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FIRST NATIONAL eMEDICAL NEWSPAPER OF INDIA

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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 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 December, 2010, Wednesday

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

Revisiting 2010: HIV–AIDS

Revised HIV treatment guidelines for patients with a CD4 cell count between 350 and 500 cells/mm3

New HIV treatment guidelines from the International AIDS Society–USA panel

  • To initiate antiretroviral therapy for patients with a CD4 count less than 500 cells.1
  • The observational data supports a mortality benefit in reducing AIDS–and non–AIDS–related complications.2,3
  • Patients should be advised of the potential risks and benefits of early treatment interventions.

References

  1. Thompson MA, Aberg JA, Cahn P, et al. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society–USA panel. JAMA 2010;304:321.
  2. HIV–CAUSAL, Collaboration. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS 2010;24:123.
  3. Kitahata MM, Gange SJ, Abraham AG, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med 2009;360:1815.
Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook
 
  HIV/AIDS Update

Rule of 3

HIV does not spread by
1. Mosquito bite
2. Sharing food and water
3. Sharing clothes

3 Types of TB to remember
1. Pulmonary
2. Extra pulmonary
3. Miliary

Health care workers at risk
1. Medical
2. Nursing
3. Paramedical

3 qualities of a HIV consultant
1. Availability
2. Behavior
3. Competency

3 steps of revival
1. Airway
2. Breathing
3. Circulation

3 steps of life style
1. Keep A1C < 6.5%
2. BP < 120/80 mm Hg
3. LDL cholesterol < 100 mg%

3 components of blood
1. Macromolecules
2. Water
3. Cells

3 common blood transfusions
1. Pack cells
2. Plasma
3. Platelets

Blood donation
One can donate blood every 3 months

Platelet donation
One can donate platelets every 3 days

300 days of plasma
Plasma can be kept for 300 days

Use blood within
30 days

 
  Quote of the Day

(By Dr. GM Singh)

"You are not here merely to make a living; you are here in order to enable the world to live more amply, with greater vision, with a finer spirit of hope and achievement. You are here to enrich the world, and you impoverish your self if you forget the errand."

Woodrow Wilson

 
    Photo Feature (from the HCFI Photo Gallery)

 Eco–Fest 2010

Students demonstrating steps of yoga during Eco–Fest, a School Eco Club Festival in the 17th MTNL Perfect Health Mela 2010

 
Dr K K Aggarwal
 
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

43 top bureaucrats retired this year (42 so far)

Kanuru Sujatha Rao Secretary Union Ministry of Health and Family Welfare retired on 30/11/2010
The new year will see a big change at the top–level bureaucracy as 43 senior IAS officers holding the rank of secretaries to the Government of India have retired or would be retiring in 2010.
P V Bhide, Revenue Secretary retired on 31/01/2010
Raghav Sharan Pandey, Secretary, Petroleum & Natural Gas retired on 31/01/2010
Rita Sharma, Secretary, Union Ministry of Rural Development, retired on 31/01/2010
T Nanda Kumar, Secretary, Union Ministry of Agriculture, retired on 28/02/2010
Satyanarayana Dash, Secretary, Union Ministry of Heavy Industries retired on 31/03/2010
Harishankar Brahma, Secretary Union Ministry of Power retired on 30/04/2010
Sudha Pillai, Secretary, Planning Commission, retired on 30/04/2010
M Ramachandran, Secretary, Union Ministry of Urban Development retired on 30/06/2010
Brahm Dutt, Secretary, Union Ministry of Road Transport and Highways retired on 31/07/2010
Gautam Buddha Mukherji, Secretary, Union Ministry of Tribal Affairs retired on 31/07/2010
Santha Sheela Nair, Secretary Department of Mines retired on 31/07/2010
Sujit Banerjee, Secretary, Union Ministry of Tourism retired on 31/07/2010
Rita Sinha, Secretary, Dept of Land Resources retired on 31/07/2010
Ashok Kumar, Secretary, Department of Pharmaceuticals retired on 31/08/2010
Brijeshwar Singh, Chairman of National Highways Authority of India (NHAI) retired on 31/08/2010
Subbaroyan Krishnan, Secretary, Union Ministry of Fertilizers retired on 31/08/2010
Anil Kumar, Secretary, Ministry of Parliamentary Affairs retired on 31/08/2010
Dinesh Rai, Secretary, Union Ministry of Micro, Small and Medium Enterprises retired on 31/08/2010
Atul Chaturvedi, Secretary, Union Ministry of Steel retired on 31/08/2010
Bijoy Chatterjee, Secretary, Department of PetroChemicals retired on 30/09/2010
Bir Singh Parsheera, Secretary, Department of Official Language retired on 31/10/2010
U N Panjiyar, Secretary, Union Ministry of Water Resources retired on 31/10/2010
S Jalaja, Secretary, Department of AYUSH retired 31/10/2010
Shantanu, Consul Secretary, Department of Personnel, retired on 31/10/2010
Shashi Prakash, Principal Advisor in Union Ministry of Home Affairs Inter–state Council retired on 31/10/2010
T K Viswanathan, Principal Advisor Union Ministry of Law & Justice retired 31/10/2010
Kanuru Sujatha Rao, Secretary, Union Ministry of Health and Family Welfare retired on 30/11/2010
N Gokulram, Officer on Special Duty, Cabinet Secretariat retired on 30/11/2010
M Madhavan Nambiar, Secretary, Union Ministry of Civil Aviation retired on 30/11/2010
Vijai Sharma, Secretary, Union Ministry of Environment & Forests will retire on 31/12/2010

 
    International News

(Dr Monica and Brahm Vasudev)

Chemicals from antibacterial soaps, plastics may depress the immune system, cause allergies

Allison Aiello, an associate professor at the University Of Michigan School Of Public Health has suggested that children with higher exposure to triclosan, which enters our bodies via everything from antimicrobial soap to toothpaste to cutting boards –– may cause them to be more frequently diagnosed with allergies. Her team also discovered that adults exposed to higher doses of Bisphenol A, which is found in many plastics like the linings of food cans and baby bottles, may also have trouble with their immune systems.

Five personality disorders eliminated from DSM–5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (due out in 2013, and known as DSM–5) has eliminated five of the 10 personality disorders that are listed in the current edition.

Being overweight or obese may raise risk of premature death

According to a study published in the Dec. 2 issue of the New England Journal of Medicine, one does not need to be obese to increase the danger of premature death. Just being overweight too carries some risk. A meta–analysis that evaluated 19 studies involving about 1.5 million people concluded that healthy white adults who were overweight were 13% more likely to die during the time they were followed in the study vs those whose weight is in an ideal range. Women who never smoked and were classified as merely overweight and not obese were at a 13% greater risk of dying earlier than normal weight peers. Women who were obese had a 44% higher risk. The results for men were similar.

Most people have adequate vitamin D in their blood supplied by their diets and natural sources like sunshine

A National Cancer Institute study last summer was the latest to report no cancer protection from vitamin D and the possibility of an increased risk of pancreatic cancer in people with the very highest D levels. Super–high doses –– above 10,000 IUs daily –– are known to cause kidney damage, and a new study sets 4,000 IUs as an upper daily limit –– but not the amount people should aim for.

 
    IMA Update

IMA Vision 2015

Vision: To be the custodian of Health of Indians

Mission:

  • Health to be declared as a Fundamental Right in India
  • Healthcare to be declared as Infrastructure category
  • Primary Care & Emergency Care to all citizen
  • Secondary & Territory care affordable to middle and low income group citizen by universal insurance
  • Demand an Autonomous MCI with adequate elected members
  • Equitable Rural & Urban Health
 
    Infertility Update

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

Can sperms be taken out from the testes?

When there are no sperm in the ejaculate but there are germ cells in the testes, ICSI can be performed with spermatozoa isolated from testicular biopsies or fine needle aspirates. Successful pregnancy has been reported even with injection of fresh or cryopreserved immature sperm cells, such as elongated and round spermatids, but not with spermatocytes.

For queries contact: banerjee.kaberi@gmail.com

 
    Medicine Update

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

How is lactose intolerance diagnosed?

In many countries lactose breath hydrogen test is available to confirm the presence of lactose intolerance. However, this test is not easily available in India. Here the diagnosis is made on ‘clinical grounds’ with a good history and physical examination and a trial of lactose–free diet. Relief of all symptoms on a lactose–free diet and recurrence of symptoms on lactose ingestion is a good way to make a diagnosis. However, it is imperative that if you have persistent lactose intolerance then the possibility of an underlying disease should be kept in mind.

 
    Medicolegal Update

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

How is a sample of hair collected in a medicolegal case?

Samples of scalp, chest, beard, pubis hair are required in medicolegal cases and the loose hair after combing/cutting are collected by the doctor. Control sample for comparison with hair under question are also required to be collected from the victim, accused, and other involved persons

  • The hair should be full strands and should represent the body part concerned as scalp, chest, beard, pubis etc.
  • In rape and other sexual offences, loose/transferred pubic hair should be collected from the victim and the accused before collecting their controls samples.
  • All samples should be placed in thick envelopes, sealed and labeled properly.
  • Scrapping of stained area with hairs must be carefully collected from body/clothing. Scrapings from the nearest unstained area should also be taken. Instruments used for scrapping the stained and unstained areas should be separate so as to avoid contamination of controls sample.
  • In all cases, soils and scrapings with hair should be dried, if necessary, transferred to clean, dry phials, sealed and labeled properly.
 
    ENT Update

Dr. Aru Handa MS, DNB (Department Co–coordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

How to differentiate if vertigo is due to pathology in the ear or brain?

Vertigo can be caused both by pathology in the ear (peripheral vertigo) or brain (central vertigo).

  • Peripheral vertigo is usually sudden in onset, very severe and may be associated with nausea and vomiting; the patient is unable to sit up. The vertigo is associated with horizonto–rotatory nystagmus and the nystagmus has a slow and a fast component.
  • Central vertigo is gradually progressing, not very severe to start with and is associated with other neurologic deficits and gait instability. Nystagmus when present can occur in any direction and is more of vertical type rather than horizonto–rotatory and may be dissociated in the eyes. The subjective feeling of nausea and vertigo is less severe compared to peripheral vertigo.
 
    Legal Question of the Day

(Contributed by Dr M C Gupta, Advocate)

When is the BRHC (Bachelor of Rural Healthcare) course starting?

Vide order dated 10–11–2010, a division bench of Delhi HC has disposed of the WPC 13208/2009 filed as a PIL by the petitioner Meenakshi Gautam and Anr. against UOI & MCI (with three interveners including Kerala State IMA; People for Better Treatment; and Central Council for Indian Medicine), stating that since the prayer of the main respondents have submitted that:

  • the MCI has accepted the suggestion of the UOI to start a short term degree course called BRHC;
  • the MCI shall decide within 2 months the curriculum and syllabus for the course;
  • The UOI will give effect to the decision within 2 months thereafter,

"We are not inclined to address the grievances of the interveners in praesenti. It is open to the interveners to challenge the decision".

 
    Medilaw – Medicolegal Judgements

What is the punishment if no consent is taken?

In case of failure to obtain proper consent a doctor would be exposed to charge of battery (which is a criminal charge), besides being liable for civil action for monetary compensation by way of damages for performing a procedure or investigation without consent of the individual concerned.

A leading case where for want of proper consent the Court held that the action of the doctor amounted to battery and awarded damages in favour of the patient and against the doctor was Bailey vs. Belinfante. A patient was referred by his dentist to an oral surgeon. While waiting in the waiting room, and before even seeing the surgeon, he was given a surgical consent form to sign which gave the surgeon authority to do whatever procedure he thought best. When he saw the surgeon it was agreed that 11 teeth would be pulled. He went to the hospital, signed another general consent, and while he was under general anaesthesia, the surgeon pulled 27 teeth. The court upheld his action for battery as to the 16 teeth for which no consent had been obtained. (Supreme Court of India: Samira Kohli Vs. Dr. Prabha Manchanda. Ref: 2008 vol2 SCC @ pg1)

 
    Lab Update

(Dr Naveen Dang and Dr Arpan Gandhi)

Serum phosphorus

Hyperphosphatemia or high serum phosphorus levels may occur in myeloma, Paget’s disease of bone, osseous metastases, Addison’s disease, leukemia, sarcoidosis, milk–alkali syndrome, vitamin D excess, healing fractures, renal failure, hypoparathyroidism, diabetic ketoacidosis, acromegaly, and malignant hyperpyrexia. Drugs causing serum phosphorous elevation include androgens, furosemide, growth hormone, hydrochlorthiazide, oral contraceptives, parathormone, and phosphates.

 
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    Medi Finance Update

Understanding Mutual Funds

Balance funds

The benefit of a balanced fund is that it provides automatic diversification by investing in a variety of asset classes and thereby reduces the risk of one asset class performing poorly. Balanced funds tend to be more risky than bond funds and less risky than equity funds.

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
Indication
DCI Approval Date
Piroxicam 20mg tab & Paracetamol 500mg tab combikit For treatment of fever and pain associated with acute upper respiratory tract inflammation, acute musculoskeletal disorders, pain after operative intervention and following trauma, chronic condition like rheumatoid arthritis, osteoarthritis etc for short–term management of acute painful episodes. 19–Jan–10
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Markers for fetal inflammatory response in premature infants

Elevated urinary β–2–microglobulin levels at birth can be used as an alternative marker of fetal inflammatory response and subsequent higher risk of bronchopulmonary dysplasia in premature infants.

(Ref: Shima Y, et al. Urinary β–2–microglobulin as an alternative marker for fetal inflammatory response and development of bronchopulmonary dysplasia in premature infants. J Perinatol 2010 Dec 2. Epub ahead of print)

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient wanted to know if he could take a tablet along with a condom for a high–risk sex.
Dr Bad: There is no such drug.
Dr Good: Yes, you can have one of the antiretroviral drugs.
Lesson: Pre–exposure prophylaxis involves giving uninfected people antiretroviral drugs as a possible means of preventing HIV infection. Just last week, the published results of the NIH–sponsored iPrEx study indicated that a daily dose of an oral antiretroviral drug cut the risk of HIV infection by more than 40 percent among men who have sex with men.
(http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx

Make Sure

Situation: An elderly died of pneumonia.
Reaction: Oh my God! Why was pneumonia not suspected?
Lesson: Make sure in all elderly, pneumonia is excluded even if the symptoms are atypical in nature.

 
    Lighter Side of Reading

An Inspirational Story

Stop thinking and Start Living
(Dr Jitendra Ingole, MD Internal Medicine)

"When you feel bad, you will have the tendency to come up with a theory as to why you feel the way you do. Without knowing the actual cause, it makes sense to create a reason. As long as you can create reasons for your depression – your marital status, your job, your children, your genes, your financial situation, your future, and so forth – you can maintain the false hope that things will get better when…But you can probably see that, in actuality, this is not true.

The mindset that says ‘Life will be better when…’ will create further conditions that must be met as soon as the initial conditions are satisfied. You need only to look at the countless times in your life that you received what you wanted – and happiness still eluded you – to realize that changing your circumstances isn’t the answer to your problems. If it were, you’d already be happy! You wanted to graduate, you graduated. You wanted a mate, you got one. You wanted a pet, you got one. You wanted a pay–cheque, you got one. And so on. Tens of thousands of times in your life you got exactly what you wanted and yet you’re still unhappy! The solution is to have the humility to admit that all along you have been creating your own pain through your own thinking. Don’t worry; almost everyone else is doing the same thing. The good news is that as soon as you see that this is true, you’ll be on your way to a far better life. No matter how depressed you have been, or how long you have been depressed, the moment you can see that it’s only your thinking that is holding your depression in place, you’re on your way to freedom."

(Source: From "Stop thinking and Start Living" by Richard Carlson)

………………………………

Mind Teaser

Read this…………………

STEP PETS PETS  

Yesterday’s Mind Teaser: "Don’t cry Spilled Milk"
Answer for yesterday’s Mind Teaser: "Don’t cry over spilled milk"

Correct answers received from: "Dr. Manjesha, Dr. T. Samra, Dr. Rajiv Dhir, Dr Kalpana Mohan, Dr Sudipto Samaddar, Skagwekar Kumar Agwekar, Dr Vishanji Karani, Dr. Amlendu Yadav, Dr Chandresh Jardosh, Dr AK Gupta, Dr U.Gaur, Dr Neelam Nath, Dr Asim Kumar Sen, Dr K P Rajalakshmi, Dr Puneet Kathuria

Answer for 6th December Mind Teaser: "I’ll be there in a minute"
Correct answers received from: Dr Sudha Nayyar, Dr Anurag Jain, Dr.Kothandaraman, Dr G Padmanabhan, Dr Shirish Singhal, Dr Manjesha, Dr Vijay Kansal, Dr. Anjani, Dr Muthumperumal Thirumalpillai, Dr KV Sarma, Dr Sudipto Samaddar, Dr SK Bansal, Dr Anupam Sethi Malhotra, Dr K P Rajalakshmi, Dr. Rohini Vaswani, Dr R S Bajaj, Dr Satyoban Ghosh, Dr Puneet Kathuria, Dr Vikas Kumar, Dr. Neeraj Sharma, Dr Prabha Sanghi 

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr G M Singh)

Kid talk
When I stopped the bus to pick up Chris for preschool, I noticed an older woman hugging him as he left the house. "Is that your grandmother?" I asked. "Yes," Chris said. "She’s come to visit us for Christmas." "How nice," I said. "Where does she live?"
"At the airport," Chris replied. "Whenever we want her, we just go out there and get her.

 
    Readers Responses
  1. Dear Dr Aggarwal, eMedinews is very readable and informative. Dr Rakesh Malhotra
  2. Dear Dr Krishan, Greetings from Bareilly, Sir I would like to make a small correction in your article on DPT vaccination. It’s not the DPT vaccination but Tdap which is to be administered to persons above the age of 7 years and above it only the low dose pertussis and diphtheria which can be administered along with full dose of Tetanus. Please issue the corrigendum otherwise some one may administer full dose DPT which will lead to serious complications. Regards: Dr Atul Agarwal, National Joint Coordinator, Advancing science of Vaccinology, IAP National Vice Chairperson Infectious Disease Chapter of IAP, 2011.
 
    Public Forum

(Press Release for use by the newspapers)

Winter Asthma

Any breathlessness after the age of 40, appearing for the first time in winter, is cardiac asthma unless proved otherwise. Such patients should immediately have their blood pressure check–up done, which if high, needs immediate medical attention. First onset breathlessness can also be an indication of angina or heart attack. This was stated by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India. However, the more common is winter asthma or acute exacerbation of winter COPD (chronic bronchitis).

Asthma is reversible airway obstruction and COPD is irreversible airway obstruction. Sudden exposure to cold, humidity, pollution at lower levels in atmosphere can precipitate asthma in susceptible individuals. Winter is the time to increase the dose of asthma medicines.

  • If a person can speak a full sentence, the asthma attack is mild.
  • If a person speaks broken sentences the asthma attack is moderate.
  • If the person is able to speak only words then the asthma attack is severe. Severe attack of asthma needs immediate hospitalization.

An attack of asthma is due to inflammation, narrowing and collection of fluid in the wind pipe and needs medicines to widen the wind pipe and reduce the inflammation.

The need of asthma medicines can be intermittent and/or permanent. The Formula of 2 becomes handy in such situations. A person who consumes more than two canisters of inhalers in a year or consumes asthma medicines more than twice in the night time in a month or more than twice in a day in a week, he or she needs continuous asthma and anti inflammatory medicines. Inhalers are the best choices.

 
    Classifieds – Situation Vacant

"Wanted a senior resident in Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta, the Medicity Hospital in Gurgaon, Delhi (NCR) .Those interested please contact: Dr. Neelam Mohan (9811043475), or Secretary to Dr. Neelam Mohan – Amit (9818200582)."

 
    Forthcoming Events

Arogya Expo 2010

Date: December 9 – 13, 2010
Venue: 4th WAC Campus, Gayatri Vihar, Palace Grounds, Bengaluru

eMedinewS Events: Register at emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 9th 2011.
The one day conference will revisit and cover all the new advances in the year 2010. There will also be a web-cast of the event. The eminent speakers will be Padmabhushan Dr Naresh Trehan (cardiac surgery); Padma Shri Dr KK Aggarwal (revisiting 2010); Dr Neelam Mohan (liver transplant); Dr N K Bhatia (transfusion medicine); Dr Ambrish Mithal (diabetes); Dr Anoop Gupta (Male infertility); Dr Kaberi Banerjee (Female infertility) and many more.

There will be no registration fee.
Delegate bags, gifts, certificates, breakfast and lunch will be provided.
Kindly register at emedinews@gmail.com

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