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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
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


8th August, 2010, Sunday

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

How to tackle insomnia

Insomnia is trouble falling asleep. One form of insomia, called sleep-maintenance insomnia, is difficulty staying asleep, or waking too early and struggling to get back to sleep. It gives rise to worry over not getting enough sleep, which further interferes with sleep, creating a vicious cycle. What can one do, reports July issue of Harvard Women's Health Watch: Sleep hygeine.

  • Watch what you drink: Avoid caffeinated beverages after 1 or 2 p.m.-or altogether, if you're especially sensitive to caffeine. Limit alcohol, and don't drink any within two hours of bedtime. Alcohol interferes with deep sleep and can interfere with breathing.
  • Exercise: Getting regular aerobic exercise such as walking, jogging, or swimming can help you fall asleep faster, get more deep sleep, and awaken less often during the night.
  • Don't watch the clock: Watching the sleepless minutes pass makes it harder to fall back to sleep in the wee hours. Turn the clock face so you can't see it.
  • Improve your sleep efficiency: Keep track of your sleep patterns for a week or two. If you find that you're spending less than 80% of your time in bed asleep, you may be spending too much time in bed. Try going to bed later, and don't nap during the day. If you find yourself falling asleep too early in the evening, keep the lights bright.
  • It's hard to get back to sleep if your mind is racing or your muscles are tense. To calm the mind and relax the muscles, try meditation, deep breathing, or progressive muscle relaxation.

Dr KK Aggarwal
Editor in Chief
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Photo Feature

 Weird X-rays

From broken bones to diseases, the X-ray is one of the most useful medical advancements in history. But as these images show they can also reveal some of the most gruesome and bizarre results. Here, an X-ray shows the abdomen of a patient who has swallowed two forks, a ballpoint pen and a toothbrush. These objects are located in the intestine. (Photo from the net)

Dr k k Aggarwal

 

News and Views ( Dr Brahm and Monica Vasudev)

Low-fat, low-carbohydrate diets have similar weight loss

An NIH study published Aug. 3 in the Annals of Internal Medicine says that low-fat and low-carbohydrate diets produce comparable weight loss and improvements in many health measures. The researchers at three major medical centers tracked the weight loss of more than 300 obese people over a period of two years. Half of participants followed a low-carb diet (20 grams of carbohydrates daily) for three months. They then gradually increased their carb intake over time. The other half consumed a low-calorie, low-fat diet of 1,200 to 1,800 calories a day, depending on their weight and gender, with less than 30% of calories from fat. It was observed that:

Studies funded by drug industry more likely to show positive results

Industry-funded trials report positive outcomes more often than government-funded trials. A review of 546 drug trials has found that industry-funded trials reported positive outcomes 85% of the time vs 50% of the time for government-funded trials vs 72% of the time for trials funded by nonprofits or non-federal organizations. Among the nonprofit or non-federal studies, those that received industry contributions were more likely to be positive than those that did not have any industry support; 85% vs 61%, respectivey.

Ketamine shows promise as treatment for depression among patients with bipolar disorder

A study published in the August 2 issue of Archives of General Psychiatry has suggested a role for ketamine in treating people with bipolar depression. Ketamine is an anesthetic drug and is used illegally as a party drug at raves. In a study from the National Institute of Mental Health, 71% of the 18 bipolar patients included in the study, who had not responded to other treatments, experienced notable improvement in symptoms of depression after a single IV infusion of ketamine. Most of these patients responded within 40 minutes of receiving the drug, and the effects lasted for about 3 days. Ketamine acts on the brain's glutamatergic system of the brain involved in information processing and memory formation. Recent research has suggested that dysfunction in this brain system may contribute to bipolar disorder.

Dealing with separation anxiety (Dr G M Singh)

It's common for young children to have a tough time when their mom or dad leaves them with someone else. Suggestions to help ease separation anxiety:

  • Both diets improved cholesterol in a two-year study of 307 adults.
  • Dieters on the low-carb diet got a bigger boost in their so-called good cholesterol, nearly twice as much as those on low-fat.
  • HDL cholesterol increased by 23 % increase from low-carb diet vs 12 % improvement from low-fat.
  • Both groups also participated in a 2-year behavioral program that focused on how to manage relapses, self-monitoring, and emphasized on moderate physical activity. After two years, both groups had a 7% weight loss.
  • The low-carb dieters also had a substantially greater decrease in diastolic blood pressure...than did the low-fat group at three and six months, a difference that persisted after two years.
  • The low-carb group reported significantly more adverse effects, especially during the first six to 12 months of the study. Low-carb diet was associated with more reports of bad breath, hair loss, constipation, and dry mouth.
    • Try not to leave the youngster with an unfamiliar caregiver while the youngster is aged 8 months to 1 year.
    • This is when separation anxiety most commonly begins.
    • Try not to leave your child when the youngster is very tired or hungry.
    • Practice leaving the youngster with someone new for short stints, then extend those periods.
    • Stay relaxed and calm, and be consistent in your drop-off routine. This will help your child understand that although are leaving, you will be back.
    • Always come back to get your child at the promised time.
    • Don't allow crying or tantrums to deter you from leaving.

 National News

Alka Desai granted transit anticipatory bail by Gujarat high court, to appear before CBI Delhi on Monday
The Gujarat high court on Wednesday granted transit anticipatory bail to Alka Desai, wife of former president of Medical Council of India Dr Ketan Desai. The court also asked her to take bail from the CBI court in Delhi. Alka Desai had sought transit anticipatory bail after her name appeared in the case filed by CBI against Desai, for having disproportionate assets. Justice Z K Saiyad while granting transit anticipatory bail said Alka needs to remain present before the CBI authorities in Delhi by August 9 (Monday). (DNA News)

 

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Medical Testimony of Doctor in the Court of law (Contd)

Cite the source of the evidence medical literature

The degree to which a medical document, literature/book, validates the point you are making depends upon the reliability of the document. The author of a document is a witness you are calling upon to testify. Conventions for citing sources are somewhat dynamic. However, at a minimum you should identify the individual, institution, or publication that authored the document and the publication date. When it is not otherwise evident, you ought to make quick reference to the qualifications of the author to lend an air of credibility to the document. Although it is not necessary to read additional information into the records, you must be prepared to provide a complete bibliographic citation if called upon to do so by the court of law or cross lawyer.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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


Childhood Pancreatitis

Acute Pancreatitis in Children

Causes
There is a wide variety of causes of acute pancreatitis in the pediatric age group. Biliary tract disease and alcoholism are two commonest causes in adults.  In contrast, the causes of acute pancreatitis in childhood are quite different, and the commonest etiologic factors are trauma, multisystem disease and drugs. Multisystem disease includes sepsis, shock, systemic infections, collagen vascular disease, inflammatory bowel disease and Reye's syndrome.  Kawasaki disease, hemolytic uraemic syndrome, Henoch schonlein purpura and congenital structural anomalies are also considered as common causes of acute pancreatitis in childhood.

Question of the day

What are the issues and concerns about oral antidiabetic agents in patients with overt diabetic nephropathy? (Dr G Vijaya Kumar, Chennai)

  • Glomerular filtration rate declines
  • delayed creatinine clearance
  • delayed drug clearance
  • Heightened risk of hypoglycemia. Thus a short acting insulin will behave like an intermediate acting one. The long acting sulfonylureas are best avoided, you may use the meglitinides since their duration of action is long, or you may use the newer sulfonylureas such as glimepiride or gliclazide that carry a low risk of hypoglycemia.
  • Increased risk of lactic acidosis. Metformin is thus best avoided.
  • Water logging; hence the use of glitazones can add to the problem; although this is a relative contraindication.
  • The kidney contributes to 33% of neoglucogenesis hence if hypoglycemia occurs it is usually severe (neuroglycopenia) and hence recovery is delayed.
  • Autonomic neuropathy usually sets in due to uremia adding to the agony; hence gastropathy and GI intolerance to alpha-glucosidase inhibitors is to be kept in mind. Acarbose is safe, but if you are using miglitol then a dose reduction in renal failure is recommended hence start with the lowest possible doses. Voglibose has been used but the long-term safety in renal failure is not really known since the drug has hit the market only for a short while.
  • On the flip side uremia can worsen insulin resistance and increase the sugars temporarily; in such a situation rather than increasing the dosage of the oral agents it is safer to use insulin. In these situation too the use of the analogs has proven beneficial i.e. low risk of hypoglycemia nevertheless you pay the premium for the drug!
 

Public Forum (Press Release for use by the newspapers)

Good news for snorers

If you are a habitual snorer, and/or your breathing stops during sleep, it is an opportunity for you to go for counseling cum check up at forthcoming BSNL Dil Ka Darbar being held on Sunday, the 26th September, at Maulana Azad Medical College to commemorate World Heart Day.

Giving the details Dr K K Aggarwal, Padma Shri & Dr B C Roy National Awardee, President Heart Care Foundation of India and BSNL Dil ka Darbar said that snoring with sleep apnea is a risk factor for sudden death. Snoring is not a sign of deep sleep but a sign of interrupted sleep.

Snoring is more common in people who are obese and whose neck circumference is more than 40 cms. Snoring is now controllable and sudden cardiac death can be prevented.

People who have more than 10 episodes of ceasation of respiration in one hour during sleep are at higher risk. These people also have daytime sleepiness.

 

Conference Calendar

Intravenous Cannulation (IV Cannulation) - Registration Closed

Date: August 10, 2010
Venue: V-70 (Old No. 89), Fifth Avenue, Anna Nagar, Chennai, Tamil Nadu.

 

An Inspirational Story

In the morning, the sun wriggles its way with piercing brightness through the mass of clouds to have a peek at you, beautiful one!

During the day the wind comes along, blowing you gently, feeling you up like a lover.

The earth has always been there to bear your weight and for you to stand on.

The rain only falls, not to wash away your fadeless beauty but to make it sparkle for the world to gaze.

The trees have been around to shade you from the sun, whom they think might be giving you an overdose of his love it barely realizes. They produce fruits in the hope that it will please you more and keep you close to them.

The night comes with darkness as its strategy for dominance, blotting out every other contestant for your attention, that you may rest knowing dullness brings drowsiness.

Mother moon and her children the stars are always favored before the night. With their soothing and gentle character, she ushers them to your place of rest. All night long they watch entranced as you sleep.

Above all, the divine Creator watches needless as His creations cater to you, cautioning them where and when necessary because you are the cream of creation.

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IJCP Special

Dr Good Dr Bad

Situation: A patient came with acid peptic disease.
Dr Bad: You can eat anything.
Dr. Good: Avoid pungent, sour and salty food.
Lesson: Pungent, sour and salty foods increases acid in the stomach.

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lasson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

Mnemonic of the Day (Dr Varesh Nagrath)

Mnemonic for Pituitary Deficiency

Causes of Pituitary Deficiency: HYPOPITS

H : Hypophysectomy & Empty sella
Y : Irradiation
P : Pituitary Adenoma /Craniopharyngioma
O : Autoimmune/ Lymphocytic Hypophysitis
P : Postpartum pituitary apoplexy /Sheehan's syndrome
I : Infection /Tuberculosis
T : Trauma
S : Sarcoidosis

Good Slogans (Dr Chandresh Jardosh)

Sign on a bulletin board

Success is relative; More the success, more the relatives.


Quote of the Day (Pankaj Agarwal)

Nothing can be changed by changing the face. But everything can be changed by facing the change.

SMS of the Day (Dr. Prachi Garg)

Nice relations are like breathing air. You can never see them but you will always feel and need their presence.

Are you fit to fly?

Deep vein thrombosis

  1. Prolonged travel confer a 2- to 4-fold increase in risk of venous clots, a phenomenon that has been termed the "economy class syndrome" when applied to air travel.

  2. The risk is one per 100 million passengers for travel distances <5000 km (3100 miles) and 4.8 per million passengers at travel distances greater than 10,000 km (6200 miles).
 

International Medical Science Academy Update (IMSA)

Polio vaccination

The Advisory Committee on Immunization Practices has issued updated recommendations regarding routine poliovirus vaccination. The final dose in the series should be administered when the child is at least four years old.

Reference

  1. Madhi SA, Cunliffe NA, Steele D, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med 2010;362:289.
 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Raltegravir (as Potassium) film coated Tablets 400mg

In combination with other anti retroviral agents for the treatment of human immunodeficiency virus (HIV-1) infection in treatment experienced patients with evidence of HIV-1 replication despite ongoing retroviral therapy.

27-Jan-10

 

Medi Finance

Q. What is the rate of standard deduction on the net annual value of income from house property?

Ans. 30% of net annual value shall be allowed as deduction from net annual value of income from house property.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Stool Examination

Diarrhea is a common symptom of a gastrointestinal disturbance.
O & P (Ova and Parasite) testing: A microscopic evaluation of stool for parasites and the ova (eggs, cysts) of parasites. A basic test but very important!!

 

Lateral thinking

Read this………………

ababaaabbbaaaabbbb ababaabbaaabbb

Send in your answer to emedinews@gmail.com

The answer for yesterday's puzzle "life after death"

Correct answers received from: Dr Mohit Joshi, Dr.Chandresh Jardosh,  Dr Peach Melba, Dr Girish Cally, Dr Rajiv Kuppusamy, Dr Prachi Garg, Dr Manu Shankar, Dr Gagan Srivastava, Dr Aanchal Jain, Dr Anurag Jain,Dr.Satish Gunawant, Dr Ashok Wasan. 

Correct answers received for 6th August Puzzle from: Dr Theogaraj Samraj 

 

Humor Section

Jokes

Doctor: Did you take those pills I gave you to improve your memory?
Patient: What pills?

Fumy One Liners

Boss: Have you ever seen an owl?
Man (looking down) No Sir.......
Boss: Don't look down. Look at me.

 

Readers Responses

  1. Dear Dr KK Aggarwal. CONGRATS & Thanks for sending the emedical newspaper. Its a wonderful idea. Slowly include all sections. Dr. R C Goyal

  2. Sir, you are doing a great job, keep on the good work, I know it is an uphill task. Vivek kumar. Editor JAMS up state
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

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