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  From the desk of editor in chief
Dr KK Aggarwal

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

17th November 2010, Wednesday

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

Osteoporosis patients on bisphosphonates should take a "drug holiday"

Long–term use of osteoporosis drugs –– particularly bisphosphonates –– may do more harm than good. Now, the opinion is to stop taking the drugs for a time or take a ‘drug holiday.’

Recently, several potential risks from long–term use of bisphosphonates have arisen, such as osteonecrosis of the jaw, an increased risk of developing cancer of the esophagus, and unusual femur fractures. Bisphosphonate drugs may remain in bone tissues for up to two years after patients cease taking them.  

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr. GM Singh)

"Our imagination is the only limit to what we can hope to have in the future."

Charles F. Kettering

    Photo Feature (from the HCFI Photo Gallery)

 Cultural Evening – 17th MTNL Perfect Health Mela 2010

Folk Dances of India was presented in a cultural fest organized at the 17th Perfect Health Mela

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/ Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Surat No. 2 on India’s diabetes map

It’s a well–known fact that India is the world’s diabetes capital. Now, it emerges that after Mumbai, Surat and Ahmedabad enjoy that dubious distinction in the country.
Abnormal blood sugar levels were found to be as high as 73.3% in Mumbai —way above levels in other cities—during a survey conducted by diagnostic chain Metropolis, among 2,28,009 people between April and September this year in cities like Delhi, Mumbai, Pune, Chennai, Ahmedabad and Surat. Meanwhile, marking World Diabetes Day on Sunday, the first–ever ‘State Diabetes Prevention Programme’ was kicked off in Ahmedabad. The programme is aimed at screening high–risk people for diabetes, creating awareness among people and giving training to over 1,200 doctors and 2,000 health workers in management of diabetes and related complications. Launched by city–based Swasthya Diabetes Care (SDC), the three–year project is supported by World Diabetes Foundation and aims at creating awareness about the growing prevalence of the disease, prompting people to adopt better lifestyles and creating an army of trainers who could help diabetics. (Source: The Times of India)

    International News

(By Dr GM Singh)

Pneumococcal vaccine recommendation updates from CDC

Initial vaccination: 23–Valent Pneumococcal Polysaccharide Vaccine (PPSV23) should be given to the following:

  • All at age 65 years
  • Age group 19–64 years with immunosuppressive or chronic conditions (including asthma or other chronic lung disease, diabetes, alcoholism, liver disease; excluding hypertension)
  • Cigarette smokers aged 19–64 years (along with smoking cessation guidance)

Routine PPSV23 use is no longer recommended for Alaskan Natives or Native Americans younger than 65 years old, unless they have medical indications for the vaccine.

Re-vaccination: The following should receive a second dose of PPSV23:

  • Those who received PPSV23 before age 65 years (for any reason) should receive a second dose at age 65 or older (if more than 5 years have passed since the previous dose)
  • Age group 19–64 years with immunosuppressive or chronic conditions (including asthma or other chronic lung disease, diabetes, alcoholism, liver disease; excluding hypertension)

Multiple PPSV23 revaccinations are not recommended, due to insufficient data regarding clinical benefit, degree and duration of protection, as well as safety.

FDA approves duloxetine for chronic musculoskeletal pain

The US Food and Drug Administration (FDA) has approved duloxetine HCl delayed–release capsules (Cymbalta; Eli Lilly and Co) for the once–daily treatment of chronic musculoskeletal pain.

(Dr Monica and Brahm Vasudev)

Omega 3s are essential fatty acids

Body needs omega 3 fatty acids but does not make them. They must be supplied from foods including fish, some plants or nut oils. Omega 3s may help people with these health conditions, or people at greater risk of acquiring them: High cholesterol; High blood pressure; Heart disease and stroke; Cancer of the colon, breast or prostate; Diabetes; Rheumatoid arthritis; Lupus; Osteoporosis; Mental health conditions such as depression, bipolar disorder or schizophrenia; Attention deficit/hyperactivity disorder and Macular degeneration of the eye. (Source: Medlineplus)

Severe acne may increase suicide risk

Severe acne may significantly increase suicide risk, and patients taking isotretinoin (Accutane) for the skin condition should be monitored for at least a year after treatment ends, reports Swedish researcher Anders Sundstrom, a pharmacoepidemiologist at the Karolinska Institute in Stockholm.

    Infertility Update

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

What are the complementary and alternative treatments of infertility?

Manual physical therapy

The Wurn Technique, a manual manipulative physical therapy treatment was shown to improve natural and IVF pregnancy rates in infertile women in a study published in 2004, and to open and return function to blocked fallopian tubes in a 2008 study. The therapy was designed to address adhesions restricting function and mobility of the reproductive organs.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

What are the prevention strategies for cystic fibrosis liver disease?

The potential approaches to preventing cystic fibrosis liver disease include:

  • Optimizing nutritional status
  • Avoiding hepatotoxic medicines
  • Immunization against hepatitis A and B to protect the individual from additional hepatic insults

Although no therapy has been shown to alter the course of progression to cirrhosis in CF, there is evidence that treatment with ursodeoxycholic acid (UDCA) improves serum liver biochemistries, hepatobiliary symptoms, and histology in these patients; it is generally well-tolerated. Potential mechanisms for these observed benefits include improvement in bile flow, displacement of toxic bile acids, cytoprotection, or stimulation of biliary bicarbonate secretion. Despite the lack of conclusive evidence that UDCA alters the course and outcome of CF liver disease, the CF Foundation Hepatobiliary Disease Consensus Group concluded that it is prudent for all CF patients with cholestasis-fibrosis-cirrhosis to receive UDCA therapy.

    Medicolegal Update

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

World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

  • Biomedical research involving human subjects must conform to accepted scientific principles and should be based on adequately performed laboratory and animal experimentation and on a thorough knowledge of the scientific literature.
  • The designs and performance of each experimental procedure involving human subjects should be clearly formulated in an experimental protocol which should be transmitted to a specially appointed independent committee for consideration, comment and guidance.
  • Biomedical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest with a medically qualified person and never rest on the subject of the research, even though the subject has given his or her consent.
  • Biomedical research involving human subjects cannot legitimately be carried out unless the importance of the objectives is in proportion to the inherent risk to the subject.
  • Every biomedical research project involving human subjects should be preceded by careful assessment of predictable risks in comparison with foreseeable benefits to the subject or to others. Concern for the interests of the subject must always prevail over the interest of science and society.
  • The right of the research subject to safeguard his or her integrity must always be respected. Every precaution should be taken to respect the privacy of the subject and to minimize the impact of the study on the subject's physical and mental integrity and on the personality of the subject.
    ENT Update

Dr. Aru Handa MS, DNB (Dept. Co–coordinator and Sr Consultant, Dept. of ENT, Moolchand Medcity)

Why should decongestant nasal drops not be used for long?

Nasal decongestant drops containing xylometazoline, oxymetazoline etc. are used only for short term to open up the nasal passages and to facilitate the drainage. The relief in congestion is very quick but long-term use can actually increase the blockage. Erythema and edema of the mucosa causing rebound nasal obstruction and congestion occur with chronic use. Increase in the use of nasal drops to manage this blockage further worsens the situation and causes dependency. Decongestant nasal drops should not be used for more than 5 – 7 days without a doctor’s prescription. Extra caution should be taken in patients with cardiac disease, hypertension or uncontrolled diabetes. 

    Lab Update

(Dr. K Raghu, Sr Consultant Hematologist, Coimbatore)

Hematology Tips

When to suspect acute leukemia

Acute leukemia, especially in children, can be missed if you are not careful. The most common symptom is fever which lasts beyond 2 weeks and which does not respond to normal treatment modalities. Many children present with unexplained limping, joint swellings or just crying spells due to severe bone and soft tissue infiltrates. Suspect leukemia if ESR is beyond 100, even if WBC counts appear normal.
Make sure a bone marrow study is done on all suspected cases since it is the only way to pick up acute leukemia with certainty. A trephine biopsy may also be needed if the aspirate reveals a ‘dry tap’. Childhood leukemia is curable most of the time (about 60% in India and about 85% in western countries).

    Medi Finance Update

Personal Accident Individual

Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not) civil war, rebellion, revolution, insurrection, military mutiny or usurped power, capture, arrests, restraint and detainments of all kings, princes and people of whatsoever nation condition or quality. Child birth, pregnancy or other physical causes peculiar to the female sex.

    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

Fixed dose combination of Analgin with any other drug

    IMSA Update

International Medical Science Academy (IMSA) Update

Treatment of recurrent pregnancy loss

A large randomized trial found that neither aspirin alone nor aspirin + heparin improved the live–birth rate of women with unexplained recurrent pregnancy loss. The live–birth rates for combination therapy, aspirin alone, and placebo were not significantly different: 69, 62, and 67 percent, respectively.

(Ref: Kaandorp SP, et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med 2010;362:1586).

    IJCP Special

Dr Good Dr Bad

Situation: A middle–aged patient was found to have central obesity.
Dr Bad: It is normal.
Dr Good: Rule out diabetes.
Lesson: As per results of a prospective cohort study (1989–2007) of 4,193 men and women 65 years of age and older in the Cardiovascular Health Study, among older adults, overall and central adiposity and weight gain during middle age and after the age of 65 years were associated with risk of diabetes.

Make Sure

Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin (macrolide) 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Rajat Bhatnagar)

Positive differences in the kids in your life

How much love they receive

This is the most important of all three because children need lots of love, support and encouragement in order to become all they are meant to be.

We all want our children to know we love them. We say it before they go to school and at bedtime. We run them around to all their activities. We provide for their needs. Sometimes though, we get so busy that we forget the best way to let children know we love them is to SHOW them. Give kids plenty of hugs and kind words, and spend quality, one–on–one time with them. Even when discipline is required, don’t withhold love, and children should never be attacked verbally or physically in a moment of anger. Teach the lesson, then give the child a big hug and remind them that the only reason you discipline them is because you love them and want them to grow up to be happy, responsible adults.


Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: "search and"

Answer for yesterday’s eQuiz: "Search high and low"

Correct answers received from: Dr K P Rajalakshmi

Answer for 15th November Mind Teaser: "Go for it"
Correct answers received from: Dr Chetana Vaishnavi, Dr. Anupam Sethi Malhotra, Dr Anurag Jain, Dr Rashmi Chhibber,  Dr Meera Rekhari, Dr Sachin  Joshi, Dr Vijay Kansal,  Dr. Anjani,  Dr Rajiv Kohli, Dr Umesh Mehta

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

Man rushes into a bar and says to the barman: "Quick, give me a double brandy before the trouble starts." The barman obliged, the man downed it in one and again said: "Quick, give me another double brandy before the trouble starts".

Again he downed it in one: "Quick, give me another……" The barman said:" Just a minute, when’s all this trouble going to start?" The man replied "Anytime now, cos I’ve got no money."

    Readers Responses
  1. I would like to add on to Dr Sudhir Gupta’s deliberation on Paracetamol poisoning. It is important to do paracetamol levels which are done 4 hrs or later after the intake. The values are then checked over the Nomogram to estimate the toxicity. One should be comfortable in working out on Nomogram for managing such patients, else one may risk giving unnecessary treatment leading to potential harm to the patient. Regards:  Dr Vivek Chhabra, Specialty Physician, Emergency Medicine, James Paget University Hospital NHS Foundation Trust, UK
    Public Forum

(Press Release for use by the newspapers)

Expressive writing can relieve stress

One can significantly boost mental and physical health by spending thirty minutes each day for four days to write out innermost thoughts and feelings, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Expressive writing simply requires a pen and paper. In expressive writing therapy, patients are encouraged to express whatever is on their mind, letting their hopes and fears flow out in a natural and unrestrained way. It is like keeping a journal, but more focused on the things that might be bothering one or triggering stress.

Talking about other updates Dr Aggarwal said that snoring at night or sleepiness during the day may be a symptom of obstructive sleep apnea, a potentially life threatening problem affecting one out of three diabetics. It occurs when the airway becomes blocked during sleep and is usually caused by the collapse of soft tissue in the back of the throat during sleep. Between snores, breathing stops for a period of 10 seconds or longer, and this pattern repeats itself multiples times over the course of a night.

Smoking while pregnant can damage thyroid function of both the mother and the foetus. Good thyroid function is the key to maintaining a pregnancy. This, in turn, affects metabolism and the risk of miscarriage, premature birth, low birth weight and impaired brain development.

People who develop chronic cough and phlegm (sputum production) are at four fold risk of developing chronic obstructive artery disease.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant

Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 – 9.30 AM:
Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
9.30 – 10.00 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Hospital
10.00 – 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 – 11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion
12.00 Noon: Lunch

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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