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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 ...

12th December, 2010, Sunday

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

Time Magazine releases list of Top 10 Medical Breakthroughs of 2010

  1. AIDS Drugs Lower the Risk of HIV Infection Antiretroviral drugs have turned the AIDS epidemic around, by thwarting the virus in HIV–positive patients. But new research suggests that this powerful treatment may have another benefit — as a weapon against infection in healthy individuals. In a trial involving nearly 2,500 HIV–negative, but high risk, gay men in six countries, researchers found that a combination antiretroviral pill called Truvada reduced the risk of HIV infection by 44%, compared with placebo. When scientists looked more carefully at the study volunteers who took the medication most faithfully, on a daily basis, they found that the risk of contracting HIV was even lower — 73% lower than the placebo group. More studies will need to confirm the benefit of antiretrovirals in the prevention of HIV, and public health experts warn that even if the results hold up, it would not replace the best method of prophylaxis: safe sex and consistent use of condoms. That’s because the way so–called pre–exposure prophylaxis, or PrEP, works is to load up high–risk people with HIV–disabling antiretroviral drugs before exposure to the virus, which allows the medication to hit HIV as early as possible. But the drugs do not work as a vaccine would, by priming the immune system to actually prevent infection.
  2. Synthetic Cell Move over, Dr. Frankenstein, and make room for your 21st–century counterpart, Dr. Venter. That’s J. Craig Venter, co–mapper of the human genome, who this year took another step toward creating life in the lab. Generated from a painstaking process of stitching together the chemicals that compose DNA, Venter synthesized the entire genome of a bacterium, which was inserted into a cell and was able to replicate. Granted, Venter’s "synthetic cell" had hardly the personality of Mary Shelley’s angst–fueled monster, but it’s man–made life nonetheless. Venter hopes his findings will be the first of a long line of lab–made creatures in synthetic biology. By mixing and matching genetic material into viable combinations, Venter is already generating organisms that may serve as new types of biofuel, or even speed up flu vaccine production by allowing researchers to keep ready–made versions of different viral strains of influenza on lab shelves.
  3. Blood Test for Alzheimer’s The degenerative illness can be definitively diagnosed only at autopsy, when pathologists can confirm the presence of hallmark plaques and tangles in the brain. But a promising new blood test may help confirm a diagnosis early in the disease's progression, which opens the possibility for prevention of dementia and mental decline even before the earliest onset of symptoms. The new test analyzes more than two dozen proteins in the blood, and is 80% accurate in identifying patients with the disease. It is only the latest in a series of new methods, including tests of spinal fluid, aimed at detecting and confirming Alzheimer’s earlier in patients’ lives. Quicker diagnoses could help patients take advantage of behavioral interventions — such as keeping the mind active by maintaining social contacts and learning new things — that may slow the mental deterioration of Alzheimer’s.
  4. FDA Approves Botox for Migraines Who knew that vanity could yield a new treatment for pain? After some patients who received Botox injections to prevent wrinkles in their forehead reported that their migraines also seemed to diminish. Based on data from two large trials involving more than 1,000 patients, the company convinced the FDA that patients receiving Botox in the facial area experienced fewer days of migraine pain each month than those who did not get the muscle paralyzing injections. It’s still difficult to predict which headache patients will benefit the most.
  5. Taking the Resuscitation Out of CPR For 50 years, rescuers have been saving lives the same way, by combining mouth–to–mouth resuscitation with chest compressions to revive unresponsive victims. But after new data showed that chest compressions alone were just as effective as traditional CPR in rescuing victims of cardiac arrest, the American Heart Association (AHA) decided to update the decades–old process. The new rules for CPR put more emphasis on the chest compressions, and in some cases do away with resuscitating breaths altogether. Several studies have found that untrained bystanders are more comfortable performing chest compressions, without mouth–to–mouth and that victims who receive only compressions are as likely to survive as those who receive full CPR. These results, coupled with the fact that only 30% of those in need of CPR actually get it — in large part because of untrained bystanders’ reluctance to perform what they view as a complex procedure — forced the AHA to revise its CPR guidelines. The new recommendations advise all rescuers, to reverse the current protocol for CPR and begin with 30 firm chest compressions, then turn to resuscitating breaths. The priority for those whose hearts may be in distress, is to get the heart pumping again, and starting off with chest compressions may keep damage from a stopped heart to a minimum.
  6. The FDA Restricts rosiglitazone Eleven years after it hit the market and became a worldwide blockbuster, the diabetes medication rosiglitazon) was slapped with the FDA’s most stringent drug restrictions yet. Now, the medication that helps control blood sugar in patients with Type II diabetes can be prescribed only by physicians who are part of a registry certifying that they are aware of the increased risk of heart attack associated with the drug. These doctors may dispense rosiglitazone only if their patients have exhausted all other treatment options, and patients must sign off on these risks as well. The FDA’s decision, according to some experts, was long overdue, considering that researchers first reported increased heart risks among rosiglitazone users in 2007. At that time, the FDA instituted its first warning on the drug’s label. And yet a government review of the drug’s safety revealed that its manufacturer, GlaxoSmithKline, was aware of the heightened risks associated with its product not long after it hit the market in 1999. The good news for patients who respond well to rosiglitazone but are finding it difficult to keep their prescription filled under the new restrictions is that a similar drug, pioglitazone, does not seem to pose the same risks to the heart.
  7. Blood Test for Heart Attack A heart attack starts with blockages in the blood vessels, so where better to look for predictors of heart trouble than in the blood? At the moment, the most reliable way to check the status of the heart’s vessels is by angiogram, an invasive procedure that involves snaking a thin tube into the vessels from an artery in the leg. But researchers have now identified a preliminary panel of 23 genes that code for blood proteins, which was 83% accurate in detecting blood–vessel obstructions typical of heart disease. When doctors added this blood test to existing measures of heart attack risk — including symptoms of chest pain and family history of health problems — it improved by 16% their ability to classify patients as being at high or low risk, compared with traditional methods alone. It’s too much to expect that the blood test by itself can predict heart attack, at least for now, but it could serve as an early warning call for patients who register as high risk. Perhaps by prompting changes in diet and lifestyle habits in these patients, it can help prevent them from ever having a heart attack at all.
  8. Predicting IVF Success For couples choosing to start a family with in vitro fertilization (IVF), the odds are not always in their favor. The procedure, even under the best circumstances, has a 30% chance of resulting in a live birth on average. So it was welcome news indeed when Stanford University researchers reported on a new method for selecting the strongest embryos, which would most likely result in a pregnancy and live birth. By filming the first few hours of an embryo’s activity after fertilization, the scientists were able to come up with a profile of characteristics of embryos that were most likely to continue developing and survive for several days, instead of dying off. Among other things, the criteria included the time that the embryos took to make their first division from one cell into two, as well as the time that this division itself took to unfold. The next step will be to put this video–based assessment to the test in an IVF clinic, and determine whether the analysis can actually improve pregnancy and live birth rates.
  9. Artificial Ovary Scientists reported success in creating an artificial ovary that could one day nurture immature human eggs outside the body. Researchers led by a team at Brown University managed to coax three primary ovary cells donated by patients into a 3–D structure resembling an ovary. In the lab, the cell types interacted with one another and functioned for all intents and purposes like a real ovary, even successfully maturing a human egg from its earliest stages in the follicle to a fully developed form. Most immediately, the structure could help IVF technicians improve success rates. Currently when women donte eggs for a cycle of IVF, they provide a range of both mature and immature eggs; the less developed ones are less likely to be fertilized to become embryos. But by allowing technicians to mature these eggs in the lab, researchers might be able to help each IVF cycle become more efficient in leading to a pregnancy and eventual life birth. In addition, the artificial ovary could help women with ovarian disease, who are unable to produce mature eggs, take advantage of IVF to have children of their own.
  10. Creating iPS Cells Safer and Faster Working with the groundbreaking type of stem cell known as induced pluripotent stem (iPS) cells — which can be generated from a skin cell, completely bypassing the need for embryos — researchers at Children’s Hospital Boston have overcome a critical hurdle in making the technology safe for human patients. Until now, to create iPS cells from skin cells, researchers needed to expose the skin cells to both viruses and cancer–causing genes to reprogram them to an embryo–like state. Now the Boston scientists report success in using another form of the added genes, known as RNA, that eliminates the danger posed by the insertion of the viruses and cancer-promoting genes. And as an unexpected bonus, the technique is about 100 times more efficient in making iPS cells than the older method. The new findings mark a significant advance toward someday using stem cells as a source of new and healthy cells to replace those that have been destroyed by disease.

(Source Times magazine. http://www.time.com/time/specials/packages/article/0,28804,2035319_2034529_2034516,00.html)

Dr KK Aggarwal
Editor in Chief
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  SMS of the Day

(By Dr GM Singh)

"Cultivate only the habits that you are willing should master you."

Elbert Green Hubbard

 
    Photo Feature (from the HCFI Photo Gallery)

HCFI: Spreading awareness on heart attacks

Heart Care Foundation of India organized a campaign on World Health Day to spread awareness on heart attacks using Mobile Exhibition Van in its Annual Perfect Health Parade.

 
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

Nanotech holds the future’

Nanotechnology, which is called the third wave of technological revolution, has the potential to reduce human suffering through tissue engineering, gene delivery and drug discovery. Inaugurating the ongoing ‘The Bangalore Nano 2010’ on Wednesday, noted scientist CNR Rao also said nanotechnology held the future. He added, "A major revolution is underway in nanoelectronics to design and develop prototype devices, including nanocomputers, though integration of systems with nanocircuits is yet to happen." Bangalore Nano 2010 is organised by the Karnataka Science & Technology Department. The third edition of the two–day conference–cum–trade show has attracted about 450 delegates, 50 speakers and 35 exhibitors from across the country and abroad. On the benefits of applying nanotechnology in creating new products, Rao cited the making of an artificial eye at the Massachusetts Institute of Technology (MIT) in the US by combining physiology, neuroscience, computer science and electrical engineering. (Source: The Pioneer, December 09, 2010)

 
    International News

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

Normal–weight children get 16 more minutes of physical activity daily vs their obese peers

USA TODAY recently reported that normal–weight children get 16 more minutes of physical activity a day than their obese peers, a new study shows. And overall, girls do 20 minutes less physical activity a day than boys. "This is a huge wake–up call to society," says Donna Spruijt–Metz, the senior author of the study and an associate professor of medicine at the University of Southern California. A third of American children are overweight or obese. The government’s physical activity guidelines recommend that kids and teens get an hour or more of moderate–intensity to vigorous aerobic physical activity a day. Researchers at the University of Southern California and the National Institutes of Health analyzed government activity data on 3,106 children. The kids wore accelerometers to measure their physical activity levels for four days. The study, published in this month’s Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine, shows: Normal–weight children ages 6 to 17 are moderately to vigorously active for 59 minutes a day, compared with 43 minutes for obese children that age. Overall, boys ages 6 to 17 are active an average of about 64 minutes a day, compared with 44 minutes for girls in that same age range. Girls need to get more exercise to establish an active lifestyle, which will help with weight control and reduce their risk of diseases such as cancer as adults, says the study’s lead author Britni Belcher.

(Dr Monica and Brahm Vasudev)

Healthbeat: How to release a frozen shoulder (Part 1)

Frozen shoulder (also called adhesive capsulitis) is a common disorder that causes pain, stiffness, and loss of normal range of motion in the shoulder. The resulting disability can be serious, and the condition tends to get worse with time if it’s not treated. It affects mainly people aged 40 to 60 — women more often than men. We don’t fully understand the causes, but an inflammatory process is probably involved. Sometimes freezing occurs because the shoulder has been immobilized for a long time by injury, surgery, or illness. In many cases the cause is obscure. Fortunately, the shoulder can usually be unfrozen, though full recovery takes time — and lots of self–help. The shoulder has a wider and more varied range of motion than any other part of the body. It pivots mainly on a ball–and–socket arrangement called the glenohumeral joint, which joins the top of the humerus (upper arm bone) to a scooped–out part of the scapula (shoulder blade) called the glenoid cavity.

Desensitization approaches effective against hay fever–like allergies

ScienceDaily: Research suggests that Immunotherapy given as pills or drops under the tongue is a safe and effective way to treat hay fever–like allergies caused by pollen and dust mites, according to a new Cochrane Systematic Review. The researchers say the approach is an attractive alternative to immunotherapy injections in children.

Music relieves stress of assisted breathing

ScienceDaily: Patients who need assistance to breathe through mechanical ventilation may benefit from listening to music, a new review published in The Cochrane Library shows. Music listening may relax patients, potentially resulting in fewer complications.

Tobacco cessation medication may reduce hospitalization for heart attacks

Science Daily: The use of tobacco cessation medication in a population may lead to reduced hospital admissions for heart attacks and for coronary atherosclerosis within the two years after use according to a study by Thomas Land and colleagues from the Massachusetts Tobacco Cessation and Prevention Program, Massachusetts General Hospital and Harvard Medical School Boston, USA, and published in this week’s PLoS Medicine. The study found no reduction in hospitalizations for other diseases, in the same two year period.

NIH study identifies ideal BMI

A study of nearly 1.5 million adults looking at deaths from any cause, found that a body mass index (BMI) between 20.0 and 24.9 is associated with lowest risk of death compared to other BMI levels. In addition, individuals who were overweight were 13% more likely to die during the study follow–up period (a median of 10 years) than those with a normal BMI.

 
    Infertility Update

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

Can semen be collected at home?

Yes, but it must be brought to the lab within 30 min to an hour. The specimen must be collected in a container provided at the centre.

What is the time taken to prepare sperms?

Native raw semen sample cannot be used for IUI or intra–uterine insemination. Depending on the method of preparation (Swim up or Swim down) it may take anywhere between 30 min to one and a half hour to complete the wash.

For queries contact: banerjee.kaberi@gmail.com

 
    Medicine Update

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

What are the causes of constipation in children?

The commonest causes of constipation in children are idiopathic or functional. In fact 95% cases are due to functional cause and only 5% are due to some organic cause. Among the organic causes, Hirschsprung’s disease is the most common and important cause. However, in neonates, organic causes like Hirschsprung’s disease, hypothyroidism, etc. are much more common than functional. Toilet training started too early and improper dietary habits too contribute to the list. Other causes are medications, hypercalcemia etc.

 
    Medicolegal Update

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

What are resuscitative injuries?

Doctor should always document in detail the resuscitative injury in case of death

The injuries produced in human body when attempting for resuscitation pose difficulty in interpretation of injuries noted at post mortem examination or in inquest paper by the investigating law enforcement agency. Before proceeding to make an interpretation, the doctor conducting the autopsy they should know if there has been an attempt for resuscitation and who did it and for how long. He should also know about the methods used in a particular case and whether all these have been documented in the clinical sheets or not. Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries. The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

  • The method generally used for life saving attempts by non–medical persons who are near the critical patient is mouth–to–mouth respiration and manual chest massage may causes contusions.
  • Resuscitation in hospitals includes bag and mask intubations, endotracheal tube, obdurate airway are used for respiratory ventilation.
  • Mechanical methods like Thumper, active compression–decompression device, and defibrillators are used in resuscitation. Closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
  • The injections and closed–chest cardiac massage and other resuscitation procedures to the patients may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral haemothorax, tension pneumothorax, rupture of kidney and of spleen.
  • Fractures of ribs and/or sternum were found in 40% of cases, the frequency increasing with age.
  • The number of fractured ribs ranged up to 16, mainly 3–8 ribs was fractured.
  • Fractures of rib No. 1 and 8–12 were very rare.
  • The common site of rib fractures after heavy blunt thoracic injuries was found in the dorsal region.
  • The injuries which are received/inflicted on body prior to death are called mortem injuries and may or may not be a contributing factor in causing the death or they may have occurred due to much other reason like resuscitation/transport of sick/ill person for medical care called artifacts.
 
    Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

Can one sterilize a patient during caesarean?

The Supreme Court of BC, Canada was considering a claim for battery by a patient who underwent a caesarean section. During the course of caesarean section, the doctor found fibroid tumors in the patient’s uterus. Being of the view that such tumours would be a danger in case of future pregnancy, he performed a sterilization operation. The court granted the claim for damages for battery to the complaining patient. It was held that sterilization could not be justified under the principle of necessity, as there was no immediate threat or danger to the patient’s health or life and it would not have been unreasonable to postpone the operation to secure the patient’s consent. The fact that the doctor found it convenient to perform the sterilization operation without consent as the patient was already under general anesthetic was held to be not a valid defence.

 
    Legal Question of the Day

(Contributed by Dr M C Gupta, Advocate)

Can an indoor patient be allowed to go home on short leave? How?

Q: Is it legally valid to allow a patient to go home on short leave while still admitted in the hospital? If yes, what precautions should be taken in case some mishap occurs while he is away, especially if he is an illiterate patient?

A:

  1. Nobody can be forcibly kept in a hospital against will.
  2. If the patient insists on leaving against medical advice, he should be discharged as LAMA "Left against medical advice" with full documentation of his condition, including case summary and results of investigations and necessary advice, with proper consent for discharge. If the patient does not give consent but leaves forcibly, 2–3 doctors should jointly document the circumstances.
  3. If the patient is allowed to go home for a short period, that means he is leaving with the consent of the doctors. They may be held liable if proper precautions are not taken. These precautions are as follows:
    • Proper informed consent of the sick patient at the time of discharge must be taken, just as a proper informed consent of the sick patient is mandatory at the time of admission and surgery. He should, in a documentable manner, be given detailed necessary instructions verbally as well as in writing in the presence of those who would be attending on him at home.
    • Necessary treatment during the period away from hospital should be prescribed and explained.
    • Necessary information/instructions should be given about when, how and whom to contact in case of emergency. Mobile numbers of responsible hospital staff/doctor may be given.
    • Essentially, the above principles would hold good, with necessary procedural modifications, even if the patient is not formally discharged but is shown as admitted in the hospital bed/room during the period of leave and the bed/room is reserved for him/ being paid for by him.
 
    Ethical earning

What is reimbursable to a doctor?

You can charge extra for issuing medical certificate.

 
    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

Platelet count

Thrombocytosis (or high platelet count) is seen in many inflammatory disorders and myeloproliferative states, as well as in acute or chronic blood loss, hemolytic anemias, carcinomatosis, post–splenectomy, post–exercise, etc.

 
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  Docconnect Dr Veena Aggarwal
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  Docconnect Dr Ashish Verma
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  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
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  Docconnect Dr. Neelam Mohan
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    Medi Finance Update

Taxation tips

In a company, always keep the investment in equity shares as low as possible. Rest of the money you can give as loans and earn interest. The personal taxation is 30% against 35% in a company. You save 5%.

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Raltegravir (as Potassium) film coated Tablets 400mg

In combination with other anti retroviral agents for the treatment of human immunodeficiency virus (HIV–1) infection in treatment experienced patients with evidence of HIV–1 replication despite ongoing retroviral therapy.

27–Jan–10

 
    IMSA Update

International Medical Science Academy (IMSA) Update

Childhood absence epilepsy

In a randomized trial in children with childhood absence epilepsy, ethosuximide and valproic acid were more effective than lamotrigine and Ethosuximide had a more favorable adverse event profile compared with valproic acid.

(Ref: Glauser TA, Cnaan A, Shinnar S, et al; Childhood Absence Epilepsy Study Group. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 2010;362:790–9)

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient was fairly well–controlled on rosiglitazone.
Dr. Bad: Stop it immediately.
Dr. Good: You may take under medical supervision.
Lesson: Though European Medicines Agency has suspended sales of rosiglitazone, the US FDA has restricted its use in patients who cannot tolerate pioglitazone or those who are fairly well controlled on rosiglitazone and have been taking it for a long time. However, their cardiac risk should be evaluated on periodic basis.
(Ref:http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ ucm226976.htm)

Make Sure

Situation: A patient died after consuming six pegs of alcohol.
Reaction: Oh my God! Why was he allowed to consume six pegs?
Lesson: Make sure that no patient is allowed binge alcohol i.e. consuming more than six pegs in a day or five pegs at a time.

 
    Lighter Side of Reading

An Inspirational Story

(Contributed by Dr Prachi Garg)

Silence Liberates

There lived a pious man in Bengal, India. Every day a Sanskrit scholar would come to his house and read aloud a few soul–stirring spiritual teachings from the Gita, the Upanishads and the Vedas. The master of the house was an aspirant. He would listen most devotedly to these discourses.

The family had a bird called Krishna. Krishna was kept in a cage in the room where the discourses were given. It also listened to these talks. One day the bird spoke to its master, "Could you please tell me what benefit you actually derive from these spiritual talks?" The master answered, "O Krishna, you don’t seem to understand that these spiritual talks will liberate me, free me from bondage!

The bird said: "You have been listening to these discourses for the last few years, but I don’t see any change in you. Would you kindly ask your teacher what will actually happen to you?" On the following day the master of the house said to his teacher, "Guru, I have been listening to your spiritual talks for the last ten years. Is it not true that I will get liberation and freedom?" The teacher kept quiet. He scratched his head, pondered over the question, but found no reply. He just remained unhappily silent for about an hour and then left the house. The master of the house was stunned. His guru could not give an answer to the bird’s question, but the bird found an answer.

The Answer

From that day on, the bird stopped eating. It stopped even its usual chirping. It became absolutely silent. The master and his family placed food inside the cage every day, but the bird would not touch anything. One day the master looked at the bird, and seeing no sign of life in it, took it gently out of the cage. With a tearful heart, he placed his Krishna on the floor. In a twinkling, the bird flew away into the infinite freedom of the sky!

The bird taught its master and his guru learned: silence liberates.

— — — — — — — — — —

eQuiz

Read this…………………

A 53–year–old female with no significant past medical history is admitted with an acute myocardial infarction. She underwent cardiac catheterization and angioplasty. She is discharged home on the usual medications for secondary prevention of coronary artery disease. Two weeks later, she is admitted with altered mental status. Entire workup is negative except for her sodium that is found to be 109 (normal 136–145). Which of the following prescription drugs may have caused this electrolyte disturbance?

1. Aspirin
2. Clopidogrel
3. Lisinopril
4. Metoprolol
5. Simvastatin

(Contributed by Dr Ashish Verma, MD)

Yesterday’s Mind Teaser: "noon good"
Answer for yesterday’s Mind Teaser:
"Good afternoon"

Correct answers received from: Dr Manjesha, Dr K P Rajalakshmi, Dr Akshat Bhargava, Dr Nagendra Gupta, Dr Joshi sachin, Dr Sudipto Samaddar, Dr Chandresh Jardosh, Dr S Upadhyaya, Dr Suman Kumar Sinha, Dr A K Gupta, Dr Muthumperumal Thirumalpillai, Dr Neelam Nath, Dr K Raju, Dr Vikas Kumar

Answer for 10th December Mind Teaser: "The land before time"
Correct answers received from: Dr Sudha Nayyar, Dr Anurag Jain, Dr U Gaur, Dr Manjesha

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr G M Singh)

A man walks into a drug store and asks the pharmacist, "Do you have any acetylsalicylic acid?"
"You mean aspirin?" asked the pharmacist. "That’s it, I can never remember that word."

 
    Readers Responses
  1. Dear Dr Aggarwal, This is in reference to letter by Dr M C Gupta regarding CEA (Clinic establishment Act). I want a debate amongst medical community on this topic through your bulletin. Let all the state branches and central body conduct a session for the same. The wordings of the Act may not be very complex at this stage but later on the interpretation varies. We accepted the "Consumer Protection Act" with all the humility after the Supreme Court gave its nod. But now is the time to look back. Did this act damaged doctor – patient relationship? Is it true that doctors are practising a defensive medicine now? Did this Act help the patients and to what extent? Is it true that all these Acts are to promote corporate clinics and hospitals and to kill the tradition of having family doctors? Are we blindly copying the USA model and not learning from their mistakes? Sooner or later the question has to be settled and court has to be approached. So why delay it and not engage a good lawyer. Time is running short. It took a lot of efforts for the advocates to get the exemption of the doctors from the IPC 304 A. I request you to kindly do something and motivate the IMA to act and act fast. Sincerely: Dr R S Bajaj
 
    Public Forum

(Press Release for use by the newspapers)

Heart Attack Symptoms in Women and elderly are Different

Winter is the month for heart attacks and the symptoms in women and the elderly may be different, warns Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

  • Chest pain is still the most common sign of a heart attack for most women but women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart pain. In a study published in Archives of Internal Medicine researchers examined 35 years of research that yielded 69 studies and found that, between 30 and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 to 27 percent of men did not experience chest discomfort.
  • Older people are also more likely to have heart attack without chest discomfort. Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays.
  • Women are also more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with acute coronary syndrome (ACS). They are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.
  • Women are, on an average, nearly a decade older than men at the time of their initial heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.
 
    Classifieds – Situation Vacant

Wanted a Senior Resident in Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta, The Medicity, Gurgaon, Delhi (NCR). Those interested please contact: Dr. Neelam Mohan (9811043475), or Secretary to Dr. Neelam Mohan – Amit (9818200582).

 
    Forthcoming Events

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 www.emedinews.in

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