emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

20th May 2013, Monday

Can a person be revived even after 10 minutes?

Until now, it was thought that death means “Your heart stops beating, your brain shuts down” or the moment of cardiac arrest. Until 50 years ago, when CPR was developed, when you reached this point, you couldn’t come back. That led to the perception that death is completely irreversible.

But remember if I were to die this instant, the cells inside my body wouldn’t have died yet. It takes time for cells to die after they are deprived of oxygen. It does not happen instantly. We have a longer period of time than people perceive.

When you become a corpse, when the doctor declares you dead, there’s still a possibility, from a biological and medical perspective, of death being reversed.

If left alone the cells become damaged. There’s going to be a time when you cannot bring them back. But nobody knows exactly when that moment is.

It might not just be in tens of minutes, but in over an hour. Death is really a process.

Death is, essentially, the same as a brain stroke. In stroke, blood flow stops from getting into the brain. Whether it is because the heart stopped pumping, or there was a clot that stopped blood flow, the cells don’t care.

Brain cells can be viable for up to 8 hours after blood flow stops.

If we can learn to manipulate processes going on in cells, and slow down the rate at which cells die, we could go back and fix the problem that caused a person to die, then re-start the heart and bring them back. In a sense, death could become reversible for conditions for which treatments become available.

If someone dies of a heart attack, for example, and it can be fixed, then in principle we can protect the brain, make sure it does not experience permanent cellular death, and re-start the heart. If someone dies of cancer, though, and that particular cancer is untreatable, then it’s futile.

When you die, most of your cell death occurs through apoptosis, or programmed cell death. If your body is cold, the chemical reactions underlying apoptosis are slower. Cooling the body slows the rate at which cells decay.

But we are talking about chilling, not freezing. The process of freezing will damage cells. (Source: Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death.)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Treating vitamin D deficiency in the country

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Heart Care Foundation of India organized a Symposium on Life after Death.

 
Dr K K Aggarwal
    National News

Should cancer to be made notifiable disease?

The cancer incidence and prevalent has been stationary with some cancers increasing and others proportionately decreasing. The Ministry is of the feeling that it should be made a notifiable disease.

Notified versus Registry

There was a debate whether cancer should be a notifiable disease or the cancer registry should be strengthened. The word ‘notifiable’ involves mandatory disclosure of information and may be a problem under the Confidentiality Act. The disease is notifiable if it is contagious or affects the safety of other people. Notifying cancer does not fall under that category. If the aim is to collection of statistics, it is better to have cancer registry and not notification.

Source: National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS): TRG 1 meeting on 07.05.2013 at Nirman Bhawan

Drug prices set to fall by up to 80%

MUMBAI: The government on Thursday issued the long-pending drug price control order, paving the way for the implementation of national pharmaceutical pricing policy, which will lead to a reduction in prices of medicines on an average by 20-25%, and in some life-saving ones, by up to 80%, reports TOI. Prices of 652 formulations under 27 therapeutic areas like anti-allergic (cetirizine), cardiac, gastro-intestinal medicines, pain-killers (paracetamol) and anti-diabetic drugs (insulin) are expected to come down. Others in the list include anti-fungal, anti-tuberculosis, anti-leprosy, anti-hypertensives and cancer drugs. In certain cancer drugs, prices may come down by up to 80%. The policy though cleared by the Cabinet on November 22 last year, was delayed due to the absence of the DPCO. The DPCO 2013-as reported by TOI first on May 16-will regulate prices of drug formulations on the basis of a market-based mechanism, as against a cost-based system which existed till now. The government on Thursday notified DPCO with effect from May 15, replacing the 1995 order. The new order will empower the National Pharmaceutical Pricing Policy 2012 to regulate prices of 348 essential drugs, while the existing policy controls only 74 bulk drugs. Over the next few weeks, drug pricing regulator National Pharmaceutical Pricing Authority is expected to announce in tranches the ceiling prices of 652 formulations, which will serve as the benchmark for companies. The industry will be given 45 days to clear the existing stock, and make the relevant changes in their prices. The DPCO, issued under the Essential Commodities Act, 1955, will lay the framework of the drug policy, mechanism of regulating prices and list the 652 commonly-used drug formulations which are being brought under price control. Significantly, imported drugs will also be brought under price control. The policy uses a market-based pricing method: 'the simple average method' for determining the ceiling price of all the molecules (drugs) under a particular therapeutic area with over 1% market share. The price to the consumer will be determined by adding 16% margin (to the retailer) as well as the local taxes to the average price (ceiling price). (Source: TOI, May 17, 2013)

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Anchoring Dr KK Aggarwal, every Thursday 4:30 PM in DD India

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Reasons

  1. Male migration to urban areas
  2. Demand for commercial sex
  3. Liberal sexual behavior
  4. High risk behavior groups
  5. Adolescents
  6. Truck drivers
  7. Isolated professionals viz. Defence personnel, touring businessmen
  8. Growth of tourism
  9. Myths and misconceptions on sexuality/ STDs and HIV/AIDS
  10. Demand for younger girls
  11. Medical/ psychiatric disorders viz. pedophilia

For comments and archives

    Valvular Heart Disease Update

When should aortic valve replacement be done?

By echocardiography, although a bicuspid aortic valve with a raphe may appear similar to a tricuspid valve during diastole, the systolic opening shape of a bicuspid valve is elliptical rather than the triangular pattern of a tricuspid valve. Echocardiography is also helpful is evaluating the diameter of the aortic root and ascending aorta

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

MRI predicts failing MoM hip implants

Synovial volume as measured by MRI is highly predictive of metal-on-metal (MoM) hip implant failure in both symptomatic and asymptomatic patients, a study has found. (Source: Medpage Today)

Schizophrenia 'guideline of guidelines' released

A team of schizophrenia experts have joined together to release worldwide "meta-guidelines" for physicians, nurses, and other healthcare professionals in managing and treating patients with the disorder. The new guidelines, which, among other clinical issues, cover brain imaging and electroconvulsive therapy (ECT), are designed to provide "the most evidence-based and up-to-date strategies for addressing treatment selection, medication-induced side effects, [and] treatment nonadherence." (Source: Medscape)

LDL won't help spot MI in renal patients

High LDL cholesterol levels were a weak predictor of myocardial infarction risk in patients with chronic kidney disease (CKD), a study found. (Source: Medpage Today)

Dietary saturated fat has undeserved bad reputation, says review

"The influence of dietary fats on serum cholesterol has been overstated," concludes a review in an American Society for Nutrition publication that, in its words, "calls for a rational reevaluation of existing dietary recommendations that focus on minimizing dietary SFAs [saturated fatty acids], for which mechanisms for adverse health effects are lacking". Source: Medscape)

Intensive BP lowering on trial again

Unlike ACCORD, the ongoing SPRINT trial has every chance of showing an impact on cardiovascular outcomes with a blood pressure goal under 120 mm Hg, an investigator on both trials argued. The large National Heart, Lung, and Blood Institute-sponsored SPRINT trial is comparing a goal of 120 versus 140 mm Hg in a broader population than included in the similarly-funded, diabetes-specific ACCORD trial. (Source: Medpage Today)

 
  Twitter of the Day

@DrKKAggarwal: The Skill Of Controlling Anger http://blog.kkaggarwal.com/2013/05/the-skill-of-controlling-anger/ …

@DrKKAggarwal: Pay attention to the richness of your inner life. Daydream, imagine, and reflect. It’s the source of infinite creativity.

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

Should Sanjay Dutt be pardoned?

Sanjay Dutt tried his level best so that he could be pardoned by the Court, President or by the Governor. Even his producers have tried but failed.

I personally feel that under the law as there is a provision for pardon, procedural terms and conditions should be clearly laid down, be transparent and fully advertised. The power of pardon is vested in the governor on the state subject, in the President for Union Subject, court marshals and death penalties (Articles 72-76).

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Is there any drug treatment for endometriosis?

A number of new drugs are under research and development for endometriosis. Antiprogestins, such as mifespristone and onapristone have had success in small studies. These medications work by modulating the estrogen and progesterone receptors in endometriosis implants and cause atrophy of endometriosis. Selective estrogen receptor modulators (SERMs) may be effective by virtue of their antiestrogen effect. Raloxifene is the SERM that currently shows some promise. In contrast, tamoxifen, another SERM, may cause endometriosis to worsen. Aromatase inhibitors, medications that inhibit aromatase, an enzyme that is required for estrogen synthesis, have had success in small studies and case reports. Anastrozole and letrozole are two examples of aromatase inhibitors undergoing investigation.

 
    An Inspirational Story

Determination and Persistence

This is a real life story of engineer John Roebling building the Brooklyn Bridge in New York, USA back in 1870. The bridge was completed in 1883, after 13 years.

In 1883, a creative engineer named John Roebling was inspired by an idea to build a spectacular bridge connecting New York with the Long Island. However bridge building experts throughout the world thought that this was an impossible feat and told Roebling to forget the idea. It just could not be done. It was not practical. It had never been done before.

Roebling could not ignore the vision he had in his mind of this bridge. He thought about it all the time and he knew deep in his heart that it could be done. He just had to share the dream with someone else. After much discussion and persuasion he managed to convince his son Washington, an up and coming engineer, that the bridge in fact could be built.

Working together for the first time, the father and son developed concepts of how it could be accomplished and how the obstacles could be overcome. With great excitement and inspiration, and the headiness of a wild challenge before them, they hired their crew and began to build their dream bridge.

The project started well, but when it was only a few months underway a tragic accident on the site took the life of John Roebling. Washington was also injured and left with a certain amount of brain damage, which resulted in him not being able to talk or walk.

“We told them so.” “Crazy men and their crazy dreams.” “It’s foolish to chase wild visions.”

Everyone had a negative comment to make and felt that the project should be scrapped since the Roeblings were the only ones who knew how the bridge could be built. In spite of his handicap Washington was never discouraged and still had a burning desire to complete the bridge and his mind was still as sharp as ever. He tried to inspire and pass on his enthusiasm to some of his friends, but they were too daunted by the task.

As he lay on his bed in his hospital room, with the sunlight streaming through the windows, a gentle breeze blew the flimsy white curtains apart and he was able to see the sky and the tops of the trees outside for just a moment.

It seemed that there was a message for him not to give up. Suddenly an idea hit him. All he could do was move one finger and he decided to make the best use of it. By moving this, he slowly developed a code of communication with his wife.

He touched his wife’s arm with that finger, indicating to her that he wanted her to call the engineers again. Then he used the same method of tapping her arm to tell the engineers what to do. It seemed foolish but the project was under way again.

For 13 years Washington tapped out his instructions with his finger on his wife’s arm, until the bridge was finally completed. Today the spectacular Brooklyn Bridge stands in all its glory as a tribute to the triumph of one man’s indomitable spirit and his determination not to be defeated by circumstances. It is also a tribute to the engineers and their team work, and to their faith in a man who was considered mad by half the world. It stands too as a tangible monument to the love and devotion of his wife who for 13 long years patiently decoded the messages of her husband and told the engineers what to do.

Perhaps this is one of the best examples of a never-say-die attitude that overcomes a terrible physical handicap and achieves an impossible goal.

Often when we face obstacles in our day-to-day life, our hurdles seem very small in comparison to what many others have to face. The Brooklyn Bridge shows us that dreams that seem impossible can be realized with determination and persistence, no matter what the odds are.

Source: http://academictips.org/blogs/determination-and-persistence/

For comments and archives

 
  Cardiology eMedinewS

Stent, then angioplasty, could increase the risk of stroke, suggests CREST analysis Read More

 
  Pediatric eMedinewS

Mycoplasma pneumoniae common in asymptomatic children Read More

 
    Rabies Update

(Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What are the precautions to be taken while administering RIGs?

  • Patient should not be on an empty stomach.
  • The RIGs vial taken out from the refrigerator should be kept outside for a few minutes to warm it to room/body temperature.
  • While infiltrating RIGs into the bite wound, care must be taken to avoid injecting into blood vessels and nerves.
  • While injecting into finger tips, care must be taken to avoid compartment syndrome.
  • All emergency drugs and facilities for managing any adverse reactions must be available.
  • For ERIG, keep the patient under observation for at least one hour after ERIG administration and then send home.
  • RIGs can be infiltrated even to already sutured wounds without disturbing the sutures.
 
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

 
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    IJCP Special

Dr Good Dr Bad

Situation: An asymptomatic diabetic patient came for a cardiac checkup.
Dr. Bad: No Echo is required.
Dr. Good: Get Echo done for diastolic dysfunction.
Lesson: A case-control prospective study done over one year has shown high incidence of diastolic dysfunction in asymptomatic diabetic subjects and, this finding was correlated with the duration of diabetes, HbA1c levels, obesity indices and diabetic microangiopathies. Early diagnosis and institution of treatment will reduce morbidity and improve the outcomes, and prevent future heart failure (J Cardiovasc Dis Res 2011 Oct;2(4):213-22).

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).

 
  Quote of the Day (Dr GM Singh)

Education is the best friend. An educated person is respected everywhere. Education beats beauty and youth. Chanakya.

 
    Legal Question of the Day (Dr MC Gupta)

Q. It is a matter of pride for a hospital to be accredited by JCI (Joint Commission International). My question is this—“whether JCI can be made a party by a complainant who goes to the consumer court alleging deficiency of service?”

Ans.

  1. A consumer complaint is filed in relation to a consumer dispute. In general, a consumer is a person who avails of services for consideration.
  2. A patient who gets treated at the hospital pays consideration to the hospital and not the JCI. The JCI provides no service to the patient. There is no consumer dispute between the JCI and the patient. The JCI is a stranger to the proceedings between the patient and the hospital. Hence the JCI cannot be made a party.
 
    Mind Teaser

Read this…………………

Before a post- thyroidectomy client returns to her room from the OR, the nurse plans to set up emergency equipment, which should include:

A. A crash cart with bed board
B. A tracheostomy set and oxygen
C. An airway and rebreathing mask
D. Two ampoules of sodium bicarbonate

Yesterday’s Mind Teaser: Following prostate surgery, the retention catheter is secured to the client’s leg causing slight traction of the inflatable balloon against the prostatic fossa. This is done to:

A. Limit discomfort
B. Provide hemostasis
C. Reduce bladder spasms
D. Promote urinary drainage

Answer for yesterday’s Mind Teaser: B. Provide hemostasis

Correct answers received from: Dr c k sharma, dr pradeep das, dr anusha, dr ayyavoo, dr santha
kumari, dr p k sahu, dr tukaram pagad, dr thakor hitendar singh, dr
chandresh jardosh, dr jayshree sen, dr bb gupta, dr pankaj agarwal

Answer for 18th May Mind Teaser: a. Comforting the child as quickly as possible

Correct answers received from:  dr jayshree sen, dr bb gupta, dr pankaj agarwal

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Funny Questions and Answers

What is the opposite of 'Pizza Hut'?

Pizza hatna mat.

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Delusions of grandeur

Also termed as delusion of exaltation

  • This is a delusion of pleasant belief or feeling. The sufferer remains in a state of feeling of greatness, power and wealth. He may be extravagant in his thinking and action and may commit some crime in such a state of mind or may ruin his money or property.
  • Erotomania is a type of delusion of grandeur, where the sufferer believes that a person of very high rank or social status loves him/her. The sufferer also believes that the imaginary person communicates his love in some manner or other, by posture or by communication in a secret or symbolic way.
  • When a person suffering from delusion of grandeur, believes that he will be killed by another person for the huge property he possesses and if as remedial step he kills that person then he will have diminished responsibility for the commission of the act because though in this case there are elements of fear and apprehension about his own life and to safeguard his life he has killed the person, yet he is not fully absolved from the act he has committed because in such a case he could have tried lawful protective steps for his life i.e., he could have sought for the help of the police…

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Women who eat lot of meat prone to weight gain

Women who eat a lot of meat are apt to weigh more than those who do not, said Padamshri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA. Previous studies have consistently shown that vegetarians are lighter and have a lower body mass index than their omnivorous counterparts.

A study from Brigham Young, evaluated 284 premenopausal women, an average of 40 years old and did not smoke. The researchers separated the women into groups classified by low, moderate, and high meat intake per 1,000 calories consumed per day.

Over the 7-day study, the investigators found that the low-intake group ate less than 1.9 three-ounce servings of meat per day, as opposed to more than 3.18 servings for the high-intake group.

More than half (52.8%) of the women classified as having a high meat intake were obese, defined in this study as having greater than 35 % body fat. Conversely, 37.3% of women in the moderate meat intake group were obese and only 15.6% of those in the low meat intake group were obese.

This was a cross-sectional study, so the findings do not show that meat causes obesity, while that could be the case, it could also be that obesity caused women to eat more meat - like more obese women following the Atkins diet, which is rich in meat.

There are a number of physiological mechanisms by which meat could fuel weight gain. Meat proteins, may elevate insulin levels, and thereby growth factors, that could influence weight and percent body fat. It has also been shown that consumption of saturated fat - most of which comes from animal products - is associated with obesity.

To sum up, it may be worth recognizing that eating less meat may be beneficial in a weight management program. It is possible to eat a healthy diet that is limited in meat. Alternative protein sources such as, lentils, nuts and legumes can provide sufficient protein and actually be beneficial in dieting.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and 50457 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10=100 per minute.”

 
    Readers Response
  1. Dear Sir, emedinews is a very useful Newspaper. Regards:Dr Tripti
 
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Name
Date
Time
Place
Duration
Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

 
    eMedinewS Special

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Dr Usha K Baveja