emedinews
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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 August 2010, Friday

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

Larger Waists Linked To Greater Risk Of Death

According to an American Cancer Institute–funded study published in August 9/23 issue of the Archives of Internal Medicine, belly bulge can be deadly for older adults, even those who aren’t overweight or obese by other measures. The study showed that men and women with the biggest waistlines have twice the risk of dying over a decade compared to those with the smallest tummies. Bigger waists carry a greater risk of death even for people whose weight is ‘normal’ by the body mass index, or BMI, a standard measure based on weight and height.

Men who had a waist size of 47 inches (120 centimeters) or higher and women with waists of 43 inches or larger had about twice the risk of dying over the 9–year study period than those with the smallest waist size of about 35 inches in men and 30 inches in women. Larger middles have been linked in previous studies to higher death rates, as well as to diabetes, heart disease and high cholesterol.

Researchers from the Epidemiology Research Program of the American Cancer Society in Atlanta looked at data among 48,500 men and 56,343 women ages 50 and older who were mostly white and took part in the Cancer Prevention Study II Nutrition Cohort, following participants until 2006, at which point 9,315 men and 5,332 women had died. Men and women with the largest waist circumferences also tended to be less educated, have a high BMI, were physically inactive, used to smoke and had a history of cardiovascular or respiratory disease or cancer.

It seems that some fat–cell–produced hormones can promote insulin resistance (leading to diabetes), and may throw off the body's hormonal balance in other ways, as well.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature

2nd BSNL Dil ka Darbar, a one-day non-stop public forum and 17th Perfect Health Mela are two major annual events being organized by HCFI, to create awareness about all aspects of health. The theme for this Dil Ka Darbar this year is "Preventing Sudden Cardiac Death"

In the photo: Press conference being held at KDB School Gaziabad on 19th August. Dr KK Aggarwal, President, HCFI, Dr B P Tyagi, Mr Ramdas from BSNL and others from the school. 

Dr K K Aggarwal

 

News and Views

National

Cashless facility in corporate hospitals to resume from Friday

 

All corporate hospitals are likely to resume cashless treatment facility as an interim measure to all insurance policyholders from today pending resolution of the impasse on standard rates.

 

As per Max Healthcare Institute CMD Pervez Ahmed  "Final rate structure would be decided in another 30-40 days. Under the structure that is being worked out, hospitals would be categorized on the basis of super specialty medical centres and premiums would vary accordingly," .  Ahmed said the package rates have been segmented on the basis of categorised hospitals. There will be three categories - A, B, C - for classification of hospitals and each segment could also have a sub-category. The categorization would happen on the basis on infrastructure facilities available in these hospitals, besides a standard rate for common procedures would help the health insurers cut down losses by up to 25%. (TOI)

 

Association of medical consultants Delhi (AMCD) oppose categorization of hospitals

 

How can we categorize the medical services in the city that means we are also categorizing the doctors into various gradation said Association of medical consultants’ press release. That means a doctor in Medanta is category A doctor and can charge more fees and another in a nursing home is category C doctor and will have to charge less fees.

 

"Categorization of consultants is not acceptable" : Dr KK Aggarwal convener of the AMCD. 

"It is not in the interest of the medical fraternity" Dr S K Sama. 

"The time for the fraternity is to unite" Dr V K Monga.

"We may have to stop cashless service as is being done in Mumbai" Dr P lal

One can become a member of the AMCD and raise the concern against the exploitation being done on the consultants. Just send your SMS to 9811090206 or write email to emedinews@gmail.com. There is no fee for the membership.

 

 

DMA Nursing Home Forum: boycott cashless treatments

In a specially convened meeting of DMA NH & MEF held at DMA House on 18th Aug, 2010, it was unanimously resolved to fight back the exploitatory attitude and tactics of the TPA’s by sidelining their presence in the whole process of Mediclaim and cashless treatment. The forum recommended to stop cash less facilities and said “ by refusing the cashless facility, the patient is not denied of the insurance right of the treatment which he can always get reimbursed from the insurance companies”. Similar efforts and stand has been taken up by the consultants of the hospitals in the other metro like Mumbai, Chennai, Kolkata etc.

 

The forum is recommending that the unified approach may be used by the hospitals and nursing homes by strongly discouraging the use of cashless services for patients. The patients can utilize their insurance by getting the hospital bills reimbursed from insurance companies.  Blackmailing tactics of the TPA’s can only be dealt by combined efforts of all the consultants of the hospitals. The forum requested to all not to avail cashless facilities from the  TPAs and to request the patients to put their claims into reimbursement.

 International

Behavior disorder in a child ( Dr G M Singh)

A child may have a behavior disorder, if the following are present:

Indicating that the child wants to hurt himself or herself, other people or animals.

Doing damage to property.
Stealing things or lying frequently.
Getting poor grades or being truant.
Abusing drugs, alcohol or smoking.
Starting sexual activity at a young age.
Arguing often or throwing temper tantrums.
Feeling hostile toward people in authority.

(Dr Monica and Dr Brahm Vasudev) 

High LDL in youth predicts coronary calcification later

Young adults whose lipid levels are less than optimal are likely in midlife to develop coronary calcium, a surrogate measure of coronary artery disease. According to Mark J. Pletcher, MD, of the University of California San Francisco, and colleagues, the adjusted odds ratio for having coronary calcium two decades later was 5.6 (95% CI 2 to 16) for young adults ages 18 to 30 years whose low–density lipoprotein (LDL) cholesterol levels were 4.14 mmol/L or greater vs those whose levels were below 1.81 mmol/L, Moreover, even those whose levels were as low as 2.59 to 3.34 mmol/L had increased risk (adjusted OR 2.4, 95% CI 1.1 to 5.3). The study is reported in the Aug. 3 issue of the Annals of Internal Medicine.

Environment influences type 1 diabetes risk

Results of a population–based study suggest that improved standards of living and hygiene may be contributing to the rising rates of type 1 diabetes, a population–based study suggested. Supporting the hygiene hypothesis, children hospitalized with a diagnosis of type 1 diabetes were less likely to have three or more older siblings (OR 0.56, 95% CI 0.45 to 0.70, P for trend <0.05), according to Marisa A. D’'Angeli, MD, of the Washington State Department of Health, and coauthors.

Dismal outcomes follow prolonged ventilation in ICU

Critically ill patients who require prolonged mechanical ventilation often have poor outcomes over the long term in contrast with initial high hopes for their recovery. In a prospective cohort study involving 126 patients, only 9% of those who got a tracheostomy or were ventilated for at least 21 days while in the ICU were alive with no functional dependency one year later. Christopher E. Cox, MD, MPH, of Duke University Medical Center, and colleagues also noted that overall, 65% of patients were completely disabled or had died by one year. The study is published in the Aug 3 issue of the Annals of Internal Medicine.

 

Legal Column

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

WMA declaration of Malta on hunger strikers– Guidelines for medical management

A thorough examination/blood/urine test of the hunger striker should be done at the start of the fast. Management of future symptoms, including those unconnected to the fast, should be discussed with hunger strikers. Also, the person’s values and wishes regarding medical treatment in the event of a prolonged fast should be noted. Sometimes hunger strikers accept an intravenous saline/glucose solution transfusion or other forms of medical treatment. A refusal to accept certain interventions must not prejudice any other aspect of the medical care, such as treatment of infections or of pain. Physicians should talk to hunger strikers in privacy and out of earshot of all other people, including other detainees. Clear communication is essential and, where necessary, interpreters in case of foreigner/language problem unconnected to the person/detaining authorities/police should be available and they too must respect confidentiality.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Chronic  Pancreatitis

Diagnosis

Diagnosis of chronic pancreatitis is based on clinical presentation, pancreatic function tests and imaging studies showing characteristic pancreatic morphology, rarely histologic features.

Pancreatic function  tests alone are not diagnostic of chronic pancreatitis because these tests do not differentiate chronic pancreatitis from pancreatic insufficiency. Therefore, morphologic or histological changes help in confirming chronic pancreatitis. The morphological changes include calcification in gland or duct and duct abnormalities like irregularity, dilation or stricture.  It is difficult to diagnosis patients with early mild or minimal change chronic pancreatitis.

Pancreatic function tests are invasive or noninvasive.  Invasive tests of pancreatic function (eg tube secretin tests) are the gold standard for determining exocrine pancreatic function.  However,   very few centres perform direct testing of pancreatic exocrine secretion.  Currently, there are two noninvasive pancreatic tests available at many centres: fecal elastase 1 (FE1) and functional MRCP.

Question of the day

Is it okay to take diphenhydramine containing pill at night?

Diphenhydramine is an antihistamine. It is sedating and can be taken to help fall asleep, but is not for regular use. Small, infrequent doses are not likely to cause any harm, although diphenhydramine is not without its problems.

The sedating effect of diphenhydramine may last. One may be drowsy the next day, even if you did sleep well. The possible side effects are blurred vision, constipation, dry mouth. Most side effects are more common and pronounced in older people. If sleep alone is the problem, one can take just diphenhydramine at a low dose of 25-50 mg, and not take the combination products.

If you need to take diphenhydramine often, you may be experiencing insomnia. Patients who have insomnia for 30 days or more are considered to have chronic insomnia. One should not treat chronic insomnia with diphenhydramine.

 

Public Forum (Press Release for use by the newspapers)

Raw milk not safe

One should not consume raw milk said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil ka Darbar & MTNL Perfect Health.

As per a report published in the Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention one should not consume raw (unpasteurized) milk or raw milk products because of the risk of E. Coli O157:H7 and other infections.

In September 2006, the California Department of Public Health was notified that two children had been hospitalized with hemolytic uremic syndrome, one of the most common causes of sudden, short–term kidney failure in children. Both children had consumed raw milk in the week before they became ill. One of the children was confirmed to have E. coli O157:H7 infection.

In the following three weeks, four more cases of E. coli O157:H7 infection were identified in children who had consumed raw cow milk or raw cow colostrum produced by the same dairy.

From 1998 to May 2005, raw milk or raw milk products have been implicated in 45 food–borne illness outbreaks that resulted in more than 1,000 cases of illness in the United States.

 

 

Conference Calendar

BIEP 2010

National Breast Imaging Education Programme 2010

Date: August 27 – 29, 2010
Venue: Hotel Savera, Chennai, Tamil Nadu.

 

An Inspirational Story

Life itself isn’t hard

Life itself isn't hard but the lives we create for ourselves are.

Remember that the next time you make a decision that will alter something you are used to. Don't take what you have created for granted, because the next thing you know, it'll crumble to pieces…… right before your eyes, and there won't be a thing you can do to stop it.

Everything that happens in your life, whether you knew about it or not, was predetermined by a choice you made earlier on. We start our life on this one road, the main road, at the very beginning we make a decision. Some go to the left, some go to the right. Others just keep going. But every person goes in a different direction. Paths collide, and paths split. There comes a time in everyone’s journey, when you come to a fork in the road. Do you take the left, or the right? There is no straight forward. Which one do you choose? How do you know that the path you will end up choosing will take you to the right place??

Choose the road that will best lead you to your final destination. Don’t take for granted the time you have as a youth to prepare yourself for the real world, because what you learn now about life, will help you when you meet reality for the first time.

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IJCP Special

Dr Good Dr Bad

Situation: A patient with pneumonia was to be treated as an outpatient.
Dr.Bad: Start a combination of macrolide + third–generation cephalosporin.
Dr Good: Take only a macrolide.
Lesson: Macrolide alone is safe as monotherapy in OPD practice in community–acquired pneumonia (CAP) with no risk for drug resistance.

Make Sure

Situation: A 60–year–old male developed acute heart attack after consuming Viagra.
Reaction: Why was cardiac clearance not taken before?
Lesson: Make sure that all older patients get a cardiac clearance before they are given Viagra group of drugs.

Quote of the Day

Shakespeare …"In the times of crisis I was not hurt by the harsh words of my enemies,
but by the silence of my friends".

Asthma Alert

Buy a Peak Expiratory Flow Rate meter

1. Is asthma meter and is equated to a thermometer.
2. All asthmatics should have it.
3. They should know their personal best value and keep it > 70%.
4. If it is < 50% they need immediate medical attention.

Peak flow measurements take less than one minute to perform, are safe and inexpensive, and, when repeated over time, can be used to monitor a patient’s response to treatment. Normal values differ with gender, height, and age, but a peak flow rate below 200 L/min indicates severe obstruction for all but unusually small adults.

 

International Medical Science Academy (IMSA) Update

Association between acute care and cognitive function in older adults

A higher risk of cognitive decline and dementia has been postulated to occur in survivors of acute medical illness, particularly in older adults. In a prospective cohort study, higher rates of cognitive decline and incident dementia were observed among those who had had acute care hospitalization compared to those who did not (JAMA 2010;303:763).

 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Cefixime 100mg/200mg + Cloxacillin 500mg/500mg tablets

For the treatment of adult patients with upper & lower respiratory tract infections, skin and soft tissue infections

12–Feb–10

 

Medi Finance

Q. To what extent can payment be made by cheque, cash, etc?

Ans. As per section 40 A (3), in case payment is made in excess of Rs. 20,000 other than by cross cheque or bank draft (cross), then of such expense shall be disallowed.

 

Lab Test

Non HDL Cholesterol = Total Cholesterol – HDL Cholesterol

 

Lateral thinking

Read this………………

1,2,3,4………………38,39,40 LIFE

The answer for yesterday’s puzzle "You are out of touch"

Correct answers received from: Dr Rawat Purushottam Singh, Dr Ashok Wasan, Dr Yogesh Saxena

Correct answer received for 17h August Puzzle from: Dr. Ashok Kumar, Dr. Shubha Laxmi Margekar

Send your answer to ijcp12@gmail.com

 

Humor Section

Joke

It got crowded in heaven, so, for one day it was decided only to accept people who had a really bad day on the day they died. St. Peter was standing at the pearly gates and said to the first man, "Tell me about the day you died."

The man said, "Oh, it was awful. I was sure my wife was having an affair, so I came home early to catch her with him. I searched all over the apartment but couldn’t find him anywhere. So I went out onto the balcony, we live on the 25th floor, and found this man hanging over the edge by his fingertips. I went inside, got a hammer, and started hitting his hands. He fell, but landed in some bushes. So, I got the refrigerator and pushed it over the balcony and it crushed him. The strain of the act gave me a heart attack, and I died."

St. Peter couldn’t deny that this was a pretty bad day, and since it was a crime of passion, he let the man in.

He then asked the next man in line about the day he died. "Well, sir, it was awful," said the second man. "I was doing aerobics on the balcony of my 26th floor apartment when I twisted my ankle and slipped over the edge. I managed to grab the balcony of the apartment below, but some maniac came out and started pounding on my fingers with a hammer. Luckily I landed in some bushes. But, then the guy dropped a refrigerator on me!"

St. Peter chuckled, let him into heaven and decided he could really start to enjoy this job.

"Tell me about the day you died?", he said to the third man in line. "OK, picture this, I was hiding inside a refrigerator…"

(Contributed by Dr GM Singh)

Scenario

Johnny falls while running during recess and scrapes his knee. He is found crying by his teacher, Mary . Mary hugs him to comfort him.

1957 – In a short time, Johnny feels better and goes on playing.

2009 – Mary is accused of being a sexual predator and loses her job. She faces 3 years in Prison. Johnny undergoes 5 years of therapy.

(Contributed by Dr Chandresh Jardosh)

  Readers Responses
  1. Thanks, I am (DR K P SINGH) very happy to learn from emedinews,that very soon cashless insurance facility is going to be restored. It will be beneficial for patients as well as doctors also. I find very interesting topic women's cholesterol level. Thanks again for providing tips on HEPATOLOGY and many more tips.
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi Gate.

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

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

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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