emedinews
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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 & 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 …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

8th January 2013, Tuesday

Revisiting2012

  • A large randomized trial (14k men) of multivitamins has shown a small, statistically-significant reduction in total cancer risk (JAMA 2012;308(18):1871-1880).
  • Vitamin D does not prevent cold (JAMA 2012;308(13):1333-1339).
  • A large randomized trial in patients at increased risk for heart disease because of dysglycemia found no effect of fish oil supplements in reducing the rate of cardiovascular events (N Engl J Med 2012;367:309-318).
  • A systematic review and meta-analysis of 9 randomized trials evaluating supplementation with beta-carotene, vitamin C, and vitamin E for one year found no evidence that vitamin supplementation reduced the risk of cataract or of cataract extraction (Cochrane Database Syst Rev 2012;6:CD004567).
  • Portable monitoring is a reasonable alternative to in-laboratory sleep study in patients with a high pre-test probability of moderate to severe obstructive sleep apnea.
  • Systemic high BP is more common among individuals who have untreated obstructive sleep apnea (snoring) than among those who do not.
  • Antiretroviral therapy is now recommended in all HIV-infected patients, regardless of CD4 cell counts.
  • Prolongation of the QT interval and torsades de pointes in ECG is associated with antibiotics, such as erythromycin and clarithromycin.
  • After a heart attack, beta-blockers may not be required for more than 4 years unless specifically indicated.
  • Anti-depression drugs SSRIs may lead to one additional brain hemorrhage for every 10,000 patients treated for one year.
  • All pregnant women should receive tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine in each pregnancy
  • Tdap should be administered after 20 weeks and optimally between 27 and 36 weeks of pregnancy.
  • Previously, Tdap was recommended only for women who had never received the acellular pertussis vaccine.
  • Tenofovir-emtricitabine is now used for pre-exposure prophylaxis among confirmed HIV-negative individuals at high risk for sexually-acquired HIV infection
  • In areas of high HIV prevalence, the daily use of tenofovir-emtricitabine reduced risk of HIV by 48 to 75%.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

   Constipation Update

What is the approach to managing constipation in the elderly?

The first step in management of constipation in older adults is to exclude secondary causes of constipation.

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Is it time to stop using sulfonylureas?

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal was felicitated by Sh L K Advani at DMA Annual Conference on 6th January 2013.

 
Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

Delhi shivers: Preventing cold deaths
Dr KK Aggarwal*

  • Hypothermia is defined as a core temperature below 35ºC (95ºF), and can be further classified by severity:
    • Mild hypothermia: Core temperature 32 to 35ºC (90 to 95ºF); findings include confusion, tachycardia and increased shivering.
    • Moderate hypothermia: Core temperature 28 to 32ºC (82 to 90ºF); findings include lethargy, bradycardia and arrhythmia, loss of pupillary reflexes and decreased shivering.
    • Severe hypothermia: Core temperature below 28ºC (82ºF); findings include coma, hypotension, arrhythmia, pulmonary edema and rigidity 2. Causes include outdoor exposure, cold water submersion, medical conditions (low thyroid state, sepsis), toxins (alcohol abuse) and drugs (oral anti diabetics, sedative-hypnotics). 3. Risk increases in elderly patients.
  • Many standard thermometers only read down to a minimum of 34ºC (93ºF).
  • The initial treatment is directed toward resuscitation, assessment of the extent of injury and rewarming.
  • Endotracheal intubation is needed in respiratory distress.
  • Patients with moderate or severe hypothermia for low BP need aggressive fluid resuscitation.
  • Passive external rewarming is the treatment of choice for mild hypothermia and is a supplemental method in patients with moderate to severe hypothermia.
  • After wet clothing is removed, the patient is covered with blankets or other types of insulation.
  • Room temperature should be maintained at approximately 24ºC (75ºF).
  • Active external rewarming is needed in moderate hypothermia, refractory mild hypothermia and as an adjunct in severe hypothermia.
  • It consists of some combination of warm blankets, radiant heat, or forced warm air applied directly to the patient's skin.
  • Re-warming of the trunk should be done BEFORE the extremities to minimize hypotension and acidemia due to arterial vasodilation and core temperature after drop.
  • For severe and recalcitrant moderate hypothermia, give warmed IV crystalloid, warmed pleural lavage.
  • For salvageable, nonperfusing patients with severe hypothermia, treatment is cardiopulmonary bypass.
  • Cardiopulmonary resuscitation (CPR) should continue until the patient is rewarmed to 30 to 32ºC (86 to 90ºF) at which point renewed attempts at defibrillation and resuscitation are undertaken.

    *Dr Aggarwal is Padma Shri and Dr B C Roy National Awardee and President Heart care Foundation of India

For Comments and archives…

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

    Valvular Heart Disease Update

When is surgery indicated in an asymptomatic patient with flail leaflet and severe MR?

For asymptomatic patients with severe MR, surgical correction should be considered early in the course of the disease if valve repair is feasible with a >90 percent likelihood of success.

(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)

Hepatitis C treated with oral nucleotide inhibitor

Twelve weeks of sofosbuvir and ribavirin treatment may be sufficient for sustained antiviral activity in untreated and pretreated patients with hepatitis C virus (HCV) genotype 1, 2, or 3, according to the findings of an open-label, phase 2 trial. Edward J. Gane, MD, from the New Zealand Liver Transplant Unit, Auckland City Hospital and the Gastroenterology Department, Christchurch Hospital, both in New Zealand, and colleagues published their findings in the January 3 issue of the New England Journal of Medicine. (Source: Medscape)

Abbott Xience Xpedition DES approved

The FDA has approved the latest incarnation of Abbott's line of Xience drug-eluting stents (DES), the Xpedition, which offers "the largest-size matrix in the US market," according to the company. It says the device, which will start selling in the US "immediately," is also available in "Europe, the Middle East, and parts of Asia." (Source: Medscape)

Minimal resection effective for some patients with epilepsy

Smaller lesionectomy resections in the surgical treatment of seizures appear to be just as effective as larger resections in select children, sparing patients the functional and developmental deficits associated with the larger resections, a new study suggests. (Source: Medscape)

Smoking increases MMP gene expression in SVGs, reduces patency following CABG

Heavy smoking prior to CABG surgery increases matrix metalloproteinase-2 ( MMP2) and MMP9 gene expression and downregulates the expression of tissue inhibitor of metalloproteinase-1 ( TIMP1) and TIMP2 in the saphenous vein conduits of Chinese patients undergoing surgery, research shows [1]. Even in patients who had stopped smoking for more than 12 months, the dysregulated expression of MMP2 and MMP9 did not recover to normal levels. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Chronological age is different than biological age: Dr KK Aggarwal The current GANGRAPE has opened a (cont) http://tl.gd/kknfpp

@DrKKAggarwal: How do we know which is the right feeling, the right road to take? My#askdeepak reply http://tinyurl.com/c7k9wc7

    Spiritual Update

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

The concept of second opinion

In legal system when you are not satisfied with a judge, you re-appeal in the same court and if you are still not satisfied, you go to double bench before going to higher court.

For Comments and archives…

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

What are the factors affecting fertility?

Age is not the only factor that affects fertility. Problems with your partner or any gynecologic or medical problems may affect your chances of conception. There are other conditions, such as uterine fibroids and endometriosis that may progress with age and affect your fertility. Exposure to sexually transmitted diseases can also affect your fertility.

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

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

In which situations do patients need blood transfusion?

A: There are many situations, which doctors face daily, when a patient may need blood to save his/her life. Some plasma substitutes can be given for the time–being. But till we give blood, everything else becomes temporary measure.

  • A patient may need blood after a major accident when there is blood loss.
  • No major surgery is performed without blood as there is bound to be blood loss. On an average, for every open heart surgery, about 6 units of blood is required. In obstetrics and gynecology, the patient may need large amount of blood to be transfused in order to save not only her life but also of the child that she carries in situations like, antepartum hemorrhage (APH; bleeding before birth), or postpartum hemorrhage (PPH; bleeding after birth).
  • For patients with blood diseases like severe anemias especially aplastic anemia, leukemia, hemophilia, thalassemia etc. Blood transfusion is the only hope for these patients; repeated transfusions are required.
  • In many cases like poisoning, drug reactions and conditions of shock, burns and many other situations, blood transfusion is the only way to save the precious human life.

To put it in a nutshell, "There is no SUBSTITUTE FOR BLOOD and a patient who needs blood to save his life can only be saved if blood is transfused to him".

For Comments and archives…

    An Inspirational Story

Couple’s heartbreak

A boy was born to a couple after eleven years of marriage. They were a loving couple and the boy was the apple of their eyes.

One morning, when the boy was around two years old, the husband saw a medicine bottle open. He was late for work so he asked the wife to cap the bottle and put it in the cupboard. The mother, preoccupied in the kitchen, totally forgot the matter.

The boy saw the bottle and playfully went to it and, fascinated with its color, drank it all. It happened to be a poisonous medicine meant for adults in small dosages. When the child collapsed, the mother hurried him to the hospital, where he died. The mother was stunned; she was terrified. How would she face her husband?

When the distraught father came to the hospital and saw the dead child, he looked at his wife and uttered just four words, “I Love You Darling.”

The husband’s totally unexpected reaction is proactive behavior. The child is dead. He can never be brought back to life. There is no point in finding fault with the mother. Besides, if only he have taken time to put the bottle away, this would not have happened.

No point in attaching blame. She had also lost her only child. What she needed at that moment was consolation and sympathy from the husband. That is what he gave her. Sometimes we spend time asking who is responsible or who’s to blame, whether in a relationship, in a job or with the people we know and miss out on the warmth in human relationships we could receive by giving each other support.

After all, shouldn’t forgiving someone we love be the easiest thing in the world to do?

Treasure what you have. Don’t multiply pain, anguish and suffering by holding onto forgiveness. Let go of all your envies, jealousies, unwillingness to forgive, selfishness, and fears and you will find things are actually not as difficult as you think.

If everyone could look at life with this kind of perspective, there would be fewer problems in the world.

Source: http://academictips.org/blogs/a-couples-heartbreak/

For comments and archives

   Cardiology eMedinewS

Predictors of adverse clinical outcomes in TAVR Read More

Prasugrel better than clopidogrel Read More

   Pedia News

Mental illness gene mutations seen in neonates Read More

    IJCP Special

Dr Good Dr Bad

Situation: A young female with tinnitus came for marriage counseling advice.
Dr Bad: It is familial.
Dr Good: It is not familial.
Lesson: Tinnitus doesn’t appear to be a highly heritable condition (Source: Arch Otolaryngol Head Neck Surg 2010;136:178–82).

Make Sure

Situation: Doctor, this patient has developed acute renal failure (ARF).
Reaction: Oh my God, I forgot that he was on furosemide. I gave him full dose of amikacin.
Lesson: Make sure, before calculating the dose of aminoglycoside (amikacin) that furosemide and other loop diuretics, which enhance its nephrotoxicity are not being given.

  Quote of the Day (Dr GM Singh)

We need others. We need others to love and we need to be loved by them. There is no doubt that without it, we too, like the infant left alone, would cease to grow, cease to develop, choose madness and even death. Leo Buscaglia

  Legal Question of the Day (Dr M C Gupta)

Q. I want to proceed against private pathlabs issuing lab reports under signatures of non-pathologists. What actions can I take?

Ans.

  • You can take the following actions:
    • Complaint to medical council for quackery—Running a pathlab and issuing a lab report amounts to practice of medicine/pathology and anybody practicing medicine without being registered with the medical council is a quack).
    • Complaints to the concerned council (Bharatiya Chikitsa Council; Homeopathy council; paramedical council etc.) if the person concerned is an AYUSH practitioner.
    • Complaint to consumer court for deficiency and negligence in service, invoking quackery;
    • Complaint to police for quackery.
    • Complaint under Clinical Establishment Act, if applicable in the state.
    • Direct complaint to the DM or SDM under Section 133 (1)(b), CrPC. (An example is the complaint dated 11-1-2010 made to SDM Jalgaon, Maharashtra, u/s 133 (1)(b), CrPC, who, in consequence, ordered immediate sealing of the illegal followed by a final order dated 13-5-2011 ordering their closure. Similar complaints u/s 133 (1)(b), CrPC can be made at other places.
  • The above actions can, in general, proceed simultaneously. It would be better to engage an advocate.
  • You can take action on the above lines even in case of lab reports that are signed for namesake by pathologists without them being really associated with the functioning of the lab by actual daily visits to the lab for at least 2-3 hours. This aspect has been dealt by the courts.
    Mind Teaser

Read this…………………

The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to:

A. Develop a teaching plan
B. Facilitate psychologic adjustment
C. Maintain the present muscle strength
D. Prepare for the appearance of myasthenic crisis

Yesterday’s Mind Teaser: Jane, a 20- year old college student is admitted to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:

A. Brief exaggeration of symptoms
B. Prolonged symptomatic improvement
C. Rapid but brief symptomatic improvement
D. Symptomatic improvement of just the ptosis

Answer for Yesterday’s Mind Teaser: C. Rapid but brief symptomatic improvement

Correct answers received from: Dr Vishal D Wahane, Dr Raghavendra jayesh, Dr Sunil Bansal, Dr Chetna Bansal, Dr Suresh Arora, Dr Kanta Jain,
Dr Arpan Gandhi, Dr Arvind Khanijo, Dr kP Chandra, Dr Jainendra Upadhyay,
Dr Avtar Krishan, Dr Jjella.

Answer for 6th Janaury Mind Teaser: C. Relieve pain and promote rapid epithelialization

Correct answers received from: Dr Arvind Khanijo, Dr Pankaj Agarwal, Dr PC Das, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr Ajay Gandhi.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Dream of a necklace

After she woke up, a woman told her husband, "I just dreamed that you gave me a pearl necklace for our anniversary. What do you think it means?"

"You'll know tonight." he said.

That evening, the man came home with a small package and gave it to his wife.

Delighted, she opened it to find a book entitled "The Meaning of Dreams."

  Medicolegal Update

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

What is blast lung?

  • When a bomb explodes, it causes disruptive effect due to burns, air blast, flying missiles injuries, falling masonry, fumes and incendiary bombs
  • A bomb explosion create a pressure of 1000 to 1500 tons per square inch; but, a pressure of 200 kg per square inch is enough to cause destructive injuries to human tissues
  • The injuries to the pulmonary tissues and alveoli tissues that occur due to air blast effect are called blast lung injuries. The lungs air blast victims show pleural patchy bleeding on scans. The reactive pulmonary swelling converts into bronchopneumonia and may prove fatal in these cases.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Nitrate-rich diet good for the heart

Do not heat leafy vegetables twice

Nitrates in foods such as spinach, beet root and lettuce stimulate the production of nitric oxide in the body. Nitric oxide relaxes blood vessels. Ingested nitrate is reduced by oral, commensal, bacteria to nitrite, which can further be reduced to nitric oxide, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Vice President (Elect.) IMA.

Vegetables are a major source of dietary nitrate. Green leafy and root vegetables, such as spinach and carrots, provide more than 85 percent of dietary nitrate. Foods in which nitrite are present are bacon, fermented sausage, hot dogs, bologna, salami, corned beef, ham and other products such as smoked or cured meat, fish and poultry. The conversion of dietary nitrate to nitrite has antimicrobial benefits in the mouth and stomach. Some epidemiological studies show a reduced rate of gastric and intestinal cancer in groups with a high vegetable-based nitrate intake. Nitrate is totally harmless; however, it can be converted to nitrite and some portion of nitrite to nitrosamines, some of which are known to be carcinogenic. Heating increases the conversion rate. The longer the heat treatment, the more nitrosamines will be formed. Hence, the recommendation not to heat leafy vegetables twice. Adding lemon juice to vegetables will reduce the formation of nitrosamines. It contains vitamin C, which also reacts with nitrite, thereby preventing the nitrosamine formation.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR 10” of 23034 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Response
  1. Sir, I disagree on few points of your recommendations? 1] Even if the culprit take shelter under alcohol/drug to claim innocence he should not be treated differently, rather he should also be punished for taking drugs.[I hope you are not trying to justify the Supreme Court order of commuting death sentence or rapist to life imprisonment]. In my opinion the punishment of rapist should be-- amputation of both arms above elbow and giving him artificial arms. Manoj.
    Forthcoming Events

4th eMedinews Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013 (8 AM to 8 PM).

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Eminent Faculty:

Dr Praveen Chandra (Cardiology)
Dr NK Bhatia (Transfusion Medicine)
Dr Ambrish Mithal (Diabetes)
Dr Kaberi Banerjee (Infertility)
Dr Yougal Mishra, Dr Manju Gupta, Dr Somesh Juneja, Dr Deepak Khurana (Valve Surgery)
Dr Rajnish Malhotra (Cardiology)
Dr Vivek Bhatia (GI)
Dr Ashish Jain (Ortho)
Dr Kailash Singla (GI)
Dr Navdeep Chabbra (Beriatric Surgery)
Dr IM Chugh (Pulmonoagy)
Dr AK Dhar (Hemato oncology)

Register at: www.emedinews.in/

rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

Dr Pawan Gupta, Past President IMA Haryana, Organizing Secretary

4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta