eMedinewS13th December 2013, Friday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at
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CT Screening can over diagnose lung cancers

About 18% of lung cancers caught by low–dose CT screening were slow–growing tumors that wouldn’t have affected patients during their lifetime, an analysis of the National Lung Screening Trial (NLST) showed. The study suggests that lung cancer screening programs should address the issue of overdiagnosis. That trial showed a mortality advantage to screening, but for every one lung cancer death prevented per 320 patients with screening in the trial, 1.38 cases of overdiagnosis would be expected, Edward F. Patz Jr., MD, of Duke University Medical Center, and colleagues found.

Doctor gets jail time, $562,500 penalty in improper–billing case

In a rare case, a California judge has ordered a South Pasadena plastic surgeon to spend five days in jail and pay $562,500 in penalties for improper billing of emergency–room patients.

Lack of exercise amounts to ‘state child abuse’

Writing in the British Journal of Sports Medicine, doctors from University College Hospital and University College London said that the failure of successive governments to encourage more children to take exercise amounts to "state child abuse".

10 Changes in HIV care that are revolutionizing the field

  1. Fourth–Generation HIV test: The new test adds p24 antigen to the HIV antibody test to permit detection of the disease before seroconversion, which is when the Western blot (WB) becomes positive. It can detect HIV during the early acute retroviral syndrome stage at Fiebig stage 2, unlike the WB results, which require waiting for 2–3 months after viral transmission at Fiebig stage 5.
  2. Point–of–Care HIV viral load testing: Point–of–care (POC) HIV testing has been extremely successful as a screening tool to detect HIV. Now, there is a POC CD4 count test that permits staging HIV at the site of care, and it is anticipated that a POC viral load test will also be available, although the timeline for this development is unclear.
  3. Early HIV therapy to achieve "Functional Cure": There is now good evidence to show that the HIV reservoir with chronic HIV infection is substantial and is probably an important factor in immune activation and our inability to achieve cure, despite viral suppression with traditional monitoring. Note that "cure" is now described in two categories: a "sterilizing cure," in which the virus is eliminated, and a "functional cure," in which the virus continues to be present but does not require antiretroviral therapy (ART) for viremic control.
  4. Preventing HIV infection: The HPTN 052 trial showed that "treatment is prevention" presumably because HIV infection, like virtually all infections, obeys the rule that probability of transmission is directly correlated with inoculum size. Pre–exposure prophylaxis (PrEP) is a newer option and seems to work in clinical trials, but the challenge of adherence may make it more difficult to implement in practice.
  5. Eliminating the Hepatitis C coinfection cohort: It is estimated that 30–35% of persons with HIV infection also have hepatitis C infection. In the United States, hepatitis C infection is the major cause of liver failure, liver transplant and liver death, with an annual mortality that now exceeds that of HIV. The sudden and dramatic change in hepatitis C management is now virtually guaranteed, with an extraordinary array of new drugs expected to cure the majority of hepatitis C–infected patients.
  6. P4P4P to address the Gardner HIV cascade challenge: P4P4P, or "pay for performance for patients," which provides financial or other reward for patients to get tested, engage care, stay in care, and achieve viral suppression. It is now being studied in a controlled trial in Washington, DC, and Bronx, New York.
  7. New approaches in HIV therapeutics on the horizon: There will always be a need for new antiretroviral agents owing to resistance and toxicity, but the small number of new drugs in the pipeline possibly reflects the adequacy of the current supply of 28 FDA–approved agents as well as the anticipated rush to generics.
  8. Redefining the HIV provider: One of the key issues is defining who will be the HIV care provider. Will it be done primarily by an HIV specialist, will HIV be enveloped within primary care, or will there be some sort of mix, as with diabetes?
  9. Evolving ethical issues in HIV care: The ethics of HIV care under healthcare reform is a good example of an evolving controversy that is likely to have an important impact on HIV drug selection in the future. It is very reminiscent of the highly quoted 1993 editorial by Marcia Angell, former editor of the New England Journal of Medicine, which stated that the doctor had become a "double agent," considering our sometimes conflicted obligation to both the patient and the payer.
  10. Generic drugs for HIV: There is great pressure for the use of generic drugs for HIV treatment, as for all medical conditions.

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Ringtone – CPR 10 Mantra Hindi
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Spiritual marriage

sprritual blog

I recently attended a marriage of the daughter of one of my colleagues. The marriage took place in one of South Indian temple located at Mayur Vihar.

The marriage was simple yet spiritual. Only traditional South Indian food was served.

Marriage is a spiritual bond between two members and if it is held in a spiritual atmosphere, it has lot of Vedic meaning.

Today, marriages have more to do with show–off and are held in noisy non–spiritual atmosphere either in five star hotels or in farm houses where serving of alcohol and non–vegetarian food has become a routine.

Conducting marriages in a spiritual atmosphere saves money. The money saved can be given to the young couple who are starting a new venture; they are also more spiritually relaxing and meaningful.

I personally feel that spiritually minded people should opt for a simple marriage in a spiritual atmosphere and can do a rajasik or tamsik reception after some time when the two partners have settled together for a few days.

cardiology news

Do not interfere in others’ business unless asked

Most of us create our own problems by interfering too often in others’ affairs. We do so because somehow we have convinced ourselves that our way is the best way, our logic is the perfect logic and those who do not conform to our thinking must be criticized and steered to the right direction, our direction. This thinking denies the existence of individuality and consequently the existence of God.

God has created each one of us in a unique way. No two human beings can think or act inexactly the same way. All men or women act the way they do because God within them prompts them that way. Mind your own business and you will keep your peace.

News Around The Globe

News

  • The US FDA has approved the first generic versions of the antidepressant duloxetine, delayed–release capsules (Cymbalta, Eli Lilly and Company).
  • The Allergenic Products advisory committee of the US FDA voted unanimously to recommend Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract Tablet for Sublingual Use (Oralair, Stallergenes, Inc) for the treatment of persons aged 10 to 65 years with grass pollen–induced allergic rhinitis or conjunctivitis confirmed by positive skin test or in vitro testing for pollen–specific IgE antibodies for any of the five grass species included in this product, with the understanding that auto–injected epinephrine be made available at home.
  • Diabetic patients who were counseled by pharmacists did better at managing their blood sugar over a 2–year period than patients in standard treatment. In the study reported at the meeting of the American Society of Health–System Pharmacists, diabetic patients who worked with pharmacists experienced mean reductions in hemoglobin A1c (HbA1c) of –1.24, which were sustained for 2 years vs smaller average reductions in control patients (HbA1c –0.59).
  • For older patients newly diagnosed with multiple myeloma, treatment efficacy was similar with any of three investigational drug regimens. Each of the three regimens, all including lenalidomide (Revlimid), was able to delay progression for similar durations and responses to treatment were roughly the same. But a regimen of melphalan (Alkeran), lenalidomide, and prednisone (MPR) had markedly increased rates of hematological toxicity, leading to higher rates of study discontinuation (annual meeting of the American Society of Hematology).
  • Eating a big, high–protein breakfast may be an effective strategy for improving glycemic control in overweight patients with type 2 diabetes. Zecharia Madar, MD, of Hebrew University in Jerusalem, and colleagues reported in the journal Obesity that 31% of overweight diabetics in the big–breakfast group could reduce use of their type 2 diabetes medications during the study, while none of the patients in the smaller breakfast group achieved this goal.

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Rabies News (Dr. A K Gupta)

Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.

cardiology news

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

  • An FDA advisory committee has voted almost unanimously in favor of the Watchman device. This investigative device can be used instead of warfarin to reduce the risk of stroke in atrial fibrillation (AF) patients. The Watchman device seals off the left atrial appendage (LAA) in the heart, which is the major source of stroke–causing thrombus in AF patients. It is implanted via a transseptal–catheter–based delivery system and is already available in Europe.
  • Dr Andrew Gonzalez (University of Illinois Hospital, Chicago) and colleagues suggest that to improve CV–surgery outcomes, the focus should shift from the perioperative period to postoperative care. They found that, as has been documented across surgery specializations, hospitals that performed the highest volume of procedures also had the lowest mortality rates for all three procedures: CABG, aortic–valve repair (AVR), or abdominal aortic aneurysm (AAA). Of note, however, rates of major complications, most strikingly for CABG and AVR, were similar between the high– and low–volume hospitals. Where differences emerged, they note, was in so–called "failure to rescue"—that is, mortality following a major complication.
cardiology news

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

  • A candidate inactivated quadrivalent influenza vaccine (QIV) has been shown in a multinational clinical trial to be safe and effective in children, according to an article published online December 11 in the New England Journal of Medicine. The quadrivalent vaccine contains antigens from both A lineages and both B lineages, whereas the older trivalent vaccine included both A lineages but only a single B lineage. Therefore, it is suggested that the quadrivalent vaccine could eliminate inadequate protection that results when there is a mismatch between circulating influenza and the single B lineage used in a trivalent influenza vaccine.
  • The incidence of illness secondary to raw milk consumption is higher than previously recognized and highlights the need for more education in this area, according to a new study published online December 11 in Emerging Infectious Diseases.
cardiology news

CT not required in appendicitis

When a patient has all the signs of acute appendicitis, waiting to get a CT scan to confirm the diagnosis is not required.

Compared with a straight–to–surgery approach, the CT strategy is linked to delayed surgery and increased risk of a burst appendix.

Pre–operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis. If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned. These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.

cardiology news

Total CPR since 1st November 2012 – 77787 trained

Media advocacy through Web Media

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Snorers at risk of sudden death

The interrupted night time breathing or sleep apnea increases the risk of dying said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. An Australian study, published in edition of Sleep, suggests that the risk is present among all people with obstructive sleep apnea.

The study researcher Nathaniel Marshall, from Woolcock Institute of Medical Research in Sydney, said that the size of the increased mortality risk is surprisingly large. The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, Marshall's team collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 77787 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Awareness Messages were spread in the CPR 10 Camp

press release

FDA panel recommends first drug for HIV prevention

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

A patient has been allegedly bitten by cobra snake. The venom in such a bite would be:

1. Musculotoxic.
2. Vasculotoxic.
3. Cardiotoxic.
4. Neurotoxic.

Yesterday’s Mind Teaser: Mummification refers to:

1. Hardening of muscles after death.
2. Colliquative putrefaction.
3. Saponification of subcutaneous fat.
4. Desiccation of a dead body.

Answer for yesterday’s Mind Teaser: 4. Desiccation of a dead body.

Correct answers received from: DR.A.K.GAJJAR, DR. BITAAN SEN & DR.JAYASHREE SEN, Dr. Brijesh Soni, Dr Ajay Gandhi, Dr Rajan John, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Sangeetha Raja, DR AVTAR KRISHAN, Tukaram Pagad,

Answer for 11th December Mind Teaser: 1.Criterion validity

Correct answers received from: DR AVTAR KRISHAN, Muthumperumal Thirumalpillai, Dr B K Agarwal, Tukaram Pagad

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update

Feeding Alligators

An old farmer had owned a large farm for many years. He had a huge man–made pond out back with a beautiful picnic area. For years it was the perfect place to unwind or hold a family get–together. As the farmer grew older, his "Oasis" was used less and less. It eventually became the local swimming hole and while his neighbors occasionally took advantage of the pond, he rarely made an appearance.

One evening the old farmer decided to go down to the pond. He hadn’t been there in a while and felt the urge to pay a visit to check on things. As he neared the pond, he heard loud playful voices giggling and laughing. As he came closer he was astonished to see that a bunch of young women had decided to skinny dip in his pond.

He made the women aware of his presence and they all went to the deep end of the pond. One of the women shouted to him, "We’re not coming out until you leave!"

The old man replied, "I didn’t come down here to watch you ladies swim or make you get out of the pond n*ked. I’m here to feed the alligator."

medicolegal update
medicolegal update

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medicolegal update

Situation: In an STD clinic, a 23–year–old heterosexual male presenting with dysuria and uretheral discharge was prescribed azithromycin to cover suspected Chlamydia trachomatis infection.
Reaction: Oh my God! Why didn’t you advise the same treatment to his partner also?
Lesson: Make sure to remember that it is essential to treat both partners in such cases.

medicolegal update

Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary. Steve Jobs

medicolegal update

Dr KK Aggarwal: Poor hygiene habits may lead to Typhoid fever http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Empirical facts are not descriptions of fundamental reality but descriptions of modes of human observation using a human nervous system

Forthcoming events

5th eMedinews Revisiting 2013

(a day long single hall medical conference on 2013 happenings, followed by doctors of the year 2013 awards)

Sunday 19th January 2014, Maulana Azad Medical College Auditorium

Dilli Gate Delhi, 10 am-6 pm


Dr KK Aggarwal
Padma Shri and Dr B C Roy National Awardee President
Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman
Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

5th eMedinewS Revisiting 2013
The 5th eMedinewS–revisiting 2013 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 19th 2014.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2013. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. Lunch will be provided.

Register at: rawat.vandana89@gmail.com/drpawangupta2006@yahoo.com

5th eMedinewS Doctor of the Year Awards
Nominations invited for 5th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2013.

pls send his/her Biodata at: emedinews@gmail.com

medicolegal update
  1. Dear Sir, very informative news. Regards: Dr Karan

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

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