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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org  
  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 …

13th January, 2011, Thursday                                eMedinewS Presents Audio News of the Day

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

NIH 2010 Clinical Breakthroughs
Prevention, Diagnosis and Treatment of Human Disease

  1. Alzheimer’s disease signature seen in spinal fluid: Levels of 2 proteins in cerebrospinal fluid might be used to identify people with Alzheimer’s disease before they show clinical symptoms. A distinct Alzheimer’s signature—reduced levels of a specific beta–amyloid protein and increased levels of a phosphorylated tau protein—was found in 90% of Alzheimer’s patients and 72% of people with mild cognitive impairment. The NIH–funded finding could open new opportunities for developing Alzheimer’s therapies.
  2. New test detects TB in less than 2 Hours: An automated test, developed with NIH support, rapidly and accurately detected tuberculosis and drug–resistant TB bacteria. In a study of 1,730 patients, the test identified 98% of all confirmed TB cases in less than 2 hours and up to 90% of TB cases that were missed by a more common diagnostic method. The finding could pave the way for earlier diagnosis and more targeted treatment of this sometimes–deadly disease.
  3. Gene variants tied to poor outcomes with heart drug: Clopidogrel, a widely prescribed anti–clotting drug, was known to be less effective for heart patients with 2 copies of a variant gene, or up to 4% of the population. An NIH–funded study showed that patients with just one variant, another 26% of the population, may also be at risk. The finding advances our understanding of how to tailor medications based on genetic makeup.
  4. Immunotherapy boosts pediatric cancer survival: A new antibody–based therapy prompted an immune system attack on tumor cells and significantly improved the survival rates of children with neuroblastoma, a deadly nervous system cancer. In an NIH–funded of 226 children with neuroblastoma, the new immunotherapy plus standard therapy raised the survival rate to 66%, compared to 46% for those receiving standard therapy. The study was stopped early because of the positive results.
  5. More frequent dialysis improves health of kidney patients: Kidney patients can fare better on an almost–daily hemodialysis regimen than on the standard 3–times–a–week plan, according to an NIH–funded study. More frequent dialysis led to improved heart health and blood pressure, better control of blood phosphate levels, and better overall health. The finding suggests that simple changes to current treatments might benefit the nearly 400,000 Americans who depend on dialysis to survive.
  6. Patient’s whole genome reveals disease and medication risks: By evaluating the entire genome of a 40–year–old man, scientists pinpointed gene variants linked to cardiovascular disease and several other conditions in the man’s family, as well as diseases not known to be in his family. Some variants predicted the man’s likely responses to common medications, including certain heart medications. This NIH–funded study provides a glimpse into how whole–genome sequencing might one day be used in the clinic.
  7. Daily drug reduces risk for HIV infection: A pill that’s currently used to treat HIV infection can also greatly reduce the risk of acquiring HIV among at–risk men, according to an NIH–funded study. The clinical trial enrolled nearly 2,500 men who have sex with men. Men who received a daily antiretroviral tablet were 44% less likely to acquire HIV infection during the study than those receiving placebo pills. The finding represents a major advance toward HIV prevention.
  8. Best treatment differs for kids with asthma: Most children who have trouble controlling their asthma with low–dose inhaled corticosteroids show improvement by increasing the dose or adding another medication, an NIH–funded study reported. However, the best option differed for each child. The clinical study of over 150 children identified characteristics, such as ethnicity, that raise the likelihood of one treatment working better than another. The finding highlights the need for a personalized approach to treating pediatric asthma.
Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  MEDICON 2010, 26 December
  53rd Annual Delhi State Medical Conference

Dr Anil Dhall speaks on ‘Approach to Patient with Heart Attack’

Audio PostCard
 
  SMS of the Day

(By Dr GM Singh)

Your attitude and the choices you make today, build the house you live in tommorrow. So, build wisely.

 
    Photo Feature (from the HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010: Doctor of the Year Award

Dr Neelam Mohan was conferred with the ‘eMedinewS Most Popular Doctor of the Year Award’ in 2nd eMedinewS Revisiting 2010.

 
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

Protocols in anaesthesia launched

BANGALORE: The department of anaesthesia, pain relief and critical care at Fortis Hospitals launched "Protocols in Anaesthesia", which aims to standardise the anaesthesia protocols to deliver quality clinical outcomes and provide better patient safety pre and post surgery. Speaking on the occasion, Lokayukta Justice N Santosh Hegde said, "Anaesthesia is largely a back office operation as far as patients are concerned. Most patients have fear about anaesthesia, because their life is in the hands of another human being. Errors on the anaesthetist’s part may result in damage to the patient. There is a huge need of avoiding such errors and with such initiatives, the processes can be made more systematic and errorfree." "Patient safety is a joint effort of everyone in the operating room, including surgeons, nurses and anaesthetists. This standardisation, which impact the actions of everyone in the operating room for the benefit of the patient and can totally eliminate wrong patient, wrong operation and wrong surgery and provide quality care to patients," said Dr Murali Chakravarthy, Consultant Anaesthesiologist, Fortis Hospital. (Source: Indian Express, 06 Jan 2011)

Lancet editor apologises for naming super bug after New Delhi

The editor of The Lancet, Richard Horton, apologised on Tuesday for naming an antibiotic–resistant superbug after New Delhi. It was an "error," he said. A report in the leading medical journal in August last stated that superbug "New Delhi metallo–beta–lactamese" (NDM–1) originated in India. It created uproar in the country. "The science behind the report was very strong, sound and correct. But it should not have been named after a city," Dr. Horton told journalists here. "It was an error and I apologise for it. I think it should be renamed, but it should be up to the microbiologists (who discovered the superbug)." Dr. Horton admitted that the name stigmatised the city or the region. Karthikeyan Kumarasawamy, a research student at the A.L. Mudaliar Postgraduate Institute of Basic Medical Sciences, who co–authored the article with Timothy Walsh, dismissed as hypothetical the conclusion that the bacteria was transmitted from the country. He said some interpretations were worked into the report without his knowledge. (Source: The Hindu, January 11, 2011)

Vivek Shauq dies of heart attack at the age of 47

Versatile actor Vivek Shauq who was best known as Jaspal Bhatti’s other half in the popular TV show Flop Show died of a heart attack on Monday. He was 47.

The news of Shauq’s death has come as a big shock not only for his friends but the whole Bollywood is mourning his absence. He is survived by his wife and three children. Neighbour of the actor, Rana Jung Bahadur, said, "As per the information I have got, he died of a heart attack. He had gone to Thane for some minor thing, as he knew someone there. The news is shocking."

Dr. Vijay Surase, a cardiologist at the Jupiter hospital informed, "His medical history shows that in 2003 he underwent a major angioplasty operation and three stents were put in his heart. He was prescribed blood–thinning medicines called Aspirin and Clopidogrel. But he discontinued them prior to his liposuction operation." Shauq was admitted to the hospital on January 3 after he suffered three cardiac arrests. "His heart had already stopped functioning. Three emergency three shocks had also been given to him. He was on life support system but he went into coma," Dr. Dayanand Kumbla, another cardiologist at the hospital said. Actor Akshay Kumar who had worked with the actor in movie Aitraaz tweeted, "This is a message, actually it’s more of a request, for all those who have had the pleasure of knowing and watching Vivek Shauq. I will say this now and always please take care of yourself and of your family’s health; we are nothing without it. I will miss u my friend."

 
    International News

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

Chefs on the Move to Help Improve Child Nutrition

Last June, First Lady Michelle Obama along with the U.S. Department of Agriculture launched a call to action for chefs across the nation to join the battle against childhood obesity. The program, called Chefs Move to Schools, helps to partner chefs with local schools in their communities as part of the Let’s Move! initiative. Since June, we have seen chefs and schools across the country form new friendships and develop delicious meals in an effort to improve nutrition. To that end, the focus of the Chefs Move to Schools program is to facilitate partnerships like Chef Raquel Rivera–Pablo’s in New York City where willing chefs work with teachers, parents, school nutritionists and administrators to create healthy meals that meet the schools’ dietary guidelines and budgets, while teaching young people about nutrition and making balanced and healthy choices. From chef Kimberley Stakal working with the Academy for Global Citizenship in Chicago to chef John Tesar at Stonewall Jackson Elementary in Dallas, the results have been great. Chefs Move to Schools has had over 1,700 schools sign up to connect with a chef through the program. And as word of this instrumental program spreads, we look forward to many more.

With more than 31 million children participating in the National School Lunch Program and more than 11 million participating in the School Breakfast Program, good nutrition at school is more important than ever. By taking advantage of the creativity of chefs like those at the California Culinary Academy and the chef D’Aun Carrell’s in St. Louis, we can bring about real change and set our kids on the right path to healthy eating and healthy lifestyles.

On the heels of so many advances on the school nutrition front, we must leverage that momentum and fully commit to these essential Chefs Move to Schools partnerships. So, I encourage both chefs and schools to make this happen today so we can raise a healthier generation of children. Let’s make this New Year count!

(Dr GM Singh)

More protein and less refined carbohydrate, best way to keep the weight off

The best way to keep the weight off following a diet is to eat more protein like lean meat, low–fat dairy products and pulse foods such as beans and lentils and less high glycemic index (GI) foods such as carbohydrate from white bread, white rice and other refined starchy foods, said researchers conducting the world’s largest dieting study; they also said with this regime you can also eat until you are full without having to watch the calories and without putting weight on. The researchers found that among adults who lost at least eight per cent of their body weight following a calorie–restricted diet, the ones who were most successful at keeping the weight off and least likely to drop out during the six months of follow up, were those who maintained a diet high in protein and low in refined carbohydrate (foods with a high glycemic index or GI). Foods with a high glycemic index (GI) are those whose carbohydrate content is digested more quickly and therefore their end–product, glucose, enters the bloodstream more quickly. Foods with a low GI have carbohydrates that break down more slowly during digestion, so the glucose enters the bloodstream over a longer period of time.

(Dr Monica and Brahm Vasudev)

Too much TV increases chances of death, cardiovascular events

A new research has shown that people who spend two hours or more a day in front of a TV screen during their leisure time double their risk of cardiovascular events over four years than those individuals who spend less than two hours a day in front of a screen.

CT, MRI Both Accurate for Assessing CAD

According to results of a prospective study reported in the January Journal of the American College of Cardiology: Cardiovascular Imaging, both computed tomography (CT) and magnetic resonance imaging (MRI) successfully identified coronary stenosis and predicted the need for later revascularization, even though CT was slightly more accurate in diagnosis. The overall diagnostic accuracy for CT was 87% vs 83% for MRI. Sensitivity for the two techniques was 90% and 87%, respectively, while specificity was 83% and 77%.

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are the causes of infertility in men?

Male infertility could be due to erectile problems or problem in the sperm count. The causes of sperm production problems can exist from birth or develop later as a result of severe medical illnesses, including mumps and some sexually transmitted diseases, or from a severe testicle injury, tumor, or other problem. Inability to ejaculate normally can prevent conception, too, and can be caused by many factors, including diabetes, surgery of the prostate gland or urethra, blood pressure medication, or impotence.

For queries contact: banerjee.kaberi@gmail.com

 
    Nutrition Update

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

Prevention of diarrhea in children with HIV infection or who were born to an HIV–infected mother

Diarrhoea is a common cause of illness in children, especially in low and middle–income countries where it accounts for nearly 2.5 million deaths per year. Infants and children with HIV infection or maternal exposure through birth or breastfeeding to HIV infection may be more vulnerable to diarrhea due to weakened immune systems, nutritional deficiencies or from having other infections.

A review evaluated three interventions to assess whether they can prevent death or illness from diarrhea in infants and children with HIV infection or exposure: vitamin A, zinc and cotrimoxazole. Vitamin A and zinc may correct micronutrient deficiencies that are prevalent in children with HIV infection or exposure, as well as prevent other infections. Cotrimoxazole is an antibiotic that helps prevent opportunistic infections in immunocompromised hosts, and may also prevent other infections. This review found nine studies that addressed these interventions in infants or children with HIV infection. It indicated that vitamin A shows reduction of mortality and morbidity due to diarrhea in children with HIV infection and a trend in lower illness from diarrhea. Zinc prevented visits due to watery diarrhea and cotrimoxazole decreased death and respiratory infections.

 
    Medicolegal Update

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

What is the medicolegal importance of age up to 15 to 21 years?

  • 15 years of age: Even if a wife, a girl of age below 15 years can’t give valid consent for sexual intercourse.
  • 16 years of age: Any girl below 16 years of age cannot give valid consent for sexual intercourse. It will amount to rape even sexual intercourse done with consent.
  • Age 18–21 years:
    • In accordance with Indian Majority Act 1875, a person attains majority on completion of 18 years.
    • In accordance with Child marriage Resistance Act, a female under 18 years and male under 21 years cannot contract marriage.
    • In accordance with Section 366 B of IPC, importation of any girl from Jammu & Kashmir or a foreign country under the age of 21 years for illicit intercourse is a criminal offence.
 
    Lab Update

Non HDL Cholesterol = Total Cholesterol – HDL Cholesterol
Non HDL cholesterol is a strong predictor of cardiovascular risk.

 
    Medi Finance Update

(Contributed by Dr GM Singh)

What is Amortization?

Amortization is a method of equated monthly payments over the life of a loan. Payments usually are made monthly but can be paid annually, quarterly, or on any other schedule. In the early part of a loan, repayment of interest is higher than that of principal. This relationship is reversed at the end of the loan.

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
Indication
DCI Approval Date
Cefixime 100mg/200mg + Cloxacillin 500mg/500mg tablets
For the treatment of adult patients with upper and lower respiratory tract infections, skin and soft tissue infections
12–Feb–10
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Association between acute care and cognitive function in older adults

A higher risk of cognitive decline and dementia has been postulated to occur in survivors of acute medical illness, particularly in older adults. In a prospective cohort study, higher rates of cognitive decline and incident dementia were observed among those who had had acute care hospitalization compared to those who did not (JAMA 2010;303:763).

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim was advised MRI post discharge.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Post hospitalization related medical expenses incurred during period upto 60 days after hospitalization of disease/illness/injury sustained are covered as part of claim.

Make Sure

Situation: A 60–year–old male developed acute heart attack after consuming Viagra.
Reaction: Oh my God! Why was cardiac clearance not taken before?
Lesson: Make sure that all older patients get a cardiac clearance before they are given Viagra group of drugs.

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Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

SMART Goals

If you ask most people what is their one major objective in life, they would probably give you a vague answer, such as, "I want to be successful, be happy, make a good living," and that is it. They are all wishes and none of them are clear goals. Goals must be SMART:

S –– specific. For example, "I want to lose weight." This is wishful thinking. It becomes a goal when I pin myself down to "I will lose 10 pounds in 90 days."

M –– must be measurable. If we cannot measure it, we cannot accomplish it. Measurement is a way of monitoring our progress.

A –– must be achievable. Achievable means that it should be out of reach enough to be challenging but it should not be out of sight, otherwise it becomes disheartening.

R –– realistic. A person who wants to lose 50 pounds in ~30 days is being unrealistic.

T –– time–bound. There should be a starting date and a finishing date.

Please comment your opinion on this and add something yours…

………………………………

Mind Teaser

Read this…………………

Eye E
See Except

Yesterday’s eQuiz: An otherwise healthy 30–year–old male patient presents with two days of cough, phlegm, fever with chills, shortness of breath and right–sided pleuritic chest pain. On examination, he is febrile, tachycardic and has clinical features consistent with right lower lobe consolidation. BP is 120/80 mmHg. Which of the following is the next best step in his management?

A. Admit him for inpatient management of pneumonia
B. Check an arterial blood gas
C. Check for Influenza A/B antigen
D. Commence empiric therapy with Azithromycin

Answer for Yesterday’s Mind Teaser: The correct answer is D. The most likely diagnosis is community–acquired pneumonia (CAP). Regardless of which pneumonia severity index score we use, this patient has a mild disease and is at low risk of death/adverse outcomes. Hence, outpatient management with empiric antibiotic therapy is appropriate for this patient. An ABG is not necessary due to mild respiratory illness and no suggestion of an acute lung injury/ARDS. The common pathogens for CAP are S. pneumoniae and atypical pathogens such as Mycoplasma pneumoniae, Chlaymydophila pneumoniae and Legionella pneumophila. An antibiotic that covers both the common and atypical organisms is indicated. Though local sensitivities differ, an advanced generation macrolide (azithromycin or clarithromycin), a ketolide (telithromycin) or doxycycline are good choices as monotherapy.

Correct answers received from: Dr Anupam, Dr Parchi

Answer for 11th January Mind Teaser: Making ends meet
Correct answers received from: Dr Bankim Parikh, Dr Sudipto Samaddar, Dr Anurag Jain, Dr. Vijay Rangachari, Dr Richa Dikshit, Dr Deepti Katyal Uppal, Dr K.V.Sarma, Dr Ajit M.Tamhane, Dr H.L. Kapoor, Dr Anil Kumar, Dr Manjesha. Dr S Upadhyaya, Dr Vikas Kumar

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr Mukul Tiwari)

On a Taxidermist’s window:

"We really know our stuff."

 
    Readers Responses
  1. Respected Sir, Hats off to you for this voluminous work. There is no doubt that the lectures and the speakers were very good, but organizing this entire event was just as wonderful. Thanks from the entire medical community. Dr Anupam Sethi Malhotra
 
    Public Forum

(Press Release for use by the newspapers)

Sudden Death

Sudden cardiac death is an instant unexpected death, which occurs within one hour of the onset of cardiac symptoms. Over 24 lakh people die in the country of heart attacks and 17 lakh of them die suddenly before reaching the hospitals. 12 lakh of them can be revived if the general public is taught basic cardio brain pulmonary chest resuscitation, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

He said that the main cause of death in such situation is generally an irregularity of the heart rhythm called ventricular tachyarrhythmia. The underlying pathology is usually coronary heart disease in middle–aged and elderly persons, but can also be one of the familial well–defined cardiomyopathies such as hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular dysplasia or long QT syndrome.

In children and young athletes, the two main causes of sudden death are long QT syndrome and hypertrophic cardiomyopathy (commonest cause of deaths during sports). Such patients are advised to avoid competitive sports.

Loss of consciousness and family history of sudden cardiac death should encourage the physician to examine the patient’s relatives.

About half of all deaths from coronary heart disease are sudden and unexpected, regardless of the underlying disease. Thus, half of all deaths due to atherosclerosis (arteries lined with fatty deposits) are sudden. So are half of deaths due to degeneration of the heart muscle, or to cardiac enlargement in patients with high blood pressure.

The term "massive heart attack" is often mistakenly used in the media to describe sudden death. The term "heart attack" or myocardial infarction refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim. While a heart attack may cause cardiac arrest and sudden cardiac death, the terms aren’t synonymous.

In people without organic heart disease, recreational drug abuse is an important cause of sudden cardiac death.

There are numerous contributors to cardiac arrest, but two of the most important ones are:

  • A previous heart attack: 75% of the people who die of SCD show signs of a previous heart attack.
  • Coronary artery disease: 80% of SCD’s victims have signs of coronary artery disease. This is a condition in which the arteries that supply blood to the heart are narrowed or blocked.

Other parameters are low heart functions and high resting heart rate.

 
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

IMSA Workshop on Rheumatoid Arthritis

Date: Sunday 16th January, 2011; Venue: Moolchand Medicity; Time: 10–12 Noon

Speakers:

  1. Understanding Biologics: Dr Rohini Handa, Former Head Rheumatology, AIIMS
  2. All what a practitioner should know about rheumatoid arthritis: Dr Harvinder S Luthra, Chief of Rheumatology, Mayo Clinic, Rochester USA

No fee. Register emedinews@gmail.com or sms 9899974439

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