emedinews
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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 & 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…

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial…

8th March 2013, Friday

Defining Acute MI

  • In 1979: The diagnosis of acute MI was based on WHO criteria based on epidemiology
  • In 2000: Joint European Society of Cardiology (ESC) and American College of Cardiology (ACC) committee proposed a clinically based definition of an acute, evolving, or recent MI.
  • In 2007: Joint Task Force of the European Society of Cardiology, American College of Cardiology Foundation, the American Heart Association, and the World Health Federation (ESC/ACCF/AHA/WHF) refined the 2000 criteria and defined acute MI as a clinical event consequent to the death of cardiac myocytes (myocardial necrosis) that is caused by ischemia (as opposed to other etiologies such as myocarditis or trauma)
  • 2012: This definition was not fundamentally changed in the third universal definition of MI released in 2012 by the ESC/ACCF/AHA/WHF.

Third universal definition

Any one of the following criteria meets the diagnosis of MI:

  1. Detection of a rise and/or fall of cardiac biomarker values (cTn with at least one value above the 99th percentile upper reference limit (URL)) and with at least one of the following:
    • Symptoms of ischemia
    • Development of pathologic Q waves in the ECG
    • New or presumed new significant ST-segment-T wave (ST-T) changes
    • New LBBB
    • Identification of an intracoronary thrombus by angiography or autopsy
    • Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality.
  2. Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemia ECG changes or new LBBB, but death occurred before cardiac biomarkers were obtained, or before cardiac biomarker values would be increased.
  3. PCI related MI: elevation of cTn >5 x 99th percentile upper reference limit in patients with normal baseline values or a rise of values >20 percent if the baseline values are elevated and are stable or falling. In addition, either (i) symptoms suggestive of myocardial ischemia, or (ii) new ischemic ECG changes or new LBBB, or (iii) angiographic loss of patency of a major coronary artery or a side branch or persistent slow- or no-flow or embolization, or (iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required.
  4. Stent thrombosis associated with MI: Detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/or fall of cardiac biomarkers with at least one value above the 99th percentile
  5. CABG associated MI: Elevation of cardiac biomarker values >10 x 99th percentile URL in patients with normal baseline cTn values. In addition, either (i) new pathologic Q waves or new LBBB, or (ii) angiographic documented new graft of native coronary artery occlusion, or (iii) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.

The joint task force further refined the definition of MI

  • Type 1 (spontaneous MI): MI consequent to a pathologic process in the wall of the coronary artery (e.g., plaque erosion/rupture, fissuring, or dissection), resulting in intra luminal thrombus
  • Type 2 (MI secondary to an ischemic imbalance): MI consequent to increased oxygen demand or decreased supply (e.g., coronary endothelial dysfunction, coronary artery spasm, coronary artery embolus, anemia, tachy-/bradyarrhythmias, anemia, respiratory failure, hypertension or hypotension)
  • Type 3 (MI resulting in death when biomarker values are unavailable): Sudden unexpected cardiac death before blood samples for biomarkers could be drawn or before their appearance in the blood
  • Type 4a (MI related to PCI)
  • Type 4b (MI related to stent thrombosis)
  • Type 5 (MI related to CABG)

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation 2012;126(16):2020-35.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Weight loss may improve sexual health of obese diabetes

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, was organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions.

In the pic: Dr KK in chat with Dr Naresh Bhatia

 
Dr K K Aggarwal
    National News

CDC issues warning over superbug

CC was given a warning that infections from carbapenem-resistant enterobacteriaceae (CRE) are spreading in health facilities. Thomas Frieden, director of the Centers for Disease Control and Prevention has referred to CRE as "nightmare bacteria. He along with other CDC officials has urged hospitals to take steps to prevent CRE infections.

The CDC is warning...of a serious and growing health risk inside hospitals: newly discovered super bugs that resist even the strongest antibiotics. So far, this particular class of superbug, called carbapenem-resistant Enterobacteriaceae, or CRE, has been found only in hospitals or nursing homes, rather than in the community. These are nightmare bacteria that present a triple threat.

  1. They're resistant to nearly all antibiotics.
  2. They have high mortality rates, killing half of people with serious infections.
  3. And they can spread their resistance to other bacteria."

Among all infections with gut bacteria, the proportion caused by carbapenem-resistant types rose to 4 percent in 2012, from 1 percent in 2001; among infections caused by one type of bacteria, Klebsiella, 10 percent have become resistant, compared with 2 percent a decade ago. They could pass their trait for drug resistance - encoded in a scrap of genetic material called a plasmid - along to other bacteria.

The bacteria usually live harmlessly in the gut but can cause pneumonia, and urinary tract and bloodstream infections if they get into other parts of the bodies of patients with weakened immune systems. As many as half the patients who get the bloodstream infections die.

CRE is especially problematic in long-term acute-care hospitals - 18% of them had at least one CRE infection in the first six months of 2012. One such hospital in Florida reportedly had a whopping 44% infection rate."

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Neglect

It is the failure to provide for the child's basic needs. Neglect can be physical, educational, or emotional.

  • Physical neglect can include not providing adequate food or clothing, appropriate medical care, supervision, or proper weather protection (heat or cold). It may include abandonment.
  • Educational neglect includes failure to provide appropriate schooling or special educational needs, allowing excessive truancies.
  • Psychological neglect includes the lack of any emotional support and love, never attending to the child, substance abuse including allowing the child to participate in drug and alcohol use.

For comments and archives

 
    Valvular Heart Disease Update

Concurrent tricuspid valve surgery with chronic MR surgery

Concurrent tricuspid annuloplasty in patients undergoing mitral repair without mitral valve prolapse who have mild to moderate TR and tricuspid annular dilatation or pulmonary hypertension

(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)

TNF inhibitors do not increase herpes zoster risk in RA

Herpes zoster (shingles) incidence is higher in patients with rheumatoid arthritis (RA) than in the general population but is not further elevated by TNF inhibitor treatment, Kevin L. Winthrop, MD, MPH, and colleagues report in an article published in the March issue of JAMA. (Source: Medscape)

Cellulitis dx often incorrect

Three-fourths of cellulitis diagnoses proved to be other skin disorders mimicking cellulitis, a retrospective review at four large medical centers showed. (Source: Medpage Today)

Reduced breast-feeding linked to postpartum anxiety

High postpartum anxiety is linked to increased maternal healthcare use and decreased breast-feeding, particularly among new mothers, according to a study published online March 4 in Pediatrics. (Source: Medscape)

Pre-exposure HIV prophylaxis type doesn't matter

A large study to determine if pre-exposure prophylaxis could prevent HIV transmission among high-risk women failed to show any significant differences between those who took oral medication or vaginal gel or placebo medications in protection against acquiring infections. (Source: Medpage Today)

 
   Twitter of the Day

@DrKKAggarwal: Give your beloved a Healthy Heart Check up http://bit.ly/XSHiZP #Health

@DeepakChopra: Always think infinite possibilities!

 
    Spiritual Update

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

Leverage your strengths

  1. Know your strengths
  2. According to a British study, only about one-third of people have a useful understanding of their strengths.
  3. If something comes easily, you may take it for granted and not identify it as a strength.

For comments and archives

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

How can assisted reproductive techniques help couples diagnosed with endometriosis?

According to western data, couples diagnosed with endometriosis have success rates with assisted reproductive technology (ART) procedures such as in vitro fertilization and embryo transfer (IVF–ET) that are similar to those for couples with other causes of infertility. Success rates for ART procedures vary greatly depending on a woman’s age. Nationally, live birth rates for IVF–ET are approximately 30-35% for women under age 35, 25% from ages 35 to 37, 15–20% from ages 38 to 40, and about 10% between 41 and 42. IVF–ET is the most effective treatment for moderate or severe endometriosis, particularly if surgery fails to restore fertility.

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

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

How much liver should be left behind with the donor?

At least 35% of the liver is left behind with the donor. CT volumetry is very important to calculate this volume.

For comments and archives

 
   An Inspirational Story

A 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.

For comments and archives

 
   Cardiology eMedinewS

Diabetes: It is all about sugar Read More

FDA again rejects Xarelto for ACS Read More

 
   Pediatric eMedinewS

IL-4 antibody tames atopic dermatitis Read More

Food-allergic kids smaller than their peers Read More

 
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Is it important to elicit information about the biting animal?

It is very important to elicit information about the biting animal.

  • Low risk category includes healthy pets and regularly vaccinated dogs/cats.
  • Moderate risk category includes healthy pets but vaccination status is doubtful or has not been done.
  • High risk category includes rabid, sick, died, stray dogs/cats, or wild animals.
 
    IJCP Special

Dr Good Dr Bad

Situation: A patient presented with subclinical hyper function of the thyroid.
Dr. Bad: No treatment is needed.
Dr. Good: You need to be on treatment.
Lesson: A study published in April 2012 in the journal Archives of Internal Medicine has shown that subclinical hyperthyroidism is associated with higher risks of overall mortality, cardiovascular mortality and atrial fibrillation.

Make Sure

Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on a sulfa drug?
Lesson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

 
  Quote of the Day (Dr GM Singh)

The most valuable thing you can make is a mistake – you can’t learn anything from being perfect. Adam Osborne

 
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

 
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    Mind Teaser

Read this…………………

A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client?

a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.
b. The most common treatment is metronidazole, which should eradicate the problem within 7 to 10 days.
c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse.
d. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex.

Yesterday’s Mind Teaser: The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination?

a. A low-riding prostate
b. The presence of a boggy mass
c. Absent sphincter tone
d. A positive Hemoccult

Answer for yesterday’s Mind Teaser: The presence of a boggy mass

Correct answers received from: Dr Thakor Hitendrsinh G, Dr PC Das, Dr Avtar Krishan, Dr (Maj. Gen.) Anil Bairaria, Dr Bharat Bhushan Aggarwal, Dr Arpan Gandhi, Dr KV Sarma, Dr Kanta Jain, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Jayashree Sen & Dr Bitaan Sen.

Answer for 5th March Mind Teaser: b. Offering information to the patient about pharmaceutical assistance programs.

Correct answers received from: Dr Kanta Jain.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Ek chor 1 crore rupees aur bahut gold chori karke bhag raha tha. Ek gunge, bahre insan ke ghar ghus gaya, Maal udhar rakh kar bola"Kal aake le jaoonga".

Dusre din gaya, Maal vahan nahin tha, Puchha to gunga aise ishare karta mano wo kuch nahin janta.

Chor apne ek aise dost ko le aaya jo gungo ki bhasha janta tha.

Chor Bola "isko puchh maal kahan hai bata de nahin to shoot kar dunga."

Gunga darr gaya aur apni bhasha mein bola, "Ghar ke pichhe jo tree hai uske niche.

"Chor ko kuch samajh nahi aaya. Usne Dost se puchha "Kya bolta hai??

Dost "Bolta hai goli marde, Main nahin bataunga.”

 
    Medicolegal Update

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

Abrasion injury in medicolegal cases

Mechanical momentum means mass with velocity discharged into the human body by a moving object or weapon or itself due to impact of moving body against a surface produces injuries over the body. In the first case, the counter force is provided by the body and in the second case, by the rigidity of the object/weapon/surface/wall against which the victim falls by himself or is forced to fall by external reason. In most cases it is seen that the mechanical injuries produced over the body are due to a combination of above two forces. Abrasion is one of the most superficial injuries and involves destruction of the superficial layers of the skin, caused by fall on a rough surface, or being dragged by a vehicle. Abrasions are of different types based on the pattern of the causative force viz. scratches, grazes, pressure, impact or imprint abrasions. A doctor can help legal investigation by his evaluation and documentation of abrasions as below.

  • They give an idea about the site of impact and direction of the force.
  • They may be the only external signs of a serious internal injury.
  • Patterned abrasions may help in relating the wound to the object which produced them.
  • The age of the injury can be determined, which helps to corroborate with the alleged time of assault.
  • Dirt, dust, grease, sand in the open wounds may connect the injuries to the scene of crime
  • Character and manner of the injury may be known from its distribution.
    • In throttling, crescent abrasions due to fingernails are found in the neck
    • In smothering, abrasions may be seen around the mouth or nose.
    • In sexual assaults, abrasions may be found on the breasts, genitals, inside of the thighs, and around the anus.
    • Abrasions on the face of the assailant indicate a struggle.
    • Abrasions on the victim may show whether the fingernails of the assailant were long, irregular or even broken.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

March 14 is World Kidney Day

Preventing kidney diseases: The 8 Golden Rules

Chronic kidney disease can strike any one. Diabetes and high blood pressure are the two leading causes. Other risk factors for kidney disease include heart disease and a family history of kidney failure—a severe form of kidney disease, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India and National Vice President-Elect IMA and Dr Ramesh Hotchandani President-Elect IMA New Delhi Branch.

If you have these risk factors, it is important to be screened for kidney disease. That usually involves simple laboratory tests: a urine test to look for kidney damage, and a blood test to measure how well the kidneys are working. The urine test checks for a protein called albumin, which is not routinely detected when your kidneys are healthy. The blood test checks your GFR—glomerular filtration rate. GFR is an estimate of filtering ability of your kidney. A GFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure.

Without treatment, kidney disease often gets worse. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis.

Heart Care Foundation of India and IMA New Delhi Branch released the 8 GOLDEN RULES to avoid or delay reaching the point of kidney failure.

  1. Keep fit and active, it helps reduce your blood pressure and on the move for kidney health.
  2. Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage.
  3. Monitor your blood pressure: It is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered prehypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular diseases
  4. Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease (CKD). Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients.
  5. Maintain a healthy fluid intake: Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease. But do not advocate “aggressive fluid loading”, which can cause side effects.
  6. Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50 percent.
  7. Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.
  8. Get the kidney function checked if you have one or more of the 'high risk' factors

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” of 30303 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. Dear Sir, The world women’s day write up was very notable. Regards: Dr PS Sharma
 
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