emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; 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


15th August, 2010, Sunday

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

Happy Independence Day

I extend my best wishes to all my fellow citizens on this 63rd Independence Day.

August 15 is celebrated each year as it was on this day India attained freedom from the British Rule. It is a matter of great pride for us all.

But, why should we still be so preoccupied with British slavery and earmark Aug 15 as a reminder of our days under the British Rule.

Let us celebrate our "Independence Day" as a day to eradicate several issues that ail our country.
15th August should not just be a reminder of independence from the British but also a commitment on a yearly basis to eradicate one more disease or other problems faced by our country. In the health front "The International Task Force for Disease Eradication" in 1992 identified six eradicable or potentially eradicable infectious diseases:  dracunculiasis, poliomyelitis, mumps, rubella, lymphatic filariasis, and cysticercosis. In 2002, measles was added to this list. Of these only guinea worm disease dracunculiasis has so far been eradicated from India after the independence.

For the year (15th August 2010 to 15th August 2011) the eradication issues can be,

  1. Can we streamline MCI issue?
  2. Can we streamline the issue of capitation fees  in DNB?
  3. Can we eradicate polio from India?
  4. Can we target 100% institutional deliveries in India?
  5. Can we make guidelines for preventing hospital acquired infections in the Country?
  6. Can we integrate research in Allopathy and Indian System of Medicine?

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature

Mr Atal Bihari Vajpayee was the chief guest during Perfect Health Mela 1995 organized by Heart Care Foundation of India. He addressed the crowd and distributed awards to the winners of various competitions.

In the photo: Former Prime Minister Mr Atal Bihari Vajpayee. Also in the photo: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI. 

Dr 

k k Aggarwal

 

News and Views

New NIH website offers easy access to information on bone health

A new Web resource providing people with the latest science–based information on bone health and bone disease is available through the NIH Osteoporosis and Related Bone Diseases ˜ National Resource Center (NRC). The site is www.bones.nih.gov. Red flag signs for suspected meningococcal disease 

Symptom Positive likelihood ratio

• Leg pain 7.6
• Cold hands or feet 2.3
• Photophobia 6.5
• Neck pain/stiffness 5.3
• Confusion 24.2
• Rash 5.5
(Source: Haj–Hassan et al, SAPC 2010 abstract 2a3)

Allergy Update

  1. Very few, if any, vacuum cleaners reduce the allergen load. In effect it is extremely difficult to avoid the allergens that cause allergic rhinitis. Covering pillows and matresses, replacing carpets with hard flooring and taking down curtains rarely give any long-term benefit. 
  2. If there is difficulty in differentiating between allergic and non-allergic rhinitis on history, skin prick testing using a standard battery of allergens including pollens, pet fur and dust mites, will inform whether the patient is atopic. If they are not atopic it is very unlikely that the patient has allergic rhinitis.
  3. A report in the American Journal of Respiratory and Critical Care Medicine says paracetamol has not been proven to cause asthma, but there was a 'significant association'.

    (Contributed by Dr GM Singh)

NIH study indicates stress may delay pregnancy

A study by researchers at the National Institutes of Health and the University of Oxford supports the widespread belief that stress may reduce a woman’s chance of becoming pregnant. The study is the first of its kind to document, among women without a history of fertility problems, an association between high levels of a substance indicative of stress and a reduced chance of becoming pregnant.

Women who had higher levels of a substance called alpha-amylase were less likely to get pregnant than were women with lower levels of the substance. Alpha-amylase is secreted into saliva by the parotid gland. Although alpha–amylase digests starch, in recent years many researchers have used it as a barometer of the body’s response to physical or psychological stress. The substance is secreted when the nervous system produces catecholamines, compounds that initiate a type of stress response. The study was published online in Fertility and Sterility.

NIH Senior Health site offers information about older adults and alcohol use

Aging lowers the body’s tolerance for alcohol, and older adults can develop problems with alcohol even though their drinking habits haven’t changed. "Older adults can experience the effects of alcohol, such as slurred speech and lack of coordination, more quickly than when they were younger," says Kenneth R. Warren, Ph.D., acting director of the NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA). Checkout the site http://nihseniorhealth.gov/alcoholuse/toc.html

 

Legal Column

Forensic Column (Dr Sudhir Gupta, MBBS (Gold Medal), MD (BHU), DNB, MNAMS, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

WMA declaration of Malta on hunger strikers

Such difficult ethical situations in medical practice and the guidelines to deal with them have been addressed thoroughly in the revised WMA Declaration of Malta on hunger strikers with principles of Duty to act ethically, in 2006. All physicians are bound by medical ethics in their professional contact with vulnerable people, even when not providing therapy. Whatever their role, physicians must try to prevent coercion or maltreatment of detainees and must protest if it occurs. The other important component is respect for autonomy. Physicians should respect individuals’ autonomy. This can involve difficult assessments as hunger strikers’ true wishes may not be as clear as they appear. Any decisions lack moral force if made involuntarily by use of threats, peer pressure or coercion. Hunger strikers should not be forcibly given treatment they refuse. Forced feeding contrary to an informed and voluntary refusal is unjustifiable. Artificial feeding in form of intravenous fluid/nutrition with the hunger striker's explicit or implied consent is ethically acceptable.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Chronic Pancreatitis

The causes of non calcific chronic pancreatitis are as follows:

• Traumatic stricture
• Pancreatic divisum
• Sphincter of Oddi dysfunction (SOD)
• Gall stone pancreatitis
• Fibrosing pancreatitis
• Sclerosing cholangitits
• Autoimmune pancreatitis
• Miscellaneous

- Inflammatory bowel disease, Coeliac disease 
- Alpha 1 trypsin deficiency 
- Radiation 
- Henoch Schonlein Purpura (HSP)  
- Systemic lupus erythematosis, Sjogren’s syndrome 
- Drugs

Question of the day

How much fiber should I have in my daily diet, and what are the five best sources?

The National Academy of Sciences recommends 25 to 38 grams of fiberes for adults below 50 years and 21 to 30 grams for those above 51 years. One way to calculate your fiber needs is to look at your calorie intake. You should have at least 14 grams of fiber for every 1,000 calories you eat. So if you eat about 2,000 calories a day, you would need about 28 grams of fiber.

 

Public Forum (Press Release for use by the newspapers)

Don’t Ignore Early Morning Chest Pain

Don’t ignore early morning chest pain as most fatal heart attacks occur early in the morning," 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.

Dr. Aggarwal said that most heart attack occur in the first three hours of getting up, more during full moon period and during winter.

A heart attack can present with chest pain, discomfort, heaviness or burning in the center of the chest lasting for minutes, always more than 30 seconds, which is diffuse in nature and never localized.

A discomfort, which lasts less than 30 seconds and which can be pinpointed with a finger, can be ignored as a non–cardiac chest pain. A burning in the chest occurring at 2 O’clock in the night may be due to acidity but any acidity occurring for the first time in life after the age of 40 years, should be considered cardiac in origin unless proved otherwise. Similarly, any breathlessness appearing for the first time in life after the age of 40 years is cardiac in origin unless proved otherwise.

Chewing a tablet of aspirin at the onset of cardiac chest pain can reduce chances of cardiac death by 22%.

All chest pain patients should be promptly taken to the nearest cardiac hospital as timely clot–dissolving therapy or clot removing angioplasty can practically cure a patient. The life saving window is to reach hospital within three hours.

Elaborating further he said that the three investigations required for evaluation of a chest pain should be available in the set up of every doctor who handle patients with chest pain and these include ViScope, an audio–visual auscultation device, ECG machine for diagnosing acute heart attack and echocardiography machine for early detection of heart attack.

ECG can often detect abnormal sounds in first six hours of heart attack but with a ViScope it is always possible to detect abnormal sounds during chest pain. Angiography is the gold–standard investigation if a patient with chest pain comes within three hours as it can help removing the clot by primary angioplasty.

 

Conference Calendar

Central and Arterial Line Training (CArT)

Date: August 17, 2010
Venue: V–70 (Old No. 89), Fifth Avenue, Anna Nagar, Chennai, Tamil Nadu.

 

Dr K K Aggarwal in the news

Press Cliping of 2nd BSNL Dil Ka Darbar 2010
 
Published in DLA am/ Agra, August 12, 2010
Pls click on the following link click here

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An Inspirational Story

On a British Airways flight from Johannesburg, a middle–aged, well–off white South African Lady has found herself sitting next to a black man.

She called the cabin crew attendant over to complain about her seating.

"What seems to be the problem Madam?" asked the attendant.

"Can't you see?" she said" You’ve sat me next to a kaffir. I can’t possibly sit next to this disgusting human. Find me another seat!"

"Please calm down Madam." the stewardess replied. "The flight is very full today, but I'll tell you what I'll do-I'll go and check to see if we have any seats available in club or first class."

The woman cocks a snooty look at the outraged black man beside her (not to mention many of the surrounding passengers). A few minutes later the stewardess returns with the good news, which she delivers to the lady, who cannot help but look at the people around her with a smug and self satisfied grin:

"Madam, unfortunately, as I suspected, economy is full. I’ve spoken to the cabin services director, and club is also full. However, we do have one seat in first class."

Before the lady has a chance to answer, the stewardess continues…

"It is most extraordinary to make this kind of upgrade, however, and I have had to get special permission from the captain. But, given the circumstances, the captain felt that it was outrageous that someone be forced to sit next to such an obnoxious person."

With which, she turned to the black man sitting next to the woman, and said:

"So if you'd like to get your things, sir, I have your seat ready for you…"

At which point, apparently, the surrounding passengers stood and gave a standing ovation while the black man walks up to the front of the plane.

Remember:
people will forget what you said…
people will forget what you did…
but people will never forget how you made them feel …

 

IJCP Special

Dr Good Dr Bad

Situation: A diabetic elderly came with low HDL levels.
Dr Bad: In elderly it is of no significance.
Dr Good: It is an important risk factor.
Lesson: Lower HDL cholesterol is an important risk factor for not only IHD but also CVD, especially in diabetic elderly individuals. (Diabetes Care 2009;32(7):1221–3.)

Make Sure

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

Quote of the Day

"The World suffers a lot sometimes not from the violence of the bad people but because of the silence of the good people." Napoleon

Are you fit to fly?

All patients preparing for air travel should be counseled on

  1. Adjusting the timing of their medicines (especially if crossing time zones)
  2. Keeping unexpired medicines with them in carry–on luggage (preferably in their original, labeled containers)
 

International Medical Science Academy Update (IMSA)

Vesicoureteral reflux

In a retrospective study of 2462 patients with primary vesicoureteral reflux (VUR) diagnosed between 1998 and 2006 from a single tertiary center, VUR resolved spontaneously in 51 percent of patients by a mean duration of two years. Factors associated with spontaneous resolution included age of diagnosis under one year of age, lower grades of VUR, prenatal hydronephrosis, and unilateral involvement.

Reference

  1. LiST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics 2010;125:26.
 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Ketorolac Tromethamine Ophthalmic Solution 0.45%.

In combination with other approved anticancer drugs is indicated for remission induction in acute non–lymphocytic leukemia of adults and children. It has also been found useful in the treatment of acute lymphocytic leukemia and the blast phase of chronic myelocytic leukemia. Intrathecal administration of cytarabine is indicated in the prophylaxis and treatment of meningal leukemia.

10–Feb–10

 

Medi Finance

Q. Is there any provision if 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

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

ADH

Also known as: Antidiuretic Hormone; To help detect, diagnose, and determine the cause of antidiuretic hormone (ADH) deficiency or excess; to investigate low blood sodium levels (hyponatremia); to distinguish between the two types of diabetes insipidus.

 

Lateral thinking

Read this………………

HE'S/HIMSELF

The answer for yesterday’s puzzle "Lucky break"

Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr Ashok Wasan, Dr Singh Simran, Susheela Gupta, Dr. Naorem Sharat

Correct answer received for 13th August Puzzle from: Dr Sunita Kalra, Dr Anupam Sethi Malhotra, Dr Ashok Kumar, Dr Alok Deb, Dr.R.K.Goel, Dr Vijay Kansal

Correct answer received for 12th August Puzzle from: DR. RohinI Dhillon, Dr Anupam Sethi Malhotra, Dr Raju Kuppusamy

Send your answer to ijcp12@gmail.com

 

Humor Section (Dr Jagjit Singh)

Jokes

Medical or Surgical?

Conversation between two small boys in the children’s ward of a hospital:
"Are you medical or surgical?"
"Gee, I don’t know what you mean by that."
"Well, were you sick when you came in, or did they make you sick after you got here?"

Funny One Liner (Dr Jagjit Singh)

Your daddy must be a terrorist because you’re a BOMB!

Scenario (Dr Chandresh Jardosh

Johnny and Mark get into a fistfight after school.
1957 - Crowd gathers. Mark wins. Johnny and Mark shake hands and end up buddies.
2009 - Police called, arrest Johnny and Mark.. Charge them with assault, both expelled even though Johnny started it. Both children go to anger management programs for 3 months. School board hold meeting to implement bullying prevention programs.

 

Anouncements/Obituary

Dr Neelam Mohan, Director Dept. of Pediatric Gastroenterology Hepatology and Liver Transplantation, Medanta Medicity has lost her mother, Mrs Sudha Wadhi, on 13th August, 2010. Uthala Ceremony will be conducted on 16th August at Abids Function Hall, Tilak Road, Hyderabad from 2 PM to 4 PM.

eMedinewS extends its condolences to the bereaved family...

 

 Readers Responses

  1. Sir, I am Dr Ajay Gandhi here (S.r. surgery). I am very thankful to you for a good thinking to create a daily medical letter and for a continuously approaching toward education.  Sir I want through this paper to message medical council to think about common entrance foe D.M./M.Ch. exam also. i hope through this column my message can reach to MCI

  2. Thanks, My dear respected sir, Dr KK Aggrawal ji, I am very happy to read the editorial of 14 th August 10, that once again the body of Padma awardees is thinking of pooled research. It also talked about the rural brain who cannot come to a metro without English update, a poor C V presentation & lack of the recommendation with others. Many such student cannot utilize the brain power up to standard labs. We have huge population which had given us   Viveka Nanda, Achrya Ramanuj, Arryabhatta, CV Raman etc. I may be wrong but BRAIN POWER IS YET IN my INDIA. ....yours  Dr KP Singh Fortis Escorts.

  3. Dear sir, I wanted to know regarding the status of the DNB board after the dissolution of MCI. Is it also undergoing some radical changes if so what are the new likely changes. Dr Mitalee

  4. IMA has opposed the clinical establishment bill. The doctors in last two months had protest rallies and dharna at district level all over the country. Doctors feel that this bill is against the poor people, as this will increase the cost of treatment.  IMA is highly thankful to the members of Rajya Sabha who have expressed the sentiments of the doctors and opposed this bill. Most of the members of the Rajya Sabha said that this bill will give wide scope to the - bureaucrats and will lead to harassment of the doctors.  Smt. Brinda Karat said that there is nothing about the regulation of the hospitals in the bill. There are number of loopholes so that the regulatory mechanism is diluted. For eg Yoga is also included, which means all the Yoga tutors will be registered. This Bill is only a bureaucratic measure just to ensure registration and to allow regulation of the private sector  to remain as untamed as it is.  SHRI AVTAR KAREEM PURI (UTTAR PRADESH) He said it is highly objectionable that this bill will include a single doctor clinic to big hospitals. He said this bill will promote corporate sector . Under these regulations the treatment will become costly and it will also create unemployment among the doctors as they will fear to open the clinics and hospitals. This will promote inspector raj and corruption.  SHRI AVINASH RAI KHANNA (PUNJAB) : He said the name of the bill should be "registration suggestion" bill. He added that health is a state subject. He further said that the medical services are covered under 43 acts and consumer protection act. So this bill will promote licence raj and inspector raj. He also said that this important bill was passed in Lok Sabha in 3 minutes, but today some members has opposed this bill and some have given some suggestions. So he proposed that this bill should be reverted back to Lok Sabha and there should be discussion by the member and the experts.  SHRI BHARATKUMAR RAUT (MAHARASHTRA): This Bill -- though well- intended -- because of the form in which it has been brought forward, would be a non-starter. This is basically because public health is a State Subject and if it was left to the States to implement it, it would have been more effective.
    There is another thing which was mentioned already but I would like to reiterate that for the District Registration Authority, the District Collector should be the chairperson. The District Collector, with all due respect to all Civil Servants, are babus and are Civil Servants. What is their expertise in medicine? Should he be there only because he is a District Collector? He or she, as the District Collector, should be the facilitator. If you could appoint the District Health Officer or the Dean of the local medical hospital as the chairperson of the District Registration Authority, then, that would serve more purpose. A District Collector would only be an administrator and not a medical person.
    Some of the members said, that there is no clarification on the inspection .This will further open a pandora s box and loopholes in the implementation of this Bill can lead to corruption.
    Friends, the Bill which was passed in two minutes in Lok Sabha ,was discussed by eighteen representatives of almost all the parties for more than three hours in Rajya Sabha and passed by vote of voice on 3.08.10.Now this Bill will get stamp of President ,this later will be notified in the Gazette as Act  and Rules will be framed.
    IMA national leaders and members has a role to think and ponder for any possible legal course of action due to following reasons:1. Doctors already covered under MCI, CPA, AND others,so this CLE  will be just a duplication of Acts.2. In this era of deregulation, How the Minister has given assurance in Rajya Sabha to fix the rates of charges of the hospitals for different procedures3. In last more than one decade the doctors were harassed under CPA and PNDT, now the Supreme Court judgements has rectified the fancies in these Acts. So we do not want that some wrong rules are framed under this CLE Bill.4. Minister has himself said in his speech in Rajya Sabha , that this Bill is not a complete document and has loopholes. How this can be a national Bill then? Regards Dr Yash
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long 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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