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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

  Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
 
  Editorial …

16th October 2012, Tuesday

Expired Drugs Potent Up to Decades

As per a new analysis of 8 drugs, published in study in October 8 in the Archives of Internal Medicine, most of the active ingredients in the drugs are present in adequate amounts decades after the drugs' expiration dates.

As per US FDA standards, adequate means that an active ingredient must be present in 90% to 110% of the amount indicated on the label. Normally drug expiration dates are set for 1-5 years after production.

Lee Cantrell, PharmD, from the California Poison Control System tested drugs which had expired 28 to 40 years ago.

In the study, 12 of the 14 active ingredients persisted in concentrations that were 90% or greater of the amount indicated on the label. These 12 compounds retained their full potency for 336 months or longer. Eight of them retained potency for at least 480 months.

Only aspirin and amphetamine fell below the 90% cut-off. Three compounds persisted in greater than 110% of the labeled contents: methaqualone, meprobamate, and pentobarbital.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

    Carnitine Update

Carnitine in Cardiomyopathy

Facts

  • Deficiencies in thiamine, selenium and L-carnitine have been reported to produce heart failure and replacement therapy results in improvement in cardiac function.
  • Carnitine deficiency impairs the oxidation of fatty acids, resulting in lipid accumulation in the myocyte cytoplasm. This problem is reversed with L-carnitine replacement.

What is viral cardiomyopathy?

Viral infection is the most common cause of myocarditis and has been implicated in the development of DCM. Viruses known to involve the myocardium include parvovirus B19, human herpesvirus 6, coxsackievirus, influenza virus, adenovirus, echovirus, cytomegalovirus and human immunodeficiency virus (HIV).

For Comments and archives…

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

AHA - ACS update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela to train 10,000 people in compression only CPR

Addressing a press conference, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that more than 10,000 members of the public would be certified in compression only CPR during the Mela.

 
Dr K K Aggarwal
    National News

India’s score alarming on hunger map

NEW DELHI: India ranks 65th out of 79 countries on the Global Hunger Index, a new report by the International Food Policy Research Institute, Welthungerhilfe and Concern Worldwide has said. The report has sharply criticized India for not moving fast enough to reduce malnourishment, and has said that its nutritional indicators are far worse than its economic indicators merit. India's ranking has not changed since 2011, when it was 67th of 81 countries. The GHI is composed using three equally weighted indices: the proportion of people undernourished, child mortality, and the proportion of underweight children. India's GHI score of 22.9 (where anything over 10 is "very serious") is back to its 1996 levels. Of the three components of the index, India performs the worst on children underweight: it is second to last of 129 countries on the proportion of its children who are underweight - 43.5 per cent. Only Timor-Leste is in worse shape. The authors of the report point out what health and nutrition experts have been saying for the last few years: India's poor monitoring of malnutrition is seriously hampering efforts to understand and tackle the problem. India has not published national data on nutrition since the last National Family Health Survey which came out in 2005-6, while no new data is available for another two years. "Nonetheless, even bearing in mind that possible recent advances in the fight against child undernutrition are not yet visible in the latest GHI, India's track record is disappointing...[G]iven India's per capita income, it has higher GHI scores than would be expected. Between 1990 and 1996, India's ...GHI score was falling commensurate with economic growth. After 1996, however, the disparity between economic development and progress in the fight against hunger widened, and India moved further away from the predicted line," the report says. "This stagnation in GHI scores occurred during a period when India's gross national income per capita almost doubled," the authors observe. (Source: TOI, Oct 12, 2012)

For comments and archives

My Profession My Concern

MCI derecognizes 25 practitioners for violating ethics

In a stern message to the doctors faking as staff in medical institutes, the Medical Council of India (MCI) has derecognized licences of at least 25 medical practitioners and professors with a Tamil Nadu-based college for violating professional ethics. The derecognition period ranges between three and five years, reports daily pioneer.

This is probably for the first time that the medical education regulator has cracked down at one go against a battery of doctors and professors by prohibiting them from medical practice and teaching for the stipulated period of time.

The recent move of the MCI’s Ethics Committee, headed by Dr Sneh Bhargava, followed a CBI complaint against the teaching faculty at Melmaruvathur Adiparasakthi Institute of Medical Sciences (MAIMS), Melmaruvathur in Tamil Nadu. The investigating agency had probed against the 35 doctors (32 faculty members and 3 doctors from management who had issued appointment orders) for giving false and misleading information regarding their working as full time faculty in lieu of money during the MCI’s inspection in 2010 at the college.

The CBI had referred the matter to the MCI in February 2012. Taking cognizance in the matter, the MCI’s ethics panel probed against the erring doctors who were registered with the Maharashtra Medical Council (ten doctors), Karnataka Medical Council (six), Tamil Nadu Medical Council (five), two each were registered with Gujarat, Travancor Cochin and Andhra Pradesh Medical Councils. However, action against remaining doctors is yet to be taken as either they were not traceable or not present during interrogation by the ethics committee.

About their modus operandi, the sources said that “Most of them had filed a false declaration form at the time of MCI inspection and as they could not produce any document to show that they were physically present in the college on a regular basis. Rather they had admitted that they were called only around the time of inspection.”

However, the sources said this is just the tip of the iceberg. There are many private medical doctors who are indulged in faking as faculty members just to make a quick buck to help get recognition for the private sector.

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

 
    Valvular Heart Disease Update

How is aortic stenosis evaluated?

When cardiac output is normal or near normal, the severity of aortic stenosis can be accurately assessed with echocardiography.

Cath should be reserved for patients in whom echocardiography is nondiagnostic or when clinical and echocardiographic data are discrepant.

More detailed evaluation is only needed in patients with low output aortic stenosis.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

No advantage for fresh blood in ICU transfusions

For critically ill patients, transfusing fresher blood didn't translate to better outcomes, researchers said during a late-breaking abstract session at the American Society of Anesthesiologists meeting. (Source: Medpage Today)

For Comments and archives…

Fracture risk up for elderly at start of BP Tx

The risk for hip fracture is increased overall among older patients beginning antihypertensive therapy, particularly with beta-blockers and angiotensin II converting-enzyme (ACE) inhibitors, a Canadian researcher reported here. (Source: Medpage Today)

For Comments and archives…

Group proposes certification in obesity

The American Association of Clinical Endocrinologists (AACE) plans to develop a certification process for physicians who treat obesity, which, they say, is a complex disease that goes beyond simple weight loss. The program will include some formal education in obesity medicine. "With today's understanding of obesity as a complex hormonal, neuronal, and metabolic disease with derangement of energy balance leading to multiple comorbidities, it is clear that highly trained and qualified endocrinologists can provide clinical leadership and mentoring in this area," the association said in a position statement published in the September/October issue of its journal, Endocrine Practice. (Source: Medpage Today)

For Comments and archives…

Integrative approach slashes costs in cancer care

An integrative approach to cancer care that includes yoga, holistic nursing, and a healing environment in the inpatient setting can save a substantial amount of money by reducing the use of adjunct medications, according to a new study. The study results were presented at the 9th International Conference of the Society for Integrative Oncology. (Source: Medpage Today)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: Singhara Flour – A Favorite Navratra Diethttp://blog.kkaggarwal.com/2012/10/singhara-flour-%e2%80%93-a-favorite-navratra-diet/ …

@DeepakChopra: Every attachment is to one's thought

 
    Spiritual Update

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

Why Lord Ganesha never suffered from diabetes despite pot belly obesity

The developing world today is facing an epidemic of potbelly obesity-related diabetes and the same has been linked to eating refined carbohydrates, especially refined sugar.

Lord Ganesha is depicted with a big tummy and sweets (laddoo) in one hand and yet he never suffered from diabetes.

For Comments and archives…

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How likely is multiple gestation?

Very possible. Depending on the type of fertility treatment used, if more than one follicle is produced, multiple gestation can occur in more than one out of 3 women successfully getting pregnant.

For Comments and archives…

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

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

Blood Donation - Gift of Liquid Love

Greater clinical appreciation of hematological physiology is reflected in requests for specific blood components, and the modern blood bank dispenses a wide variety of blood products tailored to specific patient needs.

For Comments and archives…

 
    Liver Abscess Update

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

What is the mortality associated with liver abscess?

Untreated pyogenic liver abscess may be fatal. With timely administration of antibiotics and drainage, mortality has come down to 5-30% of cases. The most common causes of death include sepsis, multiorgan failure and liver failure.

For Comments and archives…

 
    An Inspirational Story (Dr GM Singh)

It's true

We all love Sardar jokes. But do you know that Sikhs are one of the hardest working prosperous and diversified communities in the world.

My friend told me about the following incident which I wish to share with you. It has had a deep impact on my thinking.

During last vacation, his few friends came to Delhi. They rented a taxi for local sight-seeing. The driver was an old Sardar and boys being boys, these pals began cracking Sardarji jokes, just to tease the old man. But to their surprise, the fellow remained unperturbed. At the end of the sight-seeing, they paid the cab hire-charges. The Sardar returned the change, but he gave each one of them one rupee extra and said, ''Son, since morning you have been telling Sardarji jokes. I listened to them all and let me tell you, some of them were in bad taste. Still, I don't mind coz I know that you are young blood and are yet to see the world. But I have one request. I am giving you one rupee each. Give it to the first Sardar beggar that you come across in this or any other city.”

My friend continued, “That one rupee coin is still with me. I couldn't find a single Sardar begging anywhere.”

MORAL: The secret behind their universal success is their willingness to do any job with utmost dedication and pride. A Sardar will drive a truck or set up a roadside garage or a dhaba, put a fruit juice stall, take up small time carpentry, ... but he will never beg on the streets.

For comments and archives

 
   Cardiology eMedinewS

7 behaviors cut cardiac deaths, few adopt them Read More

NSAIDs disease-modifying antirheumatic drugs Read More

 
   Pediatric eMedinewS

MS risk linked to low sun exposure early in life Read More

Closed-loop insulin therapy improves glycemic control in young diabetics Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient had a strong family history of cancer.
Dr Bad: Just get regular check ups.
Dr Good: Take low dose aspirin.
Lesson: A new observational analysis published online in the Lancet reports that long–term daily aspirin reduced death due to several common cancers. (Ref: Rothwell PM, et al. Effect of daily aspirin on long–term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 2011 Jan 1;377(9759):31-41)

For comments and archives

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make Sure, to prescribe nimesulide as it is safe in acid peptic disease.

For comments and archives

 
  Lab Update (Dr Arpan Gandhi and Dr Navin Dang)

BUN:Creatinine ratio

The BUN:creatinine ratio is usually >20:1 in prerenal and postrenal azotemia, and <12:1 in acute tubular necrosis. Other intrinsic renal diseases characteristically produce a ratio between these values.

 
  Quote of the Day (Dr GM Singh)

Take chances, make mistakes. That's how you grow. Pain nourishes your courage. You have to fail in order to practice being brave.

 
    Mind Teaser

Read this…………………

A client had a laminectomy and spinal fusion yesterday. Which statement is to be excluded from your plan of care?

A. Before log rolling, place a pillow under the client's head and a pillow between the client's legs.
B. Before log rolling, remove the pillow from under the client's head and use no pillows between the client's legs.
C. Keep the knees slightly flexed while the client is lying in a semi-Fowler's position in bed.
D. Keep a pillow under the client's head as needed for comfort.

Yesterday’s Mind Teaser: The nurse enters the room of a client with chronic obstructive pulmonary disease. The client's nasal cannula oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9 per minute and shallow. What is the nurse’s best initial action?

A. Take heart rate and blood pressure.
B. Call the physician.
C. Lower the oxygen rate.
D. Position the client in a Fowler's position.

Answer for Yesterday’s Mind Teaser: C. Lower the oxygen rate.

Correct answers received from: Anmol Nagpal, Dr PC Das, Dr Thakor Hitendrsinh G, Dr Thakor Hitendrsinh G, Dr K Raju, Dr KV Sarma,
Dr Priyaranjan Bhattacharjee, Dr Pankaj Agarawl, Dr Kanta Jain, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Avtar Krishan, Muthumperumal Thirumalpillai.

Answer for 14th October Mind Teaser: D. Place items so that it is necessary to bend or stretch to reach them.
Correct answers received from: Dr BB Aggarwal, Dr KV Sarma,
Dr Priyaranjan Bhattacharjee, Dr Ashok Barat.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

The Rabbit

The L, the F, and the C are all trying to prove that they are the best at apprehending criminals. The President decides to give them a test. He releases a rabbit into a forest and has each of them try to catch it.

The C goes in. They place animal informants throughout the forest. They question all plant and mineral witnesses. After three months of extensive investigations they conclude that rabbits do not exist.

The F goes in. After two weeks with no leads they burn the forest, killing everything in it, including the rabbit, and they make no apologies. The rabbit had it coming.

The L goes in. They come out two hours later with a badly beaten raccoon. The raccoon is yelling: "Okay! Okay! I'm a rabbit! I'm a rabbit!"

 
  Medicolegal Update

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

What is lucid interval?

Lucid interval is the period during which the mentally unsound person behaves very much like a normal person. During this period all the signs and symptoms of insanity are absent. The person is responsible for all his acts performed during the period of lucid interval.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Donating blood reduces chances of heart attack

Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela, said that one should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Also, blood donation is one of the best charities that one can do as it can save multiple lives through various components obtained from one blood transfusion.

Advocating autologous transfusion, Dr. Aggarwal said that all those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

Dr. Aggarwal said in the current medical tourism scenario, many Christian patients from Jehovah’s Witness refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation. Jehovah’s Witnesses do not accept even transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

 
    Readers Response
  1. Dear Sir, Emedinews reading gives us immense pleasure. Regards: Dr Shikha
 
    Forthcoming Events
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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