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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


9th July, 2010, Friday

Urine color and vegetables, fruits, vitamins

Beets, blackberries, and rhubarb can temporarily turn urine pink or red, which may be mistaken for blood. The pigment that gives beets their deep magenta color is stable only at certain levels of stomach acidity and is usually too faint to show up in most people’s urine. The phenomenon — dubbed "beeturia" — occurs in only about 10% to 14% of the population. Even if you’re in that select group, eating beets will not always have a visible effect, because the acidity of the stomach (and therefore the urine) depends on when you ate and what else you ate. Rhubarb can also turn urine dark brown or teacolored, as can fava beans and aloe. Carrots, carrot juice, and vitamin C can color urine orange, and B vitamins can turn it a fluorescent yellow-green.

Asparagus sometimes gives urine a greenish tinge and a distinctive smell. Some blame it on the sulfurcontaining fertilizers used on asparagus plants have been implicated. Others suggest that only people who carry a particular gene break down the sulfurcontaining proteins in asparagus that release the odor. Still another view holds that the smell of everyone’s urine undergoes a change, but only some of us notice it. (Source Harvard Newsletter)

Dr KK Aggarwal
Editor in Chief

drkkaggarwal Dr K K Aggarwal on Twitter
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Photo Feature (From HCFI file)

 

Green Walk

IMA South Delhi Branch in association with Heart Care Foundation of India conducted a 'Green Walk,' slogan competitions and lectures on safe environment to celebrate the World Environment Day, June 5, in 2005. A separate plantation drive was also conducted to mark the occasion.

Dr k k Aggarwal

Dr. Yoganand Shastri, the then Health Minister Delhi, Mr Ram Bir Singh Biduri, MLA Sarita Vihar During the World Environment Day Celebrations in 2005 organized by the HCFI


 

News and Views

Atorvastatin appears to trump rosuvastatin in protecting diabetic, nondiabetic kidney function (Dr Brahma and Monica Vasudeva)

A new study from the Netherlands has found atorvastatin to be protective and rosuvastatin unprotective, and possibly harmful, in diabetic and nondiabetic patients. Highdose atorvastatin significantly reduced proteinuria and did not affect renal function, whereas rosuvastatin was associated with a significant decline in function and had no effect on proteinuria.

Common treatments for pink eye (Dr G M Singh)
  • Bacterial conjunctivitis, antibiotic ointment or eye drops may be prescribed.

  • Viral conjunctivitis usually goes away on its own without treatment.

  • Allergic conjunctivitis may be managed with anti allergy drugs.

  • Overthecounter painkillers, such as ibuprofen or acetaminophen, can make the patient more comfortable.

  • Applying a warm or cool compress to the eye can help soothe itchiness and discomfort.

  • Clean the corners of the eyes carefully with cotton balls or gauze moistened with warm water.

Leflunomide in the treatment of patients with early rheumatoid arthritis—results of a prospective non–interventional study ( Dr V Nagrath)

Leflunomide is effective and well tolerated in the treatment of rheumatoid arthritis (RA), however, only limited data is available on its use in early RA. This 24-week study evaluated effectiveness and safety of leflunomide in the treatment of early RA in daily practice. The prospective, openlabel, noninterventional, multicenter study included 334 adults with early RA (≤1 year since diagnosis). Leflunomide treatment was according to label instructions. Disease activity score in 28 joints (DAS28) response (reduction in DAS28 of >1.2 or reduction of >0.6 and a DAS28 of ≤5.1) was 71.9% at week 12 and 84.6% at week 24. 25.0% of patients achieved clinical remission (DAS28≤2.6). Most frequently reported adverse drug reactions (ADR) were diarrhea (3.0%), nausea (2.4%), hypertension (1.8%), and headache (1.5%). Serious ADR were reported in four patients (1.2%). Leflunomide showed the effectiveness which was to be expected from controlled studies without revealing any new or hitherto unknown side effects. Onset of action was quick and significant improvement of disease was seen after 12 weeks of therapy and at even higher rates after 24 weeks irrespective of the use of a loading dose. The DAS28remission rate achieved was similar to the rate seen with methotrexate or biologic therapy in other studies. Source: Kellner H, et al. Clinical Rheumatology 2010:29(8).

Digoxin unsafe for some kidney patients

A study reported in the Journal of the American Society of Nephrology states that for patients with kidney disease on dialysis, digoxin, a commonly used heart medication, may increase risk of premature death.

MCI News

Dr Setalvad on leave till retirement?

Lt. Col.(Dr.) A. R. N. Setalvad (Retd.) secretary, MCI as expected has gone on long leave. Dr P. Prasannaraj Deputy Secretary is the current officiating secretary with Dr Devender Kumar as number two. Dr Prem Kumar has rejoined as OSD along with Mr. Sanjay Prasad IRS as the other OSD.

De Desai denied bail

Patiala court today denied bail to Dr. Ketan Desai in the DA case. He will remain in the judicial custody till 20th when the case will come for hearing again.

 

Legal Column

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

What is SAFE Kit?

SAFE kit means Sexual Assault Forensic Evidence collection kit.

Medical examination and collection of medical evidences is the most important aspect of sexual assault. The landmark judgment by the Delhi High Court in 2009 in Delhi Commission for Women v. Delhi Police mandated certain changes in the police system, health services, child welfare committees, legal services and support services in order to give justice to victims of rape. These changes were to be completed within a time frame. Low conviction rates in sexual offenses, some complaints about the improper police investigative system and an insensitive society, the fact that medical opinions often lack in clarity and completion, and much medical evidence is not collected at all, the Delhi High Court pronounced its judgment specifically mandating that a SAFE Kit means Sexual Assault Forensic Evidence collection kit be used by all medical personnel for gathering and preserving physical evidence following sexual assault.

It explicitly mentions the contents of the kit: detailed instructions for the examiner, forms for documentation, a tube for the blood sample, a urine sample container, paper bags for clothing collection, a large sheet of paper for the patient to undress over, cotton swabs for biological evidence collection, sterile water, glass slides, unwaxed dental floss, a wooden stick for fingernail scrapings, envelopes or boxes for individual evidence samples, and labels. The following items could also be part of the kit a Wood's lamp, Toluidine blue dye, a drying rack for wet swabs and/or clothing, a patient gown, a cover sheet, a blanket, a pillow, needles and syringes for blood drawing, speculums, "postit" notes used to collect trace evidence, a camera (35mm, digital, or polaroid), batteries, a medscope and/or colposcope, a microscope, surgilube, acetic acid diluted spray, medications, clean clothing and shower/hygiene items for the victim’s use after the examination.

This is the first time that the court has mandated the requisite infrastructure for a proper examination and also the extent of examination, insisting on detailed documentation of history and findings.

Special rooms are to be set up for rape victims to be examined in privacy at every hospital where such cases are received. All hospitals are required to cooperate with the police and preserve the samples (that are otherwise likely to putrefy) in refrigerators or cold chambers till such time that the police are able to complete their paperwork for dispatch to a forensic laboratory for tests, include DNA. This is to ensure proper and safe storage of evidence.

 

Experts’ Views

Interesting tips in Hepatology & Gastroenterology
(Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi)

Obesity Management 

For childhood obesity, the goal is to reduce the rate of weight gain to fit the profile expected based on normal growth curves.

Starvation with a caloric intake of less than 200 kcal/d and is not medically indicated.
Because of their lowered energy expenditure, older subjects have increased difficulty is achieving sustained weight loss.

With any low-calorie diet, maintaining intake of protein with high biologic value of >1 g/kg is vital to preserve lean body mass.

A reduced-fat diet (<30%) may be more useful for prevention of weight gain in previously obese individuals, particularly in those with a familial susceptibility.

Parents have to act as role models for their children to inculcate a healthy lifestyle that includes good nutrition and regular physical activity.

Not many medications are available for the treatment of obesity, and those that are available have minimal long-term effectiveness.

Various bariatric surgical procedures have been used in adults and some adolescents with a BMI of more than 40 or weight exceeding 100% of ideal body weight.

Question of the Day (Dr Sujata Kanhere)

What should be the long-term treatment of the child with febrile seizures?

The Practice parameter for the long term treatment of simple febrile seizures by the committee on Quality Improvement, Subcommittee on Febrile seizures of the American Academy of Pediatrics states that nolong term treatment is recommended for simple febrile seizures. Neither intermittent nor continuous anticonvulsant therapy is recommended for children with one or more simple febrile seizures.

However, the Japanese consensus statement recommends the use of intermittent diazepam in children with fever with at least 2 risk factors for recurrences plus a history of at least two prior seizures or frequent seizures occurring over a short period of time. Intermittent use of Benzodiazepines such as diazepam or clobazam provides prompt anticonvulsant action.

Continuous prophylaxis with phenobarbital or valproate should be used only in highly selected cases, if at all it needs to be used. Antipyretics fail to reduce the recurrence of febrile seizures as has been shown by four well- designed placebo controlled double blinded studies. Antipyretic agents only make the child more comfortable but do not alter the risk of another febrile seizure.

 

View Point (MCI Medical Education)

In this column, eminent Padma Awardees express their thoughts on Medical education. Today, we present the views of Padma Shri Awardee Dr. Sanjeev Bagai.

Medical education in India needs to be uniform in degrees, expertise and teaching. MBBS and MD degrees should be uniform in the states with a national exam and not regional state exams. DNB teaching needs to be upgraded if it wants to match MBBS and MD/MS.

Presently, we need new colleges and more seats for medical students to cover the deficit of approximately six lakh medical professionals. Capitation colleges are often of poorer academic and faculty quality and should be stopped. There should be no capitation and no reservation in the medical selection in MBBS and postgraduate seats. Even, All India entrance exams should be unified and there should not be varied exams at state level for medical aspirants. If we do not make the system of medical education honest and transparent, students will not choose medicine as a career. The teaching faculty in medical colleges needs to be paid at par with private hospitals to retain best talent there or with equal benefits similar to IAS and Bureaucrats

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Public Forum (Press Release for use by the newspapers)

Unusual or irregular palpitation on exertion: A cause of concern

An unusual or irregular palpitation occurring while exercising, walking or climbing stairs should not be ignored, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

He said that missing of beats at rest and disappearing on exertion may be a normal phenomenon but missing of beats on exertion may indicate underlying blockages.

Any palpitation in a patient with underlying heart disease, in the setting of acute heart attack or which are unusual, unexplained or appearing for the first time also should not be ignored.

Palpitations in the presence of a low functioning heart (lower than 35%) need special investigations as these people have high chances of developing sudden cardiac arrest and death in future.

Patients who have survived a cardiac arrest should undergo more intensive investigations and evaluations to prevent a subsequent event.

Any person who can climb two flights of stairs, walk two kilometers without any discomfort or breathlessness usually require no cardiac investigations.

 

An Inspirational Story

The little wave

The story is abut a little wave, bobbing along in the ocean, having a grand old time. He’s enjoying the wind and the fresh air until he notices the other waves in front of him, crashing against the shore. "My God, this terrible",the wave says. "Look what’s going to happen to me!"

Then along comes another wave. It sees the first wave, looking grim, and it says to him: "Why do you look so sad?" The first wave says: "You don’t understand! We’re all going to crash! All of us waves are going to be nothing! Isn’t it terrible?"

The second wave says: "No, you don’t understand. You’re not a wave, you’re part of the ocean."

Source: "Tuesdays With Morrie" by Mitch Albom

 

IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient had an A1C of 12 % with a fasting sugar of 90 mg%.
Dr Bad: The report is wrong.
Dr Good: Get hemoglobinopathy ruled out.
Lesson: If a HbA1c value is obtained that does not correlate with clinical expectations i.e. HbA1c higher or lower than expected, hemoglobinopathy should be considered as a possible cause. Failure to do so may lead to mismanagement of diabetic patients due to false HbA1c results. (Diabetes Care 2000; 23(8):11978)

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Lesson: Make sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Quote of the Day (Dr. Santosh Sahi)

"Ones best success comes after their greatest disappointments." Henry Ward Beecher

Milestones in Psychiatry

Sir James Crichton–Browne (1840 1938) was a British psychiatrist recognized for his scientific study of brain tissue in cases of psychiatric disorder, for his concepts of mental illness in relation to evolutionary theory and for the development of medical psychology in public health and education.

Formula of the Day (Dr Varesh Nagrath)

Conversion of Urea to BUN

Urea in mg % = BUN in mg % x 6.006 divided by 2.8

BUN in mg % =Urea in mg % X 2.8 Divided by 6.006

 

IMSA Update

International Medical Science Academy Update (IMSA)

Chest radiography in ICU patients on mechanical ventilation

It is not necessary to perform routine daily chest radiographs on mechanically ventilated ICU patients; chest xrays in ventilated patients can reasonably be ordered on an asneeded basis. (DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV1 infected adults and adolescents. www.AIDSinfo.nih.gov. (Accessed on December 1, 2009).

 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Sumatriptan 85 mg + Naproxen 500 mg Tablets

Additional Strength for the treatment of migraine

3.08.2009

 

Medi Finance

Q. What do you mean by clubbing of income?

A. Clubbing of income means adding up the income of any person which arises on the asset transferred by other persons to the income of such other person for the purposes of determining taxable income after addition. However, upto Rs. 1,500 income of minor child is exempted from tax.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

TSH estimation by CLIA technology

Chemiluminescence Immunoassay (CLIA) detection using Microplate luminometers provides a sensitive, high throughput, and economical alternative to conventional colorimetric methodologies, such as Enzymelinked immunosorbent assays (ELISA).Recently, a chemiluminescent immunoassay has been shown to be more sensitive than the conventional colorimetric method(s), and does not require long incubations or the addition of stopping reagents, as is the case in some colorimetric assays.

 

Humor Section

Dr Jhatka bought a new mobile.
He sent a message to everyone from his Phone Book & said, "My Mobile No. has changed.
Earlier it was Nokia 3310. Now it is 6610."

Funny Definitions

Genital………………………Non–Jewish person

Medical bloopers on medical charts!

When she fainted, her eyes rolled around the room.

 

Readers Responses

  1. Doctors to treat septic patients with hypothermia: Inducing mild hypothermia is easy to implement in clinical practice and may be a valuable tool in the treatment of human sepsis patients, say researchers at the University of Brest, France. New research shows that the development of sepsis in rats living under hypothermic conditions was slower than in normal conditions and they survived much longer. The research was presented on Thursday 1st July at the Society for Experimental Biology Annual Meeting in Prague.

  2. Dear Sir, This question is for Dr. Sudhir Gupta, regarding availability of Sexual Assault Forensic Evidence kits. Are they commercially available or only in teaching hospitals? If they are commercially available, will u please let me know the address of the vendor, so that we can procure kits for our hospital. Sir, your column is highly useful to all Emergency physicians. I am a regular reader of e–medinews: Dr. KV Sarma, Senior Consultant & HOD Emergency, Fortis Hospital, Shalimar Bagh, Delhi––110088

    Dr Sudhir Gupta Responds: You may ask for the COMPLIMENTRY kit……from CEHAT. Below are the contact details.
    Mumbai Office: CEHAT, Survey No. 2804 & 2805, Aaram Society Road,Vakola, Mumbai 400 055. India Tel: (91) (022) 26673571, 26673154 Fax: (91) (022) 26673156 Email: cehat@vsnl.com.
    Pune Office: CEHAT, Flat No. 3 & 4, Aman–E Terrace, Plot No. 140, Dahanukar Colony, Kothrud, Pune – 411 029. India Tel: (91) (020) 25452325, Phonefax (91) (020) 25451413, Email: cehatpun@vsnl.com.

  3. Thanks e–Medinews. The story of Alexander Fleming, the discoverer of penicillin, on how he got quality education might have reminded so many readers about the many geniuses that might have remained un–accomplished in rural areas. The attitude displayed by Rudolf Churchill underscores two virtues—gratitude and importance of good education, money is not everything. Gratitude and education both can make a person better human-being. Reading HbA1C variation story created a doubt in my mind if my count was low because I am using fresh lemon daily these days. "Take care of your health in Monsoon"—is very timely. It was startling great information that Management of Dengue involves fluid resuscitation, and not platelet resuscitation: Vinod Varshney
 

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

12th September: BSNL Dil ka Darbar A daylong 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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