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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

  Editorial ...

18th September, 2010, Saturday

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

US FDA approves new drug for gout

The US Food and Drug Administration (FDA) has approved pegloticase to treat gout in adults who do not respond to or who cannot tolerate conventional therapy. Gout occurs due to an excess of the bodily waste uric acid, which is eventually deposited as needle–like crystals in the joints or in soft tissue. These crystals can cause intermittent swelling, redness, heat, pain and stiffness in the joints. Gout has a strong association with obesity, high blood pressure, high cholesterol and diabetes, and occurs more often in men, in postmenopausal women and in people with kidney disease.

About 3% of the three million adults who suffer from gout are not helped by conventional therapy i.e. use of drugs that lower the amount of uric acid in the blood, for example, the xanthine oxidase inhibitors allopurinol and febuxostat. Pegloticase is an important new option for such patients.

Pegloticase is an enzyme that lowers uric acid levels by metabolizing it into a harmless chemical that is excreted in the urine. The drug is administered to patients every 2 weeks as an IV infusion. Two 6–month clinical trials of 212 total patients demonstrated that the drug lowered uric acid levels and reduced deposits of uric acid crystals in joints and soft tissue. The drug is not yet introduced in India.


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Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Heart Care Foundation of India, congratulates Sushil Kumar on becoming the first Indian wrestler to win a gold medal at the World Wrestling Championship in Moscow. Sushil Kumar made India proud by defeating Gogaev Alan of Russia 3–1 in the final of the 66kg category.
 

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Combination therapy for falciparum malria

Pyronaridine–artesunate is an excellent addition to the artemisinin combination therapy armamentarium for treatment of uncomplicated falciparum malaria.

(Reference: Tshefu AK, et al. Efficacy and safety of a fixed–dose oral combination of pyronaridine–artesunate compared with artemether–lumefantrine in children and adults with uncomplicated Plasmodium falciparum malaria: a randomised non–inferiority trial. Lancet 2010;375:1457).

  National News

More hands for sanitation, water schemes

The Union Rural Development Ministry has given the go–ahead for recruitment of 21,000 persons to man the Block Resource Centres across the country for managing drinking water schemes and to achieve total sanitation in the rural areas. The Ministry has also made provision for procuring the services of another 3,200 sector specialists, who will be hired by the year–end to manage the water and sanitation schemes. The specialists will help generate awareness, monitoring and evaluation and hydrology for these schemes. The Block Resource Centres (BRC) will be set up in all the 6,442 blocks/talukas/mandals of the country, each to be manned by one to four staff. The manpower of the BRC will support 2.5 lakh gram panchayats and 6 lakh Village Water and Sanitation Committees. The BRCs, along with the staff, will be set up by March 31, 2011. (Source: The Pioneer)

1st Indian website on kidney disease in Hindi

The first Indian & Global Website on Kidney Disease in Hindi will be launched today by Dr Vidya Acharya at the Annual Conference of the Indian Society of Nephrology at Daman. An excellent tool for the education of kidney patients, it has been prepared in National Language for the benefit of Large Number of Hindi Speaking People (Population of Hindi Speaking is 350 Million – Third most widely spoken Language of World). It provides Free Access to "Suraksha Kidney Ki", a 200-page book. The book has been compiled by Dr Sanjay Pandya (Rajkot, Gujarat) after 20 years of his experience as a Nephrologist.

Visit the site www.kidneyinhindi.com

  International News

When measuring blood pressure, care should be taken to

  • Allow the patients to sit for several minutes in a quiet room before beginning blood pressure measurements.
  • Take at least two measurements spaced by 1–2 min, and additional measurements if the first two are quite different.
  • Use a standard bladder cuff 12–13 cm long and 35 cm wide but have a larger and a smaller bladder available for fat and thin arms, respectively. Use the smaller bladder in children. Have the Cuff at the heart level, whatever the position of the patient. Use phase I and V (disappearance) Korotkoff sounds to identify systolic and diastolic blood pressure, respectively.
  • Measure BP in both arms at first visit to detect possible differences due to peripheral vascular disease. In this instance, take the higher value as the reference one, when the auscultatory method is used.
  • Measure BP 1 and 5 min after assumption of the standing position in elderly subjects, diabetic patients, and in other conditions in which orthostatic hypotension may be frequent or suspected.
  • Measure heart rate by pulse palpation (30 s) after the second measurement in the sitting position.

(Contributed by Dr G.M. Singh)

Physical fitness may protect men who work long hours from heart disease

According to findings of a study published in the journal Heart, physical fitness protects men who work long hours from the heart disease that is associated with putting in overtime.

Protein that causes Progeria could be heart disease factor

The protein progerin, which accumulates in children with Progeria, the disease that causes rapid aging, accumulates in people with advancing age. A study by National Institutes of Health and the Progeria Research Foundation suggests that progerin may be a new risk factor for heart disease.

UK regulators seek to pull avandia from market

UK’s Medicines and Healthcare products Regulatory Agency says that an independent panel of experts concluded that the risks of Avandia (rosiglitazone) outweigh its benefits, and that it should no longer be sold in Britain.

(Dr Monica and Brahm vasudev)

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

Practice frequent and responsive feeding during and after illness

  • During illness, increase fluid intake by more frequent breastfeeding, and patiently encourage children to eat favorite foods.
  • After illness, breastfeed and give foods more often than usual, and encourage children to eat more food at each sitting.

References

  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/ UNICEF, 1998.
  2. Dewey KG. Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/ WHO, 2003.
  3. WHO. Complementary Feeding: Family Foods for Breastfed Children. Geneva: World Health Organization, 2000.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is the treatment for infertility?

Initial test results help the consultant to guide the couple. Most of the times making the couple understand the physiology and the planned treatment will give good results. Induction of ovulation with only the oral medicines first and then if required costly gonadotrophin injections, correcting subtle endocrino-pathies will help.
For tubal factor: Either corrective endoscopic surgery or cornual cannulation may be considered depending on the site of obstruction. There is good chance of conception with IVF, if surgery cannot restore fertility in tubal factor.
Unexplained infertility and early endometriosis cases:  Controlled ovarian stimulation with IUI has given some promising results.

Is IVF painful?

It is a strong fear in the mind of patient that IVF is a painful process. This is however not entirely true. The patient has to certainly tolerate the pain of injection. The other painful process of egg retrieval is done under anesthesia. Embryo transfer is also a painless procedure.

  Cardio Update: Question of the Day

Can a patient with pacemaker, touch an electric appliance (microwave, electric brush, shaver, etc.), have an MRI scan, go through airport metal detector or use a mobile phone? (Dr. B. Soma Raju, Hyderabad)

Yes, patients with pacemakers can use household electrical appliances like microwave, electric brush, shaver, etc. However, MRI should be avoided in a pacemaker patient. Regarding metal detector at the airport, we recommend that patient with pacemaker should avoid security ward as programming changes may occur in the pacemaker. The modern day pacemakers are compatible with cell phones. However, as a general measure, we suggest patients with pacemaker to use the cell phones in the opposite ear i.e., if pacemaker is on the right side, use the cell phone in left ear, or use a hands–free set.

  Medicolegal Update

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

What are the futile treatments in medical care delivery?

Unilateral DNR policies to allow clinicians to provide a do–not–resuscitate (DNR) order

In the late 1980s and early 1990s, some argued that clinicians could terminate futile treatments. Unfortunately, the term futility has been used inconsistently. Physiologic futility means that an intervention will have no physiologic effect.

  • Qualitative futility refers to an intervention that "fails to end a patient’s total dependence on intensive medical care".
  • Quantitative futility occurs "when physicians conclude (either through personal experience, experiences shared with colleagues, or consideration of reported empiric data) that in the last 100 cases, a medical treatment has been useless."

In general, it is now agreed that there is no objective standard of futility; the term merely conceals subjective value judgments about when a treatment is "not beneficial" Some hospitals have enacted "unilateral DNR" policies to allow clinicians to provide a do-not–resuscitate order in cases where consensus cannot be reached with families and there is medical opinion that resuscitation would be futile if attempted. Texas, Virginia, Maryland, and California have enacted so–called medical futility laws. These laws protect clinicians from liability if they terminate life–sustaining treatments against family wishes. In Texas, if the medical team and family continue to disagree about terminating interventions despite an ethics consultation, then the hospital is supposed to try to facilitate transfer of the patient to another institution willing to provide treatment. If this fails after 10 days, then the hospital and clinician may unilaterally withdraw treatments determined to be futile. The family may appeal to a state court. Early data suggest the law increases futility consultations for the ethics committee and most families concur with withdrawal decision.

  Medi Finance Update

Investment Tips

  • One should always start investing early and regularly.
  • Never put all your eggs in one basket.
  • Investment in gold, real estate and equity funds, in today’s date may not be recommended.


Q: How much can a Doctor deposit in a PPF A/C? I heard that he/she can deposit upto Rs. 1 Lakh per year, but the Tax Benefit is only upto Rs 70,000/- for PPF deposits. Please clarify if this information is correct. Dr. Raghuveer Rao.

CA Arun Kishore Answers: As per clause 3(1) of the Public Provident Fund Scheme 1968 any  individual can deposit minimum Rs.500/- and maximum Rs.70000/- in a  year. Deduction under the Income Tax Act is allowed for investments and deposits made under the options given in Section 80C (2) of the IT Act 1961 (The Act) upto a maximum of Rs.100000/- per year. Thus the doctor can only deposit Rs.70000/- in PPF account in a year and for claiming balance deduction, He/she can to deposit/ invest Rs.30000/- under any other options listed u./s 80C (2) of The Act. 

Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date

Notification

Fixed dose combination of Loperamide Hydrochloride with Furazolidone

Jan 1, 2002

GSR 170(E)
dt.12.3.01

  Lab Update

Prostate specific antigen (PSA)

A transurethral resection of the prostate (TURP) can elevate PSA levels by a median of 5.9 ng/mL. Levels remain high for about 3 weeks. A screening PSA test should not be performed for at least 6 weeks following this procedure.

  IJCP Special

Dr Good Dr Bad

Situation: A 25 year–old patient was brought to the emergency room after kerosene ingestion.
Dr Bad: Put in a Ryle’s tube and do gastric lavage.
Dr Good: Refrain from a Ryle's tube lavage. Get CXR done to see for lipid pneumonia.
Lesson: Never attempt Ryle’s tube insertion and lavage in kerosene poisoning as it can cause perforation. Instead, chemical pneumonitis should be suspected and an X–ray chest should be ordered for confirmation.

Make Sure

Situation: A 26–year–old pregnant woman complaining of lower abdominal pain, burning during urination and increased vaginal discharge is prescribed ofloxacin.
Reaction: Oh my God! Why did you give flouroquinolone! They are contraindicated during pregnancy. You should have given a safe and effective antibiotic like azithromycin.
Lesson: Make sure to remember that 1 g single–dose regimen of azithromycin is safe and effective in pregnant woman.

Quote of the Day

"A lifetime of happiness? No man could bear it: it would be hell on earth." George Bernard Shaw
(Contributed by Dr. G.M. Singh)

Hypertension Alert

  • In all patients presenting with severe hypertension, repeat BP measurement after rest in a quiet room.
  • Have the initial goal of reducing the blood pressure to ≤160/100 mmHg over several hours to days with conventional oral therapy.
  • Adjust the existing medication regimen, or reinstitute the drugs (if nonadherent).
  • For all patients, do initial close follow–up (every one to two days).
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  Mind Teaser

Read this…………………

What word ends with an S in its plural masculine form, but changes to singular feminine when another S is added to the end?

The answer for yesterday’s Mind Teaser: 'Defencelessness'

Correct answers received from: Dr.Susheela Gupta, Dr Chandresh Jardosh, Dr Kamlesh Kanodia, DR.K.P.RAJALAKSHMI, Dr Neelam Nath, Dr Rawat Purushottam Singh, Dr Kalpana Mohan

Answer for 16th September Mind Teaser is:“Dextrose 5% with 0.45% normal saline (half-normal saline)’
Correct answers received from: Dr PC Das, Dr Nagendra Gupta, Dr Uma Gaur, Dr Muthumperumal Thirumalpillai.

Send your answer to ijcp12@gmail.com

  Humor Section

Interesting aspect of mathematical calculation in human life
Longevity
Married men live longer than single men do, but married men are a lot more willing to die.
(Contributed by Dr Dewat Ram Nakipuria)

Funny one liner

If you do NOT have a Girl Friend – You are missing SOME thing in your life.
If you HAVE a Girl Friend – You are missing EVERY thing in your life.
(Contributed by Dr Chandresh Jardosh)

  An Inspirational Story

The seeker of truth

After years of searching, the seeker was told to go to a cave, in which he would find a well. ‘Ask the well what is truth’, he was advised, ‘and the well will reveal it to you'. Having found the well, the seeker asked that most fundamental question. And from the depths came the answer, 'Go to the village crossroad: there you shall find what you are seeking’.

Full of hope and anticipation the man ran to the crossroad to find only three rather uninteresting shops. One shop was selling pieces of metal, another sold wood, and thin wires were for sale in the third. Nothing and no one there seemed to have much to do with the revelation of truth. Disappointed, the seeker returned to the well to demand an explanation, but he was told only, ‘You will understand in the future.’ When the man protested, all he got in return were the echoes of his own shouts. Indignant for having been made a fool of – or so he thought at the time – the seeker continued his wanderings in search of truth.
As years went by, the memory of his experience at the well gradually faded until one night, while he was walking in the moonlight, the sound of sitar music caught his attention. It was wonderful music and it was played with great mastery and inspiration. Profoundly moved, the truth seeker felt drawn towards the player. He looked at the fingers dancing over the strings. He became aware of the sitar itself. And then suddenly he exploded in a cry of joyous recognition: the sitar was made out of wires and pieces of metal and wood just like those he had once seen in the three stores and had thought it to be without any particular significance.
At last he understood the message of the well: We have already been given everything we need: our task is to assemble and use it in the appropriate way. Nothing is meaningful so long as we perceive only separate fragments. But as soon as the fragments come together into a synthesis, a new entity emerges, whose nature we could not have foreseen by considering the fragments alone.

  Readers Responses
  1. Many Many thanks DR K K Aggrawal Ji, for providing different different news of medical as well as medico elections  in IMA Level along with new inventions and research in fields of medical sciences. Dr KP SINGH Fortis Escorts, Okhla Road.
  Public Forum

(Press Release for use by the newspapers)

Practice monogamy to prolong life

Giving details about sexual life after heart diseases, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela said that extramarital affairs are not safe for heart patients as they are usually done with much younger partner at unusual time, circumstances, situation, and place. Extramarital affairs can put strain on the heart, increase pulse rate and cause heart attack.

Extramarital affairs also involve indiscriminate use of Viagra–like drugs, which may be harmful to the heart if underlying serious blockages are present and the person is not accustomed with normal sexual life. Dr. Aggarwal said that there is a rule of thumb, if a person can walk 2 kms or climb 2 flights of stairs; he or she is cardiac safe to enter into marital relationships.

Working hard when tired not good for the health

Dr Aggarwal said that doing mental or physical work while exhausted may harm your health, as per a study from University of Alabama at Birmingham and published in International Journal of Psychophysiology. Commenting on the study he said that fatigued people have bigger spikes in blood pressure than well–rested people while doing a memorization test. When fatigued people regard a task as worthwhile and achievable, they increase their effort to compensate for their diminished capability. As a result, the blood pressure of a tired person increases and remains high until the task is completed or the person gives up.

In this study, Wright and colleagues told 80 volunteers they could win a modest prize by memorizing two or six nonsense trigrams (meaningless, three–letter sequences) within two minutes. Compared to volunteers with low levels of fatigue, those with moderate fatigue had stronger blood pressure while doing the two-trigram memorization task.

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday–BSNL Dil ka Darbar A daylong 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

Dr. Sood Nasal Research Foundation Announces 

Rhinology Update 11th to 15th November, 2010, at Dr. Shroff’s Eye & ENT Hospital, New Delhi.

22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 At Dr. Shroff’s Eye & ENT Hospital, New Delhi.
 
Cadaveric Sessions on 13th November, 2010 at Lady Harding Medical College.
                                                                                                                                          
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital,
Preet Vihar, Vikas Marg, New Delhi.
 
For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center,
212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi-110092 (India).
Tel: 011-22440011, 42420429.  
E-mail: drvpsood@gmail.com,
vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com