emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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


You can follow Dr KK Aggarwal at www.twitter.com/drkkaggarwal and get regular medical news updates.

12th July, 2010, Monday

Vegetable juice or soup: the soup is better

The death of a scientist after drinking ‘lauki’ (bottle gourd) juice has created another controversy. Though the chances are that he may not have died due to ‘lauki’ yet the question arises can  diabetics take raw vegetables? Is 'lauki' juice the right drink to take? Or is ‘lauki’ soup the answer.

Medically the key is hygiene. If hygiene can not be maintained, follow the formula "heat it, boil it, cook it, peel it or forget it." One should not eat or drink raw vegetables especially in the rainy season. In rainy chaturmas, the intake of leafy raw vegetables is prohibited. Also if a vegetable has got rotten after boiling or cooking, the poison part will get nullified.

A raw vegetable is o.k. for purchase if it:

  • Tastes the same
  • Smells the same
  • Feels the same
  • Looks the same

Beware… if a vegetable is more pulpy, has powder on the surface, is more bitter, is more brighter… it may be denatured or ripened with artificial chemical ripeners.

Dr KK Aggarwal

Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature (From HCFI file)

 

Second Meeting of Padma Awardee Doctors

Padma Awardee Doctors met for the second time at the Conference Hall of ‘The Lalit’ on July 3, 2010 to discuss various issues related to medical education.

Dr k k Aggarwal

 

News and Views

emedinews Guest Editor: Dr. Neelam Mohan – Consultant Pediatric Gastroenterologist, Hepatologist, therapeutic Endoscopist and Liver Transplant Physician had moved to Medanta Medicity – Gurgaon on 10th July 2010 as Director Pediatric Gastroenterology, Hepatology and Liver Transplantation.

Dr Nilam

She’s moved to head the FIRST Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation in the country, which would provide comprehensive care in all fields of pediatric gastroenterology and Hepatology including the highest level of care that’s liver transplantation. She was initially Incharge Hepatologist of the pediatric liver transplant programme at Sir Ganga Ram Hospital, which was the busiest pediatric liver transplant programme in the country and had completed 50 pediatric liver transplants (the entire liver transplant team has moved to Medanta Medcity now). She’s credited with several firsts in the field of Liver Transplantation and Therapeutic Endoscopic work especially in newborns and young children. Besides liver transplantation, the department would cater to all problems relating to GI and liver diseases in children and adolescents and would provide facilities such as diagnostic and therapeutic endoscopy in children including newborns, manometery, motility studies, 24 hrs pH monitoring, capsule endoscopy, and endoscopic ultrasound. There will be special clinics such as liver clinic, coeliac disease clinic, nutrition clinic, metabolic disease clinic, etc.The department would also provide fellowship programme (IAP certified) in field of Pediatric Gastroenterology, Hepatology & Liver Transplantation to pediatricians.

Situations Vacant

Posts are available for senior residency or fellowships in pediatric gastroenterology hepatology and liver transplantation at Medanta Medicity, the first department of Pediatric Gastroenterology and Hepatology in private sector. Those with Post MD or Post DCH with experience in pediatrics may contact Dr Neelam Mohan at drneelam@yahoo.com or at 9811043475.

Common Causes for shoulder pain (Dr. G. M. Singh)

  • Tendinitis (inflammation of a tendon in the shoulder)

  • Bursitis (inflammation of a sac of fluid in the shoulder which limits friction during shoulder movement)

  • An injury that leaves the shoulder joint out of position or unstable

  • Shoulder Arthritis
FDA approves ADHD patch for adolescent use (Dr Monica and Brahma Vasudeva)

US regulators approved the first transdermal attention deficit hyperactivity disorder patch 'Daytrana' (methylphenidate transdermal) for use in adolescents aged 13 to 17 years.

Changes in albuminuria predict cardiovascular, renal outcomes and mortality

A new analysis of the large ONTARGET trial presented at the recent European Society of Hypertension (ESH) European Meeting on Hypertension 2010 has shown that large changes in albuminuria predict cardiovascular and renal outcomes and mortality, independent of baseline albuminuria.

Women interested in preventing age related weight gain should bike or brisk walk

Hop on a bike or take a brisk walk to prevent weight gain with age is the new mantra for women. In a Harvard study, women who did no brisk walking or cycled, gained an average of 20½ pounds over 16 years, but those who regularly biked or walked briskly were less likely to gain as much. The findings are based on the second Harvard Nurses’ Health Study, which is tracking 116,608 female nurses who periodically fill out questionnaires about their health, weight, diet and behavior.


MCI News
It is competent to hear fresh bail plea of Dr Desai: Court (PTI News)

A Delhi court has rejected a petition filed by the CBI questioning its jurisdiction to hear an anticipatory bail plea by former MCI president Dr Ketan Desai in a fresh corruption case lodged against him in Chennai. "Fix the bail application for hearing on July 12," special judge O P Saini said, dismissing CBI's contention that it was not within his jurisdiction as the offence was committed outside the territorial bounds of the Delhi court. Being a special court to deal with cases lodged under the Prevention of Corruption Act, it was very much competent to hear the plea, the judge said. Senior advocate Sidharth Luthra has filed the bail plea, apprehending arrest of Desai in connection with a fresh corruption case lodged against him recently in Chennai. Earlier, the court dismissed Desai's bail plea in the disproportionate assets case.

 

Legal Column

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

Is there any defined minimum / maximum age to charge a person with rape in India?

Records confirm that a 10-year-old boy was convicted in the offense of rape of a European girl. There are also many cases of persons aged 60 years and above been charged for the offense of rape.

Section 82 of IPC clearly states that a child below 7 years of age cannot be charged for any criminal offense. But, for a child above 7 years of age and under 12 years, Section 83 IPC states that nothing is offense if the child has not attained sufficient maturity of understanding to judge the nature and consequences of his conduct/act on that occasion. Hence, the child in the age group of 7–12 years can be charged if the above medical rider in Section 83 is absent.

From the legal point of view, age estimation is very important. So is the medical examination of accused child to assess the mental /physical maturity/ potency test of the boy and other biological evidences to corroborate the medical examination of female victim and her statement. In Indian law there is no definition/presumption of any age limit of child/man/old man for incapability of committing rape. This means that the law presume every male person to be potent unless proved otherwise.

In United Kingdom the law is that persons/male children below the age of 14 years are impotent and he cannot commit the offence of rape.

There is no boundary of upper age limit for accused male as well as for the female victims in our country.

 

Experts’ Views

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

Where does one get liver for transplantation from ?

1. Cadaver Donor Transplantation 2. Living Donor Transplantation.

Cadaveric donor transplantation: Liver is used from a brain dead person for cadaveric transplantation.

Living donor transplantation: A living person donates a part of his/her to the recipient.

Types of graft

  • Whole graft: The entire graft is transplanted in the recipient. Obviously a brain dead persons liver can only be used as a whole graft.

  • Split graft: The shortage of suitable organs for young children led to development of split livers. The liver of the cadaveric donor is divided and used for two patients usually the right lobe for adults and left lobe for children.

  • Reduced graft: When only a part of the cadaveric liver (i.e. right/ left/left lateral part) is used for the recipient

  • Auxiliary liver transplant: when a part of the donor liver (usually segments 2+3) is implanted beside or in continuity with the native liver. The main purpose is to ensure that the native liver is retained in the event of graft failure or for the future development of gene therapy. Auxiliary transplant is now accepted therapy for Crigler–Najjar syndrome type I and also for propionic acidemia and ornithine transcarbamalase deficiency. The role of auxiliary liver transplant in the management of fulminant hepatic failure is more controversial. The rationale for using this technique in this condition is that, with time, the native liver may regenerate.

A living related donor’s graft could either be right lobe / left lobe /left lateral lobe. Liver is the only organ in body which Regenerates. Therefore one can donate a part of his/her liver and the healthy liver would

Question of the Day

What are the dental problems commonly seen in patients with diabetes? (Dr VS Mahesh, Bangalore)

Severe periodontal disease has been seen more in both type 1 and type 2 diabetic patients than in patients without diabetes. There is also evidence that diabetic patients with periodontal disease (and dental caries) have poor glycemic control as evidenced by increased levels of HbA1C. There are 2 types of periodontal diseases.

  • Gingivitis: Gingiva surrounding the teeth is reddened, inflamed and bleeds easily.

  • Periodontitis: Condition where the infection and inflammation surrounding the teeth has proceeded to destroy the ligamentous attachment of the teeth as well as alveolar bone surrounding the teeth.

The ultimate result of periodontal disease is loss of teeth. Periodontal disease is caused by infections with oral organisms that form biofilms around the teeth. These organisms include Actino bacillus Actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus and Treponema denticola. Viruses like Epstein-Barr virus type 1 (EBV–1) and human cytomegalovirus (HCMV) may also play a role in the development of peridental disease by altering local host responses. The biofilms are constantly forming and maturing, difficult to remove and highly resistant to antibiotics and other antimicrobial agents. Periodontitis is often an asymptomatic or silent infection that goes undetected by both the patient and the physician. Even an oral examination may reveal nothing other than gingival redness, spacing between the teeth and occasional bleeding of gingiva. Several longitudinal epidemiological studies have shown that patients with severe periodontal disease are at increased risk of developing atherosclerosis, myocardial infarction and stroke. Diabetic patients with peridental disease have shown poor glycemic control over time. When periodontal disease is treated in diabetic patients, the patients glycemic control improved.

Signs and symptoms: Red or swollen gingival; Presence of copious amounts of dental plaque or stains and tartar; Gingiva pulled away from the teeth; Teeth that are loose or have recently developed spaces; Halitosis; In severe cases pain may be felt.

  • High–risk patients: Patients who smoke and those with poor glycemic control.

  • Low risk patients: Patients with well–controlled diabetes; nonsmoking patients; patients with no positive findings on intra-oral examination or history.

Management of periodontal disease: Good control of diabetes mellitus; In case of infection oral antibiotic/local antibiotics, if infection present.

 

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 Padma Shri Awardee Dr. Ashok K. Vaid.

Medical education today has to undergo a change from being too much of a basic oriented course to something which is more clinically–oriented. Students are spending lot of time with anatomy, physiology, forensic medicine. What should happen is that they may continue with the basic science, but clinical subjects should begin much earlier. At present, medical students spend one and half year with basic sciences before entering the clinical sciences and coming into contact with patients.

Our one problem is that we are producing 35,000 graduates every year, whereas we need more than 50,000 in a year. There is already a gap. Our graduates need to be more practical-oriented and be more oriented towards diseases which are at the community level. Out of these 35000, only 13,000–14,000 get an opportunity to do MD/MS. Therefore, the 20,000 who do not get an opportunity to do their post graduation are neither fit for the villages nor for the cities.

There has to be a revamping at the education level. We need to have a look at the places where they are going to work. These are old and rented buildings with no facilities. Doctors do not have a suitable place to stay. Even the veterinary dispensaries are better than the medical dispensaries meant for humans. Veterinary dispensaries have refrigerators in village but not the medical dispensaries.

Our orientation has been such that if we do not have money, means and measure or the tools, the doctor is ineffective. To overcome these problems, there should be more and more mobile units in villages. If we have mobile units equipped with the investigation tools like x–ray etc. which can move from village to village, this will improve the healthcare at the grass root level. This is a model which has been tried and tested in many countries.

IJCP
IJCP
ijcp
ijcpgroup
nuspera
Docconnect
IJCP
 

Public Forum (Press Release for use by the newspapers)

Age No Bar for Blood Pressure

The formula ‘Age + 100 is normal blood pressure’ is no more true today. Blood pressure at any age should be kept lower than 120/80 mmHg.

Quoting an international study, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela, said that giving blood–pressure reducing drugs even after the age of 80 reduces the risk of paralysis, heart attack, and deaths. The study, Hypertension in the Very Elderly trial, included 3800 people above the age of 80 people with high BP.

Ignore pain lasting less than 30 seconds

Dr. Aggarwal said that any chest pain which lasts for less than 30 seconds is not a heart pain. Heart pain classically lasts for minutes and if it lasts for more than 20 minutes, heart attack should be suspected.

Dr. Aggarwal also said that any chest pain which can be pinpointed by a finger is unlikely to be a heart pain. A heart attack pain is diffuse in the centre of the chest and is in the form of burning, discomfort, heaviness or feeling of pressure.

Dr. Aggarwal said that first-onset breathlessness, chest pain, weakness, exhaustion, after the age of 40 should not be ignored. He also said that people after the age of 40 should not do unaccustomed exercises whether it is pushing a car, having extra marital sex or participating in strenuous sports for the first time in life.

 

An Inspirational Story

I must at least try

In June 1985, two British mountaineers Joe Simpson and Simon Yates made the first–ever climb of the West Face of the 21,000 foot snow–covered Siula Grande mountain in Peru. It was an exceptionally tough assault – but nothing compared to what was to come. Early in the descent, Simpson fell and smashed his right knee. Yates could have abandoned him but managed to find a way of lowering him down the mountain in a series of difficult drops blinded by snow and cold. Then Simpson fell into a crevasse and Yates eventually had no choice but to cut the rope, utterly convinced that his friend was now dead.

In his subsequent book on the climb entitled "Touching The Void", Joe Simpson wrote:

"As I gazed at the distant moraines, I knew that I must at least try. I would probably die out there amid those boulders. The thought didn’t alarm me. It seemed reasonable, matter–of–fact. That was how it was. I could aim for something. If I died, well, that wasn't so surprising, but I wouldn't have just waited for it to happen. The horror of dying no longer affected me as it had in the crevasse. I now had the chance to confront it and struggle against it. It wasn’t a bleak dark terror any more, just fact, like my broken leg and frostbitten fingers, and I couldn’t be afraid of things like that. My leg would hurt when I fell and when I couldn’t get up I would die."

The survival of Yates himself was extraordinary. That Simpson somehow found a way of climbing out of the crevasse after 12 hours and then literally crawled and dragged himself six miles back to camp, going three days and nights without food or drink, losing three stone, and contracting ketoacidosis in the process, would be the stuff of heroic fiction if it was not so true. Indeed, six operations and two years later, he was even back climbing.

All because, against all the odds, he tried

Source: "Touching The Void" by Joe Simpson

 

IJCP Special

Dr Good Dr Bad

Situation: An asymptomatic patient came with erectile dysfunction.
Dr Bad: You can start taking the drug Viagra.
Dr Good: Rule out CAD first.
Lesson: Patients with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of coronary or other vascular disease, should be screened for cardiovascular disease prior to initiating therapy for their sexual dysfunction, as there are potential cardiac risks associated with sexual activity in patients with heart disease.

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminium toxicity.
Reaction:You should have put him on magaldrate preparations
Lesson: Magaldrate preparations do not cause aluminium toxicity in patients undergoing dialysis.

Quote of the Day (Dr. Santosh Sahi)

"There are two mistakes one can make along the road to truth, not going all the way, and not starting." Budda

Back from Work

After 6 weeks: Honey, I’m home!
After 6 months: I’m BACK!!
After 6 years: Have you cooked yet?

Milestones in Gastroenterology

Ludwig G. Courvoisier (1843–1918) was a pioneer in billiary tract surgery and gallbladder disease. He iss remembered for his diagnostic law and sign for cancer head of pancreas.

 

IMSA Update

International Medical Science Academy Update (IMSA)

Blood pressure control in children with chronic kidney disease

Intensified blood pressure control with a targeted goal of a 24–hour mean arterial pressure (MAP) below the 50th percentile, compared with conventional blood pressure control, results in slower progression of chronic kidney disease in children.

Reference

Wuhl E, Trivelli A, Picca S, et al. Strict blood–pressure control and progression of renal failure in children. N Engl J Med 2009;361:1639.

 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Ezetimibe 10 mg + Fenofibrate 145 mg Film coated tablets

For the treatment of combined hyperlipidemia in patients with normal hepatic and renal function

01.09.2009

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Q. Is getting of permanent account number (PAN) compulsory?

A. Yes, it is, if a doctor has an income which exceeds the basic exemption limit.

 

Humor Section

Jokes ( Dr Jhatka Dr Matka) 

Dr Jhatka: People consider me as a ‘GOD’

Wife: How do you know??

Dr Jhatka: When I went to the Park today, everybody said,

Oh GOD! U have come again.

Medical bloopers on medical charts!

Enema………………………Not a friend

 

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, 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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.