emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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

 

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  Editorial …

11th September 2011, Sunday

Hepatitis B Vaccination update

  • The regimen for the vaccine is three doses at one and six months apart.
  • Longer than recommended intervals between doses do not reduce final antibody concentrations, although protection might not be attained until the recommended number of doses has been administered.[1-5]
  • A positive immune response to the vaccine is defined as the development of hepatitis B surface antibody (anti-HBs) at a titer of >10 mIU/mL.
  • An interruption in the vaccine schedule does not require restarting the entire series of vaccination or adding extra doses.[6,7]
  • If the vaccination schedule is interrupted after the first dose, the second dose should be administered as soon as possible.[8]
  • The second and third doses should be separated by an interval of at least two months.
  • If only the third dose is delayed, it should be administered when convenient.
  • Protective anti-HBs titers may be attained in some after only one or two doses of vaccine, completion of the full course (three doses) is recommended to maximize the anti-HBs titer and duration of protection.
  • Anti-HBs titers decrease with time but the duration of protection is long (15 -22 years after the primary vaccination schedule).[9-13] Routine booster injections are not required.[14,15]
  • Patients with serologic markers of past HBV infection (anti-HBc and anti-HBs positive) do not need HBV vaccination even if they have low titers of anti-HBs.
  • Vaccines should be given intramuscularly since deposition of the vaccine into adipose tissue result in a lower seroconversion rate.[16]
  • Deltoid is the preferred site in adults for vaccination.
  • Longer needles should be used in overweight individuals.
  • Hepatitis B vaccine is effective not only in preventing HBV infection but also in preventing the sequelae of chronic HBV infection.
  • It is the first example that cancer can be prevented by vaccination.

References

  1. Wiström J, Ahlm C, Lundberg S, et al. Booster vaccination with recombinant hepatitis B vaccine four years after priming with one single dose. Vaccine 1999;17:2162.
  2. Zechowy R, Rubin LG. Effect of the time interval between the first and second doses of hepatitis B vaccine on the antibody titer achieved after the third dose. Child Hos Q 1997;9:67.
  3. Middleman AB, Kozinetz CA, Robertson LM, et al. The effect of late doses on the achievement of seroprotection and antibody titer levels with hepatitis b immunization among adolescents. Pediatrics 2001;107:1065.
  4. Halsey NA, Moulton LH, O'Donovan JC, et al. Hepatitis B vaccine administered to children and adolescents at yearly intervals. Pediatrics 1999;103:1243.
  5. Heron LG, Chant KG, Jalaludin BB. A novel hepatitis B vaccination regimen for adolescents: two doses 12 months apart. Vaccine 2002;20:3472.
  6. Saito K. Introductory remark of Dr. Rokuzo Kobayashi's achievements. Keio J Med 2002;51 Suppl 2:2.
  7. Hepatitis B vaccine: What you need to know. Available at: www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-b.pdf (Accessed on October 20, 2009).
  8. Hoofnagle JH. Toward universal vaccination against hepatitis B virus. N Engl J Med 1989;321:1333.
  9. Liao SS, Li RC, Li H, et al. Long-term efficacy of plasma-derived hepatitis B vaccine: a 15-year follow-up study among Chinese children. Vaccine 1999;17:2661.
  10. Lin HH, Wang LY, Hu CT, et al. Decline of hepatitis B carrier rate in vaccinated and unvaccinated subjects: sixteen years after newborn vaccination program in Taiwan. J Med Virol 2003;69:471.
  11. Yuen MF, Lim WL, Chan AO, et al. 18-year follow-up study of a prospective randomized trial of hepatitis B vaccinations without booster doses in children. Clin Gastroenterol Hepatol 2004;2:941.
  12. McMahon BJ, Bruden DL, Petersen KM, et al. Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up. Ann Intern Med 2005;142:333.
  13. Zanetti AR, Mariano A, Romanò L, et al. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet 2005; 366:1379.
  14. Lu CY, Chiang BL, Chi WK, et al. Waning immunity to plasma-derived hepatitis B vaccine and the need for boosters 15 years after neonatal vaccination. Hepatology 2004;40:1415.
  15. Jan CF, Huang KC, Chien YC, et al. Determination of immune memory to hepatitis B vaccination through early booster response in college students. Hepatology 2010;51:1547.
  16. Shaw FE Jr, Guess HA, Roets JM, et al. Effect of anatomic injection site, age and smoking on the immune response to hepatitis B vaccination. Vaccine 1989;7:425.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Hepatitis B Vaccination update

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Excellence in Social Service Award – 2011

Heart Care Foundation of India is Awarded as one of the 10 best NGO of the Country by Punjab Kesari, Delhi on 9th September 2011. This Award is given for Oustanding dedication, devotion and contributions.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

Two-day U.N. meet to push for NCDs as a Millennium Development Goal

NEW DELHI: Alarmed at the heavy toll non-communicable diseases (NCDs) were taking across the world, the two-day special session of the United Nations General Assembly scheduled later this month has been assigned to discuss NCDs, where world leaders will push for declaring NCDs as a global health and development emergency requiring an urgent multi-sectoral response. In addition to demanding that 2011-2020 be pronounced as the Decade of Combating NCDs and ensuring specific indicators with a timeline for action, the meet will also speak in favour of including NCDs in the current U.N. Millennium Development Goals and any subsequent commitments. (Source: http://www.thehindu.com/health/article2439772.ece, September 9, 2011)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Dr Monica and Brahm Vasudev)

FDA warns of new infections with TNF blockers

The Food and Drug Administration has updated the boxed warning for all tumor necrosis factor-alpha (TNFa) inhibiting drugs to reflect the risk of infection from the bacteria Legionella and Listeria.

There now have been more than 100 cases of infection with these pathogens, according to the agency. The TNFa inhibitors licensed in the United States are infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi). The drugs are used to treat rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and juvenile idiopathic arthritis. Serious infections involving viral, bacterial, and mycobacterial pathogens are a recognized risk of treatment with these and other immunosuppressive drugs. (Source: Medpage Today)

For comments and archives

Panel endorses Xarelto for stroke prevention

An FDA advisory committee has voted 9-2, with one abstention, to recommend that the FDA approve the direct oral factor Xa inhibitor rivaroxaban to prevent stroke in patients with atrial fibrillation. (Source: Medpage Today)

For Comments and archives

COPD stent fails clinical test

Patients with severe emphysema derived no significant benefits from a less invasive alternative to surgical lung-volume reduction, investigators in a randomized trial reported. Airway bypass failed to improve lung function or dyspnea as compared with a sham procedure, despite successful release of trapped air in emphysematous lung tissue. The composite six-month endpoints for efficacy and safety were met in 14.4% of patients randomized to active treatment and 11.2% of those in the sham group, as reported online in The Lancet. (Source: Medpage Today)

For comments and archives

 
  Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Nearly half of runners may be drinking too much during races

Nearly half of recreational runners may be drinking too much fluid during races, according to a survey of runners by Loyola University Health System researchers. Expert guidelines recommend runners drink only when thirsty. But the Loyola survey found that 36.5 percent of runners drink according to a preset schedule or to maintain a certain body weight and 8.9 percent drink as much as possible.

For comments and archives

 
  Twitter of the Day

@DrKKAggarwal: Onam, Ramadan and Navratra festivals have the same medical significance. They detoxify the body.

@DeepakChopra: #cwellbeing What is the one thing you can do today to improve your community well being? Use hashtag and country when responding.

 
    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Which is the best juice to break the fast?

Sugarcane juice is the best juice to break the fast. Unrefined sugarcane contains many minerals and nutrients including phosphorus, calcium, iron, magnesium and potassium. Pure sugarcane has 11 calories per one teaspoon. Sugarcane juice being high in K, Mg and phosphate levels can prevent re-feeding syndrome. It should be given 10 cal per kg in the first day.

For comments and archives

 
    Spiritual Update

Soul does not leave the body immediately after the death

According to Prashna Upanishad, at the time of death, the Prana Vayu (respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body. But this does not happen immediately after clinical death which is defined as stoppage of heart and respiration. Medically the term used for clinically dead patients is cardiac arrest.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Everybody has a dream

Some years ago I took on an assignment in a southern county to work with people on public welfare. What I wanted to do was show that everybody has the capacity to be self-sufficient, and all we have to do is to activate them. I asked the county to pick a group of people who were on public welfare, people from different racial groups and different family constellations. I would then see them as a group for three hours every Friday. I also asked for a little petty cash to work with as I needed it.

The first thing I said after I shook hands with everybody was, "I would like to know what your dreams are." Everyone looked at me as if I were kind of wacky. "Dreams? We don't have dreams." I said, "Well, when you were a kid what happened? Wasn't there something you wanted to do?" One woman said to me, "I don't know what you can do with dreams. The rats are eating up my kids."Oh," I said. “That’s terrible. No, of course, you are very much involved with the rats and your kids. How can that be helped?"

"Well, I could use a new screen door because there are holes in my screen door." I asked, "Is there anybody around here who knows how to fix a screen door?" There was a man in the group, and he said, "A long time ago I used to do things like that, but now I have a terribly bad back, but I'll try."

I told him I had some money if he would go to the store, buy some screening, and go and fix the lady's screen door. "Do you think you can do that?" "Yes, I'll try. “The next week, when the group was seated, I said to the woman, "Well is your screen door fixed?"

"Oh, yes," she said. "Then we can start dreaming, can't we?" She sort of smiled at me. I said to the man, who did the work, “How do you feel? He said, "Well, you know, it's a very funny thing. I'm beginning to feel a lot better." That helped the group to begin to dream. These seemingly small successes allowed the group to see that dreams were not insane. These small steps began to get people to see and feel that something really could happen.

I began to ask other people about their dreams. One woman shared that she always wanted to be a secretary. I said, "Well, what stands in your way?" (That's always my next question). She said, "I have six kids, and I don't have anyone to take care of them while I'm away." "Let's find out," I said. "Is there anybody in this group who would take care of six kids for a day or two a week while this woman gets some training here at the community college?” One woman said, "I got kids, too, but I could do that."

"Let's do it," I said. A plan was created and the woman went to school. Everyone found something. The man who put in the screen door became a handyman. The woman who took in the children became a licensed foster care person.

In 12 weeks I had all these people off public welfare. I've not only done that once, I've done it many times.

For comments and archives

 
    Gastro Update

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

What are the endoscopic findings in UC and CD?

  • Ulcerative colitis: On endoscopy, lesions in colon are typically diffuse, continuous extending proximally from rectum. The rectum is almost always involved. Mucosal pattern is lost, there is easy friability and the ulcers are broad and shallow.
  • Crohn’s disease: Characterized by skip lesions; rectum is frequently spared. On endoscopy, there are aphthous lesions, deep ulcers and fissures with intervening edematous areas giving a "cobblestone" appearance. Even strictures may be seen as the depth of inflammation is transmural unlike in UC where the lesions are mucosal except in severe disease. Histologically, non caseating granulomas with fibrosis are seen in CD.

For comments and archives

 
    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

CUPART 2011

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50-60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

Day – 1 Interesting Highlights

Debate

Topics:
Single Embryo transfer

Allowing Known Gamete Donation

Renumeration to donors and surrogates is justified

Endometrial biopsy TB PCR positive should be treated in all

Speakers: Adrian Shulman (UK), Renu Misra (New Delhi), Parul Sehgal (New Delhi), RS Sharma (ICMR), Manika Khanna (New Delhi), Pankaj Talwar (New Delhi), Sudha Prasad (New Delhi), JB Sharma (New Delhi)

Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan-e-Hindustan – Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Contact: Address: E -23 Ayurvigyan Nagar New Delhi – 110049

For details contact +91 9871250235

For comments and archives

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

ADH

Also known as: Antidiuretic Hormone

  • To help detect, diagnose, and determine the cause of ADH deficiency or excess
  • To investigate low blood sodium levels (hyponatremia)
  • To distinguish between the two types of diabetes insipidus

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with diabetic nephropathy was found to have a high homocysteine levels.
Dr Bad: Homocysteine has no correlation with nephropathy.
Dr Good: You should control your homocysteine levels.
Lesson: Results of a nested case–control study suggest that hyperhomocysteinemia has an etiologic role in the pathogenesis of diabetic nephropathy. In the study, baseline plasma homocysteine concentrations and mean HbA1c levels during follow–up were significantly higher in patients who developed microalbuminuria than in those who remained normoalbuminuric. Multivariate logistic regression analysis showed that baseline plasma homocysteine level and mean HbA1c were independent predictors of microalbuminuria in type 2 diabetes (Korean Diabetes J 2010 June; 34(3): 200–206).

For comments and archives

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

For comments and archives

 
  Quote of the Day

(Dr Chandresh Jardosh)

A happy marriage has in it all the pleasures of a friendship, all the enjoyments of sense and reason, and indeed, all the sweets of life. Joseph Addison

 
  IDIOMS

He lost his head: Angry and overcome by emotions.

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Immediate first aid may stop serious poisoning and may save life

If breathing and the heart stop, the person will die within a few minutes unless first aid is administered at once. Here is an action list. Each step is explained in more detail below the list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

  • Check if the patient is conscious try to make the patient wake up. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
  • Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within 4 minutes. In an unconscious patient, the tongue may block the throat and the airway.
  • Make sure the airway is open and air can get down the throat. Place the patient on his/her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
  • Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient's breathe on your cheek. Listen for breath sounds. Put your ear close to the patient's mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

For comments and archives

 
    Mind Teaser

Read this…………………

HPV vaccine is a:

a. Live attenuated vaccine
b. Heat inactivated vaccine
c. Killed vaccine
d. Virus-like particle vaccine

Yesterday’s Mind Teaser: The femoral ring is bounded by the following structures except:

1. Femoral vein
2. Inguinal ligament
3. Femoral artery
4. Lacunar ligament

Answer for Yesterday’s Mind Teaser: 3. Femoral artery

Correct answers received from: Dr BB Aggarwal, Dr Chandresh Jardosh, Dr Surendra Bahadur Mathur, Dr Anil kumar Jain, Dr Dilip Kumar Jha, Prabha Sanghi, Dr Anil Kela, Dr Jainendra Upadhyay,
Dr Anil Bairaria, Dr Anil Kumar Jain, Dr Valluri Ramarao.

Answer for 9th September Mind Teaser: c) Distal gastrectomy
Correct answers received from:Dr Valluri Ramarao.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr. Chandresh Jardosh)

Men, Fear, and Marriage

The British had an organization that Americans are now considering adopting. It seems that in England, they had a men's club, Bachelors' Anonymous. It was highly successful in making men fear or even hate marriage.

The club provided a unique way to treat the problem of bachelors wanting to marry. They send over a mother-in-law in nightgown, hair curlers, and a mud pack.

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name

Indication

DCI Approval Date

Eslicarbazepine acetate Tablets 200mg/400mg/600mg/800mg

As an adjunctive therapy in adults with partial-onset seizures with or without secondary generalisation.

07.03.11

 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Strenuous exercise may increase risk of cardiac disorders

Quoting a study presented at the European Society of Cardiology meeting, Padma Shri and Dr B C Roy National awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela, said that strenuous exercise, whether performed by elite athletes or competitive weekend warriors, comes with a risk of developing cardiac disorders, including atrial fibrillation.

Investigators found that among people who exercise four hours or more during the week, there was about a 39% increased risk of developing atrial fibrillation that required medical treatment.

Among elite cross-country endurance skiers, the risk of developing arrhythmias increased by 37% when compared with athletes in the same race that skied at a more moderate pace.

For comments and archives

 
    Readers Response
  1. Dear Sir, Fantastic Information. Regards., Dr Raghunath
 
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,
Website:www.assocham.org/ihps2011

……………………………………………………………………

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals

…more

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta