emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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

 
  Editorial …

23rd April, 2011, Saturday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

IS Diabetes a Coronary Heart Disease Risk Equivalent?

Patients with coronary heart disease or a CHD risk equivalent who can tolerate statins should be given moderate dose of statins (40 mg of lovastatin, pravastatin, or simvastatin, 20 mg of atorvastatin, or 5 to 10 mg of rosuvastatin) independent of the baseline LDL Cholesterol. That is, even if a patient’s baseline LDL–C is below goal, or is close to goal such that a low dose of a statin would be expected to reduce the LDL–C below the ATP–III goal, one should initiate a statin at a moderate dose.

One should no longer consider all patients with diabetes mellitus to have a CHD risk equivalent. The risk of CHD varies widely in patients with diabetes and is not consistently greater than 20 percent in 10 years.

The following patients with DMare considered to have a CHD risk equivalent

  • Men over age 40 with type 2 DM and any other CHD risk factor, or over age 50 with or without other CHD risk factors
  • Women over age 45 with type 2 DM and any other CHD risk factor, or over age 55 with or without other CHD risk factors
  • Men or women of any age who have had DM (type 1 or type 2) for more than 20 years if they have another risk factor or more than 25 years without another risk factor

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

 
  Changing Practice – Evidence which has changed practice in last one year

Treatment for solid tumor bone metastases

The new recommendation is to use an osteoclast inhibiting agent to reduce the risk of skeletal complications in patients with bone metastases from a wide variety of solid tumors, including breast and prostate cancer. For most patients who do not have multiple myeloma, start denosumab as the preferred agent (Grade 2A).

References

  1. Henry D, von Moos R, Vadhan–Raj S, et al. A double–blind, randomized study of denosumab versus zoledronic acid for the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma (abstract 20LBA). Data presented at the joint 15th Congress of the European Cancer Organization and the 34th Congress of the European Society for Medical Oncology, Berlin, September 20–24, 2009. Abstract available online at http://ex2.excerptamedica.com/CIW-09ecco/index.cfm?fuseaction=CIS2002&hoofdnav=Abstracts&content=abs.details&what=
    AUTHOR&searchtext=Henry&topicselected=*&selection=
    ABSTRACT&qryStartRowDetail=1, accessed April 7, 2010.
  2. Stopeck A, Martin M, Ritchie D, et al. Effect of Denosumab Versus Zoledronic Acid Treatment in Patients with Breast Cancer and Bone Metastases: Results from the Extended Blinded Treatment Phase. Results presented at the 33rd Annual CTRC–AACR San Antonio Breast Cancer Symposium, held December 8-12, 2010. Abstr P6–14–01.
  3. Stopeck AT, Lipton A, Body JJ, et al. Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: a randomized, double–blind study. J Clin Oncol 2010; 28:5132–9.
  4. Fizazi, K, Carduccin MA, Smith MR, et al. A randomized phase III trial of denosumab versus zoledronic acid in patients with bone metastases from castration resistant prostate cancer (abstract #4507). J Clin Oncol 2010; 28:951s.
  5. http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/125320s007lbl.pdf (Accessed on November 22, 2010).
 
  eMedinewS Audio PostCard

 HIV Update

Dr Nalin Nag Speaks on
‘Diagnosing HIV: Cautions’

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2011 Observed

Students of Delhi Public School, Mathura Road performing a lively Skit on the World Earth Day organized by Heart Care Foundation of India jointly with World Fellowship of Religions on 21st April 2011 to mark the World Earth Day.

 
Dr K K Aggarwal
 
    National News

Microwave–size test kit detects TB in 90 mins

A rapid molecular test kit – the size of a microwave — has undergone a successful trial in a resource poor, primary–care setting by detecting both TB and multi–drug resistant TB in just 90 minutes. While the same sample took three days to confirm through a microscopy test — most prevalent now — and 106 days through a culture test. The findings of the study, carried out simultaneously in India’s Christian Medical College, Vellore; South Africa, Peru, Azerbaijan, the Philippines and Uganda and published in the medical journal "The Lancet" , said the Xpert MTB/RIF test eventually reduced delays in diagnosis and treatment, and thus reduced morbidity and mortality. The test was conducted on 6,648 patients of which 1,033 were found to be TB positive. Interestingly, 90% of these cases were detected by Xpert when 77% of these cases were found to be negative through microscopy. The kit’s specificity rate – how many of those who are found positive are actually positive of TB — was 98.3% and its sensitivity – how many of the total cases did it detect — stood at 90.3%. In India, it tested 902 patients and found 101 to have TB with 7 being multi–drug resistant. (Source: TOI, Apr 20, 2011)

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

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

High intensity walking increases metabolism in overweight adults

You have probably heard that metabolism increases after a bout of exercise, and can even be increased throughout the day after an intense workout. Many research studies have measured the amount of calories burned after a single bout of exercise, but few have examined these effects on overweight people. A new study conducted in Australia suggests that overweight people do benefit from increased energy expenditure after exercise, but these effects are different than in normal weight subjects. Researchers measured nonexercise activity thermogenesis (NEAT), which is also called metabolism (or calories burned), after workouts in a group of overweight adults. The group was divided into two groups: one group performed a high intensity walking bout, and the other performed a moderate intensity walking workout. The measurements were taken with accelerometers, and were taken before the exercise, during the exercise, and at one-day intervals after the workout. The results of the study indicated that thermogenesis did increase after the high intensity workout – but it took seven days for the increase to take effect. After seven days, metabolism increased by 25% after the exercise session compared with the exercise day, and increased by 30% compared with the pre–exercise period. There was an increase in metabolic rate during the day after the activity, but it was not statistically significant. Therefore, overweight people should focus on high intensity training and should exercise daily to maximize their potential for increasing their metabolic rate after exercise.

(Dr GM Singh)

What are bacteria?

Bacteria are microscopic, single–celled organisms found in air, water, soil, and food. They live on plants, insects, animals, pets, and even in the human digestive system and upper respiratory tract. There are thousands of kinds of bacteria, but only a few actually cause disease in humans.

  • Bacteria are frequently identified by their shape, the makeup of their cell walls, and their ability to grow in air. They can be round (such as staphylococci or streptococci), rod–shaped (such as bacillus or E. coli), or corkscrew–shaped (Borrelia species). In most cases, bacteria have cell walls that provide a target for many antibiotics (antibiotics easily identify bacteria).
  • They are also classified by their color after a Gram stain is applied. Gram–positive bacteria stain blue, while gram–negative bacteria stain pink.
  • Gram–negative bacterial cell walls contain a substance known as lipopolysaccharide (LPS), a highly inflammatory chemical that provokes an immune response in the human body. LPS is responsible for triggering the overreaction of the host immune system, which results in the release of oxygen and nitrogen species, cytokines, and other proinflammatory mediators.

(Dr Monica and Brahm Vasudev)

FDA clears new N95 surgical respirator that kills MRSA

The Food and Drug Administration announced that it has cleared a novel type of N95 surgical respirator that kills methicillin–resistant Staphylococcus aureus (MRSA) and two other common bacterial pathogens.

Data reinforce high hopes for bioabsorbable stents

New data from a meeting of the American College of Cardiology in New Orleans last week reinforced the big hopes for ‘bioresorbable’ or ‘bioabsorbable’ stents.

FDA panel endorses everolimus for pancreatic cancer

WASHINGTON –– The FDA’s Oncologic Drugs Advisory Committee has voted unanimously to recommend approval for everolimus (Afinitor) to treat patients with advanced pancreatic neuroendocrine tumors (pNET).

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with pneumonia not responding to antibiotics came to the hospital.
Dr Bad: Change the antibiotic.
Dr Good: You need hospitalization.
Lesson: Any patient not responding appropriately to oral antibiotic therapy requires in–patient management.

Make Sure

Situation: A hypertensive with obstructive sleep apnea (OSA) was not responding to CPAP?
Reaction: Oh my God! Why was an anti hypertensive drug not started?
Lesson: Make sure that all hypertensives with OSA are given anti HT drugs in addition to CPAP. In a randomized crossover trial of 23 patients with OSA and systemic hypertension, an anti–hypertensive medication (valsartan 160 mg per day) lowered the mean 24–hour blood pressure significantly more than CPAP (Continuous positive airway pressure therapy)therapy alone. (Am J Respir Crit Care Med 2010;182:954).

 
    An Inspirational Story

(Dr Prachi Garg)

Use this time management story to show how planning is the key to time management. Start with a bucket, some big rocks enough to fill it, some small stones, some sand and water.

  • Put the big rocks in the bucket – is it full?
  • Put the small stones in around the big rocks – is it full?
  • Put the sand in and give it a shake – is it full?
  • Put the water in. Now it’s full.
  • The point is: unless you put the big rocks in first, you won’t get them in at all.

In other words: Plan time–slots for your big issues before anything else, or the inevitable sand and water issues will fill up your days and you won’t fit the big issues in (a big issue doesn’t necessarily have to be a work task – it could be your child’s sports–day, or a holiday).

 
    Pediatric Update

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

What are the different positions of appendix in children?

The different positions of appendix in children are:

  • Intraperitoneal 95%
    • In pelvis 30%
    • Behind cecum 65%
  • Retroperitoneal 5%
 
    Medicolegal Update

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

Human body dies in bits and pieces termed as molecular death

The corneal reflex and papillary reflex disappear at the time of death. The pupil reacts to the drugs like atropine that causes dilatation up to 1 hour. The cornea can be removed for transplant for up to 6 hours and blood can be transfused for up to 6 hours of death. Therefore, we die in bits and pieces.

  • Clinical death implies the failure of the body as an integrated system. For some time afterwards, life continues in the separate tissues, which constitute the body. These only die after varying periods depending upon the ability of the tissue to function without blood supply. This is called molecular or cellular death. The nervous tissue dies rapidly and the vital centers die in about 5 minutes. The muscles live longer and they will constrict to direct electrical stimuli up to 3 hours.
  • The legal definition of death depends upon the diagnosis of somatic death. The distinction between somatic and molecular death becomes important because in order to remove essential tissues and organs for transplantation there is a relatively short time for the biological properties of living matter to persist after somatic death. With somatic death, there is complete generalized anoxia of the tissue and consequently stoppage of metabolic process carried out by the tissue cells.
  • The metabolic process of the ganglion cells stops in minutes, which are most sensitive whereas that of connective tissue stops in hours, which are the least sensitive.
 
ijcpgroup
ijcpgroup
Docconnect
 
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Obesity – Mother of Type 2 diabetes

Obesity refers to an excess amount of body fat sufficient enough to harm health. The risk of developing type 2 diabetes is directly proportional to the degree of overweight. Overweight and obesity are associated with insulin resistance and metabolic syndrome. The presence of abdominal obesity is more strongly correlated with the metabolic risk than is an elevated BMI. Waist circumference in combination with BMI has been shown to be the best predictor of obesity associated health risks.

  • Obesity substantially increases the risk of developing a number of diseases of adult life like hypertension, ischemic heart disease, stroke, gall bladder disease, joint problems, sleep apnea, respiratory problems, malignancies of endometrium, breast, colon and prostate, and even pancreatic malignancy.
  • The duration of obesity is directly proportional to the risk of diabetes and is inversely associated with fasting serum insulin levels. The weight increase of 0.5kg has been shown to be accompanied by a rise in the risk for type 2 diabetes by 6%, and for every kilogram of self reported weight gain, the risk for diabetes increased by about 9%.
 
    Mind Teaser

Read this…………………

Hi Way Pass

Yesterday’s Mind Teaser: The maximum recorded duration of efficacy after prophylactic HPV vaccine is:

a. 2 years
b. 5 years
c. 10 years
d. Life-long

Answer for Yesterday’s Mind Teaser: b.

Correct answers received from:: Dr Chandresh Jardosh, Dr U Gaur, Dr Neelam Nath, Dr Prabha Luhadia

Answer for 21st April Mind Teaser: Feeling under weather
Correct answers received from: Dr Anupam, Dr Prachi

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr. GM Singh)

Good Milk

There once was a 94 year old nun back in the 1890s whose worn out body began to surrender. Her doctor prescribed for her a shot of whiskey three times a day, to relax her. However, not to be lured into worldly pleasures, she huffily declined. But her mother superior knew the elderly sister loved milk. So she instructed the kitchen to spike the milk three times a day. Eventually, the elderly pious one approached her final hour. As several sisters gathered around her at bedside, the mother superior asked if she wanted to leave them any words of wisdom. "Oh, yes," she replied. "Never sell that cow!"

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

The American Diabetes Association (ADA) has recommended HbA1C as the diagnostic test for diabetes.

 
    Medi Finance Update

(Dr GM Singh)

How do I make a nomination?

Nomination can be made either at the time of making an investment or subsequently at any time. If the nomination is not made at the time of application for units, a nomination form can be used for making the nomination subsequently. It must give details of the folio for which the nomination is sought to be made and the names and address of the nominees and relationship with the investor. A folio can have up to three nominees. The investor making the nomination can also specify the percentage allocation of the investment to each nominee. The nomination form must be signed by all the holders of the folio.

 
    Drug Update

List of Approved Drug From 01.01.2010 TO 31.8.2010

Drug Name

Indication

DCI Approval Date

Gemfibrozil Capsule USP & Gemfibrozil Tablet USP 200mg/600mg (Addl. Indication)

For the treatment of other dyslipidemias: (a) Fredrickson Types III and V (b) Associated with diabetes (c) Associated with xanthomata.

05/04/2010

 
    IMSA Update

International Medical Science Academy (IMSA) Update

American Academy of Neurology updated guidelines for driving risk in patients with dementia

Mild dementia increases the likelihood, but does not establish that a patient is an unsafe driver. A score of 24 or less on the Mini Mental Status Examination (MMSE) is useful in identifying patients at increased risk for unsafe driving

 
  Quote of the Day

(Dr GM Singh)

The alphabet ‘O’ stands for Opportunity which is absent in yesterday, available once in tOday, and thrice in tOmOrrOw, so always think positive about future.

 
    Readers Response
  1. Dear Dr Aggarwal, Your views on Binayak Sen’s judgment are timely. That is the issue for doctors while treating a patient. I hope people, judiciary and civil society will understand our predicament. Sincerely: Dr R S Bajaj, Pediatrician, Rohini.
  2. Dear Sir (Dr K K Aggarwal), I am a regular follower of e medinews. I liked the article written on TPA and CGHS issue very much. This is something we face daily and sometimes even patients compel us to do unnecessary tests or admission so that it is reimbursed by TPA. If we want to make our healthcare system corruption free then we need to raise a voice to amend the policies of insurance (Mediclaim) and CGHS policies.
 
    Public Forum

(Press Release for use by the newspapers)

Seminar on Corruption–Free India to be held on 24th April

Acharya Sushil Muni Memorial Trust, Heart Care Foundation of India and World Fellowship of Religions are organizing a seminar on "Towards a Corruption–Free India" on Sunday 24th April, 9.3012pm at Acharya Sushil Muni Ashram, C 599 Defence Colony, New Delhi. The seminar will be a part of 16th Environmental Protection and Ethical Consciousness Conference being celebrated to commemorate the 17th death anniversary of Acharya Sushil Muni Ji Maharaj.

The panelists will include Acharya Dr. Sadhvi Sadhna Ji Maharaj; Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal; Mr. Joginder Singh, Former Director, Central Bureau of Investigation; Swami Sh Sushil Goswami Ji; Mr. Vijay Dutt Former Editor Hindustan Times UK Edition; Mr HT Sangliana, Vice Chairman National Commission for Minorities and Mr. Kunnikrishna, a renowned Vedic Scholar. The Guest of Honour will be Sardar Buta Singh Ji, Former Union Home Minister GOI.

There will be over 350 participants from various organizations. You are requested to depute your photographer/cameraman/reporter to cover the event. The seminar will be followed by lunch.

This well–timed seminar has been organized to bring out a white paper on the subject that today has become the talk of the nation.

Giving the details, Dr Aggarwal who is also the President, Heart Care Foundation of India said that during the era of Ramayana in Tretya Yuga also, there were Kalyugis like Ravana and his army. Similarly, there are also Satyugi people in the Kalyuga era today. Our aim should be to become Satyugi while still living in this era of Kalyuga. If a person is born in Kalyuga it does not mean that he is a Kalyugi.

 
    eMedinewS Special

1. eMedinewS audio lectures (This may take a few minutes to open)

2. eMedinewS ebooks (This may take a few minutes to open)

HCFI
Activities eBooks


  HCFI

  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

Pesticides Safely

  Towards Well Being

 

 
    Forthcoming Events

May 7–8, 2011, National Seminar On Stress Prevention

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com

………………………………………………………………

September 30 – October 02, 2011; XVIth World Congress on Cardiology, Echocardiography & Allied Imaging Techniques

Venue: The Leela Kempinski, Delhi (NCR), September 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
Highlights of Pre – Conference CME: Case based learning experience & audience interaction, Maximum 250 delegates for CME will be accepted, who will be divided in 5 batches and will rotate to different halls every 90 minutes. The topics are:(A) Right heart pressures & functions (From basics to newer methods (RV anatomy, echo views, echo assessment of RV function, prognostic impact of RV function) (B) Carotid Doppler: How do i assess and interpret in my daily practice.: Technical tips (Anatomy of the vessel, views of ultrasound scanning, Normal & abnormal Doppler hemodynamics, how to measure IMT) (C) Valvular stenosis: Assessment, limitations and their solution: (Anatomy of the valves, 2–D findings of stenotic lesions, quantitation of lesion, limitations) (D) How do I assess and report ventricular dyssynchrony in my lab. (What is ventricular dyssynchrony, what are the types of dyssynchrony, in whom, when & why do we assess it, various echo methods to assess it) (E) Live 3–D Echo: Protocol for acquisition. How to slice and get full information. Aim is that by end of the day, every participant is well conversant with all the topics
Dr (Col) S.K. Parashar, President, e–mail: drparashar@yahoo.com, Mob:09810146231/Dr Rakesh Gupta, Secretary General, email:jrop2001@yahoo.com, Mob:09811013246
worldcon2011@in.kyoni.com, www.worldcon2011.org

………………………………………………………………

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 Hamdarad 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 and Dept of Health and Family Welfare Govt of NCT of Delhi.

Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).

Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at
medifilmfestinhealthmela@gmail.com

………………………………………………………………

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Naveen Dang, Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta