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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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

  Editorial ...

14th September, 2010, Tuesday

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

11 ways to comfort someone who’s grieving
(Health Beat: Harvard Medical School)

  1. Name names. Don’t be afraid to mention the deceased. It won’t make your friend any sadder, although it may prompt tears. It’s terrible to feel that someone you love must forever be expunged from memory and conversation. (This suggestion does not apply in cultures in which mentioning the dead is taboo or bad luck, however.)
  2. Offer hope. People who have gone through grieving often remember that it is the person who offered reassuring hope, the certainty that things will get better, who helped them make the gradual passage from pain to a renewed sense of life.
  3. Make phone calls. Call to express your sympathy. Try to steer clear of such phrases as "It’s God’s will" or "It’s for the best" unless the bereaved person says this first. Your friend or relative may need you even more after the first few weeks and months, when other people may stop calling.
  4. Write a note. If you had a relationship with the deceased, try to include a warm, caring, or funny anecdote that shows how important to you he or she was. If you didn’t know the deceased, offer your sympathy and assure the bereaved that he or she is in your thoughts or prayers.
  5. Help out. Be specific when offering help. Volunteer to shop or do laundry, bring dinner, pass on information about funeral arrangements, or answer the phone. Pitch in to clean up the kitchen. A lawyer might volunteer to help with the estate. A handy person might button up the house as winter approaches.
  6. Be sensitive to differences. People mourn and grieve in different ways. Religion plays a big role in how death is treated; so do ethnic, cultural, and family backgrounds. Avoid criticizing the funeral arrangements or memorial service. Also, try not to impose your beliefs about death on your friend.
  7. Make a date. Ask your friend to join you for a walk or meal once a week. Be aware that weekends are often very difficult, and suggest an activity. Low–stress activities may be best: watch a video at home together versus going out to a movie. Sometimes just being there without saying much is enough — it may even be exactly what your friend wants.
  8. Listen well instead of advising. A sympathetic ear is a wonderful thing. A friend who listens even when the same story is told with little variation is even better. Often, people work through grief and trauma by telling their story over and over. Unless you are asked for your advice, don’t be quick to offer it.
  9. Express your feelings. If you share your friend’s sorrow, say so. It’s even all right to blurt out that you don’t know what to say. Most likely, nothing you say will turn the tide, but your sympathetic presence may make your friend feel slightly less alone. (One caveat: try not to express your feelings so emphatically that your friend has to take care of you.)
  10. Handle anger gently. People who are grieving sometimes direct angry feelings toward the closest target. If that happens to be you, try to be understanding. That is, wait until well after the person has cooled down before raising your concern in a nonthreatening way.
  11. Keep your promises. If you offer to do anything, follow through. This is especially important where promises to children are involved. Losing a loved one is abandonment enough.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Book Release Function

Sadhna Vithi, written by Acharya Dr Sadhvi Sadhna Ji Maharaj was released at a function organized by Acharya Sushil Muni Ahimsa Peace Award Trust on 5th September. In the photo: Padma Shri and Dr B C Roy National Awardee Dr K K  Aggarwal, Dr Mohini Giri, Sardar Buta Singh, Dr Naresh Trehan, Chairman and Managing Director, Medanta –The Medicity and Acharya Dr Sadhvi Sadhna Ji Maharaj, Chairperson, World Fellowship of Religions

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Early use of cerebral MRI led to the reclassification from possible to definite infective endocarditis in one–third of cases in a study involving 53 patients.

Reference: Duval X, Iung B, Klein I, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis. Ann Intern Med 2010;152:497–504.

  National News

State No.2 in dengue cases

Karnataka has the second highest number of dengue cases this year up to August, higher than even Delhi, though lower than that of Kerala. While other states have shown a slight improvement in controlling dengue cases, this year Karnataka has reached the second position. According to the statistics from Directorate of National Vector-borne Disease Control Programme, Karnataka has moved up a notch from third position last year. Dr Naresh Shetty, medical director, professor of orthopaedics with MS Ramaiah Hospital, said the number of dengue cases are increasing in the state. While Karnataka reported 1,764 dengue cases with eight deaths in 2009, it recorded 1,338 with one death just from January to August 2010. (Source: The Times of India)

  International News

Long–term use of bisphosphonates may increase risk of esophageal cancer

A British study published in the Sept. 2 online edition of the BMJ states that antiosteoporotic drugs such as ibandronate, alendronate or risedronate may increase risk of cancer of the esophagus in people who are taking these drugs. Dr. Jane Green, a clinical epidemiologist, in the Oxford University’s Cancer Epidemiology Unit said that "Esophageal cancer is rare, and even if risk is doubled it is still low" for any one person.

Study identifies risks for painkiller addiction

Researchers from the Geisinger Health System in Pennsylvania have identified factors that predispose some people to become addicted to opioid painkillers. Age (being younger than 65); a history of depression; prior drug abuse; and using psychiatric medications were the four main risk factors that were found to be common to the group most susceptible to addiction. Painkiller addiction rates among patients with these factors are as high as 26 %.

Study recommends disclosure of medical mistakes that affect multiple patients

A study published in the September 2 issue of the New England Journal of Medicine suggests that health establishments should reveal medical mistakes that affect multiple patients even if they have suffered no harm on account of the event. These medical mistakes, termed as large–scale adverse events (LSAEs), are incidents or series of related incidents that harm or could potentially harm several patients. They include incompletely sterilized surgical equipment, poor laboratory quality control and equipment malfunctions.

NIH News: Third generation map of human genetic variation published

An International Consortium published a third–generation map of human genetic variation, called the HapMap, which includes data from an additional seven global populations, increasing the total number to 11 populations. Any two humans are more than 99 percent the same at the genetic level. But, the small fraction of genetic material that varies among people can help explain individual differences in susceptibility to disease, response to drugs or reaction to environmental factors. Variation in the human genome is organized into local neighborhoods called haplotypes, which usually are inherited as intact blocks of DNA sequence information. Consequently, researchers refer to the map of human genetic variation as a haplotype map, or HapMap. "The generated HapMap provides an important foundation for studies aiming to find genetic variation related to human diseases. It is now routinely used by researchers as a valuable reference tool in our quest to use genomics for improving human health," said Eric D. Green, M.D., Ph.D., director of the National Human Genome Research Institute (NHGRI), a part of the National Institutes of Health, which provided major funding for the HapMap Project.

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

Increase feeding frequency as the child ages.

  • 6– 8 month old infants: Feed complementary foods 2– 3 times per day.
  • 9– 11 month old infants: Feed complementary foods 3– 4 times per day.
  • 12– 24 month old children: Feed complementary foods 3– 4 times per day.
  • Offer nutritious snacks 1– 2 times per day, as desired.

References

  1. Brown KH, Dewey KG, Allen LH. Complementary feeding of young children in developing countries: a review of current scientific knowledge. WHO/ UNICEF, 1998.
  2. Dewey KG. Guiding principles for complementary feeding of the breastfed child. PAHO/ WHO, 2003.
  3. WHO. Complementary feeding: family foods for breastfed children. Geneva: World Health Organization, 2000.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

Q Does IVF always leave us with twin or triple pregnancies?  What is the average number of embryos transferred?  Please explain.

A. The doctor will make the decision after discussing this with you. Generally, two or three embryos will be transferred, but the number may vary slightly depending on the quality of the embryos and the age of the female partner.

Q How much does IVF cost?

A. This varies enormously between different clinics in the same country.  Generally, it costs between Rs.1 to 1.5 lakh rupees.
 

  Diabetes Update: Question of the day

What are beneficial effects of insulin over other modalities of management of diabetes? (Dr KM Prasanna Kumar)

Insulin is the most potent glucose lowering agent, which can effectively and immediately control blood sugar level and hence is indicated in all hospitalized patients with hyperglycemia. Studies have shown long–lasting benefits of insulin therapy in patients after an acute coronary event and revascularization. Reduction in the length of hospital stay; re–hospitalization rate, mortality and morbidity have been documented with improved postoperative glycemic control with insulin.

Several comprehensive reviews of diabetes management in the hospital agree that the glucose goals once focused on preventing hypoglycemia are now shifting towards avoiding hyperglycemia and achieving near normal euglycemia. In patients with significant weight loss due to hyperglycemia, insulin therapy leads to modest weight gain due to the anabolic action of insulin. Insulin is the antidiabetic agent indicated in diabetic ketoacidosis (DKA) to reverse the pathogenesis. Insulin is the only antidiabetic agent indicated in significant hepatic dysfunction, renal failure and gestational diabetes. It can be safely given to lactating diabetic mothers. All oral agents as per current guidelines are contraindicated in pregnancy.

  Medicolegal Update

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

How can a doctor assess the decision–making capacity of patient?

Method for determining medical capacity*: Assess the patient’s ability to reason and deliberate about treatments and their consequences. The patient should be able to express their goals and values and explain their choices by reference to these values and goals. Sometimes a patient is unable to give reasoning for his or her decision; this makes it difficult to consider the patient fully capacitated. In addition, the patient’s behavior should be consistent with his or her general character i.e. the decision should not be widely "out–of–character". There may be good reasons for a complete "change of heart" but at least preliminarily consistency with past preferences is a reasonable test.

If a patient is not able to fulfill these requirements, then his or her capacity to make health care decisions is questionable.

*Veatch RM, ed. Medical Ethics, 2nd ed, Jones and Bartlett, Boston 1997.

  Medi Finance Update

Gift Tax

Gifts in excess of Rs. 25,000 received from non-relatives by an individual or HUF could be considered as taxable income subject to certain exemption.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date

Notification

Fixed dose combination of Phenobarbitone with Hyoscin and/or Hyoscyamine

Jan 1, 2002

GSR 170(E)
dt.12.3.01

  Lab Update

Prostate-specific antigen (PSA) Velocity

PSA increases more rapidly in men with prostate cancer than in healthy men. Accurate measurement of PSA velocity requires 3 serial readings, ideally with the same assay, obtained over at least a 12– to 24–month period. In the Baltimore Longitudinal Study of Aging (BLSA), men with a PSA rate of change (PSA velocity) > 0.75 ng/mL/year were at increased risk of being diagnosed with prostate cancer and that PSA velocity was more specific than a 4.0 ng/mL PSA cutoff (90 vs 60 % specificity).

  IJCP Special

Dr Good Dr Bad

Situation: A patient came with recurrent headaches.
Dr. Bad: It is a sinus headache.
Dr. Good: It may be migraine.
Lesson: Sinus headache is commonly diagnosed by clinicians and self–diagnosed by patients, but acute or chronic sinusitis appears to be an uncommon cause of recurrent headaches, and many patients presenting with sinus headache turn out to have migraine or, less often, TTH (tension–type headache).

Make Sure

Situation: A patient with blood in the sputum came back with massive bleeding.
Reaction: Oh my God! Why was the first bleeding ignored?
Lesson: Make sure
that even minor bleeding in sputum is properly investigated.

Quote of the Day
"Work spares us from three evils: boredom, vice, and need" Voltaire
(Contributed by Dr Prachi)

Hypertension Alert

Lifestyle management
Lifestyle modifications reduce BP, enhance anti–hypertensive drug efficacy, and decrease cardiovascular risk. If there is no target organ damage diabetes or multi cardiac risk factors one can try lifestyle management for up to 6 months. Presence of target organ damage necessitates drug treatment to lower the BP.

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  Mind Teaser

Read this…………………

This is an unusual paragraph. I’m curious how quickly you can find out what is so unusual about it. It looks so plain you would think nothing was wrong with it. In fact, nothing is wrong with it! It is unusual though. Study it, and think about it, but you still may not find anything odd. But if you work at it a bit, you might find out.

(Contributed by Dr. Jagjit Singh)

The answer for yesterday’s Mind Teaser: "Upside down"

Correct answers received from: Dr.K.V.Sarma, Dr Jayashree B Keshav, In Charge - Scientific Publications, The Himalaya Drug Company, Dr Meera Rekhari, Meera Rekhari, Dr Muthumperumal Thirumalpillai,  Dr Manoj Aron, Dr Simran Singh, Dr Rawat Purushottam Singh, Dr. Nagendra Gupta, Dr Shashi Saini, Dr.Satish Gunawant, Dr Kalpana Mohan, Dr R S Bajaj, DR. Manjesha, Dr.G. Padmanabhan, Dr.K.Raju, Dr Anupam Sethi Malhotra, DR. Manjesha, DR. Manjesha, Dr.G.Padmanabhan, Dr.K.Raju, Dr Anupam Sethi Malhotra,  Dr Roshini, Dr Vijay Kansal

The answer for 12th September Puzzle: "Yesterday, Today, and Tomorrow!"
Correct answers received from: Dr Jayashree B Keshav, In Charge - Scientific Publications, The Himalaya Drug Company, Dr.Biswaranjan Mishra, Dr T. O .P. Singh, Dr Muthumperumal Thirumalpillai, Dr.G.Padmanabhan, Dr S Upadhayaya, Dr.K.V.Sarma, Dr.Vijayakumar, Dr Vijay Kansal, Dr. Shashi Saini, Dr. Anita Rajorhia, Dr Manisha Kukreja
 
Send your answer to ijcp12@gmail.com

  Humor Section

Jokes
On a sunny Sunday afternoon, two young church members were going door–to–door to invite people to visit their services. When they knocked on one door, it was immediately clear the woman who answered was not happy to see them.

She told them in no uncertain terms that she did not want to hear their message, and before they could say anything more, she slammed the door in their faces. To her surprise, however, the door did not close; in fact, it bounced back open. She tried again, really putting her back into it, and slammed it again with the same result – the door bounced back open.

Convinced these rude young people were sticking their foot in her door, she reared back to give it a slam that would teach them a lesson. Just then, one of them said quietly: "Ma’am, before you do that again, you really need to move your cat."
(Contributed by Dr. GM Singh)

Funny One Liner

Telling a lie is a fault for a little boy, an art for a lover, an accomplishment for a bachelor and a matter of survival for a married man.…
(Contributed by DR Chandresh Jardosh)

  An Inspirational Story

In the 1940s, a young inventor named Chester took his idea to 20 corporations, including some of the biggest in the country. They all turned him down.

In 1947, after seven long years of rejection, he finally got a tiny company in New York, the Haloid company, to purchase the rights to his invention – an electrostatic paper–copying process. Haloid became Xerox Corporation.

He is Chester Carlson.
(Contributed by Hozie Kapadia)

  Readers Response
  1. Dear Sir, I read with great interest the description on Lord Ganesha. The elephant headed giant ears, big eyes; small mouth and several other features of Lord Ganesha are indeed symbolic of all the traits which we should adopt in our day to day professional as well as personal lives. Wishing you a very happy Ganesh Chaturthi…. Regards:Dr Prachi
  Public Forum

(Press Release for use by the newspapers)

Laboratory testing in swine flu

Not all individuals with suspected pandemic H1N1 influenza A need to have the diagnosis confirmed, particularly if the illness is mild said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

The recommended test for suspected cases is real-time reverse transcriptase (RT)-PCR for influenza A, B, H1, and H3, which is generally performed at a state health department
laboratory.

To establish the diagnosis of pandemic H1N1 influenza A, an upper respiratory sample (nasopharyngeal swab, nasal swab, throat swab, combined oropharyngeal/nasopharyngeal swab, or nasal aspirate) should be collected.

Whom to test — Testing for pandemic H1N1 influenza A should be considered in individuals with an acute febrile respiratory illness (i.e. a measured temperature of 100ºF or higher and recent onset of at least one of the following: Runny Nose (rhinorrhea), nasal congestion, sore throat, or cough or sepsis-like syndrome, a condition due to infection that has spread in the entire body.
 
Priority for testing should be given to:

•    Those who require hospitalization and
•    Those who are at high risk for severe complications.

Specimens — To establish the diagnosis of pandemic H1N1 influenza A, an upper respiratory sample (nasopharyngeal swab, nasal swab, throat swab, combined
oropharyngeal/nasopharyngeal swab, or nasal aspirate) should be collected.

Recommended tests
 
The recommended test to confirm the diagnosis of pandemic H1N1 influenza A virus is real-time reverse transcriptase (RT)-PCR for influenza A, B, H1, and H3.

Rapid antigen tests — Clinicians may consider using rapid influenza antigen tests as part of their evaluation of patients suspected of having pandemic H1N1 influenza A, but results should be interpreted with caution.
Confirmation of pandemic H1N1 influenza A infection can only be made by real-time reverse-transcriptase (RT)-PCR or culture.

Certain rapid influenza antigen tests that are commercially available can distinguish between influenza A and B viruses. Thus, a patient with only influenza B virus infection would not be suspected of having pandemic H1N1 influenza A virus infection. In contrast, a patient with a positive rapid antigen test for influenza A may be considered a probable case if he or she meets the other criteria. A negative rapid influenza test does not exclude infection.

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday–BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi 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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