emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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; Member 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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

8th March 2010, Monday

Let each day be an International Women’s Day

eMedinewS wishes all women a very Happy Women’s Day.

It is an undeniable fact that women today enjoy a lot of opportunities and independence compared to women of older times. Various social and educational reforms have opened doors for women that were closed to them for long.

As a result, more and more women have now stepped out of their homes and treading the less traveled paths. They are now walking shoulder to shoulder with men in nearly just about every field, be it academic, medicine, engineering, corporate, armed forces, bureaucratic, political and other careers and are even marching ahead of them and emerging winners. Today, a woman can balance her family with a career.

These achievements undoubtedly give us enough reasons to celebrate, yet a lot still needs to be done. Women are still not being represented in equal numbers in business and politics. Also, women across the world continue to lag behind men in terms of health and education. Violence against women is still common.

It has been said that the ‘educating a woman means educating an entire family’. An educated woman is better equipped to take care of herself and her family, and contribute to the social and economic development of the community.

Let’s make each day an International Women’s Day and strive to ensure them a bright and safe future and a life of dignity.

 

Dr KK Aggarwal
Chief Editor

News and Views

Elderly patients who survive ICU stay have high rate of death in following years

An analysis of Medicare data indicates that elderly patients who are hospitalized in an intensive care unit (ICU) and survive to be discharged from the hospital have a high rate of death in the following three years, and that, in particular, patients who receive mechanical ventilation have a substantially increased rate of death compared with both hospital and general population controls in the first several months after hospital discharge, according to a study in the March 3 issue of JAMA.

Moderate drinking before trauma leads to more flashbacks

People who have drunk a moderate amount of alcohol before a traumatic event report more flashbacks than those who have had no alcohol, according to new research at UCL (University College London).

Freezing breast tumors helps stop cancer’s spread in mice

Freezing a cancer kills it in its place, and also appears to generate an immune response that helps stop the cancer’s spread, leading to improved survival rates over surgery, according to a new study in mice from researchers at the University of Michigan Comprehensive Cancer Center

Hangover–Free Booze?

Oxygen for ethanol oxidation is supplied through breathing, the stomach, and the skin. There is a great deal of genetic and environmental variability in the pharmacokinetics of alcohol absorption, distribution, metabolism, and elimination. A new study has found that increasing dissolved oxygen concentrations in alcohol may help to reduce alcohol-related side effects and accidents.(May 2010 issue, Alcoholism: Clinical & Experimental Research)

New TB vaccine shows promise

Results of a phase I study in healthy adults have shown encouraging results for a new vaccine against Mycobacterium tuberculosis. The study results were published online February 18 in the American Journal of Respiratory and Critical Care Medicine. The vaccine, AERAS–402 was safe and immunogenic and induced a robust CD8 T cell response as well as a polyfunctional CD4 T cell response. The AERAS–402 vaccine is a recombinant, replication–deficient Adenovirus, serotype 35 that expresses a fusion protein created from sequences of the mycobacterial antigens Ag85A, Ag85B, and TB10.4. The encouraging results advocate more clinical trials to study the efficacy of AERAS–402 as a vaccine to boost BCG immunization.

Urinary symptoms more common with hysterectomy for heavy menstrual bleeding

A study published online February 15th in BJOG suggests that risk of urinary symptoms should be considered when women and their doctors are making treatment decisions for heavy menstrual bleeding. Women who underwent hysterectomy or were given Mirena intrauterine device (IUD) were compared and followed up for 10 years. Higher rates of urinary tract infections and incontinence were observed in the hysterectomy group.
At year 10, 48% of women in the hysterectomy group had stress incontinence 34% of women in the Mirena group. At least one episode of UT was reported by one–third of women who had had a hysterectomy compared with 14% of women treated with Mirena.

Eye care snippets by Dr. Narendra Kumar

(OptometryToday@gmail.com):
Lens materials and coatings (Part 3)

Many types of coatings are, available for lenses. For glass, the available coatings are coloured coatings, anti–reflective (AR) coatings and mirror coatings. For plastic, the available coatings are scratch–resistant coatings, anti–ultraviolet coatings, anti–reflective coatings and mirror coatings.

Glass coatings: Colours may be deposited on the surface of a glass by the ‘vacuum deposition’ method by vaporizing metal oxides in a vacuum chamber so that molecules of the metal float onto the lens surface. The colour so deposited is of uniform density at the edge and at the centre of the lens, and is durable. Plus power lenses made from coloured glass will be darker at the centre than at the edge, and minus power lenses will be lighter at the centre than at the edge. Light transmission of glass lenses can be increased from about 92% to 99.8% with anti–reflective coatings by way of the deposition of layers of magnesium fluoride. Multi–layer coatings are more expensive than single layer but more effective in reducing surface reflections. High index lens materials reflect more light than low index materials, and AR coatings are a must in these materials. These coatings should be placed on both sides of the lens to attain full benefit.

Plastic coatings: Coatings on plastic lenses are done mainly to increase their scratch resistance. Different types of coatings are scratch resistant, anti–UV, AR and mirror coatings.

Impact resistance. Plastic lenses have higher impact resistance than glass lenses. Glass lens tempering can be done, to increase their impact resistance, by way of heat or by chemicals. However, some glass materials cannot be chemically tempered with.

Photochromics: These lenses contain silver halide crystals which respond to light and become dark. When light is no more, the lenses become clear gain. Till recently photochromics were available in only glass, but now plastic photochromic lenses are also available, but these lenses are more expensive. It can be dangerous to drive with photochromiclenses and on sudden passage from bright light to a long dark tunnel. The reading in a bifocal in a photochromic lens will appear lighter unless this is also photochromic. Otherwise, they lenses are advantageous as these change in light or darkness according to the amount of light available.

Polarizing lenses: Plain polarized light reflected from a horizontal surface, e.g., a table top or water or snow, is basically glare, which reduces visual acuity by affecting contrast sensitivity. Glare can also cause asthenopia and its related symptoms of eye fatigue. When glare is eliminated by a vertically polarizing filter, only then the remaining useful light enters the eye and forms the image. Polarizing lenses are good in all weather conditions, on wet roads, and at seaside, not only in sunny situations but also on cloudy days. These lenses are ideal for glare reduction as well as for true colour reproduction, and are, thus, good for driving. Polarizing lenses are available in both CR39 and polycarbonate materials. Tints within the lens provide protection from both UV–A and B.(For Part 1 and 2 se emedinews dated 22nd February and 1st March.)

Conference Calendar

Basic Life Support (BLS) Provider Course American Heart Association (AHA) Accredited – Target Audience – All Healthcare Personnel – Date: March 9, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Quote of the Day

I believe in prayer. It’s the best way we have to draw strength from heaven. (Josephine Baker).

Public Forum (Press Release)

Stop all herbal medicines seven days before any surgery

Herbal medications are frequently used by patients undergoing surgery. Some of these agents have physiologic effects that could be deleterious in the perioperative period, including precipitation of clotting disorders and interactions with anesthetics.

Most patients may not disclose their during the preoperative assessment, said Dr K K Aggarwal, president, Heart Care Foundation of India and Editor eMedinewS. Since there is no evidence that herbal medications improve surgical outcomes, and there are theoretic reasons that these agents may increase perioperative morbidity, they must be stopped before surgery.

  1. Ephedra (ma huang) may increase the risk of heart attack and stroke and should be discontinued at least 24 hours prior to surgery.

  2. Garlic may increase bleeding risk and should be discontinued at least 7 days prior to surgery.

  3. Ginkgo may increase bleeding risk and should be discontinued at least 36 hours prior to surgery.

  4. Ginseng lowers blood sugar and may increase bleeding risk and should be discontinued at least seven days prior to surgery.

  5. Kava may increase the sedative effect of anesthetics and should be discontinued at least 24 hours prior to surgery. The Food and Drug Administration (FDA) has issued a safety alert about an association between kava use and fatal hepatotoxicity.

  6. St. John’s wort may diminish the effects of several drugs by induction of cytochrome p450 enzymes and should be discontinued at least five days prior to surgery.

  7. Valerian may increase the sedative effect of anesthetics and is associated with benzodiazepine–like withdrawal. There are no data on preoperative discontinuation. Ideally it is tapered weeks before surgery; if not, withdrawal is treated with benzodiazepines.

  8. Echinacea is associated with allergic reactions and immune suppression. There are no data on preoperative discontinuation.

Take home message: Herbal drugs be stopped at least one week before surgery.

Question of the day

Colonoscopy for routine screening: Is it worth it?

Occult blood testing is too inadequate and sigmoidoscopy only sees on–equarter of the organ. If there are polyps on colonoscopy, they can be removed immediately, thus stopping the polyp–to–cancer sequence.
Colonoscopy is an ideal tool to screen for colon carcinoma. Other tests do not have the same reliability. The Sloan–Kettering Center Polyp Study has shown convincingly that removing polyps is a good way to prevent cancer. The real practical issue is the feasibility of embarking on this in the average–risk person. In the meantime, average–risk individuals can still benefit from screening by flexible sigmoidoscopy and annual stool testing for occult blood. Of course, colonoscopy is indicated for and is done in high-risk individuals.

eMedinewS Try this it Works

The jaws that bite

While performing an oral exam fold the lower or upper lip over the incisal edge of the teeth. If an attempt is made to bite you, the patient will bite his or her own lip first.

Dr Good Dr Bad

Situation: A diabetic patient on hemodialysis developed hypoglycemia after dialysis.
Dr Bad: It’s a progression of disease.
Dr Good: On post dialysis day, you need close monitoring of sugar. Lesson: Glucose values are significantly lower on dialysis than non–dialysis days despite similar energy intake. The risk of asymptomatic hypoglycemia is highest within 24 hours of dialysis. Physicians caring for these patients need to be aware of this phenomenon and consider enhanced glycemic monitoring following a hemodialysis session. (Diabetes Care 2009 Feb 5.)

Make Sure

Situation: A known patient of NIDDM on oral hypoglycemics presents with hyperglycaemic crisis.
Reaction: Oh, my God! I did not manage the patient aggressively Make sure that patients with impaired glucose tolerance (IGT) or NIDDM are fully evaluated for complications at the first visit. Present approach to therapy of NIDDM is characterized by approach to therapy of NIDDM is characterized by proactive shifts to agents that may be combined or prescribed in maximal doses to achieve normal or near normal glycemia from the time of diagnoses of NIDDM or IGT, in order to prevent complications.

Medi Finance
(BUDGET 2010–2011)

DIRECT TAXES

INDIVIDUAL

New SARAL–II form for individual salaried taxpayers for the coming assessment year shall be introduced.

Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
Nestle
 
nuspera
 
Docconnect

Laughter the best medicine

GP Referral: Dear Doctor,
I am apparently referring this man to you!
Unfortunately I can’t find any records in the notes as to why, but I’m sure you will find out.

Formulae in Critical Care

LDL cholesterol (Friedewald formula)
 
a. VLDL = TG/5

b. LDL = TC – (HDL + TG/5) Or

LDL = TC – (HDL + VLDL)

Milestones in Neurology

Domenico Felice Antonio Cotugno (January 29, 1736 – October 6, 1822) was an Italian physician. Cotugno wrote a classic monograph on sciatic neuralgia, and is also credited the discovery of the cerebrospinal fluid in 1774. He investigated smallpox, was deeply concerned with controlling pulmonary tuberculosis, and exemplified to many students the true investigative and selfless spirit in anatomy and medicine. The Ospedale Domenico Cotugno in Napoli is named for him.

Mistakes in Clinical Practice

A trailing zero should never be used after a decimal (eg, 1 mg not 1.0 mg).

11th March World Kidney Day (Dr N P Singh)

Testing for Kidney Disease

Kidney diseases develop slowly and the symptoms only appear at a late stage when the patient already has kidney failure and may even need dialysis. Renal Replacement Therapy (RTT) requires major burdensome lifestyle changes for the patient and is extremely costly for any country’s healthcare system. A routine test of urine, blood and blood pressure can reassure or detect if there are any early signs of kidney problems. The needed laboratory tests are done on small samples of blood and urine. When your kidneys are damaged, proteins leaks into your urine.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

The most commonly accepted symptom score is the IPSS (international prostate symptom score) which is a seven–item score having 0 – 35 points.

Lab test (Dr Navin Dang)

Prolactin estimation should only be done with a mid morning pooled sample i.e. 3 samples taken at 20 minutes interval. A single sample can give an erroneous reading.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Isosorbibe 20 mg + Hydralazine 37.5 mg tablets

For the treatment of heart failure as an adjunct to standard therapy in patients to improve survival, to prolong time to hospitalization for heart failure and to improve patients reported functional status.

18.09.2009


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen Immune Power – a known immunity booster with ability to help reduce absorption of aluminum from the GI tract and enhance excretion through kidneys and is a key to eliminate aluminum toxicity and the related systemic involvement.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com emedinews@gmail.com

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April)

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2pm onwards) and Sunday 18th April (7am–4pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome.
For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

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Readers Responses

1. Congratulations Dr Aggarwal for prestigious award: R K Goel

2. Respected Doctor Saheb, many many congratulations for Padma shri award: V B Nagpal and family

3. Congratulations Dr. Aggarwal for your award and your modesty and kindness in dedicating this to all your well wishers. All the best. 9811142877