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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


20th July, 2010, Tuesday

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

CW Games special

Beware about malaria in Delhi during common wealth games.

NATIONAL DRUG POLICY ON MALARIA (2010) Guidelines

  • Malaria is a major public health problem.
  • Every year 15 lakh lab confirmed cases of malaria are reported in India.
  • 50% of the total malaria cases are due to P.falciparum.
  • The reason attributed to rise in P.falciparum cases is resistance to chloroquine, which has been used for a long time as the first line of treatment of malaria cases.
  • All fever cases suspected to be malaria should be investigated by microscopy or RDT(Rapid diagnostic tests).

Treatment of uncomplicated malaria

P. vivax

  • Treat with chloroquine for 3 days and Primaquine to prevent relapse for 14 days.
  • Primaquine is contraindicated in pregnant women, infants and individuals with G6PD deficiency.
  • Stop primaquine if hematuria or high colored urine / cyanosis or blue coloration of lips.
  • Chloroquine: 25 mg/kg body weight divided over three days i.e. 10mg/kg on day 1, 10mg/kg on day 2 and 5mg/kg on day 3. (4 tab day 1, 4 tab day 2 and 2 tab day 3)
  • Primaquine: 0.25 mg/kg body weight daily for 14 days.
  • Presumptive treatment with chloroquine is no more recommended.

P. falciparum

  • Treat with artemisinin–based Combination Therapy (ACT)
  • Artesunate 4 mg/kg body weight daily for 3 days plus Sulfadoxine (25 mg/kg body weight) – Pyrimethamine (1.25 mg/kg body weight) on first day PLS single dose primaquine on day 2.
  • Do not give ACT in 1st trimester of pregnancy.
  • Sulphadoxine–Pyrimethamine (SP) tablet contains 500, mg sulphadoxine and 25 mg pyrimethamine.

Pregnant women with uncomplicated P. falciparum

  • 1st Trimester:Quinine salt 10mg/kg 3 times daily for 7 days. It may induce hypoglycemia; pregnant women should not start taking quinine on an empty stomach and should eat regularly while on quinine treatment).
  • 2nd & 3rd Trimester: ACT
  • Primaquine is contraindicated in pregnant woman

Mixed malaria (P. vivax + P. falciparum) cases

Full course of ACT and Primaquine 0.25 mg per kg body weight daily for 14 days.

Severe malaria

  • Artesunate: 2.4 mg/kg body weight IV or IM given on admission (time = 0 h); then at 12 h and 24 h and then once a day

  • Artemether: 3.2 mg/kg body weight IM given on admission and then 1.6 mg/kg body weight per day or

  • Arteether: 150 mg IM daily for 3 days in adults only (not recommended forchildren) or

  • Quinine: 20 mg/kg body weight on admission (IV infusion or divided IM injection) followed by maintenance dose of 10 mg/kg body weight 8 hourly. The infusion rate should not exceed 5 mg salt/kg body weight per hour. Loading dose of Quinine i.e. 20mg/kg body weight on admission may not be given if the patient has already received quinine or if the clinician feels inappropriate.

Parenteral treatment in severe malaria cases should be given for minimum of 24 hours once started (irrespective of the patient’s ability to tolerate oral medication earlier than 24 hours). After parenteral artemisinin therapy, patients will receive a full course of oral ACT for 3 days. Those patients who received parenteral quinine therapy should receive: Oral Quinine 10 mg/kg body weight three times a day for 7 days (including the days when parenteral Quinine was administered) plus Doxycycline 3 mg/kg body weight once a day or Clindamycin 10 mg/kg body weight 12–hourly for 7 days (Doxycycline is contraindicated in pregnant women and children under 8 years of age) or ACT as described.

Chemoprophylaxis

Short term chemoprophylaxis (up to 6 weeks)

Doxycycline: 100 mg once daily for adults and 1.5 mg/kg once daily for children (contraindicated in children below 8 years). The drug should be started 2 days before travel and continued for 4 weeks after leaving the malarious area. It is not recommended for pregnant women and children less than 8 years.

Chemoprophylaxis for longer stay (more than 6 weeks)

Mefloquine: 250 mg weekly for adults and should be administered two weeks before, during and four weeks after exposure. Mefloquine is contraindicated in individuals with history of convulsions, neuropsychiatric problems and cardiac conditions. Therefore, necessary precautions should be taken and all should undergo screening before prescription of the drug.

Special situations

  • When parasitological diagnosis is not possible due to non–availability of either timely microscopy or RDT, suspected malaria cases will be treated with full course of chloroquine, till the results of microscopy are received. Once the parasitological diagnosis is available, appropriate treatment as per the species, is to be administered.

  • Suspect resistance if in spite of full treatment with no history of vomiting, diarrhea, patient does not respond within 72 hours, clinically and parasitologically. Such cases not responding to ACT, should be treated with oral quinine with Tetracycline/Doxycycline. These instances should be reported to concerned District Malaria /State Malaria Officer/ROHFW (Regional Office of Health and Family Welfare) for initiation of therapeutic efficacy studies.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)

 

Heart Care Foundation of India (HCFI) announced the ‘Injection Safety Week’ from November 1117, 2005 in support of One InjectionOne Syringe, a worldwide movement against unsafe injection practices at a press conference.

Dr k k Aggarwal
Marc Koska, the inventor of non reusable Auto Disable Syringe and Padma Shri and Dr B C Roy National Awardee Dr K.K. Aggarwal, President HCFI, at the press conference

 

News and Views

National

Women are most attractive at 31 (TOI)

Women are most attractive at 31 (Getty Images)
Women are at their attractive bets when they are 31— that’s the precise age when, according to a survey, they are considered most beautiful.

SC permits winding up of BMHT and hospital take over by Centre (TOI)
More than 12 years after setting up the Bhopal Memorial Hospital Trust under the chairmanship of former CJI A M Ahmadi, the Supreme Court on Monday gave the green signal for winding up of BMHT and permitted the Union government to take over management of the super-speciality hospital run by the trust.

63 dead, 150 injured as trains collide in West Bengal (TOI)
Death came at express speed to the sleepy station of Sainthia early Monday when the Uttar Banga Express roared in at 90kmph and crashed into the rear of the Ranchi-bound Vananchal Express, which was about to pull out of the platform. At least 63 people died and more than 150 were injured but what increased the tragedy's magnitude manifold was the bizarre sight it threw up -- a compartment flung in the air by the impact and landing in a mangled heap on a 25-foot-high road bridge running across the station.

International ( Dr G M Singh)

Getting Cardiac Rehabilitation

A cardiac rehabilitation program helps patients to recover from a heart attack, heart surgery or another medical procedure involving the cardiovascular system. Cardiac rehabilitation involves counseling and educating people about making lifestyle changes, getting healthier, exercising and minimizing the risk of a future cardiac event. People who may benefit from a cardiac rehabilitation program:

  • Someone who has had a heart attack
  • Someone with heart failure, angina or coronary artery disease.
  • Someone who has had cardiovascular surgery, such as a coronary artery bypass graft,coronary angioplasty and stenting, or valve replacement.
  • Someone who has had a pacemaker or implantable cardioverter defibrillator installed.

Close monitoring and management in patients on QT–prolonging drugs

A scientific statement from the American Heart Association and the American College of Cardiology Foundation published online Feb. 8 in Circulation says that hospitalized patients taking QT–prolonging drugs may be at risk for drug–induced long–QT syndrome (LQTS) and should be closely monitored by electrocardiogram (ECG) for the incidence of the serious arrhythmia known as torsade de pointes (TdP), according to .

Parents often make mistakes when using a dosing cup to measure out liquid medicine for their children

In a study undertaken by Dr. H. Shonna Yin of New York University School of Medicine in New York City and her colleagues, only half of the parents got the dose right when using a cup with etched markings, while only 30% measured accurately using a cup with printed markings. But when parents used a dropper, dosing spoon, or oral syringe, they got the dose right 85% of the time.

Warning on treating MI with longterm clopidogrel

GPs treating patients at risk of recurrent myocardial infarction with clopidogrel may be keeping some of them on the drug for far longer than is required. Their study of 12,000 patients found those on clopidogrel for six months after a percutaneous coronary intervention (PCI) had similar rates of death and recurrent MI as those on the medication for 12 months. They suggest that adopting a shorter time period could be beneficial in reducing the occurrence of bleeding. Bleeding occurred in 3.5% of patients in the 6–month regimen and 4.1% in the 12–month regimen. Study author Dr Rikke Sørensen, a research fellow from Copenhagen University Hospital Gentofte, said that the potential benefit of prolonged clopidogrel treatment in real life settings remains uncertain.

 

Legal Column

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

Medical Testimony of Doctor in the Court of law

The attitude of a medical/clinician/scientific witness should be the same whether he is called by the defense or prosecution. The doctor really testifies neither for nor against the prosecution or the defense. The doctor’s expertise lies in the application of science to a legal controversy and the proper interpretation of scientific findings. His sole obligation is to present the truth as he sees it, adding nothing, withholding nothing and distorting nothing. This means revealing the whole truth. He should not concern himself with the past character of the accused or with other evidences in the case. Emotions such as sympathy or antipathy should not color his judgment.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

In a patient with liver disease needs to receive all vaccination including optional vaccinations. It is a myth in some physician that the patients are very sick and not fit for vaccination. In fact these patients must receive all vaccinations to prevent infections which can further worsen the underlying liver disease.

Question of the Day

What are the systemic manifestations of diabetic autonomic neuropathy? (Dr Shashank Joshi, Mumbai)

Diabetic neuropathy is a heterogenous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous systems. Autonomic neuropathy affects various system like:

  1. Gastrointestinal transit (GIT) causing diabetic gastroparesis: delayed gastric emptying. Patient has symptoms of belching, bloating, flatulence, constipation. Sometimes watery diarrhea at night. Prokinetic agents like metoclopramide and domperidone 10 mg thrice daily help to reduce symptoms. In resistant cases, erythromycin 250 mg thrice daily can be given. Treatment needs to be given for usually 2 weeks to 2 months.

  2. Genitourinary system: Urinary retention may occur due to autonomic neuropathy affecting the detrusor contractility as well as sphincter functions. Betacholine can help but may cause significant anticholinergic symptoms.

  3. Cardiovascular system: Fluctuations in heart rate and blood pressure can occur due to autonomic neuropathy affecting CVS.

  4. Cutaneous manifestations: Autonomic neuropathy that affects sweat glands can cause excessive dryness of skin, leading to increased incidence of fungal as well as bacterial infections. Peripheral neuropathy and vasculopathy add up to these effects, causing increased trophic changes of skin and sweat glands. Emollients like white soft paraffin can help reduce symptoms of xerosis. Topical antifungal/antibiotic creams are useful in fungal/bacterial infections.
 

Public Forum (Press Release for use by the newspapers)

Post menopausal women should get their insulin levels done

All postmenopausal women should try to keep insulin at normal levels through weight loss, regular exercise and other methods, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela. Postmenopausal women with elevated insulin levels are at higher risk of developing breast cancer.

As per a report published in the International Journal of Cancer from Researchers at Albert Einstein College of Medicine of Yeshiva University in New York City, there is a strong association between elevated insulin levels in the blood and increased risk of breast cancer. The researchers examined data on 5,450 women who took part in the Women’s Health Initiative (WHI) and found that women with insulin levels in the highest third were twice as likely to develop breast cancer as women in the bottom third.

The link between elevated insulin levels and breast cancer was stronger for thin women than for obese women, who tend to have higher insulin levels. This finding is potentially important because it indicates that, in postmenopausal women, insulin may be a risk factor for breast cancer that is independent of obesity.

 

Medi Finance

Q. When are doctors required to submit compulsory audit of accounts?

Ans. If gross receipts of doctors are more than Rs. 10 lakhs, then audit report of CA is to be furnished along with return.

IJCP
IJCP
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ijcpgroup
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Docconnect
IJCP
 

An Inspirational Story

THIS ONE IS ABSOLUTELY WORTH YOUR READING

A nurse took the tired, anxious serviceman to the bedside."Your son is here," she said to the old man. She had to repeat the words several times before the patient’s eyes opened. Heavily sedated because of the pain of his heart attack, he dimly saw the young uniformed Marine standing outside the oxygen tent. He reached out his hand. The Marine wrapped his toughened fingers around the old man's limp ones, squeezing a message of love and encouragement.

The nurse brought a chair so that the Marine could sit beside the bed. All through the night, the young Marine sat there in the poorly lighted ward, holding the old man’s hand and offering him words of love and strength. Occasionally, the nurse suggested that the Marine move away and rest awhile. He refused. Whenever the nurse came into the ward, the Marine was oblivious of her and of the night noises of the hospital – the clanking of the oxygen tank, the laughter of the night staff members exchanging greetings, the cries and moans of the other patients. Now and then she heard him say a few gentle words. The dying man said nothing, only held tightly to his son all through the night.

Along towards dawn, the old man died. The Marine released the now lifeless hand he had been holding and went to tell the nurse. While she did what she had to do, he waited. Finally, she returned. She started to offer words of sympathy, but the Marine interrupted her.
"Who was that man?" he asked.

The nurse was startled, "He was your father," she answered."No, he wasn't," the Marine replied. "I never saw him before in my life."

"Then why didn’t you say something when I took you to him?"

"I knew right away there had been a mistake, but I also knew he needed his son, and his son just wasn’t here. When I realized that he was too sick to tell whether or not I was his son, knowing how much he needed me, I stayed. I came here tonight to find a Mr. William Grey. His Son was Killed in Iraq today, and I was sent to inform him. What was this Gentleman’s Name?"

The Nurse with Tears in Her Eyes Answered, Mr. William Grey…………

The next time someone needs you … just be there… Stay

 

IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have BP >170/110 mm Hg.
Dr Bad: Start with one drug.
Dr Good: Start with two drugs.
Lesson: For every 20/10 mm Hg reduction in BP, one drug needs to be added.

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbAIC is very high!
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Quote of the Day

"Be sincere; be brief; be seated" Franklin D Roosevelt

Are you fit to fly? Can pregnant females fly?

Obstruction of the vena cava from uterine compression and altered clotting factors combined with immobility and dehydration place the pregnant passenger at increased risk for deep vein thrombosis. She should be encouraged to ambulate every hour or two.

Milestones in Gabapentin

Richard Silverman (1989) is a chemistry professor at Northwestern University, Illinois, United States. He is well known for his development of Pregabalin.

 

International Medical Science Academy Update (IMSA)

Sexually transmitted infections

In an observational study of urban adolescent females (age 14 to 17 years at enrollment), 25 percent were diagnosed with a sexually transmitted infection (STI) within one year of first intercourse

Reference

Tu W, Batteiger BE, Wiehe S, et al. Time from first intercourse to first sexually transmitted infection diagnosis among adolescent women. Arch Pediatr Adolesc Med 2009;163:1106

 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Clozapine Tablet 200mg (Addl. Strength)

Indicated in the management of Schizophrenic patients

19.08.2009

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Tests for Pancreatitis

Serum Amylase: increases from 2 to 12 hours after symptoms and peaks at 12 to 72 hours. It may rise to 5 to 10 times the normal level and will usually return to normal within a week.
Lipase (the enzyme that, along with bile from the liver, digests fats) increases in the blood within 4 to 8 hours of the beginning of an acute attack and peaks at 24 hours.
Stool trypsin for pancreatic insufficiency and for chronic pancreatitis.
Trypsinogen to check pancreatic sufficiency in those with chronic pancreatitis.

 

Inspiration (Dr Jagjit Singh): Secret of Success

Sir: What is the secret of your success? a reporter asked a bank President.
Two words.
And, Sir, what are they?
Right decisions.
And how do you make right decisions?
One word.
And, sir, What is that ?
"Experience.
"And how do you get Experience?
Two words
And, Sir, what are they?
Wrong decisions.

Humor Section

Medical bloopers on medical charts!

Pap Smear…………………………A fatherhood test

 

Readers Responses

  1. Dear Dr Aggarwal, I request you to kindly inform the readers about the new drug policy of NVBDCP, 2010 which is available on our website www.nvbdcp.gov.in for treatment of malaria cases, in your eMedinewS which I find is very useful in updating the practitioners: Dr AC Dhariwal, Director, NVBDCP, Dte.GHS, Ministry of Health & FW, Govt. of India 22–Sham Nath Marg 09968070427.
     
  2. eMedinewS is interesting. I wouldn’t be so apologetic for editorial oversights on spelling. After all, English isn’t my native tongue. I will also not blame the computer! Dr. B N Gangadhar Faculty, Dept of Psychiatry NIMHANS

  3. Dear Dr K.K Aggarwal, Seasons Greeting, I was getting emedinews through email and I was enjoying it. I take this opportunity to appreciate you and thank you for your sincere effort. A few days ago my account has been hacked by someone. He is sending false messages in my name. Do not believe these messages. I am not using my old email now. Here is the new email address:drvuseethi@gmail.com. I request you to send eMedinewS to my new email address. Dr.V.U.Seethi, Perintalmanna.

  4. Dr Aggarwal, we are very grateful to you, to read and receive the very useful medi–magazine. Dr S Sakthi Velavan, Tamil Nadu, Tirupur.

  5. Respected Dr. KK Aggarwal, eMedinewS is an excellent e-letter/journal worth reading having participation of many faculties under your guidance; accept our best wishes for this: Dr D R Nakipuria, Dr Mrs R Nakipuria, Ambika Multispeciality Hospital 29 Agrasen Road, Khalpara, P.O.Siliguri-734005, 09434143550, Darjeeling (WB).

  6. Sir, Thank you for the emedinews journal. Very informative with various aspects of medicine. Very interesting & also worth spending time in reading daily. Thank you: Dr.B.V.Sai Chandran
 

Forthcoming Events

STEP 2010

Senior Resident Training on Educational Principles

The Medical Education Unit, University College of Medical Sciences, Delhi is organizing a three day workshop "Senior resident Training on Educational Principles" (STEP) for the senior residents on 26–28 July 2010. The goal is to sensitize the participants to basic medical education technologies, and to provide them a repertoire of powerful pedagogical practices to prepare them for their future endeavors: Dr Satendra Singh, MD, FSS, Assistant Professor of Physiology, University College of Medical Sciences, University of Delhi, Delhi, India110095

Program Director: Dr Navjeevan Singh, STEP 2010
Program Coordinator: Dr Satendra Singh, STEP 2010
Email: mededucms@gmail.com

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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