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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 ...

22nd November 2010, Monday

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

Do not re warm cardiac arrest patients too soon after hypothermia

In cases of cardiac arrest, American Heart Association (AHA) guidelines suggest lowering patient’s body temperature to between 90 and 93 degrees Fahrenheit for about 24 hours in order to reduce the demand for oxygen and give the brain and other organs time to recover. The body is eventually and slowly warmed back to normal temperature and neurological activity is assessed after three days. But, three separate studies have shown that three days may be too short a period. These patients may need care for up to a week before they regain neurological alertness. Withdrawing life support 72 hours after re–warming ‘may prematurely terminate life in at least 10 percent of all potentially neurologically intact survivors’ of cardiac arrest treated with hypothermia.

Intensive statin therapy lowered risk even for low LDL patients

A meta–analysis has shown that as LDL cholesterol decreased further, the risk of heart attack, revascularization and ischemic stroke also decreased, with no bottom threshold or significant increase in adverse events. The analysis included data from 170,000 patients in 26 randomized trials comparing either more intensive against less intensive statin regimens or statins against controls. The more intensive regimens reduced major vascular events by 15% more than the less intensive regimens. For every 39 mg/dL that statins lowered patients’ LDL cholesterol, all–cause mortality was reduced by about 10%. The benefits were similar in all types of patients, including those with LDL lower than 77 mg/dL. The greatest reductions were seen in CHD deaths and death from other cardiac causes. The analysis, published in The Lancet on Nov. 13, also found a non significant increase in hemorrhagic strokes associated with lowering LDL. The overall effect of reduced LDL on deaths from stroke or other vascular causes was not significant. There was no evidence of an increase in cancer associated with the use of statins. Blood monitoring should be considered for any patients placed on an 80–mg dose of simvastatin, the study authors concluded. The results of the meta–analysis should not be understood to suggest that statin therapy should target an LDL of less than 77 mg/dL but that high–risk patients whose baseline is below that level may still benefit from intensive therapy. (ACP Internist)  

Dr KK Aggarwal
Editor in Chief
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  SMS of the Day

(By Dr. G M Singh)

"It’s nice to be important, but it’s more important to be nice."

    Photo Feature (from the HCFI Photo Gallery)

 17th MTNL Perfect Health Mela

Divya Jyoti – Nurses festival
Students performing Skit in the 17th MTNL perfect Health Mela from different nursing Schools as a part of Divya Jyoti fest.

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

A quarter of total deaths from pneumonia among children occur in India: survey

India has the highest number of pneumonia–related deaths in the world

Only three countries reported coverage above the target level of 90 per cent for any vaccine

Pneumonia, which is the world's leading infectious killer among children, claims the lives of nearly 1.6 million children under five every year, with more than 3,70,000 or nearly one–quarter of deaths occurring in India alone. A Pneumonia Report Card released by the International Vaccine Access Centre (IVAC), on behalf of the Global Coalition against Child Pneumonia, evaluates prevention, protection and treatment efforts in India and in 14 other countries with the most child pneumonia deaths against the pneumonia intervention targets established in the Global Action Plan for the Prevention and Control of Pneumonia (GAPP) issued by the World Health Organisation and the United Nations International Children’s Emergency Fund in 2009. (Source: The Hindu)

    International News

(Dr Monica and Brahm Vasudev)

Having first–degree relative with atrial fibrillation linked with increased risk

An examination of the heritability of atrial fibrillation (AF) among more than 4,000 participants in the Framingham Heart Study finds the occurrence of AF in first–degree relatives was associated with AF risk after adjustment for established AF risk factors and AF–related genetic variants, according to a study that will appear in the November 24 issue of JAMA.

EPO no help for STEMI patients

Erythropoietin administered after successful PTCA in patients with ST-segment elevation MI did not reduce infarct size and resulted in an increase in adverse events in a randomized trial. Two to six days after drug administration, infarct size was 15.8% in the erythropoietin group and 15% in the placebo group, a nonsignificant difference.

Poor sleep quality increases inflammation

People who sleep poorly or do not get enough sleep have higher levels of inflammation, a risk factor for heart disease and stroke (Dr Alanna Morris, a cardiology fellow at Emory University School of Medicine)

Drug–eluting stents are as safe as non–coated stents for large arteries

For patients with narrowed large coronary arteries (greater than 3mm across), drug–eluting stents were as safe as non–coated stents, according to a late–breaking clinical trial reported at the American Heart Association’s Scientific Sessions 2010.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is IUI? What is the average success rate of IUI? How many cycles of IUI can we try?

IUI is a simple OPD procedure. In this procedure, washed capacitated sperms are put in the uterus. The ovary is stimulated by giving hormone injections to produce multiple follicles and the procedure is carried out when the eggs are about to be released. We have had a good success rate with this method and recommend it as the first line of treatment in patients who have patent tubes and a reasonably good semen count.

Success rate varies according to the indication but around 15% to 18% can be considered good. Most couples conceive within first three cycles of IUI, in subsequent cycles the positive outcome is less. One can try up to six IUI cycles then probably turn to IVF–ET.

For queries contact: banerjee.kaberi@gmail.com

    Hepatology Update

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

How common is Allagille’s?

Allagille’s occurs approximately once in every 100,000 live births with equal incidence between boys and girls. For a couple who already have an affected child, the risk of a further child being affected are 1 in 30 if neither parent has any signs, and 1 in 10 if one of the parents has signs of the syndrome.

    Medicolegal Update

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

What is an autopsy?

An autopsy, or post–mortem examination, is the examination of the body of a dead person and is performed primarily to determine the cause of death, to identify or characterize the extent of disease states that the person may have had, or to determine whether a particular medical or surgical treatment has been effective. The postmortem examination includes external and internal cavity and viscus organ examination.

  • The word autopsy is derived from the Greek word autopsia meaning "to see with one’s own eyes."
  • The doctor who conducts autopsy is an eye witness as well as an expert medical witness
  • Forensic autopsies are autopsies with legal implications and are performed to determine if death was an accident, homicide, suicide, or a natural event on inquest and request of law enforcement agency by a designated center and notified doctor
  • Police and magistrate are empowered to order an autopsy under section 174CrPc and 176 CrPc respectively.
  • As per law the forensic/legal autopsies are performed in India by an MBBS (minimum) medical doctor; however, legal autopsy should only be conducted by doctor (pathologists/forensic medicine) who has received specialty training in the diagnosis of diseases by the examination of body fluids and tissues.
  • The doctor conducting autopsy in any dilemma must consult with forensic medicine/experienced doctor before finalizing medicolegal opinion
  • In academic institutions/hospitals, autopsies sometimes are also requested for teaching and research purposes called pathological autopsy. Pathological autopsy is conducted only after obtaining valid informed consent of the legal heirs of deceased.
  • Doctor–patient confidentiality applies to autopsy examinations as to medical records of living patients. This means that doctors are not allowed to reveal the results of an autopsy examination to third parties without the permission of the legal heirs of the deceased.
  • In many medical centers, the autopsy report is first submitted to the physician who treated the patient; the treating physician then shares the findings with the family.
  • The legal heirs are always entitled to receive a copy of the autopsy report.
  • The hospital is not allowed to give out any information about an autopsy or to respond to inquiries about an autopsy from any third parties.
  • The family may choose to share the information with anyone they wish, but they must give written permission for the hospital to release autopsy records, just as with any medical records.
    Clinical Tips

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

Step 5. Develop back–healthy habits

Everyday activities, from vacuuming your house to sitting in front of the computer for hours, can take a toll on your back, particularly if you aren’t schooled in proper body mechanics. But you can take some of the pressure off your back by following these simple tips:

  • While standing to perform ordinary tasks like ironing or folding laundry, keep one foot on a small step stool. Don’t remain sitting or standing in the same position for too long.
  • Stretch, shift your position, or take a short walk when you can.
  • When bending from the waist, always use your hands to support yourself. When sitting, keep your knees a bit higher than your hips and bend them at a 90–degree angle.
  • Sit with your feet comfortably on the floor.
  • If your feet don’t reach the floor, put a book or a small stool under them.
  • Because vacuuming can take a toll on your back, tackle rooms in chunks, spending no more than five to 10 minutes at a time doing this task.
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Anticardiolipin antibodies
Anticardiolipin antibodies are used to help investigate inappropriate blood clot formation, to determine the cause of recurrent miscarriage, or as part of an evaluation of antiphospholipid syndromes.

    Medi Finance Update

Equity Funds

Investing in stocks is also riskier than other investments as stock prices can fluctuate more than other types of investments. The market price of a stock will vary with the company’s financial performance, general economic conditions in the country in which it operates, as well as investor perceptions.

    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

Fixed dose combination of Diazepam and Diphenhydramine Hydrochloride

    IMSA Update

International Medical Science Academy (IMSA) Update

Stress urinary incontinence

Tension–free vaginal tape (TVT) may be regularly investigated using ultrasound. In combination with the clinical outcome, it represents an important method of evaluating the tape and assists in the planning of a future therapeutic course of action in cases of postoperative problems.

(Ref: Flock F, et al. Ultrasound assessment of tension–free vaginal tape (TVT). Ultraschall Med 2010 Nov 15. (Epub ahead of print))

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with cardiomyopathy.
Dr. Bad: It is primary cardiomyopathy.
Dr. Good: Rule out atherosclerosis.
Lesson: Cardiac atherosclerosis is the most common cause of cardiomyopathy (in 50–70% of patients of heart failure).

Make Sure

Situation: A patient having 106 degree fever with dry axillae died.
Reaction: Oh my God! Why was aggressive management not given?
Lesson: Make sure that patients with high fever with dry axillae are treated on the lines of heat stroke.

    Lighter Side of Reading

An Inspirational Story

Silence speaks, Silence answers

There was once a very great spiritual Master whose name was Troilanga Swami. He was the possessor of tremendous occult power and spiritual power. Sri Ramakrishna went to see him a few times. According to Sri Ramakrishna, he was the moving Lord Shiva. Once, Sri Ramakrishna asked him, through gestures, about God. Also through gestures, Troilanga Swami made it clear to Sri Ramakrishna that high above in Heaven, God is One, but when we are in the body, then the body becomes the only reality for us and God becomes many.

Commentary: When silence answers a question, the answer is most effective. Here, in silence one spiritual Master put the question, and in silence another Master answered. The giver and the receiver were extremely pleased with each other.

Indeed, the body sings the song of God’s multiplicity and the soul sings the song of God's unity or God the transcendental Vision.


Mind Teaser

Read this…………………


Yesterday’s eQuiz: "water basket weaving"
Answer for yesterday’s Mind Teaser: "underwater basket weaving"

Correct answers received from: Dr.K.P.Rajalakshmi, Dr Sudipto Samaddar, Dr Chandresh Jardosh, Dr Rashmi Chhibber

Answer for 20th November Mind Teaser:"A"
Correct answers received from: Dr Varesh Nagrath, Dr. Amritpal Bhatia, Dr U gaur

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

Seven months pregnant, my hand on my aching back, I stood in line at the post office for what seemed an eternity.

"Honey," said a woman behind me, "I had back pain during my pregnancy. I was bedridden for four months because my baby was sitting on a nerve."

Then the man in front of me piped up… "You’d better get used to it now. Once those kids get on your nerves, they can stay there till they’re 18."

    Readers Responses
  1. The inspirational story on 20th Nov reveals a message that we all have experienced but dont know, but its should be known to everybody. The lessons of life are not imbibed from the sweets, rosy, dreamy, smooth, easies or cakewalks, its the opposites. All the shortcuts ultimately lead to disaster short joys albeit. Medical education is something in the same lineage. the kind of youth we have today fed on totally consumerist and cheap values is now getting in the, mainly the private medical colleges. Those who condemn ragging based on 19 students killed as part of in college incidents so attributed to ragging must know the necessity of the standard and controlled ragging supervised and precautioned to a good extent. The mindless hyperbolic responses against ragging in medical colleges is wrong and has started showing in disintegrated and less devoted medical students not only in private colleges. In this crumbling nation of disrupting integrities we are finding it hard to save this only a few of the remaining valued Institution. The same message also transponds to students coerced or eased into medical profession by their parents for the sake of money making only. I don't know what others think. Thanks. Dr Shailesh Gupta, IMS,BHU,VNS.
    Public Forum

(Press Release for use by the newspapers)

Absence of shivering, a bad sign in winter

Absence of shivering in a patient with hypothermia is a bad sign and should be attended to immediately said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, and Heart Care Foundation of India.

Hypothermia is defined as a core temperature below 35°C (95°F), and can be further classified by severity:

  1. Mild hypothermia: Core temperature 90 to 95°F; symptoms include confusion, increased heart rate and increased shivering.
  2. Moderate hypothermia: Core temperature 82 to 90°F; symptoms include lethargy, low heart rate, irregular pulse, loss of eye pupillary reflexes, and reduced or absent shivering.
  3. Severe hypothermia: Core temperature below 82°F; findings include coma, low blood pressure, irregular pulse, pulmonary edema, and rigidity

The factors contributing to the development of hypothermia include outdoor exposure, cold water submersion, medical conditions like hypothyroidism, sepsis, toxins like ethanol abuse, and drugs like oral anti diabetics, sedative hypnotics. Risk is highest in the elderly as the ability to autoregulate core temperature is impaired.

The condition can be diagnosed with a low reading thermometer as many standard thermometers only read down to a minimum of 93°F. A rectal or esophageal temperature probe is preferred for severe hypothermia.

The initial treatment of hypothermia is directed toward heat resuscitation, assessment of the extent of injury, and re warming.

Passive external re warming is the treatment of choice for mild hypothermia and is a supplemental method in patients with moderate to severe hypothermia.

  • Remove the wet clothing.
  • Cover with blankets.
  • Maintain room temperature at approximately 24°C (75°F).
  • Do active external rewarming in patients with moderate to severe hypothermia. It consists of combination of warm blankets, radiant heat, or forced warm air applied directly to the patient’s skin.
  • Re warm the trunk first BEFORE the extremities to minimize hypotension and acidemia due to arterial vasodilatation and core temperature after drop.
  • For severe hypothermia, treat with less invasive re warming techniques (eg, warmed IV crystalloid), and progressively adding more invasive ones (eg, warmed pleural lavage) as needed.

Rough handling of the moderate or severe hypothermic patient can precipitate arrhythmias, including ventricular fibrillation, that are often unresponsive to defibrillation and medications. Cardiopulmonary resuscitation (CPR) should continue until the patient is re warmed to 30 to 32°C (86 to 90°F), at which point renewed attempts at defibrillation and resuscitation with ACLS (advanced cardiovascular life support) medications are undertaken.

    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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