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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; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

  Editorial ...

16th October 2010, Saturday

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

Alpha linolenic acid in walnuts,
flax seeds improve response to stress

According to study published in the Journal of the American College of Nutrition, the alpha linolenic acid found in walnuts and flax seeds may improve people’s response to stress. In the study, 22 adults with high LDL levels were put on one of three calorie-matched diets with identical amounts of fat and protein.

  • Standard American diet without nuts
  • A similar diet, with 1.3 ozs of walnuts and a tablespoon of walnut oil replacing some of the fat and protein
  • Diet including walnuts, walnut oil and 1.5 tablespoons of flax seed oil.

Study participants who consumed walnuts and walnut oil not only reduced their LDL levels, but they also showed significant drops in resting blood pressure and, most surprisingly, in their blood pressure response to stress.

Dr KK Aggarwal
Editor in Chief
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  Dengue Update

What are the side effects of platelets transfusions?

  • Non–hemolytic transfusion reactions (NHTR): Febrile NHTRs are caused by the interaction between anti–leukocyte antibodies in the patient’s plasma and leukocytes in the platelet product. To prevent such reactions, leukocyte reduction filters are now recommended for patients who are likely to receive long–term platelet support. Some NHTR are caused by inflammatory cytokines that are released from leukocytes in platelet concentrates during storage. A febrile NHTR is conventionally defined as a rise in temperature of ≥1°C in association with a transfusion. Transfused patients having an NHTR will still often complain of chills and discomfort even after the fever has been subdued with prophylactic antipyretics.
  • Bacterial infection: Blood products can provide an excellent medium for bacterial growth, and can become contaminated after collection while they are being stored. The risk is highest with platelet transfusion, since platelets must be stored near room temperature and cannot be refrigerated. The risk of severe bacterial infection and sepsis is estimated at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions.
  • Viral infection: Hepatitis can be transmitted in one in 50,000 platelet transfusions; Hepatitis C in 1 in 3000 transfusion and HIV in 1 in 150,000 platelet transfusions.
  Photo Feature (from the HCFI Photo Gallery)

Countdown to the 17th MTNL Perfect Health Mela

Mr Santosh Anand, noted Bollywood Poet & Lyricist, released two health messages that “Food of plant in origin contain no cholesterol” and another one that “Dry fruits have no cholesterol” at a Press Meet.
In the Photo (right to left): Padma Shri & Dr. BC Roy National Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India; Mr Santosh Anand; Mr S Bhatnagar, GM Sales MTNL Delhi and Acharya Dr. Sadhvi Sadhna Ji Maharaj, Chairperson World Fellowship of Religions at the Press Meet

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Psychosocial intervention for bipolar disorder

In a randomized trial of outpatients with bipolar disorder, patients who were assigned to group psychoeducation plus treatment as usual (pharmacotherapy) had a significantly reduced risk of relapse compared with usual treatment alone. Patients assigned to group sessions had a significantly reduced risk of relapse for any type of mood episode. (Ref: Castle D. Group–based psychosocial intervention for bipolar disorder: randomised controlled trial. Br J Psychiatry 2010 May;196(5):383–8).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

World Spirometry Day observed

Bangalore Allergy Centre, along with European Respiratory Society and European Lung
Foundation conducted free lung capacity test to mark 'World Spirometry Day' on Thursday. The
clinic conducted free spirometry test for over 50 patients. It will also conduct free tests every
Friday from 4 pm to 6 pm. Dr Nagendra Prasad K V, Allergy Physician at the Centre said that
there are two kinds of lung diseases, obstructive and restrictive. "Obstructive normally occurs
when a person is suffering from asthma and other breathing related problems. Restrictive lung
diseases are caused due to extensive smoking where a person develops uneasiness in breathing,"
he said. (Source: Deccan Herald)

India leads Commonwealth tally in underweight children

India may rank second in the medals tally, but it is on top of the heap among the Commonwealth countries as the home to the highest number of underweight children. About 43% of India's children are underweight, and 7 million under fives are severely malnourished, says a new report "Commonwealth or Common Hunger", released by Save the Children, a child rights NGO. The report reveals that 64% of the world's underweight children live in 54 Commonwealth countries, and India has both the highest number and the highest proportion of underweight children. More than two-thirds of stunted children (88.5 million or 68.6%) and nearly half of those who are underweight (95 million or 48.7%) live in just seven Commonwealth countries. (Source: The Times of India)

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

Dr. Chander Bose, National President, IMA passes away. eMedinews convey our heartfelt condolences to the bereaved family and pray to the almighty God to give peace to the departed soul.

  International News

(Dr Monica and Brahm Vasudev)

Is Infertility more common in women with epilepsy?

Women with epilepsy, those taking multiple epilepsy drugs in particular, are more likely to experience infertility than women with no epilepsy and those not on antiepilepsy drugs, according to new research published in the Oct. 12, 2010 issue of the journal Neurology.

Lifestyle intervention helps even most obese

Even the most severely obese adults derived important clinical benefits from a lifestyle intervention that combined dietary restriction with either six or 12 months of physical exercise. Participants who began an exercise program along with a diet at the start of the study had lost significantly more weight at six months –– 10.9 kg (24 lbs) –– than the amount lost by those who only followed the diet (8.2 kg of 18 lbs). The difference was significant at P=0.02 for group × time interaction, according to Bret H. Goodpaster, PhD, of the University of Pittsburgh, and colleagues. But at 12 months, when all participants had been exercising, the amount of weight loss was similar in the two groups, at 12.1 kg (26.6 lbs) in the initial exercise group and 9.9 kg (21.8 lbs) in the delayed exercise group, the investigators reported online in the Journal of the American Medical Association. (Medpage)

First FDA–approved trial using human embryonic stem cells underway

In the first test approved by the FDA, a patient in Atlanta has been injected with stem cells taken from a human embryo. The hope is these cells will eventually help repair recent spinal cord injuries. The study, taking place at up to seven medical centers, will enroll 10 patients in its first stage. Patients with complete grade A thoracic spinal cord injuries will be treated seven to 14 days after their injury.

Physicians call for more restricted use of codeine

Common wisdom says that codeine is safer than morphine. But in a commentary being published in CMAJ, the journal of the Canadian Medical Association, two doctors argue that morphine’s effects are more predictable.

  Hepatology Update

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

What are the first signs of biliary atresia?

The symptoms of biliary atresia are usually evident between 2 and 6 weeks after birth. The baby will appear jaundiced, and may develop a large, hardened liver and a swollen abdomen. The stools are usually pale grey and the urine appears dark. Some babies may develop intense itching, or "pruritus," which makes them extremely uncomfortable and irritable. The exact cause of this itching is not yet known, although researchers have found a connection between it and the backup of bile.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is secondary infertility?

Secondary infertility is when a man and woman do not conceive after one year of trying, despite having conceived children in the past without any problems. While primary infertility gets the most media attention, secondary infertility is also as common as primary infertility. According to statistics collected by the Center for Disease Control (CDC), 11% of couples who already have a child go on to experience secondary infertility. That’s approximately 4 million families, or about half of all infertility cases.

  Gastro Update: Question of the Day

If a patient with Crohn’s colitis needs an antibiotic for a dental abscess or pneumonia, which one is safe to use? (Dr A Murugnathan)

The primary condition should determine whether you’ll use an antibiotic at all and, if so, what the appropriate drug would be. I doubt that one antibiotic is better than any other in preventing C. difficile infection in patients with Crohn's colitis. Watch for the onset of any diarrhea, however, investigating it promptly and discontinuing the antibiotic right away. Could there be a role for "prophylactic" use of Lactobacillus in such situations? I honestly don’t know, although it’s sometimes recommended in the actual management of difficult-to-eradicate C. difficile infections, so it may be worth trying.

  Medicolegal Update

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

A medicolegal case must be informed to the nearest police

Not informing the police by doctor is criminal offence under Sections 177 & 201 IPC

Medico–legal report is prepared for the purpose of litigation – imminent or prospective by the treating doctor. The responsibility to label any case as a medicolegal case (MLC) rests solely with the attending medical practitioner in absence of police or any other legal references. According to the Hon’ble Supreme Court, whenever any MLC comes to the hospital, the government doctor on duty or private doctor attending the case should start the treatment of the patient and if he thinks that the case needs to be reported to the police, he should do so without fail and without any justified delay to the police on duty, giving the name, age, sex of the patient and the place of occurrence of the incident and. It will be the duty of the said Constable/duty officer of police station to inform the nearest concerned police station/ higher police functionaries for further action.

  • Section 177 IPC states that giving false information is punishable criminal offence and if proved the doctor may be punished up to six months however
  • Section 201 IPC deals with causing disappearance of evidence of offence or giving false information to screen the offender. This is a graver offence and imprisonment depends on the gravity of case
  Medi Finance Update

Money Market Funds

  • Fund managers attempt to control risk by managing the credit quality and the average term of the bonds in the fund.
  • Fixed income funds generally have the potential for higher returns than money market or guaranteed funds, but there tends to be a greater risk of a loss.
  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Penicillin skin/eye Ointment

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Peritoneal Fluid Analysis To help diagnose the cause of peritonitis and/or peritoneal fluid accumulation (called ascites)

  IJCP Special

Dr Good Dr Bad

Situation: A patient came with severe secondary MR with refractory end–stage heart failure.
Dr. Bad: Go for mitral valve repair.
Dr. Good: Try biventricular pacing.
Lesson: As per 2005 ACC/AHA heart failure guidelines, effectiveness of mitral valve repair or replacement for severe secondary mitral regurgitation in refractory end–stage HF is not established. (Circulation 2009; 119:e391)

Make Sure

Situation: A 13–year–old girl complained of epigastric pain, fatigue and anorexia. Elevated serum gastric level (900 MIU/l) raised the suspicion of gastrinoma.
Reaction: Oh my God! Why did you not put her on triple therapy for H. pylori infection?
Lesson: Make sure to remember that H. pylori infection is the most important cause of hypergastrinemia other than gastrinoma in childhood.

Quote of the Day (Dr.G M Singh)
"Men are rich only as they give. He who gives great service gets great rewards." Elbert Hubbard

Mnemonic of the Day (Dr Varesh Nagrath)
Mnemonic for ring-enhancing lesion in brain in patient with AIDS
Toxoplasma (Most common)


Read this…………………

A 65–year–old man with past medical history of endoscopy–proven peptic ulcer presents with a six month history of worsening, dull epigastric pain that is non–radiating. He also has early satiety and a 10 kg weight loss. Current medications include over–the–counter antacid and ranitidine that provide some relief of his symptoms. On examination, he is cachectic, has epigastric tenderness and an enlarged liver. Lab work reveals iron deficiency anemia and all other lab work is normal. Endoscopy shows a large ulcerated mass in the gastric body that on biopsy is found to be an adenocarcinoma.

Which of the following is the most appropriate next step in the management for this patient?

A. Endoscopic ultrasound CT scan of the abdomen
B. CT scan of the abdomen
C. Positron emission tomography
D. Helicobacter pylori testing

Contributed by Ashish Verma MD

Answer for yesterday’s Mind Teaser: "Splitting hairs"

Correct answers received from:  Dr KP Rajalakshmi, Dr Chandresh Jardosh, Dr Rohini Vaswani, Dr Anurag Jain, Dr Kalpana Mohan, Dr Susheela Gupta, Dr Muthumperumal Thirumalpillai, Dr Virender Prakash Gautam, Dr S Upadhyaya, Dr. T. Samraj, Dr. Shashi Saini, Dr. Prashant Bharadwaj

Answer for 14th October Mind Teaser is: "Too big to ignore"
Correct answers received from: Dr. Satish Gunawant, Dr Anjani Kumar, Dr Meera Rekhari, Dr K V Sarma

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)
Doctors often have ready–made sentences on their lips. For example, a nervous patient went to the doctor and said, "Doctor, whenever I have this severe headache I feel like killing myself. What should I do?"
The doctor replied, "Leave it to me."

An Inspirational Story

Positive Thinking

Jerry is the kind of guy you love to hate. He is always in a good mood and always has something positive to say. When someone would ask him how he was doing, he would reply, "If I were any better, I would be twins!" He was a unique manager because he had several waiters who had followed him around from restaurant to restaurant. The reason the waiters followed Jerry was because of his attitude. He was a natural motivator. If an employee was having a bad day, Jerry was there telling the employee how to look on the positive side of the situation.

Seeing this style really made me curious, so one day I went up to Jerry and asked him, I don’t get it! You can’t be a positive person all of the time. How do you do it?" Jerry replied, "Each morning I wake up and say to myself, Jerry, you have two choices today. You can choose to be in a good mood or you can choose to be in a bad mood. I choose to be in a good mood. Each time something bad happens, I can choose to be a victim or I can choose to learn from it. I choose to learn from it. Every time someone comes to me complaining, I can choose to accept their complaining or I can point out the positive side of life. I choose the positive side of life. "Yeah, right, it’s not that easy," I protested. "Yes, it is," Jerry said. "Life is all about choices. When you cut away all the junk, every situation is a choice. You choose how you react to situations. You choose how people will affect your mood. You choose to be in a good mood or bad mood. The bottom line: It’s your choice how you live life."

I saw Jerry about six months after the accident. When I asked him how he was, he replied, "If I were any better, I'd be twins. Wanna see my scars?" I declined to see his wounds, but did ask him what had gone through his mind as the robbery took place. "The first thing that went through my mind was that I should have locked the back door," Jerry replied. "Then, as I lay on the floor, I remembered that I had two choices: I could choose to live or I could choose to die. I chose to live." "Weren’t you scared? Did you lose consciousness?" I asked. Jerry continued, "…the paramedics were great. They kept telling me I was going to be fine. But when they wheeled me into the ER and I saw the expressions on the faces of the doctors and nurses, I got really scared. In their eyes, I read 'he's a dead man.’

I knew I needed to take action." "What did you do?" I asked. "Well, there was a big burly nurse shouting questions at me," said Jerry. "She asked if I was allergic to anything. ‘Yes,’ I replied. The doctors and nurses stopped working as they waited for my reply. I took a deep breath and yelled, ‘Bullets!’ Over their laughter, I told them, ‘I am choosing to live. Operate on me as if I am alive, not dead.’" Jerry lived thanks to the skill of his doctors, but also because of his amazing attitude. I learned from him that every day we have the choice to live fully.

Positive thinking the first step towards a happy life. Attitude is everything……

  Readers Responses
  1. Respected Boss: The comment regarding eryhromycin estolate vs stearate was excellent. Thanks. Dr  Varesh Nagrath
  2. Dear Dr KK Aggarwal, I am a regular reader of your newsletter like so many other doctors and persons interested in medical news in India and abroad. I request you to give instruction to your editorial team to check the content of your newsletter. For example I did not like the column
    “You are an Indian if (Anuj Goel)
    You use grocery bags to hold garbage.”
    Your news letter goes to eminemt personalities in India and abroad and such columns are derogatory for all respectable Indians. I request (Dr?) Anuj Goel not to share what he does in his day to day activities and generalized it for all Indians. I hope all sensible Indians will agree with me. I am sorry if I am hurting the feelings of someone.Dr Rajiv Bhatt,MBBS, DTCD, MD,Consultant Chest Physician & Allergist.
  Public Forum

(Press Release for use by the newspapers)

Sarvadharma Sammellan at the Mela

The 17th MTNL Perfect Health Mela is being organized by Heart Care Foundation of India (HCFI) jointly with various Departments of Delhi Government, NGOs and public sector undertakings from 23rd to 31st October at NDMC Grounds Laxmi Bai Nagar, New Delhi.

The Mela will be used as an out and out entertainment forum with various academies and organizations putting up their shows in the evenings, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President HCFI and MTNL Perfect Health Mela. All through the day different entertaining programs in the form of competitions will be held. Each day of the Mela is designated to a major activity, some of them being Heritage, Divya Jyoti, Medico Masti, Anmol, Harmony etc. A special day will be devoted for the care of women and a Sarvadharma Sammellan will be organised in collaboration with World Fellowship of Religions.

The sammellan would discuss importance of all Indian Festivals and Religions. For example, Dusshera which falls on October 17 represents the victory of the good over the evil. The implied health message is the killing of Tamas, Rajas and Ego, said Dr. Aggarwal. He said that Tamas represents Kumbhakaran, Rajas Meghnath and Ego Ravana. If one lives yogic lifestyle involving living in the present, one can get rid of all the three vices.

Tamas or Kumbhakaran represents inertia, lethargies, and early morning sleepiness. It increases by eating food grown under the ground and non–vegetarian food. Rajas, on the other side, represents aggression, anger and increases by taking hot, spicy, oily foods and alcohol. Ego or Ravana represents Ahankar.

Fast is an integral part of any religious festival. In general, the advice is abstaining from tea, coffee, sugar, rice, wheat etc and avoiding garlic and onion as it can stimulate unnecessary excitements and causes indigestion. One should take out time to meditate, read spiritual scripture, and strengthen inner immunity by meditation.

  Forthcoming Events

CPLD 2010: Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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