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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08c); 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

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

16th May 2012, Wednesday

Long commutes may be harmful to your health

Commuting distance is adversely associated with moderate to vigorous physical activity, adiposity, and blood pressure. The longer you drive to work, the more likely you are to be overweight and have high blood pressure according to Christine Hoehner, PhD, of Washington University in St. Louis, and colleagues in the June issue of the American Journal of Preventive Medicine.

Those who commuted more than 15 miles to work were less likely to meet recommendations for moderate to vigorous physical activity, possibly because time spent commuting is time not spent in the gym. Those whose daily trip was 15 miles or more also were more likely to be obese, while those who traveled at least 10 miles had a greater risk of high blood pressure. There might be several reasons for the latter link, including the stress of battling congested roads day in and day out. (MedPage today)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Long commutes may be harmful to your health

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

National Summit on "Stress Management" 2012

The National Summit was organised by Heart Care Foundation of India in association with Bramkumaris. Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal interacting with the audience.

 
Dr K K Aggarwal
 
    National News

Common MBBS, MD entrance exams from 2013: Govt to MPs

The proposed common exams for admission to MBBS and MD courses all over the country will be held from the next academic session, Health Ministry officials said. The officials told MPs at the Consultative Committee Meeting on Health that the proposed common tests, the National Eligibility cum Entrance Test for Undergraduate (NEET–UG) and Postgraduate (NEET–PG) medical courses, have been notified for commencement from 2013–14. "The common entrance tests for admission to MBBS and MD courses have been notified on February 25, this year for commencement from academic year 2013–14," they said. The NEET for admission to UG courses would be conducted by the CBSE and the NEET for PG courses would be carried out by the National Board of Examinations, they said. "The common entrance tests are aimed at mitigating the need of students to appear in multiple tests and promote merit in admission process," the officials said at the meeting presided over by Health Minister Ghulam Nabi Azad. The tests, earlier notified by the Medical Council of India (MCI), were to be first conducted from the current session but have been postponed due to lack of preparedness on its part, they said.

(Source: The Indian Express, May 14 2012)

For Comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Urine test spots kidney injury in sepsis patients

A simple and inexpensive urine test appears to predict which sepsis patients will go on to develop an acute kidney injury (AKI), researchers said. Patients who were found to have de novo dipstick proteinuria had a significantly higher risk of AKI (P=0.001), Javier Neyra, MD, of the Henry Ford Hospital in Detroit, and colleagues reported at the National Kidney Foundation meeting. (Source: Medpage Today)

For comments and archives

Age may no longer be a barrier in kidney donation

The overhauled United Network for Organ Sharing (UNOS) kidney transplant allocation guidelines will likely remove a controversial age–matching component from its algorithm, researchers said at the National Kidney Foundation meeting. (Source: Medpage Today)

For comments and archives

Chronic benzodiazepines risky in adults with schizophrenia

In patients with schizophrenia, chronic use of benzodiazepines is associated with an increased risk of death, whereas treatment with an antidepressant or several concomitant antipsychotics is not, according to a Finnish study published this month. (Source: Medscape)

For comments and archives

Progestin–based IUD not linked to weight gain

There was no significant difference in weight gain between users of a hormone–eluting intrauterine device (IUD) and users of a copper IUD, according to a small, retrospective study. (Source: Medpage Today)

For comments and archives

Interferon–gamma release assays better for TB testing

Interferon–gamma release assays (IGRAs) are significantly better than tuberculin skin tests (TST) at predicting progression from latent tuberculosis (TB), a new meta–analysis from Germany shows. This means that patients with a positive IGRA, "especially if they belong to high risk groups for TB, will probably have a higher benefit when receiving preventive therapy in order to avoid TB disease later on than subjects scored positive by the TST," Dr. Roland Diel told Reuters Health. (Source: Medscape)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Side effects of certain drugs incre…: http://youtu.be/YwnIPDjH8Vc via @youtube

@DeepakChopra: The moment is eternal. The situation is transient.

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

  • Kauravas, numbering one hundred, and the five Pandavas will violate the Ministry of Health and Family Welfare family norms.
  • As per Ministry of Parliamentary Affairs, there can be no kings and emperors in this democratic age.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

Does surgery is used after non–hormonal contraception?

Sterilization is the most commonly used form of non hormonal contraception around the world; but it is a permanent procedure. Depending on the type of procedure used, only small surgical incisions are required. A tubal ligation involves separation of the fallopian tubes into two segments using a ring, clip, stitch, or electric current. This prevents the egg from moving through the tube and keeps the sperm from reaching the egg. Another method of female sterilization involves placing a spring–like coil through the cervix and into the uterus. These coils are placed into the area of the uterus where the fallopian tubes enter. In men, sterilization is called vasectomy. Before ejaculation, sperm travel through a tube called the vas deferens. At the time of vasectomy, the tubes are tied, cut, clipped, or sealed to prevent the release of sperm. There may still be sperm in the semen for up to three months after the vasectomy is performed, and men should use back–up contraception for at least eight ejaculations or up to 12 weeks. There is no increase in testicular or prostate cancer in men after a vasectomy.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Platelet concentrates

Description: Prepared from whole blood donations; a single donor unit in volume of 50–60 ml of plasma should contain:

  • At least 55×109 platelets
  • <1.2×109 red cells
  • <0.12×109 leukocytes

Unit of issue: May be supplied as either:

  • Single donor unit: platelets prepared from one donation
  • Pooled unit: platelets prepared form 4 to 6 donor units ‘pooled’ into one pack to contain an adult dose of at least 240×109 platelets

Infection risk

  • Same as whole blood, but a normal adult dose involves between 4 and 6 donor exposures.
  • Bacterial contamination affects about 1% of pooled units.

Storage

  • Up to 72 hours at 20°C to 24°C (with agitation) unless collected in specialized platelet packs validated for longer storage periods; do not store at 2°Cto 6°C.
  • Longer storage increases the risk of bacterial proliferation and septicemia in the recipient.

Indication: Treatment of bleeding due to thrombocytopenia, platelet function defects and/or prevention of bleeding due to thrombocytopenia, such as in bone marrow failure

Contraindications: Not generally indicated for prophylaxis of bleeding in surgical patients, unless known to have significant pre–operative platelet deficiency. Also not indicated in the following conditions:

  • Idiopathic autoimmune thrombocytopenic purpura (ITP)
  • Thrombotic thrombocytopenic purpura (TTP)
  • Untreated disseminated intravascular coagulation (DIC)
  • Thrombocytopenia associated with septicemia, until treatment has commenced or in cases of hypersplenism

Dosage

  • 1 unit of platelet concentrate/10kg of body weight: in a 60or 70 kg adult, 406 single donor units containing at least 240×109 platelets should raise the platelet count by 20–40×109/L
  • Increment will be less if there is: Splenomegaly, disseminated intravascular coagulation and septicemia

Administration

  • After pooling, platelet concentrates should be infused as soon as possible, generally within 4 hours, because of the risk of bacterial proliferation
  • Must not be refrigerated before infusion as this reduces platelet function
  • 4–6 units of platelet concentrates (which may be supplied pooled) should be infused through a fresh standards blood administration set
  • Special platelet infusion sets are not required
  • Should be infused over a period of about 30 minutes
  • Do not give platelet concentrates prepared from RhD positive donors to an RhD negative female with child–bearing potential
  • Give platelet concentrates that are ABO compatible whenever possible

Complications: Febrile non hemolytic and allergic urticarial reactions are not uncommon, especially in patients receiving multiple transfusions.

For comments and archives

 
    An Inspirational Story

(Dr GM Singh)

Believe in your dreams

Dream what you want to dream; Go where you want to go; Be what you want to be, because you have only one life and one chance to do all the things You want to do.

May you have enough happiness to make you sweet, Enough trials to make you strong, Enough sorrow to keep you human and Enough hope to make you happy.

The happiest of people don’t necessarily Have the best of everything; They just make the most of Everything that comes along their way.

The brightest future will always Be based on a forgotten past; You can’t go forward in life until You let go of your past failures and heartaches.

When you were born, you were crying And everyone around you was smiling Live your life so at the end You're the one who is smiling and everyone Around you is crying

For comments and archives

 
    Cardiology eMedinewS

PGIMER: US doctors to collaborate on child cardiology Read More

Local anesthesia may be enough for TAVI Read More

Titrating beta–blockers likely improves outcomes in HF patients with systolic dysfunction Read More

 
    Pediatric eMedinewS

Lack of gut bugs linked to extra pounds on kids Read More

Elective labor induction at term may reduce perinatal death Read More

Mandates boost vaccine coverage in tweens Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came with acute gout.
Dr. Bad: Take high–dose colchicine.
Dr. Good: Start low–dose regimen of colchicine.
Lesson: As per a randomized, placebo–controlled trial, a lower dose regimen of colchicine has similar efficacy and fewer side effects than a traditional, higher dose regimen in acute gouty arthritis. The trial compared 1.2 mg colchicine followed by one additional dose of 0.6 mg an hour later (total dose 1.8 mg) vs 1.2 mg followed by 0.6 mg every hour for up to six hours (total dose 4.8 mg) (Arthritis Rheum 2010;62:1060).

For comments and archives

Make Sure

Situation: A patient died after receiving 30 ml IV potassium chloride (KCl) bolus.
Reaction: Oh my God! Why was KCL given as bolus?
Lesson: Make sure that IV KCL is not given @ >10 mEq per hour.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

  1. The language in the present MCI Code of ethics states "A Physician should participate in professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five years, organized by reputed professional academic bodies or any other authorized organisations. The compliance of this requirement shall be informed regularly to Medical Council of India or the State Medical Councils as the case may be." This indicates a suggestion rather than a rule.
  2. Further, a letter from the then secy. of MCI (Setalvad) dated 24.8.09 suggests that there is no change in the rules for removing a name from the register of the MCI (i.e. no rule for compulsory re–registration with 30 hrs. of CME was yet operative). Registration is "life long and does not need renewal"
  3. On the basis of a circular from the undersecretary health govt. of Goa (with the HMs blessings) in 2009, 30 hours of CME accreditation were made a requirement for renewal of registration and the Goa Medical Council was made the authorized body to supervise this.
  4. We drew up guidelines for CME and have been implementing them

My queries are as below:

  1. Is renewal of registration mandatory with 30 hours of CME?
  2. If tomorrow a doctor presents for renewal without the CME requirements, do we have the legal authority to deny him renewal of registration? (I am a member of the Goa Medical Council and Chairman of the Accreditation Committee) bearing in mind that the MCI act has not yet been amended on this issue
  3. Very often we have bills being introduced which have clauses which appear contrary to natural justice. For example, CEA bill and the recovery of costs for providing emergency treatment; the NCHRH bill and the clause of "Bar of Jurisdiction" (clause 100). Committees do the rounds, ask for suggestions and then ignore them. If there is a genuine grievance, what is the most EFFECTIVE course of action for redressal. You often mention a WP. As a member of an NGO how does one go about it. Do you handle these? And if so what would be the procedure/costs etc.

My reason for asking is that on a personal level I am fed up with talk and feel that we should resort to affirmative action if we wish to rectify issues. I therefore wish to be aware of the proper course of action if the situation arises.

Dr. Gladstone D’Costa

Ans.

  1. Registration is primarily with the SMC. It has been made compulsory under the amended Punjab medical Registration Act, 1916. It is thus mandatory for those registered in Punjab and similar other states, such as Delhi.
  2. As I mentioned earlier, doctors are, in general, not registered directly with the MCI. The SMC rules apply.
  3. When a Bill has been circulated and is found to have objectionable provisions, the proper course is to send a properly/legally drafted representation to the concerned authorities which would form the basis for a WP if the same becomes necessary. Yes, I handle such issues. Costs etc. are to be discussed in personal mail.

For comments and archives

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  Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Management of accidental exposure to blood and OPIMs

We have discussed the details of management of accidental exposure to blood and OPIMs, needle stick injury in earlier issues of the eMedinewS. However, keeping in view the importance of the matter I would like to sum it up, so that any HCW who experiences accidental exposure to blood and OPIM can take immediate actions listed below:

  • Manage the site by simply washing with running tap water for a few minutes.
  • Assess the status of source material for infectious markers (HIV, HBV and HCV).
  • If possible, assess the clinical status of the patient whose blood is involved in the accident.
  • Grade the type of injury–mild moderate or severe.
  • Collate the above factors and immediately take drug prophylaxis for HIV, HBIG for HBV and HBV vaccine as required (already discussed). First dose of HIV drugs must be taken within two hours after exposure to HIV positive blood/OPIM for effective prevention of transmission of HIV.
  • Baseline testing of the HCW for HIV, HBV and HCV at zero hour i.e. immediately after the above things has to be done.
  • In case HCW is positive for any of the markers–access the services of an ART center for management of HIV and hepatologist for Hepatitis B and Hepatitis C.
  • Follow–up testing up to 6 months need to be done to ensure that no infection has occurred.
  • PEP drugs for HIV must be taken for four weeks.
  • HCW needs to be counseled and supported for PEP.

We all must take responsibility to take care of our health and should never treat accidental exposure to blood and OPIM lightly.

For comments and archives

 
  Quote of the Day

(Dr Prabha Sanghi)

The nicest place to be is in someone’s THOUGHTS! The safest place to be is in someone’s PRAYERS! And the best place to be is in GODS HANDS!

 
  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum osmolality

Serum osmolality (US) = (2*(Na) + (BUN/2.8) + (glucose/18)
SI units are all molar, so no need to divide by 2.8 or 18

Normal serum osmolality = 285–295 mOsm/kg

 
    Mind Teaser

Read this…………………

Nurse Hazel teaches the client with angina about common expected side effects of nitroglycerin including:

a. high blood pressure
b. stomach cramps
c. headache
d. shortness of breath

Yesterday’s Mind Teaser: A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be:

a. Ineffective health maintenance
b. Impaired skin integrity
c. Deficient fluid volume
d. Pain

Answer for yesterday’s Mind Teaser: a. Ineffective health maintenance

Correct answers received from: Rajiv Kohli, Dr PC Das, Dr Ragavan Sivaramakrishnan Moudgalya, YJ Vasavada, Dr Kanta Jain, Dr BB Aggarwal, Raju Kuppusamy, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Jainendra Upadhyay.

Answer for 12th May Mind Teaser: b. Myocardial damage

Correct answers received from: Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Jainendra Upadhyay.

Send your answer to ijcp12@gmail.com

For comments and archives

 
    Laugh a While

(Prabha Sanghi)

A wife was making a breakfast of fried eggs for her husband. Suddenly, her husband burst into the kitchen. ‘Careful,’ he said, ‘CAREFUL! Put in some more butter! Oh my gosh! You’re cooking too many at once. TOO MANY! Turn them! TURN THEM NOW! We need more butter. Oh my gosh! WHERE are we going to get MORE BUTTER? They’re going to STICK! Careful. CAREFUL! I said be CAREFUL! You NEVER listen to me when you’re cooking! Never! Turn them! Hurry up! Are you CRAZY? Have you LOST your mind? Don’t forget to salt them. You know you always forget to salt them. Use the salt! USE THE SALT! THE SALT!’ The wife stared at him. ‘What in the world is wrong with you? You think I don’t know how to fry a couple of eggs?’ The husband calmly replied, ‘I just wanted to show you what it feels like when I'm driving.’

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

How can exit and entry wounds be identified?

  • Entry wound are small and neat in most cases. But, with ultra–high velocity small bullets or bomb splinters, the entrance wound may be of the ‘blowout’ type.
  • Exit wound are generally big. The size of the exit wound depends upon the shape of the local track, the temporary cavitation effect at the site of the exit, the impact velocity and type of bullet. If the missile has remained stable in the tissues, or alternatively has expended most of its energy, a relatively small exit wound results.

Handgun wounds such as revolver and semiautomatic pistol bullet wounds are very important in medicolegal practice. As the wounds caused by pistol and revolver bullets are similar, and the caliber of bullets used in the weapons are roughly the same, it should be noted that the muzzle velocities of magnum revolvers are higher than those of modern pistols.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Diabetes can be delayed by 14 years

A defined Diet and Exercise Programme in people at high risk of diabetes, if followed for six years, can delay the onset of diabetes for 14 years as per a report published in the edition of "The Lancet".

Commenting on the trial, Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India said that in the study called China DA Quing Diabetes Prevention Outcome Study, 577 adults with high blood sugar levels at risk of diabetes from 33 clinics in China were randomly assigned to any of the three lifestyle interventions. One group on diet, second on exercise, and the third on combination. They were compared with the control group without any diet or exercise programme.

The interventions included reducing the amount of food, sugar and alcohol and putting more vegetables and increasing the level of physical activities.

Lifestyle interventions reduced the incidence of diabetes by 51% over the six years of the programme and over the whole 20 years period, the incidence of diabetes was reduced by 43% in those people who have been in diet and exercise programme.

 
    Readers Responses
  1. I wish to disagree with a comment raised by Dr Ramarao about the standards of medical education. Whether you study in a private medical college or govt medical college it is up to the medical student to learn, acquire required skills by observation and, hard work. I belong to 1971 batch from Govt Stanley Medical College. The standard of teachers we had and the standard of my own classmates are so different. Teaching is an art and one should have a passion and unconditional dedication to share his wisdom and knowledge. There is no training programme for medical teachers and teaching is not remunerative. We get teachers like Dr KK Aggarwal and Dr KV Thiruvengadam once in a blue moon. The MCI should conduct teachers training programme regularly to raise the standard. Dr R Mani, Chennai.
 
    Forthcoming Events
Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
    eMedinewS Special

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta