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

 

  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; 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 …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–7 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

20th September 2012, Thursday

PCI in Stable CAD of Limited Benefit

PCI held no edge over optimal medical therapy in all–cause mortality, the primary outcome according to Sripal Bangalore, MD, MHA, from New York University School of Medicine in New York City, and colleagues. PCI did not significantly improve cardiac death, nonfatal myocardial infarction (MI), or repeat revascularization. The report is published in August issue of Circulation: Cardiovascular Interventions.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What are the risk factors for chronic constipation?

The risk factors for chronic constipation include female gender, older age, physical inactivity, low caloric intake, low-fiber diet, low educational level and income, concurrent medication use and depression.

For Comments and archives…

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Avoid these foods for a healthier heart

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

A non–stop Interaction between Patients and Cardiologists

The Heart Care Foundation of India announced details of the forthcoming 4th Dil Ka Darbar at a press conference. The Darbar will be held on Sunday, 23rd September, 2012 at Talkatora Stadium. The event is being organized by Heart Care Foundation of India.

 
Dr K K Aggarwal
 
    National News

4th Dil Ka Darbar

September 23, 2012, 9:00 AM–6:00 PM , Tal Katora Indoor Stadium, Connaught Place, New Delhi

A non stop question answer–session between all top cardiologists of the NCR region and the public.

Delhi cardiologist shot dead, suspect arrested

As reported in the Hindustan Times, the suspect Dharmendra Kumar who fatally shot Dr Sanjeev Dhawan has been arrested by the Delhi police. Kumar reportedly reached Dr Dhawan's residence looking for a domestic help that worked there. The help was to quit her job on Wednesday. Dr Sanjeev Dhawan, a cardiologist at Sir Ganga Ram hospital in Rajinder Nagar was gunned down in New Delhi early morning at around 3 am on Wednesday. He was taken to nearby hospital where he was declared brought dead. (Source: Hindustan Times, September 19, 2012)

Congrats Dr Bhullar. Great team work!
(Diwan Singh Bhular)

Report: National CME Programme by IMA Patiala

More than 550 delegates from Punjab and other states participated in the National CME Programme on "Clinical & Medico Legal Update" organized by Indian Medical Association Patiala on September 09, 2012 in Government Medical College Patiala.

This was the first National level academic meet by local IMA organized in collaboration with departments of Medicine, Gynecology and Forensic Medicine of the medical college. The main topics of discussion and deliberations included safe blood transfusion, AIDS, Universal Work Precautions, Recent advances in treatment of Diabetes Mellitus, Revised TB Control Programme, PNDT Act, Early Detection and Prevention of Cancer, Intervention Cardiology, Bio–Medical Waste Management, Medico Legal liabilities of allopathic doctor and loopholes in prevention of illegal abortions.

The Punjab Medical Council has sanctioned four CME Credit Hours for the programme. Dr D R Rai IMA Hon. Secretary General HQ, Punjab Rural Development & Panchayats Minister Surjit Singh Rakhra, National and State leaders of Indian Medical Association and members of Punjab Medical Council participated in the programme.

(Dr B L Bhardwaj, President, Dr DS Bhullar, Hon. Secretary & Past President IMA Patiala Pres)

For comments and archives

All it takes is a smile
(Ashish Sabharwal)

"All It Takes Is A Smile" is a campaign initiated by Smile Train, which began on September 12th and conclude on October 5th, with a special event in Times Square, New York City. October 5th is also the World Smile Day. Under this campaign, users can upload their photos of a smile to Instagram, Twitter or Tumblr using the hashtag #SmileTrainWSD in the photo caption, between September 12 and October 5. (See the website http://www.smiletrain.org/wsd/) For each photo uploaded, Smile Train gets a $10 donation from the famous Famiglia Pizzeria of New York.
Smile Train is a leading charitable organization that provides free cleft lip and cleft palate surgery to poor children in the developing countries and thus makes these children smile.

Here is a unique opportunity for you to make a difference…make a child smile

For comments and archives

My Profession My Concern

Drunken Driving: Indian Perspective in World Scenario & the Solution

Drunken driving and overspeeding are the two major causes of road accidents in India. According to the experts, increasing road accidents in the country have become major cause of concern as more than one lakh people die in road accidents and over a million are injured annually. India has just one percent of the world vehicular population but accounts for more than 8% accidental deaths. The road traffic accident awareness needs to be converted into habit in the Indian population. Also, doctors are generally unaware of the relevance of preservation of blood and urine samples in cases of alleged drunkenness. Just because blood and urine samples were not preserved in such cases, persons accused of the offence of drunken driving are acquitted in the courts. With increasing incidents of road rage and drunken driving across the country, the government of India has approved harsher punishment for traffic violations by amending the Motor Vehicle Act. If the public, police and road transport authorities collectively put efforts, road accidents can be reduced remarkably.

For comments and archives

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

 
    Valvular Heart Disease Update

What is low gradient severe aortic stenosis?

Some patients with severe AS (aortic valve area <1.0 cm2) have a low gradient (mean gradient <30 mmHg) across the aortic valve that can reflect one of two different abnormalities:

  • True stenosis with secondary left ventricular dysfunction induced by a severe stenotic lesion that reduces the stroke volume and the transvalvular pressure gradient.
  • Pseudostenosis in which there is both moderate AS and a low cardiac output due to myocardial disease that is unrelated to the valvular lesion. The calculated valve area may mistakenly suggest severe stenosis in this setting because of valve area equation limitations when applied to low flow rate conditions.

It is important to distinguish between these disorders because surgical correction of the valve lesion in pseudostenosis is associated with a high mortality rate and is unlikely to be beneficial.

(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)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Weight loss by any means eases sleep apnea

Compared with a conventional weight–loss program, laparoscopic adjustable gastric banding did not significantly improve symptoms of obstructive sleep apnea, a randomized trial showed. (Source: Medpage Today)

For comments and archives

British engineers develop ultra–cheap ultrasound

Engineers in Britain have developed an ultrasound scanner that costs under 40 pounds ($75) to make and could improve prenatal care in parts of the developing world where this technology is out of reach. The device, if it gets commercial backing, would enter a market where hospital–based ultrasound scanners cost anything between 20,000 pounds and 100,000 pounds ($32,100 to $160,600) and low–cost, portable devices sell for around 4,500 pounds ($7,300) each. (Source: Medscape)

For comments and archives

Tranexamic acid could save lives in all traumatic bleeding

Hundreds of lives might be saved worldwide if the clot stabilizer tranexamic acid (TXA) were used promptly in all instances of traumatic bleeding, not just among the most severely injured, according to results from a study published online September 11 in the British Medical Journal. The study aims to quell a longstanding debate, which erupted with the initial publication of the randomized, multicenter Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2 (CRASH–2) trial, regarding use of the antifibrinolytic agent in trauma bleeding. (Source: Medscape)

For comments and archives

FDA OKs device to screen dense breasts

An ultrasound device for breast cancer screening –– the somo–v ABUS –– has been approved for use in women with dense breasts, the FDA announced Tuesday.

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: 50% of adverse drug reactions can be prevented

@DeepakChopra: How do we figure out our purpose and what path to take to achieve that purpose? http://tinyurl.com/9am6oqo

 
    Spiritual Update

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

Draupadi had five husbands and Dashrath had four wives

Does this mean polygamy was permissible in ancient era? The answer is yes.

1. If we take mythology as what actually happened then the above story is true

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the legal issues related to the surrogacy?

There are a number of legal issues that concern third party reproduction. Written consent should be obtained for any procedure. In situations of known sperm or egg donors, both donors, as well as intended parents, are advised to have separate legal counsel and sign a legal contract that defines the financial obligations and rights of the donor with respect to the donated gametes. With surrogacy arrangements, legal contracts, in addition to delineating financial obligations, may include details regarding the expected behavior of the surrogate to ensure a healthy pregnancy, prenatal diagnostic tests, and agreements regarding fetal reduction or abortion in the event of multiple pregnancies or the presence of fetal anomalies. Finally, many states allow for a declaration of parentage prior to the child’s birth obviating the need for adoption proceedings. The laws regarding third party reproduction are either non–existent or different from one state to another.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Does the donor suffer from any harmful effects after giving blood donations?

Absolutely not, rather a donor after having given blood voluntarily gets a feeling of great pleasure, peace and bliss. Soon within a period of 24 – 48 hours the same amount of new blood gets formed in his body, which helps the donor in many ways. His own body resistance improves, the circulation improves, and he himself feels healthier than before.

For comments and archives

 
    An Inspirational Story

God Created The Teacher
–– Author Unknown

On the 6th day, God created men and women. On the 7th day, he rested. Not so much to recuperate, but rather to prepare himself for the work he was going to do on the next day. For it was on that day – the 8th day – that God created the FIRST TEACHER.

This TEACHER, though taken from among men and women, had several significant modifications. In general, God made the TEACHER more durable than other men and women. The TEACHER was made to arise at a very early hour and to go to bed no earlier than 11 PM, with no rest in between.
The TEACHER had to be able to withstand being locked up in an air–tight classroom for six hours with thirty–five "monsters" on a rainy Monday. And the TEACHER had to be fit to correct 103 papers over Easter vacation. Yes, God made the TEACHER tough…but gentle, too. The TEACHER was equipped with soft hands to wipe away the tears of the neglected and lonely student… those of the sixteen–year old girl who was not asked to the prom.

And into the TEACHER God poured a generous amount of patience. Patience when a student asks to repeat the directions the TEACHER has just repeated for someone else. Patience when the kids forget their lunch money for the fourth day in a row. Patience when one–third of the class fails the test…patience when the text books haven’t arrived yet, and the semester starts tomorrow.

And God gave the TEACHER a heart slightly bigger than the average human heart. For the Teacher’s heart had to be big enough to love the kid who screams, "I hate this class – it’s boring!" and to love the kid who runs out of the classroom at the end of the period without so much as a "goodbye," let alone a "thank you."

And lastly, God gave the TEACHER an abundant supply of HOPE. For God knew that the TEACHER would always be hoping. Hoping that the kids would someday learn how to spell… hoping not to have lunchroom duty… hoping that Friday would come… hoping for a free day… hoping for deliverance.

When God finished creating the TEACHER, he stepped back and admired the work of His hands. And God saw that the TEACHER was good. Very Good! And God smiled, for when he looked at the TEACHER, he saw into the future.

He knew that the future is in the hands of the TEACHERS. And because God loves TEACHERS so much… on the 9th day God created… SNOW DAYS!

(http://www.inspire21.com/stories/educationstories)

For comments and archives

 
    Cardiology eMedinewS

NSAIDS may pose risk after heart attack Read More

Heavy drinkers may face greater risk for stroke at young age Read More

 
    Pediatric eMedinewS

Corticosteroids increase infections in pediatric AML Read More

Frequent asthma symptoms may make kids sleepy during the day
Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A smoker was found to have abnormal lung density on CT chest.
Dr. Bad: It is not related to smoking.
Dr. Good: It is related to smoking.
Lesson: In a study published in the NEJM, it has been shown that 10% of smokers have abnormal lung densities in CT chest suggestive of interstitial lung disease

For comments and archives

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

For comments and archives

 
  Quote of the Day (Dr GM Singh)

Every day may not be good, but there’s something good in every day.

 
    Legal Question of the Day (Dr MC Gupta)

Q. I am private practitioner radiologist. A press reporter is seeking RTI information from the income tax department regarding my income tax returns and from the CMO regarding the USGs done by me. What problems he might create for me? What should I do?

Ans.

  1. He is probably trying to make an allegation against you that you are earning a lot from USGs but not fully reporting your income. A CA may help you regarding this.
  2. He can also get a few persons to say on affidavit that you performed their USG but never sent the reports to the CMO as required. You must ensure that your USG records, including F forms and monthly reports in order.
  3. The IT deptt. should not divulge you IT returns to him without the permission of the third party (yourself) as per the RTI Act.
  4. The CMO should not divulge under RTI the details of patients examined by you because that would be breach of confidentiality to which the patients are entitled.
  5. You can write to the CMO and the income tax department that if any request as above is received for information under RTI, the same should not be revealed for the reasons mentioned above without your consent. This will ensure that if they do it behind your back, you can sue them.

For comments and archives

 
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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

CA15–3 cancer antigen

This test is done during or after treatment for breast cancer to monitor advanced breast cancer and response to treatment. CA 15–3 is not a blood test that screens for breast cancer.

  • In general, the higher the CA 15–3 level, the more advanced the breast cancer and the larger the tumor burden.
  • In metastatic breast cancer, the highest levels of CA 15–3 are seen when the cancer has spread to the bones and/or the liver.
  • Mild to moderate levels of CA 15–3 also are seen in a variety of conditions, including liver and pancreatic cancer, cirrhosis and benign breast disorders as well as in a certain percentage of apparently healthy individuals.
  • Pregnancy and lactation also increase levels of CA 15–3.
  • Several noncancerous conditions (benign breast or ovarian disease, endometriosis, pelvic inflammatory disease and hepatitis) can increase the levels of CA 15–3.
 
    Rabies Update (Dr. A. K. Gupta, Author of "RABIES - the worst death")

Can a rabies patient make a valid will?

A rabies patient can make a valid will. According to Section 59 in the Indian Succession Act, 1925

Person capable of making will:

  • Every person of sound mind not being a minor may dispose of his property by will.
  • A married woman may dispose by will of any property which she could alienate by her own act during her life.
  • Persons who are deaf or dumb or blind are not thereby incapacitated for making a will if they are able to know what they do by it.
  • A person who is ordinarily insane may make a will during the interval in which he is of sound mind.
  • No person can make a will while he is in such a state of mind, whether arising from intoxication or from illness or from any other cause that he does not know what he is doing.

What are monoclonal antibodies?

Monoclonal antibodies (mAb) are important reagents used in biomedical research, in diagnosis of diseases, and in treatment of such diseases as infections and cancer. These antibodies are produced by cell lines or clones obtained from animals that have been immunized with the substance that is the subject of study. The cell lines are produced by fusing B cells from the immunized animal with myeloma cells.

 
    Mind Teaser

Read this…………………

Chemical burns of the eye are treated with

A. Local anesthetics and antibacterial drops for 24 – 36 hours
B. Hot compresses applied at 15–minute intervals
C. Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water
D. Cleansing the conjunctiva with a small cotton–tipped applicator

Yesterday’s Mind Teaser: Which of the following biliary injuries do not present immediately after surgery?

a. Type A
b. Type B
c. Type C
d. Type D

Answer for Yesterday’s Mind Teaser: b. Type B

Correct answers received from: Dr Satya Bhooshan Sood, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai.

Answer for 18th September Mind Teaser: D. Pericardial tamponade

Correct answers received from:
Dr Mohan.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Just Can’t Win

"I see you were last employed by a psychiatrist," said the employer to the applicant. "Why did you leave?" "Well," she replied, "I just couldn’t win…

If I was late to work, I was hostile.
If I was early, I had an anxiety complex.
If I was on time, I was compulsive."

 
    Medicolegal Update

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

UK Clinical negligence law –Bolam – v – Friern Hospital Management Committee 1957

Sir Liam Donaldson – "Patients deserve to receive quality healthcare"

  • UK Clinical negligence law defines negligence as any act or omission which falls short of a standard to be expected of "the reasonable man."
  • It is necessary to show that whatever the Doctor did or did not do fell below the standard of a reasonably competent Doctor in that field of medicine.
  • In the leading case of "Bolam – v – Friern Hospital Management Committee 1957" it was stated that a doctor must act in accordance with a practice which is accepted as proper by a responsible body of men
  • There are several acceptable ways of doing something and this may mean that there is no negligence if an alternative method is chosen.
  • The fact that another person would not have done things in the same way does not automatically mean that there was clinical negligence.
  • The Doctor will be able to defend the compensation claim successfully, if it can be shown that a responsible body of reputable Doctors in the relevant field would have acted in a similar manner.
  • This means that a judge will hear evidence from experts and decide whether the actions taken were appropriate.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

5% high risk patients get heart attacks during perioperative period

Patients with underlying heart blockages or those with risk factors are at increased risk for perioperative heart attacks. Perioperative period is the time period extending from when the patient goes into the hospital for surgery until the time he/she is discharged home, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India, Dil Ka Darbar to be held on 23rd September at Talkatora Stadium and MTNL Perfect Health Mela.

The largest data on the subject comes from over 8000 patients in the randomized POISE trial of perioperative beta–blocker therapy, which has shown that at 30 days after the surgery the incidence of heart attack is 5 percent and 71 percent of these occur within 48 hours of surgery. Approximately 65 percent of patients with heart attack are without symptoms.

Therefore, perioperative heart attack is not uncommon and occurs with increasing frequency as the number of identified risk factors increases. Both short– and long–term survival are decreased in patients who have sustained a perioperative heart attack.

Treatment for perioperative heart attack is same as for any heart attack in the general population. However anticlotting drugs should be started carefully.

Perioperative heart attack is detected by presence of an elevated heart muscle injury blood test (troponin) and one or more of the following: ischemic (heart pain) symptoms, ECG changes in two contiguous leads, coronary artery intervention (balloon dilatation or stenting), or evidence of heart attack on cardiac echocardiography or autopsy.

All high–risk patients with cardiac troponin both before and after non cardiac surgery should be screened in order to detect a perioperative heart attack. Cardiac troponin levels should be measured for the following patients:

  • Patients with symptoms or ECG changes suggestive of ischemia or heart attack (2 or 3 serial biomarkers).
  • Patients at high cardiac risk (at 6 to 12 hours, and days 1, 2, and 3 after surgery)

High risk is defined as high–risk surgery with one or more additional risk factors of the revised cardiac risk score.

A 12–lead ECG in the perioperative period should be done for the following patients

  1. All patients with symptoms of myocardial ischemia
  2. All patients with risk factors for perioperative heart attack (baseline and daily for two, and possibly, three days)
 
    Readers Responses
  1. In the movie ‘3 idiots’, Aamir Khan and friends deliver a baby by using a vacuum cleaner as ventouse. The baby doesn’t cry despite efforts at resuscitation, but when they say ALL IS WELL the baby kicks up his leg –not once but twice and then starts crying. Dr Anita Kant
 
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