emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
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; Member 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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

14th March 2010, Sunday

Medical Navratras

Any change in season requires the ‘human body’ to be detoxified so as to bear the seasonal burden on the health. The spiritual way for the same is to follow a natural detoxification process by observing navratra fasts, a nine–day purification process. They are observed at the start of summer (Navratras- Ramnavmi) and at the start of winter (Navratras - Dusshera).

 

The process of detoxification involves cleaning the physical body externally and internally; the mind; intellect; ego and the soul.

 

A spiritual fast aims at both willful control of the desires and moving towards positivity. Desires can be to eat refined carbohydrates; to smell, to stimulating music or to watch beautiful things. 

 

Components of fast include food fast (eating only satvik food); mental fast (restraining from stimulating thoughts and behavior); intellectual fast (positive behavior) and ego fast (practicing humility). The process therefore involves living a satvic life style. One should avoid eating rajasic and tamasic foods during fast. Satvik foods are the foods offered to the God and mainly consists of fruits, leaves, nuts and milk (phalahar).

 

Abstaining from speaking evil or anything negative is another component called maun vrat. Now, instead of proper spiritual fast people only observe food fast during navratras. The physical purification process for the entire nine days involves regular bath (of the external body as well as various orifices).

 

These nine days also have spiritual significance. They are divided into three days each of mental purification.
During the first three days, a person is required to reduce the negativity in his mind. The activities involve confession and keeping negative thoughts at bay. During these three days, a person tries to restrain from thinking, speaking or doing anything that can harm another person. The five obstacles to internal happiness are attachment, anger, desire, greed and ego. A person tries to restrain from all these. Negative thoughts should not be suppressed or repressed, but acted, as otherwise they will manifest as disease.

 

The next three days, involves building positivity in the mind by way of various positive mental exercises and positive behaviors. These involve interacting with people, sharing, giving, donating, socializing, appreciating etc. Thinking positive is the easiest way of tackling negative thoughts. Remember darkness cannot be removed physically; it can only be removed by bringing in light. So is true for negative thoughts, which are nothing but absence of positive thoughts.

 

Once negativity is conquered in the first three days (which represents Kali) and happiness and positivity is built up in the mind (which represents Lakshmi), it is time to acquire knowledge (which represents Saraswati).

 

During the last three days a person is purified enough to understand and grasp the knowledge of self and understand and discriminate between good and bad. The last three days therefore involve reading and understanding scriptures and learning from the experiences of others.

 

Once all these are practiced, the mind is calm regardless of the happenings in the world. A continued action of detachment sets in. After nine days of self-discipline are complete, internal happiness is experienced, a connection with the soul is made and pure consciousness is awakened.

 

The birth of consciousness (connection with soul) is equivalent to the birth of Lord Rama which is observed as ‘Ramnavmi’. Hence, Ramnavmi should be celebrate as a disciplined way of acquiring internal happiness and not as a forced nine days of fasting.


Dr KK Aggarwal
Chief Editor


News and Views (by Dr Monica Vasudeva)

Long–term exposure to the air pollution particles caused by traffic has been linked to an increase in blood pressure

In a new report, researchers analyzed data from 939 participants in the Normative Aging Study, who were assessed every four years between 1995 and 2006. A computer model was used to estimate each participant’s exposure to traffic air pollution particles during the entire study period and for the year preceding each four–year assessment. Increased exposure to traffic pollution particles was associated with higher blood pressure, especially when the exposure occurred in the year preceding a four–year assessment (3.02 mm Hg increase in systolic blood pressure, 1.96 mm Hg increase in diastolic pressure, and 2.30 mm Hg increase in mean arterial pressure).
This link between long–term exposure to traffic air pollution particles and higher blood pressure readings may help explain the association between traffic pollution and heart attacks and cardiovascular deaths reported in previous studies, according to study author Joel Schwartz, of Harvard School of Public Health in Boston.

Study suggests that both central and peripheral visual impairment are independent risk factors (Dr G M Singh)

In adults, central visual impairment and peripheral visual impairment are independently associated with an increased risk of falls and fall-related injuries, according to a study in the February issue of Ophthalmology.

Obese children as young as 3 could harbor a warning sign that they’re at risk of heart disease in the future (Dr G M Singh)

In a study published online March 1 in the journal Pediatrics, researchers found higher levels of C–reactive protein, a sign of inflammation and heart disease risk, in obese kids. They also found higher levels of two other signs of inflammation in kids starting at ages 6 and 9.

Allergic vs non allergic rhinitis ( Dr G M Singh)

This is a complex area and it cannot be answered thoroughly and concisely. Nevertheless, sneezing and nasal running, often accompanied by symptoms of allergic conjunctivitis such as itching, injection and tearing, all suggest allergic rhinitis. If the symptoms are seasonal or intermittent, the cause is more likely to be allergic. If the predominant symptom is nasal blockage, particularly when exacerbated by things such as alcohol, spicy foods and smoke, the problem is more likely to be non–allergic.

Conference Calendar

ASICON 2010 (3rd National Conference of AIDS Society of India)
Date: March 19–21, 2010
Venue: Hotel Hyderabad Marriott, Hyderabad, Andhra Pradesh.

What’s New

Geriatrics: benefits of exercise

The benefits of exercise, including lower mortality and maintaining independence, have been associated with initiating, as well as continuing, exercise in older adults including those ages 78 to 85 years.

Stessman J, Hammerman–Rozenberg R, Cohen A, et al. Physical activity, function, and longevity among the very old. Arch Intern Med 2009;169:1476.

Cancer Alert

Screening sigmoidoscopy

Results from the Norwegian Colorectal Cancer Prevention trial in which individuals aged 55 to 64 years were randomly assigned to colorectal cancer sigmoidoscopy screening or no screening found a significant CRC mortality reduction for those who participated in screening

Hoff G, Grotmol T, Skovlund E, et al. Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ 2009;338:b1846.

Quote of the Day

When we talk to God, we’re praying. When God talks to us, we’re schizophrenic. (Jane Wagne)

Diabetes Fact

DPP–4 inhibitors increase GIP1 and GLP–1. Sitagliptin and Vildagliptin, are given in type 2 diabetes.

Public Forum (Press Release)

Chickenpox: anti viral drugs can prevent complications

March is the season for chicken pox. Primary infection with varicella virus causes chickenpox in susceptible hosts. It can cause significant complications, such as soft tissue infection, pneumonia, hepatitis and encephalitis in adults, pregnant women and immuno–suppressed hosts. All adults and older children should receive anti viral drugs said Dr K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

Treatment Guidelines

  1. Anti allergic drugs can be given for pruritus.

  2. Fingernails should be closely cropped to avoid significant excoriation and secondary bacterial infection.

  3. Paracetamol should be used to treat fever, particularly in children, since the administration of aspirin has been associated with the onset of Reye syndrome.

  4. The, anti viral drug is an Acyclovir (noit a trade name) is effective therapy for primary varicella in both healthy and immunosuppressed hosts.

  5. Acyclovir is safe and effective for varicella, if given during the first 24 hours of rash.

  6. Acyclovir should be given to all older children and adults (older than 12 years of age), secondary household cases, history of chronic cutaneous or cardiopulmonary disorders, on steroids, on chronic salicylates.

Vaccination

  1. Varicella vaccination is recommended for all children between 12 and 15 months of age without evidence of immunity.

  2. Routine second dose of varicella vaccine at age four to six years.

  3. All susceptible children aged 19 months to 13 years should be fully vaccinated (with two doses) by their 13th birthday.

  4. Routine vaccination for all healthy persons aged >13 years is recommended for those without evidence of immunity.

  5. Two doses of single-antigen varicella vaccine should be given 4–8 weeks apart.

  6. Varicella vaccine is highly recommended in VZV–seronegative adults with ongoing risk of exposure (e.g. day care employees), those who are household contacts of immunosuppressed hosts and in women of child–bearing age.

  7. A second dose of varicella vaccine is recommended for adolescents and adults who had previously received only one dose.


Question of the day

What is the role of CT in Splenic Trauma?

Spleen is the most commonly injured intra–abdominal organ, occurring due to blunt or penetrating trauma. Nonoperative management is the accepted strategy to avoid the weakening of the defense system after splenectomy.1,2 Of all imaging techniques, CT scan is the modality of choice for evaluating splenic trauma. Splenic injury may be simple laceration, intrasplenic hematoma, subcapsular hematoma, infarction or delayed rupture. In severe cases, there may be shattered spleen with small segments. Splenic laceration appears as irregular linear area or reduced density on CECT. It is almost always associated with hemoperitoneum. Splenic fracture appears as thick irregular defect. Intrasplenic hematoma is seen as broad–based nonperfused area. It may be hyperdense on noncontrast study. Crescent collection of fluid that flattens/indents splenic parenchyma is subcapsular hematoma. Splenic infarct appears when there is vascular injury and seen as a wedge–shaped area of nonperfusion that extends upto capsule. Delayed rupture occurs after 48 hours. Shattered spleen shows multiple fragments. Splenic injuries can be graded according to CT based score (1-6) referring to parenchymal injury and amount of hemoperitoneum. Scoring system is based on that proposed by Resciniti et al.2 Patients with score <2.5 can be treated conservatively as in our cases. Cases with score equal to or more than 2.5 are likely to need surgery.3
In a CT follow–up study by Pranikoff et al.4, it was demonstrated that 44% of their patient (n = 25) showed complete healing, while rest had at least partial healing with progression towards normal architecture irrespective of grade of injury (including shattered spleen).

Hence nonoperative management of splenic injury allows splenic preservation and they eliminate postsplenectomy infection in a child and selective adults.

References

  1. Williams MD, Young DH, Schiller WR. Trend towards non–operative management of splenic injuries. Am J Surg 1990;160:588–93.

  2. Resciniti A, Fink MP, Raptopoulos V, et al. Non–operative treatment of adult splenic trauma: development of a computed tomographic scoring system that detects appropriate candidates for expectant management. J Trauma 1988;28:828–31.

  3. Scatamacchia S, Vassilios R, et al. Splenic Trauma in adults: impact of CT grading on management. Radiology 1989;171(3):725–9.

  4. Pranikoff T, Hirschl RB, et al. Non–operative management of splenic trauma. J Ped Surg 1994;29 (10):1366–9.


eMedinewS Try this it Works

Tips for examining infants and toddlers

When examining infants and toddlers, I find that it is comforting to the child if he or she remains on the parent’s lap. I delay transferring the child to the examination table until it is absolutely necessary. Some children associate the table with past injections.

Examination of the oral cavity in this age–group is most difficult. One tactic is to have the parent tickle the child; when he or she laughs, you have an opportunity to look into the mouth.

Dr Good Dr Bad

Situation: A diabetic hypothyroid on metformin came for evaluation
Dr Bad: Get A1C done.
Dr Good: Get A1C and TSH done.
Lesson: Administration of metformin in diabetics with hypothyroidism (both on therapy and untreated), is associated with a significant reduction in the serum TSH levels, with no change in FT4. Re–evaluation of thyroid function within 6–12 months after starting metformin is necessary. (Source: Diabetes Care 2009;32(9):1589–90.)

Make Sure

Situation: A–28–year old male presents with increased frequency and occasional blood in urine remained undiagnosed. Examination of urine shows sterile pyuria.
Reaction: Oh my God! Why didn’t you check for TB?
Make Sure to rule out TB in patients with frequency, dysuria, hematuria. Sterile pyuria is the first clue to diagnosis.

Medi Finance : (BUDGET 2010–2011): TDS

It is proposed to raise the limit for payments mentioned in section 194B, 194BB, 194C, 194D, 194H, 194I and 194J as under:

Section

Nature of Payments

Limit of Payments (Amount in Rs.)

194B

Winnings from Lottery or crossword puzzles

10,000

194BB

Winnings from horse race

5,000

194C

Payment to contractors

30,000

194D

Insurance Commission

20,000

194H

Commission and Brokerage

5,000

194I

Rent

1,80,000

194J

Fee for professional or technical services

30,000


This amendment is proposed to take effect from 01/07/2010
Punjab & Sind Bank
 
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Laughter the best medicine: Actual medical record

The patient’s past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.

Formulae in Critical Care: Conversion of kg into Ibs

Formula: Weight in Ibs = Weight in Kg × 2.2

Milestones in Ortho: THOMAS SYDENHAM (1624–1689)

Sydenham is likened to Hippocrates. Also known as the father of English medicine. He himself suffered from gout and wrote an excellent description of the disease, detailing the attack, the changes in urine and the link with renal stones.

Mistakes in Clinical Practice

Often the Latin abbreviations are misread.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

All men above 50 years should have a digital rectal examination done by expert to rule out prostatic diseases.

Lab test (Dr Navin Dang)

Serum Angiotensin converting enzyme factor is used to help diagnose and monitor sarcoidosis and to help differentiate this systemic condition from other disorders causing similar symptoms

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Artesunate (25/50/100mg) + Amodiaquine (67.5 mg/135/270mg) bilayered Tablets

For the treatment of uncomplicated malaria due to Plasmodium falciparum strain in various age groups

01.09.2009


(Advertorial section)

ZEN IMMUNE–FACT SHEET

ZENIMMUNE SLIM IS KNOWN TO HELP PREVENT PLAQUE FORMATION IN THE BLOOD VESSELS AND FACILITATE IMPROVED BLOOD CIRCULATION.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com emedinews@gmail.com

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April) . Over 300 registrations done already.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs (Last day today)

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

Readers Response

Sir: yesterday I saw a programme on NDTV regarding the code of ethics announced by IMA in the media regarding the HOSPITALITY provided by pharma cornpones to doctors. I am not debating who is right and who is worng. MY ONLY QUESTION IS THAT WHERE WAS THE NEED TO TO DEGRADE OUR PROFESSION IN THE EYE OF general PUBLIC BY MUD SLINGING IN MEDIA? IF IMA REALLY WANTS TO DO SOMETHING THEY CAN SIMPLY convey TO ALL PHARMA companies TO STOP ALL HOSPITALITY ACTIVITIES, and not to SEND THEIR REPS and  DETAIL THEIR PRODUCTS ONLY VIA MAILS, etc. manojaron@rediffmail.com

Dr Sanjiv Chopra Faculty Dean at Harvard to talk in Delhi on Leadership
20th March Saturday 2.30pm Venue DMA Hall Daryaganj or MAMC Auditorium (to be confirmed on Monday). No fee. Register at emedinews@gmail.com. Organised by emedinws and Delhi Medical Association in association with IMSA Delhi Chapter.

 

Title of Talk:  Leadership for the 21st Century:  The Ten Tenets of Leadership”

 

Learning Objectives:

1. Discuss the qualities of great leaders.
2. Elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience.
3. Emphasize that we can all lead and can do so at many different levels.
4. Explore what made or makes many leaders – historical and contemporary – so effective.

 

Leadership Talk Description

In this talk Dr. Sanjiv Chopra  will discuss historic figures such as Mahatma Gandhi, Florence Nightingale, and Winston Churchill, as well as contemporary leaders, and examine what makes them effective.  What are some of the qualities and attributes of the great leaders?  What is leadership, and can it be taught or is it something you’re born with?  It’s a subject I’ve been fascinated with.

He will assert that great leaders listen will, they have empathy, they dream big, they’re resilient, they have a sense of purpose.  The possess humility and humor, they also have integrity and great people skills.
Dr. Sanjiv Chopra will examine whether Adolf Hitler, who was certainly a charismatic figure and fiery orator, was a great leader.

Dr. Sanjiv Chopra  will discuss 10 Tenets of Leadership, and I believe anyone who follows these tenets will be on the path to becoming a better leader.
Leaders occur in all walks of life, and one can lead at many different levels. 

 

About Sanjiv Chopra, M.D., MACP

Dr. Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Dr. Chopra has scores of publications.  He has four books to his credit.  His books have been translated into several languages including Portuguese, Japanese, Italian and Czech.

Dr. Chopra is  Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world (subscribed to by an estimated 300,000 physicians worldwide).

Dr. Chopra has received a number of teaching awards:

 

1. The George W. Thorn Award presented by the Brigham and Women’s Hospital Housestaff, Harvard Medical School in 1985 for his outstanding contribution to clinical education
2. In 1991 he received the highest accolade from the 1991 graduating class of Harvard Medical School, the Excellence in Teaching Award.
3. In 1995 Dr. Chopra was the recipient of the Robert S. Stone Award, a prestigious award given to a faculty member who is an outstanding clinician and teacher and is chosen by colleagues, housestaff and students from the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
4. In 2003 he was honored by being chosen as the recipient of the American Gastroenterological Association’s Distinguished Educator Award.
5. In 2009 Dr. Chopra was elected as a Master of the American College of Physicians, a singular honor bestowed to only a select few individuals for being “citizen physicians, educational innovators, scientific thinkers and humanists who inspire those around him or her and sets the standards for quality in medicine.”


Dr. Chopra has been invited to lecture in numerous countries abroad.

 

Dr. Chopra serves as the Course Director of several CME courses including seven annual Current Clinical Issues in Primary Care  (PriMed) conferences held in collaboration with UCLA, Johns Hopkins, Baylor College of Medicine, University of Miami, Northwestern University and Columbia Presbyterian College of Physicians and Surgeons.   In addition to directing these conferences, he delivers several lectures, moderates a number of sessions and has served as a Keynote speaker on several occasions.  Each of the PriMed conferences are attended by 4,000 – 8,000 clinicians.

 

Dr. Chopra has had a life long passion in educating clinicians and lay people.  He has conducted scores of workshops on Success and Life Principles.  He has given a number of Keynote addresses on the topic of Leadership – “Leadership for the 21st Century:  The Ten Tenets of Leadership” to wide acclaim in the United States and several countries abroad.