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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 …

18th January, 2011, Tuesday                                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

New drug for premature ejaculation

The year 2010 ended with the launch of an SOS drug for premature ejaculation. This will be breakthrough for the community. Premature ejaculation, the most common sexual problem apart from erectile dysfunction, has been often found to put marriages under strain. While the existing drugs, which are not specific to treat premature ejaculation, need to be taken regularly, the new pill can be popped just a few hours (1–3 hours) before sexual act. It works by altering levels of serotonin, a chemical in the brain. The drug, dapoxetine, belongs to a family of drugs called selective serotonin reuptake inhibitors (SSRIs), which block the reabsorption of the neurotransmitter serotonin.

The drug is approved based upon two randomized trials of nearly 2000 men with premature ejaculation who were randomly assigned to receive placebo or dapoxetine (30 mg or 60 mg/day). The mean ejaculatory latency time before treatment in all groups was approximately 0.9 minutes, while the mean intervals in the placebo and dapoxetine groups (30 and 60 mg) on treatment were 1.8,2.8, and 3.3 minutes, respectively. The most common side effect with dapoxetine was nausea (8 and 20 percent with 30 and 60 mg, respectively). Dapoxetine is not commercially available in all countries. (Ref: Pryor JL, Althof SE, Steidle C, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double–blind, randomised controlled trials. Lancet 2006;368:929).

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  ANCIPS 2011

Prof. M. Thirunavukarasu, President Indian Psychiatric Society gives his vision for IPS.

Audio PostCard
 
  SMS of the Day

(By Dr GM Singh)

"The only reason people get lost in thought is because it's unfamiliar territory."

 
    Photo Feature

ANCIPS 2011

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal gave a mesmerizing talk on Indian Mythology, Life Style and Psychiatry at the ANCIPS 2011. Mesmerizing because of his vast knowledge of a non allopathic subject, his clarity of thought and scientific correlation with all our ancient scriptures and traditions and the wisdom theirien. Even 2 hrs proved insufficient as the audience clamoured for more!
Follow him on drkkaggarwal Dr K K Aggarwal on Twitter to get more insights and get your queries answered.
.

 
Dr K K Aggarwal
 
    ANCIPS 2011

Presidential Address
A Utilitarian Concept of Manas and Mental Health.

Mental Health cannot be a Diagnosis of Exclusion Because Such a Concept Defeats the Whole Purpose of conceptualizing it’

‘‘Psyche’ has been the name for a disembodied soul since the time of Descartes and even before. The Cartesian doctrine has deeply penetrated modern thought, which is the reason why disorders for which an organic biological (i.e. typically biological) cause could not be identified are often referred to psychiatrists. This is because, as mental health professionals, we have not filled the big gap of what constitutes the target of psychiatric practice. We have also not identified what constitutes the healthy state of that target - something that almost every other medical discipline has been able to achieve. Unless we identify the target of our practice and identify its healthy state, psychiatrists will continue to be called ‘shrinks’, and skeptic meaningless anti-psychiatry propaganda will continue to find ground. In order to identify that target of our practice, we need to deliberately eliminate all pre-existing misconceptions attached to the words ‘mind’, ‘psyche’, ‘soul’, etc. Also, psychiatrists are people of medicine and people of science.
Hence, scientific methods of inquiry should be rigorously adopted to deliver progress. How can such scientific methods be adopted if we have not identified the target of our practice and the healthy state of that target?
As a first step, I have made an attempt to conceptualize the target as the manas - a concept that is quite different from other major theories of the mind philosophized before. Which of these concepts of the mind is the right one? I don’t know. More importantly, I don’t care! 1 do not care what the mind is; I only care about that part of the self that I am medically and scientifically concerned about. To differentiate what I am concerned about from what may or may not exist, I have used a different name, unused in western mainstream psychiatric literature before. Mind could be anything, for what it is worth but, I am only concerned about the manas! A condition, medical or non-medical that does not have an identifiable biological cause cannot be, by default, placed under the jurisdiction of psychiatry. If there is no detectable problem with the manas (i.e. its substituents or its amalgamation) in that condition, it can safely be considered non-psychiatric, for all practical purposes. But regardless of whether a subject has a psychiatric condition or not, every person in the population can be individually assessed for his/her mental health status, and thereby public health measures to promote mental health can be undertaken. This will also allow us to study mental health (not just mental illness alone) from an epidemiological standpoint, which 1 believe is very important for expanding our idea of mental health. Most controversies around psychiatry are because we have practically only one diagnosis, at least from the standpoint of the common public. And that diagnosis is ‘mental illness’ - a label that has humungous consequences for the subject in all spheres of life. This is the reason for the stigma in psychiatry and Rosenhan has pointed it out clearly. Placing all mental health states under this one label is what that invites controversy, skepticism and dissent. Such dissent is understandable. For example, there is no reason why fetishism and schizophrenia should both be given the label ‘mental illness’. There is also no reason why anxiety and pedophilia are both given the same label ‘mental illness’. It is important to identify not just mental health, but the varying shades of it by the type of clinical strategy needed. Several disorders in diagnostic manuals of psychiatry may not be mental illnesses but merely mentally unhealthy or mentally not healthy states. This will allow for the elimination of stigma attached to psychiatry.
Clearly, the above concepts are infantile and need to be fine-tuned further. These concepts are open to modification, given the appropriate reasons. Future directions would include reassembling all diagnostic categories in the DSM and/or ICD, according to mental health states of the manas. Another important future direction would be to conduct population-based epidemiological studies of the mental health states and their distributions.
So manas can be defined as a functional concept constituted by mood, thought, and intellect, which are nicely amalgamated and synchronized and cannot function in isolation. They always function in unison.
Mental health can be defined as a person who fulfils the following three characteristics: a) awareness about one’s own self, b) ability to relate well with fellow human being and c) all his or her deeds and activities are useful to one’ own self as well as others, at least not detrimental to self as well as others.

Message for OC Of ANCIPS 2011

One of the most wonderfully organized conferences of ANCIPS
Message For Delegates


Attend the academic events….Try to learn and try to contribute to improve the mental health standards of India. We do have many budding psychiatrists who are at par with international standards. In South-east Asia, Indian Psychiatric Society is a major organization and we do have a lot of talent. For teaching, skill training, skill building in neighboring countries, India is contributing to a large extent, especially in Bangladesh, Sri Lanka and even in Pakistan and Nepal. Out of all these regions, apart from East Asia (Japan, Korea), we have very good expertise. The only thing is that we should have more research skill training.

Culture, Personality & Migration

Professor Dinesh Bhugra, President, Royal College of Psychiatrists

Prof Bhugra, in a very lucid and detailed talk, described culture, cultural identity in a different societal settings. He also gave recommendations for clinicians, policy makers and service providers to deal with these complex issues. Some highlights of his talk are presented here.
Culture is defined as…’That complex which includes knowledge, belief, art, morals, law, customs and any other capabilities and habits acquired by man as a member of society (Taylor, 1871) Culture is a collective programming of the mind that distinguishes the members of one group or category of people from another (Hofstede,) Cultural identity involves at its core a sense of attachment or commitment to a cultural group and is thus both a cultural and a psychological phenomenon (Berry, 2007)

Recommendations

Clinicians

  • Resources
  • Awareness and competence
  • Specific vs. general services
  • Curriculum and training
  • Cultural training

Policy Makers

  • Clear policies – human rights
  • Adequate resources for services
  • Adequate resources for training
  • Joined up working e.g. Health, Justice, Education
  • Clear criteria Public education
  • Easy to navigate services

Service Providers

  • Culturally sensitive
  • Geographically and emotionally accessible
  • Cultural competence training
  • Cultural brokers vs. cultural liaison
  • Research – qualitative and quantitative Audits

Classification of Psychotic Disorders in DSM-5

Dr. Rohan Ganguli, Presenting on Behalf of Dr. Rajiv Tandon

Current Diagnostic Criteria for Schizophrenia

  • Characteristic Symptoms Positive symptoms (delusions, hallucinations, disorganized thinking, disorganized behavior) Negative symptoms (poverty of speech, flat affect)
  • Social and occupational dysfunction Duration > 6 months
  • Not primarily a mood disorder with psychotic symptoms
  • Not due to substance intoxication or because of a metabolic or neurological disorder
  • Not a pervasive developmental disorder

Schizophrenia - ICD-10 vs. DSM-IV

  • Characteristic symptoms (including impaired reality testing for > 1 month)
  • Deterioration not required
  • Long duration of symptoms not required
  • Less restrictive exclusion for mood disorders and schizoaffective disorder
  • Exclude general medical conditions and substance-induced disorders
  • Distinction from pervasive developmental disorders not mentioned

Key Considerations for DSM-5

  • Simplify Critical, tractable, and supported by data
  • Emphasize validity
  • Better link to etiology and pathophysiology
  • Use of endophenotypes
  • Fewer disorders with greater “meaning”
  • Better grouping of disorders (eg. internalizing, externalizing, psychotic, and cognitive)
  • Driven by data and amenable to easy change with new data
  • Should be broadly useful for both the clinician (specialist and generalists) and researcher

New Thinking about Nature of Schizophrenia Since 1994

  • Multiple dimensions of illness-Positive, negative, mood, disorganization, cognitive, motor
  • Distinct stages of illness-Premorbid, prodromal, onset, variable progression with varying degrees of deficit
  • Better understanding of neurobiology and relationship to different dimensions and stages

Clinical Needs with regard to better definition of Schizophrenia

  • Simplify
  • Are current subtypes useful?
  • Better delineate from other disorders, from schizoaffective disorder
  • Better define relationship with other conditions, with catatonia

Three Challenges for the Schizophrenia Construct

  • Establish as a single disease entity or
  • Find disease entities within the schizophrenia syndrome and/or
  • Deconstruct the syndrome
 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How to retrieve sperm from the testis?

New surgical techniques have been introduced to retrieve spermatozoa from patients with nonobstructive azoospermia.
Microdissection of the testis to extract sperm (TESE) from the seminiferous tubules has been successful in obtaining sperm in over 50 percent of patients with nonobstructive azoospermia, including patients with Klinefelter syndrome.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

Should genotype testing be done on all chronic hepatitis B?

Recent data suggest that the HBV genotypes may play an important role in the progression of HBV–related liver disease as well as response to interferon therapy. Studies from Asia found that HBV genotype B is associated with HBeAg seroconversion at the earlier age, more sustained remission after HBeAg seroconversion, less active hepatic necroinflammation, a slower rate of progression to cirrhosis and a lower rate of HCC development compared to genotype C. Another study of peg IFN– reported that genotype A but not genotype B was associated with a higher rate of HBeAg seroconversion. Studies of nucleoside analogue therapies have not shown any relation between HBV genotypes and response. Thus, additional data on the relation between HBV genotypes and treatment response are needed before testing for HBV genotypes in clinical practice is recommended.

 
    Medicolegal Update

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

What is World Medical Association Declaration Principle VIII–Continuing Medical Education

  • All physicians are committed to lifelong learning.
  • These educational experiences are essential if the physician is to keep updates of developments in medicine and if the physician is to maintain the knowledge and skills necessary to provide high quality care; scientific advances are essential to an adequate health care of the people.
  • Medical schools, hospitals and professional societies share the responsibility for developing and making available to all physicians opportunities for continuing medical education.
  • The demand to provide medical care, prevent disease and give advice in health matters calls for the highest standards of undergraduate post graduate and continuing medical education.
  • Internationally standardize methods of assessing professional competence and performance should be developed and applied in medical care.

(Adopted by the 39th World Medical Assembly Madrid Spain, October 1987)

 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

The pay structure and service conditions of doctors in medical colleges varies markedly with particular reference to central or state service and government or private service. The disparity is particularly marked in respect of junior cadres. Tutors in some colleges continue to be paid very low salary. Why does the MCI not do anything in this regard?

The MCI Act, 1956, is "An Act to provide for the reconstitution of the Medical Council of India, and the maintenance of a Medical register for India and for matters connected therewith." The "matters connected therewith" include recognition to medical colleges. No institution of higher learning can function properly and keep high standards unless it has proper working conditions, including appropriate pay scales. The MCI ought to be conscious of this and ought to lay norms for doctors’ emoluments that should be a pre–condition for granting recognition. Since the MCI has failed in its legitimate duty, it needs to be woken up. This can only be done by making a proper legally drafted representation to the MCI/MOH which may form the basis of a PIL if not suitably responded to. The MCI has invited, by 17 January 2011, comments/suggestions comments regarding its "Vision 2015" proposals for revamping UG and PG medical education. Doctors and their associations should send their comments/suggestions and should specifically include therein the issue of doctors’ emoluments. They should also send their comments regarding pay scales etc. to the state/central IMA, requesting the central IMA to take up the matter with the MCI/MOH in an appropriate manner.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

T3 uptake

This test measures the amount of thyroxine–binding globulin (TBG) in the patient’s serum. When TBG is increased, T33 uptake is decreased, and vice versa. T3 uptake does not measure the level of T3 or T4 in serum.

  • Increased T3 uptake (decreased TBG) in euthyroid patients is seen in chronic liver disease, protein–losing states, and with use of the following drugs: androgens, barbiturates, bishydroxycourmarin, chlorpropamide, corticosteroids, danazol, d–thyroxine, penicillin, phenylbutazone, valproic acid, and androgens. It is also seen in hyperthyroidism.
  • Decreased T3 uptake (increased TBG) may occur due to the effects of exogenous estrogens (including oral contraceptives), pregnancy, acute hepatitis, and in genetically–determined elevations of TBG. Drugs producing increased TBG include clofibrate, lithium, methimazole, phenothiazines, and propylthiouracil. Decreased T3 uptake may occur in hypothyroidism.
 
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
Indication
DCI Approval Date
Pemetrexed Disodium 500mg/100mg Powder for Injection (additional indication)
Indicated as a monotherapy for the maintenance treatment of locally advanced or metastatic Non Small Cell Lung Cancer (NSCLC) other than predominantly squamous cell histology in patients whose disease has not progressed immediately following platinum–based chemotherapy. First line treatment should be a platinum doublet with gemcitabine, paclitaxel or docetaxel.
16–Jan–10
 
    Medi Finance Update

Stock Basics: What are Stocks?

Plain and simple, stock is a share in the ownership of a company. It represents a claim on the company’s assets and earnings. As you acquire more stock, your ownership stake in the company becomes greater. Whether you say shares, equity, or stock, it all means the same thing.

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Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Gout: Lower dose colchicine

A lower dose regimen of colchicine may have similar efficacy and fewer side effects than a traditional, higher dose regimen for patients with acute gouty arthritis. This was supported by the results of a randomized, placebo–controlled trial that compared colchicine given as 1.2 mg followed by one additional dose of 0.6 mg an hour later (total dose 1.8 mg), versus 1.2 mg followed by 0.6 mg every hour for up to six hours (total dose 4.8 mg).

(Ref: Terkeltaub RA, et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty–four–hour outcome of the first multicenter, randomized, double–blind, placebo–controlled, parallel–group, dose–comparison colchicine study. Arthritis Rheum 2010;62:1060)

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient had a break of policy for two days.
Dr. Bad: You will have to go for new policy now.
Dr. Good: Your old policy should be continued.
Lesson: Cumulative bonus provisions are applicable only in respect of continuous insurance without break excepting, however, in exceptional circumstances, the break in period for maximum of seven days is approved as a special case subject to medical examination and explanation of diseases contracted during the break period.

Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

A small boy worked as an apprentice in a bicycle shop. A man sent a bicycle for repair. After repairing the bicycle, this boy cleaned up the bicycle and it looked like a new one. Other apprentices laughed at him for doing redundant work. The second day after the owner claimed the bicycle back, this boy was pinched and offered a job.

Moral of the story

  • Go the extra mile to be successful.
  • Doing more gains more and doing less loses more.

………………………………

Mind Teaser

Read this…………………

sailing
ccccccc

Yesterday’s Mind Teaser: "six kings"can be converted into what word?

Answer for Yesterday’s Mind Teaser:
VI kings = Vikings

Correct answers received from: Dr Rakesh Bhasin, Dr K.P.Rajalakshmi, Dr Neelam Nath

Answer for 16th January Mind Teaser: Envelope
Correct answers received from: Dr Anupam Sethi Malhotra, Dr Satyoban Ghosh, Dr K.V.Sarma, Dr, N.Sandhya, Dr U. Sridhar Murty

Send your answer to ijcp12@gmail.com

………………………………

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

Traffic Court

A New York man was forced to take a day off from work to appear for a minor traffic summons. He grew increasingly restless as he waited hour after endless hour for his case to be heard. When his name was called late in the afternoon, he stood before the judge, only to hear that court would be adjourned for the next day and he would have to return the next day. "What for?" he snapped at the judge.

His honor, equally irked by a tedious day and sharp query roared, "Twenty dollars contempt of court. That’s why!" Then, noticing the man checking his wallet, the judge relented. "That’s all right. You don’t have to pay now." The young man replied, "I’m just seeing if I have enough for two more words."

 
    Readers Responses
  1. I would like to thank you to give an opportunity to be a part of such an esteemed gathering of 2nd emedinews revisiting 2010 at MAMC. It was wonderful to hear from Dr. Naresh Trehan, Dr. Kriplani & others & gather such useful information regarding medical advancements. Regards: Dr Prachi
 
    Public Forum

(Press Release for use by the newspapers)

Check your BMI to know chances of future heart attack

If you are less than 40 years of age, male, with a strong family history of diabetes, blood pressure or heart disease, have a normal weight as judged by Body Mass Index (BMI) but have a pot belly, or have gained more than 10 kg since the age 18, do not ignore and go to your cardiologist to reduce your chances of a future heart attack, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

A BMI of 20 to 23 kg/m2 is associated with little or no increased risk unless visceral fat is high, or the subject has gained more than 10 kg since 18 years.

  • Subjects with a BMI of 23 to 30 kg/m2 may be described as having low risk, while those with a BMI of 30 to 35 kg/m2 are at moderate risk.
  • Subjects with a BMI of 35 to 40 kg/m2 are at high risk, and those with a BMI above 40 kg/m2 are at very high risk from their obesity.
  • At any given level of BMI, the risk to health is increased by more abdominal fat (increased weight to hip ratio, WHR), hyperlipidemia, hypertension, age less than 40 years, male sex, and a strong family history of diabetes, hypertension, or heart disease.

The body mass index (BMI) is the most practical way to evaluate the degree of obesity. It is calculated from the height and weight as follows:

BMI = body weight (in kg) ÷ square of stature (height, in meters)

Overweight is defined as a BMI between 23 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2.

 
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