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FIRST NATIONAL eMEDICAL NEWSPAPER OF INDIA

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  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 …

19th January, 2011, Wednesday                                 eMedinewS Present Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Adverse Reactions and Warnings

Rosiglitazone: Due to accumulating evidence of an increased risk of cardiovascular disease, the European Medicines Agency (EMA) suspended sales of Rosiglitazone Sibutramine – Sibutramine is a sympathomimetic drug used for appetite suppression. In a trial conducted in obese patients with or at high risk for cardiovascular disease, long–term sibutramine use increased the risk of nonfatal myocardial infarction and nonfatal stroke. The US FDA and Health Canada removed sibutramine from the market. The European Medicines Agency had previously recommended suspending the marketing of sibutramine in the European Union.

Propoxyphene (dextropropoxyphene): Propoxyphene is a weak opioid agonist that is metabolized to a relatively toxic compound (norpropoxyphene). It has been associated with seizures and cardiotoxicity in patients who have a drug overdose or who accumulate high levels in the setting of rapid dose escalation or renal insufficiency. Because of these safety concerns, and new data showing prolongation of the QTc interval at maximum approved dosing, the US FDA has removed propoxyphene from the market. In the European Union, a phased withdrawal has been underway since mid 2009.

Angiotensin receptor blockers: A meta–analysis of five randomized trials that included 61,590 patients suggested that use of angiotensin receptor blockers (ARBs), particularly telmisartan is associated with a small but significant increase in the risk of a new cancer diagnosis.

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Editor in Chief
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  eMedinewS Audio PostCard

ANCIPS 2011

Dr Neelam K Bohra shares his views on evolution of ‘Biological Psychiatry’

Audio PostCard
 
  SMS of the Day

(By Dr GM Singh)

Fear is that little darkroom where negatives are developed.

Michael Pritchard

 
    Photo Feature

Editor meets Editor in ANCIPS 2011

Dr T S Sathyanarayana Rao, Hony. Editor Indian Journal of Psychiatry and Dr Veena Aggarwal, Joint MD & Group Executive Editor, IJCP Group of Publications meet at ANCIPS 2011.

 
Dr K K Aggarwal
 
    ANCIPS NEWS

Can psychopharmacology prevent suicide?

Dr. Sagar Lavania
Assistant Professor of Psychiatry, S. N. Medical College, Agra

No treatment could do any good until I understood the voice and saw that it was running me, that I was an automaton… It’s incredible to know that the voice prevented me from doing this (writing an autobiography) even took over my real self image…… feel as if I’ve been reprieved from a life long sentence – James Masterson (From the Journal of a borderline patient)

  • Suicide is a multifaceted phenomenon.
  • It is not possible for any research design to realistically capture and control all the factors impinging on suicide risk or the potential effects of any one psychiatric treatment.
  • Given data still reveals inconclusive information regarding the antisuicide effects of psychotropic drugs.
  • The clinicians must be cautious in reaching conclusions as to which treatment will reduce suicide risk for particular patients.
  • Literature is consistent with the possibility that lithium may reduce the risk for suicide and it should be considered in the regimen of bipolar (and possibly other mood disorder) patients at high suicide risk.
  • Same holds true for using clozapine in schizophrenia.
  • Olanzepine and possibly other atypical antipsychotics also show promise of reducing suicide risk in severe psychiatric disorders, but recommendations await more extensive trials.
  • Distinct antisuicide benefits with antidepressants await empirical demonstration from prospective long– term investigations.
  • Antidepressant pharmacotherapies should be considered for treating depressive syndromes rather than suicide as an isolated target symptom.
  • Clinicians should be alert to the possibility that antidepressants may exacerbate a bipolar diathesis or, much more rarely, induce paradoxical agitation or disinhibition states.
  • High risk patients with personality disorders may benefit from treatment with SSRI or low dose antipsychotics, though this requires further investigation.
  • The use of benzodiazepines is associated with increased risk of self harm in some group of subjects, and these should be used with caution, particularly as a single drug therapy in patients with high risk of suicidal behavior.

Neurobiology of Suicide in Major Depressive Disorders

Meera Narasimhan, M.D.
Professor and Interim Chairman, Dept of Neuropsychiatry and Behavioral Science
University of South Carolina School of Medicine

Suicide Facts: Magnitude of the problem

  • 10 million attempts occur world wide
  • 1 million suicides occur per year world wide
  • There are approximately 31,000 suicides per year in the United States.
  • 10–20 times more suicide attempts
  • 3rd leading cause of death in 15–34 year olds in the USA
  • Autopsies in completed suicides show that 90% of cases have a diagnosable psychiatric illness.

Suicide: The role of the HPA axis

  • Stress hormones cortisol and CRF are elevated in blood or CSF of suicide attempters.
  • Fewer prefrontal CRF receptors in suicide victims suggest excess CRF release.
  • Abuse history in childhood associated with excessive adult stress responses in terms of both cortisol and NE

Key points

  • Prevention starts with recognition of psychiatric illnesses associated with the highest risk of suicidal behavior and then recognition of individual patients at higher risk.
  • Treatment of psychiatric illness will reduce suicide rates.
  • Prediction of risk based on biological correlates has improved tremendously.
  • Novel medications may offer efficacious treatments, minimize risk of adverse effects and suicide.
  • Psychotherapeutic interventions need to be looked into in reducing predisposition to suicidal behavior.

The Global Mental Health Assessment Tool – Primary Care Version

Vimal Sharma
GMHAT/PC is a computerized clinical assessment tool developed to assess and identify a wide range of mental health problems. It generates a computer diagnosis, a symptom rating and risk assessment. The published data suggests that the GMHAT/PC is an easy to administer computerized tool which can be used in primary care for the standardized assessment of mental health problems.

Sexual dysfunction in male subjects receiving Trifluoperazine, Risperidone & Olanzapine

Naresh Nebhinani, Sandeep Grover, Ajit Avasthi
Dept of Psychiatry, PGIMER, Chandigarh

  • Sexual dysfunction is seen in about one third of patients receiving antipsychotics
  • Prevalence of sexual dysfunction is more in patients receiving risperidone than those receiving trifluoperazine and olanzapine
  • The rate of sexual dysfunction varies from scale to scale

Hence there is a need to have a comprehensive instrument to assess sexual dysfunction in subjects receiving antipsychotic

Good Psychiatric Practice and Medical Ethics

Dr. Swaminath G

Medical Ethics

  • Standards of professional conduct
  • Derived from the special influence that doctors have
  • Secondary to the trust that people place in them

Dealing with Pharma

  • Psychiatrists need to evaluate benefit of rx is worth cost to society
  • Should save resource of society
  • While dealing with pharma rep make sure that they are committed to well being of patient, give priority time to patient and keep professional and ethical outlook by always endorsing scientific views/promote rational use
  • Avoid expensive and personal gifts
  • Gifts should provide value to practice of medicine or pharmacy
  • Reasonable and promote professional education and efficacy
  • If gifts are intended to promote education and scientific character of doctor’s practice, they need not be objected avoid conflict of interest.
 
    Infertility Update

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

What is Intracytoplasmic sperm injection?

ICSI has revolutionized the treatment and improved the prognosis for fertility of men with very severe oligospermia, asthenospermia (low sperm motility), teratospermia (a higher rate of abnormal sperm morphology), and even azoospermia. This technique involves the direct injection of a single spermatozoon into the cytoplasm of a human oocyte, usually obtained from follicles produced under controlled ovarian hyperstimulation. This technique has also been successful in men with nonmosaic Klinefelter syndrome where spermatozoa are obtained from testicular biopsies.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

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

What is the risk of acquiring chronic HBV infection after acute exposure?

The risk of developing chronic HBV infection after acute exposure ranges from 90% in newborns of HBeAg–positive mothers to 25% to 30% in infants and children under 5 and to less than 5% in adults. However, immunosuppressed persons are more likely to develop chronic HBV infection after acute infection.

 
    ENT Update

Dr. Aru Handa, MS, DNB (Department Co–coordinator and Senior Consultant Dept. of ENT, Moolchand Medcity)

What are the indications of tonsillectomy and/or adenoidectomy?

Absolute indications for tonsillectomy and adenoidectomy are adenotonsillar hyperplasia causing obstructive sleep apnea and/or abnormal dentofacial growth and possibility of malignant disease or unilateral enlargement with suspicion of malignancy for pathological diagnosis.

Relative indications for adenotonsillectomy are adenotonsillar hyperplasia causing upper airway obstruction, difficulty in swallowing, recurrent otitis media and recurrent or chronic rhinosinusitis or adenoiditis and relative indications of tonsillectomy are recurrent (3 or more tonsillar infections per year) or chronic tonsillitis, peritonsillar abscess and streptococcal carriers not responding to antibiotics.

 
    Medicolegal Update

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

World Medical Association Declaration–WMA 5th World Conference on Medical Education

The prime concern of all Medical Associations in every country should be dedicate themselves to marshalling the resources needed to provide for and guide quality medical education. This should be done in the context of appropriately sized classes with access to adequate faculty member, facilities and funding.

  • To focus professional and public support for medical education, medical associations in all countries should be acutely aware of the needs, opinions, expectations and personal dignity of their citizens.
  • The goal of medical education should be to produce competent and ethical physicians, who respect their roles in the physician patient relationship.
  • The elements of competence must include knowledge, skills, values behaviors, and ethics which provide quality preventive and curative care for individual patients and the community.
  • Research, teaching and ethical patient care are inseparable and essential to achieving the goal of physician competence.
  • An international core curriculum should be developed that will produce and maintain a competent physician whose skills transcend international borders.
  • Internationally standardize methods of assessing professional competence and performance should be developed and applied in undergraduate, graduate and continuing medical education.
  • Free and prompt international dissemination of professionally generated and analyzed medical information should be exchanged on epidemiological and public health problems to guide the development of public policies, the education of physician, and the public.
  • International standards should be established for the evaluation of educational programs across the country.

(Adopted by the 43rd World Medical Assembly Malta, November 1991)

 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. I have the following qualifications: B.Sc. (MLT), P.G.D.C.P; M.Sc. (Micro). Can I start my own diagnostic laboratory? Dr. ABC

A.

  • It seems you do not have a medical qualification. The so called PGDCP, if it means Post Graduate Diploma in Clinical Pathology, is probably a misnomer and is not a recognised qualification and has been probably given by an unrecognised institution. You do not seem to be entitled to put the prefix Dr. before your name.
  • In view of the above, you are not legally competent to start your own diagnostic laboratory independently because that amounts to practice of pathology which is a medical specialty.
  • However, you can own the laboratory and can employ a pathologist or enter into a partnership with him with an arrangement that he medically supervises the laboratory and interprets and signs the reports.
 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Thyroxine (T4)

This is a measurement of the total thyroxine in the serum, including both the physiologically active (free) form, and the inactive form bound to thyroxine–binding globulin (TBG). It is increased in hyperthyroidism and in euthyroid states characterized by increased TBG (See "T3 uptake," above, and "FTI," below). Occasionally, hyperthyroidism will not be manifested by elevation of T4 (free or total), but only by elevation of T3 (triiodothyronine). Therefore, if thyrotoxicosis is clinically suspect, and T4 and FTI are normal, the test "T3–RIA" is recommended (this is not the same test as "T3 uptake," which has nothing to do with the amount of T3 in the patient’s serum).

T4 is decreased in hypothyroidism and in euthyroid states characterized by decreased TBG. A separate test for "T4" is available, but it is not usually necessary for the diagnosis of functional thyroid disorders.

 
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Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Medi Finance Update

Equity Funds

  • Equity funds invest primarily in stocks.
  • It is because stocks have traditionally risen in value.
  • More than other types of investments, they offer the greatest potential for long–term growth.
 
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
Indication
DCI Approval Date
Levobetaxolol HCl Opthalmic Suspension 0.5%
For lowering of intraoccular pressure in patients with chronic open–angle glaucoma or occular hypertension.
16/01/2010
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Lung cancer screening

A randomized trial of lung cancer screening in over 3,000 high–risk individuals found cumulative probability of a false positive finding of 33 percent for screening by low–dose CT and 15 percent for chest x–ray.

(Reference: Croswell JM, Baker SG, Marcus PM, et al. Cumulative incidence of false–positive test results in lung cancer screening: a randomized trial. Ann Intern Med 2010;152:505).

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim of 2 lakhs of seven years duration needed a claim of Rs. 2.2 lakhs.
Dr. Bad: You will have to pay Rs. 20,000 from your pocket.
Dr. Good: You can claim cumulative bonus.
Lesson: Sum insured under the policy shall be progressively increased by 5% for each claim–free year of insured subject to maximum accumulation of 10 claim–free years of insurance.

Make Sure

Situation: A patient with fever and cough developed complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

How would you like to be remembered?

About a hundred years ago, a man looked at the morning newspaper and to his surprise and horror, read his name in the obituary column. The newspapers had reported the death of the wrong person by mistake. His first response was shock. Am I here or there? When he regained his composure, his second thought was to find out what people had said about him. The obituary read, "Dynamite King Dies." And also "He was the merchant of death." This man was the inventor of dynamite and when he read the words "merchant of death," he asked himself a question, "Is this how I am going to be remembered?" He got in touch with his feelings and decided that this was not the way he wanted to be remembered. From that day on, he started working toward peace.

His name was Alfred Nobel and he is remembered today by the great Nobel Prize.

Just as Alfred Nobel got in touch with his feelings and redefined his values, we should step back and do the same.

What is your legacy? How would you like to be remembered?

Will you be spoken well of? Will you be remembered with love and respect? Will you be missed?

………………………………

Mind Teaser

Read this…………………

c
o
n

Yesterday’s Mind Teaser: "sailing ccccccc"
Answer for Yesterday’s Mind Teaser: Sailing over the seven seas

Correct answers received from: Dr Anupam Sethi Malhotra, Dr Rashmi Chhibber, Dr Rajiv Kohli, Dr Neelam Nath, Dr KV Sarma, Dr Satyoban Ghosh, Dr Rakesh Bhasin, Dr Prabha Sanghi, Dr Deepti Katyal Uppal, Dr Arvind Khanijo, Dr Harimohan Goel, Dr Satish Gunawant, Dr Rajiv Dhir, Dr Sudipto Samaddar, Dr KP Rajalakshmi, Dr AK Gupta, Dr Anil Kumar, Dr K Raju, Dr Shirish Singhal, Dr Rohini Vaswani, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Subashini Kaliaperumal, Dr Apurva Koirala

Answer for 17th January Mind Teaser: VI kings = Vikings
Correct answers received from: Dr. Prachi, Dr. Anupam

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr. G.M.Singh)

An old lady went to her doctor to see what could be done about her constipation. "It’s terrible," she said. "I haven't moved my bowels a week." "I see have you done anything about it?" asked the doctor" Naturally", she replied. " I sit in the bathroom for a half hour in the morning and again at night"."No," the doctor said," I mean do you take any thing?" "Naturally" she answered, "I take a book."

 
    Readers Responses
  1. Dear Sir, the ANCIPS News has been very enlightening to us because psychiatry is a subject which is not covered in great detail in our undergraduate studies. So these stories served as a refresher course. Dr Prachi Garg
 
    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

Its wrong to say eat less fat; 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.

White 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.

 
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