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; 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


18 August, 2010, Wednesday

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

Knee hygiene

  1. Lifestyle changes can help stave off arthritis
  2. Protecting the knees when one is younger may help prevent serious problems such as arthritis and the need for knee replacement when one is older
  3. Nearly half of adults develop arthritis in at least one knee by age 85, and the risk is even greater for obese people.
  4. Extra pounds increase the strain on knee joints
  5. Every time one takes a step one applies three times the body weight to the knee. When one runs it’s five times, when one jump it’s seven times.
  6. Weight loss is 70 percent diet and 30 percent exercise. One cannot eat the same and exercise the pounds. It’s a myth.
  7. Low–impact activities such as swimming and cycling are better for the knees than high–impact workouts such as running or aerobics.
  8. Good core strength (abs, back and pelvis) also helps protect the knees
  9. The knees can be subjected to abnormal stress if the shoes don’t give a stable base as one walks. Many patients experience dramatic reductions in knee pain after getting orthotics or shoes specifically made to fit their feet.
  10. If the knee pain lasts more than two weeks, one needs to see a doctor because there might be something mechanically wrong with the knee. [Source Harvand News Letter]

Dr KK Aggarwal
Editor in Chief
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Photo Feature

 Valentine's Day Press Conference

On the ocassion of  the valentine's day in the year 2009, Heart Care Foundation of India held a press conference to make people aware of the importance of relationships in Human life.

In the photo: Ashish Nehra, Cricketer, Mr. Anil Jaju. Also in the photo Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI

Dr K K Aggarwal

 

News and Views

Use of MRI (Dr Dr G M Singh)

MRI can be used to help diagnose

  1. Tumors in the pelvic, abdominal or chest areas, reproductive organs, kidneys or urinary tract.
  2. Some heart problems.
  3. Enlarged or blocked blood vessels.
  4. Abnormalities that affect the liver, gallbladder, and bile and pancreatic ducts.
  5. The cause of pelvic pain, which could include endometriosis, fibroids or adenomyosis.
  6. Abnormalities affecting the uterus.
  7. Breast cancer.

(Dr Brahm and Dr Monica Vasudev)

CKD patients insured by some federally sponsored healthcare systems more likely to undergo AVF before dialysis

Patients with chronic kidney disease are significantly more likely to initiate hemodialysis (HD) with an arteriovenous fistula (AVF) if they are in federally sponsored national healthcare systems, such as the Department of Veterans Affairs and the Department of Defense, than patients who receive their care in the commercial market and from Medicare. Placement of AVFs months before the start of HD will improve morbidity and mortality and decrease costs.

Microvascular decompression surgery may help control diabetes

According to a study published Aug. 12 in the journal Surgical Neurology International, a surgical procedure that reduces pressure on the blood vessels of a brain region that regulates the body’s vital functions appears, in some cases, to improve glucose control in patients with type 2 diabetes. By lifting and repositioning an artery that lay across the vagus nerve, improvements in the metabolic function of seven of 10 patients were noted.

NIH begins human clinical testing of dengue vaccine

The National Institutes of Health (NIH) has begun human clinical testing for a vaccine to prevent dengue infection.

 

Legal Column

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

WMA declaration of Malta on hunger strikers – Confidentiality & Gaining trust

The duty of confidentiality for a doctor in dealing such cases is important in building trust but it is not absolute. It can be overridden if non–disclosure seriously harms others. As with other patients, hunger strikers’ confidentiality should be respected unless they agree to disclosure or unless sharing of information is necessary to prevent serious harm. If individuals agree, their relatives and legal advisers should be kept informed of the situation. Fostering trust between physicians and hunger strikers is often the key to achieving a resolution that respects the rights of the hunger strikers and minimizes harm to them as well. Gaining trust can create opportunities to resolve difficult situations. Trust is dependent upon physicians providing accurate advice and being frank with hunger strikers about the limitations of what they can and cannot do, including situations where confidentiality cannot be guaranted.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Chronic pancreatitis

Categories of chronic pancreatitis

• Chronic calcifying pancreatitis
• Chronic obstructive pancreatitis
• Chronic inflammatory pancreatitis

Question of the day

What is the role of patient education in the management of diabetes mellitus? (Dr S Vijayalakshmi, Bangalore)

"The root of education is bitter, but the fruit is sweet"

Education is an art and fledging science. Diabetes education plays a crucial role in treatment of diabetes. For patient with a chronic disease, education is a lifelong process and an opportunity to improve self–care techniques. Diabetes education incorporates discipline into their lifestyle rather than permitting this condition to overwhelm them and control their lives. Education improves well–being and quality–of–life, self–care management, metabolic control, enhances the prevention of early detection of complication and decrease cost of care.

The onset of diabetes, either type 1 and type 2, is a difficult time emotionally for the patient, the physician must be a source of encouragement and as well as provider for treatment. Emotions related to the psychological burden of diabetes such as anxiety, depression and poor self confidence have been shown to be associated with poor control. At its best an education program empowers those with diabetes to achieve optimal self–management of their condition.

The initial goals of education are to understand the basic pathophysiology of diabetes and the difference between type 1 and type 2. The family must be involved in the education process as much as possible, in adults with diabetes involving spouse in the educational process can be very appreciable. However, the patient must be encouraged to accept the responsibility unless there are mitigating conditions. Patient with diabetes and their family should know the basic skills necessary for the patient survival that include nutritional program, weight control, insulin administration, SMBG (self monitoring blood glucose), adjusting insulin dosage and food intake for exercise, sick day care and prevention of diabetic ketosis and preventing hypoglycemia.

The program can be formalized and prescribed in a classroom setting or in a one–to–one fashion. In education session the size of the group may vary and the form of interactive mode used may include discussion, lecture interactive learning activities. Innovative educational techniques, such as programs incorporating computers, the internet, and other audiovisual media, can enhance the educational program.

Education for diabetes may be provided in variety of settings such as hospitals, education center, clinics and physician office. Self–management and future research is needed to evaluate and clarify optimal methods for educational process. Diabetes education already encompasses the family and social support. Researches have now started to consider public health aspect of diabetes education at the community level and possible in national level.

Evidence–Based Medicine

Treatment of hypertension improves executive function
(Dr N P Singh (Nanu), Professor of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital)

The FDA has approved a new emergency contraceptive drug, ulipristal acetate (Ella), a progesterone agonist/antagonist that works mainly by inhibiting or delaying ovulation. The single tablet is intended for use within 120 hours (5 days) after failure of standard contraception or after unprotected intercourse. It is available only by prescription. In two trials leading to the approval, the most common adverse effects were headache, nausea, abdominal pain, dysmenorrhea, fatigue, and dizziness. It is not intended for routine use as a contraceptive. Since May 2009, the prescription product has been available in Europe under the brand name EllaOne. The safety and efficacy of Ella were demonstrated in two Phase III clinical trials. One study was a prospective, multi–center, open–label, single–arm trial conducted in the United States; the other was a randomized, multi–center, single-blind comparator–controlled trial conducted in the United States, United Kingdom and Ireland. According to the product’s labeling, women with known or suspected pregnancy and women who are breastfeeding should not use Ella. A patient package insert also will be provided to ensure that women are fully informed of the benefits and risks involved in the use of Ella.

 

Public Forum (Press Release for use by the newspapers)

Sudden Cardiac Death

It is easy to anticipate and identify people at risk of sudden cardiac death, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

Talking about sudden cardiac death, Dr Aggarwal, said that the following people are at risk:

  • People who have survived a past cardiac arrest.
  • Heart patient with pumping action of the heart less than 30%
  • ECG showing wide QRS conduction of more than 120 msec.
  • Inability to climb two flight of stairs without symptoms.
  • Inability to walk 2 kms on level ground without symptoms.
  • Inability to do exercise in the bed with the partner without symptoms.
  • Patient with uncontrolled blood pressure, diabetes, smoking and people who drink more than 5 pegs of alcohol in one hour or 6 pegs of alcohol in one day.
  • People who have uncontrolled snoring.

He said that a campaign should be started all over the country and awareness to be created to the general public about the following messages related to sudden cardiac death:

  1. Sudden cardiac death is preventable. Learn only chest compression CPR
  2. Revival from Cardiac Arrest is possible in first 10 minutes. Earlier the better.
  3. Sudden Cardiac Death is common in the first hour of acute heart attack.
  4. Most heart attacks occur in the early hours of the day.
  5. Chewing a tablet of water-soluble aspirin at the onset of the heart attack reduces the chance of death by 22%.
  6. Heart attack can be reversed within three hours of chest pain with clot dissolving drug or by angioplasty.
  7. All heart patients should know their ejection fraction; if less than 30%, they need further evaluation.
  8. Sudden cardiac death is preventable – quit smoking today.
  9. Sudden cardiac death is preventable – keep your Blood Pressure under control.
  10. Sudden cardiac death – keep your diabetes under control.
  11. A 5 mm reduction of Blood Pressure can reduce chances of heart attack by 21%.
  12. All group residential colonies should keep automatic external defibrillator to tackle a cardiac arrest.
  13. If you are a heart patient with less than 30% ejection fraction, talk to your doctor for AICD (internal electric shock device)
  14. All heart patients should know their QRS duration on ECG (should be
    < 120 ms).
  15. Heart patients with QRS duration on ECG is more than 120 ms need further evaluation.
  16. To reduce sudden cardiac death, all post heart attack patients should be on beta blockers if not contraindicated.
  17. To reduce sudden cardiac death, all post heart attack patients should be given cholesterol lowering drugs.
  18. To reduce sudden cardiac death, all post heart attack patients should be on lifelong aspirin.
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Conference Calendar

BIEP 2010
National Breast Imaging Education Programme 2010

Date: August 27 - 29, 2010
Venue: Hotel Savera, Chennai, Tamil Nadu.

 

Dr KK Aggarwal on Net

The news Ramesh Sharma with Dr KK Aggarwal published at www.sidhibat.com

http://www.sidhibat.com

 

An Inspirational Story

Perceptions

There were two brothers in a small village in the Eastern Cape. The twin brothers grew up knowing nothing else but poverty. Their father was an alcoholic and their mother a domestic worker. They grew up with very little.

On their way home one day, their parents were involved in a bus accident and died instantly. The brothers’ condition became even worse. At age 17 they separated. Years and years later a family member decided to find them for a family reunion.

One of the brothers was a wealthy engineer owning a construction company. He had a wife and three beautiful kids. The other was an alcoholic with no sense of direction for his life.

The family member asked the engineer, "How did your life turn out like this?" "What did you expect with a childhood like mine?" he answered.

She moved on to the other brother with the same question."What did you expect with a childhood like mine?" was his answer.

This tells us that, "men are not disturbed by the things that happened but by their perception of the things that happened".

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with Rheumatoid Arthritis was to be put on Leflunomide.
Dr.Bad: Go ahead.
Dr.Good: Avoid it.
Lesson: Exposure to leflunomide, embryotoxic and teratogenic, must be avoided during pregnancy. (Arthritis Rheum 2010;62:1494)

Make Sure

Situation: A foreigner with a single loose stool developed sepsis.
Reaction: Oh my God! Why were antibiotics not started in time?
Lesson: Make sure to remember that all foreigners are diagnosed to be suffering from Traveler's diarrhea even if there is one single loose motion.

Quote of the Day

Shakespeare …"Laughing faces do not mean that there is absence of sorrow, but it means that they have the ability to deal with it"

Asthma Alert

Asthma can be intermittent or persistent.

Persistent asthma (Formula of 2)

One gets > 2 asthma attacks in the night in a month

One gets > 2 attacks of asthma in day in a week

One uses more than 2 canisters of asthma in a year

Persistent asthma (mild, moderate or severe) needs continuous drugs. On the contrary, intermittent asthma may be put on intermittent drugs.

 

International Medical Science Academy (IMSA) Update

Randomized controlled trials comparing carotid artery stenting with endarterectomy in symptomatic carotid stenosis have shown that the periprocedural and short term rates of serious complications are higher with stenting than with endarterectomy. (Lancet 2010;375:985; N Engl J Med 2010 May 26)

 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Chemically Modified Sodium Hyaluronate and Caboxymethylcellulose Absorbable Adhesion Barrier.

As an adjunct in abdominal or pelvic surgery for reducing the incidence, extent and severity of postoperative adhesions at the site of placement.

11–Feb–10

 

Medi Finance

Q. Is there any provision if a doctor fails to file the return within the time limit?

Ans. A doctor can file a belated return within a year from the assessment year or before the assessment is completed, whichever is earlier.

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Swine Influenza Flu (H1NI Virus)

Laboratory confirmation of cases is done by swabs taken from nose, naso–pharynx or throat preferably within 5 days of onset of illness. At this time RT–PCR technique is the authorized assay for confirmation of novel influenza A (H1N1) virus infection.

 

Lateral thinking

Read this………………

PRO/MISE

The answer for yesterday’s puzzle "just between you and me"

Correct answers received from: Dr Jayashree B Keshav, In Charge – Scientific Publications,.The Himalaya Drug Company, Dr Ashok Wasan,Dr Sushma Sraw, Dr Anurag Jain

Correct answer received for 16h August Puzzle from: Dr Girish Cally, Dr.Akshat Bhargava

Send your answer to ijcp12@gmail.com

 

Humor Section (Dr G M Singh)

Jokes

A very elderly couple is having an elegant dinner to celebrate their 75th wedding anniversary.

The old man leans forward and says softly to his wife … "Dear, there is something that I must ask you. It has always bothered me that our 10th child never quite looked like the rest of our children. Now I want to assure you that these 75 years have been the most wonderful experience I could have ever hoped for, and your answer cannot take that all away. But, I must know, did he have a different father?"

The wife drops her head, unable to look her husband in the eye. She paused for moment and then confessed. "Yes. Yes he did."

The old man is very shaken, the reality of what his wife was admitting hit him harder than he had expected. With a tear in his eye he asks "Who? Who was he? Who was the father?"

Again the old woman drops her head, saying nothing at first as she tried to muster the courage to tell the truth to her husband. then, finally, she says……… "You."

Scenario

Mark gets a headache and takes some aspirin to school.

1957 – Mark gets glass of water from Principal to take aspirin with.

2009 – Police called, Mark expelled from school for drug violations. Car searched for drugs and weapons.

(Contributed by Dr Chandresh Jardosh)

  Readers Responses
  1. Dear Dr Aggarwal: In the name of Ayurveda common man is exploited at village level, hardly any one with ayurveda degree is practicing it, most of them use them as a license to use modern medicine. Condensed ayurveda course in MBBBS curriculum is mockery, ayurvedic people should stick to their system and should learn to practice ayurveda purely rather than mixing it with allopathy. Vivek Kumar, Varanasi.
     
  2. Thanks, most respected sir, first of all I congratulate Dr Gaurav Garg, I am very much happy to learn through this e medinews that many of us living in hibernation, silently reading the e-medinews daily and some of us now have starting to speak on the burning issues like, claims by the BABAs to cure all types all diabetes, cancer, metabolic, hormonal, congenital disorders, etc without any control group. Another big issue is practice of all types medications, prescription without the knowledge of the medical science. Why are chemists dispensing antibiotics without valid prescription and not maintaining records properly? Why are generic medicines cheaper than branded? Dr KP Singh (drkpalsingh@sify.com)

     
  3. Thanks to Dr Gaurav Garg for raising the issue of Baba Ramdev. The way this country is being run , we feel helpless & sad. Dr Sunil Bhatnagar.

 

  1. 4. Dear Dr. Aggarwal, It pains me to hear from some quarters of the Modern Medicine Practitioners that a condensed course of Ayurveda should be introduced in the MBBS curriculum. First of all let me remind my dear friends that the recognized systems of Medicine in India are: Modern scientific medicine, Ayurveda, Siddha, Unani, Tibb, homeopathy, Yoga and Naturopathy along with acupuncture if practiced by a Registered Medical Practitioner in any of the recognized systems of Medicine. Each one of them is a complete system of medicine and analyzes the functioning of the Human Body and the disease process fundamentally different to each other. Ayurveda works on parameters of Triguna (Vata, Pitta and Kapha) and this classification of the disease process is so dominantly important that the entire treatment methods of Ayurveda are based related to these classifications. Similarly Homeopathy works on its own dominant classification of the disease process based on the doctrine of similarities and so do Unani , Tibb, Siddha, Yoga and Naturopathy on their respective widely varying and sometimes contradictory to each other doctrines . Each has its own pharmacopoeia and formula .Integrating the various systems of Medicine will kill the systems since it will generate quacks who will know nothing about any system but will only prescribe drugs from all systems. It is because of this precise reason that they were never integrated during their centuries of stay in this country .We all know "There is no such thing called poison, it all depends on the dose.” I would also like to make a small observation about the March 2010 judgment of the Hon'ble Supreme court division bench which did not agree with the observations and directions expressed by the previous division bench headed by Hon'ble justice Katju. IMA or for that matter nobody has any role to play in this regard since this matter can only be put to rest when the question of law is raised before a larger bench of the Hon'ble Supreme Court. Till then the matter will be decided on case to case basis as expressed in the said judgment. We have already tasted the results of intervening in IMA vs. VP Shanta when the whole community was put under the consumers protection act [Dr. Arvind Singh. Banaras]

    5. Dear Dr Aggarwal, There are many issues that confront doctors and medical profession in general. The various bills and laws pertaining to medical profession and its implementation are left to bureaucrats. There is a tendency in the bureaucrats to undermine the doctors and the profession. There is an element of jealousy or a complex in their mind. The recent incidence “ROPED IN FOR GAMES DUTY, DOCTORS GET ILL TREATMENT” – TOI dated 13.8.10 is the result of this thinking only.  My suggestion to solve this problem is to have a lobbying group of doctors turned bureaucrats. There are many medicos amongst them. Even this year the topper of batch is a medico from J& K only. He should be honored by IMA/DMA and the brotherhood should be cultivated.  They should be invited into social functions and other important meetings. They are also supposed to follow the ethics and Hippocratic Oath. Many of their batch mates will be in practice also and that helps in bonding. I am of the opinion that these friends who have studied medicine know what ails this profession and will help their profession. [Dr R.S.Bajaj, Consultant Pediatrician, Rohini, Delhi]

 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi 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.

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