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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


for regualr emedinews updates follow at www.twitter.com/DrKKAggarwal

13th July, 2010, Tuesday

Can one fly again after having a DVT?

A. Yes, one can fly again though with some precautions.

The fact that one has developed deep vein thrombosis and/or a pulmonary embolism (PE) indicates that the blood has a tendency to clot under certain stressful conditions, such as sitting on an airplane for several hours. Having one episode of DVT or PE makes one high risk for another, even if air travel is avoided.

Without an anticoagulant, the risk of suffering a repeat DVT or PE is about 3050% over the next 10 years. It is usually advised to take an anticoagulant indefinitely.

Prolonged sitting and dehydration create an environment inside veins that promotes clot formation. Both situations are common among airline passengers. Being confined to bed, having a leg in a cast, or other types of immobility also set the stage for a DVT or PE.

The following can be done to minimize the chances of developing a DVT or PE.

  1. Stay hydrated. Drink plenty of water to make you get up and use the rest room several times. These walks provide opportunities to exercise the leg muscles.

  2. Avoid alcohol. Alcohol can dry you out. It can also make one drowsy.

  3. Move your muscles. Stand up and stretch your arms and legs at least once an hour. Walk up and down the aisle. Do simple exercises such as straightening your knee and stretching your leg, and pointing your toes up, then down while standing or sitting. Give more room to move by storing as little as possible under the seat in front of you.

  4. Consider compression stockings. Elastic support stockings keep blood flowing by gently squeezing the legs and moving blood back to the heart. This prevents the buildup of fluid around the ankles that ordinarily occurs during longhaul air travel.
  5. Consider low moleculay weight heparin prophylaxis (Source Harvard Newsletter)

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)

 

17th MTNL Perfect Health Mela from Oct 2331, 2010

 

The dates for the 17th MTNL Perfect Health Mela were anounced at a .press conference held on 30.6.’10. This year the Mela will be held from October 2331.

Dr k k Aggarwal
Mr. KK Dwivedi, Head NCSTC, Dept. of Science & Technology, GOI & Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, President HCFI at the press conference

 

News and Views

Changes in albuminuria predict cardiovascular, renal outcomes and mortality (Dr Monica asnd Brahm Vasudeva)

Large changes in albuminuria predict cardiovascular and renal outcomes and mortality, independent of baseline albuminuria, as per results from a new analysis of the large ONTARGET trial presented at the recent European Society of Hypertension European Meeting on Hypertension 2010.

Median rhomboid glossitis (Dr G M Singh)

A type of chronic and asymptomatic atrophic candidiasis, median rhomboid glossitis is seen in the posterior middorsum of the tongue. It was earlier considered a developmental defect; but, the lesion is not seen in children. The condition has a consistent association with Candida albicans. Clinically, it appears red, usually lobulated, and lacks filiform papillae. Clinical signs can help diagnose candida; but, demonstration of hyphae on cytology confirms the diagnosis.

Patients with CHD who also have anxiety may be at greater risk for cardiovascular events

Patients with coronary heart disease may be at higher risk of heart attacks, strokes, heart failure and death if they suffer from anxiety too, according to research published in the Archives of General Psychiatry. A 74% increased risk of cardiovascular events was observed in those with an anxiety disorder.

Visit–to–visit variation in BP readings soon may be the new way to detect at–risk hypertensives

According to new research presented at the recent 2010 European Society of Hypertension  Meeting on Hypertension, variation in blood pressure readings on each visit may now be another way of screening at-risk hypertensive patients. It may indeed be more reliable indicator of cardiovascular risk than the currently used mean BP.

MCI update

Thje anticipatory bail plea of Dr Ketan Desai will now come on 15th in the Delhi CBI court. It is likely that he may have to file a case in Chennai High Court for the bail in a new case where he is likely to get arrested.

 

Legal Column

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

What is a ‘designer’ drug?

Designer drugs are widely known as ‘club drugs’ for their prevalence at trendy night clubs and teenage rave parties. These are synthetic substances created by changing the molecular structure of existing drugs; most commonly, amphetamines or methamphetamine and fentanyl to create new drugs with similar or enhanced/much enhanced pharmacological effects.

Designer drugs initially came into vogue as an attempt to circumvent the narcotic law which strictly/legally bans various narcotic/psychotropic drugs and chemical. Their effect varies widely, depending on potency and the latest recipe employed by their illicit manufacturer/s. The most commonly used such drugs in Delhi are club drugs derived from methylenedioxymethamphetamine (MDMA) sold as Ecstasy in rave parties. Ecstasy initially produces feeling of euphoria, which helps/increases rave energy for/in active and fatigueless participation in club/party . When the dose of drug is increased, it generates paranoia and hallucinations. It is regarded as a strong performanceenhancer in rave parties; but, it finally causes depression and irrational violence resulting in many criminal acts like rape/murder/severe car accident under the influence of this drug by the users, usualy teenaged boys/girls. Chronic symptoms of use of Designer drugs are confusion/irritability/amnesia/insomnia and severe anxiety. Teenagers who have such symptoms require immediate medical care.

The existing Indian laws require amendment in the same directions as in Australia and New Zealand. Instead, they have moved in an entire opposite direction and enacted sweeping bans based on chemical structure only, making chemicals illegal even before they are created.

 

Experts’ Views

Interesting tips in Hepatology & Gastroenterology

Dr. Neelam Mohan – Consultant Pediatric Gastroenterologist, Hepatologist, therapeutic Endoscopist and Liver Transplant Physician has moved to Medanta Medicity – Gurgaon as Director Pediatric Gastroenterology,  Hepatology and Liver Transplantation.

We have only one liver. How can a person donate liver?

Liver is the only organ in body which regenerates. Therefore one can donate a part of liver and the healthy liver would soon regenerate. Liver is divided into 2 lobes – right and left and into a total 8 segments. Each lobe has a separate arterial (hepatic artery – right and Left branches) venous (Portal vein – right & left branches) ductal (bile duct – right and left) supply.

What is the time taken by the liver to regenerate back?

It takes less than 3–4 weeks for more than 80–90% of the liver to regenerate.

Question of the Day

Why are people with diabetes more prone to develop CVD? (Dr Ranjit Unnikrishnan & Dr V Mohan, Chennai)

Hyperglycemia, hypertension, obesity and dyslipidemia are common in people with diabetes. Insulin resistance is the underlying factor for this metabolic cluster which increases the risk of Cardiovascular disease. In the CUPS study , it was noted that the metabolic abnormalities tend to cluster and that subjects with more than one metabolic abnormality had a higher prevalence of CVD compared to those with a single metabolic abnormality.1

Diabetes is also considered to be a hypercoagulable, hypofibrinolytic and proinflammatory state. Clinical studies have indicated increased levels of fibrinogen, PAI-1, platelet activation markers and hsCRP in diabetic subjects.2 The levels of small dense LDL and oxidative modification of LDL also increase in diabetic subjects, increasing the risk of CVD. Overall, all cardiovascular risk factors operating in nondiabetic subjects operate in diabetic subjects as well, but to a higher degree, resulting in increased risk for CVD.

References

  1. J Am Coll Cardiol. 2001;38:6827.

  2. J Assoc Physic India 2002;50:9016.
 

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 Dr (Prof) HS Rissam

My suggestions to the President, Medical Council of India (MCI) are that the number of MBBS seats in the country must be increased to at least 3 times more than what it is today. Similarly, the number of Post Graduation seats MD / MS must also be increased by at least 3 times. The politicianprivate institution nexus must be broken. This shall need a bold intervention.

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Public Forum (Press Release for use by the newspapers)

Diabetics should undergo cardiac evaluation

All diabetics should have their cardiac examination done as cardiovascular disease accounts for 65% of deaths in patients with type 2 diabetes, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Intensive and aggressive management of diabetes can reduce the risk of getting future heart attacks. As per the new guidelines, all patients with diabetes should have a blood pressure below 120/80 mmHg and fasting blood sugar lower than 90 mg%. The ABC of diabetes management is to keep abdominal circumference, lower blood pressure, and LDL cholesterol  all lower thamn 80.

Do not ignore sudden hearing loss

Dr Aggarwal also said that unexplained, unilateral, sudden hearing loss should not be ignored and medical consultation should be taken immediately. A hearing loss of more than 30 dB is considered significant. Quite often these patients have associated ringing in the ears and vertigo. The cause may be viral infections and/or vascular insults. In such patients, hearing may be restored if they are treated early. CT scan needs to be done in such cases to rule out brain tumour.

Do not ignore exertional dental pain

He further said that a dental pain which comes on exertion and is relieved at rest, may be an indication of underlying severe heart blockage. Typically, heart attack patients often present to dentists, orthopaedicians, GI physicians or with ENT surgeons. Any discomfort in the chest, arm, teeth, back of the neck or shoulders which comes on exertion and is relieved by rest, unless proved otherwise, should be considered cardiac in origin.

 

An Inspirational Story

Virtually no competition

While professional soccer was still struggling to find a firm foothold in the United States, in the 1970s, the North American Soccer League marked the brave first attempt to introduce the game to American sports fans. While most teams had only limited success at best, one did manage to break through to genuine mainstream popularity the New York Cosmos. It was the brainchild of Steve Ross, a passionate soccer fan who was also a major executive at Warner Communications. Max Ross told his son Steve: "In life there are those who work all day, those who dream all day, and those who spend an hour dreaming before setting to work to fulfil those dreams. Go into the third category because there’s virtually no competition". [Source: "Once In A Lifetime The Extraordinary Story Of The New York Cosmos" by Gavin Newsham]

 

IJCP Special

Dr Good Dr Bad

Situation: A child came with gynecomastia.
Dr Bad: This is puberty gynecomastia.
Dr Good: You are obese and it can be fat.
Lesson: Gynecomastia should be differentiated from pseudogynecomastia, which is due to an increase in breast fat, but not glandular tissues.

Make Sure

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid.
Lesson: Make sure, to evaluate only moderately tap ascitic fluid as overenthusiastic tapping can be life-threatening.

Quote of the Day (Dr. Santosh Sahi)

" Who has not tasted what is bitter does not know what is sweet." James Allen

Milestones in Gabapentin

ObsessiveCompulsive symptoms: In 1998, CoraLocatelli G et al demonstrated the use of Gabapentin use in obsessivecompulsive symptoms.

 

IMSA Update

International Medical Science Academy Update (IMSA)

Preoperative skin cleansing with chlorhexidinealcohol is superior to providone-iodine

In a trial of 849 patients undergoing cleancontaminated surgery, the overall rate of surgical site infection was significantly lower in the chlorhexidine-alcohol group than in the povidoneiodine group (9.5 vs 16 %).

Reference

Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine-alcohol versus povidoneiodine for surgicalsite antisepsis. N Engl J Med 2010;362:18.

 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Chlorthalidone Tablet 6.25mg

For the treatment of mild to
moderate hypetension.

03.10.09

 

Medi Finance

Can any deductions be claimed if one is building a hospital?

Yes, deduction can be claimed against the income of such hospitals.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Peritoneal Fluid Analysis

To help diagnose the cause of peritonitis and/or peritoneal fluid accumulation or ascites. 

 

Humor Section

Jokes

Patient: Doctor, in my dreams, I play football every night.

Dr Jhatka: Take this tablet, you will be ok.

Patient: Can I take it tomorrow, tonight is final game.

Medical bloopers on medical charts!

Labor Pain…………………Getting hurt at work

 

Readers Responses

  1. Dear Dr Aggarwal, I must compliment you for bringing out eMedinewS religiously without fail everyday for Medical Fraternity. Especially the column on Mnemonics can be of great help to Medical Students and even Practicing Physicians. I suggest we compile all of them and let it be available on your website for it to be utilized when the need arises. Sincerely, you deserve all the Awards: Dr NP Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi

  2. Sir please elaborate & tell something more about the word 'Habilitation' – as u said that it is the highest achievement in medical field in European countryies like France, Russia, Ukraine etc. Sir I have never heard of this word before in Russia or somewhere near. I am Russian degree holder doctor. I would like to improve myself, so if I request you to tell me more. Regards: Lalit Tanwar

    eMedinewS Responds:
    Habilitation is the highest academic qualification a person can achieve by his or her own pursuit in certain European and Asian countries. Earned after obtaining a research doctorate (Ph.D. or equivalent degrees), the habilitation requires the candidate to write a professorial thesis based on independent scholarly accomplishments, reviewed by and defended before an academic committee in a process similar to that for the doctoral dissertation. However, the level of scholarship has to be considerably higher than that required for a PhD thesis. Sometimes a book publication is required for the defence to take place. Whereas in the United States, the United Kingdom and most other countries, the PhD is sufficient qualification for a faculty position at a university, in other countries only the habilitation qualifies the holder to supervise doctoral candidates. Such a post is known in Germany as Privatdozent and there are similarly termed posts elsewhere. After service as a Privatdozent, one may be summoned to the faculty as a professor.

    This habilitation qualification exists in France ("Habilitation à diriger des recherches"), Switzerland, Germany (Priv.–Doz. and/or Dr. habil.), Austria (formerly Univ.–Doz., now Priv.–Doz.), Denmark, Bulgaria, Poland (dr hab.), Portugal (Agregação), Sweden and Finland (Docent or Doc.) the Czech Republic (Docent or DrSc), Slovakia, Hungary, Slovenia, and countries of the former Soviet Union, such as Armenia, Azerbaijan, Belarus, Latvia, Lithuania, Moldova, Kyrgyzstan, Kazakhstan, Russia, Uzbekistan, Ukraine, etc. (Doktor nauk). A similar qualification known as Livre–docência still exists also in public universities in the Brazilian state of São Paulo, but has disappeared in other parts of Brazil. In Spain it is called "acreditación" it is requirement for access to some kind of posts in state owned universities. Similarly, the so-called Libera docenza has existed in Italy until 1970. The habilitation, derived from the Medieval Latin habilitare — "suitable, fit" — developed in the eighteenth century.

    The word habilitation can be used to describe the qualification itself, or the process of earning that qualification. It is sometimes incorrectly used to refer to the thesis written as part of that process (what is called Habilitationsschrift in German). A successful habilitation requires that the candidate (called Habilitand in German) be officially given the venia legendi, Latin for "permission for lecturing," or the ius docendi, "right of teaching" a specific academic subject at universities for a lifetime. This status is called Privatdozent (for males) or Privatdozentin (for females), abbreviated PD or Priv.–Doz…

  3. Dear Dr Aggarwal, One of my relatives had poisoning with ‘lauki’ juice but the point is that it was definitely very bitter and they thought, the bitter the better. But she landed up in renal failure and was lucky to survive after remaining in ICU for 3 days. She didn't have karela juice, she had taken only lauki juice. I think there must be milder cases of poisoning presenting as gastritis only, which go unreported: Dr Puneet Wadhwa, Pediatrician, Faridabad
 

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, New 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.

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