emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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 (07–08); 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

 

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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 1st Mega Ajmer Health Camp 2012

 
  Editorial …

17th April 2012, Tuesday

Five Things Physicians and Patients should question (Part 7)

American Society of Clinical Oncology

  1. Don’t use cancer–directed therapy for solid tumor patients with the following characteristics: low performance status (3 or 4), no benefit from prior evidence–based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment. Studies show that cancer directed treatments are likely to be ineffective for solid tumor patients who meet the above stated criteria. Exceptions include patients with functional limitations due to other conditions resulting in a low performance status or those with disease characteristics (e.g., mutations) that suggest a high likelihood of response to therapy. Implementation of this approach should be accompanied with appropriate palliative and supportive care.
  2. Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis. Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types. However, these tests are often used in the staging evaluation of low-risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival. Evidence does not support the use of these scans for staging of newly diagnosed low grade carcinoma of the prostate (Stage T1c/T2a, prostate–specific antigen (PSA) <10 ng/ml, Gleason score less than or equal to 6) with low risk of distant metastasis. Unnecessary imaging can lead to harm through unnecessary invasive procedures, over–treatment, unnecessary radiation exposure, and misdiagnosis.
  3. Don’t perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis: Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types. However, these tests are often used in the staging evaluation of low–risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival. In breast cancer, for example, there is a lack of evidence demonstrating a benefit for the use of PET, CT, or radionuclide bone scans in asymptomatic Individuals with newly identified ductal carcinoma in situ (DCIS), or clinical stage I or II disease. Unnecessary imaging can lead to harm through unnecessary invasive procedures, over–treatment, unnecessary radiation exposure, and misdiagnosis.
  4. Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent. Surveillance testing with serum tumor markers or imaging has been shown to have clinical value for certain cancers (e.g., colorectal). However for breast cancer that has been treated with curative intent, several studies have shown there is no benefit from routine imaging or serial measurement of serum tumor markers in asymptomatic patients. False–positive tests can lead to harm through unnecessary invasive procedures, over–treatment, unnecessary radiation exposure, and misdiagnosis.
  5. Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20% risk for this complication. ASCO guidelines recommend using white cell stimulating factors when the risk of febrile neutropenia, secondary to a recommended chemotherapy regimen, is approximately 20% and equally effective treatment programs that do not require white cell stimulating factors are unavailable. Exceptions should be made when using regimens that have a lower chance of causing febrile neutropenia if it is determined that the patient is at high risk for this complication (due to age, medical history, or disease characteristics).

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

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

Varenicline go ahead in heart patients

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

First Mega Ajmer Health Camp – Checkups

Both general and specialty consultations were available incorporating all pathies.

 
Dr K K Aggarwal
 
    National News

Need for Intensive-care units will increase manifold by 2020

JAIPUR: Critical care services should be made cheaper and made accessible to the poor as the need for ICUs would increase manifold by 2020, said experts. Doctors from various countries took part in the conference on critical care medicines held in Jaipur on Saturday. Leads, UK senior professor and researcher Dr Abhiram Malik said ICU is a branch in medicine which started in 1940. Explaining the concept of ICU in 2020, he said, it has come to light in a European Survey that there would be heavy demand for ICUs in 2020, because obesity is increasing in the entire world which causes organ failure, so will the need for ICUs. And in the times to come, ICUs will be made in cubicle shape, so that infections do not spread to other places. (Source: TOI, Apr 16, 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

Doubled dose of rabeprazole increases cure rate of refractory esophagitis

A Japanese team has confirmed endoscopically that when a standard once–daily dose of rabeprazole fails to resolve reflux esophagitis, a twice–daily regimen may be more successful. "In subgroup analyses, the endoscopically confirmed healing rates were higher in the RPZ (rabeprazole) 10 and 20 mg b.i.d. groups than in the 20 mg q.d. group, particularly in patients with nocturnal heartburn or sleep disorders due to nocturnal symptoms," the investigators noted in the American Journal of Gastroenterology, online March 20. (Source: Medscape)

For Comments and archives…

Hospital–acquired infections quadruple ICU mortality

Elderly patients treated with central catheter and/or mechanical ventilation devices in intensive care units (ICUs), admitted from the emergency department or as an urgent case, are at very high risk for hospital–acquired infection (HAI), according to the results of research presented here at the 22nd European Congress of Clinical Microbiology and Infectious Diseases. (Source: Medscape)

For Comments and archives…

Fecal microbiota transplant effective for refractory C. difficile infection

Instillation of donor fecal material in the colon of patients with refractory Clostridium difficile infection leads to rapid resolution of the condition in more than 90% of cases, investigators reported late last month. (Source: Medscape)

For Comments and archives…

Older varieties of fruits, vegetables were healthier

LONDON: Older varieties of fruits and vegetables may be considerably healthier than their modern supermarket equivalents, a new study has claimed. A pilot study found that an unfashionable dessert apple that dates back to Victorian times had ten times more of a disease–preventing chemical than its newer, shiny–skinned equivalents. A team of scientists will now undertake a three-year study, examining older varieties of apples, bananas, onions, mangos and teas. It has already been found that the Egremont Russet apple, which is often used to make cider, contains considerably more phloridzin than modern glossy fruits. The chemical increases the absorption of sugar from the digestive system into the blood, and can reduce the risk of type–2 diabetes. (Source: TOI, Apr 13, 2012)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: Earthquakes are a common occurrence, rumbling below Earth’s surface thousands of times every day.

@DeepakChopra: Addiction attempts to numb emotional pain but only aggravates it. Pain is relieved by feeling it & bringing the light of awareness

 
    Spiritual Update

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

To let go of the ego

Is counseling process used in the treatment of personality disorders?

In mythology it is learnt in Ramayana where ego represents Ravana, and the process to win over the Hanuman (Breath control); Monkey Army (thoughts), Sugriva (Intellect), Bali (Lust), Tams

For Comments and archives…

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What do you mean by barrier contraception?

Barrier contraceptives prevent sperm from entering the uterus and fallopian tubes. The barrier may be chemical (spermicide) or physical (male and female condoms, diaphragm, cervical cap, Lea’s shield, contraceptive sponge). According to western figures, couples using a barrier method of contraception can notice a failure rate (number of failures per 100 women who use the method) that ranges from 15% (male condom) to 20% (diaphragm, cervical cap) to 32% (cervical cap or sponge) of the time. When two barrier methods are used together (like a diaphragm and a condom), they become highly effective (up to 95%). If the barrier method breaks or falls out during sex, a woman may consider taking emergency contraception (the "morning–after" pill).

For Comments and archives…

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

(Dr Sanjay Chaudhury, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre)

Q. Do religious authorities approve of donating one’s eyes?

Yes, all religious faiths support this vital sight restoration program.

Q. Is the whole eye used for transplant?

No. Only the thin transparent layer in front of the iris, called the cornea, is used for transplant.

For Comments and archives…

 
    An Inspirational Story

(Dr. Anil Kumar Jain)

This story from Mahabharata brings to light that our spiritual achievement is useless if we neglect our duties or Dharma.

Kaushika was his parents’ only son. "Mother," he said one day, "I want to go off into the jungle and devote myself to spiritual studies."

His mother said with concern, "But son, your father and I are very old. Your father is so sick he can hardly move. If you go away, what will happen to us? Who will attend to our needs?" Kaushika did not listen. He was determined to study the Vedas. His mother cried in vain as she watched her son turn his back on her and leave for the jungle. Eventually Kaushika acquired great mystical powers.

One afternoon, as he was meditating under a tree, a crane flew up, and perched herself on a branch above Kaushika. Some bird droppings fell on Kaushika’s head. Kaushika furiously threw a fiery gaze at the crane. The crane immediately fell dead.

The sage felt sorry for what he had done. "How could I have allowed my anger to take over me that way?" He mourned.

Later in the day, he went to a village to beg for alms. The lady of the house asked him to wait and went to get some food. Right then her husband arrived. She immediately set aside the pot of food she was taking to the sage and went to attend her husband.

After washing his feet, giving him food, and attending to his needs, she came back out to give the alms to the sage. The sage was very insulted. "You put your husband before a pious sage? Do you know the power of a Brahmin?"

She calmly replied, "Yes, a true Brahmin is he who has mastered his anger. Please do not threaten me, I am not a crane that will die by your fiery gaze."

The sage was amazed. "How does she know about the crane?" he wondered.

The lady continued, "Oh holy one! You are a learned Brahmin but you have not understood the truth about virtue. If you want to be enlightened, go to Dharmavyadha who lives in Mathura. Any one will tell you where he lives."

The sage thanked the lady and hurried to Mathura. "He must be a great and learned sage indeed," Kaushika thought to himself. But when he finally reached Dharmavyadaha’s place, he found it to be a butcher shop!

A very ordinary looking man came out and said, "Welcome holy one. I am Dharmavyadaha, the man you seek."

"How can a butcher be spiritually enlightened?" Kaushika asked in amazement.

Dharmavyadaha smiled and said with compassion, "I know the story of the crane and of the woman who sent you here. Come, let us go to my house."

The sage could not contain himself and blurted out, "But butchering animals is such a sinful profession! Are you not ashamed?" "I am not," the butcher calmly said. "I am engaged in a family trade. I work hard and honestly at it. There is no reason for me to be ashamed of my work!"

"Holy one," continued the butcher. "If I do injury to other creatures, so do you as you did to the crane. As we walk on the soil, we are trampling on numerous creatures. Nor is the air devoid of creatures. You see that farmer tilling the land? He is killing so many animals that thrive under the soil."

They reached the butcher’s house. The butcher’s wife was doing her household chores and his two boys were playing. The butcher introduced the sage to his wife and boys. Then the butcher entered the house and touched his parents’ feet.

"Here is a learned Brahmin who has come from a far–off place." the butcher told his old father.

"Welcome, holy one," the father said.

Before leaving the room, the butcher remarked, "My parents are my Gods. My wife and my children attend to them with devotion and love. We consider caring for them to be our greatest duty."

"In doing one’s duty cheerfully, lies true virtue. This is what the dutiful wife sent you to learn." "Oh learned one!" the butcher continued, "You have run away from your responsibilities and deserted your aged father and mother. Spiritual achievement is useless if one has neglected one's Dharma, or duties."

The sage remembered his mother crying, "Who will look after us when you are gone my son?"

The sage apologized, "You have shown me the path of true virtue, the true meaning of Dharma, Oh pious one. I am deeply indebted to you."

Kaushika immediately returned to his parents and served them lovingly till the end of their days.

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)

Magnitude of occupationally acquired infections in healthcare workers

The fundamental requirement of health care is that sick persons, irrespective whether contagious or otherwise must receive care and this exposes healthcare workers (HCWs) to occupational risk of HAIs. The annual death rate for healthcare workers from occupational events, including infection in USA, is 1757 per 1 million workers. The vulnerability of HCW was re–emphasized during the SARS epidemic. HWCs were the group most affected by this emerging agent. According to the WHO, HCWs accounted for 1,707 (21%) out of 8,098 cases that occurred during the outbreak, and 774 (9.6%) persons died. During the past two decades, occupationally acquired hepatitis B, HIV infection, multidrug–resistant tuberculosis, and viral hemorrhagic fevers, among others, have killed HCWs. The Centers for Disease Control and Prevention (CDC) and others have prepared and distributed guidelines for healthcare worker protection, recommending vaccination, early patient screening, isolation precautions, and use of personal protective equipment.

To date, 26 (46%) of 57 US healthcare workers with voluntarily reported, documented, occupationally acquired HIV infection have progressed to AIDS, as have 121 (88%) of 138 healthcare workers with possible occupational transmission. In the UK, as of November 2008, the Health Protection Agency (HPA) reported that there have been five documented cases of HIV infection after occupational exposure in the healthcare setting, the last being in 1999. There is one documented case of occupationally–acquired HIV infection in a nurse in India that was reported by us (Baveja UK, Chattopadhya D, Datta KK and Joshi PL. JCD 2002;36:63–4).

For comments and archives

 
   Cardiology eMedinewS

Mortality Risk in Heart Failure No Higher with Losartan Read More

Rituximab, Standard Immunosuppressive Combo Fails In Lupus Nephritis Read More

Weight–Loss Fads Less Effective Than Exercise, Eating Less Read More

US Kids Should Cut 64 Calories a Day To Reverse Obesity Trend Read More

 
   Pediatric eMedinewS

Co–Sleeping Linked To Sudden Death In Infants Read More

Children With Duct Obstruction At Risk For Amblyopia Read More

Reporting Tool For Abusive Pediatric Head Trauma Developed Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A lady who became pregnant while on Leflunomide came for Detox.
Dr Bad: No Detox is required.
Dr. Good: Start Cholestyramine Protocol.
Lesson: Elimination of leflunomide can be accelerated in pregnancy through the administration of cholestyramine (8 g orally three times daily for 11 days) and confirmed by measurement of drug levels less than 0.02 mg/L on two tests performed two weeks apart. Additional cholestyramine treatment is indicated if plasma levels remain greater than 0.02 mg/L (Arthritis Res Ther 2006;8:209).

For comments and archives

Make Sure

Situation: A patient died after receiving IV isoprin stat.
Reaction: Oh my God! The order was for IV Isoptin.
Lesson: Make sure while ordering the drug to spell out the name of the medicine correctly and clearly.

For comments and archives

 
  Legal Question of the day

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

Q. I am not a doctor. I have the following questions:

  • Why has the quality of diagnosis and treatment deteriorated despite advanced equipments?
  • Does the quality of a doctor depend on academic qualifications alone?
  • Why do doctors in USA and India recommend C section delivery even though normal delivery is possible?
  • If doctors misguide patients and patients keep suffering perpetually, what should patients do?

Ans.

  1. Advanced equipments do not diagnose or treat a patient. Advanced equipments are merely aids to diagnosis and treatment which remain important brain functions of the physician. In the absence of proper intellectual inputs, there can be serious adverse situations like: Wrong diagnosis; wrong advice to get costly and unnecessary investigations done; Wrong interpretation of tests; Wrong prescription of medicines; Careless prescription of medicines with the result that an equally good, generically same drug is not prescribed and the same drug from another company with ten times the cost is prescribed; Unnecessary prescription of drugs; Irrational prescription of drugs/drug combinations etc.
  2. The knowledge and competence of a doctor certainly depends to a good extent on the academic qualifications of a doctor. However, the quality of a doctor has other attributes such as honesty; capacity to work hard, the ability to work tenaciously and sincerely in pursuit of set goals, etc.

    A student who has such qualities and has demonstrated the same through his performance during school years and has scored good academic scores without indulging in dishonest practices like copying will always have them, even as a doctor.

    A student who does not have such qualities and has not been able to demonstrate the same through his performance during school years will, even though he gets admitted to the medical college on the basis of diluted selection criteria will always lack them, even as a doctor.
  3. Those doctors who advise any surgery unnecessarily commit a wrong. If any doctor recommends surgical delivery when normal delivery is safely possible, this would be a wrong and illegal advice and the doctor would be liable for this.
  4. If a doctor misguides a patient and the patient suffers in consequence;
    1. He can do three things against the doctor:
      1. Complain to the medical council against the doctor.
      2. Complain to the consumer court against the doctor and the hospital.
      3. If there is gross negligence, complain to the police against the doctor.

        All three complaints can be made simultaneously
    2. He can do two things against the hospital:
      1. In states where Clinical Establishments Act, 2010, is applicable or there is already in place a state Act of similar nature, make a complaint against the hospital under the relevant Act.
      2. In states where the above type of Act is not there, make a complaint to the State Health Directorate against the hospital.
 
  Quote of the Day

(Dr GM Singh)

A successful man is one who can lay a firm foundation with the bricks others have thrown at him. David Brinkley

 
  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Fasting is not required for total cholesterol and HDL cholesterol.

 
    Mind Teaser

Read this…………………

What is the main reason women have problems becoming pregnant after age 30?

A. Their ovaries release fewer eggs.
B. Their eggs have begun to degenerate.
C. They have sex less frequently.
D. The uterine lining thins.
E. It is a high–stress period in their lives.

Yesterday’s Mind Teaser: When should you have your first cholesterol screening?

A. At age 10.
B. At age 20.
C. At age 35.
D. At age 40.
E. It depends on your risk factors.

Answer for Yesterday’s Mind Teaser: B. At age 20.

Correct answers received from: Dr Dinesh Paul, Dr Mrs S Das, Dr PC Das, Raju Kuppusamy,
Dr Chandresh Jardosh, Dr U gaur, Anil Bairaria, Dr Jainendra Upadhyay.

Answer for 15th April Mind Teaser: B. Heart disease
Correct answers received from: Dr PC Das, Yogindra Vasavada.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Kidneys and Livers

Two old men were arguing the merits of their doctors. The first one said, "I don’t trust your fancy doctor. He treated old Jake Waxman for a kidney ailment for nearly a year, and then Jake died of a liver ailment." "So what makes you think your doctor is any better?" asked his friend.

"Because when my doctor treats you for a kidney ailment, you can be sure you’ll die of a kidney ailment.

 
  Medicolegal Update

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

Is Touch DNA test different from a DNA test?

Human being shed tens of thousands of skin cells each day, and these cells are transferred to every surface with which human skin comes into contact.

  • Both are the same. But, a DNA test is done using visible biological samples like blood, saliva, semen etc. While, samples for touch DNA are usually not visible and since they are often deposited in smaller amounts than the DNA found in bloodstains or other body fluids, it is more difficult to obtain DNA profiles from these samples. This means that low copy DNA profiling allows a very small amount of DNA to be analyzed, from as little as 10 to 30 cells. DNA in skin cells that are left at a crime scene may be sampled from a variety of items including gun grips, steering wheels, eating utensils, luggage handles, and clothing
  • Touch DNA samples are also processed exactly the same way as blood, semen, and saliva etc. Touch DNA analysis may be able to link the perpetrator to the crime scene, by collecting the skin cells and analyzing them.
  • The key to obtaining successful Touch DNA results depends on recognizing items which may be suitable for Touch DNA analysis and using the sampling technique or collection method that will recover the highest number of skin cells.
  • Locard exchange principle states that with contact between two items, there will always be an exchange. So, when a crime is committed, if the perpetrator deposits a sufficient number of skin cells on an item at the scene, and that item is collected as possible evidence.
  • The techniques used are:
    • Swabbing: The surface of the item is rubbed with a cotton swab to collect possible cells. This method is preferred for hard items such as glass or plastic.
    • Cutting: May be used for soft items, such as clothing, in which fabric from areas of interest is cut to collect possible cells.
    • In addition to the commonly used swabbing and cutting methods, the latest technologies has recently started using the "Scraping" and "Tape Lift" methods, in which the surface of soft items such as clothing are either scraped with a blade, or sampled with a small piece of tape, to collect possible cells.
 
    Public Forum

(Press Release for use by the newspapers)

Low-calorie soup good for health

Having a bowl of low-calorie soup prior to a meal may help cut the total mealtime intake of amount of food and calories, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

As per the Penn State researchers, diners who were given, low–calorie soup made of chicken broth, broccoli, potato, cauliflower, carrots and butter to volunteers before they ate a lunch, consumed 20 percent fewer calories. The NIH study showed that all versions of soup recipe –– separate broth and vegetables, chunky vegetable soup, chunky-pureed vegetable soup and pureed vegetable soup proved equally filling.

Consuming a first–course of low–calorie soup, in a variety of forms, can help manage weight. Using this strategy allows people to get an extra course at the meal, while eating fewer total calories.

One should take only low–calorie, broth–based soups that are about 100 to 150 calories per serving and not higher–calorie, cream–based soups.

Remember anything that is bad for your heart is also bad for your brain.

 
    Readers Response
  1. Dear Sir, You are really doing a wonderful and commendable job which is benefiting so many doctors.Hats-off to you Sir. Regards: Dr HP Mishra
 
    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