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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 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

 

eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

 
  Editorial …

21st July 2011, Thursday

Schedule HX is not patient–friendly

The recent move on the part of the Union Health Ministry to amend the Drugs and Cosmetic Rules 1945 through Schedule HX is creating a stir among chemists and pharmacists, who are opposed to it. Even for the medical profession, this amendment is not patient–friendly.

Under the Schedule HX, the drugs for TB (Rifampicin, Isoniazid and Pyrazinamide), Ciprofloxacin and Norfloxacin (for Diarrhea) and Framycetin (for burns) would no longer be as easily available as they are today.

The Schedule HX has Part A and Part B. And, according to it, 16 antibiotics in Part A would be sold directly by drug manufacturers to the tertiary care hospitals, and 74 drugs in Part B can be sold by the chemist only on the prescription of Registered Medical Practitioners in duplicate. The extra copy of the prescription would be kept with the chemist for a further 2 years.

The schedule talks about the need to have tertiary hospitals, registered medical practitioners and prescriptions in duplicate for the drugs in Schedule HX.

  1. There are no tertiary hospitals in the rural areas.
  2. Newer antibiotics are very costly and if they can only be prescribed in a tertiary care hospital, will people be able to afford these hospitals?
  3. ICU care in a tertiary hospital may cost 30-50,000 per day.
  4. Today many chemists offer hefty discounts on branded drugs as they play with margins of up to 40%. No tertiary care hospital will pass on this discount to the patient.
  5. A patient may have to be given antibiotic for weeks and most of this period may be ambulatory at home through a private nurse. Will the prescription be allowed from a tertiary care hospital pharmacy as an outpatient?
  6. Patients requiring these drugs invariably will be required to be transferred to a tertiary care hospital for the treatment. This may not be in the interest of the patient and the treating doctor.

For More editorials...

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

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

Schedule HX is not patient–friendly

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issues

Dignitaries on the dias at the recently concluded National Conference on Insight on Medico Legal Issues

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

78–yr–old man is oldest to undergo liver transplant

A resident of Mumbai, Mehra was on Sunday declared the oldest recipient of a living donor liver transplant who is now leading a normal life. He underwent a successful liver transplant after his daughter donated a portion of her liver. "In today’s fast changing world age remains no criteria for getting a liver transplant done. We have one successful liver transplants on 240 patients at New Delhi’s Medanta Hospital in the last one year on patients of three months of age to 78 years," Dr A Soin, chairman, Institute of Liver Transplant and Regenerative Medicine, Medanta Hospital, said. (Source: TOI, Mumbai edition July 18, 2011) For comments and archives

13 cases of malaria in a week

NEW DELHI: The city has registered 13 cases of malaria in the last one week. According to statistics by MCD, a total of 53 cases of malaria have been reported in the current season as against 13 cases registered in the same period last year. Five cases of dengue have been reported but there have been no cases of chikungunya so far. "Mosquito–breeding has gone up due to intermittent rain. Fumigation and other measures to check mosquito–breeding have been taken up," said Dr V K Monga, chairman of the MCD health committee. (Source: TOI, Jul 19, 2011) For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Dr Monica and Brahm Vasudev)

Rapid TB test reliable in kids

A rapid automated test for tuberculosis –– already recommended by the World Health Organization for disease detection in adults –– proved more effective than smear microscopy for identifying Mycobacterium tuberculosis infection in children, a large prospective study found. Using two induced sputum samples from children whose median age was 19.4 months, the Xpert MTB/RIF test detected 75.9% (95% CI 64.5 to 87.2) of cases of tuberculosis, according to Mark P. Nicol, PhD, of the University of Cape Town in South Africa, and colleagues. In contrast, smear microscopy only detected 37.9% (95% CI 25.1 to 50.8), the researchers reported online in The Lancet. Diagnosis of tuberculosis –– particularly in the lower–income parts of the world where the disease flourishes –– typically has relied on smear microscopy. (Source: Medpage Today) For comments and archives

ICAD: Eyes have it for early Alzheimer’s detection

The eyes are a window into the brain for many disorders, and Alzheimer’s disease may be no exception, a researcher said here. In a pilot study, retinal scans to measure blood vessel thickness at the back of the eye showed strong correlations with the level of beta–amyloid deposits in the brain, said Shaun Frost, a doctoral student in the e–Health Research Center operated by the Australian national research organization CSIRO. (Source: Medpage Today) For comments and archives

FDA reviewers flag cancer risk in diabetes drug

FDA reviewers said the novel diabetes drug dapagliflozin appears effective at treating diabetes, but may pose breast and bladder cancer risks as well as liver toxicity. The FDA’s Endocrinologic and Metabolic Advisory Committee will meet Tuesday vote whether the drug –– which is the first of its kind to go before an FDA panel –– should be approved as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Dapagliflozin is an inhibitor of the sodium glucose cotransporter–2 (SGLT2) which works by increasing renal glucose elimination, allowing more sugar to be excreted with urine rather than being absorbed into the bloodstream. (Source: Medpage Today)

For comments and archives

 
    Fitness Update

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

Older people must work out more to keep muscles

The older you get, the more you may have to work to maintain your muscles, according to a new study. Researchers report that men and women over the age of 60 have to lift weights more often than younger adults to maintain muscle mass and muscle size. "Our data is the first to suggest that older adults require greater weekly maintenance dosing than younger individuals to maintain resistance–training–induced increases in muscle mass," study co–researcher and physiologist Marcas Bamman, PhD, of the University of Alabama, Birmingham, says in a press release. The study is published in Medicine & Science in Sports & Exercise. (Source: http://www.webmd.com/fitness-exercise/news/20110708/older–people–must–work–out–more–to–keep–muscles)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: #AJOR Common overuse injuries in runners and other endurance athletes include patellofemoral pain syndrome,… http://fb.me/DzBDNewY

@DeepakChopra: #CosmicConsciousness Before you have a creative idea does it exist in a field of possibilities or a field of molecules?

 
    Dr KK Answers

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

What is the role of apixaban in AF?

Apixaban (Factor Xa inhibitor) as anticoagulant (blood thinner) is being tested. In the AVERROES trial, 5599 atrial fibrillation (irregular heart rhythms of the smaller atrial chamber) patients in whom warfarin was felt to be unsuitable were randomly assigned to either apixaban or aspirin. The study was stopped prematurely because of a clear benefit in favor of apixaban (lower rate of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage). (N Engl J Med 2011;364(9):806–17) For comments and archives

 
    Spiritual Update

Formulas to Improve the Soul Profile

The soul in Vedic description is described as ‘Satchitananda’ where ‘Sat’ means ‘truth or knowingness’; ‘Chita’ means ‘conscious–based’ and ‘Ananda’ means ‘bliss or inner happiness’. People in touch with their soul speak the truth, take consciousness–based decisions an For comments and archives

 
    An Inspirational Story

(Dr Prachi)

For closeness: T–R–A–V–E–L

Inmate Mitchell King had a visitor — his wife. King was serving a six–year jail term in Auckland, New Zealand for armed robbery. But his wife did not want to be away from him for that long. So they held hands… and they stuck. She had rubbed her palms with Super Glue. Their new–found closeness was short–lived. And their separation was painful.

This technique is not recommended for a "close relationship." But if you want more closeness… if you desire relationships that are deeper and broader, more meaningful and longer–lasting, then remember the acronym "TRAVEL."

T is for TRUST – Trust is the glue that holds people together (not Super Glue). A relationship will go nowhere without it.

R is for RESPECT – "Do not save your loving speeches for your friends till they are dead; do not write them on their tombstones, speak them rather now instead," writes Anna Cummins. It’s about respecting others and letting them know that you value them.

A is for AFFECTION – Sometimes affection means love. Sometimes it means a touch. Always it means kindness.

V is for VULNERABILITY – Though we may feel afraid to let another too close, no relationship will go anywhere without risking vulnerability. Entrepreneur Jim Rohn says, "The walls we build around us to keep out the sadness, also keep out the joy." And the love.

E is for EMOTIONAL INTIMACY – Learn to be open. Learn to communicate freely. What kinds of relationships you make are largely determined by how openly you have learned to communicate.

L is for LAUGHTER – Victor Borge got it right when he said, "Laughter is the shortest distance between two people." It’s also the most enjoyable.

For relationships that can really go somewhere, just remember the word "TRAVEL"… Then enjoy the trip!

(Source: http://www.inspire21.com/stories/friendshipstories/TRAVEL)

For comments and archives

 
    Idioms

(By Ritu Sinha)

A piece of cake: A task that can be accomplished very easily.

 
    Pediatric Update

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

What is the best vaccination schedule for hepatitis B?

The reasons for recommending hepatitis B vaccine, at birth are firstly, people have a very high risk for developing chronic HBV infection if they become infected at birth or during childhood, with an increased risk of dying prematurely from liver cancer or cirrhosis. In addition, HBV infection in infants and young children usually produces no symptoms, so these individuals can spread the infection to others without knowing it. Thirdly, most early childhood spread of HBV occurs in households where a person has chronic HBV infection, but the spread of HBV has also been recognized in daycare centers and schools. Fourthly, long–term protection following infant vaccination is expected to last for decades and will ultimately protect against acquiring infection at any age. The best vaccination schedule suggested for our country where horizontal and vertical transmission are common is at birth, 1 month and 6 month. At the same time, do not use the combination vaccine before the age of 6 weeks. For comments and archives

 
    Did You Know

(Dr Uday Kakroo)

The moon moves about two inches away from the Earth each year.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

CBC (Complete Blood Count)

CBC can reveal problems with RBC production and destruction, or help diagnose infection, allergies, and problems with blood clotting. A CBC test measures the following:

  • The number of red blood cells (RBCs)
  • The number of white blood cells (WBCs)
  • The total amount of hemoglobin in the blood
  • The fraction of the blood composed of red blood cells (hematocrit)

It also provides information about the following measurements:

  • Average red blood cell size (MCV)
  • Hemoglobin amount per red blood cell (MCH)
  • The amount of hemoglobin relative to the size of the cell (hemoglobin concentration) per red blood cell (MCHC)

MCV, MCH, and MCHC values reflect the size and hemoglobin concentration of individual cells, and are useful in diagnosing different types of anemia.

The platelet count is also usually included in the CBC.

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A 39–year–old male with community–acquired pneumonia came for OPD treatment.
Dr Bad: You need admission for IV ceftriaxone therapy.
Dr Good: Take Levofloxacin 500 mg orally.
Lesson: A prospective, randomized, multicenter trial of 599 adults with community-acquired pneumonia who could be treated as an outpatient or in the hospital compared the efficacy of levofloxacin (500 mg IV or orally daily) to ceftriaxone (1 to 2 g IV once or twice daily) and/or cefuroxime (500 mg orally twice daily) with or without erythromycin or doxycycline. Clinical success at 5 to 7 days after treatment was superior with levofloxacin (96%) compared with either cephalosporin arm (90%) (Antimicrob Agents Chemother 1997;41(9):1965–72). For comments and archives

Make Sure

Situation: A patient with suspected heart attack with blood pressure of 40 mm Hg with warm peripheries died?
Reaction: Oh my God! Why was a diagnosis of anaphylaxis not considered?.
Lesson: Make sure all patients with warm shock are managed on the lines of sepsis or anaphylaxis. Heart attack will present as cold shock. For comments and archives

 
  Quote of the Day

(Dr GM Singh)

To acquire knowledge, one must study; but to acquire wisdom, one must observe. Marilyn vos Savant

 
    Medicolegal Update

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

What is the Section 324 of IPC in medical practice?

Section 324. Voluntarily causing hurt by dangerous weapons or means: "Whoever, except in the case provided for by section 334, voluntarily causes hurt by means of any instrument for shooting, stabbing or cutting, or any instrument which, used as weapon of offence, is likely to cause death, or by means of fire or any heated substance, or by means of any poison or any corrosive substance, or by means of any explosive substance or by means of any substance which it is deleterious to the human body to inhale, to swallow, or to receive into the blood, or by means of any animal, shall be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both".

It is the duty of the attending doctor to record all injuries, their dimension as much as possible, and the body parts where the injuries are located; the nature of injury whether simple or grievous, whether caused by sharp/blunt object, age or duration of injury and vital parameters like blood pressure, pulse respiration along with the mental status of the patient.

When an investing officer comes to the hospital he needs some specific answers for his legal investigation and to book a case under the law of land.

  • Are the injuries present self–inflicted or fabricated? If yes, please mention the forensic justification.
  • Are there any signs/symptoms or smell of alcohol or any drug intoxication? If yes, please opine about the mental status due the influence of intoxication. Also, preserve the sample of blood.
  • Please opine if the injured or intoxicated patient is fit to give statement? If no, please give due reasons and an approximate time interval for medical re–evaluation for his/her fitness for statement.
  • Is the condition of patient critical, severe or serious? If so, the dying declaration must be recorded by attending doctor before one or two witnesses.
 
    Mind Teaser

Read this…………………

The prevalence of symptomatic bacteriuria in pregnant women is

a. 25%
b. 30%
c. 10%
d. <5%

Yesterday’s Mind Teaser: timertimer

Answer for Yesterday’s Mind Teaser: Two–timer

Correct answers received from: Dr K Raju, Dr Sudipto Samaddar, Dr Rajiv Dhir, Dr HL Kapoor,
Dr yj vasavada, Dr Neelam Nath.

Answer for 19th July June Mind Teaser
: Little House on the Prairie
Correct answers received from: Dr Anupam, Dr Sobodh, Dr Priyanshu, Dr Ketan, Dr Ravi, Dr Rashmi.

Send your answer to ijcp12@gmail.com

 
    Medi Finance Update

(Dr GM Singh)

What is wealth management?

Wealth management is the management of one’s wealth by a professional trained to get maximum value for one’s financial assets. An investment advisory discipline, it incorporates various aggregated financial services such as financial planning, investment portfolio management, etc.

 
    Laugh a While

(Dr GM Singh)

"As a nurse midwife in a hospital, we know babies are slippery. After delivering the baby, the doctor dropped it into the bucket. Fortunately, it wasn’t harmed. Then, he dropped it a second time, and again, the baby was unharmed.

And what was the doctor’s quick remark to the parents? "Sometimes we have to drop them twice to get them to cry."

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
Indication
DCI Approval Date
Metformin HCl IP 500mg + Alpha Lipoic Acid USP 200mg Tablet
For the treatment of patients with diabetic polyneuropathy

05.01.11

 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online (English/Hindi/Audio/Video/Photo)

18th MTNL Perfect Health Mela 2011 in October

The 18th MTNL Perfect Health Mela 2011, a joint Bhagidari project of Heart Care Foundation of India and World Fellowship of Religions with Dept of Health Govt. of Delhi, MCD and NDMC will be held from 14th to 23rd October 2011. The event will include multi location activities from 14th to 18th and then the Health Mela from the 19th to 23rd at the NDMC Ground, Laxmibai Nagar, New Delhi.

The basic objective of the Mela is to create awareness about all aspects of health among people from all sections of the society and walks of life by incorporating all pathies under one roof using cost-effective infotainment modules.

The main activities will involve Harmony-inter school festival, Eco Fest-inter echo clubs school festival , Divya Jyoti-inter nursing school festival, Medico Masti-inter medical college and college festival , Heritage-inter dancing school festival, Anmol- Festival for children with special needs, Medline-live video conferencing between Delhi & Mumbai doctors interacting with patients, Jaago India-media festival, Swasthya Pavillion-general and specialty checkups and cultural programs.

The main focus of the event this year will be on creating awareness on Normal Weight Obesity, which affects over 75% of the society and Science behind Rituals and Mythology. Giving the details, Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart care Foundation of India and MTNL Perfect Health Mela said that every ritual has some scientific basis and explanation.

Talking about normal weight obesity, Dr. Aggarwal said that any weight gain of more than 5 kg after the age of 18 is abnormal and one can have obesity even when the weight is within the normal range.

There will be a special campaign on awareness on Facebook and Twitter about the events and activities.

For comments and archives

 
    Readers Responses
  1. Great idea, must be propagated in a big way. Guru Purnima as Teacher’s Day. No need for 5th Sept Teacher’s Day, Religion and politics combined. Vivek Kumar, Varanasi.
  2. Dear Dr Agarwal, I wish to congratulate you on today’s editorial regarding MOH new policy. You have echoed the thoughts of all the medical professionals.The Hippocraic Oath is the deciding principle of doctor-patient relationship. Only a doctor can look into the interests of patient. Most of us always think of the paying capacity of the patient before writing prescription. Different formulations available in market have different stregths and cannot be left to the discretion of the pharmacist. Generic drugs, which in many chemist stores have inflated MRP written over them and in fact in many cases are costlier than the branded drugs. In pediatric practice sometimes we have to change the brand because children like different flavors and may vomit out the medicine if they do not like the flavour of a certain medicine that has been prescribed. I hope some person from MOH reads the emedinews daily. Sincerely: Dr R S Bajaj, Consultant Pediatrician, Rohini, Delhi
 
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.

...more

………………………………………………………………

Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011
(Screening of films October 14–17, Jury Screening at Jamia Hamdard University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi

...more

………………………………………………………………

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