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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

  Editorial ...

20th September, 2010, Monday

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

Type D personality associated with higher future heart risk

Heart patients considered "chronically distressed" (Type D personality) are at a higher risk of recurrent cardiac events.
Type D personality is associated with higher risk of future psychological problems such as depression or anxiety in heart patients.
Heart patients with the distressed (Type D) personality profile may face a higher risk of future cardiovascular problems, according to a summary article published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes. An analysis of previous reports involving more than 6,000 patients found an association between the Type D personality and future cardiovascular issues among heart patients.
Type D is a personality marked by chronic negative emotions, pessimism and social inhibition. There is a 3–fold increase for Type D heart patients in risk of future cardiovascular issues such as peripheral artery disease, angioplasty or bypass procedures, heart failure, heart transplantation, heart attack or death. A Type D profile was also linked to a 3–fold increase in long–term risk of psychological conditions including clinical depression, anxiety or poor mental health. Type D patients appear to respond differently to cardiovascular stress. Type D is associated with differences in cortisol, a stress hormone that can temporarily increase blood pressure. It also may be related to elevated levels of inflammation. In addition, heart patients with Type D personality may be less likely to get regular medical checkups or communicate effectively with their physicians.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Medico Masti 2003


Perfect Health Mela organised by Heart Care Foundation of India is a mix of infotainment, exhibitions, competitions and Checkups. Medico Masti (College and Youth Festival) is a very popular event of the Mela. In the photo: Harbajan Mann, famous Punjabi singer; Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI.

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Influenza vaccine

In December 2009, the US Food and Drug Administration approved a high–dose inactivated influenza vaccine for individuals ≥65 years of age.

(Reference:Licensure of a high–dose inactivated influenza vaccine for persons aged ≥65 years (Fluzone High–Dose) and guidance for use – United States, 2010. MMWR Morb Mortal Wkly Rep 2010;59:485).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association. Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well-known for his work in the field of academics
 

MBBS must clear exit test to practice

Those intending to become doctors and treat patients may soon have to clear a common exit test after getting the MBBS degree from medical colleges. The regulating body, Medical Council of India (MCI), has given a statutory recommendation for a mandatory exit test, which is under active consideration of the health ministry, the Supreme Court was informed on Friday. Considering the sensitive nature of the profession –– dealing with life and death –– and keeping in mind varying standards of education in medical colleges, MCI has proposed a common exit examination for MBBS pass–outs intending to become doctors and treat patients, Solicitor General Gopal Subramaniam told a Bench of Justices R V Raveendran and H L Gokhale. This recommendation of the MCI was to standardise the skills of doctors, said the regulatory body’s counsel senior advocate Amarendra Saran supplementing the arguments of the health ministry advanced through the SG. This is in line with the decision of the Bar Council of India (BCI) making it mandatory for law graduates to clear a test to be able to practice in courts. (Source: The Times of India) .

  International News

Meds don’t increase suicide risk for epileptics, but may for depressed

Taking antiepileptic drugs does not increase epilepsy patients’ risk of suicide, says a new analysis published in the Aug. 5 issue of New England Journal of Medicine.

Vena cava filters might fracture, embolize

FDA warns that there is a risk of serious cardiac events in patients who have retrievable inferior vena cava (IVC) filters implanted but not removed.

HPV vaccine protects against low–grade lesions

The human papillomavirus (HPV) vaccine substantially reduces the incidence of low–grade neoplasia and genital warts (condyloma) for more than three years after vaccination, according to data gathered from two international randomized, controlled trials of the quadrivalent HPV vaccine. The trials included more than 17,000 women ages 16 to 26. Participants were excluded for a history of more than four sexual partners, abnormal cervical smear test results or pregnancy. They were given three doses of the vaccine (which targets HPV types 6, 11, 16 and 18) or placebo. The follow–up was continued for 42 months, and the study was published online by BMJ on July 21.

NIH News: Association between elevated levels of lead, cadmium and delayed puberty in girls

Exposure to lead in childhood may delay puberty in young girls, with higher doses increasing the chance for later maturation. Researchers at the National Institutes of Health and other analyzed data on blood drawn from more than 700 girls aged 6 to 11 years. Girls with elevated levels of lead (≥5 mcg of lead per dL of blood) were 75 % less likely than girls with low levels of lead to have key adolescent hormones at levels that are associated with the beginning of puberty. In girls with elevated levels of both lead and cadmium, this pattern was even more pronounced. According to the researchers, lead, alone or in concert with cadmium, might suppress ovarian production of hormones that prepare a young girl’s body to ovulate, or release an egg, for the first time.

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

Supporting advice for caregivers and families

  • Make sure children’s immunization schedules are complete by 1 year of age.
  • Use ORT to rehydrate children during diarrhea.
  • Give liquid iron supplements daily (12.5 mg/ day) to infants 6 months to 1 year of age if daily vitamin––mineral supplements or iron–fortified foods are not being given. If the prevalence of anemia is known to be very high (≥40 %), continue supplementation until 24 months of age. For low birthweight infants, start supplementation at 2 months.
  • Give semi–annual, high-dose vitamin A supplements after 6 months (100,000 IU for infants and 200,000 IU for children 12 months and older) in areas where vitamin A deficiency occurs.

References

  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/ UNICEF, 1998.
  2. Dewey KG. Guiding principles for complementary feeding of the breastfed child. PAHO/ WHO, 2003.
  3. WHO. Complementary feeding: family foods for breastfed children. Geneva: World Health Organization, 2000.
  Infertility Update

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

Who can be a sperm donor?

A young healthy male can be a sperm donor. He has to be screened and given clearance for certain medical illnesses and sexually transmitted diseases. The ICMR guidelines encourage anonymous donation through sperm bank. International anonymity is not a major criterion.

Who can be an egg donor?

Egg donation can be achieved through professional donors, egg sharing and known donors. ICMR guidelines suggest that donors should be anonymous.

  Cardio Update: Question of the Day

How do you manage an elderly hypertensive? (Sukumar Mukherjee, Ajoy Biswas)

Due to increased vascular stiffness, elderly patients often tend to yield a higher reading. In view of possibility of orthostatic fluctuation, both supine and sitting/standing BP should be noted. A reduction of 34% in stroke, 19% in CHD and 23% in vascular death was noted with a reduction of 12–4 mmHg in SBP/5–6 mmHg in DBP over a 5–year period.
Lifestyle modification remains of primordial significance. Restriction in daily salt intake, body weight reduction and reducing the waist circumference may minimize the need for pharmacotherapy (Trial of Non Pharmacological interventions in Elderly – TONE).1 Low dose thiazide (12.5–25 mg/day) combined with potassium–sparing diuretics are recommended as first choice for their proven efficacy in reducing mortality and morbidity. Long–acting CCBs are suitable alternatives though STOP 2 trial noted higher incidence of ACS and CAD associated CHF with CCBs compared to ACEs. Bilateral atherosclerotic renovascular disease has to be considered while using ACEI in elderly. Presence of comorbid disease conditions by and large determines the choice of antihypertensive in elderly

References
Espeland MA, Whalton PK, Kostis JB, et al. Predictors and mediators of successful long term withdrawal from antihypertensive medications. Arch Fam Med 1999;8:228–36.

  Medicolegal Update

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

What criteria are used by doctors to make decisions to stop medical care?

Competent patients have the right to refuse medical care and can use whatever criteria they deem acceptable; it is their values, whatever they are, that guide their choice. Similarly, for mentally incapacitated patients who left advance directives that specify the interventions they want or do not want, their values determine their choices. Regarding mentally incapacitated patients who either appointed a proxy without specific indications of their wishes or who never completed an advance care directive, this question remains controversial.
The following 4 criteria have been proposed to help guide surrogate decision makers although none of these is ideal: Ordinary/extraordinary care distinction; futile care; substituted judgment and best interests.*

*Emanuel EJ. A review of the ethical and legal aspects of terminating medical care. Am J Med. 1988;84: 291–301.

  Medi Finance Update

Taxation Tips

  • In a partnership firm, even an unqualified person can become a partner.
  • Sole proprietorship should be preferred over partnership firm. It is so because aggregate amount of tax liability on firm and partners is generally higher than that of the case when the same amount of income is generated through sole proprietorship.
  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date

Notification

Astemizole

Apr.1,2003

GSR 191(E)
dt.5.3.03

  Lab Update

Prostate specific antigen (PSA)

Finasteride and dutasteride (5–alpha reductase inhibitors) lower PSA levels. Finasteride lowers PSA by a median 50 % within 6 months of use, though the effects can vary widely; dutasteride has been reported to reduce PSA
48 to 57 %.

  IJCP Special

Dr Good Dr Bad

Situation: A diabetic on exercise protocol came for blood sugar check up.
Dr Bad: Get fasting sugar done.
Dr Good: Get fasting and post prandial sugar done.
Lesson: The 2–h plasma glucose level is more sensitive than fasting plasma glucose level to the beneficial effects of physical activity. These beneficial effects are apparent across the waist circumference spectrum. (Diabetes Care 2006; 29:2598–2604).

Make Sure

Situation: A 62–year–old–diabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

Quote of the Day

"The reward of a thing well done is to have done it". Ralph Waldo Emerson

Hypertension Alert

  1. In the patient who does not have certain follow–up, particularly patients at high risk for cardiovascular or cerebrovascular disease, one may admit them.
  2. Over the course of weeks to months, the dose and selection of medications is modified to achieve desired goals (eg, <140/90 or <130/80 mmHg, as appropriate), usually with longer acting agents.
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  Mind Teaser

Read this…………………

poFISHnd

The answer for yesterday’s Mind Teaser: "An eye for an eye."

Correct answers received from: Dr Virender Prakash Gautam, Dr Aruna Tyagi, Dr Anurag Jain, Dr. Anupam Sethi Malhotra, Dr R S Bajaj, Dr. Satish Gunawant, Dr Deepak Bhardwaj, Dr Devi Pasad Mohapatra, Dr. Suman Kumar Sinha, Dr Kamlesh Kanodia, Dr.K.P.Rajalakshmi, Dr.Meenakshi, Dr Neelam Nath, Dr Muthumperumal Thirumalpillai, Dr.G.Padmanabhan,     Dr Kalpana Mohan, Dr Chandresh Jardosh, Dr Meera Rekhari

Answer for 18th September Mind Teaser is:"Princes/Princess".

Correct answers received from: Dr Kalpana Mohan, Dr Riddhi Jaiswal, Dr Chandresh Jardosh

Send your answer to ijcp12@gmail.com

  Humor Section

Interesting aspect of mathematical calculation in human life

Discussion technique
A woman has the last word in any argument.
Anything a man says after that is the beginning of a new argument.
(Contributed by Dr Dewat Ram Nakipuria)

Important laws which great Newton forgot to state

Law of Telephone When you dial a wrong number, you never get an engaged tone.
(Contributed by Dr Chandresh Jardosh)

  An Inspirational Story

The frogs and the tower

There once was a bunch of tiny frogs…… who arranged a running competition. The goal was to reach the top of a very high tower. A big crowd had gathered around the tower to see the race and cheer on the contestants… The race began… Honestly, no–one in crowd really believed that the tiny frogs would reach the top of the tower. You heard statements such as: "Oh, WAY too difficult!!" "They will NEVER make it to the top".

"Not a chance that they will succeed. The tower is too high!" The tiny frogs began collapsing. One by one … Except for those who in a fresh tempo were climbing higher and higher… The crowd continued to yell "It is too difficult!!! No one will make it!"

More tiny frogs got tired and gave up… …But ONE continued higher and higher and higher… This one wouldn't give up! At the end, everyone else had given up climbing the tower except for the one tiny frog who, after a big effort, was the only one who reached the top!

THEN all of the other tiny frogs naturally wanted to know how this one frog managed to do it? A contestant asked the tiny frog how the one who succeeded had found the strength to reach the goal? It turned out… that the winner was deaf.

  Readers Responses
  1. Acceptance of gifts is ethical or unethical is a very personal matter, more important is reciprocating the gifts by unethical means like using certain drugs in patients when they are not needed, you are prescribing them only to reciprocate the gift you have accepted. Dr Vivek Kumar, Varanasi
  2. Dear Dr Aggarwal, Recetly again there was a news regarding death with Mealses Vaccine. BUT THIS TIME IT WAS NOT GOVT HOSPITAL OR DISPENSARY. As per newspaper reports it was Divay Jyoto Nursing Home in Ghaziabad. The measles vaccine is being manufactured in India only by Public Sector companies. I will appreciate if you can publish the name of the public sector company which manufactured the vaccine and its batch no etc -So that all doctors become a little cautious pending detailed investigation as to the cause of death. If the vaccine is faulty - who is responsible? Why to punish and demae the doctor/ Sincerely: DR R S Bajaj, Consultant Paediatrician
  3. Respected Dr KK Aggarwal, I am happy u are doing a great service to doctors by giving small-small tips. These are very useful in day to day practice. Keep up with all these ideas. urs DR VK SHARMA.
Public Forum

(Press Release for use by the newspapers)

Tobacco as harmful as cigarette

Taking one pinch of smokeless tobacco delivers the same amount of polycyclic aromatic hydrocarbons (PAHs) as smoking five cigarettes does. This was stated by 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 Mela.

PAHs are common environmental contaminants that are formed as a result of incomplete burning of wood, coal, fatty meat or organic matter, according to American Chemical Society. PAHs also form during the grilling of meats. Some are known carcinogens. Smokeless tobacco contains two dozen other carcinogens that cause oral and pancreatic cancers, scientists say.

People think that because it doesn’t burn, smokeless tobacco is safer. A total of 28 carcinogens are identified in smokeless tobacco. Continued exposure to these over a period of time can lead to cancer.

Until recently, scientists wrongly believed that, because the tobacco was not burned when used, only trace amounts of PAH existed in snuff. Even though smokeless tobacco use does not involve burning, tobacco gets contaminated with PAH during its manufacturing.

  Conference Calendar

Intensive Care Unit Safety Workshop
Date: September 20–21, 2010
Venue: Johns Hopkins Hospital, Baltimore, USA

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday–BSNL Dil ka Darbar A daylong 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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November, 2010, at Dr. Shroff’s Eye & ENT Hospital, New Delhi.
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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