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  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 …

14th December, 2010, Tuesday

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

Revisiting 2010
Medscape Rheumatology’s 2010 Highlights (Part 1)

1. New treatment data in lupus

  • Biologics in the treatment of systemic lupus erythematosus
  • Update on new therapies in SLE
  • Belimumab for the treatment of SLE
  • Antimalarials and mortality in lupus: should hydroxychloroquine be in the water?

2. Systemic sclerosis

  • B–cell depletion with rituximab: a promising treatment for diffuse cutaneous systemic sclerosis
  • Relaxin for diffuse systemic sclerosis: cause for alarm?

3. Fibromyalgia

  • Fibromyalgia drugs are "as good as it gets" in chronic pain: In a recent issue of The Journal of Pain, Hauser et al performed a meta-analysis of published trials of the three drugs approved in the USA for use in fibromyalgia: duloxetine, milnacipran and pregabalin. 11 randomized controlled trials including a total of 6,388 patients met the inclusion criteria and were included in the review. Outcomes of interest were improvements in pain, fatigue, sleep disturbance, depressed mood and health–related quality of life, as well as adverse events. The authors concluded that the three drugs were superior to placebo for all outcomes noted above, with the exceptions of duloxetine for fatigue, milnacipran for sleep disturbance, and pregabalin for depressed mood. They did not note any substantial differences between the drugs in the proportion of individuals who achieved a 30% improvement in pain (the value generally considered to be the minimum clinically important difference), but they did note quantitative differences in the symptoms that were most improved by each drug. Duloxetine and pregabalin were superior to milnacipran in reducing pain and sleep disturbances, duloxetine was superior to milnacipran and pregabalin in reducing depressed mood, and milnacipran and pregabalin were superior to duloxetine in reducing fatigue. Thus, there is some rationale for initially choosing the drug most likely to favorably influence an individual patient’s symptom profile.
  • Fibromyalgia: New Diagnostic Criteria

4. Your Malpractice Advisor: Unique Malpractice Risks for Rheumatologists: Rheumatologists may face unique malpractice risks, for a variety of reasons. One reason is that rheumatologists may have a more difficult treatment decision than other specialists. Another is that a notable percentage of rheumatology patients may be using complementary and alternative treatments while also following a traditional medical regime. These pose risks on a number of levels. As a result, rheumatologists need to be alert to numerous issues, and should also take extra steps to protect themselves to prevent a malpractice lawsuit. These extra steps could include having a detailed informed consent document, which is typically not standard other than with surgeons. Most specialists treat patients for definitive diagnoses, made after diagnostic testing objectively identifies the condition. But rheumatologists often treat patients with less well–defined diseases. The treatment options often include powerful edications such as steroids and steroid–sparing alternatives with their own potentially serious side effects, as well as addictive pain medications. Additionally, the severity of the patient’s condition, and the pain that may be associated with it, are often difficult to quantify. The less precise the diagnosis will result in less precise standards of treatment and the more opportunity for disagreement over the best course of care

5. Senate approves last–minute delay for Medicare pay cuts

Dr KK Aggarwal
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  SMS of the Day

(By Dr GM Singh)

" The advantage of smile: Smile is greatly infectious; it is a virus that spreads fast. "

    Photo Feature (From the Net)

(Contributed by Dr Mukul Tiwari)

Weird X–rays

X–rays are one of the most useful medical advancements in history. But they can also reveal some of the most gruesome and bizarre results. The accompanying picture shows a colored X–ray of objects, including a spoon and a blade, swallowed and lodged in the intestine of a patient.

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

Bringing Ayurveda into healthcare system

On Sunday, international delegates and representatives from more than 23 countries took a pledge at the 4th World Ayurveda Congress to support, promote and contribute towards the growth and sustenance of Ayurveda. Representative countries included USA, Canada, UK, Germany, Brazil, Australia, Italy, Greece, Nigeria, Kenya, Malaysia and Singapore. Secretary General, Vijnana Bharati, India, A Jayakumar said the vision was to make Ayurveda an integral part of the healthcare system, not only in India but across the world. (Source: Indian Express, Dec 13, 2010)

Supreme Court clears MCI’s common medical entrance test

The Supreme Court permitted the MCI to conduct a common test for undergraduate medical courses even as it decides on pending cases against the council. An apex court bench headed by Justice RV Ravindran said the central government did not need the court’s approval for framing the rules and regulations for the examination. (Source: The Times of India, Dec 13, 2010)

    International News

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

Survey shows families are eager to get healthy and active

The preliminary results of a survey conducted by the American Dietetic Association Foundation show that parents and children are taking steps to make healthier lifestyle choices, but there is still a need–and a want–for improvement. A majority of both parents and children expressed interest in being given more information from health and fitness professionals who could help educate them on how to make the best choices. Following up on a similar survey from 2003, the 2010 Family Nutrition and Physical Activity Survey studied 1,193 pairs of children (ages 8 to 17) and their parents, revealing significant positive changes in eating patterns, meal and snack purchases and family patterns that are related to healthier weights in children. 64 percent of family activities are sedentary (watching movies, playing video games, etc.), but there was a 93 percent increase in the number of children being physically active with their parents three or more days a week from 2003.

(Dr Monica and Brahm Vasudev)

Healthbeat: Who gets frozen shoulder? (Part 3)

The risk is increased when you don’t receive exercise therapy after tendinitis or an injury, and when you wear a sling for more than a few days without intermittent stretching. About 10% of people with rotator cuff disorders develop frozen shoulder. Enforced immobility resulting from a stroke, heart condition, or surgery may also result in a frozen shoulder. Other conditions that raise the risk are thyroid disorders, Parkinson’s disease, and diabetes (frozen shoulder affects 10% to 20% of people with diabetes).

J&J ordered to pay $1.8 million in Levaquin case

A federal court jury on Wednesday ordered healthcare company Johnson & Johnson to pay damages of $1.8 million in the case of an 82–year–old man who sued over claims the antibiotic Levaquin (levofloxacin) caused him severe tendon injuries. The trial was the first on more than 2,600 other US lawsuits making similar claims. In 2008, the US Food and Drug Administration required J&J and makers of related drugs in the class of antibiotics called fluoroquinolones to include warnings on the risk of tendon ruptures. The risk was higher in patients older than 60, those taking steroids, and recipients of kidney, heart or lung transplants.

FDA approves Orthovita’s new bone graft substitute

FDA cleared Vitoss Bioactive Foam–2X bone graft substitute, which can be used to fill bone gaps in the spine, pelvis, and extremities. Carfilzomib may benefit patients with multiple myeloma. Carfilzomib shrank the tumors of one–third of study patients with multiple myeloma. The reduction in tumor size was maintained for a median of eight months.

Low–dose aspirin may improve FOBTs’ ability to detect colon cancer

Taking a low–dose aspirin prior to having a fecal occult blood test appears to increase the ability of the test to detect colorectal cancer, according to a paper in JAMA. Low–dose aspirin use increases the likelihood of bleeding from a colorectal tumor, thus increasing the odds that the test will detect blood. The sensitivity of the hemoglobin FOBT for detecting advanced neoplasms among the aspirin users was 70.8% compared with 35.9% among nonusers.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is a typical IVF calendar ?

The sequence of events depends on the treatment protocol that has been planned for you. Usually OPD–based injections are started on Day 20 of previous menses, further gonadotrophins with follicular monitoring and blood tests start from 2nd day of menses for about 10 days. You may need daycare admission for oocyte retrieval as you will be administered anesthesia. Two days later you will come back for Embryo transfer which is an OPD USG–guided procedure. In a different protocol, stimulation starts from Day 2/3 of period and collection is done around day 15 after 10–12 days of stimulation.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

How do we manage a case of chronic constipation in children?

The basic aim for treating such cases is cleaning of fecal retention, prevention of further retention and promotion of regular bowel habits. The general approach includes:

  • Disimpaction
  • Initiation of maintenance treatment with laxative
  • Dietary modification, toilet training, and close follow–up
    Medicolegal Update

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

Facilitate cadaver organ retrieval for transplantation

  • The concept of ‘required request’ required to be introduced, wherein hospitals will be allowed to ask ICU patients, whether they would be willing to donate organs.
  • It should be made mandatory for hospital ICUs to declare all brain deaths and register them with an online central organ registry for better coordination of cadaver organ donation, retrieval and transplantation.
  • The hospitals equipped with ventilators and artificial life support system must make mandatory efforts to coordinate with organ bank and retrieve organs and the reason of failure must be documented for further review.
  • The World Medical Association also recommends that the physician may, when the patient cannot reverse the final process of cessation of vital functions, apply such artificial means as are necessary to keep organs active for transplantation provided he acts in accordance with the laws of the country or by virtue of a formal consent given by the responsible person and provided the certification of death or the irreversibility of vital activity had been made by physicians unconnected with the transplantation and the patient receiving treatment.
  • These artificial means shall not be paid for by the donor or his relatives. Physicians treating the donor shall be totally independent of those treating the recipient and of the recipient himself.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q: How can I discharge an indoor patient under my care if, due to some reason, I don’t want to treat him?

Ans: You should keep in mind the regulations 2.1.1 and 2.4 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, reproduced below––

"2.1.1 Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.

2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care."

You should inform the patient that you don’t want to continue to treat him and give him adequate notice to make alternate arrangements. You may also make arrangements for transfer of the patient, with his consent, to the care of another physician. All this should be well documented.

    Medilaw – Medicolegal Judgements

(Dr KK Aggarwal)

Can DMC take su moto action?

DMC/DC/F.14/Comp.695/2/2010/ 7th June, 2010; the council took suo motu action against Dr. BPS for indulging in act of professional misconduct. The council noted that a representation was received from MS MKW Hospital seeking verification of registration of doctors employed with the said Hospital. Dr BPS photocopy bearing DMC registration No. dated 23.7.2003 was sent by MKW Hospital for verification, on examination of records maintained in the Delhi Medical Council, it was noted that the name of Dr. BPS was removed from State Medical Register of Delhi Medical Council on 22nd July, 2008 on account of non–renewal. The Council that the date of registration mentioned therein has been tampered (date changed from 23rd July, 2003 to 23rd July, 2008).

Dr. BPS produced his original DMC registration certificate and stated that no tampering of date has been made in the same and that he does not have any knowledge as to how the photocopy of his DMC registration certificate sent to Delhi Medical Council has been tampered. The council further noted that Dr. BPS had not applied for renewal of registration with DMC (even after suo motu action was initiated against him) and had been practicing in violation of the provisions of DMC Act, 1997. The explanation put forth by Dr. BPS pleading ignorance as to the tampered photocopy of Delhi Medical Council registration certificate submitted to MKW Hospital and from where it was sent for verification to DMC, was found to be unsatisfactory and inexplicable and the same raises a strong resumption that Dr. BPS has himself indulged in an act of forgery of DMC registration certificate. The DMC directs that the name of Dr. BPS be removed for three months from the State Medical Register of Delhi Medical Council. The Order shall come into effect after 30 days from the date of this Order.

    Ethical earning

What is reimbursable to a doctor?

You can bill for email consultation.

    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

Serum calcium

Hypercalcemia (or high serum calcium level) is seen in

  • Malignant neoplasms (with or without bone involvement),
  • Primary and tertiary hyperparathyroidism,
  • Sarcoidosis
  • Vitamin D intoxication
  • Milk–alkali syndrome
  • Paget’s disease of bone (with immobilization)
  • Thyrotoxicosis
  • Acromegaly
  • Diuretic phase of renal acute tubular necrosis
  • Drugs: alkaline antacids, DES, diuretics (chronic administration), estrogens (incl. oral contraceptives), and progesterone

For given total calcium level, acidosis increases the physiologically active ionized form of calcium. Prolonged tourniquet pressure during venipuncture may spuriously increase total calcium.

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
    Medi Finance Update

Housing Loans

There is no income tax benefit on mere land alone; the benefit comes only when there is land with construction. If the property is in your and your wife’s name, the benefit is given to your wife only if she has invested in it. If she hasn’t invested, she cannot earn benefit.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Dicyclomine 2.5mg + Dried Aluminimum Hydroxide 200mg + Light Magnesium Oxide100mg + Simethicone 20mg per 5ml suspension.
For the treatment of the symptoms of functional gastrointestinal disorders like irritable bowel syndrome, functional dyspepsia, peptic ulcers., GERD which includes smooth muscle spasm, flatulence, abdominal distension, hyperacidity, gastric distress, bloating etc
    IMSA Update

International Medical Science Academy (IMSA) Update

Safety guidelines for atypical antipsychotic medications in children

With exception of using risperidone (i.e., for the management of irritability associated with Autism, manic and mixed episodes associated with Bipolar I Disorder, and Schizophrenia) and aripiprazole (i.e., for manic and mixed episodes associated with Bipolar I Disorder and Schizophrenia), the Food and Drug Administration (FDA) has not approved the use of AAMs in children and adolescents.

(Ref: McKinney C, Renk K.Atypical antipsychotic medications in the management of disruptive behaviors in children: Safety guidelines and recommendations. Clin Psychol Rev 2010 Nov 18. Epub ahead of print)

    IJCP Special

Dr Good Dr Bad

Situation: A patient of asthma was put on tiotropium.
Dr. Bad: Stop it.
Dr. Good: Continue it.
Lesson: The addition on tiotropium to low–dose, inhaled steroids has been shown to improve asthma control in many studies.

Make Sure

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

    Interesting Website to know

Dr Jitendra Ingole, MD Internal Medicine, Asst Professor (Medicine), SKN Medical College, Pune

Oprah.com is the official website for everything in Oprah’s world.
Find advice on your health, inspiration, beauty, money, decorating, relationships and more!

    Lighter Side of Reading

An Inspirational Story

(By Dr Prachi Garg)

The Buddha’s silence wins

One day the Buddha was meditating. An elderly man came in and started abusing the Buddha most ruthlessly. The Buddha remained absolutely silent. How long could he continue his abuse? After a while he stopped and was about to leave the place. But the Buddha said, "Just wait, please. I have something to ask you. Tell me, when you offer gifts to a person, if he does no accept your gifts, what do you do?" "I just take them back."

The Buddha said, "Well, you have been trying to offer me the gifts that you brought with you. Since I have not accepted your gifts, you are taking them back with you." The man felt sad and ashamed of his conduct. He begged forgiveness of the Buddha. The Buddha forgave him, and eventually he became a close disciple of the Buddha.


Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: W a t e r

Answer for Yesterday’s Mind Teaser:

Correct answers received from: Mrs. Meena D'Souza, Dr. Manjesha, Dr Sudipto Samaddar, Dr Sachin Joshi, Dr Chandresh Jardosh, Dr KP Rajalakshmi, Dr U Gaur, Dr. Amlendu Yadav, Dr Alok Gupta, Dr Nageshwar Rao, Dr Neelam Nath.

Answer for 12th December Mind Teaser: "The correct answer is 3. Lisinopril."
Correct answers received from: Dr Gattani RK 

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr GM Singh)

"We have some good news and some bad news." The good news is, I’m going to buy that new BMW. The bad news is, you’re going to pay for it.

    Readers Responses
  1. Dear Doctor, The story "Value your spouse" has really touched us & I still could not able to come out it, even though three days have passed. Kudos & by posting this gripping story which is very relevant in this modern era, ‘YOU ADD MEANING TO OUR LIFE’ Thanks, S. Sureshkumar, Chennai
    Public Forum

(Press Release for use by the newspapers)

The holiday season is also the season for heart attack

A look at a U.S. database of 53 million deaths occurring between 1973 and 2001 reveals that deaths from heart disease peak in December/January, with spikes on Christmas and New Year’s Day. Giving reasons for this, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India, said that:

  1. People with symptoms of heart trouble tend to delay going to the doctor prior to the holidays as they do not want to spoil holiday fun.
  2. They are less likely to see their physicians over this period of time in order to get the acute care they may need.
  3. During the holidays, many people take a break from their diet and exercise programs.
  4. The amount of time spent eating out and eating over at friends and family becomes more than usual.
  5. It becomes easier to find excuses not to stay on an exercise regimen.
  6. Alcohol consumption can increase during the holidays, which can contribute to something called "holiday heart syndrome."
  7. Alcohol has a toxic effect on the heart muscle. It can lead to atrial fibrillation –– an abnormal heart rhythm, which is a classic finding of the holiday heart.
  8. The hectic pace of the holiday season can cause people to forget to take medications such as blood thinners and pills for high blood pressure. Such lapses can lead to acute coronary trouble.
  9. Winter is any way the peak season for heart attacks. Most heart attacks and paralysis due to brain haemorrhage peak during early morning periods of winter season due to sudden rise in BP reading.
    Classifieds – Situation Vacant

Wanted a Senior Resident in Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta, The Medicity, Gurgaon, Delhi (NCR). Those interested please contact: Dr. Neelam Mohan (9811043475), or Secretary to Dr. Neelam Mohan – Amit (9818200582).

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 9th 2011.
The one day conference will revisit and cover all the new advances in the year 2010. There will also be a web–cast of the event. The eminent speakers will be Padmabhushan Dr Naresh Trehan (Cardiac Surgery); Padma Shri Dr KK Aggarwal (Revisiting 2010); Dr Neelam Mohan (Liver Transplant); Dr N K Bhatia (Transfusion Medicine); Dr Ambrish Mithal (Diabetes); Dr Anoop Gupta (Male Infertility); Dr Kaberi Banerjee (Female Infertility) and many more.

There will be no registration fee.
Delegate bags, gifts, certificates, breakfast and lunch will be provided.
Kindly register at www.emedinews.in

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