Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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 (07–08); 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 November 2010, Thursday

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

Emergency Vs Urgency

Most of the medicolegal cases arise in the hospital settings when one fails to differentiate between emergency and urgency. Emergency is an emergent condition requiring immediate steps and remedies. On the other hand, urgency requires medical attention but one can wait for few hours. Routine care on the other hand can be handled under routine schedule of appointments. It is the duty of every doctor to triage their patients on routine/urgent/emergent cases. One of the formulae which can be used is the formula of "first time, unusual, unexplained". Any symptom or sign appearing for the first time in life or/and is unusual or/and cannot be explained needs immediate attention. For example after resting if you are feeling tired you need consult or when you have headache for the first in life, you need consult. One should also be aware of life-threatening emergency situations. A few situations are:  

  • Respiratory rate > 35 per minute
  • Inability to speak a sentence along with breathlessness.
  • Suspected heart attack chest pain (diffuse pain lasting > 30 sec in the center of the chest)
  • High fever with no sweating
  • No fever with absent shivering
  • Altered consciousness
  • Inability to move a limb, difficulty in speech, facial irregularity
  • Any bleeding in pregnancy
  • Blood in the sputum or vomiting
  • First onset of seizures
Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook
  Quote of the Day

(By Dr. G.M.Singh)

"In the hopes of reaching the moon men fail to see the flowers that blossom at their feet."

Albert Schweitzer

    Photo Feature (from the HCFI Photo Gallery)

 Festival of Classical Dance – 17th MTNL Perfect Health Mela 2010

Perfect Health Mela is a perfect platform for upcoming talent. Heritage, a Festival of Classical Dances, is a regular event of the Perfect Health Mela, which showcases the traditional classical dances of India in the form of competitions for students.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/ Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Centre plans diabetes screening scheme for schoolchildren

Concerned at the high incidence of diabetes in the country, especially among children, the Centre will soon launch a diabetes screening scheme for schoolchildren. It also proposes screening of all individuals for the disease in the next five years. This was disclosed by Union Health and Family Welfare Minister Ghulam Nabi Azad at the launch of the urban slum health check–up scheme for diabetes and blood pressure here on Sunday, the World Diabetes Day. The scheme has been introduced in Delhi, Kolkata, Mumbai, Chennai, Hyderabad and Bangalore. The Centre will provide the test kit, including the glucometers, and the States will chip in with logistics. (Source: The Hindu)

    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC

Exercise associated with 34% reduced risk for endometrial cancer

As reported by HemOnc Today, women who exercise at least 150 minutes per week saw their risk for endometrial cancer fall by more than one–third compared with inactive women, according the results of a population–based, case-control study. Hannah Arem, a doctoral student at Yale School of Public Health, New Haven, Conn., said risk was reduced for women who engaged in moderate–to–vigorous exercise, such as fast–paced walking or certain forms of yoga, regardless of BMI.

Regular Exercisers Experience Fewer & Milder Colds

The belief that physically active people get sick less often than people who are largely sedentary is gaining scientific support. Researchers of a recent study recruited 1,002 men and women, ages 18-85, to keep a daily log of upper respiratory tract infection symptoms for 12 weeks, during cold and flu season. Participants were also asked about how much and what types of aerobic exercise they perform, eating habits, lifestyle and stressful events. They found that those who exercised 5 days a week, for 20 minutes or more, experienced 43 percent fewer days of symptoms from an upper respiratory tract infection compared to those who did less than 1 day of week of activity. Also, colds appeared to be less severe for the most active participants. The severity of symptoms dropped by 32 percent among active individuals, and by 41 percent among the most active individuals.

(Dr Monica and Brahm Vasudev)

Timely depression diagnosis critical to maintain health of elderly

ScienceDaily: Depression affects 30 to 40 percent of nursing home residents, but it often goes unrecognized, which can lead to lower quality of life or even suicide. (Researchers at the University of Missouri)

American Heart Association’s Scientific Sessions 2010 update (ScienceDaily)

Women who report having high job strain have a 40 percent increased risk of cardiovascular disease, including heart attacks and the need for PTCA compared to those with low job strain.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are the ethical issues associated with infertility and its treatment?

  • High–cost treatments are out of financial reach for some couples.
  • Debate over whether health insurance companies should be forced to cover infertility treatment.
  • Allocation of medical resources that could be used elsewhere
  • The legal status of embryos fertilized in vitro and not transferred in vivo.
  • Pro–life opposition to the destruction of embryos not transferred in vivo.
  • IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems.
  • Religious leaders' opinions on fertility treatments.
  • Infertility caused by DNA defects on the Y chromosome is passed on from father to son. If natural selection is the primary error correction mechanism that prevents random mutations on the Y chromosome, then fertility treatments for men with abnormal sperm (in particular ICSI) only defer the underlying problem to the next male generation.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

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

What are the treatment options in cystic fibrosis liver disease?

  • In addition to UDCA treatment, treatment of cystic fibrosis liver disease includes supplementation of fat soluble vitamins.
  • Treatment of complications of portal hypertension and associated hypersplenism include variceal banding, portosystemic shunting, transjugular portosystemic shunt (TIPS), splenectomy, and liver transplant. Given that respiratory disease is the main contributor to CF mortality, however, liver transplantation is rarely required and is generally not indicated unless there are additional features of liver decompensation.
    Medicolegal Update

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

World Medical Association (WMA) guidelines for medical doctors in biomedical research involving human subjects

  • Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.
  • In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.
  • In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.
  • When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.
  • In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.
  • The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).

    Evidence-based Medicine

Dr. Surender N. Gupta, Faculty, Regional Health and Family Welfare Training Centre, Chheb, Kangra, Himachal Pradesh, India

Outbreak of gastroenteritis in Tibetan transit school, Dharamshala, Himachal Pradesh, India, 2006

Background: On 28th June, 2006, 55 cases of the gastroenteritis were reported among the hostellers of the Tibetan Transit School, Dharamshala. We investigated the outbreak to identify the source, propose control and preventive measures. Materials and Methods: We defined a case of the gastroenteritis as the occurrence of more than three smelly loose motions between 28 th June to 2 nd July, 2006 among some sections of the resident hostellers. We determined age and sex specific attack rate. We hypothesized it as a food borne beef meat outbreak. We conducted the case control study and collected the information about the food items consumed inside and outside the hostel at dinner using the standardized questionnaire. We calculated floor wise incidences of four hostels, odds ratios and attributable fractions. We interviewed food handlers. We lifted the seven rectal stool, four water and three samples from floor, kitchen and meat chopper room for culture and sensitivity. Results: 116 cases patients of 802 hostellers met the case definition. The maximum attack rate (16%) was in the youngest group (15–20yrs) and nil in staff and 31–40 years age group with 5 overall attack rate as 14%. Sex specific attack rate was more (18%) in females. The floor wise incidences of the case patients were the highest in 2nd and 3rd floors, occupied by the youngest group. The median age was 20 yrs (Range 17–40 yrs). The most common symptoms were watery diarrhea (71/116, 61%) and bloody diarrhea–(45/116, 39%); abdominal pains– (87/116, 75%). Of the six food/water items examined, the food specific attack rate was highly statistically significant in the beef meat eaters (82% with PAF 71%), and Odds Ratio 19.19 (95% C.I. as 9.3–140). The food handlers & their cooking conditions in the kitchen were unhygienic. The food was not available for testing. Escherichia coli were detected in the samples from rectal stools, kitchen and meat chopper room. No fatality was reported.
Conclusion/Recommendation: The beef meat purchased from outside was implicated for the explosive common source outbreak. The school authorities were counseled for hygienic food handling.

(Ref: Gupta SN, Gupta N. Outbreak of gastroenteritis in Tibetan transit school, Dharamshala, Himachal Pradesh, India, 2006. Indian J Community Med 2009;34:97–101).

    Useful Tips

5 steps to a pain-free back (Harvard News Letter)

In Step 1. Stay fit

Weak back and abdominal muscles cause or exacerbate low back pain. Stretching and strengthening both back and abdominal muscles is important not only for treating low back pain, but also for helping to prevent a recurrence of the problem. A stretching and strengthening regimen should target the back, abdominal, and buttock muscles. Strong abdominal or flexor muscles help people maintain an upright posture, as do strong extensor muscles, which run the full length of the back and maintain alignment of the vertebrae. Supple, well-stretched muscles are less prone to injury. Shorter, less flexible muscle and connective tissues restrict joint mobility, which increases the likelihood of sprains and strains.
Certain aerobic activities are safer for the back than others. For instance, bicycling (either stationary or regular), swimming, and walking lead the list of low-risk, high-benefit activities for most people’s backs. All are low- or minimal-impact exercises that strengthen muscles which support the back. None involve awkward or stressful actions that are detrimental to back muscles.
Sports and activities such as football, tennis, gymnastics, wrestling, weight lifting, rowing (crew), running, aerobic dance, and ballet involve a relatively high risk for back injury because of the extension, lifting, or impacts involved. Other unnatural motions that could induce pain include back arching (during gymnastics and diving), twisting (while hitting a golf ball, swinging at a baseball, or bowling), vertical jolting (while riding a horse), and stretching your legs strenuously (when hiking or when balancing a sailboat during a race).

  Lab Update

(Dr Naveen Dang and Arpan Gandhi)

Iron deficiency anemia

In iron deficiency anemia, the serum iron concentration is reduced, and the level of transferring also measured as total iron binding capacity (TIBC) is elevated; the latter finding reflects the reciprocal relationship between serum iron and transferrin gene expression in most nonerythroid cells.

    Medi Finance Update

Personal Accident Individual

During the first year of the operation of insurance cover, the expenses on treatment of diseases such as cataract, benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal diseases, fistula in anus, piles, sinusitis and related disorders are not payable if these diseases (other than congenital internal diseases/defects) are pre existing at the time of proposal that will not be covered even during subsequent period of renewal too. If insured is aware of the existence of congenital internal diseases/defects before inception of policy it will be treated as preexisting.

    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combination of dextropropoxyphene with any other drug other than anti–spasmodics and/or non–steriodal anti–inflammatory drugs (NSAIDs)

    IMSA Update

International Medical Science Academy (IMSA) Update

Biomarkers of ovarian carcinoma

As a single marker, HE4 had the highest sensitivity for detecting ovarian carcinoma specially early stage disease. Combined CA125 and HE4 was a more accurate predictor of ovarian malignancy than either alone.

(Ref: Abdel–Azeez HA, et al. HE4 and mesothelin: novel biomarkers of ovarian carcinoma in patients with pelvic masses. Asian Pac J Cancer Prev 2010;11(1):111–6).

    IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure came for cardiac evaluation.
Dr. Bad: Go for Echo test.
Dr. Good: Go for Tissue Doppler Echo test.
Lesson: A patient with heart failure must go for Tissue Doppler Echo Test for evaluation of diastolic functions.

Make Sure

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops. (Br J Clin Pharmacol 1999;48(6):861–5)

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Chitra Raj)

A woman baked ‘chapatis’ for members of her family and an extra one for a hungry passerby. She kept the extra ‘chapati’ on the window–sill, for whosoever would take it away. Everyday, a hunchback came and took away the ‘chapati’.’ Instead of expressing gratitude, he muttered the following words as he went his way: "The evil you do remains with you: The good you do, comes back to you!" This went on, day after day. Everyday, the hunch–back came, picked up the ‘chapati ‘and uttered the words: "The evil you do, remains with you: The good you do, comes back to you!" The woman felt irritated. "Not a word of gratitude," she said to herself…"Everyday this hunchback utters this jingle! What does he mean?

"One day, exasperated, she decided to do away with him."I shall get rid of this hunchback," she said. And what did she do? She added poison to the ‘chapati’ she prepared for him! As she was about to keep it on the window sill, her hands trembled. "What is this I am doing?" she said. Immediately, she threw the ‘chapati’ into the fire, prepared another one and kept it on the window– sill. As usual, the hunchback came, picked up the 'chapati' and muttered the words: "The evil you do, remains with you: The good you do, comes back to you!" The hunchback proceeded on his way, blissfully unaware of the war raging in the mind of the woman. Everyday, as the woman placed the ‘chapati’ on the window–sill, she offered a prayer for her son who had gone to a distant place to seek his fortune.

For many months, she had no news of him. She prayed for his safe return. That evening, there was a knock on the door. As she opened it, she was surprised to find her son standing in the doorway. He had grown thin and lean. His garments were tattered and torn. He was hungry, starved and weak. As he saw his mother, he said, "Mom, it’s a miracle I'm here. While I was but a mile away, I was so famished that I collapsed. I would have died, but just then an old hunchback passed by. I begged of him for a morsel of food, and he was kind enough to give me a whole chapati. "As he gave it to me, he said, "This is what I eat everyday: today, I shall give it to you, for your need is greater than mine!"

"As the mother heard those words, her face turned pale. She leaned against the door for support. She remembered the poisoned ‘chapati’ that she had made that morning. Had she not burnt it in the fire, it would have been eaten by her own son, and he would have lost his life! It was then that she realized the significance of the words: "The evil you do remains with you: The good you do, comes back to you! Do good and Don’t ever stop doing good, even if it’s not appreciated at that time."


Mind Teaser

Read this…………………

|……| ome  

Yesterday’s Mind Teaser: "agebeauty"
Answer for yesterday’s eQuiz:
"Age before beauty"

Correct answers received from: Dr S. Upadhyaya,  Dr. Rajiv Dhir, Dr Chandresh Jardosh, Dr Neelam Nath, Dr Meera Rekhari, Dr Shirish Singhal, Dr Vishanji Karani, Dr. T. Samra, Dr Chetana Vaishnavi.

Answer for 16th November Mind Teaser: "Search high and low"
Correct answers received from: Dr Sudipto Samaddar, Dr.K.Raju, Dr Muthumperumal Thirumalpillai.

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

Three handsome male dogs are walking down the street when they see a beautiful, enticing, female Poodle. The three male dogs fall all over themselves in an effort to be the one to reach her first, but end up arriving in front of her at the same time. Aware of her charms, and her obvious effect on the three suitors, she decides to be kind and tells them, "The first one who can use the words liver and cheese together in an imaginative, intelligent sentence can go out with me".

The sturdy, muscular black Lab speaks up quickly and says "I love liver and cheese." "Oh, how childish," said the Poodle. That shows no imagination or intelligence whatsoever."

She turns to the tall, shiny Golden Retriever. "Um. I hate liver and cheese," blurts the Golden Retriever. "My, my," said the Poodle. "I guess it’s hopeless. That’s just as dumb as the Labs’ sentence."

She then turns to the last of the three dogs and says, "How about you, little guy?" he last of the three, tiny in stature, but big in fame and finesse, is the Taco Bell Chihuahua. He gives her a smile, and a sly wink, turns to the Golden Retriever and the Lab and says, "Liver alone, Cheese mine."

    Readers Responses
  1. Respected Editor, Sir, can you elaborate on the likely daily doses which can lead to toxicity of Paracetamol. What is the duration of drug intake which can lead to toxic symptoms? Dr VK Sharma.
    eMedinewS Responds:
    • The therapeutic dose is 10-15 mg/kg/dose in children and 325-1000 mg/dose in adults, given every 4 to 6 hours (max recommended daily dose: 80 mg/kg in children or 4 gm in adults).
    • Toxicity is unlikely to result from a single dose of < 150 mg/kg in a child or 7.5-10 g for an adult.
    • Toxicity is likely to occur with single ingestions > 250 mg/kg or those >12 gm over a 24-hour period.
    • Virtually all patients who ingest doses in excess of 350 mg/kg develop severe liver toxicity (defined as peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels > 1000 IU/L) unless appropriately treated.
    • Paracetamol is rapidly and completely absorbed from the gastrointestinal tract.  Serum concentrations peak between one-half and two hours after an oral therapeutic dose.
    • Peak serum concentrations are reached within four hours following overdose of immediate-release preparations but may be delayed beyond four hours when drugs that delay gastric emptying (e.g., opiates, anticholinergic agents) are co ingested, or following overdose of extended releases preparations.
    Public Forum

(Press Release for use by the newspapers)

Do not replace Saturated Fat with Refined Carbohydrates: White sugar, white rice and white maida may be more harmful

It’s wrong to say eat less fat, instead the real message should be eat more fresh fruits and vegetables, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

While advocating low–fat diets it is easier for patients to understand advice given in terms of foods (e.g. "eat more fresh fruit") rather than nutrients (e.g."reduce your intake of fat to less than 30 percent of your total energy intake").

The message to reduce fat has been translated by food manufacturers and consumers into a potentially harmful set of food choices.

Instead of replacing high–fat foods with naturally low–fat foods with other benefits, such as fruits, vegetables, legumes, and whole grain foods; consumers have often increased their consumption of low–fat or "fat–free" varieties of naturally high–fat foods, such as fat–free snack or junk foods. The result is an increase in refined carbohydrates which lower good HDL–cholesterol concentrations with a possible increase in the incidence of type 2 diabetes and obesity, and failure to gain the benefits of more low–fat foods.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant

Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 – 9.30 AM:
Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
9.30 – 10.00 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Hospital
10.00 – 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 – 11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion
12.00 Noon: Lunch

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

Share eMedinewS

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