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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 (07–08c); 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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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of 1st Mega Ajmer Health Camp 2012

  Editorial …

18th April 2012, Wednesday

Five Things Physicians and Patients should question (Part 8)

American Society of Nephrology

  1. Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms: Due to high mortality among end–stage renal disease (ESRD) patients, routine cancer screening—including mammography, colonoscopy, prostate–specific antigen (PSA) and Pap smears—in dialysis patients with limited life expectancy, such as those who are not transplant candidates, is not cost effective and does not improve survival. False–positive tests can cause harm: unnecessary procedures, overtreatment, misdiagnosis and increased stress. An individualized approach to cancer screening incorporating patients’ cancer risk factors, expected survival and transplant status is required.
  2. Don’t administer erythropoiesis–stimulating agents (ESAs) to chronic kidney disease (CKD) patients with hemoglobin levels ≥10 g/dL without symptoms of anemia. Administering ESAs to CKD patients with the goal of normalizing hemoglobin levels has no demonstrated survival or cardiovascular disease benefit, and may be harmful in comparison to a treatment regimen that delays ESA administration or sets relatively conservative targets (9–11 g/dL). ESAs should be prescribed to maintain hemoglobin at the lowest level that both minimizes transfusions and best meets individual patient needs.
  3. Avoid NSAIDS in individuals with hypertension or heart failure or CKD of all causes, including diabetes. The use of NSAIDS, including cyclo–oxygenase type 2 (COX–2) inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate blood pressure, make antihypertensive drugs less effective, cause fluid retention and worsen kidney function in these individuals. Other agents such as acetaminophen, tramadol or short–term use of narcotic analgesics may be safer than and as effective as NSAIDs.
  4. Don’t place peripherally inserted central catheters (PICC) in stage III–V CKD patients without consulting nephrology: Venous preservation is critical for stage III–V CKD patients. Arteriovenous fistulas (AVF) are the best hemodialysis access, with fewer complications and lower patient mortality, versus grafts or catheters. Excessive venous puncture damages veins, destroying potential AVF sites. PICC lines and subclavian vein puncture can cause venous thrombosis and central vein stenosis. Early nephrology consultation increases AVF use at hemodialysis initiation and may avoid unnecessary PICC lines or central/peripheral vein puncture.
  5. Don’t initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians: The decision to initiate chronic dialysis should be part of an individualized, shared decision-making process between patients, their families, and their physicians. This process includes eliciting individual patient goals and preferences and providing information on prognosis and expected benefits and harms of dialysis within the context of these goals and preferences. Limited observational data suggest that survival may not differ substantially for older adults with a high burden of comorbidities who initiate chronic dialysis versus those managed conservatively.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

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

Weight loss may improve sexual health of obese diabetes

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

1st Mega Ajmer Health Camp 2012

For the first time in the history of India, a camp attracted over 72,000 people.

Dr K K Aggarwal
    National News

Teenage pregnancy adversely affecting health indicators

JAIPUR: Child marriages leading to early pregnancies are making an adverse effect on health indicators like infant mortality rate (IMR) and maternal mortality rate (MMR) in the state. Since the state is at number two slot in child marriages in the country, its IMR and MMR is above national average. "Early pregnancies are one of the reasons of infant deaths and maternal mortality. A girl who is not 18 and if she delivers a baby, it would be harmful for her and her baby. A girl, who is below 18 is not physically fit to deliver a baby," said a reproductive and child health officer. In fact, teenage pregnancies in the state are also high. Every year, out of 19 lakh pregnancies, 5% of them are teenage pregnancies, which was the finding of the District Level Household and Facility Survey (DLHS) 2007–08, a health department official said. (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

Refractory ALL needs tailored treatment

If initial chemotherapy fails to bring acute lymphoblastic leukemia into remission, the best choice for additional therapy may depend on whether the disease is B–cell or T–cell, researchers found. (Source: Medpage Today)

For comments and archives

CDC warns of skin lesions from goats, sheep

People can contract skin lesions from goats and sheep infected with the Orf virus through household meat preparation or when slaughtering the animals, a federal agency said on Thursday in a report aimed at doctors in ethnically diverse communities. The Orf virus – sometimes misdiagnosed as a more serious disease such as anthrax – is most commonly transmitted to humans on farms. It has also been reported in children who visited petting zoos and livestock fairs, the Centers for Disease Control and Prevention said. (Source: Medscape)

For comments and archives

Urine is not sterile, PCR analysis shows

The bladder holds a world of bacteria that do not show up in standard cultures, regardless of whether a woman has symptoms of a urinary tract infection, according to a study published online January 25 and in the April print issue of the Journal of Clinical Microbiology. (Source: Medscape)

For comments and archives

Shift work may set stage for obesity, diabetes

Short sleep on a disrupted schedule –– common in shift work –– significantly increases blood sugar, setting the stage for obesity and diabetes, a new study shows. The study found that otherwise–healthy adults who were both sleep deprived and sleeping on schedules that put them at odds with their biological clocks –– common problems for millions of people who work at night –– made 32% less insulin, the hormone that controls blood sugar, than they do when they are well rested. As a result, their blood sugar rose significantly. In some cases, those increases reached pre–diabetic levels. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Treatment of Summer Diarrhea http://blog.kkaggarwal.com/2012/04/13/treatment–of–summer–diarrhea/

@DeepakChopra: Always think infinite possibilities.

    Spiritual Update

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

The Role of Prayer in Healing

Prayers work on the principle that in the relaxed state, the mind becomes suggestive. The inner healing starts when the intent reaches the inner consciousness or a state of stillness.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What do you understand by natural family planning?

The time during which the egg moves from the ovary to the uterus lasts a few days and is the only time in which a woman can become pregnant. Couples who use natural family planning have to determine when the woman is ovulating and avoid having sex during that time. There are ways that you can tell if you are ovulating and should not have sex:

  • Keeping track of menstrual periods: Ovulation occurs two weeks before the next menstrual period. Therefore, having a calendar of 3–4 cycles will provide an estimate of when ovulation may take place.
  • Recording body temperature each morning: Basal body temperature falls prior to ovulation with a rise after ovulation
  • Observing cervical mucus: It will be thinner and "stretchier" right before ovulation.
  • Breastfeeding: Women may not ovulate when they are breastfeeding. This may depend on the frequency of breastfeeding.

For comments and archives

    Tat Tam Asi………and the Life Continues……

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity)

Who can donate liver?

A willing family donor with matching blood group can donate liver. The donor should provide an informed consent and also must undergo psychological evaluation. The donor should be 18–55 years old, weighing 55–85kg but not fat, should be healthy with normal liver and kidney functions, HBsAg, HCV– and HIV–negative.

It is very important that the donor liver is not fatty therefore a plain CT scan is performed first to calculate the LAI (liver attenuation index). This should normally be more than 6. One would accept a liver with a positive LAI (as compared to spleen) but not a fatty liver. The donor undergoes complete evaluation of heart, lungs, kidney and other organs. A CT scan is carried out on the donor to evaluate vascular anatomy and graft volume. MRI (MRCP) provides information of the biliary ducts.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Two Frogs in the Milk

This is the story of two frogs. One frog was fat and the other skinny. One day, while searching for food, they inadvertently jumped into a vat of milk. They couldn’t get out, as the sides were too slippery, so they were just swimming around. The fat frog said to the skinny frog, "Brother frog, there’s no use paddling any longer. We’re just going to drown, so we might as well give up." The skinny frog replied, "Hold on brother, keep paddling. Somebody will get us out." And they continued paddling for hours.

After a while, the fat frog said, "Brother frog, there’s no use. I’m becoming very tired now. I’m just going to stop paddling and drown. It’s Sunday and nobody’s working. We’re doomed. There’s no possible way out of here." But the skinny frog said, "Keep trying. Keep paddling. Something will happen, keep paddling." Another couple of hours passed. The fat frog said, "I can’t go on any longer. There’s no sense in doing it because we’re going to drown anyway. What’s the use?" And the fat frog stopped. He gave up. And he drowned in the milk. But the skinny frog kept on paddling.

Ten minutes later, the skinny frog felt something solid beneath his feet. He had churned the milk into butter and he hopped out of the vat.

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, www.mymonavie.com/sonraj)

Exercise in pregnancy is safe for baby

Research indicates that many women get less physical activity during pregnancy. However, according to a new study it is safe to exercise, even for women who were not regular exercisers beforehand. Researchers at Johns Hopkins observed 45 women in their third trimester (28–32 weeks) on the treadmill for 30 minutes at moderate intensity, and monitored several measures of fetal well being such as heart rate and blood flow. They noted no changes in these measures during the exercise period. These findings are in line with federal recommendations that during pregnancy, women who are healthy get at least 2.5 hours of moderate exercise per week, even if they did not exercise regularly before, to help improve heart health and reduce the risks of complications.

For comments and archives

    Cardiology eMedinewS

Carotid Test Boosts Cardiac Risk Prediction Read More

High Pulse Pressure Associated With Proteinuria In Diabetes. Read More

One’s Stroke Risk May Be Linked To Whether Sibling Has Experienced One Read More

GLP–1 is a Good Choice For Glycemic Control Read More

    Pediatric eMedinewS

Young Kids Most Susceptible To Influenza A (H3N2) variant Read More

Maternal Obesity Linked To Autism, Other Developmental Disorders
Read More

Vitamin D’s Brain Benefits May Not Emerge Until Adulthood Read More

    IJCP Special

Dr Good Dr Bad

Situation: A physician wanted to know how to rule out depression in diabetes.
Dr. Bad: Depression and diabetes are not related.
Dr. Good: Use PAID scale.
Lesson: Problem Areas of Diabetes scale (PAID) scale, a measure of emotional functioning in diabetes, is a valuable tool for the evaluation of quality–of–life (QoL) in type 2 diabetes and the screening of depressive symptoms. In a study, the perception degree of the QoL related with diabetes was associated with the severity of depressive symptoms.

For comments and archives

Make Sure

Situation: A patient with LDL cholesterol 100 mg/dL% and hsCRP 3 developed MI.
Reaction: Oh my God! Why was a statin not started earlier?
Lesson: Make sure all patients with even normal cholesterol are considered for statins if the CRP is high.

For comments and archives

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  Quote of the Day

(Dr GM Singh)

The stupid neither forgive nor forget; the naive forgive and forget; the wise forgive but do not forget. Thomas Szasz

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Uric acid

  • To detect high levels of uric acid, which could be a sign of the condition gout
  • To monitor uric acid levels when undergoing chemotherapy or radiation treatment
    Mind Teaser

Read this…………………

You’ve had yeast infections before, but in the past year they haven’t really gone away. This could be a sign of:

A. Diabetes
B. Emphysema
C. Stomach ulcers
D. Depression
E. Food allergies

Yesterday’s Mind Teaser: 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.

Answer for yesterday’s Mind Teaser: B. Their eggs have begun to degenerate.

Correct answers received from: Lalchand Dhoka, Dr Valluri Ramarao, Dr Avtar Krishan.

Answer for 16th April Mind Teaser: B. At age 20.

Correct answers received from: Dr Srikant, Dr PS Sharma, Dr Aman.

Send your answer to ijcp12@gmail.com

For comments and archives

    Laugh a While

(Vivek Chhabra)

Me in Amrica – By Reshma Ghouri

…Dedicated to all NRIs

Na Idhar ke Rahe… Na Udhar ke Rahe… Beech adhar atke rahe…

Na India ku bhula sake… Na Amrica ko apna sake…Indian–Amrican ban’ke kaam chalate rahe…

Na Gujarati ko chhod sake… Na Angrezi ko pakad sake… Desi accent mein goron ko confuse karte chale…

Na Turkey ko paka sake… Na gravy bana sake… Murgi ko dam de ke Thanksgiving manate chale…

Na Christmas tree laga sake… Na bacchon ko samjha sake… Diwali par Santa banke tohfe bat–te chale…

Na shorts pahen sake… Na salwar chod sake… Jeans pe kurta aur sneakers chadake itraate chale…

Na, Nashte mein donut kha sake…Na khichdi kadhi bhula sake… Pizza par mirchi chidak kar maza lete rahe…

Na garmiyon ko bhula sake… Na baraf ko apna sake… Khidke se suraj ko dekhke ‘beautiful day’ kahte rahe…

Ab ayi baari Vadodara ko jane ki… toh haath mein paani ka sheesha lekar chale…

Lekin wahan par… Na bhelpuri kha sake… Na lassi pee sake… Pet ke darad se tadapte mare…

Harde–Isabgol kha ke kaam chalate rahe… Na macchar se bhaag sake…

Na khujli ku rok sake… Cream se dardon ko chupate chale…

Na fakiron se bach sake… Na dollar ko chupa sake… Naukaron se bi peecha chuda kar bhaagte rahe…

Na khuddi par baith sake… Na Kamod ku bhool sake… Bas beech adhar jhukke kaam chalate rahe…

Na idhar ke rahe… Na udhar ke rahe… Kambaqt, kahin ke Na rahe

Bus ‘ABCD’ aulaad ko aur confuse banate chale…

    Medicolegal Update

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

What is the approach to acute ethanol and isopropanol poisoning?

  • Do a complete medical examination to exclude other causes of the patient’s condition, such as head injury
  • Correct fluid and electrolyte imbalance.
  • Hypoglycemia should be treated with oral or intravenous glucose.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Gum bacteria can cause preterm delivery

Proper dental care can prevent heart attacks, heart blockages, asthma and COPD. This was stated by Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India. Bacteria present in the gums have been linked to many diseases in the past.

Periodontal treatment should be included in prenatal care programs, as per a study in the Journal of Periodontology, which has shown that treating gum disease in pregnant women may prevent preterm birth.

The study has shown that while pregnant women, in whom the periodontal disease was treated, were no more likely to deliver their babies prematurely than women with no gum disease. Those who did not get treatment had a nearly 90–fold increased risk of premature delivery.

Another study found that the more bacteria women with periodontal disease had in their gums during and after pregnancy, the more likely they were to deliver their infants prematurely.

    Readers Responses
  1. I became an avid watcher of e–medinews and Dr. Aggarwal's blog from 2009. This pioneering concept of bringing medical news related to Indian scenario is a commendable achievement. I should honestly say that reading emedinews has helped me abreast of the latest medical news more than all the textbooks I read in the past three years. I wish that this tremendous and selfless service shall continue forever. Dr. KMK Masthan, MDS, Director, Oral Cancer Research Centre, Sree Balaji Dental College, Bharath University, Chennai.
    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

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

1. IJCP’s ejournals (This may take a few minutes to open)

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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