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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

  Editorial ...

8th October 2010, Friday

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

The inner Mahabharat

Ramayana and Mahabharata are the two great epics of our country and represent either the conflicts that occur in our mind internally in everyday life or the situations that we encounter with different types of people.

A symbolic representation of Ramayana involves a union of soul (Rama) with Manas (Lakshmana) and Body (Sita), by killing Tamas (Kumbhakaran), Rajas (Meghnatha) and Ego (Ravana) with the help of breath control (Hanumana) and the intellect (Sugriva). Similarly, a continuous Mahabharata war is being waged within each one of us at all crucial moments of life, and often, the negative tendencies within us are larger in number and usually mightier in their effectiveness, while the inner divine army is ever less in number and apparently weaker in efficiency.

The Kauravas represent the innumerable ungodly forces or negative tendencies led by the materialistic desires within man; while, the Pandavas represent the diviner impulses in man.

The five divine forces are represented by the five Pandavas; Yudhishthira (the one who is sthir in yudha or the one who is balanced in both win or loss situations and has learned all about Dharma), Arjuna (one who has mastered the technique of concentration or one-point resoluteness), Bhima (bal, or one who has determined willpower and strength), Sahadeva (one who has conquered the power to help others or sahayoga) and Nakul (the one who has conquered the power to remain neutral when required). Five brothers married to one wife, Draupadi, denote a perfect person with all the above five qualities who can control the materialistic bodily desires governed by the five senses (Panchali or Draupadi). The 100 Kauravas represents the 99 negative tendencies in the body led by 100th leader or Duryodhana (du means dusht and Yodhan means Yudh or war). He is helped by Dushasana (du means dusht and shasana means rule).

Most scriptures enlists five main negativities viz. kama, krodha, lobha, moha and ahankar; but others described them in details under 17 main segments: Pranatipata (Violence), Mrshavada (Untruth), Adattadana (Theft), Maithuna (Unchaste behavior), Parigraha (Possessiveness), Mithyatva (Wrong belief), Krodha (Anger), Mana (Arrogance), Maya (Illusion), Lobha (Greed), Raga (Attachment), Dvesha (Hate), Kalaha (Agitation), Abhyakhyana (Accusation), Paishunya (Gossip), Para–parivada (Criticism) and Rati–Arati (Likes and Dislikes).

Each of these can be done knowingly or unknowingly, and in thought, speech or desire. If we do all permutations and combinations, they turn out to be 99. Jainism also talks about 99 types of minor violations in life called atichars, which are the tendencies of a person to indulge with. Regardless of the scripture one follows, it is evident that we need to acquire and cultivate only five habits and that of Pandavas in the body to take away 100 negative tendencies of the mind.

If we evaluate Mahabharata with Ramayana, then Rama will the near equivalent of Yudhishthir and Arjuna; Lakshamana with Bhima; Bharat with Sahadeva and Shatrughana with Nakul.

When it comes to fight only two tendencies of the mind can play a role and this is evident from the Mahabharata war where most of the killings were done by the Arjuna and Bhima. Sahadeva only helped wherever necessary, Nakul acted as a balancing factor and Yudhishthir was in charge so that the war remained ethical.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Tobacco Vision

A series of interactions led by Heart Care Foundation of India were conducted under an Anti–tobacco conference with a vision to reduce tobacco consuption in Delhi. Manpreet Brar, Former Miss India was part of one such event to enhance its impact.
In the photo: Manpreet Brar; Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI; Er Anuj Sinha, DST

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Dementia and safe driving

In dementia, a score of 24 or less on the Mini Mental Status Examination (MMSE) is useful in identifying patients at increased risk for unsafe driving.

(Reference: Iverson DJ, et al. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74:1316).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

Air show to celebrate IAF anniversary

To celebrate its 78th anniversary, the Indian Air Force is organising an air display at Air Force Station Hindon this Friday. The Air Force Day Parade-cum-Investiture ceremony will begin with para-motor and powered hang glider performance. The grand finale would be marked by aerobatics by Sarang (ALH) and HJT – 16 aircraft of the Surya Kiran Aerobatics Team (SKAT). The IAF has requested the citizens of Delhi and the National Capital Region not to throw eatables and garbage in the open as birds pose a serious threat to aircraft flying at low levels. (Source: The Hindu)

  International News

(Dr Monica and Brahm Vasudev)

New method could make IVF more effective

Researchers using a microscope and time–lapse photography believe they have developed a method for predicting which test–tube embryos are the most likely to develop properly, and are licensing development of a commercial test. Their findings are published in the journal Nature Biotechnology. This would save mothers from having several treatments and help improve on the current method of implanting multiple embryos to try to get one pregnancy and risk multiple births in the process.

Researchers find seasonal variation in UACR in patients with type 2 diabetes and nephropathy

According to research presented at the annual meeting of the European Association for the Study of Diabetes, a seasonal variation in the urinary albumin–to–creatinine ratio (UACR) was observed in Japanese patients with type 2 diabetes and early nephropathy. UACR peaked in winter, an effect at least partly attributable to seasonal changes in systolic blood pressure.

Amount of sleep in pregnancy associated with elevated BP in third trimester

Pregnant women who get too much or too little sleep early in their pregnancy could develop elevated blood pressure in their third trimester, according to a new study published in the October issue of the journal Sleep.

Low vision

Vision impairment, or low vision, means that even with eyeglasses, contact lenses, medicine or surgery, you don't see well. Vision impairment can range from mild to severe. The leading causes of vision impairment and blindness in the United States are age-related eye diseases: macular degeneration, cataract and glaucoma. Other eye disorders, eye injuries and birth defects can also cause vision loss.

  Hepatology Update

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

How can biliary atresia be differentiated from neonatal hepatitis?

Liver biopsy is considered by many as the most important investigation in differentiating neonatal hepatitis and biliary atresia with reported accuracy of 83% –97%. A recent report found that liver biopsy was 100% sensitive and 76 % specific in detecting biliary atresia. Characteristic features of large duct obstruction include bile duct proliferation, bile plugs in small bile ducts, portal tract edema and fibrosis. However, these findings require time to develop. Biopsy also rules out paucity of intrahepatic ducts and provides important clues to the etiology of neonatal hepatitis e.g. α1 AT deficiency, CMV hepatitis etc., and is useful for storage disorders too. In suspected metabolic disorders it’s a good idea to save liver biopsy sample for electron microscopy. It is also important from prognostic point of view as it can grade and stage liver disease.

When the above tests are inconclusive, ERCP (endoscopic retrograde cholangiopancreatography) in expert hands or operative cholangiography is performed to confirm or rule out biliary atresia.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is the treatment for infertility?

Initial test results help the consultant to guide the couple. Most of the times making the couple understand the physiology and the planned treatment will give good results. Induction of ovulation with only the oral medicines first and then if required costly gonadotrophin injections, correcting subtle endocrino-pathies will help.

  • For tubal factor: Either corrective endoscopic surgery or cornual cannulation may be considered depending on the site of obstruction. There is good chance of conception with IVF, if surgery cannot restore fertility in tubal factor.
  • Unexplained infertility and early endometriosis cases: Controlled ovarian stimulation with IUI has given some promising results.
  Evidence Based Medicine

Dr NP Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi

Alcohol consumption and kidney function decline in the elderly

Background: Alcohol consumption appears to be protective for cardiovascular disease; however, its relationship with kidney disease is unclear. Methods: This prospective cohort study included 4343 subjects from the Cardiovascular Health Study, a longitudinal, community-based cohort of persons aged ≥65 from four US communities. A previously defined categories based on weekly alcohol consumption were used: none, former, <1 drink, 1–6 drinks, 7–13 drinks and ≥14 drinks. Cystatin C was measured at baseline, year 3 and year 7; eligible subjects had at least two measures. Estimated GFRcys was calculated from cystatin C. The primary outcome was rapid kidney function as an annual estimated GFR (eGFRcys) loss >3 mL/min/1.73 m2/year. Results: Eight percent of the cohort reported former alcohol use and 52% reported current alcohol consumption. During a mean follow-up of 5.6 years, 1075 (25%) participants had rapid kidney function decline. In adjusted logistic regression models, there was no association between alcohol use and kidney function decline (odds ratio, 95% confidence interval: none = reference; former = 1.18, 0.89–1.56; <1 drink = 1.20, 0.99–1.47; 1–6 = 1.18, 0.95–1.45; 7–13 = 1.10, 0.80–1.53; >14 = 0.89, 0.61–1.13). Results were similar with kidney function decline as a continuous outcome. Conclusions. The results suggest that moderate alcohol consumption has neither adverse nor beneficial effects on kidney function. Although clinicians will need to consider the potential deleterious effects associated with alcohol consumption, there does not appear to be a basis for recommending that older adults discontinue or initiate light to moderate alcohol consumption to protect against kidney disease.

Vandana Menon et  al. Nephrol Dial Transplant,2010; 25(10):3301-3307.

  Medicolegal Update

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

What are the cases that should be regarded as medicolegal?

The following cases must be labeled as medicolegal by treating doctor and medicolegal report should be prepared for further legal investigation
  • All injury/hurt cases, circumstances of which suggest commission of offence by someone
  • All traffic vehicular, railways, aeroplane, ship, boat, factory, construction site or other unnatural accidents
  • Self-infliction of injuries/ attempted suicide
  • Cases of criminal abortion
  • Accidents where there is likelihood of death or grievous hurt
  • All cases of suspected or evident poisoning
  • Suspected or evident homicide, suicide including attempted
  • All burn injuries, whatever the cause of burn
  • All suspected or evident sexual assaults
  • All suspected or evident criminal abortion
  • Unconscious cases where the cause is not natural or not clear
  • Cases referred by Courts for age estimation
  • Cases brought dead with improper medical history
  • Dead on arrival cases or patients who die shortly after being brought to the hospital before a definite diagnosis can be made
  • Patients dying suddenly after parenteral administration of a drug or medication
  • Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital
  • Death on Operation table
  • Unexplained death after surgery or Interventional procedure
  • Unexplained ICU death
  • Patient treated and then referred from a private hospital or other Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.
  • Relatives of the patient assault the treating doctor or other staff of the hospital.
  • Any other case not falling under the above mentioned category but has legal implications like medical examination of arrested accused without consent of person.

In case of death of a medicolegal case, the treating doctor has to only handover the body to the concerned police officer with written recommendation for medicolegal (Forensic) autopsy in final death summary/discharge report and a receipt must be obtained for record.

  Medi Finance Update

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.

  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combinations of Penicillin with Sulphonamides

  Lab Update

(Dr Arpan Gandhi and 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.

  IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine and palpitation came for treatment.
Dr. Bad: No drug is needed.
Dr. Good: Take Verapamil.
Lesson: Verapamil is frequently used as a first choice for preventive migraine therapy because it is easy to use and has few side effects.

Make Sure

Situation: A 19–year–old boy came to the clinic with complains of rectal pain, tenesmus and bleeding per rectum. He gave the history of anorectal intercourse. Rectal culture was positive for Chlamydia trachomatis.
Reaction: Oh my God! Why did you not prescribe macrolides?
Lesson: Make sure to remember that treatment with single dose of 1 g azithromycin is effective in treatment of LGV proctitis.

Quote of the Day (Dr. G M Singh)

"I’ve learned that finishing a marathon isn’t just an athletic achievement. It’s a state of mind; a state of mind that says anything is possible." John Hanc

  Mind Teaser

Read this…………………

Beating Bush Beating

Answer for yesterday’s Mind Teaser: "change of plans "

Correct answers received from:  Dr Rashmi Chhibber, Dr Deepti Katyal Uppal, Dr Chandresh Jardosh, Dr.Susheela Gupta, Dr Virender Prakash Gautam, Dr Muthumperumal Thirumalpillai, Dr Anurag Jain

Answer for 6th October Mind Teaser is:
"Three strikes and you’re out."
Correct answers received from:Dr K Raju

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr. G M Singh)

A dentist charged a mother fifty dollars for pulling her small son’s tooth. "I thought you only charged ten dollar for pulling a tooth," she complained.
"That’s right," the dentist said. "But your boy screamed and cried so loud out of pain that he frightened for new patients out of my waiting room."

You are an Indian if (Anuj Goel)
You take Indian snacks anywhere it says ‘No Food Allowed.’

  An Inspirational Story

Shake It Off and Step Up
A parable is told of a farmer who owned an old mule. The mule fell into the farmer’s well. The farmer heard the mule ‘braying’ – or – whatever mules do when they fall into wells. After carefully assessing the situation, the farmer sympathized with the mule, but decided that neither the mule nor the well was worth the trouble of saving. Instead, he called his neighbors together and told them what had happened…and enlisted them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially, the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back…a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back…he should shake it off and step up! This he did, blow after blow. "Shake it off and step up…shake it off and step up…shake it off and step up!" he repeated to encourage himself. No matter how painful the blows or distressing the situation seemed the old mule fought "panic" and just kept right on shaking it off and stepping up! You’re right! It wasn’t long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him, actually blessed him…all because of the manner in which he handled his adversity.

That’s Life! If we face our problems and respond to them positively, and refuse to give in to panic, bitterness, or self–pity…the adversities that come along to bury us usually have within them the potential to benefit and bless us!

Remember that forgiveness––faith––prayer–– praise and hope…all are excellent ways to "shake it off and step up" out of the wells in which we find ourselves!

  Readers Responses
  1. The poem published in the inspirational story column on 1st October was very touching and at the same time, it highlights the very important issue of drunken driving so relevant today. An innocent victim dying is perhaps the most serious and most tragic. A more concerted effort by all, authorities and the people, is required. More public awareness and educational programs to educate the public about the dangers of drunken driving are needed. Dr Prachi.
  Public Forum

(Press Release for use by the newspapers)

Harmony & Eco Fest at MTNL Perfect Health Mela

Harmony and Eco Fest, two school festivals, are two main events in the forthcoming MTNL Perfect Health Mela being organised by Heart Care Foundation of India in association with various Departments of Delhi Government, NGOs and public sector undertakings from 23 to 31st October at NDMC Grounds Laxmi Bai Nagar, New Delhi.

Giving the details Padma Shri and Dr BC Roy National Awardee Dr. K K Aggarwal, President, Heart Care Foundation of India, said that the events will be organised in association with Dept. of Science & Technology and Ministry of Environment, Govt. of India. The events will be a perfect opportunity for 5000 school children know about  health awareness messages through competitions. He said that the purpose of this competition is not only to have a competition but to learn preventive strategies so that the children in future can become healthy adults. The competitions will include poster and slogan competition, skit, yoga, aerobics, dancing, etc and will be judged by eminent personalities.

  Forthcoming Events

CPLD 2010: Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation AnnouncesRhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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