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FIRST NATIONAL DAILY 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

 
  Editorial …

17th January, 2011, Monday                             eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Winter is the month of depression and
Uttarayana is the start of positive state of mind

Dear Colleague

In Indian mythology, the word ‘Sankranti’ relates to any transformation or change. Makar Sankranti which is celebrated on the 14th of January, one day after Lohri, indicates change in the direction of the sun as it starts moving north causing longer days and shorter nights. In Hindu mythology, this is called Uttarayan. This was the period which Bhishma Pitamah chose for his death during Mahabharat. He died on the day of start of the Uttarayan.

Uttarayana and Dakshinayana are not only time periods mentioned in the Vedic literature but they also depict states of mind. Uttarayana denotes a period for a positive state of mind and Dakshinayana a period for a relatively negative state of mind. A positive state of mind in Uttarayana makes meditation easier in this period and more fruitful. A beginner should learn the process of meditation and pranayama during Uttarayana.

The Bhagwad Gita talks about Moksha and liberation. Those who believe in the philosophy of rebirth know that once a soul is liberated at death, a person is not reborn. Those who believe that hell and heaven are in this birth only for them liberation means dying peacefully and without sufferings. The theory of rebirth is well described in the Bhagwad Gita in Chapter 8. The gist of Lord Krishna’s teaching is:

Whatever you think throughout your life will be your thought at the time of death.

  • Whatever is the state of mind at the time of death will be the atmosphere you will get in the rebirth. E.g. if your state of mind is in cruelty at the time of death, you will be born in a cruel family.
  • If you are relaxed, thinking of God or Chanting AUM at the time of death, there are chances your soul will be liberated.
  • Fire, illumination, daytime, fortnight before the full moon and Uttarayana are the paths for liberation. It means these are the periods/ways for spontaneous positive thinking.

From mental health point of view, this knowledge can be converted into medical prescription. Uttarayana means satwa, a healthy state of mind and Dakshinayana means a depressed state of mind. Performing and attending to Yagna, sitting in well illuminated lights or exposing oneself to day sunlight can be an adjunct to depression treatment. During the first fortnight of full moon and during Uttarayana, psychotherapy and counseling invariable will work better and the requirement of drugs may get reduced.

Uttarayana is also the period for ‘Snana’ (bath); ‘Daan’ (charity); ‘Dhayana’ (concentration), ‘Upwas’ (detoxification) and ‘Sun worship’ (Sunbath).

Snana signifies cleansing of the body, mind and the soul and combined with fast or upwas and sun bath is the procedure for detoxification. Once the body is detoxified, it’s in a positive state of mind, can concentrate better and gets detached to material things and starts to donate in charity whatever one has in excess.

First National Valve Summit 3011: 16th January: Hotel Suryaa Organized by Fortis Escorts Heart Institute Excerpts

Dr Ganesh Manoharan and Dr Ashok Seth (on PAVI percutaneous AV replacement)

a. TAVI is now a feasibility in the country
b. Requires a dedicated team
c. There is a learning curve
d. There are two available devises
e. No TOE guidance is required f. Its possible to use axillary and subclavian approach apart from femoral     approach

Dr Ted Feldman, Dr Ramesh Arora and Dr Vijay Trehan (on PMVR)

  1. LA smoke is not a contraindication
  2. Intra cardiac echocardiography can delineate the extent of valvular deformity and may also be useful in visualizing several key steps of the valvotomy procedure, including trans septal puncture of the interatrial septum, exclusion of thrombus from the left atrial appendage, optimizing balloon placement across the valve orifice and initial assessment of the results of dilatation
  3. In young patients, eventual surgical valve replacement is likely to be necessary in the long term, even for very successful percutaneous procedures. Nevertheless, the benefit of postponing surgery for as long as a decade or more can be significant, depending upon the individual patient.
  4. A surgical approach with mitral valve repair, if possible, or valve replacement is indicated in patients with moderate to severe symptomatic MS who have moderate to severe (3+–4+) mitral regurgitation or left atrial thrombus that persists despite anticoagulation or who have valve morphology that is not favorable for PMBV
  5. Tips
    a. Safe puncture
    b. SVC is posterior
    c. Gliding movement or rotary movement are
    d. Hold the needle and the sheath together or may injure vessesl
    e. Puncture under echo guidance

3D Echo Update: Dr Omar, Dr Aasha Gopal

  • 3D imaging is superior to 2D techniques in two clinical scenarios: Quantification of left ventricular volume, mass wall motion and Quantification of the mitral valve area in mitral stenosis.

Echocardiographic evaluation of the tricuspid valve
 Dr R Alagesen, Dr J S Dhillon, Z S Meherwal

  1. TV consists of anterior, septal and posterior leaflets.
  2. The normal TV thickness is less than or equal to 3 mm.
  3. In the 2–D parasternal long axis (right ventricular inflow) view, the septal and anterior leaflets are generally visualized.
  4. In the parasternal short axis view at the level of the aortic valve, the posterior leaflet is imaged along the right ventricular free wall and either the septal or anterior leaflet is imaged adjacent to the aortic root.
  5. In the apical four chamber view, the anterior and septal leaflets are visualized.
  6. 3D enables en face visualization of the three leaflets
  7. The TV valve annulus is slightly apically displaced compared with the mitral valve annulus.
  8. TEE: TV is more difficult to accomplish than imaging the mitral and aortic valves for two reasons: The TV is thinner and generally further from the transducer than the left sided valves. The higher frequency waves used in TEE do not penetrate deeply into the far field and the tricuspid valve is occasionally shadowed behind an aortic or mitral prosthesis or annular calcification.
  9. The TV is best visualized in multiple planes: the mid–esophageal four–chamber view at 0º, rotation at the mid–esophageal level to 30° and 60°, and from the transgastric view.
  10. In the four–chamber view, the septal and anterior leaflets are usually seen, and retroflexing the probe can bring the posterior leaflet into view.
  11. Tricuspid regurgitation jet velocity is best measured in a view in which the ultrasound beam and the regurgitant jet are most parallel, often between 30° and 60° in the mid–esophageal view.
  12. In the transgastric position, the tricuspid valve is brought into view by turning the probe clockwise from the mitral valve short axis view (0°) or left ventricular long axis view (90°).
  13. Methods for calculating mitral valve area, such as pressure half–time, the continuity equation, and proximal isovelocity surface area, can be applied to the tricuspid valve. Tricuspid valve area in cm2 may be estimated as 190 divided by the pressure half–time
  14. TV with valve area less than 1 cm is severely stenotic.
  15. 70% of normal individuals have evidence of trace or functional TR and more than 90 percent with established heart disease have evidence of TR.
  16. In the normal individual, the finding of trivial TR is of no clinical importance beyond providing a means of obtaining an accurate determination of pulmonary artery pressure.
  17. The magnitude of the TR gradient does not necessarily correlate with TR severity.
  18. On the 2–D echocardiogram (using TTE or TEE), the presence and degree of TR can be evaluated by inspection of RV size and function, right atrial size and function, the tricuspid valve, and the vena cavae
  19. Hemodynamically significant chronic TR is generally associated with dilation of the RV. In the presence of significant TR, the RV may become hyperdynamic.
  20. It is useful to examine the descent of the RV base toward the apex as a guide to RV systolic function. The excursion of RV base frequently becomes accentuated when significant TR is present.
  21. RV may fail and become hypokinetic in the setting of severe TR and chronic overload; in this setting, RV systolic function may not adequately reflect TR severity.
  22. When severe TR is present, right ventricular volume overload causes diastolic interventricular septal flattening. Septal flattening is best appreciated in the short–axis view at the level of the basal or mid–left ventricle.
  23. For central jets imaged using a Nyquist limit of 50 to 60 cm/sec, a jet area of <5 cm2 suggests mild, 5 to 10 cm2 suggests moderate and >10 cm2 suggests severe TR.
  24. The 2003 ASE recommendations include jet contour as a parameter to grade TR. Mild TR is associated with a parabolic shape, moderate TR is associated with a variable contour, and severe TR is associated with a triangular early peaking jet
  25. Use of agitated saline or other ultrasound contrast agents can enhance the tricuspid regurgitation jet signal
  26. Contrast enhancement of weak TR velocity signal may permit more accurate determination of right heart hemodynamics
  27. A right–sided contrast agent such as agitated saline may also enhance visualization of hepatic vein flow reversal. Following administration of contrast into an upper extremity vein, the inferior vena cava and hepatic veins are monitored for systolic appearance of contrast. Normally, only minimal contrast enters the hepatic veins but in the presence of significant TR, abnormal reflux can be detected by two–dimensional imaging, pulsed Doppler, color Doppler, or M–mode.
     
Dr KK Aggarwal
Editor in Chief
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Valve
 
  eMedinewS Audio PostCard

  MEDICON 2010, 26 December
53rd Annual Delhi State
Medical Conference

Dr Rajesh Marya Speaks on "Diabetic Dyslipidemia"

Audio PostCard
 
  SMS of the Day

(By Dr GM Singh)

Don’t be afraid to fail because only through failure do you learn to succeed…

 
    Photo Feature (from the HCFI Photo Gallery)

ANCIPS 2011 Welcomes Delegates

The 63rd Annual National Conference of Indian Psychiatric society was inaugurated yesterday evening at Hotel Ashok. Ms. Krishna Tirath Minister of State holding independent charge for Women and Child Development lit the inaugural lamp with other dignitaries on the stage including Dr. Sunil Mittal, Dr. NK Bohra, Shri RK Srivastava, Dr M Thirunavukkarasu, Dr Ajit Avasthi, Shri UP Garg, Shri Asim Kumar Malik, Dr TSS Rao amongst others. Dr. NK Bohra, Chairperson, ANCIPS in his welcome speech thanked the delegates for their participation amidst huge applause.

 
Dr
                        K K Aggarwal
 
    ANCIPS 2011

63rd Annual National Conference of the Indian Psychiatric Society
16th Jan. 2011 (Sunday) to 19th Jan 2011 (Wednesday)

The Ashok Hotel, New Delhi

CME Inauguration

The CME was formally inaugurated with a Sarsawati Vandana by Dr Kumud Dewan. Dr NK Bohra, Chairperson, ANCIPS 2001 welcomed all delegates. The chief guest Dr Shiv K Sarin, Chairman Board of Governors, MCI stressed on the need for the psychiatrist to liase with other specialties as they are woefully uninformed about psychiatric conditions due to the lack of teaching of the subject in the UG curriculum. He invited suggestions, comments about education and training in psychiatry from the august gathering and was open to the idea of upgrading the curriculum to include the teaching of psychiatry as a UG subjects.

Dr G Prasada Rao, Chairperson of the CME session highlighted that ANCIPS 2011 is trying to cover roots of psychiatry i.e. the etiology of the disease.

Other dignitaries present on the occasion were Dr Ajit Avasthi, President IPS,Dr UC Garg, Hony Gen Secretory, IPS,Dr TSS Rao, Hony Editor, IPS.Dr M. Thirunavukarasu, Vice President, IPS.Dr Sunil Mittal, gave the "Vote of Thanks"

Alcohol Dependence: Understanding the Etiological Basis

 Dr. K Suresh Kumar, Consultant Psychiatrist, Psymed Hospital, Chennai

There are 2 billion alcohol users in the world. Many, as individual users become dependent on alcohol. Why this happens is important to know, to develop intervention efforts.

  • Risk factors like alcohol (early use, accessibility), environmental, Biology (genetics, gender and psychiatric disorders) interact and produce some mechanism in brain that leads to alcohol dependence.
  • Age at initiation is why important in alcohol dependence. Data form SAARC countries show that age of alcohol initiation is less than 18 years
  • Type 1 alcoholism is of late onset, Low inheritance, Less novelty seeking. There is lot of guilt and fear about alcoholism. Type 2 alcoholism is of early onset (<25 years), there is more of novelty seeking
  • Two subgroups have been identified:
  • Negative affect regulation, whereby drinking is used to relieve negative state… ‘sad individual’
  • Behavioral disinhibition, where the increased drinking is a manifestation of impulsivity… ‘sensation seeking individual’
  • There is a close correlation between externalizing behavior and alcohol use disorder (AUD).
  • Externalizing problems predicts adolescent alcohol use
  • Social anxiety is implicated in psychopathogenesis of AUD.

Key Points

  • Alcohol use disorders (AUDs) are complex disorders, quite devastating to the individual, family and society
  • To provide treatment, it is important to understand complexities of mechanisms involved
  • The influence of genes in genesis of alcohol dependence cannot be under estimated
  • Understanding etiology will help individual specific risk assessment
  • Early use predicts further use.
  • Preventing alcohol initiation at an early age is an important message

Skills in Sex Therapy…Eliciting and Utilizing Therapeutic Skills

"Experience is the name everybody gives to their mistakes–oscar wilde"
The roots of management of sexual disorders go back to our ancient ayurvedic system which have now been systematically put down by the western practitioners, said Dr Rao in his very interesting, intriguing and humorous talk. Not an easy topic to discuss, but Dr Rao made sexuality appear so commonplace and matter of fact that none present in the audience was squirming, on the contrary everyone enjoyed and appreciated and ofcourse learnt from his wisdom.
According to Dr Rao lack of inquiry into the sexual history is the major cause for missing the diagnosis as most patients do not come with primary complaints of sexual disorders. Only 10% of patients initiate information on their own whereas this goes up to 50% by careful questioning.
Dr Rao emphasized that touch, touch and touch is the most important of all senses and the most potent arousal factor for women and also for men. His comment’ if a man becomes adept at ‘fingering’ he can be a successful lover’ had the audience in splits!

The goals of sex therapy

  • To enhance loving intimacy and not for achieving orgasms
  • Not to teach to love one another but to show love by meaningful and pleasurable sexual expression
  • Relationship issues must be sorted out before attempting treatment Comorbid issues like alcoholism, psychopathology need to be treated before attempting sex therapy For those adjusted to sexual dysfunction, its best not to impose sex therapy

Riders to treat sexual problems

  • Any sexual dysfunction cannot be treated in isolation
  • Individuals have to be seen in context of their relationship
  • Biosocial issues need to be taken into consideration
  • Essential to give basic anatomical and physilogical information
  • Remove performance anxiety
  • Eliminate myths and false expectations

Harvard format for Pt screening

  • Can I ask you few q’s about sexual matters?
  • Have you been sexually active with a partner in the past 6 months?
  • With women?men?both?
  • Do you or your partner have any sexual concerns?

Management

  • Rule out organic causes
  • Establish ground rules for treatment
  • Ve a part of an integrated unit
  • Relationship must be viewed in entirety from the drawing room to the bedroom
  • Focus on education specially regarding attitude change, cognitive restructuring,video models, reading materials and therapists verbal communications.
  • Reduce performance anxiety
  • Focus on comfort pleasures and emotions
  • Sexual intimacy building excercises by nondemanding pleasuring
  • Set realistic sexual expectations

Depressive Disorders: Understandings Etiological Basis

Dr Sandeep Grover, Asst Prof. Dept of Psychiatry, PGIMER Chandigarh

  • When we try to understand depressive disorders, we have moved from psychodynamic theory to neurobiological theory to intracellular mechanism.
  • The neurotransmitter hypothesis emerged between 1950s to 1970s. Reservpine precipitated depression, role of LSD, nor epinephrine, iproniazid (an anti TB drug) were during this period, there was an upsurge in the of TCAs used initially for anxiety
  • Through the 1970s to 1990s, more TCAs came up. We realized problems with high dose of TCAs. The neurotransmitter (monoamine) hypothesis underwent various revisions.
  • In the 1990s to 2000s – serotonin, dopamine, norepinephrine came up. There is delay in onset of actions of antidepressants, why do some patients respond or do not respond? These questions remain ill understood.
  • Research has now focused on post synaptic receptor changes to understand etiology of depression. We are now trying to link monoamine and other biological changes or newer genes
  • Genetic contribution to depression is 40-50%. There is not one single gene that can be implicated; instead it’s a combination of multiple genes.
  • Exposure to stressful life events has been linked to development of depression. Early adversity increases risk of depression.
  • Role of glutamate is now more and more understood.
  • Role of circadian rhythm has since long been postulated. Recently, the molecular mechanisms have been the focus of research.
  • Cytokines have been linked to depression. The cytokines may reduce serotonin levels and lead to depression
  • Stress has important role.
  • Vulnerability to stress may be influenced by early life adversities which lead to permanent changes in brain structure and changes in gene.
  • BDNF may play a final common role.

Schizophrenia: an ill understood disorder

Dr. Matcheri S Keshavan, Harvard Medical School, Boston, USA

Schizophrenia is a major public health problem. Only about 10% are gainfully employed. Only 40% respond to antipsychotics. But, causes of schizophrenia are still not well understood. Various theories have been put forth: virus, abnormal neurochemistry, immune dysfunction and so forth. Mental disorders are considered chronic diseases of the young, so it becomes important to understand the neurobiology of adolescents. Adolescence is a phase of major reorganization of neural and endocrinal system. Schizophrenia begins in adolescence or early childhood. It is an evolving picture and is not of abrupt onset. Subtle dysfunction is cognition, social competence begin before any psychosis develops. Then follows the functional decline which continues for further years. Psychosis is a late stage in the evolution of schizophrenia. The synaptic mass may be reduced in premorbid stage followed by exaggerated pruning in adolescence which continues after illness onset. Premorbid stage is related to abnormal proliferation of neurons. Psychosis is related to reduced brain plasticity due to abnormal pruning. Genetic risk is the best known causative factor. Environmental factors interact with genes and increase vulnerability. This has implication for early diagnosis and intervention. Prodrome can be defined and can help to predict psychosis i.e. it can tell us who might develop psychosis or not. One can have primary, secondary or tertiary preventions for each of proposed sequential event

Schizophrenia: an elusive enigma

Schizophrenia can be aptly called an elusive enigma and understanding the molecular geneses can be elusive. With these opening remarks Dr Ganesh Venkatasubramanian from NIMHANS, Bangalore began the 1st CME of the conference.

Key Points

  • Importance of endophenomenology paradigm
  • Functional MRI, which also gives idea about the function of brain beside structure of brain
  • The revolution of neuroimaging is because of computational neuoanatomy
  • Genetic findings are inconsisited and need further work
  • Evolutionary theory of schizophrenia: more proximal than distal approach
  • There are several ways of looking at schizophrenia, yet we are far away from understanding the disease.

Blues’ of Adolescence: a much neglected entity

Dr. Ajith Bhide, Dr. G Prasad Rao, Dr. Kersia Chavda

Adolescent depression is a somewhat neglected topic in our country. Its important to discuss adolescent depression as more and more young people seem to prevent with this condition. This 2 hour session covered this very important topic and a very relevant one today. Adolescent depression has many clinical features similar to adult depression. Despite this similarity, they present differently; they present with less of psychotic features.

Comorbidities are quite common in adolescent depression: Dysthymia, anxiety, Substance abuse, ADHD, CD/ODD (Conduct disorder/oppositional defiant disorder). Depression can lead to: Problems in School ’School refusal’, Running away from home, Eating disorder, Substance abuse, Recently, internet addiction has been seen, Self injury, Reckless behaviour, Suicide.

Presenting symptoms of adolescent depression

  • Irritable/angry mood: they are more irritable than sad
  • Unexplained aches/pains which can be missed as they can be taken to the GP/Pediatrician
  • Extreme sensitivity to criticism: This can often be an early symptom recognized by parents.
  • Withdrawal from usual day to day activities
  • Associated anxiety symptoms or somatic complaints (stomachache, headache etc) are more common

When to hospitalize

Patient related variables: If behavioral disturbance viz. aggression, psychosis, catatonia, stupor, then hospitalize; Suicidality; Diagnostic dilemma ‘for observation’; Substance abuse – alcohol, cannabes etc
Family related variables: Pathological intra family interaction; Inability to manage the depressed individual e.g single parent; Social reason Clinical variables are important, so are the psychosocial variations, when deciding to hospitalize the child.
Pharmacological Tips Remember, half life of antidepressants is shorter in children and adolescent; Watch for withdrawal symptoms on Qd dosing; Goal for remission at 12 weeks.
Non pharmacological interventions are useful as they help to reduce amount of medications, their side effects on long term use. They play a very important role especially in young child.
A Combination of non pharmacological and pharmacological approach is more useful than either alone

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is IUI? What is the average success rate of IUI? How many cycles of IUI can be tried?

IUI is a simple OPD procedure. In this procedure, washed capacitated sperms are put in the uterus. The ovary is stimulated by giving hormone injections to produce multiple follicles and the procedure is carried out when the eggs are about to be released. We have had a good success rate with this method and recommend it as the first line of treatment in patients who have patent tubes and a reasonably good semen count. Success rate varies according to the indication but around 15% to 18% can be considered good. Most couples conceive within first three cycles of IUI, in subsequent cycles the positive outcome is less. One can try up to six IUI cycles then probably turn to IVF–ET.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

Managing lead toxicity in children

  • A well–balanced diet is very important.
  • Children with empty stomachs absorb more lead than children with full stomachs.
  • Provide your child with four to six small healthy meals during the day.
  • A diet rich in calcium and iron can reduce the amount of lead a child absorbs.
  • Eating foods with vitamin C helps increase the amount of iron in the blood.
 
    Medicolegal Update

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

What is World Medical Association Declaration – Principle V – Clinical Education?

The clinical component of medical education must be centered on the supervised study of patients and must involve direct experiences in the diagnosis and treatment of disease. The clinical component should include personal diagnostic and therapeutic experience with gradual access to responsibilities. An adequate relation of the numbers of students admitted for training and teaching at the bedside of the individual patient must be observed.

  • Before beginning independent practice, every physician should complete a formal program of clinical education. This program, usually of at least one year’s duration, should be characterized by a supervised increase of responsibility for the management of clinical problems.
  • The faculty is responsible for determining that students who receive the first professional degree, have acquired a basic understanding of clinical medicine the basic skills needed to be evaluated.
  • Addressing clinical problems and to take appropriate action independently, and have the attitude and character to be an ethical physician.
 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Can MBBS doctors perform endoscopies?

  • There can be only two situations when an MBBS doctor performs endoscopies:
    • When he is an employee and is asked to do so by the employer. Here the liability, if any, will have to lie with or be shared with the employer.
    • When he is in his own private practice and the patient/consumer requests his service. Here there will be no liability unless the act is done illegally or negligently.
  • The MBBS doctor would be within legal rights to offer endoscopy services if he has been trained in endoscopy and has reasonable knowledge, experience and confidence. However, he should not do so under misrepresentation. He should clearly state that he is just an MBBS and should not claim to be a gastro–enterologist etc. He must perform the endoscopy after due written consent where the qualifications etc. of the doctor should be clearly mentioned.
 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Globulin, A/G ratio

Globulin is increased disproportionately to albumin (decreasing the albumin/globulin ratio) in states characterized by chronic inflammation and in B-lymphocyte neoplasms, like myeloma and Waldenström’s macroglobulinemia. More relevant information concerning increased globulin may be obtained by serum protein electrophoresis.

Decreased globulin may be seen in congenital or acquired hypogammaglobulinemic states. Serum and urine protein electrophoresis may help to better define the clinical problem.

 
    Medi Finance Update

Investment tips

An investment in bank’s fixed deposits (FDs) has low risk but minimum gain. A bank gives 6% interest with inflation of 5%; the yield is only 1%. Company FDs can be invested in only after thorough analysis of the company.

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    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
Indication
DCI Approval Date
Buclizine Hcl 25mg Tablet (Additional Indication)
For the Symptomatic treatment of various allergic conditions (rhinitis, conjunctivitis and urticaria) and for prevention and treatment of motion sickness
16/01/2010
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Screening for colorectal cancer

A UK randomized trial found that one–time screening by sigmoidoscopy in individuals aged 55 to 64 years decreased the incidence of colorectal cancer (CRC) and overall mortality at 11 year follow–up.

(Ref: Hoff G, Grotmol T, Skovlund E, et al. Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ 2009;338:b1846).

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim for the last seven years came for executive checkup.
Dr. Bad: You will have to pay from your pocket.
Dr. Good: You can claim it from Mediclaim.
Lesson: In addition to cumulative bonus, the insured shall be entitled for a reimbursement of the cost of medical checkup once at the end of block of every four underwriting years provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount of 1% of the total amount of the average sum insured during the block of four claim free underwriting years.

Make Sure

Situation: An asthmatic patient became worse after receiving a painkiller.
Reaction: Oh my God! Why was he not put on a leukotriene receptor antagonist?
Lesson: Make sure that a patient with asthma is not given aspirin or he is put on a leukotriene receptor antagonist (zafirlukast or montelukast).

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

ABCs

A shop is always brightly lit up. Someone asked : "What brand of bulb are you using? It is so lasting."
The shop owner replied: "Our bulbs blew out frequently. We replaced them once a bulb blew out."

Moral of the story

  • It is simple to maintain brightness , change the bulbs regularly.
  • To brighten up everyday life, endeavour to abandon unwholesome states of mind and make an effort to encourage wholesome states to grow.

———————————

Mind Teaser

Read this…………………

"six kings" can be converted into what word?

Yesterday’s Mind Teaser: word starts with an "e", ends with an "e" and contains only one letter?
Answer for yesterday’s Mind Teaser: Envelope

Correct answers received from: Dr.B.N.Ganagdhar, Dr Sudipto Samaddar, Dr. Manjesha, Dr. Rohini Vaswani, Dr B K Agarwal, Dr Rakesh Bhasin, Dr Neelam Nath, Dr Satish Pandey, Dr. H.L. Kapoor, Dr Prabha Luhadia, Dr A K Gupta, Dr.Parvesh Sablok, Dr. Suman Kumar Sinha, Dr Chandresh Jardosh, Dr.K.Raju, Dr S K Bansal, Dr Arvind Khanijo, Dr Shashi Saini, Dr Muthumperumal Thirumalpillai, Dr.C.S.Bhaskaran, Dr. Vijay Rangachari

Answer for 15th January Mind Teaser: Two in One
Correct answers received from: Dr N Sandhya, Dr Rashmi Chhibber, Dr. K.Raju, Dr. Naorem Sharat, Dr. Manjesha.  

Send your answer to ijcp12@gmail.com

——————————

Laugh a While
(Contributed by Dr G.M.Singh)

Listening

The teacher, during an English lesson, asked her students: "Now tell me, what do you call a person who keeps on talking when people are no longer interested?"
Little Johnny, in the back row, raised his hand. "Yes, Johnny," said the teacher
"A teacher!"

 
    Readers Responses

ACC/AHA Focused Update: Management of Atrial Fibrillation Key points

  1. In the RACE II trial of heart rate control (JW Cardiol Mar 15 2010), aiming for a resting heart rate of <110 beats per minute was noninferior to aiming for <80 beats per minute; a new Class III recommendation thus advises against such strict rate control.
  2. In the ACTIVE A trial involving patients considered poor candidates for warfarin treatment, a combination of clopidogrel and aspirin appeared to be more efficacious than aspirin alone but also conferred a higher bleeding risk (JW Cardiol Mar 31 2009). This combination is now considered an option in patients who have difficulty with warfarin (Class IIb).
  3. Although not a potent antiarrhythmic, dronedarone is a reasonable therapy for decreasing rates of recurrence in patients with histories of AF (Class IIa). It can be initiated on an outpatient basis but is contraindicated in patients with NYHA class IV heart failure symptoms or a recent episode of decompensated heart failure (Class III).
  4. Catheter ablation now carries
  • Class I (rather than Class IIa) recommendation for treating symptomatic paroxysmal AF that is uncontrolled with antiarrhythmic agents.
  • Class IIa recommendation for treating persistent symptomatic AF.
  • Class IIb recommendation for treating symptomatic paroxysmal AF in the presence of left atrial dilatation or left ventricular (LV) dysfunction. Regards: Dr GM Singh
 
    Public Forum

(Press Release for use by the newspapers)

Economy–class syndrome

All doctors should diagnose and treat venous thromboembolisms, which include deep-vein thrombosis and pulmonary embolism, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal, President, Heart Care Foundation of India. These are potentially fatal conditions that occur when a blood clot that’s formed at one point of the venous circulatory system detaches and travels to the lungs.

A pulmonary embolism occurs when this kind of clot, which usually forms in the veins of the leg, obstructs the pulmonary artery in the lungs or one of its branches. This can cause acute right heart failure or sudden death.

The problem of deep–vein thrombosis gained notoriety when passengers on long–haul flights develop deep vein thrombosis and lung embolism now called as "economy–class syndrome." It results from long hours of minimal movement for example airline passengers sitting in their seats for hours and not being able to move. Treating the condition at an early stage can help save lives and prevent complications such as pulmonary embolism or recurrent deep vein thrombosis. Deep vein thrombosis claims the life of at least one airline passenger a month at Heathrow.

Precautions

  • Get up and walk about at least once an hour.
  • While seated, flex your ankles and move your feet around to stimulate blood circulation.
  • Remain hydrated.
  • Consider wearing support stockings or elastic wraps to keep blood from settling in the veins in your legs.
  • A simple aspirin tablet taken a few hours before take-off thins the blood during long periods of inactivity. The number of victims would fall significantly if more passengers followed this advice.
  • Severe risk for thrombosis should be given injections with low molecular weight heparin (LMWH), a form of prophylaxis already in common use in hospital patient.
  • One should abstain from alcoholic beverages and caffeine.
 
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