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  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 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 November 2010, Saturday

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

Cell-Phone rash on the rise: nickel allergy is to blame

In incessant cell phone users, a mysterious rash appearing along the jaw, cheek or ear may signify allergy to nickel, a metal commonly used in cell phones said Dr. Luz Fonacier, Head of Allergy and Immunology at Winthrop University Hospital in Mineola, N.Y in Nov. 14 at the annual meeting of the American College of Allergy, Asthma and Immunology annual in Phoenix.

Symptoms include a red, bumpy, itchy rash in areas where the nickel–containing parts of a cell phone touch the face. It can even affect fingertips of those who text continuously on buttons containing nickel. In severe cases, blisters and itchy sores can develop. Nickel allergy affects 17% of women and 3% of men.Women develop rash more often because they are more likely to have been sensitized to nickel after ear piercing, or had an allergic reaction to nickel–containing jewelry. To treat cell phone rash, you can apply a mild over–the–counter corticosteroid. 

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr. GM Singh)

"Love: a temporary insanity, curable by marriage."

Ambrose Bierce

    Photo Feature (from the HCFI Photo Gallery)

 17th MTNL Perfect Health Mela – Valedictory Function

Students performing Martial Arts in the valedictory function of the 17th Perfect Health Mela

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/ Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Country grappling with mixed burden of diseases: Azad

As the country grapples with a "mixed burden" of diseases that beset the developing as well as developed countries, Union Health and Family Welfare Minister Ghulam Nabi Azad on Monday said adequate research was needed to deal with the challenge of non–communicable and re–emerging diseases. Addressing the centenary celebrations of the Indian Council of Medical Research (ICMR) here, Mr. Azad said as the country moved from a developing nation to the status of a developed one, it had to face the challenge of communicable, non–communicable and re-emerging diseases. (Source: The Hindu)

    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC http://www.isfdistribution.com )

Supervised exercise training has valuable role in treatment of type 2 diabetes

The Italian Diabetes and Exercise Study recently published the results of a study that presents new evidence supporting the value of supervised exercise training for people with type 2 diabetes. In the study, 606 sedentary patients with type 2 diabetes underwent supervised aerobic and resistance training plus structured exercise counseling (versus counseling alone) twice a week for 12 months. The study concluded, "This exercise intervention strategy was effective in promoting PA (physical activity) and improving HbA1c and cardiovascular risk profile. Conversely, counseling alone, though successful in achieving the currently recommended amount of activity, was of limited efficacy on cardiovascular risk factors, suggesting the need for a larger volume of PA in these high–risk subjects."

(Contributed by Dr. GM Singh)

Verrucous carcinoma (VC) is a form of squamous cell carcinoma, seen in elderly patients. VC usually grows slowly. The clinical picture shows a large exophytic papillary or a verrucous, white or pink asymptomatic area. It has low metastatic potential and has a relatively nonaggressive course. VC is treated with relatively conservative excision without a mutilating procedure. However, VC may have late metastasis. Also, some cases evolve or are associated with a more aggressive form of carcinoma. In these cases, the worst area dictates the type of treatment.

(Dr Monica and Brahm Vasudev)

Gout, hyperuricemia prevalence rising

National data indicate that gout and hyperuricemia, are becoming more common among Americans. The age–adjusted prevalence of gout in the 2007–2008 edition of the National Health and Nutrition Examination Survey (NHANES) was 3.9%, up from 2.7% in the 1988–1994 series (p<0.05) (Yanyan Zhu, PhD, of Boston University in American College of Rheumatology meeting).

Diuretic cuts morbidity, mortality in mild HF

Mildly symptomatic heart failure patients have better outcomes with the selective aldosterone–receptor blocker eplerenone. A randomized controlled trial showed that the drug cut the risk of death from cardiovascular causes or hospitalization for heart failure by 37% compared with placebo in patients with functional class II heart failure with absolute rates for the combined outcome of 18.3% vs 25.9% (P<0.001). (Dr Faiez Zannad, of Nancy University in Nancy, France)

Obesity linked to asthma among allergic patients

Obesity and "super–obesity" were significantly associated with asthma in a predominantly black group of inner city patients who also had allergies. In a retrospective single practice–based cohort study, increasing body mass index (BMI) was associated with a greater prevalence of asthma, according to Sara Fitzpatrick, MD, of SUNY Downstate Medical Center in Brooklyn, New York.

    Infertility Update

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

When is the insemination done?

Insemination is usually done around the time of ovulation. The timing is assessed by serial ultrasound and time is fixed after the injection for follicular rupture.

Do we need anesthesia for IUI?

IUI is an OPD procedure done without anesthesia. Some times abdominal cramps are noted after the procedure. These are due to uterine contractions and usually subside in short time.

For queries contact: banerjee.kaberi@gmail.com

   Hepatology Update

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

What are the other associated features of Alagille’s Syndrome and how do they affect the child? 

  • Particular type of facial features – prominent forehead, fairly wide, apart deep set eyes and small pointed chin. These do not affect the child, and do not generally make them look markedly different form other children.
  • Cardiovascular (heart or blood vessel) abnormalities: range from ery mild with no symptoms to being so severe as to require surgery and/or be the cause of early death.
  • Abnormality of some of the vertebrae (bones in the spine) giving a ‘butterfly–like’ appearance on X–ray. This abnormality is only visible on X–ray and does not affect the growth of the spine.
  • Embryotoxon in the eyes (an accumulation of substance on the inner aspects of the cornea), which can only be seen on slit-lamp examination of the eyes. It does not affect vision and is known to be present in up to 15% of the normal population.

Other associated problems though they occur much less frequently are:

  • Growth retardation
  • Kidney problems
  • Mental retardation
  • Further abnormalities of the bone
  • High – pitched voice
    Medicolegal Update

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

WMA guidelines for clinical research combined with professional care

The mission of medical doctor is to safeguard the health of the people. The Declaration of Geneva of the World Medical Association (WMA) binds the doctor with the words, "The health of my patient will be my first consideration." In the treatment of the sick person, the doctor must be free to use a new diagnostic and therapeutic measure, if in his/her judgment it offers hope of saving life, re–establishing health or alleviating suffering.

  • The potential benefits, hazards and discomfort of a new method should be weighed against the advantages of the best current diagnostic and therapeutic methods.
  • In any medical study, every patient including those of a control group, if any, should be assured of the best proven diagnostic and therapeutic method.
  • The refusal of the patient to participate in a study must never interfere with the doctor–patient relationship.
  • If the doctor considers it essential not to obtain informed consent, the specific reasons for this proposal should be stated in the experimental protocol for transmission to the independent committee.
  • The doctor can combine medical research with professional care, the objective being the acquisition of new medical knowledge, only to the extent that medical research is justified by its potential diagnostic or therapeutic value for the patient.

(Ref: 18th World Medical Assembly, Helsinki, Finland, 1964 and revised by the 29th World Medical Assembly, Tokyo, Japan, 1975).

    Clinical Tips

5 steps to a pain–free back (Harvard News Letter)

Step 3. Kick the habit

Research shows that smokers have more frequent episodes of back pain than nonsmokers, and the more people smoke, the higher the risk of such episodes. Nicotine in cigarettes contributes to low back pain in two ways. First, nicotine hampers the flow of blood to the vertebrae and disks. This impairs their function and may trigger a bout of back pain. Second, smokers tend to lose bone faster than nonsmokers putting them at greater risk for osteoporosis, another common cause of back pain.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Cervical cancer is the only cancer suggested by WHO for routine screening.

    Medi Finance Update

Shall professional tax paid be allowed as deduction?

Any amount paid as professional tax shall be allowed as deduction in the year of payment.

    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Mepacrine hydrochloride (Quinacrine and its salts) in any dosage form for use for female sterilization or contraception

    IMSA Update

International Medical Science Academy (IMSA) Update

Sterilization does not impact sexual function

Sexual function appears to be unchanged or improved in women following sterilization. In a large prospective study of women who underwent tubal sterilization, almost all women reported no change in, or increased, sexual desire or pleasure.

(Ref: Smith A, et al. Are sexual problems more common in women who have had a tubal ligation? A population–based study of Australian women. BJOG 2010;117:463).

    IJCP Special

Dr Good Dr Bad

Situation: An obese patient with heart failure was not responding.
Dr. Bad: Increase your drugs.
Dr. Good: Start 10% weight reduction program.
Lesson: In patient with heart failure, reducing 10% of the body weight can help reducing symptoms.

Make Sure

Situation: A patient with 105 degree fever was not responding to the paracetamol.
Reaction: Oh my God! Why was IM paracetamol given?
Lesson: Make sure to remember that when the fever is more than 105 degree only fever medicines will not work. The answer is tap water sponging to lower the temperature.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Jitendra Ingole, MD Internal Medicine)

One young academically excellent person went to apply for a managerial position in a big company.
He passed the first interview; the director did the last interview, made the last decision. The director discovered from the CV that the youth’s academic result was excellent all the way, from the secondary school to postgraduate research. He never had a year when he did not score high marks. The director asked, "Did you obtain any scholarships in school?" And the youth answered "None". The director asked, "Is it your father who paid your school fees?" The youth answered, "My father passed away when I was one year old, it is my mother who paid for my school fees."

The director asked, "Where did your mother work?" The youth answered, "My mother worked as a cloth cleaner." The director requested the youth to show his hands, the youth showed a pair of hands that looked smooth and perfect to the director. The director asked, "Did you ever help your mother wash clothes before?" The youth answered, "Never. My mother always wanted me to study hard and read more books. Furthermore, my mother can wash clothes faster than me. The director said, "I have a request, when you go back today, go and help to clean your mother's hand, and then see me tomorrow morning".

The youth felt that his chance of landing the job was high. When he went back home, he happily wanted to clean his mother’s hand. His mother felt strange and happy but had mixed feelings. She showed her hands to the boy. The youth cleaned his mother’s hands gently, his tears streamed down his cheeks as he cleaned them. That was the very first time that he noticed that his mother’s hands were so wrinkled, and that there were so many cuts in her hands. Some of the cuts and bruises were so deep that they caused her a lot of pain when he gently cleaned them with water.

This is the first time the youth had realized and experienced how very hard his mother had worked with her pair of hands…the hands that washed clothes everyday to earn enough money to put him through school over the years. That was the ultimate price that his mother had paid so willingly for his entire education…his academic excellence and probably his future.

After finishing the cleaning of his mother hands, the youth quietly cleaned all remaining clothes for his mother. That night, mother and son talked for a very long time. Next morning, the youth went to the director’s office. The director noticed the tears in the youth’s eyes, and asked him: "Can you please tell me what exactly you did when you went home yesterday and what lessons you have learned from the work you did?" The youth answered: "I cleaned my mother’s hands, and only then I realized how hard she had worked to put me through school all these years. Those hands were so pale and wrinkled and had deep cuts. Some of those cuts were bleeding when I gently washed them. I then told my mother to sit down while I washed the remaining clothes. I was ashamed of myself for not helping my mother with the house work all these years. I truly love my mother for being there for me. She sacrificed her life for me and now it is my turn to look after her and I am going to do that until the day I leave this world."

The Director noticed the tears in the boy’s eyes as he related his experiences. He looked at the boy and asked him what he had learnt from doing that work. The youth said, Number 1: Now I know what appreciation is. Without my mother, who worked so hard work to put me through school, I would not have been the man that I am today. I consider myself blessed to have a loving mother beside me all these years.
Number 2: Now I know how to work together with my mother. I know the difficulties of life.
Number 3: I know the importance and value of family relationships.

The Director said: "This is what I expect from each employee in this Company. I want each one to appreciate the help of others. A person who knows the suffering of others and how to co–operate with others gets things done. And lastly, and the most important one, I want a person who would not put money as his only goal in life to be my Manager. You are hired." Later on, this young person worked very hard, and received the respect of his subordinates. Every employee in his team worked diligently and the company’s sales and image improved tremendously.

A child who has been protected and habitually given whatever he or she wants will not realize the hardships the parents go through to give whatever the child wants. This causes the entitlement mentality, and will always put himself or herself first. A child who has grown up oblivious to life’s hardships will assume that everyone in the workplace must listen to him. And when he or she becomes a Manager, he/she would not know the difficulties of his/her employees. If the workload in the Department is not met, he/she will always blame others.

Managers who fall into this category, will only want good results. They may be successful for a while, but eventually would not feel sense of achievement. They will always grumble and will never be satisfied or be happy at the workplace or at home. If we are this kind of protective parents, did we love the kid or destroy the kid?

The most important thing is that your kid will appreciate the difficulties of life and learn to work with others.



(Contributed by Dr Ashish Verma, MD)

A 71–old–woman presents with a couple of weeks of generalized headaches with achiness of her shoulders and lower back. Her physical examination is completely normal apart from a limited motor exam due to muscle pain. Lab data shows mild normocytic anemia, normal creatinine kinase and ESR was 20. Which is the next best test to perform?

A. Temporal artery biopsy
B. MRI of the brain
C. Electromyogram
D. Carotid artery Doppler  

Yesterday’s Mind Teaser: "coORDERurt "
Answer for yesterday’s Mind Teaser:
"Order in the court "

Correct answers received from: Dr Joshi Sachin, Dr. K. Raju,  Dr. Rajiv Dhir, Dr Bhavisha Brahmbhat, Dr Meera Rekhari, Dr Avdhesh Shukla, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Sudha Nayyar, Dr. Uma Gaur, Dr. Suman Kumar Sinha, Dr. Manjesha, Dr Jainendra Upadhyay, Dr. Prashant Bharadwaj, Dr S. Upadhyaya, Dr. K P Rajalakshmi, Dr. Parvesh Sablok.

Answer for 18th November Mind Teaser: "A long letter from home"
Correct answers received from: Dr. Gitanjali Arora,  Dr Avdhesh Shukla, Dr Vijay Kansal, Dr.K.P.Rajalakshmi, Dr Rashmi Chhibber.

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

A young woman wasn’t feeling well, and asked one her co-workers to recommend a physician. "I know a great one in the city, Dr. Robert but he is very expensive.2000/– for the first visit, and 1000/– for each one after that."

The woman went to the doctor’s office and, trying to save a little money, cheerily announced. "I’m back!" Not fooled for a second, the doctor Robert quickly examined her and said, "Very good, just continue the treatment I prescribed on your last visit."

    Readers Responses

To The BOG, MCI,
Dwarka Phase I, New Delhi,

Sub: Recent affairs in the Forensic Medicine.

Sir, I am writing this letter to express my view regarding the recent reduction of staff in the department of Forensic Medicine for your kind consideration.

  1. At anytime of the year, we have two batches of students in the department. Moreover, teaching of the subject involves theory as well as practicals, including the demonstration in the form of OSPE and all as well as the tutorial classes. In a tutorial or practical class, we can take care of only twenty or at the most twenty students; more than this number makes a crowd and the teaching process is hampered. So, reduction of staff will lower the standard of teaching.
  2. The department is involved in the medico–legal autopsies as well as other medic–legal works. As a result of it, they have to frequently attend the Hon’ble courts. So, reduction of staff will sometime create a situation, when no one will be available for taking class in the department.
  3. Reduction of staff will also discourage the doctors for coming to this department for MD courses that will lead to less number of forensic medicine experts in the country as well as, there shortage of faculty for the upcoming medical colleges. Moreover, we need more and more forensic medicine experts in the country not only for the medical colleges, but also, for performing the medico–legal works in the PHCs or the district hospital. In most of the time, the medico–legal works in the peripheral hospitals are done by non forensic medicine persons which are not up to the mark and that leads to denial of justice to the victims. So, I feel that we need a lot of specialists in this branch of not only for the interest of medical teaching, but also for the interest of criminal justice. So instead of reducing the staff in the department, we should think about increasing the PG seats in the subject with adequate facilities in the department.
  4. The marks for Forensic Medicine in the 2nd Prof exam have been reduced few years back resulting in decreased importance of the subject amongst the students which is not good for the interest ML cases in the country. I, therefore, propose to increase the marks at least to 200 (theory–100, viva–40, practical–40, theory internal assessment–10 and practical internal assessment–10.).

Hope you will actively consider the above mentioned points and do the needful accordingly in this regard. Dr. A.J. Patowary, Asstt. Prof. Forensic Medicine, Assam Medical College, Dibrugarh, Assam.

    Public Forum

(Press Release for use by the newspapers)

Stress may increase smoking habits

Stress increases the risk of heart attack by pushing people toward bad habits, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. K K Aggarwal, President, Heart Care Foundation of India.

A British study published in the Journal of the American College of Cardiology suggests that people with psychological stress had a 50 percent increased risk of a cardiovascular disease event over the follow–up period. The reasons were higher smoking rates and low exercise levels of individuals who were stressed.

In the study, over a seven year follow–up period, incidence of cardiovascular events –– heart attacks, stroke, bypass surgery and the like –– was 50 percent higher among people with a high level of depression and anxiety when compared to happier people. Smoking and lack of physical activity explained about 63 percent of the increase, with smoking alone responsible for 41 percent. Alcohol intake explained less than 2 percent of the increase, with high blood pressure assigned 13 percent of the blame.

All such patients should be treated with combined physiological approaches with intensive lifestyle changes to reduce modifiable risk.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant

Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani

9.00 – 9.30 AM:
Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
9.30 – 10.00 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Hospital
10.00 – 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 – 11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion
12.00 Noon: Lunch

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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