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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 ...

9th November 2010, Tuesday

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

Screening older smokers,
ex–smokers for lung cancer may save lives

Largest study ever of lung cancer screening indicates that it helps reduce the likelihood of death. Effectiveness of CT scanning for lung cancer has been debated for years, because the test can pick up lung abnormalities like scars from past infections that are not cancer. Such irregularities are common in heavy smokers and can result in costly anxiety producing tests. Radiation is also a concern, because a CT scan, even low dose, delivers about 15 times more radiation than a chest x–ray. However, the authors of the latest study concluded that low–dose spiral CT scan can actually help reduce the death rate from lung cancer. Chest X–rays, an earlier form of screening tested repeatedly in the 1970s, have never been shown to save lives.

The current eight–year study conducted at 33 sites, known as the National Lung Screening Trial (NLST), is the first to provide ‘clear evidence’ of a significant reduction in lung–cancer deaths with screening in a randomized controlled trial. Researchers noted 20 % fewer deaths from lung cancer among those screened with spiral CTs than among those given chest X–rays. The results were so conclusive that the study was terminated ahead of schedule.  

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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  Quote of the Day

"Too many people are anxious to give advice, when what you really need is help."

    Photo Feature (from the HCFI Photo Gallery)

 Divya Jyoti
17th MTNL Perfect Health Mela 2010

Nurses from various hospitals, nursing schools and colleges participated in Skit and Role Play competitions organized as part of Divya Jyoti (Inter Nursing School Festival), a day-long event in the Perfect Health Mela.

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

PM's intervention sought on pictorial warnings issue

Civil society organisations have urged the Prime Minister to ensure that “effective” pictorial health warnings on tobacco product packages are enforced from December 1, 2010.In a bid to demonstrate civil society's disapproval of any further delay and dilution of pictorial health warnings on tobacco product packages to be implemented from December 1, tobacco control organisations across the country have urged the Prime Minister to take cognizance of the issue. Sixty-four organisations under the umbrella of the Advocacy Forum for Tobacco Control (AFTC) have written to Prime Minister Manmohan Singh and Union Minister for Health and Family Welfare Ghulam Nabi Azad requesting them to act urgently for the implementation of pictorial health warnings from December 1 following a deferral from June 1, 2010. (Source: The Hindu)

    International News

(Dr Monica and Brahm Vasudev)

Certain type 2 diabetes patients at high risk for CV events

Type 2 diabetes patients with gated myocardial perfusion single–photon computed tomography (SPECT) imaging abnormalities, who are otherwise asymptomatic, are at high risk for cardiovascular (CV) events and death according to the study published in Diabetes Care. Other significant risk factors were having a low estimated glomerular filtration rate and being a current smoker.

Shopping for Shoes

Here are few tips from The American Academy of Orthopaedic Surgeons on how to choose the right footwear and keep your feet happy:

  • Always measure both feet each time you go shoe shopping.
  • Try on shoes late in the day, when the feet tend to be a bit larger.
  • Women should opt for heels that are no higher than 2 1/4 inches.
  • Make sure the shoes fit properly in the heels and the toes, with inch of space between the shoe and your longest toe.
  • Try on both shoes to be sure that they fit comfortably on both feet. Opt for the size that is most comfortable on your largest foot.
  • Walk around the store with both shoes on to make sure the fit is comfortable. Don't count on ‘breaking them in.’

New rules for truck drivers returning after stroke

A U.S. expert panel has recommended that commercial truck and bus drivers who suffer a stroke should wait at least a year and be able to pass a driving test and a series of health assessments before getting in front of a wheel again. The panel, appointed by the Department of Transportation, also recommends annual check–ups on health and driving records as a requirement for continued driving.

Levels of coumarin in cassia cinnamon vary greatly even in bark from the same tree

There is a vast variation in the amounts of coumarin in bark samples of cassia cinnamon from trees growing in Indonesia, scientists are reporting in a new study. That natural ingredient in the spice may carry a theoretical risk of causing liver damage in a small number of sensitive people who consume large amounts of cinnamon. The report appears in the Journal of Agricultural and Food Chemistry.

    Infertility Update

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

What are the specific female causes for infertility?

For a woman to conceive, certain things have to happen: intercourse must take place around the time when an egg is released from her ovary; the systems that produce eggs and sperm have to be working at optimum levels and her hormones must be balanced. Some women are infertile because their ovaries do not mature and release eggs. Problems affecting women include endometriosis or damage to the fallopian tubes. Other factors that can affect a woman’s chances of conceiving include being over– or underweight for her age. Female fertility declines sharply after the age of 35. Sometimes it can be a combination of factors, and sometimes a clear cause is never established. Some of the common causes of infertility of females include: ovulation problems, tubal blockage, age-related factors, uterine problems, previous tubal legation.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

What is the role of surgery in IBD?

The rate of surgical interventions is reducing in children. Proctocolectomy with ileostomy is curative for ulcerative colitis. It is generally avoided in Crohn’s disease. Stricture resection or plasty for treating stricture is usually done.

    Medicolegal Update

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

What is the approach to acute ethanol and isopropanol poisoning?

  • Do a full medical examination to exclude other causes of the patient’s condition, such as head injury
  • Correct fluid and electrolyte imbalance.
  • Hypoglycemia should be treated with oral or intravenous glucose.
    Inf Update: Question of the Day

What is a malaria paroxysm?

Malaria causes an acute febrile illness which, in its most typical form, consists of febrile paroxysms occurring every 48 hours followed by afebrile intervals. These regular paroxysms separated by virtually asymptomatic intervals represent the only typical clinical feature suggestive of malaria. Typically, the following sequence may be observed: A cold stage, followed by a hot stage and a sweating stage. The total duration of the attack is 8–12 hours. The febrile paroxysm may be preceded by symptoms of fatigue, headache, dizziness, nausea and vomiting for 2–3 days before the attack. Children may have convulsions. The interval between paroxysms is determined by the length of the erythrocytic cycle of the parasite species involved ("tertian" or every 48 hours for Plasmodium falciparum, Plasmodium vivax and Plasmodium ovale; "quartan" or every 72 hours for Plasmodium malariae). Splenomegaly may be the only reliable sign at this stage. Nail or palmar pallor (anemia) and dark–colored urine, may be suggestive. In case of falciparum malaria, the paroxysm may rapidly evolve towards a severe complication of the disease (e.g., cerebral malaria or severe anemia):

This is a medical emergency where diagnosis needs to be confirmed urgently and treatment started. In non–falciparum infections, fever disappears after a few paroxysms, even in the absence of treatment; relapses or recrudescences may occur a few weeks or months later.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Uric acid

To detect high levels of uric acid, which could be a sign of the condition gout, or to monitor uric acid levels when undergoing chemotherapy or radiation treatment.

    Medi Finance Update

Family Package Cover

Self covered for 100% indemnity. Spouse covered for 50% of indemnity. Dependent child for 25% of indemnity.

• For children, the maximum cover shall be limited to death and permanent disablement (total and partial).
• A discount of 10% may be granted on the gross premium under the Family Package Cover. Where sum insured pertaining to spouse works out to less than the sum insured allowable, and if such spouse was not earning the later sum insured may be allowed.

    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

Fixed dose combination containing Pectin and/or Kaolin with any drug which is systemically absorbed from GI tract except for combinations of Pectin and/or Kaolin with drugs not systemically absorbed.

    IMSA Update

International Medical Science Academy (IMSA) Update

Acute decompensated heart failure

A systematic review suggested that noninvasive positive pressure ventilation may reduce mortality in patients with an acute decompensation of heart failure. (Ref: Weng CL, et al. Meta–analysis: Noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med 2010;152:590).

    IJCP Special

Dr Good Dr Bad

Situation: A physician wanted to know how to rule out depression and diabetes.
Dr. Bad: Depression and diabetes are not related.
Dr. Good: Use PAID scale.
Lesson: Problem Areas of Diabetes scale (PAID), a measure of emotional functioning in diabetes, is a valuable tool for the evaluation of quality–of–life (QoL) in type 2 diabetes and the screening of depressive symptoms. In a study, the perception degree of the QoL related with diabetes was associated with the severity of depressive symptoms.

Make Sure

Situation:A patient with LDL cholesterol 100 mg % and hsCRP 3 developed MI.
Reaction: Oh my God! Why was a statin not started earlier?
Lesson: Make sure all patients with even normal cholesterol are considered for statins if the CRP is high.

    Lighter Side of Reading

An Inspirational Story

The Scholar’s Four Questions

There was once a great scholar. Everybody in the kingdom appreciated him because he was so learned. Unfortunately, in spite of his great learning he had great pride. One day this scholar put on a gold necklace and went to the palace of another king. He said, "Whoever can defeat me in wisdom will get this necklace. I challenge everybody!" All the scholars in that particular kingdom had heard about this scholar and they were afraid that they would lose. So they would not accept his challenge. The king was very sad that nobody would accept the challenge.

Finally, the court jester said, I accept your challenge."

The king had almost surrendered to the scholar but thought it would be amusing to see his jester compete. He believed he was only a joker and would not be able to win the necklace. The court jester said, " I will ask you four questions. if you answer any of my questions correctly, then you will lose, but if all your answers are incorrect, then I will accept defeat and the king will give you anything you want."

Then the court jester asked his first question: "Where do you come from?"

The scholar said, I live here." This was incorrect, since he came from another kingdom. So by giving the wrong answer the scholar passed the first test.

The jester’s second question was, "How long have you been here?"

"Three years," the scholar said, which was also incorrect. Still the court jester was unable to trick him.
The third time the jester asked, "Our king is good, kind and generous. Do you agree?"

The scholar said, "Your king? What you are saying is totally wrong. Your king is undivine and very unkind." So again the scholar passed the test.

The court jester said, "It seems that I can’t defeat you. How many questions have I asked so far?" The scholar said, "You have asked me three questions; you have one more. If I do not answer it correctly you will lose."

The court jester cried out, "Look! The scholar has lost. He has answered this question correctly." So the scholar gave his necklace to the court jester, and the jester immediately gave it to the king. The scholar’s pride was totally smashed. He said, "I will never come to your kingdom to challenge anybody again."

All the scholars were very impressed by the court jester’s cleverness. They knew that they would not have been able to defeat the great scholar. The jester said, "You see, when great scholars are not alert, they lose. Had he been alert, he could have saved himself."

Mind Teaser

Read this…………………


Answer for yesterday’s Mind Teaser: "Day in day out"

Correct answers received from: Dr Marak, Dr S Upadhyaya, Dr Nageshwar Rao, Dr Chandresh Jardosh, Dr Santanu Guria, Dr Shashi Saini, Dr Muthumperumal Thirumalpillai, Dr Apurva Koirala, Dr. Suman Kumar Sinha, Dr Meera Rekhari, Dr. Prabha Sanghi, Dr. Satish Gunawant, Dr. Manjesha, Dr U C Vasavada, Dr. Susheela Gupta, Dr.K.P.Rajalakshmi, Dr. Prashant Bharadwaj, Dr Vishanji Karani

Answer for 7th November Mind Teaser: "Capital punishmen"
Correct answers received from: Dr Virender Prakash Gautam, Dr Jayashree B Keshav, Dr. Manjesha

Send your answer to ijcp12@gmail.com

Humor Section
(Dr G M Singh)

Nurse: Doctor, there is an invisible man in your waiting room.
Doctor: Tell him I can’t see him now. Next.

    Readers Responses
  1. Happy Deepawali to Dr Krishan Aggarwal & all the readers of emedinews. Danny & Swaraj.     
    Public Forum

(Press Release for use by the newspapers)

Beware of winter sore throat in Children: It can bite the heart

Viral sore throats in children are closely followed in frequency by group A streptococcal (GAS) sore throats, which is the most frequent bacterial cause of infectious pharyngitis, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.
In the winter months as many as 30 percent of episodes of pharyngitis may be caused by the bacterium Streptococcus pyogenes. If not detected and treated in time it can bite the heart valves and lick the joints (temporary joint pains)
GAS accounts for 15 to 30 percent of all cases of pharyngitis in children between the ages of 5 and 15 years. In temperate climates, the incidence peaks during the winter and early spring. GAS pharyngitis is seen most frequently in school-age children, but may occur in younger children, especially if they have contact with school-age children.
In children older than 3 years, GAS pharyngitis typically has an abrupt onset. Fever, headache, abdominal pain, nausea, and vomiting may accompany the sore throat, which can lead to poor oral intake. Quite frequently, cough and nasal discharge are absent, which if present often represent viral cough.
Additional features may include exudative pharyngitis, enlarged and painful  anterior cervical lymph nodes, palatal petechiae, and an inflamed uvula. Symptoms usually resolve spontaneously in three to five days.
Streptococcal infections usually manifest with atypical symptoms in children younger than 3 years of age. Instead of a well-defined episode of pharyngitis, they may have prolonged symptoms of nasal congestion and discharge, low-grade fever, and painful anterior cervical lymph nodes. This GAS symptom complex is called "streptococcosis".
Infants younger than 1 year may present with fussiness, decreased appetite, and low-grade fever. These children often have either older siblings or daycare contacts with GAS infection.

    Forthcoming Events

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS , Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9-12 noon
Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 - 9.30 AM:    Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
9.30 - 10.00 AM:  Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Hospital
10.00- 10.30 AM:  Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor  Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30-11.00 AM: Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion
12.00: Lunch

eMedinewS Events: Register at emedinews@gmail.com

November 29, 2010, Monday, 9 AM – 1PM, Moolchand Medcity – “Update on Kidney Transplant”. No Fee. Entry by Invitation.  Contact: emedinews@gmail.com
eMedinewS Revisiting 2010

The 2nd eMedinewS  - revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08-09, 2011.

January 08, 2011, Saturday, 6PM – 9PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6PM – 2nd eMedinewS revisiting 2010, A Medical Update

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