emedinews
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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; 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

15th June 2010, Tuesday

Remembering the Bhopal Disaster

 
1.    It was the night of 2nd and 3rd December 1984 when 40 tons of Methyle Isocyanate (MIC-toxic gas) was released in the atmosphere from the pesticide plant belonging to Union Carbide. The gas soon spread over an area of 40 square kilometer. Being a cold and humid night, it got converted into aerosol mushrooming all over the atmosphere.
2.    The population of Bhopal at that time 832904 out of which 62.58% (521262) got affected with the gas sparing 37.42% (311642) people.
3.    2000 people died in the first 72 hours and the rest had involvement of lungs, eyes and nervous system.
4.    32476 people (3.9%) were severely affected; 71917 (8.63%) moderately and 416869 (50.5%) were mildly affected by the gas.
5.    Acute phase: Hamidia Hospital analyzed 544 patients out 978 admitted with acute exposure to the gas. 99.9% people had shortness of breath; 98.4% had cough; 52% had pink froth coming from the mouth; 25% had chest pain; 12.6% had blood in the sputum; 2% had hoarseness of voice. 85.8% persons also had eyes involvement; 91.87% had loss of appetite; 25% people had myasthenia like muscle weakness) and 54% people had high heart rate. 98% people had abnormal X-ray with ground glass appearance.
6.    Sub acute phase 0-3 months: The hospital analyzed 129 patients (90 males and 39 females) with persistent symptoms at one to three months. Severity of exposure was severe in 51.2%, moderate in 3.8% and mild in 10.8%. Exertional breathlessness was still present in 90%, cough in 74% and chest pain in 33%. 56% people still had abnormal x-ray. 55.8% people showed abnormal lung functions with 10.1% showing obstruction, 12.1% showing restriction and 21.7% mix picture.
7.    At 128 days: 119 severely exposed patients were analyzed and the data showed development of alveolo- plural fibrosis; airway constrictive lesions involving predominantly smaller air waves (less than 2 mm). The clinical picture was that of brochiolitis obliterans and COPD.
8.    Five years follow up: 250 patients (67.2% male and 32.8% female) were followed up for five years. Out of them 141 (56%) were severely affected, 69 (29.8%) moderately affected and 40 (16%) were mildly affected. By 5th year only 168 completed the follow up. 67% were males and 33 were females. 107 were from the severely affected group, 32 moderate and 26 from mildly affected disease. 70% of them showed persistent symptoms at the end of one year and then gradual subsiding of the symptoms. 5 people died and in 25% of the people X-ray showed further deterioration.
9.    The autopsy of the people who died in the first three days showed cherry red discoloration of the lungs, pulmonary edema, emphysema, hemorrhage, cerebral edema, anoxic brain damage and visceral congestion.  People who died during 1-4 months showed severe pulmonary edema and presence of exudates. People who died from 4 months to 1 year, the pathology was diffused interstitial; pulmonary fibrins.
10.    Pregnancy outcome: At the time of gas tragedy, 2566 women were pregnant out of them 373 aborted and 82 had still birth.
11.    The data in the year 1985-86 of pregnant women exposed to the gas was compared to that of controls.  The gas affected pregnant ladies had 1468 spontaneous abortions (controls 48); 355 abortions (controls 27) and 26 induced abortions (3 controls). There was no difference in congenital anomalies between the gas affected pregnancy and controls (14.2% Vs 12.6%).
12.    5% of the population at any given time is suffering from some form of lung disease. They are the worst sufferers from such a disaster. The same was observed in the Bhopal gas tragedy.
13.     Mortality: The immediate mortality rate was 22 per 1000 in the severely affected individuals and 7.5% in the moderately affected persons. By second year the mortality rate reduced to 7% in the severely affected individuals. By third year the mortality was same as that in the general population. That means all who had to die of the gas died in the first two years.
14.      Morbidity: 95% morbidly in the first month became 12-17% by first year. But even at 10 years, the morbidity did not touch the normal morbidity of normal population.
15.    Why tragedy occurred: In 4 km radius of such an industry, habitat should not have been there. The gas Methyle Isocyanate (MIC) if stored for a longer period is likely to leak.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Using the Power of Youth for Health Advocacy

The power of the youth is an important building block for the success of any campaign. They have immense storage of energies in them to speak out and work tirelessly for building a better and healthy world. Heart Care Foundation of India, understands the role of youth in generating awareness and has thus involved the youth in its various programs. Youth icons are also invited in such events to encourage the participants and also to ensure huge participation. In the photo: Cricketer Ishant Sharma with the winners of Medico Masti event during one of the Perfect Health Mela. Also in the photo: Padma Shri and Dr BC Roy Awardee Dr K K Aggarwal, President HCFI (extreme right)

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New Drug Update

Polio vaccination

The Advisory Committee on Immunization Practices (ACIP) has issued updated recommendations regarding routine poliovirus vaccination.

Vaccination of bone marrow transplant recipients

New guidelines have been published for preventing infectious complications after hematopoietic cell transplantation (HCT), which include detailed recommendations regarding immunization. These guidelines represent the collaboration of several organizations including the European Blood and Marrow Transplant Group, the American Society of Blood and Marrow Transplantation, the Canadian Blood and Marrow Transplant Group, the Infectious Diseases Society of America, and the US Centers for Disease Control and Prevention.

References

  1. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding routine poliovirus vaccination. MMWR Morb Mortal Wkly Rep 2009;58:829.

  2. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009;15:1143.

Mnemonic of the Day (Dr Prachi)

Morphology and symptoms of Crohn's disease: CHRISTMAS

Cobblestones
High temperature
Reduced lumen
Intestinal fistulae
Skip lesions
Transmural (all layers, may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

News and views

Severe combined immunodeficiency in infants: a new contraindication to rotavirus vaccine

A new contraindication has been added in the list of contraindications to rotavirus vaccine. According to the Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA)–approved prescribing information and patient safety labeling, infants with severe combined immunodeficiency (SCID) should not be given either the monovalent (RV1) or pentavalent (RV5) rotavirus vaccine as they may cause vaccine-acquired infection. The report is published in the June 11 issue of Morbidity and Mortality Weekly Report

Bioidentical hormones may not be more effective than traditional treatments

Dr Nanette Santoro, chair of the department of obstetrics and gynecology at the University of Colorado Health Sciences Center in Denver and vice president of clinical science for the Endocrine Society says that there is no evidence that bioidentical hormones are any safer or more effective than traditional treatments. Bioidentical hormones have an obvious appeal to women in quest of relief from menopausal symptoms as they do not suffer from side effects associated with the synthetic hormones such as depression and weight gain, as well as an increased risk of breast cancer and heart disease.

Don’t make these five common mistakes (health insurance): Dr G M Singh

Mistake No. 1: You don’t choose.
Mistake No. 2: You assume your boss will pay for your family’s care.
Mistake No. 3: You’re oblivious to your healthcare needs.
Mistake No. 4: You assume high–deductible plans are always a bum deal. Mistake No. 5: You volunteer to get taxed on your health care.

Robotic surgery better (Dr N P Gupta)

Complications of robotic radical prostatectomy are significantly less in comparision to open Radical Prostatectomy. (Carlsson stefan et al. Urology, 2010 May;75(5):1092–1099). Between January 2002–August 2007, 1738 consecutive radical prostatectomies were done for localized cancer prostate, robotic radical prostatectomy (RARP) was done in 1253 cases and open radical prostatectomy in 485 cases. In RARP, there is decreased number of patient with Clavien grade IIIb–V complications such as bladder neck contractures, a decreased number of patients required blood transfusions, and decreased number of patients with post operative wound infections.

eMedinewS on the Net

Red chili has been found good in reducing bad cholesterol and increasing good cholesterol. Click below to read:
http:// www.mynews.in /News /Red_Chili_is_Good_for_Healthy_Heart_N61448.html

Interesting tips in Hepatology & Gastroenterology (Dr. Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant physician Sir Ganga Ram Hospital – Delhi)

Yesterday I wrote on Who needs a liver transplant?

Where does one get liver for transplantation from ?

There are two options for liver transplantation: 1. Cadaver Donor Transplantation 2. Living Donor Transplantation.

Cadaveric donor transplantation: Liver is used from a brain dead person for cadaveric transplantation. However the family of the brain dead person has to volunteer to donate organ for transplantation.

Dr k k Aggarwal

What’s Brain dead?: Irreversible cessation of brain stem function with irreversible damage to the vital centres in the base of the brain, leading to loss of the capacity for consciousness, loss of the capacity to breathe and loss of the capacity to repair damaged tissues and cells, is called brain stem death. After onset of brain stem death, the individual’s heart stops beating within hours to a few days, even if full medical support like ventilator and drugs are continued.

Living donor transplantation: A living person donates a part of his/her to the recipient.

Types of graft

  • Whole graft: The entire graft is transplanted in the recipient. Obviously a brain dead persons liver can only be used as a whole graft.

  • Split graft: The shortage of suitable organs for young children led to development of split livers. The liver of the cadaveric donor is divided and used for two patients usually the right lobe for adults and left lobe for children.

  • Reduced graft: When only a part of the cadaveric liver (i.e. right/ left/left lateral part) is used for the recipient

  • Auxiliary liver transplant: The term auxiliary liver transplant is referred when a part of the donor liver (usually segments 2+3) is implanted beside or in continuity with the native liver. The main purpose of this form of liver transplant is to ensure that the native liver is retained in the event of graft failure or for the future development of gene therapy. Auxiliary transplant is now accepted therapy for Crigler–Najjar syndrome type I and also for propionic acidemia and ornithine transcarbamalase deficiency. The role of auxiliary liver transplant in the management of fulminant hepatic failure is more controversial. The rationale for using this technique in this condition is that, with time, the native liver may regenerate. Two recent studies in adults demonstrated that the native liver regenerates in approximately half of the patients.

A living related donor’s graft could either be right lobe / left lobe /left lateral lobe.

Liver is the only organ in body which Regenerates. Therefore one can donate a part of his/her liver and the healthy liver would

For any queries GI & liver related contact Dr Neelam Mohan on drneelam@yahoo.com

Tomorrow I shall write on "How can a person donate liver ?

Conference Calendar

GCLP 2010
Workshop on "Good Clinical Laboratory Practices"
Date: June 18–20, 2010
Venue: Ticel Bio–Park, Taramani, Chennai, Tamil Nadu.

Quote of the day (Dr Santosh Sahi)

"Hard work is a investment. The more you invest in terms of hard work, more is the profit you earn in term of success." Koyel Shee

Evidence based Medicine

Breaking News {DR NP SINGH (Nanu), Professor of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital}

Gout drug benefits kidney disease patients: Allopurinol helps kidney function and cuts heart risks

Allopurinol, a gout drug may help maintain health of patients with kidney disease, according to an analysis appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The research is the first to show that allopurinol treatment in patients with chronic kidney disease (CKD) decreases inflammation, slows the progression of kidney disease, and reduces patients’ risk of experiencing a cardiovascular event or being hospitalized.

Allopurinol is a drug used primarily to treat individuals with excess uric acid in their blood (hyperuricemia). (The agent inhibits an enzyme involved in the production of uric acid.) Hyperuricemia can lead to gout and, in extreme cases, kidney failure. Elevated uric acid levels in the blood may also increase one’s risk of developing hypertension and heart disease. Patients with CKD – who most often die from heart disease - often experience hyperuricemia because of decreased uric acid excretion in the urine; however, studies have not looked at the benefits of allopurinol in these individuals.

To investigate, Marian Goicoechea, PhD, Jose Luño, MD (Hospital General Universitario Gregorio Marañón, in Madrid, Spain) and their colleagues conducted a prospective, randomized trial of 113 CKD patients who received either allopurinol (100 mg/day) or who continued taking their usual therapy. The researchers assessed kidney disease progression, cardiovascular events (such as heart attacks), and hospitalizations among patients in the study over two years.

The blood levels of uric acid and C-reactive protein (a marker of inflammation) significantly decreased in patients treated with allopurinol. In the control group, kidney function declined after two years, but in the allopurinol–treated group, kidney function improved. Allopurinol treatment slowed down kidney disease progression regardless of patients’ age, gender, and diabetes status; their blood levels of uric acid and C–reactive protein; the amount of protein patients lost in the urine; and the other types of medications patients used. In addition, compared with usual therapy, allopurinol treatment reduced the risk of cardiovascular events by 71% and the risk of hospitalizations by 62%.

While allopurinol has significant potential benefits for CKD patients, these results have to be confirmed in larger prospective trials and are the basis for a hypothesis that still needs to be tested.

This article, "Effect of Allopurinol in Chronic Kidney Disease Progression and Cardiovascular Risk," appeared online at http://cjasn.asnjournals.org/ on June 10.

eMedinewS Comments: We have been using Allopurinol for all patients with metabolic syndrome and acute MI with borderline high uric acid levels.

Question of the Day (Dr Shabina Ahmed)

How much does a child need to sleep?

1 – 3 months
4 – 6 months
7 – 9 months
10 – 12 months
2 – 3 years
4 – 5 years
6 - 7 years
8 – 13 years

14.4 hours
13.2 hours
12.7 hours
11.8 hours
12.5 hours
11.5 hours
11 hours
11 decreasing to 9 hours

MedinewS Try this it Works

How much Viagra?

The recommended dose of sildenafil citrate (Viagra) is 25 to 100 mg, taken at least one hour before anticipated sexual intercourse and not exceeding once in 24 hours. However, many patients with mild erectile dysfunction find that a smaller dose (6.25 to 12.5 mg) is sufficient.

Get 100–mg tablets. Use a pill cutter to divide each 100 mg tablet into eight pieces and increase the dose by one eighth of a tablet at least 24 hours apart to determine the dose needed to achieve a satisfactory erection.

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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–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 .

 

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Dr Good Dr Bad

Situation: A female with past history of DVT needed a OC prescription.
Dr Bad: Start OC patch (transdermal).
Dr Good: You cannot be on OCs.
Lesson: There is a possibility of an increased risk of venous thromboembolism in oral contraceptive patch users.

Make Sure

Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on bimanual palpation.
Reaction: Oh my God! You should do cervical swabs and consider starting antibiotics.
Lasson: Make sure to remember that women with such symptoms may have endometritis, which requires prompt diagnosis. It may respond to doxycycline and metronidazole.

Humor Section

IMANDB Joke of the Day (Dr Tarun)

Bigamy

What is the penalty for bigamy? Two mothers–in–law.

Funny Definitions

Neurotic – a woman who likes a psychiatrist’s couch better than a double bed

Formulae in Clinical Practice

Lean body weight (LBW)

The drug dose for many drugs is calculated per kilogram of body weight. The formulas below can be used to estimate the LBW from the patient’s height. The. lesser of the actual or LBW should generally be used for drug dosing.

Formula for males: LBW (kg) = {0.73 × height in cm} – 59.42 LBW (kg) = 50 ± {2.3 × each inch above or below 5 ft

Milestones in Gabapin

1995: Mellick et al reported role of gabapentin in the management of Complex Regional Pain Syndrome type one (CRPS I) or formerly Reflex Sympathetic Dystrophy (RSD).

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Urine cytology

Examining a urine sample under a microscope may reveal cancer cells that could come from the bladder, ureters or kidneys. This is an important screening test.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Doxyphylline 400 mg + Terbutaline 5mg tablets

For the treatment of asthma and chronic obstructive pulmonary disease in adult patients only

23.02.09



Public Forum (Press Release for use by the newspapers)

Nine modifiable risk factors for heart attack

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, daily consumption of fruits and vegetables, regular alcohol consumption, and regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10–year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one–half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

(Advertorial section)

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli 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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Response

Open letter to MCI Board of Governors
Dr Ch. Srinivasa Raju, N.R. Pet, Eluru–534006

To The governing council members, MCI
Sub: Recognize all PG clinical diplomas as requisite PG qualification to allow them as teaching faculty of their respective branch.

Respected sir, Indian medical education system has been producing number of PG MEDICAL DIPLOMA HOLDERS IN ALL CLINICAL and para–clinical SUBJECTS. According to MCI regulations,these diploma holders have no eligibility to be promoted as assistant professor except as tutosr as like any other MBBS graduate. These diploma holders are usually doing private practice or doing some tutor jobs at par with MBBS graduates, in medical colleges.

If these diploma holders cannot be permitted as faculty in their respective departments, why is our MCI promoting these post graduation diploma courses? Nowadays, a dearth of teaching faculty is plaguing all medical colleges in our country. MCI is allowing non–medical post graduates(M.Sc) in some clinical and para-clinical departments. But why this discrimination towards clinical PG diploma holders? There is only one year difference of study between PG degree and diploma.

As per the Indian Medical Council Act – Dated the November, 1998 No. MCI–12(2)/98–Med./ In exercise of the powers conferred by section 33 of the Indian Medical Council Act, 1956 (102 of 1956), the Medical Council of India, with the previous sanction of the Central Government, hereby makes the following regulations, namely:– "Minimum Qualifications for Teachers in Medical Institutions Regulations, 1998." And this was amended as –

The Principal Regulations namely, "Minimum Qualifications for Teachers in Medical Institutions Regulations 1998" were published in Part – III, Section (4) of the Gazette of India on the 5th December, 1998, and amended vide MCI notification dated 16/03/2005, dated 21/07/2009 and dated 28/10/2009.

As per SCHEDULE –I, Medical teachers in all Medical Colleges except the Tutors, Residents, Registrars and Demonstrators must possess the requisite recognized Postgraduate Medical qualification in their respective subject. In case of the paucity of teachers in non–clinical departments, relaxation upto the Head of the Department may be given by the appointing authority to the non–medical persons if suitable medical teacher in the particular non–clinical specialty is not available for the said appointment. However, such relaxation will be made only with the prior approval of the Medical Council of India. In cases where candidates with requisite experience are not available, a reference may be made by the appointing authority to the Medical Council of India for consideration on merits. So to become eligible as assistant professor in medical college one has to fulfill the following criteria. (i) Requisite recognized postgraduate qualification in the subject. (ii) Three years teaching experience in the subject in a recognised medical college as resident/ Registrar/Demonstrator/ Tutor.

Our request is to recognize all clinical PG diplomas as requisite PG qualification to allow them as teaching faculty of their respective branch. It will solve the problem of dearth of teaching faculty as well as the travails of the diploma holders. The MCI can allow these diplomas to be promoted as assistant professors after working as tutor for 5 yrs. in teaching institution. We hope that this new governing body will think into this matter with broad mind and practicality to safeguard the clinical PG diploma holders and to improve the quality of medical education. Dr.ch. srinivasa raju; Hony. National joint secretary –IMA–H.Q.