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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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  Editorial …

13th April 2013, Saturday

Say no to FNAC in prostate cancer

Over 95 percent of malignancies arising in the prostate are adenocarcinoma. The remaining types include urothelial carcinoma, basal cell carcinoma, small cell carcinoma, lymphoma and sarcomas.

Core needle biopsy of the prostate is used to determine whether or not cancer is present in men with an elevated serum PSA level and/or an abnormal digital rectal examination.

The recommendation is to take multiple core biopsies under transrectal ultrasound guidance.

Primary diagnosis of prostate cancer by using fine needle aspiration is not acceptable.

When positive the combined Gleason score, based upon architectural features of the prostate cancer cells, should be reported because it correlates closely with clinical behavior and has been incorporated into the tumor, node, metastasis (TNM) prognostic group staging system.

One should also report number of positive cores, the percentage (or length) of cancer in the positive core, the presence of perineural invasion or extraprostatic extension, and the presence of histologic types other than conventional adenocarcinoma.

The accuracy of pathological diagnosis of prostate cancer can be improved by using immunohistochemistry markers.

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

Ventilator-associated tracheobronchitis

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Krishna Tirath endorses CPR 10

Union Minister of State (Independent Charge), Ministry of Women and Child Development, Government of India, Smt Krishna Tirath in a statement to Heart Care Foundation of India and Indian Medical Association said that everybody should learn cardiopulmonary resuscitation (CPR).

Dr K K Aggarwal
    National News

Docs without skill will land in the dock

TNN Kochi: Doctors without reasonable skill or knowledge are liable to compensate for medical negligence as per high court of Kerala.

A medical professional is expected to bring reasonable degree of skill and knowledge, and must exercise care, a division bench comprising justices Thottathil B Radhakrishnan and B Kemal Pasha held.

The court was considering an appeal filed by Medical Mission Hospital, Kasaragod, challenging a subcourt’s order to pay compensation of Rs 75,000 for wrong diagnosis. The hospital had wrongly diagnosed a 25-year-old woman, Asiya, with tuberculosis and prescribed medicine. She was in fact, suffering from cancer. As her condition worsened, she was taken to Malik Dinar Hospital and then to Kasturba Medical College, Manipal.

The hospital at Manipal found her to be suffering from synovial sarcoma, a form of cancer. She died on September 19, 1999. Following Asiya’s death, her husband moved the subcourt, seeking a compensation of Rs 1.5 lakh. The court held that the doctor was negligent, and ordered a compensation of Rs 75,000. When the doctor and the hospital approached the high court, Asiya’s husband filed a counterclaim, requesting the court to raise the compensation to Rs 1.5 lakh.

While allowing the claim of Rs1.5lakh, the court pointed out that doctors were liable to diagnose diseases correctly and that arriving at two different inferences in two hospitals that used the same laboratory equipment was due to wrong diagnosis at one hospital.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Parental risk factors include young or single parents, parents with lower levels of education, and unstable family situations.

    Valvular Heart Disease Update

Severity of aortic stenosis

Based upon a variety of hemodynamic and natural history data, clinicians generally grade the severity of stenosis as mild, moderate, severe, or critical

  • Mild: Valve area exceeds 1.5 cm2
  • Moderate: Valve area of 1.0 to 1.5 cm2
  • Severe: Valve area less than 1.0 cm2

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

AAN issues guideline on parenchymal neurocysticercosis

A combination of albendazole plus a corticosteroid should be considered for adults and children with parenchymal neurocysticercosis, a new evidence-based guideline from the American Academy of Neurology (AAN) advises. (Source: Medscape)

For comments and archives

Guidelines urge statins at 40 for diabetics

All patients with diabetes should start taking statins when they turn 40 and blood pressure drugs when they turn 55, even if they have no other risk factors at the time, according to new Canadian guidelines. (Source: Medpage Today)

For comments and archives

Bariatric surgery changes metabolism and genes

Weight loss following gastric bypass surgery was associated with changes in gene methylation that may affect insulin sensitivity, researchers said. (Source: Medpage Today)

For comments and archives

British IVF pioneer Robert Edwards dies

Robert Edwards, a British Nobel Prize-winning scientist known as the father of in vitro fertilization (IVF) died on Wednesday at age 87 after a long illness, his university said. Edwards, who won the Nobel Prize for medicine in 2010, started work on developing IVF in the 1950s, and the first so-called "test tube baby," Louise Brown, was born in 1978 as a result of his research. (Source: Medscape)

For comments and archives

Lost pregnancies linked to long QT mutations

At least some unexplained miscarriages and stillbirths appear to be associated with mutations in genes for long QT syndrome susceptibility, researchers found. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Allopathic Medical Vrat Dr K K Aggarwal There was a time everybody in India, especially the women, used to (cont) http://tl.gd/n_1rjnege

@DeepakChopra: Some of my influencers pic.twitter.com/n1CDz1f2Vl

    Spiritual Update

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

Maa Brahmacharini (2nd Chaitra Navratri)

“Spiritual summary: Purify the mind (white clothes) with continuous efforts (japa mala) by accepting the things and situations as they are (kamalandu) and building humility in the mind (egoless state)”. This can be assisted by chanting VAM focusing on 2nd gonadal chakra.

Navratri is the detoxification of body, mind and soul. The nine-day purification process is observed twice in a year, at the start of summer and winter. Chaitra Navratri is observed at the start of the summer for preparing the body to tolerate summer.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What could happen to the babies in multiple births?

The babies could be born too early, which is called premature birth. Half of all twins and 90% of all triplets are born prematurely. These babies may have many health problems as seen in babies born early without the help of fertility treatments. Their lungs might not be strong enough, so they might have trouble breathing. The blood vessels in their brains might bleed easily. The babies will probably be underweight and may get sick or even die. Twins, triplets, and other multiples are more likely to have problems with their brain development and nerves if they are born early. One of the more common problems is cerebral palsy, an abnormality of the brain.

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Immune antibodies

  • The immune or isoantibodies are IgG.
  • Best react at body temperature and readily cross the placenta.
  • Most antibodies are complement binding; the notable exceptions being Rh and MN.

For comments and archives

    An Inspirational Story

Things change, keep up your faith!

For most people, graduation is an exciting day – the culmination of years of hard work. My graduation day… was not.

I remember that weekend two years ago. Family and friends had flown in from across the country to watch our class walk across that stage. But like everyone else in my graduating class, I had watched the economy turn from bad to worse my senior year. We graduates had degrees, but very limited prospects. Numerous applications had not panned out and I knew that the next day, when my lease ended, I would no longer have a place to call home.

The weeks ahead weren’t easy. I gathered up everything I couldn’t carry and put it into storage. Then, because I knew my small university town couldn’t offer me any opportunities, I packed up my car and drove to Southern California to find work. But what I thought would take a week dragged into two, and then four, and 100 job applications later, I found myself in the exact same spot as I was before. And the due date to begin paying back my student loans was creeping ever closer.

You know that feeling when you wake up and you are just consumed with dread? Dread about something you can’t control – that sense of impending failure that lingers over you as you hope that everything that happened to you thus far was just a bad dream? That feeling became a constant in my life.

Days felt like weeks, weeks like months, and those many months felt like an unending eternity of destitution. And the most frustrating part was no matter how much I tried, I just couldn’t seem to make any progress.

So what did I do to maintain my sanity? I wrote. Something about putting words on a page made everything seem a little clearer – a little brighter. Something about writing gave me hope. And if you want something badly enough… sometimes a little hope is all you need!

I channeled my frustration into a children’s book. ‘Beyond the River’ was the story of an unlikely hero featuring a little fish who simply refused to give up on his dream.

And then one day, without any sort of writing degree or contacts in the writing world – just a lot of hard work and perseverance – I was offered a publishing contract for my first book! After that, things slowly began to fall into place. I was offered a second book deal. Then, a few months later, I got an interview with The Walt Disney Company and was hired shortly after.

The moral of this story is… Don’t give up. Even if things look bleak now, don’t give up. Two years ago I was huddled in my car drinking cold soup right out of the can. Things change.

If you work hard, give it time, and don’t give up, things will always get better. Oftentimes our dreams lie in wait just a little further upstream… all we need is the courage to push beyond the river.

For comments and archives

  Cardiology eMedinewS

Hypertension rising in semi-urban & rural areas, warn experts Read More

Methane-producing gut organism may promote weight gain Read More

  Pediatric eMedinewS

Car emissions tied to rare pediatric cancers Read More

Newborn readmissions may largely be preventable Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Do newborn or neonates or infants require smaller volume/lesser dosage of rabies vaccine?

All modern rabies vaccines have a uniform dosage for all age groups.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with suspected malaria was found to have negative falciparum smear.
Dr. Bad: This is not malaria.
Dr. Good: Repeat the smear every six hours for the next 72 hours.
Lesson: If initial screening is negative and an alternative diagnosis is not available, smear examinations should be repeated every 6–12 hours for the next 48–72 hours (Clin Microbiol Rev 2002;15:66)

Make Sure

Situation: A patient with Chikungunya had persistent joint pain.
Reaction: Oh my God! Why was hydroxychloroquine not given?
Lesson: Make sure that all patients with post Chikungunya arthritis are treated with hydroxychloroquine to reduce disability.

  Quote of the Day (Dr GM Singh)

The ingredients of health and long life are great temperance, open air, easy labour and little care. Sir Philip Sidney

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Mind Teaser

Read this…………………

Which nonpharmacologic intervention is difficult to use with older adults who are cognitively impaired?

a. Aromatherapy
b. Distraction
c. Guided imagery
d. Heat application

Yesterday’s Mind Teaser: An older adult patient is discharged from the hospital with nortriptyline for neuropathic pain. Which statement indicates the patient's need for additional education?

a. “I will chew sugarless gum and mints.”
b. “I will drink carbonated beverages.”
c. “I will take my medication at breakfast.”
d. “I will use a humidifier at bedtime.”

Answer for Yesterday’s Mind Teaser: “I will take my medication at breakfast.”

Correct answers received from: Tukaram Pagad, Dr Santha Kumari, Dr Ayyavoo, Dr KV Sarma, Dr BB Gupta, Dr Raghavendra Jayesh, Anil Bairaria, Dr Thakor Hitendrsinh G, Dr K Raju, Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Avtar Krishan, Dr Kanta Jain, Dr Jella.

Answer for 10th March Mind Teaser: may be in conflict with the pain rating, and accepts the report of pain.

Correct answers received from: Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Deepali Chatterjee, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

A kangaroo kept getting out of his enclosure at the zoo. Knowing that he could hop high, the zoo officials put up a 10-foot fence. He was out the next morning, just sauntering around the zoo. A 20-foot fence was put up. Again he got out. When the fence was 40 feet high, a camel in the next enclosure asked the kangaroo, “How high do you think they’ll go?” The kangaroo said, “About a thousand feet, unless somebody locks the gate at night!”

    Medicolegal Update

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

Integrity of a doctor must be whole and complete

  • The word "integrity" stems from the Latin adjective "integer" meaning whole and complete. In the context of medical professional, integrity is the inner sense of "wholeness" of a doctor deriving from qualities such as honesty and consistency of character. As such, one may judge that others "have integrity" to the extent that they act according to the values, beliefs and principles they claim to hold. Integrity is a concept of consistency of actions, values, methods, measures, principles, transparency, expectations, and outcomes.
  • In medical ethics, integrity is regarded as the honesty and truthfulness or accuracy of one's actions in medical care delivery in the form of diagnosis and therapeutic intervention. Integrity can be regarded as the opposite of hypocrisy in that it regards internal consistency as a virtue, and suggests that parties holding apparently conflicting values should account for the discrepancy or alter their beliefs.
  • One essential aspect of a consistent framework is its avoidance of any unwarranted or arbitrary exceptions for a particular doctor especially the doctor that holds the framework in medical setup. In law, this principle of universal application requires that even those in positions of official power be subject to the same laws as pertain to their fellow person.
  • In personal ethics, this principle requires that one should not act according to any rule that one would not wish to see universally followed. For example, one should not steal unless one would want to live in a world in which everyone was a thief.
  • Speaking about integrity can emphasize the "wholeness" or "intactness" of a moral stance or attitude. Wholeness may also emphasize commitment and authenticity. Integrity "does not consist of loyalty to one’s subjective whims, but of loyalty to rational principles and practice of medicine in the interest of patient and public at large that strictly apply in medicolegal cases
  • In a formal study of the term "integrity" and its meaning in modern ethics, Law. Professor Carter sees integrity not only as a refusal to engage in behavior that evades responsibility, but also as an understanding of different modes or styles in which discourse attempts to uncover a particular truth/fact in public interest. Carter writes that integrity requires three steps: "discerning what is right and what is wrong; acting on what you have discerned, even at personal cost; and saying openly that you are acting on your understanding of right from wrong." He regards integrity as being distinct from honesty.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Krishna Tirath endorses CPR 10

Union Minister of State (Independent Charge), Ministry of Women and Child Development, Government of India, Smt Krishna Tirath in a statement to Heart Care Foundation of India and Indian Medical Association said that everybody should learn cardiopulmonary resuscitation (CPR). She also said that if the focus of training is on women and children, then the message can spread in the community like a wild fire. Such training camps should be organised on a regular basis in all schools.

The meeting was organised by Heart Care Foundation of India jointly with Indian Medical Association (IMA). Present on the occasion were Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India; Dr. D R Rai, Sr. Vice President, India Medial Association; Dr. Narender Saini, Secretary General IMA and Dr. Ajay Gambhir, Finance Secretary IMA.

Briefing the Minister, Dr. KK Aggarwal said that the only way to remember how to do CPR is to memorize the CPR Savitri Mantra which is “Marne ke dus minute ke bheetar (jitna jaldi utna behtar) kam se kam agle dus minute tak (jitni der tak ho utna behtar) apni chhati peetne ke badle mare hue vyakti ki chhati peeto.”
The last phrase of the Mantra “apni chhati peetne ke badle mare hue vyakti ki chhati peeto” has proved to have a higher recall value and makes it easy for one to remember it.

The Mantra in English reads as: “Within 10 minutes of death (earlier the better), at least for the next 10 minutes (longer the better), instead of beating your chest, beat the chest of the deceased effectively and continuously with a speed of 10x10 i.e. 100 per minute.”

    Readers Response
  1. Dear Sir, emedinews is very informative. Regards:Dr SP Mishra
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