stroke has published updated guidelines on primary prevention of stroke from the American Heart Association and the American Stroke Association. The guidelines take a patient–oriented approach, emphasizing healthy lifestyle choices. Among the recommendations for clinicians:

  • All patients should have their stroke risk evaluated.
  • Systolic blood pressure should be targeted to below 140 mm Hg, with diastolic under 90 mm Hg. (The goal in diabetics is <130/80.)
  • An angiotensin–receptor blocker (ARB) or an angiotensin–converting–enzyme (ACE) inhibitor can help control blood pressure in adult diabetics.
  • Statins are recommended in patients with coronary heart disease and high–risk conditions such as diabetes.
  • Adjusted–dose warfarin (international normalized ratio target between 2.0 and 3.0) is recommended for high–risk patients with nonvalvular atrial fibrillation (use antiplatelet therapy with aspirin for low–risk afib patients).
  • Patients should reduce sodium intake and increase potassium intake. The DASH diet is recommended.

(Dr Monica and Brahm Vasudev)

Patient successfully treated his IBD by self–medicating with parasitic worm eggs

The growing incidence of autoimmune disease in the developed world is the result of improved sanitation, which limits our exposure to infectious diseases during childhood. In the 1990s, Dr. Joel Weinstock, then at the University of Iowa and now at Tufts University, observed that the eradication of intestinal worms in the developed world was followed soon after by a rise in inflammatory bowel disease. A 34–year–old Northern California man with ulcerative colitis found a way to treat his condition: parasitic worms. He gulped down 1,500 parasitic worm eggs. The study findings are published in the Dec. 1 issue of Science Translational Medicine. He was virtually symptom–free for almost three years, but when his colitis flared in 2008, he swallowed another 2,000 eggs and got better again. Samples taken during active colitis showed a large number of CD4+ T–cells. However, "tissue taken after worm therapy, when his colitis was in remission, contained lots of T–cells that make interleukin–22 (IL–22), a protein that promotes wound healing. The Trichuris trichiura worms seemed to stimulate the production of mucus in the gut. P’ng Loke, PhD, believe that the mucus is produced in an effort to expel the worms from the gut, but instead of doing this it heals the lesions caused by the disease.

Women who experience miscarriages may face increased risk of heart attack later in life

Women who experience a stillbirth or repeated miscarriages have a dramatically increased risk of heart attack later in life, according to a study published online in Heart.

Cancer risk for patients undergoing CT scans may be lower than previously thought

Two studies published last year in the Archives of Internal Medicine asserted that CT scans deliver far more radiation than has been believed and may contribute to 29,000 new cancers each year, along with 14,500 deaths. New research suggests that the cancer risk may have been overestimated. Researchers at Stanford University conducted an eight–year analysis of Medicare records covering nearly 11 million patients and found that cancers associated with radiation exposure were estimated to be 0.02 percent of the first group and 0.04 percent of the second. The previous estimates ranged from 1.5 percent to 2 percent.

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How to choose a Fertility Center?

A couple whose infertility is mostly due to a male factor should seek ART treatment only in a center in which ICSI is available.

For queries contact: banerjee.kaberi@gmail.com

 
    Gastro Update

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

What are the different types of lactose intolerance?

There are several types of lactose intolerance and include–

  1. Congenital lactase deficiency: Very rare, in fact only a few dozen patients with this condition have been described worldwide. It is a serious illness. The intestinal cells just do not produce any lactase enzyme and newborn babies present with profound osmotic diarrhea when they are given milk. Treatment is easy, once the diagnosis is considered, which is to give a lactose–free formula.
  2. Primary lactase deficiency: Overall this is the most common cause of lactose intolerance all over the world; almost 80% of the adult population is affected. It is mostly seen above the age of 5 years. Intestinal epithelial cells are programmed to reduce lactase enzyme production after a certain age. As it is a genetic disorder it often runs in families.
  3. Secondary lactase deficiency: This is also a common problem but is often only transient. It follows any acute insult to the GIT like acute infectious gastroenteritis, persistent diarrhea, cancer chemotherapy, celiac disease or milk allergy. The condition usually resolves within a few weeks of resolution of the underlying disease as the tips of the villi along with the lactase enzyme regenerate.
 
    Medicolegal Update

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

Dos & Don’ts in cases of sexual assault

  • Detailed and consistent history about time, place and circumstances of occurrence. The examination of scene of incidence, collection of various evidences like, spot of blood, semen, bed sheet etc should be recorded.
  • Doctor should neither act as detective nor as curtain for law
  • Police should be informed only with the consent of the victim or her parents; otherwise, it will be a violation of professional secrecy. Sometimes, the victim may not give the correct history and alleged cause of injuries as due to rape.
  • Doctors do not have the role of a detective. Even if the findings are suggestive of a sexual assault, he should not interrogate the victim to ascertain the veracity of the history.
  • The version of the woman should be recorded verbatim and necessary treatment should be given. If the victim is unconscious or unable to give a coherent version of the history, the police should be notified.
  • Whatever be the case, all the details should be entered in the register, collect necessary samples and keep them in safe custody. Victim may change her/his mind and file a complaint before the police at a later date. Then the doctor has to disclose all the information to the Police.
 
    Legal Question of the Day

(Contributed by Dr.Gunajit Das MD Asst Professor, Dept of Forensic & State Medicine)

Q: Can a sexual assault victim be seen by a nurse?

A: An Order dated 19/08/2010 passed by the Hon’ble Gauhati High Court in PIL No.75/2009 (Dr.Lakshmi Kumari Goswami–Vs–State of Assam) says ".............................that female victim of sexual offence is examined only by Lady Government Doctor and if there is no Lady Doctor available, by a private female practitioner at State expense or by a trained female Nurse..............................................."

 
    Medilaw – Medicolegal Judgements

Can one puncture ovarian cyst during non ovarian surgery?

Where there is no emergency condition, before the surgeon proceeds to extend surgery he should attempt to get the consent of someone in the patient’s family. If this is not possible, he should probably decide not to extend the scope of the surgery unduly. An extension of a minor operation into a major one is usually considered assault and battery in the absence of an emergency. However, want of consent would not impede a doctor from extending the operation if the said extension was demanded in exercise of sound professional judgment and was required to remedy any abnormal or diseased condition of the patient.

The Courts have upheld, in another case, surgery which was extended beyond the consent taken and observed as under: During an appendectomy the surgeon discovered that his patient had several large ovarian cysts, which he punctured. The patient sued him for assault and battery but did not allege negligence. The Court dismissed the action and stated that it was "unreasonable to hold a physician to the exact operation that the preliminary examination indicates is necessary. A complete diagnosis may not be possible until the incision is made. The surgeon may extend the operation to remedy any abnormal or diseased condition in the area of the original incision whenever he, in the exercise of sound professional judgment, determines that correct surgical procedure demands it (In Murray v. McMurchy 1949 (2) DLR 442)

 
    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

  • Increase in serum uric acid: Idiopathic, in renal failure, disseminated neoplasms, toxemia of pregnancy, psoriasis, liver disease, sarcoidosis, ethanol consumption, etc. Many drugs elevate uric acid, including most diuretics, catecholamines, ethambutol, pyrazinamide, salicylates, and large doses of nicotinic acid.
  • Decreased serum uric acid: Wilson’s disease, Fanconi’s syndrome, xanthinuria, and (paradoxically) in some neoplasms, including Hodgkin’s disease, myeloma, and bronchogenic carcinoma. Decreased levels may not be of clinical significance.
 
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    Medi Finance Update

Understanding Mutual Funds

Money Market Funds

  • 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.
  • The risk on a bond fund is that the bond issuer is not able to repay the borrowed amount.
 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
Indication
DCI Approval Date
Propranol 1–ol 18gm + Ethanol 100% 45gm/100ml solution For hygienic and surgical hand disinfection 18–Jan–10
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Combination MMRV vaccine

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR vaccine and varicella vaccine) for the second dose of measles, mumps, rubella, and varicella vaccines at any age (15 months–12 years) and for the first dose at age ≥48 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 patient with Chikungunya had high ESR.
Dr Bad: It cannot be Chikungunya.
Dr Good: It’s seen in Chikungunya.
Lesson: ESR may be raised in Chikungunya arthritis.

Make Sure

Situation: A patient of pulmonary Koch’s taking ATT complains of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson: Make sure that in patients talking ATT (including INH) B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

 
    Lighter Side of Reading

An Inspirational Story

Beautiful Thought by Buddha

Once Buddha was traveling with a few of his followers. While they were passing a lake, Buddha told one of his disciples, "I am thirsty. Do get me some water from the lake." The disciple walked up to the lake. At that moment, a bullock cart started crossing through the lake. As a result, the water became very muddy and turbid. The disciple thought, "How can I give this muddy water to Buddha to drink?"
So he came back and told Buddha, "The water in there is very muddy. I don’t think it is fit to drink."
After about half an hour, again Buddha asked the same disciple to go back to the lake. The disciple went back, and found that the water was still muddy. He returned and informed Buddha about the same. After sometime, again Buddha asked the same disciple to go back. This time, the disciple found the mud had settled down, and the water was clean and clear. So he collected some water in a pot and brought it to Buddha.

Buddha looked at the water, and then he looked up at the disciple and said," See what you did to make the water clean. You let it be, and the mud settled down on its own –– and you have clear water. Your mind is like that too! When it is disturbed, just let it be. Give it a little time. It will settle down on its own. You don’t have to put in any effort to calm it down. It will happen. It is effortless."

Having ‘Peace of Mind’ is not a strenuous job; it is an effortless process!

Treat everyone with politeness, even those who are rude to you not because they are not nice, but because you are nice.

………………………………

Mind Teaser

Read this…………………

Don’t cry
Spilled Milk  

Yesterday’s Mind Teaser: minI’LL BE THEREute

Answer for Yesterday’s Mind Teaser:
"I’ll be there in a minute"

Correct answers received from: "Dr Bhavisha Brahmbhatt. Dr Vishanji Karani, Dr Shashi Saini,
Dr Chandresh Jardosh, Dr A K Gupta, Dr. U Gaur"

Answer for 5th December Mind Teaser: "Love at first sight."
Correct answers received from: "Dr Sudipto Samaddar" 

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr GM Singh)

Battling Egos

A Bishop, a Judge, and a Conductor were discussing their careers, and got into an argument about which of them was the greatest.
The Judge said, "When I step into the courtroom, everyone stands to pay me respect." The Bishop said, "They stand? I have people kneel before me and kiss my ring." To which the Conductor replied, "Ha! I got you both beat. When I step on the podium people look down, cover their eyes, and say ‘Oh my God!’

 
    Readers Responses
  1. Respected Dr. K.K. Aggarwal, since you are a well–known "celebrity" figure in our medical field, through you, I want to highlight a very important point regarding issuance of driving license and Diabetes. Ordinary driving licenses can be held by diabetic patients whether on Insulin or not, provided they are otherwise physically fit and not suffering from blackouts. What I want to emphasize is that when anybody applies for a driving license, Diabetes (Blood Glucose) report MUST be declared on the application form and this report should be re–declared whenever practically possible, may be every three years. This is particularly important for people driving public transport and heavy goods vehicles because of the serious potential consequences of Hypoglycemia. It should be mandatory to declare that the applicant is diabetic or not. At the same time, I find that mentioning the blood group is not so important. No blood group makes a driver unfit but a hypoglycemic diabetic may be UNFIT as well as a hazard to the society. I know, only you can be instrumental in getting this important suggestion implemented. Dr AK Gupta (DNZ–354), C–1/15, R.P. Bagh, Delhi E–mail: guptanift@gmail.com
 
    Public Forum

(Press Release for use by the newspapers)

Pyramid Meditation Class held

Live pyramid meditation class was held from 7 am to 8 am at Ahimsa Sadhna Pyramid Meditation Centre at C–599 Defence Colony. The meditation was conducted by Padma Shri & Dr. B.C. Roy National Awardee Dr KK Aggarwal who is a qualified meditation teacher trained under the new age guru Dr. Deepak Chopra. Over 50 people participated in the live meditation programme.

Conducting the meditation, Dr. Aggarwal said that meditation is better than medication in many respects. Meditation shifts one from sympathetic mode to parasympathetic mode and helps in healing. Under parasympathetic mode, the lower blood pressure, pulse, blood sugar reduces and skin resistance increases. Twenty minutes of meditation provides relaxation which is equivalent to that of seven hours of deep sleep.

Parasympathetic breathing involves breathing at a rate of 3–4 per minute to be practiced for 20–30 minutes. Parasympathetic breathing can help reverse most of the lifestyle disorders.

The use of a pyramid in meditation can give rise to feelings of calmness, wellbeing and a more open and a positive attitude. Many users claim increased memory recall, visions of past incarnations, telepathic communication and an expansion of awareness, by the use of this technique.

Meditation in pyramid helps the person meditating to focus more clearly on their meditation. It is thought that meditation pyramids help to more clearly put some contemplation into the meditation session, allowing for a higher state of being. Open–framed meditation pyramids are said to produce a certain type of energy that is conducive to the meditative state of mind. It helps the brain reach another level of consciousness and awareness. The purpose of pyramids as related to meditation is not always understood.

 
    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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