emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

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

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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

17th March 2010, Wednesday

Dr Sanjiv Chopra, Faculty Dean at Harvard, to speak on Leadership

On 20th March Saturday 2.30pm in New Delhi Dr Sanjiv Chopra Faculty Dean at Harvard will deliver a talk on "Leadership for the 21st Century: The Ten Tenets of Leadership". The learning Objectives will be to discuss the qualities of great leaders; to elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience; to emphasize that we can all lead and can do so at many different levels and to explore what made or makes many leaders – historical and contemporary – so effective. This talk is organized by emedinews in collaboration with Delhi Medical Council (DMC), Delhi Medical Association (DMA), International Medical Sciences Academy (IMSA) (Delhi chapter) and World Fellowship of Religions (WFR)

In this talk Dr. Sanjiv Chopra will discuss historic figures such as Mahatma Gandhi, Florence Nightingale, and Winston Churchill, as well as contemporary leaders, and examine what makes them effective. What are some of the qualities and attributes of the great leaders? What is leadership, and can it be taught or is it something you’re born with? He will assert that great leaders listen well, they have empathy, they dream big, they’re resilient, they have a sense of purpose.They possess humility and humor, they also have integrity and great people skills.

Dr. Sanjiv Chopra will examine whether Adolf Hitler, who was certainly a charismatic figure and fiery orator, was a great leader. He will discuss the 10 Tenets of Leadership. Anyone who follows these tenets will be on the path to becoming a better leader. Leaders occur in all walks of life, and one can be a leader at many different levels.

Dr Sanjiv Chopra, M.D., is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts. He has scores of publications and four books to his credit. His books have been translated into several languages including Portuguese, Japanese, Italian and Czech. He is Editor–in–Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world (subscribed to by an estimated 300,000 physicians worldwide). He has received a number of teaching awards.


The George W. Thorn Award was presented by the Brigham and Women’s Hospital Housestaff, Harvard Medical School in 1985 for his outstanding contribution to clinical education. In 1991 he received the highest accolade from the 1991 graduating class of Harvard Medical School, the Excellence in Teaching Award. In 1995, Dr. Chopra was the recipient of the Robert S. Stone Award, a prestigious award given to a faculty member who is an outstanding clinician and teacher and is chosen by colleagues, housestaff and students from the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. In 2003 he was honored with the American Gastroenterological Association’s Distinguished Educator Award. In 2009, Dr. Chopra was elected as a Master of the American College of Physicians, a singular honor bestowed to only a select few individuals for being "citizen physicians, educational innovators, scientific thinkers and humanists who inspire those around him or her and sets the standards for quality in medicine."

He has been invited to lecture in numerous countries abroad. He serves as the Course Director of several CME courses including seven annual Current Clinical Issues in Primary Care (PriMed) conferences held in collaboration with UCLA, Johns Hopkins, Baylor College of Medicine, University of Miami, Northwestern University and Columbia Presbyterian College of Physicians and Surgeons. In addition to directing these conferences, he delivers several lectures, moderates a number of sessions and has served as a Keynote speaker on several occasions. Each of the PriMed conferences are attended by 4,000 – 8,000 clinicians.


Dr. Chopra has had a life long passion in educating clinicians and lay people. He has conducted scores of workshops on Success and Life Principles. He has given a number of Keynote addresses on the topic of Leadership – "Leadership for the 21st Century: The Ten Tenets of Leadership" to wide acclaim in the United States and several countries abroad.

He is the younger brother of Dr Deepak Chopra and son of late Dr K L Chopra.

Dr KK Aggarwal
Chief Editor


News and Views

Who should be offered desensitisation treatment and is it safe? (Dr GM Singh)

Desensitization should only be offered to those whose symptoms have been confirmed by history and skin prick testing or to those with serum allergen–specific IgE whose symptoms are not adequately controlled on standard treatment. Sublingual immunotherapy is now available in the UK for grass pollen – in the form of Grazax – but is not available on NHS prescription. It has proven itself safe and effective.
Other forms of desensitization – such as house dust mite and birch – are available, but require frequent visits during the up–dosing phase and so have an adverse impact upon the patient’s life, at least in the short term. Subcutaneous immunotherapy should only be administered by an allergist after a full assessment.

Vessel diameter in normotensive persons with type 1 diabetes unaffected by ACEIs, ARBs (Dr GM Singh)

In patients with type 1 diabetes mellitus who have normal blood pressure, neither angiotensin–converting enzyme inhibitors nor angiotensin–receptor blockers have an effect on retinal arteriole or venule diameter, according to a study in the February issue of the Archives of Ophthalmology.

IgE analysis identifies people with severe peanut allergy

Analysis of IgE to peanut allergen components may be helpful in identifying peanut–sensitized subjects who are at risk for severe symptoms, according to a report in the February 8th issue of Allergy.

Diagnostic yield of elective coronary angiography low (Dr Brahm Vasudeva)

Nearly two–thirds of those who undergo cardiac catheterization when they do not have diagnosed heart disease receive a clean report, suggesting that the expensive procedure, which exposes the patient to substantial amounts of radiation, may be overused, according to a study published in the New England Journal of Medicine. Investigators studied more than two million people who underwent cardiac catheterization. The investigators suggested that doctors should be less willing to order an angiogram for symptom–free patients, a group that made up 30 percent of the study sample.

High fat, meat consumption associated with elevated diabetes risk

As per a study in Diabetes Care, foods high in meat and fat confer an increased risk for diabetes in all ethnic groups, whereas the effects of other dietary patterns vary by gender and ethnicity. After following 29, 759 Caucasians, 35, 244 Japanese Americans, and 10, 509 Native Hawaiians aged 45 to 75 for 14 years and examining their diets, researchers found that high fat and meat consumption was associated with elevated diabetes risk among all ethnic groups in men, and also, albeit to a lesser degree, in women.

FDA adds boxed warning to winRho SDF

FDA, a boxed warning has been added to WinRho SDF (Rho(D) immune globulin intravenous), a drug used to treat immune thrombocytopenic purpura or ITP. The warning says that cases of intravascular hemolysis have been seen in patients being treated with WinRho SDF, and some cases have been fatal. The warning also states that patients should be closely monitored for at least eight hours after WinRho SDF is administered to look for signs of intravascular hemolysis.

Conference Calendar

Community Critical Care Training Program Indian Medical Association (IMA) (Target Audience – Doctors only)
Date: March 20–21, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue, Anna Nagar, Chennai, Tamil Nadu

What’s New

Vertebroplasty Update

In two blinded trials comparing vertebroplasty with a sham procedure for osteoporotic vertebral compression fracture, there was no immediate or delayed benefit of vertebroplasty for the reduction of pain.

  1. Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009;361:557.

  2. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009;361:569.

Cancer Alert

Lung cancer screening

Interim results from the randomized DANTE trial of spiral CT scan for lung cancer screening found that more stage I cancers were found in the CT–screened group, compared with annual clinical follow–up, but the number of advanced lung cancer cases and lung cancer mortality were the same for screened and control patients.

(Infante M, Cavuto S, Lutman FR, et al. A randomized study of lung cancer screening with spiral computed tomography: three–year results from the DANTE trial. Am J Respir Crit Care Med 2009;180:445.)

Quote of the Day

The trouble with our praying is, we just do it as a means of last resort. (Will Rogers)

Diabetes Fact

The usual dose of saxagliptin is 2.5 or 5 mg once daily, with the 2.5 mg dose recommended for patients with moderate to severe chronic kidney disease (GFR =50 mL/min) and for patients taking strong cytochrome P450 3A4/5 inhibitors

Public Forum (Press Release)

Act fast: You can reduce the Damage and Death from Heart Attack if……?

Water–soluble aspirin and clot-dissolving drugs can stop most heart attacks in progress, reduce disability and save lives. They work best if given within one hour of when sings of heart attack begin to appear.

It is therefore important to recognize the warning signs of a heart attack and act right away, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

Every year, over 24 lakh people die of heart attacks in India. About half of those deaths take place within one hour of the onset of warning signs and before the patient ever reaches a hospital.

The 5 Warning Signs of a Heart Attack, which every body must know

  • Pain or discomfort in the jaw, neck or back

  • Feeling weak, lightheaded, or faint

  • Chest pain or discomfort

  • Pain or discomfort in the arms or shoulder

  • Shortness of breath

Act fast

  1. Take 300 mg water–soluble aspirin and chew it if a heart attack is suspected.

  2. Get yourself rushed to a nearest heart centre for clot–dissolving therapy.

  3. You may require an emergency angiography and angioplasty to remove the clot.

  4. If there is a cardiac arrest, the bystander should give chest compression, 100 per minute, over the centre of the chest for the next 10 minutes.

 

Question of the day

How is hepatorenal syndrome managed?

SC Tewari, New Delhi

The hepatorenal syndrome refers to the development of acute renal failure in a patient who usually has advanced liver disease due to cirrhosis, severe alcoholic hepatitis, or (less often) metastatic tumor, but can occur in a substantial proportion of patients with fulminant hepatic failure from any cause.1–5

The hepatorenal syndrome usually represents the end–stage of a sequence of reductions in renal perfusion induced by increasingly severe hepatic injury.

  1. Combination therapy with midodrine and octreotide or single agent therapy with norepinephrine should be considered in patients with hepatorenal syndrome, given the apparent absence of significant side effects and the dismal prognosis with other available therapies (excluding liver transplantation).

  2. One can also administer intravenous albumin at approximately 1 g/kg day (100 g maximum) for two or more days.

  3. In the United States, liver transplant candidates who develop end–stage renal disease usually undergo hemodialysis; those who are not transplant candidates, commonly receive the combination of midodrine and octreotide when they are not in an intensive care unit (ICU) and norepinephrine when they are in an ICU.

  4. The role of terlipressin is under study. Overall, the mortality of patients with liver failure is substantially worse if they develop hepatorenal syndrome.

The outcome of patients with hepatorenal syndrome, as well as recovery of kidney function, is strongly dependent on reversal of the hepatic failure, whether spontaneous, following medical therapy, or successful liver transplantation.

References

  1. Arroyo V, Guevara M, Gines P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology 2002;122:1658.

  2. Gines P, Arroyo V. Hepatorenal syndrome. J Am Soc Nephrol 1999;10:1833.

  3. Wong F, Blendis L. New challenge of hepatorenal syndrome: Prevention and treatment. Hepatology 2001;34:1242.

  4. Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet 2003;362:1819.

  5. Wadei HM, Mai ML, Ahsan N, Gonwa TA. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol 2006;1:1066.

eMedinewS Try this it Works

When ear preparations irritate

Some ototopical agents are acidic and can irritate the ear canal, especially if the tympanic membrane is perforated. When patients complain that the otic preparations are irritating, try using ophthalmic preparations instead. These contain less acid and usually cause less irritation.

Dr Good Dr Bad

Situation: A diabetic had normal self–monitoring of blood sugar levels.
Dr Bad: No more tests are required.
Dr Good: Get A1C done.
Lesson: Self–monitoring of blood glucose (SMBG) is a partial and incomplete picture of blood glucose excursions. Well–controlled type 2 diabetic patients have a considerable number of hypoglycemia and hyperglycemia events that may be missed by SMBG. Hypoglycemia, especially nocturnal hypoglycemia, is the most prevalent complication in the tight control of diabetes that is usually not detected by SMBG. Postprandial hyperglycemia may occur, which has been shown to be closely related with cardiovascular disease, aggravation of oxidative stress and endothelial dysfunction. (Source: Indian J Med Sci 2009; 63:66–71.)

Make Sure

Situation: A terminally ill patient who develops bed sores, is given systemic antibiotics only.
Reaction: Please change the position of the patient frequently and keep the skin clean and dry.
Make sure that good nursing care and maintenance of skin hygiene is advised first to patients with bed sores, along with topical antibiotics.

Medi Finance  Indirect Tax

OTHERS

  • Additional banking licenses to private sector players may be granted

  • Non Banking Financial Companies could also be considered, if they meet the RBI’seligibility criteria.
Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
Nestle
 
nuspera
 
Docconnect

Laughter the best medicine

Medical Outpatient Clinic Summary:

Fundoscopy revealed second–degree hemorrhoids, but nothing more sinister

Formulae in Critical Care

Metabolic acidosis
Expected PaCO2 in mmHg
Formula: PaCO2 = [(1.5 × HCO3 + 8] + 2

Milestones in Orthopedics

Jean–Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children’s skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopedist in consideration of the establishment of his hospital and for his published methods.

Mistakes in Clinical Practice

QD (daily) Mistaken for QID Write “daily”

Lab test (Dr Navin Dang)

Serum Angiotensin converting enzyme factor is used to diagnose and monitor sarcoidosis and to help differentiate this systemic condition from other disorders causing similar symptoms.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Cefovecin( as sodium) 80mg/ ml Lyophilised powder for injection (Veterinary)

For the treatment of skin bacterial infections in dogs and cats.

03.10.09


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen Immune Power – a known immunity booster with ability to help reduce absorption of aluminum from the GI tract and enhance excretion through kidneys and is a key to eliminate aluminum toxicity and the related systemic involvement.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com emedinews@gmail.com

eMedinewS–PadmaCon 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April). Over 400 registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

INVITATION

Heart Care Foundation of India
Jointly with


eMedinewS, World Fellowship of Religions, Delhi Medical Council,
Delhi Medical Association, IMSA (Delhi chapter) and MAMC
takes pleasure to cordially invite you to

A lecture by
World renowned Dr Sanjiv Chopra, M.D., MACP
Dean Faculty Harvard, Boston USA
on
"Leadership for the 21st Century –Ten Tenants of Leadership"
on
Saturday 20 – 3–2010 (2pm–4pm)

at
MAMC Auditorium, Maulana Azad Medical College, Delhi Gate.

RSVP:
Dr KK Aggarwal
Padma Shri Awardee 2010

N.B
Dr Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts. He has four books to his credit. His books have been translated into several languages including Portuguese, Japanese, Italian and Czech. He has given a number of Keynote addresses on the topic of Leadership – "Leadership for the 21st Century: The Ten Tenets of Leadership" to wide acclaim in the United States and several countries abroad

Learning Objectives:

  • Discuss the qualities of great leaders.
  • Elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience.
  • Emphasize that we can all lead and can do so at many different levels
  • Explore what made or makes many leaders – historical and contemporary – so effective.

(Entry Free by prior registration only.
For registration call; 9810301261, 9971994518)
e-mail: drkk@ijcp.com, drkakroo@gmail.com
— — — — — — — — — — — —

Readers Responses

  1. Respected Prof. Dr. KK Aggarwal ji, Chief Editor, IJCP: I congratulate you for bringing out well informative medical journal, Medinews especially news related to Medical Council of India. Congrats on receiving Padma Shri. Dr. N.S. NEKI, MD, FRCP(EDIN), FAMS, FICP, FACP, Prof. of Medicine, Govt. Medical College, Amritsar Punjab.

  2. Appreciations for the great work done sir: Dr. A. Selvarajan



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