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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 …

15th February, 2011, Tuesday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Researchers devise process to create ready–made blood vessels for kidney,
heart patients

Scientists have devised a process to create ready–made, easily stored blood vessels that may be used for patients undergoing heart surgery or kidney dialysis. The procedure uses donor tissue cultured on biodegradable tube–shaped frames called scaffolds to form off–the–shelf blood vessels, which cannot be rejected by patients’ immune systems and are resistant to infection or clotting. The tissue–engineered grafts are strong and pliable even after being refrigerated for a year, which means that they could be made ahead of time and kept at the hospital to be used when surgeons need them.

Researchers took smooth muscle cells from cadaver donors and seeded them onto mesh tubes made from the same strong, flexible material used to make dissolvable stitches. Then, the muscle cells…secreted proteins, primarily collagen, which formed a ring of biosynthetic tissue around the gradually dissolving scaffold. The research is published in the Feb. 2 issue of Science Translational Medicine.

Dr KK Aggarwal
Editor–in–Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook
 
  eMedinewS Audio PostCard

  2nd eMedinewS revisiting 2010

Revisiting the Year 2010 with Dr KK Aggarwal
Prostate cancer screening guidelines updated by ACS

Audio PostCard
 
  Quote of the Day

(Dr GM Singh)

Be at least as interested in what goes on inside you as what happens outside. If you get the inside right, the outside will fall into place.

Eckhart Tolle

 
    Photo Feature (From the HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010

The audience had plenty of questions for the experts during the 2nd eMedinewS revisiting 2010 at Maulana Azad Medical College on 9th January 2011.

 
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

Online training programme

(Dr Vivek Chhabra)

To achieve a uniform understanding and training for treating stroke patients with probable thrombolysis, National Institute of Health is running a wonderful online training programme utilising small video clippings for MCQs aimed at training any interested doctor dealing in evaluation of Stroke. This training is getting mandatory for all NHS doctors dealing with Stroke and Stroke Nurses in the UK for scoring the patients who arrive within 3 hrs of onset of Stroke and are potential candidates for thrombolysis. This video assisted training is very useful and certificate with CME points also gets generated in the end which one can utilise for their portfolios. There are 90 MCQs and one must not make more than 6 mistakes to fail. The logistics one needs is a broad band and login to http://nihss–english. trainingcampus.net/The course is free of cost and a sheer delight to educate self via novel mechanisms and internet technology. One can do it in one go or in multiple sittings as the system keeps on saving simultaneously online. I am sure all enthusiastic doctors will enjoy it and propagate it further.

 
    International News

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

February is Heart Health Month. Today’s tip

Fish is a good alternative to meat and is a low–fat protein source. Certain types of fish are heart healthy because they're rich in omega–3 fatty acids, which can lower blood fats called triglycerides. You’ll find the highest amounts of omega–3 fatty acids in cold–water fish, such as salmon, mackerel and herring.

(Dr Monica and Brahm Vasudev)

Biphasic or prandial insulin may help larger proportion of patients with type 2 diabetes achieve HbA1c target

A larger proportion of Type 2 diabetes patients can achieve a glycated hemoglobin (HbA1c) target of less than 7% if they are treated with biphasic or prandial rather than basal insulin, according to a study published in Diabetes Care.

Eating over 53gm of cheese a day may increase risk of bladder cancer

A daily helping of cheese could increase the risk of bladder cancer, according to a study in the European Journal of Cancer. Researchers studied the eating habits of 200 bladder cancer victims and compared them with 386 volunteers who had not developed tumours. They found that eating cheese had little effect unless the amount exceeded 53g a day. After that, the risk went up by more than half. (AMA news)

Abstract of the day

Antiplatelet therapy in the perioperative period

Antiplatelet drugs are the cornerstone treatment in the secondary prevention of arterial thrombosis. Until recently, their intake was interrupted in the perioperative period because of fear for bleeding, but new insights have challenged this old habit: In patients at high risk for atherothrombotic events who need to undergo surgery or an invasive procedure, the risk for bleeding complications because of a treatment with low–dose acetylsalicylic acid (LD ASA) needs to be balanced against the risk of atherothrombotic events after treatment discontinuation. For patients at high risk of atherothrombotic complications recent guidelines do no longer advocate to interrupt LD ASA routinely. However, the likelihood of bleeding versus atherothrombotic complications should be considered on a case–by–case basis. When continued perioperatively, the bleeding risk associated with thienopyridines (ticlopidine, clopidogrel and prasugrel) is higher than that of LD ASA. It is recommended to stop their intake 1 week before the surgical intervention, except in patients with (recent) coronary stenting. (Engelen S, Sinnaeve P, Van Damme H, Verhamme P. Acta Anaesthesiologica Belgica 2010;61(3):139–43)

 
    IMT Update

Calcific plaque, better predictor for CAD than that of fibrous plaque and increased IMT. Women with chest pain and normal CCA wall morphology may not need coronary angiography. (Angiology 2006 Oct–Nov; 57(5):585–92)

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is Intrauterine insemination?

The IUI procedure consists of washing an ejaculated semen specimen to remove prostaglandins, concentrating the sperm in a small volume of culture media, and injecting the sperm suspension directly into the upper uterine cavity using a small catheter threaded through the cervix. The insemination is timed to take place just prior to ovulation, typically using home urine luteinizing hormone (LH) measurement. In couples with mild male infertility, IUI does improve pregnancy rates in couples when compared to intracervical insemination or timed natural cycles.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

What is the role of peak expiratory flow in asthma?

Standard values for various populations have not been defined. Thus, the currently accepted norm is to utilize personal best values as a benchmark. In order to obtain personal best values, monitoring of PEF should be performed over one to two weeks (8.00 a.m. and 8.00 p.m. daily) during asymptomatic periods. This limits the role of PEF in initial diagnosis and assessment of severity but makes it better suited to monitor therapy and in follow up for reassessment of the grade of severity. Technique, compliance and reproducibility are also difficulties that may be encountered. Children can be trained to use the peak flow meter after approximately 5 years of age. Asthma, being a dynamic condition as mentioned earlier, the only merit of PEF monitoring over spirometry is that it can be performed over a one to two week period at home thereby giving a temporal profile.

Note that a peak flow of less than 80% of the patient’s personal best indicates a need for additional medication and a peak flow below 50% indicates severe exacerbation.

For queries contact: drneelam@yahoo.com

 
    Medicolegal Update

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

What are autopsy artefacts?

When an autopsy is conducted on a body, surgical interventions are made for internal examination that may damage blood vessels and organs, cause skull bone fracture, etc. These are the artifacts of post–mortem examination and absolutely unrelated with the natural state of the dead body. Sometimes it is grossly mistaken especially in cases of repeat autopsy taking place in a different center.

  • Using chisel and hammer to loosen the skull cap may produce additional fractures or may cause extension of an already present antemortem fracture.
  • Rough handling of the brain during removal may produce midbrain tears. If the neck structures are pulled too hard during autopsy, they may be torn.
  • Pulling of the dura in the sagittal line will cause the air to enter the blood vessels at the top of the brain. Due to the reflection of the skin, air may enter the veins of the neck. This may lead to erroneous diagnosis of air embolism.
  • In case of a suspected cranial injury, the body should be opened, and the cardiovascular system decompressed by opening heart before the head is opened.
  • Large blood vessels may be cut while opening the thoracic and abdominal cavities, and considerable amount of blood escapes to the pleural and peritoneal cavities.
  • Air may be drawn back into the circulation and enter coronary vessels and give false impression of air embolism.
  • During autopsy, the handling of organs and incision of vessels may result in extravasation of blood into the tissues.
  • In older persons, the hyoid bones and thyroid cartilage may be fractured while removing the neck organs. Surrounding the fracture regions, haemorrhages are not seen.
  • Osseous union between the segments of hyoid may be unilateral. Such unilateral mobility or artefact by dissection may lead to erroneous impression of an antemortem fracture.
  • While dissecting the neck structures, if toothed dissecting forceps are used, it may damage the intima of the carotid artery which resembles a tear, as seen in case of strangulation.
  • The toxicological artefacts may be introduced due to the contamination of viscera with stomach contents due to autopsy, or by putting all the organs in one container or by using faulty techniques in collecting or storage of samples.

(Reference Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of Forensic Medicine, Peepee Publisher)

 
    Usefeul Websites

(Dr Surendernikhil Gupta)

KidSurvival

For the greatest hits of 2010/reader feedback on malaria surveillance, click on the link below

http://www.childsurvival.net/?content=com_articles&artid=297

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests for Adrenal Insufficiency & Addison’s Disease

Electrolytes (Sodium, Potassium, Chloride and Carbon dioxide): To help detect and evaluate the severity of an existing electrolyte imbalance and to monitor the effectiveness of treatment. Electrolytes may be affected by many conditions; with Addison’s disease the sodium, chloride, and carbon dioxide levels are often low, while the potassium level may be very high.

BUN and Creatinine are tests also done.

 
    Medi Finance Update

Q. Is there any provision in case a doctor fails to file the return within the time limit?

Ans. A doctor can file a belated return within a year from the assessment year or before the assessment is completed, whichever is earlier.

 
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
Indication
DCI Approval Date
Doxofylline MR Tablet 650 mg
For the treatment of Bronchial Asthma and COPD in Adults
11/03/2010
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Ankylosing spondylitis and interleukins

The increased serum IL–17 and IL–23 levels in ankylosing spondylitis (AS) patients found in a preliminary study suggest that these two cytokines may play critical roles in the pathogenesis of AS.

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Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  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
 
    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady died.
Dr Bad: Declare her dead.
Dr Good: Deliver the infant within 5 minutes.
Lesson: "Five minute rule", the best outcome with regards to neonatal neurological outcome is most likely when delivery occurs within five minutes of maternal cardiac arrest.

Make Sure

Situation: A rape victim became pregnant.
Reaction: Oh my God! Why was emergency contraceptive not given to her?
Lesson: Make sure that all victims of rape are given an emergency contraceptive.

Exercise tips

Adding as little as half an hour of moderately intense physical activity to your day can help you avoid a host of serious ailments, including heart disease, diabetes, depression, and several types of cancer, particularly breast and colon cancers.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

The Ballerina who give in too easily

There was once a young ballerina who had taken ballet lesson all through her childhood. She wanted to be a prima ballet dancer but she wanted to be sure that she had the talent. When a ballet company came to town, she went backstage after the performance and spoke to the ballet master. "I want to be a great ballet dancer but I don’t know if I had the talent" she said. "Dance for me" the master said. After a minute or two, he shook his head and said "No, no, no, you don’t have what it takes to be a great ballerina." The young woman went home heartbroken. She tossed the ballet slippers into the closet and never wore them again. Instead she got married, had children. when the kids are old enough, she took a part time job manning a cash register at a corner shop.

Years later, the same ballet company came into town. She attended it and on the way out, she ran into the same old ballet master who was then in his eighties. She reminded him that they had spoken before. She showed him photos of her children and told him about the corner shop job that she is doing now. And then she asked "There is just one thing that really bothered me. How could you tell me that I don’t have what it takes to be a great ballerina?"

"Oh, I barely look at you when you danced, that’s what I told all of them who came to me" he said.

"But…but, that’s unforgivable! You have ruined my life, I could have been a great ballet dancer!" she cried.

………………………………

Mind Teaser

Read this…………………

house
prarie

Yesterday’s Mind Teaser: $0 all all all all
Answer for Yesterday’s Mind Teaser: Free for all

Correct answers received from: Dr KP Rajalakshmi, Dr Sudipto Samaddar, Dr K Raju, Dr Muthumperumal Thirumalpillai, Dr Manjesha

Answer for 13th February Mind Teaser: Inside information
Correct answers received from: Dr Rajiv Dhir, Dr K.P.Rajalakshmi

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr GM Singh)

For Sale

A real–estate agent was driving around with a new trainee when she spotted a charming little farmhouse with a hand–lettered "For Sale" sign out front. After briskly introducing herself and her associate to the startled occupant, the agent cruised from room to room, opening closets and cupboards, testing faucets and pointing out where a "new light fixture here and a little paint there" would help. Pleased with her assertiveness, the woman was hopeful that the owner would offer her the listing. "Ma’am," the man said, "I appreciate the home–improvement tips and all, but I think you read my sign wrong. It says, "HORSE for sale."

………………………………

Knowledge is amusing

Women BLINK nearly twice as much as men!!

Do you know

Why the 2011 is special
It has the dates like
a. 1.1.11
b. 11.1.11
c. 9.2.11
d. 1.11.11
e. 11.11.11
f. 9.10.11
also one can do permutation and combinations hours, minutes and seconds e.g.
1.1.11; 1.1.11 (1 minute and eleven seconds past 1 o’clock)

5–Minute Management Course
(By Dr Mukul Tiwari)

Lesson 2

An eagle was sitting on a tree resting, doing nothing.
A small rabbit saw the eagle and asked him, ‘Can I also sit like you and do nothing?’
The eagle answered: ‘Sure, why not.’
So, the rabbit sat on the ground below the eagle and rested.

All of a sudden, a fox appeared, jumped on the rabbit and ate it.

Moral of the story: To be sitting and doing nothing, you must be sitting very, very high up.

 
    Readers Responses
  1. Dear Sir, eMedinewS is providing useful information. It is like morning tea for us. Regards: Dr Anupam
 
    Public Forum

(Press Release for use by the newspapers)

Good news for heart patients on Valentine’s Day

On Valentine’s Day, Dr. K.K. Aggarwal Padma Shri and Dr B C Roy National Awardee and President Heart Care Foundation of India said that there is little danger in having sex after a heart attack. One can have sex with the partner again in 3 to 4 weeks after a heart attack. As with other types of activity, one may need to start out slowly and work the way back into your normal pattern.

One should not be afraid of sex because of a heart attack.

Data from the Framingham Heart Study indicate that the baseline risk that a 50–year old, nonsmoking, non-diabetic man will experience a heart attack is about 1% per year, or one chance in a million in any hour. Since the relative risk of heart attack is about 2, engaging in sexual activity increases his risk to 2 in a million, and only for a two–hour period.

Exercise can reduce, and not increase the sexual risk of heart attack. There is a continuous benefit i.e. the more a person exercised, the less the risk.

Heart attack triggers are anger, heavy exertion, and getting out of bed in the morning. Added up, these triggers account for 17 percent of all heart attacks.

Sexual intercourse is rated as mild–to–moderate exercise (the equivalent of briskly walking half a mile or climbing a few flights of stairs). If one can tolerate exercise, one is probably physically ready for sex. Sex once a week poses only minimal risk and the doctor should encourage heart patients not to abstain from sex for fear of triggering a heart attack.

For a small number of patients, however, sex can be a real threat. According to a report in the American Journal of Cardiology, one may need to abstain from sex –– at least temporarily, till the conditions are under control – if one has any of the following conditions:

  • Unstable angina: Chest pain that is either severe, becoming more frequent, or occurring during rest.
  • The onset of angina or chest pain caused by heart problem.
  • Uncontrolled high blood pressure
  • Advanced heart failure marked by shortness of breath at rest
  • A heart attack within the last two weeks
  • Certain arrhythmias, abnormal heart rhythms, especially in the ventricles of the heart
  • Cardiomyopathy or weak heart muscle

To help overcome fear and anxiety related to sex after a heart attack, one should avoid sex after heavy meals and do it only when rested under the cover of a soft, relaxing music and a comfortable room temperature.

 
    Forthcoming Events

Delhi Medical Council Inaugural CME on Managing Common Emergencies
Date: Sunday, February 20, 2011
Programme – 1.00 PM – 4.00 PM
1.00 PM 1.30 PM Lunch
1.30 PM 1.45 PM Inauguration
1.45 PM 4.00 PM Scientific Programme

Topics Time Speakers Chairpersons
RTA, Emerging Epidemic
1:45 PM – 2.05 PM
 
Dr MC Misra
Dr BK Dhaon, Dr Praveen Bhatia, Dr Chander Prakash
Acute Febrile Illness
2.05 PM – 2.25 PM
Dr N.P Singh
Dr OP Kalra, Dr SP Byotra,
Dr B Gupta
Haematuria – Red Alarm
2.25 PM – 2.45 PM
Dr Anil Goyal
Dr P.N Dogra, Dr. Rajeev Sood
Managing PPH – Saving Lives
2.45 PM – 3.05 PM
Dr Reva Tripathi
Dr Sharda Jain
Panel Discussion of Update of Lt. Side chest pain 3.05 PM – 3.50 PM Dr Purshottam Lal,
Dr Naresh Gupta
Dr PS Gupta, Dr K.K Aggarwal, Dr Ashok Seth

Vote of Thanks: 3.50 PM – 4.00 PM

Followed by Tea

Please Note: Prior Registration Is Mandatory (No Registration Charges)

For Registration e–mail to delhimedbalcouncil@gmail.com, SMS to Secretary – 9868116494 & Organizing Chairman – 9811101454

Organization: President: Dr Arun Aggarwal, Vice President: Dr Vinay Aggarwal, Secretary: Dr Girish Tyagi, Organizing Chairman: Dr Anil Goyal, CME Committee Members: Dr Anil Bansal, Dr Manoj Singh, Dr NP Singh, Dr Praveen Bhatia.

eMedinewS Events: Register at emedinews@gmail.com

World Fellowships of Religions and Perfect Health Parade
First ever Conference which will talk about science behind all Religions, Dharmas and Pathies under one roof
Subject: Global Warming, Ethnic Crises, How to be Healthy
Date: Sunday 3rd April, 2011
Venue: Maulana Azad Medical College, New Delhi
Time: 8 AM – 4 PM
Register: rekhapapola@gmail.com

4th Study Camp on ‘Mind–Body Medicine and Beyond’
Organizer: Sri Aurobindo Ashram – Delhi Branch
Venue: Nainital Centre (Van Nivas)
Day: July 2–9, 2011

A Camp for doctors, medical students and other health professionals at its from. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind-body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of a mind-body medicine clinic at AIIMS, and the author of Back to Health through Yoga.

For more details, contact the ashram reception in Delhi (011–2656–7863) or e–mail Dr. Bijlani (rambij@gmail.com).

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