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FIRST NATIONAL 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 ...

22nd September, 2010, Wednesday

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

Medicare to cover smoking cessation: will India follow?

The US Medicare will now cover tobacco cessation counseling –– the Department of Health and Human Services announced. The new coverage was mandated by the Affordable Care Act (ACA), which contains a number of measures that focus on preventing diseases before they occur, such as paying for cancer screenings, and annual no–cost wellness checkups. Previously, Medicare only covered smoking cessation counseling if a recipient had already been diagnosed with a tobacco–related disease or showed symptoms of such a disease.

In India, the insurance companies, PSUs, CGHS etc should follow that and pay for the addiction screening and de-addiction program. In long run it will be cheaper for them.

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

  Photo Feature (from the HCFI Photo Gallery)

Perfect Health Mela (PHM) since its inception has been an effort for creating health awareness using various modules and folk forms. The Mela utilizes the talents of budding artists to bring about health awareness among masses.
In the photo: Dr Harsh Vardhan, politician; Mr Shatrughan Sinha, Actor Politician.

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Lung cancer screening

A randomized trial of lung cancer screening in over 3,000 high–risk individuals found cumulative probability of a false positive finding of 33 percent for screening by low–dose CT and 15 percent for chest x–ray.

(Reference: Croswell JM, Baker SG, Marcus PM, et al. Cumulative incidence of false–positive test results in lung cancer screening: a randomized trial. Ann Intern Med 2010;152:505).

  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.

Raise retirement age of government doctors’

To overcome the shortage of medical practitioners, the Medical Council of India (MCI) has recommended enhancing the retirement age of government medical professionals to 70 years from the existing 65 years. It has also suggested relaxations in the land requirement for setting up new medical colleges. Announcing this at a press conference here on Saturday, S.K. Sarin, Chairman of the Board of Governors of the MCI, said enhancing the retirement age of government medical professionals would help in producing more MBBS doctors and prevent private medical colleges from poaching on experienced and talented teachers. (Source: The Hindu)

  International News

(Dr Brahm and Dr Monica Vasudev)

Bariatric surgery may reduce medication use for the obese with type 2 diabetic

A new research from the Johns Hopkins University School of Medicine has found that diabetics who undergo weight–loss surgery need fewer medications to control blood sugar. In the study, three–quarters of obese patients with type 2 diabetes are able to stop insulin and other blood–sugar controlling drugs within six months of undergoing bariatric surgery. The study is published in the Aug. 16 in the Archives of Surgery.

Dark chocolate may reduce heart failure risk in women

According to a study published in the journal Circulation: Heart Failure, eating a little dark chocolate in moderate amounts can be healthful. Women who consumed 1 to 2 servings of chocolate a week enjoyed a 32% lower risk of heart failure than those who ate no chocolate at all during the 9–year trial.

Red meat may be linked to increased heart risks in women

If you eat red meat more than one time in a day, reducing this to one serving every other day can reduce to a large extent your risk of having a heart attack or dying from heart disease, says a study published in the journal Circulation. A serving of chicken or turkey to replace one of beef, pork, or lamb would lower coronary heart disease risk 19%.

Competitive, aggressive individuals more prone to heart attack and stroke

Individuals who tend to be confrontational, especially those who are competitive and aggressive, run a higher risk of heart attack and stroke, according to a study published in Hypertension: Journal of the American Heart Association.

New Rotavirus Vaccine

As per a recent publication in Lancet, an effective Rotavirus vaccine to control diarrhea in children of Asia and Africa subcontinent has been found to be effective as shown in clinical trials carried out in Ghana, Kenya, Bangladesh and Vietnam. This vaccine reduces mortality of about 48.3% in vaccinated children. Non vaccinated children may also benefit due to herd immunity.

(Contributed by Dr. D. R. Nakipuria, Siliguri)

  Hepatology Update

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

Can celiac disease present with abnormal liver function tests?

Yes, celiac disease can present with abnormal liver enzymes; therefore, screening of celiac disease in patients with raised liver enzymes, especially if there is associated anemia, is a must.

  Infertility Update

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

What is ICSI?

ICSI stands for intracytoplasmic sperm injection. It is used in cases of very low sperm counts. The single sperm after preparation is injected in the oocyte. The sperm can be ejaculated or aspirated from testis or epididymis. This is an advanced ART procedure and technically demanding.

What are the risks of IVF?

Ovarian hyperstimulation, ectopic pregnancy, multiple pregnancy are seen occasionally. Risks at oocyte retrieval of bowel and vascular injuries are also mentioned in the literature.

  ENT Update

Dr. Aru Handa MS, DNB (Dept, Co–ordinator and Senior Consultant Dept. of ENT, Moolchand Medcity)

What is Tinnitus?

Tinnitus or ringing in the ear is a symptom and not a disease. It is a subjective feeling of sound in the ear or head without there being a physical sound in the external environment. Most of us experience some degree of tinnitus when put in a sound proof room. It can be very troublesome for some leading to lack of concentration, insomnia and even depression. The causes for tinnitus can be as simple and innocuous as wax in the ear to as serious as eighth nerve tumor. Loud sound exposure, hearing loss, ear infection and ototoxic drugs are some of the other causes. All patients of tinnitus should undergo a thorough ENT examination including audiological assessment. Some may also require radiological investigations. Management depends on the cause. Patients troubled by tinnitus require tinnitus retraining therapy which includes counseling and sound therapy.

  Cardio Update: Question of the Day

Should all patients with suspected heart failure have an echo and BNP testing? (Dr GM Singh)

The updated NICE guideline for heart failure, currently out for consultation, recommends BNP testing for all patients suspected of having heart failure. But those who have had a previous myocardial infarction should go straight forward for an echocardiogram – within 14 days – without the need for BNP. A heart failure prevalence study in Birmingham showed an incidence of LVSD of 22% in patients with previous MI, so referring patients with a previous myocardial infarction for echocardiography mines a rich seam of heart failure. These patients are often tired and breathless but simply put it down to having had a heart attack.

BNP is incredibly helpful for GPs as a rule–out test. The symptoms of heart failure can be very vague. We are used to dealing with uncertainty but having a test with such high sensitivity and specificity is a boon and very few people with heart failure have a normal BNP – fewer than 1%. The value of BNP in prognosis and follow-up is still a matter of debate and research in cardiology circles and the test cannot yet be recommended routinely for this. But we do know that the higher a patient’s BNP, the more likely they are to die and it is probably a closer indicator of mortality than any other biomarker outside oncology.

  Medicolegal Update

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

Family decisions in US court Terminate medical care when the patients have not left explicit statements

In Cruzan, the US Supreme Court held that there is no constitutional requirement that families be permitted to exercise the right of mentally incapacitated patients to terminate care when the patients have not left explicit statements of their preferences. Importantly, however, the Court did not delineate uniform national rules regarding who should decide for mentally incapacitated patients. Instead, the Court permitted each state to make the rules it deemed best. The Court also endorsed, as legally acceptable but not required, Missouri’s contention that the "evidence of the incompetent’s wishes as to the withdrawal of treatment be provided by clear and convincing evidence".

  Medi Finance Update

Equity Funds

  • Equity funds invest primarily in stocks.
  • It is because stocks have traditionally risen in value.
  • More than other types of investments, they offer the greatest potential for long–term growth.
  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date

Notification

Fenformin

Oct.1, 2003

GSR 780(E)
dt.1.10.03

  Lab Update

Renal Biopsy, Light Microscopy

For clinical evaluation and management of patients with undiagnosed kidney disease; the clinical setting may include acute renal failure, nephrotic syndrome, asymptomatic proteinuria and hematuria. Biopsy of the transplanted kidney is important in the determination of the presence of acute rejection, infection, or recurrent disease.
Optimal interpretation of a kidney biopsy requires integration of clinical and laboratory results with light microscopic, immunofluorescent histology, and electron microscopy findings.

(Contributed by Dr Arpan Gandhi and Dr Navin Dang)

  IJCP Special

Dr Good Dr Bad

Situation: A 16–year–old female was diagnosed to have calcific lesions in the ventricles on a CT scan.
Dr Bad: This is a typical case of neurocysticercosis.
Dr Good: This is not neurocysticercosis.
Lesson: Calcification in neurocysticercosis is seen only in the parenchyma and not in the ventricles or cisterns.

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics.
Reaction: Oh my God! What was the need of giving the antibiotics?
Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.

Quote of the Day

"Honesty is something you can’t wear out". Waylon Jennings
(Contributed by Dr. GM Singh)

Hypertension Alert

One should consume a diet rich in fruits, vegetables, and low fat dairy products with a reduced content of saturated and total fat. It can reduce blood pressure by 8–14 mm Hg.

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  Mind Teaser

Read this…………………

AALLLL

The answer for yesterday’s Mind Teaser: "Odds and ends".

Correct answers received from: Dr.K.V.Sarma,, Dr.Lokesh kumar Garg, Dr Jayashree B Keshav, In Charge - Scientific Publications, The Himalaya Drug Company, Dr Chandresh Jardosh, Dr Kalpana Mohan, Dr Sudha Nayyar, Dr.R.K.Agarwal, Dr.Susheela Gupta

Answer for 20th Sept Mind Teaser is: "Big fish in a little pond".
Correct answers received from: Dr.Asim Kumar Sen, Dr Anurag Jain, Dr Riddhi Jaiswal, Dr Rashmi Chhibber, Dr U Gaur, Dr Aruna Tyagi, Dr. Alok Deb, Dr Vijay Gaur, Dr Aditya Rattan, Dr Rajiv Khosla, Dr S. Upadhyaya, Dr.R.Dhillon, Dr.G.Padmanabhan, Dr Devi Prasad Mohapatra, Dr. Dinesh Kumar S

Send your answer to ijcp12@gmail.com

  Humor Section

Interesting aspect of mathematical calculation in human life
How to avoid irritation
A Man mostly never irritated by A Woman during first and personal encounter.
A Woman mostly shows irritation with modesty even during first and
personal encounter.
(Contributed by DR. Dewat Ram Nakipuria)

Important laws which great Newton forgot to state

Law of the Workshop
Any tool, when dropped, will roll to the least accessible corner.
(Contributed by Dr. Chandresh Jardosh)

  An Inspirational Story

30 Seconds speech by Bryan Dyson – Former CEO of the Coca Cola

Imagine Life as a game in which you are juggling some five balls in the air. They are Work, Family, Health, Friends and Spirit and you’re keeping all of these in the air.
You will soon understand that Work is a rubber ball. If you drop it, it will bounce back. But the other balls - Family, Health, Friends and Spirit – are made of glass. If you drop one of these; they will be irrevocably scuffed, marked, nicked damaged or even shattered. They will never be the same. They will never be the same. You must understand that and strive for it.
Work efficiently during office hours and leave on time, give the required time to your Friend, Family and have proper rest.

Value has a Value only if its Value is Valued
(Contributed by Sumit Chug)

  Readers Responses
  1. Dear Sir, I congratulate emedinews for providing us with daily updates on happenings in India and around the world. It’s an excellent roundup of new research from all over the globe. I especially read with interest the inspirational stories. As has been rightly said, we should not look to changing others, but changing ourselves. Regards: Dr GM Singh
  Public Forum

(Press Release for use by the newspapers)

 Dil Ka Darbar to Focus on Heart Diseases in Women

The forthcoming BSNL Dil Ka Darbar being organised by Heart Care Foundation of India, to earmark World Heart day, on Sunday 26th September at Maulana Azad Medical College Auditorium will have a special focus on women and sudden cardiac death.
Addressing a press conference here today Padma Shri and Dr BC Roy National Awardee Dr. K K Aggarwal, President, Heart Care Foundation of India and BSNL Dil Ka Darbar, and Dr Aparna Jaiswal, Sr. Cardiologist, Escorts Heart Hospital, said that heart disease kills more women than all cancers combined in women including breast cancer. Normally, women are not supposed to get heart attack before menopause but the ratio now a days, is 40:60 indicating a faulty lifestyle amongst women.
Being an Indian woman, is a risk factor for heart attack. A study from UK had shown that Indian women are 17% more prone to get heart attack than a local UK women. Indian women are more prone to develops obesity, fatty liver, diabetes and insulin resistance.
Earlier women used to prevent heart attack by indulging into regular walks, skipping, dancing and games like Kikli at ceremonies but now, most women are living a faulty lifestyle indulging into both active and passive smoking, having late nights with faulty diet heavy in white sugar, white maida and white rice.
Heart attack in women is more serious, more fatal and less attended to. Chances of women undergoing angioplasty or bypass surgery are also less than that of any man.
Star attraction of the press conference was the presence of renowned Bharatnatyam exponent Padma Shri Ms Geeta Chandran who laid stress on the danger of heart diseases on women. She said that smoking boosts the risk of stroke and that dancers cannot perform if they smoke.

Formula of 10 released
In cardiac arres one should rememebr the formula of ten " dus minute ke ander, dus minute tak, apni chaati peetne ke badle, marij ki chaati 100 per minute ki speed se peeto". The formula was released by Padma Shri Geeta Chandran.
 
Free check ups at Darbar
Free ECG, consultation, lipid profile and other blood tests will be available at the Darbar. Heart drugs can be purchased at 50% of the cost and special cardiac blood tests will also be available at 50% of the cost. Angiography facilities will be available at Rs 6999/- for the needy.
 
Ask your questions at the Darbar
8-4 pm will have top cardiologists Dr KK Aggarwal, Dr Aparna Jaswal, Dr Naresh Trehan,  Dr OP Yadava, Dr Vanita Arora, Dr Anil Saxena, Dr KK Saxena, Dr Neelam Mohan, Dr Kaberi Banerjee, Dr Vinod Sharma, Dr Praveen Chandra, Dr Vijay Trehan, Dr Sanjay Tyagi etc answering public queries on all issues related to heart disease. Experts from other pathies will also be present.
 
Sh Rakesh Mehta CS Delhi to be the chief guest
Sh Gopal Das CMD BSNL will inaugurate and Sh Rakesh Mehta CS Delhi will be the chief guest for the function. 
 
Facts about women and heart
Although traditional risk factors for coronary artery disease such as high cholesterol, high blood pressure and obesity affect both women and men equally, many factors play a bigger role in the development of heart disease in women. For example:

1. Metabolic syndrome a combination of fat around the abdomen, high blood pressure, high blood sugar and high triglycerides has a greater impact on women than on men.
2. Mental stress and depression affect women's hearts more than men's.
3. Smoking is a greater risk factor for heart disease in women than in men.
4. Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease).
5. While heart disease is the leading cause of death for women 65 and older, it's the third-leading cause of death for women aged 25 to 44 year and the second-leading cause of death for women aged 45 to 64 year. Women under the age of 65 who have a family history of heart disease should pay particularly close attention to the heart disease risk factors. Still, all women, of all ages, should take heart disease seriously.
6. The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it's not always severe or even the most prominent symptom, particularly in women. Women are more likely than men to have signs and symptoms unrelated to chest pain, such as:  Neck, shoulder, upper back or abdominal discomfort; shortness of breath; nausea or vomiting; sweating; light-headedness or dizziness; unusual fatigue. These signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks. This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart a condition called small vessel heart disease.
7. In some women, plaques build up as an evenly spread layer along artery walls, which isn't treatable using procedures such as angioplasty and stenting designed to flatten the bulky, irregular plaques in arteries of men. For some women, drug treatment rather than angioplasty or stenting may be a better option.
8. Certain heart medications, such as clot-busting drugs (thrombolytics) tend to be more effective in women than in men. Aspirin therapy benefits both men and women, but there's also a difference between men and women in the effects of aspirin therapy. In women,
aspirin therapy seems to reduce the risk of stroke more than in men, while in men it reduces the risk of heart attack more than it reduces stroke.
9. There are several lifestyle changes that women can make to reduce their risk of heart disease:  Exercise 30 to 60 minutes a day on most days of the week; Maintain a healthy weight; Quit or don't start smoking and eat a diet that's low in saturated fat, cholesterol and salt.  
10. Some women at high risk of heart disease may also benefit from the use of supplements, such as omega-3  fatty acids.
11. Today 1 in 2 women die of heart disease or stroke, compared with 1 in 25 women who die of breast cancer. 42% of women who have heart attacks die within 1 year compared with 24 percent of men. 
12. Smoking by women causes almost as many deaths from heart disease as from lung cancer.
13. Women with heart disease are more likely to die (5.6% of the women versus 4.3% of the men).
14. one of every 2 deaths in women is from heart disease, only 1 in every 30 deaths is from breast cancer. Over 60% of women believe their biggest health threat is breast cancer but heart disease kills 6 times as many women as breast cancer. Most women do not realize heart disease is a health threat. 
15. Women who smoke are 2 to 6 times more likely to suffer a heart attack than a non smoking woman and the risk increases with the number of cigarettes you smoke each day. Smoking also boosts the risk of stroke. Women who smoke risk having a heart attack 19 years earlier than non smoking women.
16. Women with diabetes are 2 to 3 times more likely to have heart attacks.

Both cardiologists who addressed the media appealed to the public to attend the Darbar in large numbers.
Acharya Dr. Sadhavi Sadhna Ji Maharaj, Chairperson, World Fellowship for Religions said that coronary heart disease is every woman’s concern.
Sh Sanjay Sinha Jt GM (PR) from BSNL said that coronary heart disease is the number one cause of death in women and BSNL has taken the responsibility to spread this message.
Dr P K Sharma MOH NDMC, Dr N K Yadav MHO MCD said that the survival rate following a heart attack is lower among women than men. Reasons for high mortality in women include differences in diagnosis, treatment, symptoms, reaction to drugs and age at the onset of the disease.

  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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