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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


16th May, Sunday, 2010

MCI finally dissolved

MCI finally got dissolved today. An ordinance dissolving the scam-tainted MCI was signed by President Pratibha Patil and notified by the Law Ministry. With that was the end of Dr Ketan Desai’s  era in MCI. As expecetd his resignation as president MCI was finally not accepted as his tenure ended with the dissolution of the council.

While there is a provision for a board of seven members, the Centre announced six members including the chairperson. The Board of Governors will be chaired by Padmabhushan Awardee Dr. S.K. Sarin, Department of Gastroenterology, G.B. Pant Hospital. The other members are: Dr. Devi Shetty of Narayana Hrudayalaya in Bangalore; Dr. Gautam Sen, former Dean of the J.J. Hospital Mumbai; Dr. Sita Nayik of Sanjay Gandhi Post Graduate Medical Institute in Lucknow; Padmashri Awardee Dr. Ranjit Roy Chowdhury, clinical pharmacologist and Emeritus Scientist at the National Institute of Immunology, and Dr.R.N. Salhan, Dean of Sikkim-Manipal University. The seventh seat is vacant as one of the members refused and did not accept the invitation.
 

Dr Sarin is currently the Director Professor of Gastroenterology at the G B Pant Hospital in the capital. He is an AIIMS alumnus and has been in several other Government panels. The panel will be in charge till the next one year.

The national IMA, sleeping uptil now and reacted (but late) and tried to oppose the government move by a last minute hurriedly called press conference without taking the state branches into confidence. On the other hand the state branch of IMA, Delhi Medical Association welcomed the move and gave assurance to the newly elected body all its possible assistance.

The Government will bring in a new law for the formation of an overarching body to regulate medical education in the country.  A draft law for the formation of such a body will be formulated within a month. The draft law will be a legislative response to the credibility crisis which the MCI was in. The other option was to bring in an amendment to the MCI Act of 1956 to give Government some power in the regulatory body.
 
Act amended: Amending the Indian Medical Council Act, 1956, the government has inserted Article 3 (a) through the ordinance that authorises the government to intervene in matters of “national policy.” In case of a dispute over “national policy,” the view of the government will prevail. The ordinance will be in effect for one year. The original 30 member executive body will become functional again, if the government does not dissolve the MCI. However, in all probability the government will split the MCI with medical education falling within the purview of the National Commission for Higher Education and Research as proposed by the Ministry of Human Resource Development and the licensing part going with the National Council for Human Resources in Health being piloted by the Ministry of Health and Family Welfare.
 

MCI president Ketan Desai was arrested on April 22 by Central Bureau of Investigation (CBI) for allegedly accepting a bribe of Rs 2 crore to give permission to a Punjab medical college to recruit a fresh batch of students without having requisite infrastructure.
 
The problem for Dr Desai continues. It is heard that world medical association, of whom he is the president elect is also having its emergency executive council meeting on this subject.

 

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Abdul Kalam recipient of first Fortis Oration

Giving the first Fortis oration on "multi dimensions of health care and India in 2020" at Hotel Grand New Delhi, former President of India Dr Abdul Kalam said that the qualities of a doctor should be generosity, pure ethics, tolerance, perseverance, pure concentration and intelligence.

At the age of 78, Dr Kalm looks like in sixties., He said his mother lived up to 93, father up to 103 and grandparents all above 90. He said his parental teaching has been to keep 'giving'  even when you have "nothing with  you" and keep walking for the maintenance of health. He is in habit of walking upto tem kilometers a day. For the last 50 years he is a convert vegetarian and does prayer Namaz regularly. 

The oration, attended by over 300 eminent persons of the city, was introduced by Shivinder M. Singh CMD Fortis healthcare and. Dr Bhavdeep Singh CEO also spoke on the occasion.
 

In the news

 PPIs increase risk of bone fracture and bacterial infection

Around 119 million PPI (proton pump inhibitors) prescriptions last year were from the United States alone, making them a part of the third-largest selling group of medications. In patients with less severe disease, the risks of taking PPIs may outweigh the benefits. Many studies published in the journal Archives of Internal Medicine, have reported on the side effects caused by PPIs including an increased risk of bacterial infection and bone fracture.

1. A research from the University of Washington examined at 161,806 postmenopausal women who were enrolled in the Women's Health Initiative and had no history of hip fracture. About 21,247 bone fractures were reported over eight years of the study. Even though participants taking PPIs had no greater risk for hip fracture vs women not on PPIs, the risk of spine fractures increased by 47%, forearm or wrist fractures by 26% and other fractures by 25%.

2. Analysis of data from more than 100,000 patients discharged from Boston Medical Center over a period of five years showed an increased risk of C. difficile infection by 74% with daily intake of a PPI. Patients who took the PPI for a longer duration doubled their risk of developing this infection. For every 533 people taking proton pump inhibitors there is about one added case of C. difficile infection. Also the use of PPIs was associated with a 42% increase in the risk of recurrent C. difficile infection. Patients above 80 years of age and those receiving antibiotics not targeted to the bacterium had the greatest risk.

3. Taiwanese researchers showed that treatment with high-dose PPI is no more effective than lower doses for controlling bleeding ulcers.

 

 

Photo Feature (From HCFI file)

Involving Film Stars

Film star's  involvement plays a key role in attracting media and to draw–in a huge crowd. Involvement of a film star is a time tested module for health awareness used by Heart Care Foundation of India. Many stars like, latet. Sh. Amrish Puri, were regularily  involved to release  health messages. 

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Prostate cancer

Back–to–back studies have detailed the efficacy of screening for prostate cancer. (N Engl J Med 2009;360;1310–1320 and N Engl J Med 2009;360;1320–1328)

 

DMC Update

Can an unregistered complaint be considered?

No: An unsigned complaint from Shri AD an Advocate on behalf of his client Dr. VG and Shri VK New Delhi, alleging medical negligence on the part of Dr. M and Dr. NS was received. Being unsigned, it was not entertained.

News and Views

Lack of clear criteria for diagnosing food allergies

A review published in the May 12 issue of JAMA has found that a lack of consensus about the diagnostic criteria for food allergy. The differing definitions of food allergy increase the likelihood of misdiagnosis of the condition. Food allergies can manifest in various ways, ranging from mild skin rashes to the life–threatening anaphylaxis.

Fatty acid to enhance anticancer drug

Bioavailability and therapeutic efficacy of azacytidine increase when it is coupled to a fatty acid. This was reported by researchers at the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ). Azacytidine is used in management of blood cancer. The study is published in May 2010 issue of Molecular Cancer Therapeutics.

Taking care of partners with dementia may take its toll on caregivers

Results of a 12–year study state that husbands or wives who care for spouses with dementia have 6–fold higher chances of developing dementia as compared to those whose spouses do not have it. The study examined more than 1000 married couples aged 65 years or older. This enhanced risk among caregivers was similar to a gene variant which makes one vulnerable to Alzheimer’s disease. (May 2010 issue of Journal of the American Geriatrics Society)

Non-cardiac surgery too soon after stenting increases heart problems

Scottish researchers have found that patients who can postpone non–cardiac surgery for at least six weeks after receiving a coronary stent are less likely to suffer decreased blood flow to the heart, heart attack and death vs those who undergo surgery earlier. They found that 42% of patients undergoing non-cardiac surgery within six weeks of stent implantation were at greater risk of developing serious heart complications compared to 13% of those who underwent surgery beyond this time period.

Quote of the Day (Paramjeet Chadha)

Attitude that one needs to develop:
When Snake is alive, Snake eats Ants.
When Snake is dead, Ants eat Snake.
Time can turn at any time.
Don't neglect anyone in your life......

Mnemonics of the Day (Dr Prachi)

Causes of Hematemesis – GUM BLEEDING

Gastritis
Ulcer
Mallory–Weiss
Biliary (Haemobilia)
Large varices
Esophagitis
Entero–aortic fistula
Duodenitis
IBD
Neovascularisation
Gastric carcinoma

Question of the Day

What is the management of hypothyroidism in presence of ischemic heart disease?

Thyroid hormone has a direct influence on cardiac function. Thyroid hormone receptors are present on the nucleus of the cardiomyocytes. Tri–iodothyronin (T3) is transported to these receptors which then bind to the thyroid hormone response elements in target genes leading to protein synthesis. Apart from this genomic action, T3 also causes increased cardiac contractility through its effects on the sodium, potassium and calcium channels of the cardiac myocyte. In addition, T3 causes vasodilatation through its stimulatory action on synthesis and secretion of vasodilatory substances by the endothelial cells. Hence in hypothyroidism, there is decreased cardiac output, decreased heart rate and increased peripheral vascular resistance. These hemodynamic alterations result in the clinical features of bradycardia and mild diastolic hypertension with a narrow pulse pressure. There is a decrease in cardiac output, but there is no cardiac failure as there is a decreased metabolic rate. Thyroxine therapy reverses all these changes. In a patient with overt hypothyroidism and ischemic heart disease, thyroxine therapy would be beneficial in improving cardiac function. Chronic hypothyroidism is now considered as a risk factor for atherosclerosis as there is dyslipidemia, diastolic hypertension and increased inflammatory markers. The aim of treatment should be to give the smallest dose of thyroxine that maintains normal serum thyroid stimulating hormone (TSH).

Hence, it is advisable to start with a small dose of 12.5–25 µg/day of thyroxine (T4) and increase the dose every 6–8 weeks by 12.5–25 µg/day, till the 100 µg/day dose is achieved in frank hypothyroidism. At this time, estimation of TSH should be done and the dose modified as required. In mild hypothyroidism, TSH should be done when the dose reaches 50 µg/day before increasing the dose any further. Angina is likely to be worsened in one-fifth of patients, the rest may have no change or have an actual decrease in the anginal symptoms.

In patients with subclinical hypothyroidism, whether thyroid replacement is beneficial is a controversy yet to be resolved, especially as to what level of TSH actually needs treatment. A meta–analysis of patients treated with radioactive iodine ablation for thyrotoxicosis and followed up showed that subclinical hypothyroidism (TSH >5.0 mIU/l, with normal FT4) has an increased mortality from ischemic heart disease as compared to general population and recommended prompt treatment (JAMA 2005). The treatment should aim at keeping TSH <0.5 mIu/L and should in no event result in subclinical toxicosis.

The effect of hyperthyroidism on heart is exactly opposite to that of hypothyroidism. There is increase in the heart rate and cardiac output with a decrease in the peripheral vascular resistance. The increase in the rate and output can precipitate angina, myocardial infarction, arrhythmias or even heart failure, especially in patients with ischemic heart disease. Hence, sufficient care must be exercised during T4 therapy to make sure that the TSH is within the normal limits and not suppressed. (Padma S Menon)

Suggested reading

  1. Klein I, Ojamma K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001;344:501–9.

  2. Kenneth A. Woeber. Treatment of hypothyroidism. In: Werner and Ingbar’s The Thyroid. 9th edition, Braverman LE, Utiger RD (Eds.), Philadelphia: Lippincoat Williams & Wilkins 2004:864–9.

  3. Jayne AF, Michael CS, Patrick M. Thyroid function and mortality in patients treated for hyperthyroidism. JAMA 2005;294:71–80.

eMedinewS Try this it Works: Augmented Valsalva’s for PAT (Paroxysmal atrial tachycardia)

Valsalva’s maneuver efficacy can be increased by applying firm pressure to the right side of the hypochondrium during the expiration phase at the end of the maneuver. This increases the venous return to the right side of the heart and augments the effect on cardiac stretch receptors, thereby increasing the chance of successful arrhythmia termination.

Dr Good Dr Bad

Situation: A patient of hypertension comes for advice as his BP keeps fluctuating.
Dr Bad:
Don’t worry! these fluctuations are normal.
Dr Good: Keep it under control.
Lesson: For every 7.5 mmHg increase in diastolic BP, stroke risk increases by 46%.

Make Sure

Situation: An HIV patient died after sulfa prophylaxis.
Reaction: Oh my God! You should have known that he was sulfa–sensitive. Lesson: Make sure that patients with a history consistent with Stevens Johnson syndrome and toxic epidermal necrolysis or an exfoliative dermatitis due to a sulfonamide medication should strictly avoid the culprit drug and other agents in the same sulfonamide group. Re-exposure to the same agent may be fatal.

IMANDB Joke of the Day (Dr Tarun Gupta)

COMPENSATION

Isaac and Moses dined in a restaurant that was new to them, and were pained seriously by the amount of the check. Moses began to expostulate in a loud voice, but Isaac hushed him with a whisper:

"Sh! I haf the spoons in my pocket."

Formulae in clinical practice

TLC: Multiply the number of WBC per high power field by 5. This gives approximate TLC.

Myth of the Day: Dr Gurinder Mohan Singh

Myth: Eating carrots is good for the eyes.

Fact: There is some truth in this. Carrots, which contain vitamin A, are one of several vegetables that are good for the eyes. But fresh fruits and dark green leafy vegetables, which contain more antioxidant vitamins such as C and E, are even better. Antioxidant vitamins may help protect the eyes against cataract and age–related macular degeneration. But eating any vegetables or supplements containing these vitamins or substances will not prevent or correct basic vision problems such as nearsightedness or farsightedness.

Milestones in Medicine

1870–1945: Hugh Hampton Young, MD was an American urologist and medical researcher. His innovation was the "boomerang needle", a type of surgical needle designed for working with deep incisions. He also invented a device known as the Young punch, an instrument used in prostatectomy procedures.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Erythropoietin, also known as EPO

To help differentiate between different types of anemia and to determine whether the amount of erythropoietin being produced is appropriate for the level of anemia present.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Artesunate (25/50/100mg) + Amodiaquine (67.5 mg/135/270mg) bilayerd Tablets

For the treatment of uncomplicated malaria due to Plasmodium falciparum strain in various age groups

01.09.2009

MCI Update

Dr Ketan Desai, continues to be a member of Gujarat University's executive council. This despite the fact that Desai was suspended from the post of urology professor at BJ Medical College by the state government last week. As a registered graduate from GU's faculty of medicine, Desai, who was recently arrested by the CBI on corruption charges, is a member of the GU Court and had been elected to the executive council of the varsity on the seat of non-teaching members of court. Gujarat University vice chancellor Parimal on behalf of the university is seeking legal opinion on Desai's membership in the executive council and the university court before taking any decision in this regard.

 

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eMedinewS–Padma Con 2010

Will be organized at
Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

 
 

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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Public Forum (Press Release for use by the newspapers)

May 17 is World Hypertension Day

When you regularly change the oil in your car, and don't wait until it's performing poorly to change it, then why should you treat your body any differently.

On the eve of World Hypertension Day, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, said that cardiovascular disease (CVD) is the leading cause of death and hypertension is the most common, reversible risk factor for CVD. High blood pressure goes hand-in-hand with, heart disease, stroke, kidney disease, overweight/obesity and diabetes. In the United States alone, 7.2 crore people age 20 and older have high blood pressure. Of those with high blood pressure, nearly 30 percent are unaware that they have it, and in 65 percent the high BP is not under control. In India, this number is over 10 crore. Worldwide, an estimated 97.2 crore people had hypertension in the year 2000. By 2025, an estimated 156 crore people will have it. High blood pressure is easily detected and usually controllable. Normal blood pressure is systolic below 120 and diastolic below 80. Hypertension is systolic blood pressure at or above 140 mm Hg and/or diastolic blood pressure at 90 mm Hg or higher.

"Prehypertension" is systolic pressure of 120-139 mm Hg, and/or diastolic pressure of 80-89 mm Hg. This is the point at which lifestyle changes are recommended to reduce blood pressure. There are dramatic benefits from small decreases in blood pressure, even in people without hypertension by current definitions.

  1. Systolic increase in systolic blood pressure by 3-4 mm Hg would translate into a 20 percent higher stroke death rate and a 12 percent higher death rate from ischemic heart disease.

  2. In patients with obesity, diabetes and hyperlipidemia, the impact of these small changes in blood pressure on CVD is even greater

  3. Hypertension does not typically cause symptoms, that's why it's called the "silent killer"

  4. There is a long lag period from the beginning of the problem to the time when patients are aware of the damage it has caused

  5. Have your blood pressure checked routinely.

  6. Live a healthy lifestyle to prevent hypertension

  7. Keep weight in a healthy range.

  8. Be physically active

  9. Eat a diet high in fresh fruits and vegetables and low in saturated fat and sodium.

  10. Avoid tobacco.

  11. Those who choose to drink; do so in moderate amounts (no more than an average of one drink a day for women or two for men).

  12. If you already have high blood pressure, keep it controlled under a physician's supervision

Readers Responses

  1. Dear Dr. K.K.Agarwal, My first ever communication to you and at the outset, wish to congratulate you for the tremendous contribution you are doing to the profession. I also admire you for the way you are able to achieve this. On 7th of May, 2010, I lost my father around 11.00.P.M. I was out of the country and my wife and son who are doctors took him to Alchemist Hospital on Golf Course Road, Gurgaon. Whatever they did they billed us an amount which was dually paid. One actually never checked that but as I went to the Hospital for the death certificate process, I found they have mentioned brought dead and at the same time charged one consult in the name of Dr. Ashok Yadav. I informed the Hospital front desk people and they agreed to what I said. Why I am bringing this issue to you is that this is how the name of the profession gets ruined. Dr. Ashok Yadav may be a young doctor but once he gets away with this practice now, he is a potential rotten apple in the basket. It is purely in the interest of my profession that I am raising this issue first to you and If you think that a message can be passed on to the medical community to refrain from such practices. How you do it I leave it to you. If not please ignore my mail. I am O.K. either way but shall raise the issue in a different way positively. Best regards: Dr.P.N.Kakar, Medical Director and HOD Anesthesia, Fortis Hospital, Shalimar Bagh, New Delhi. (M)+919810853355
    Can’t thank you n ur team enough for your pains n efforts to bring out such delightful, uptodate knowledge n that too every single day. Hats off to your spirit! Charu Arora

  2. Hello Sir, Due to osmotic effect any juice in the gut exacerbates diarrhea thus worsening the dehydration. If one has to take the juice than it shall be diluted with water at least by 50:50 ratio. I feel the same stands true for traveller’ s diarrhoea as well. Kindly enlighten if you still consider otherwise. Best wishes: Dr Vivek Chhabra
    eMedinewS Responds: In traveler’s diarrhea, even one loose stool classifies it as mild diarrhea, In mild diarrhea, juices are ok.

  3. Given the emerging evidence that osteoarthritis (OA) may have a vascular basis, the aim of this study was to determine whether serum lipids were associated with change in knee cartilage, presence of bone marrow lesions (BMLs) at baseline and the development of new bone marrow lesions over a 2 year period in a population of pain free, women in mid-life.In this study of asymptomatic middle-aged women with no clinical knee OA, serum cholesterol and triglyceride levels were associated with the incidence of BMLs over 2 years. This provides support for the hypothesis that vascular pathology may have a role in the pathogenesis of knee OA. (Dr.G.M.Singh)