emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
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; Member 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


18th June, 2010, Friday

Dr Deepak Chopra gets Goi peace award

Dear Colleague

The Goi Peace Foundation bestowed upon Dr Deepak Chopra the 2010 Goi Peace Award in recognition of his visionary leadership in promoting global peace and well–being through human empowerment. Previous honorees include Bill Gates, Dr Oscar Arias Sanchez and Ervin Laszlo. His followers can join Deepak and his family at the ceremony to be held at the 2010 Goi Peace Foundation Forum in Tokyo, Japan on November 7, 2010.

The mission of the Goi Peace Foundation is to bring together people in wisdom, united in their hearts toward the common goal of peace on Earth. By encouraging public awareness of peace and by building cooperation among individuals and organizations in all fields, including education, science, culture and the arts, the organization aims to build an international peace network and to stimulate the global trend toward a culture of peace.

Onre can congratulatre Deepak at carolyn@chopra.com

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Special Campaigns on Outbreak of a Pandemic

Heart Care Foundation of India (HCFI) believes that an infectious disease spreading among human populations, not only needs immediate attention and concern but it calls for immidiate action. HCFI has conducted various campaigns on outbreak of almost every Pandemic to erradicate the disease completely through public participation.The efforts have also been to save as many lives as possible by making public aware of necessary precautions, available treatments and the possible impacts of the disease on neglegience. Swine flu has been the focus of the recent campaigns of HCFI.

Dr k k Aggarwal

In the photo: Ms. Shibani Kashyap, singer and Padma Shri & Dr BC Roy Awardee Dr. K. K. Aggarwal, President HCFI, during a campaign for generating swine flu awareness

International Medical Science Academy Update (IMSA): New Drug Update

Rotavirus vaccine

Vaccine–acquired rotavirus disease within one month of the first or second dose of pentavalent human–bovine reassortant rotavirus vaccine (RV5) has been reported in three infants who subsequently were diagnosed with severe combined immunodeficiency (SCID).1 The addition of SCID to the mandatory newborn screening panel in the United States will help to prevent future occurrence of this adverse event. Studies in Africa and Mexico confirm the efficacy and effectiveness of rotavirus vaccines in developing countries.2,3 These findings support the WHO Strategic Advisory Group of Experts on Immunization's recommendation for worldwide use of rotavirus vaccine.4,5

Reference

  1. Patel NC, Hertel PM, Estes MK, et al. Vaccine–acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med 2010;362:314.

  2. Madhi SA, Cunliffe NA, Steele, D, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med 2010;362:289.

  3. Richardson V, Hernandez–Pichardo J, Quintanar–Solares M, et al. Effect of rotavirus vaccination on death from childhood diarrhea in Mexico. N Engl J Med 2010;362:299.

  4. Santosham M. Rotavirus vaccine––a powerful tool to combat deaths from diarrhea. N Engl J Med 2010;362:358.

  5. Meeting of the immunization Strategic Advisory Group of Experts, April 2009––conclusions and recommendations. Wkly Epidemiol Rec 2009;84:220.

Mnemonic of the Day (Dr Prachi)

Hepatic encephalopathy: precipitating factors (HEPATICS)

Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedatives

News and views

1. Rational use of Medicine (Vivek Chhabra)

‘More than 50% of all medicines are not correctly prescribed, dispensed, and sold; more than 50% of patients take their drugs incorrectly. The situation is worse in developing countries, with less than 40% of patients in the public sector and less than 30% in the private sector being treated according to clinical guidelines. Several factors contribute to the incorrect use of medicines – e.g., prescribers might obtain information about treatments from pharmaceutical companies rather than referring to evidence–based clinical guidelines…

‘Incorrect use of drugs might result in adverse events that increase the period of their illness, cause death, or reduce their faith in health–care providers… Because the reasons for the lack of rational use of medicines are known, health–service providers in all countries need to be proactive in quickly putting the relevant recommendations into practice and thereby improving the quality of the lives and life expectancies of patients.1

A letter in the 12th June 2010 issues of BMJ calls for high–level international agreements on standards for antimicrobial usage to tackle antibiotic resistance – similar to those used to address climate change. ‘International agreements do not yet exist, but perhaps, as with carbon dioxide, the control of antibiotic resistance requires such agreements.’ 2

References

  1. Rational use of medicines. The Lancet, Volume 375, Issue 9731, Page 2052, 12 June 2010. http:// www.lancet.com/journals/ lancet/ article/ PIIS0140–6736(10)60944–0/ fulltext (free access)

  2. Tackling antibiotic resistance. BMJ 2010;340:c2978 http://www.bmj.com/cgi/content/extract/340/jun09_3/c2978 (restricted access)

2. Terminal care (Dr (Mrs) Kiran Vinayek, Dr Vikram Vinayek)

All clinicians are responsible for care of the "dying" and should adopt a kind and sensible approach. Attention should be paid to relief of suffering, both physical and psychological. Investigations and treatment may be done away with because prolonging life may in fact be making the process of dying more difficult. It is a delicate matter for which there is no simple formula. The judgement of spouse and relatives is definitely clouded by emotion and interpersonal relationships become strained and suspicion, fear and mistrust are present.

The disclosures should be made gently and by degree and by a stepwise approach. One should not assault the patient with the truth. A fairly frank explanation may get an openly expressed gratitude response. Assurances and positive statements by the physicians provide security and comfort to the patient despite the fact that life is drawing to its conclusion. One should provide kind and courteous general care. The patient is charged with many strong emotions and the physician should provide comfort and support in the face of suffering and decrease the unpleasantness. The different emotions experienced may be sadness, depression or despair and also hopefulness and optimism and finally acceptance and inner tranquility. This peace of mind is a source of strength to the family while anger and resentment does the reverse. A kind, open and supportive discussion helps in achieving acceptance.

There should be a good liaison between the senior nurse, medical team, the social worker and the physiotherapist.

The family should be welcomed on the ward and home visits with the realatives should be allowed. The patient should be discharged with adequate social support. A sympathetic care should be delivered as if it is a privilege and not a chore.

3. The International Continence Society (ICS) announces June 21–27, 2010 as the Second World Continence Week

World Continence Week will help promote global awareness of continence by providing contact points for those seeking treatments and information, creating a network of events and organizations, and by promoting a multi–disciplinary approach to treatment. In honor of this special week, Ranbaxy Urology Speciality announced various events throughout the country centered around incontinence awareness including free information on Incontinence to one and all.

An estimated 33 million people experience urinary incontinence. Apart from bringing communities together to build a better understanding of urinary and fecal incontinence, World Continence Week strives to promote a multidisciplinary approach to treatment. According to Diane Newman, University of Pennsylvania’s Center for Continence and Pelvic Health, a staggering number of incontinent men and women are unaware of the treatment options available to them. The objective of the World Continence Week’s is not only to open people’s eyes to how many suffer from incontinence, but also to let them know that they have options.

4. Vitamin B6 may lower lung cancer risk

Vitamin B6 and the amino acid methionine are associated with a reduced risk of lung cancer. The cohort study, involving more than 500,000 patients from 10 countries, found those patients with the highest serum levels of vitamin B6 had a 56% reduced risk of lung cancer as those with the lowest levels, Paul Brennan, PhD, of the International Agency for Research on Cancer in Lyon, France reported in the June 16 issue of the Journal of the American Medical Association.

The chequered history of antiobesity drugs (Dr G M Singh)

February 1998: Sibutramine launched in the UK – a centrally–acting appetite suppressant– the first in the ‘new–generation’ of obesity treatments

September 1998: Orlistat launched, which acts locally on the GI tract to reduce the absorption of dietary fat

July 2006: Rimonabant launched in the UK, a centrally-acting, cannabinoid receptor antagonist

October 2006: The first reports suggesting side effects with rimonabant– particularly depression – are more common in practice than in clinical trials

October 2008: The European Medicines Agency(EMEA) cautions GPs to not prescribe rimonabant due to the risk of psychiatric side effects. The drug is suspended ‘temporarily’.

January 2009: Orlistat goes OTC in the UK as Alli – at 60mg, half the dose of the prescription product Xenical

December 2009: Both the EMEA and the US Food and Drug Administration (FDA) warn about a potential cardiovascular safety risk with sibutramine in patients at higher risk of CVD.

January 2009: The MHRA (Medicines and Healthcare products Regulatory Agency) announces the suspension of sibutramine as ‘the increased risk of non-fatal heart attacks and strokes with this medicine outweighs the benefits of weight loss’

Interesting Tips in Hepatology & Gastroenterology

(Dr Neelam Mohan, Consultant Pediatric Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician, Sir Ganga Ram Hospital, Delhi)

How much liver does a recipient need?

Well, a liver disease patient needs approximate 0.8 –1% of liver volume of his body weight. For example, a 10 kg child would need at least 80 –100 gms while a 50 kg adult would need at least 400 – 500gms.

If the patient is relatively well–preserved, then a lesser volume graft i.e. 0.8% would suffice. However, if the patient is very sick / critical / in acute liver failure, then one prefers to give around 1% of the body weight.

How does one calculate graft weight ?

All prospective liver donors are subjected to CT scan (triphasic Angiography with volumetry) which provides information on the volume of various lobes of liver– right lobe volume, left lobe volume, and left lateral lobe volume. However, the exact assessment is obtained only on surgery.

Tomorrow I shall write on "What tests are performed on liver donor."

Conference Calendar

VERTIGO 2010
State of the Art Workshop on Dizziness
Date: June 27, 2010
Venue: Taj Deccan, Banjara Hills, Hyderabad, Andhra Pradesh.

Moral of the story (Anupam Sethi Malhotra)

Many years ago in a small Indian village, A farmer had the misfortune of owing a large sum of money to a village moneylender. The Moneylender, who was old and ugly, fancied the farmer’s beautiful daughter. So he proposed a bargain. He said he would forgo the farmer’s debt if he could marry his daughter. Both the farmer and his daughter were horrified by the proposal.

So the cunning money–lender suggested that they let Providence decide the matter. He told them that he would put a black pebble and a white pebble into an empty money bag. Then the girl would have to pick one pebble from the bag.

  1. If she picked the black pebble, she would become his wife and her father’s debt would be forgiven.

  2. If she picked the white pebble she need not marry him and her father’s debt would still be forgiven.

  3. But if she refused to pick a pebble, her father would be thrown into Jail.

They were standing on a pebble–strewn path in the farmer’s field. As they talked, the moneylender bent over to pick up two pebbles. As he picked them up, the sharp–eyed girl noticed that he had picked up two black pebbles and put them into the bag. He then asked the girl to pick a pebble from the bag.

Now, imagine that you were standing in the field. What would you have done if you were the girl? If you had to advise her, what would you have told her?

Careful analysis would produce three possibilities:

  1. The girl should refuse to take a pebble.

  2. The girl should show that there were two black pebbles in the bag and expose the money–lender as a cheat.

  3. The girl should pick a black pebble and sacrifice herself in order to save her father from his debt and imprisonment.

Take a moment to ponder over the story. The above story is used with the hope that it will make us appreciate the difference between lateral and logical thinking. The girl’s dilemma cannot be solved with traditional logical thinking. Think of the consequences if she chooses the above logical answers. What would you recommend to the Girl to do?

Well, here is what she did ……

The girl put her hand into the moneybag and drew out a pebble. Without looking at it, she fumbled and let it fall onto the pebble–strewn path where it was immediately lost among all the other pebbles.

"Oh, how clumsy of me," she said. "But never mind, if you look into the bag for the one that is left, you will be able to tell which pebble I picked."

As the remaining pebble was black, it must be assumed that she had picked the white one. And since the money–lender dared not admit his Dishonesty, the girl changed what seemed an impossible situation into an extremely advantageous one.

Moral of the story: Most complex problems do have a solution. It is only that we do no attempt to think.

Question of the Day

Who are the candidates for HPV vaccine? (Dr Harish Pemde)

HPV is the commonest sexually transmitted infection in USA. Nearly half the sexually active men and women become infected at the same time. Prepubertal females will benefit the most with this vaccine. Young men should be vaccinated as they are the carriers and can infect the partner. The vaccine contains HPV types 16 and 18, which cause cancers and also protects against the less virulent HPV 6 and 11 strains, which are responsible for common genital warts. In this regard, both men and women would benefit from vaccination.

Reference

Who should receive the new HPV vaccine? http://www.medscape.com

Exercise your mind : Give your mind a scratch: Dementia preventing exercise

Can you figure this out?
Yes, the answer is given at the end.

This is strange…can you figure it out? Are you the 2% or 98% of the population?
Follow the instructions!

  • Just follow these instructions, and answer the questions one at a time and as quickly as you can!

  • Again, as quickly as you can but don't advance until you've done each of them… really.

  • Now, scroll down (but not too fast, you might miss something).

Think of a number from 1 to 10

Multiply that number by 9

If the number is a 2–digit number, add the digits together

Now subtract 5

Determine which letter in the alphabet corresponds to the number you ended up with (Example: 1=a, 2=b, 3=c,etc.)

Think of a country that starts with that letter
Remember the last letter of the name of that country
Think of the name of an animal that starts with that letter
Remember the last letter in the name of that animal
Think of the name of a fruit that starts with that letter
Are you thinking of a Kangaroo in Denmark eating an Orange?

This was FREAKY!!

If not, you’re among the 2% of the population whose minds are different enough to think of something else. 98% of people will answer with kangaroos in Denmark when given this exercise. This is based on mind's easy escape mechanism.

IJCP
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ijcpgroup
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Docconnect
 
 

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month.

Contact: drkk@ijcp.com emedinews@gmail.com

 
 
 

eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .

 

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Dr Good Dr Bad

Situation: A patient with heart failure came with chronic anemia.
Dr. Bad: Give blood transfusion.
Dr. Good: You need to be investigated.
Lesson: Patient with heart failure and chronic anemia don’t urgently need correction of anemia by the use of transfusion or erythropoiesis stimulating agents. Iron supplement is recommended only when clinically indicated.

Make Sure

Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on bimanual palpation.
Reaction: Oh my God! You should have done cervical swabs and consider starting antibiotics.
Lasson: Make sure to remember that women with such symptoms may have endometritis, which requires prompt diagnosis. It may respond to doxycycline and metronidazole.

Humor Section

IMANDB Joke of the Day

A little girl attending the school clinic started crying as the doctor approached her.
"I’m only going to take your pulse," the doctor explained.

"But don’t I need it?" sobbed the little girl.

Funny Definitions

Artery…………………The study of paintings

Formulae in Clinical Practice

                                                  Women

Height

Kilograms

Healthy Weight Range (Pounds)

4’10"

49–54

109-121

5’0"

51–57

113–126

5’1"

52–58

115–129

5’2"

53–59

118–132

5’3"

54–61

121–135

5’4"

56–62

124–138

5’5"

57–63

127–141

5’6"

58–65

130–144

5’7"

60–66

133–147

5’8"

61–68

136–150

5’9"

63–69

139–153

5’10"

64–70

142–156

5’11"

65–72

148–162

6’0"

67–73

148–162

Milestones in Cardiology

1873–1944: Alexis Carrel was a French Surgeon and Biologist. Heart transplantation has become a reality through the pioneering work of Alexis Carrel. He mastered the technique of suturing blood vessels as a young physician in Lyon, France, for which received the Nobel Prize in 1912. The technique of ‘triangulation’ is still being used today.

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Rheumatoid Factor

To help diagnose rheumatoid arthritis (RA) and Sjogren’s syndrome: When a patient has fatigue, joint pain, weakness, or dry eyes or dry mouth then your doctor may suspect it to be due to RA or Sjogren’s syndrome.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

                        Sucralose

for use as sweetner in drug formulations

09.05.2009


 

Public Forum (Press Release for use by the newspapers)

Pumpkin Extract Beneficial for Diabetic Patients

Pumpkin extract has insulin–like effects. It can help people with diabetes keep their blood sugar under control said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Quoting Chinese researchers Dr Aggarwal said that animals with drug-induced diabetes treated with pumpkin extract had lower blood glucose levels, greater insulin secretion, and more insulin–producing beta cells than diabetic rats that weren’t given the extract. This action was attributed to the presence of both antioxidants and D–chiro–inositol, a molecule that mediates insulin activity.

Pumpkin extract is potentially a very good product for pre–diabetic persons, as well as those who have already developed diabetes.

Pumpkin is frequently used to treat diabetes and high blood glucose in Asia.

The results of an animal study have shown that rats with diabetes had 41 percent less insulin in their blood than normal rates; giving them pumpkin extract for 30 days boosted levels of the blood sugar–regulating hormone by 36 percent. And after 30 days of being fed pumpkin extract, diabetic rats had blood glucose levels similar to those of non–diabetic rats.

(Advertorial section)

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. All India Institute of Medical Sciences, New Delhi, India is organizing an International Conference on Opportunistic Pathogens from September 27–30, 2010. The conference will focus on several breakthroughs which have occurred recently in the field of HIV/AIDS such as co–pathogens of HIV, receptor attachment, neuropathology, tissue tropism, use of nanomedicine in HIV treatment, testing guidelines for diagnosis and blood safety, opt–out and universal testing strategies, drug resistance mechanisms and future vaccines against HIV. The pattern of OIs and the supervised treatment protocols have also gained momentum. Most of these issues will be discussed during this unique conference on first two days. Beside HIV/AIDS, opportunistic infections are also major cause of mortality and morbidity in organ transplant recipients, including the bone–marrow and stem cell recipients and also in all solid organ transplants. Therefore, we have given a full day for scientific deliberations on opportunistic pathogens in organ transplants and those who have congenital immune–deficiencies. For details please log on to www.icopa–india.org; Prof. Sarman Singh, MD, FAMS Chairman, Organizing Committee; O-(0091–11) 2658 8484, 2659 4977

  2. Morbidity and Mortality Weekly Report (MMWR) Conjugate Vaccine (PCV13) and Recommendations for Use among Children – Advisory Committee on Immunization Practices (ACIP), 2010: Dr Kamlesh Kanodia
    A 13-valent pneumococcal conjugate vaccine (PCV13 (Prevnar 13, Wyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc.) was licensed by the Food and Drug Administration (FDA) for prevention of invasive pneumococcal disease (IPD) caused by the 13 pneumococcal serotypes covered by the vaccine and for prevention of otitis media caused by serotypes in the 7–valent pneumococcal conjugate vaccine formulation (PCV7 (Prevnar, Wyeth)). PCV13 is approved for use among children aged 6 weeks––71 months and succeeds PCV7, which was licensed by FDA in 2000. The Pneumococcal Vaccines Work Group of the Advisory Committee on Immunization Practices (ACIP) reviewed available data on the immunogenicity, safety, and cost–effectiveness of PCV13, and on estimates of the vaccine–preventable pneumococcal disease burden. The working group then presented policy options for consideration of the full ACIP. This report summarizes recommendations approved by ACIP on February 24, 2010, for
    1) routine vaccination of all children aged 2––59 months with PCV13,
    2) vaccination with PCV13 of children aged 60––71 months with underlying medical conditions that increase their risk for pneumococcal disease or complications, and
    3) PCV13 vaccination of children who previously received 1 or more doses of PCV7
    .
    CDC guidance for vaccination providers regarding transition from PCV7 to the PCV13 immunization program is also included.

  3. Dr K K Aggarwal, After having worked as a faculty for more than 25 years i have seen the plight of diploma holders and agree with the travails of Dr Ch. Srinivasa Raju. I feel it would be difficult for MCI to make diploma holder eligible for faculty posts. I have time and again suggested that all the diplomas in all the disciplines of medicine should be scrapped and equal number of degree seats be added as the options available to diploma holders are few in view of availability of post graduate degree holders in almost all the disciplines: Dr Y.K.Saxena, Prof and Head, Department of Radiotherapy and Oncology, Lady Hardinge Medical College, New Delhi–110092.
  4. Respected Padamshree Dr KK Agrawal: in reference to the news item carried in e medinews bulletin dated 16.06.2010 Rumors about Dr Sudhir Gupta and subsequent carrying my clarification on 17.06.2010, i appreciate your prompt response, respect of medical ethics for fellow doctor and thankful for the same. Dr SUDHIR GUPTA  MBBS (Gold Medal), MD(BHU), DNB, MNAMS: mob-9810877713