emedinews
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FIRST NATIONAL DAILY 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 ...

23rd September, 2010, Thursday

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

New test detects TB in less than 2 hours (NIH)

Scientists have developed an automated test that can rapidly and accurately detect tuberculosis and drug–resistant TB bacteria in patients. The finding could pave the way for earlier diagnosis and more targeted treatment of this disease. Current diagnostic tests have many shortcomings. The most widely used test, called smear microscopy, misses more than half of TB cases and cannot determine whether the bacteria are drug resistant. A more sensitive test involves growing bacterial cultures. It can spot drug resistance but may take up to 6 weeks to get results. Both tests require assessment by trained staff.

To develop a faster and easier–to–use test, researchers led by Dr. David Alland of the University of Medicine and Dentistry of New Jersey collaborated with Cepheid, a diagnostics company, to create a DNA–based test called Xpert MTB/RIF. The test detects the TB–causing bacterium Mycobacterium tuberculosis and also resistance to rifampin (RIF), one of the most common treatments. RIF resistance is a good indicator of multidrug resistance. Drug–resistant TB requires different treatment than drug–susceptible TB. NIH’s National Institute of Allergy and Infectious Diseases (NIAID) has supported the development of the MTB/RIF test for more than 8 years. To use the test, a technician adds a small sample of a patient’s sputum to a plastic test cartridge and loads it into the machine. The instrument then automatically performs a series of steps that ultimately leads to an analysis of DNA from bacteria in the sample. A computerized printout
reports the presence of TB bacteria and whether or not the bacteria are resistant to RIF

As described in the September 1, 2010, issue of the New England Journal of Medicine, the researchers assessed the performance of the new automated test on 1,730 patients with suspected TB in 4 countries. Each patient provided 3 sputum specimens. The samples were assessed by MTB/RIF and by conventional smear microscopy and bacterial culture tests. The new automated test successfully identified 98% of all confirmed TB cases and 98% of patients with RIF–resistant bacteria in less than 2 hours. In addition, a single MTB/RIF analysis detected TB in over 72% of patients who did not appear to have TB according to smear microscopy but who were later found to have TB in culture tests. When the automated test was repeated, the sensitivity increased by about 13%. When the test was run a third time, it detected about 90% of TB cases that were missed by smear microscopy.

The scientists note that the MTB/RIF test makes it possible to detect TB and drug resistance in a single clinic visit and perhaps begin treatment immediately, a significant advantage in developing countries. "The test also indicates rapidly whether difficult–to–treat drug–resistant forms are present," says Alland. "This is a major advance over other rapid TB detection methods, which are complex, labor–intensive, and technically challenging."

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

2nd BSNL Dil Ka Darbar: Special  focus on ‘Women and sudden cardiac death.’

The forthcoming 2nd BSNL Dil Ka Darbar is being organized by Heart Care Foundation of India, to earmark World Heart day, on Sunday 26th September at Maulana Azad Medical College Auditorium In the Photo: Mr. Sanjay Sinha Jt GM (PR), BSNL; renowned Bharatnatyam exponent Padma Shri Ms Geeta Chandran; Dr. K K Aggarwal, President, HCFI and BSNL Dil Ka Darbar, and Dr Aparna Jaiswal, Sr. Cardiologist, Escorts Heart Hospital at the Press Conference

 
Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Screening for colorectal cancer

A UK randomized trial found that one–time screening by sigmoidoscopy in individuals aged 55 to 64 years decreased the incidence of colorectal cancer (CRC) and overall mortality at 11 year follow–up.

(Reference: Hoff G, Grotmol T, Skovlund E, et al. Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ 2009;338:b1846).

  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.

Dengue cases keep rising, not enough beds in New Delhi

A sharp rise in dengue cases over the past few weeks has resulted in an acute shortage of beds and availability of platelets at city hospitals. On Monday itself, 75 new cases were reported which took the toll up to 2,371. With hospitals claiming that they are running out of beds, some have resorted to only admitting those patients who either have a platelet count of less than 40,000 and are showing symptoms of dengue shock syndrome (DSS) or of dengue haemorrhagic syndrome (DHS). Experts also believe that due to the panic that has been created, people are choosing admission in a hospital as a first course of action. This year the strain is not as virulent because of which mortality is very low, say experts, and a majority of patients can be managed at home. The common misconception, doctors say, is if the platelets are low then the patient needs to be admitted to a hospital. (Source: The Times of India)

  International News

(Dr Brahm and Dr Monica Vasudev)

Diet and exercise intervention for at-risk patients for heart disease improves quality of life

Findings from a study published in the September 13 issue of Archives of Internal Medicine suggest that a lifestyle intervention incorporating exercise training and diet counseling in primary health care settings appears to improve quality of life among adults at moderate to high risk for heart disease and appears cost–effective compared to standard care.

Organ wash may extend life of kidney transplant

Scientists from the UK have developed a technique that could extend the life of a kidney transplant significantly. The new approach involves washing the organ in the engineered drug solution during the transfer from the donor to the recipient, which protects the organ from the immune system. According to Professor Steve Sacks from the Medical Research Council Centre for Transplantation at King’s College London, it can be expected to almost double the life of a graft.

Weight–loss surgery may decrease risk of pregnancy–related diabetes

For severely obese women, having weight–loss surgery may reduce the risk of developing diabetes during pregnancy, according to a study published in the Journal of the American College of Surgeons.

Parachute device helps treat heart failure

Pilot studies presented at the Heart Failure Society of America meeting found that implanting an investigational ventricular partitioning device that resembles a tiny parachute improved both function and structure in patients with advanced heart failure and ventricular wall motion abnormalities.

  Gastro Update

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

What is the commonest manifestation of celiac disease in adults besides diarrhea?
Iron deficiency anemia is the commonest manifestation besides diarrhea in adults.

  Infertility Update

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

What is IUI? What is the average success rate of IUI? How many cycles of IUI can be tried?

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.

  Diabetes Update: Question of the Day

When called to see an unconscious diabetes patient, how can you differentiate between hyperglycemia and hypoglycemia? (Dr Nihal Thomas, Vellore)

Both hypoglycemia and hyperglycemia can lead to an alteration in sensorium which can progress to unconsciousness in a patient with diabetes.

The physical features of a patient with hypoglycemia is usually that of normal hydration with a borderline high blood pressure and a bounding pulse, owing to the effect induced by catecholamines; the central venous pressure in acute hypoglycemia tends to be normal. In contrast, the hyperglycemic state is associated with dehydration due to osmotic diuresis which leads to a low or low normal blood pressure and a low volume pulse, reduced skin turgor, dry tongue and a reduced central venous pressure.

It is always prudent to inject a bolus dose of 50 ml of 50% dextrose after a random blood sugar is checked; in such a situation, a patient with more acute or sub–acute hypoglycemia may respond with an improvement in sensorium or may even totally recover to normal within a few minutes. This is not the scenario in a case of hyperglycemic coma.

Seizures are more commonly associated with hypoglycemia. Hyperglycemia associated with significant ketosis usually does not present with seizures, since ketone bodies are neural inhibitory factors (though this may not be invariably the case). A breath with a fruity odor is a feature of ketosis and indicates the presence of excessive acetone in the body, thus is associated with some cases of hyperglycemia.

A previous history of use of metformin or thiazolidinediones without a history of use of sulfonylureas or insulin indicates that the cause for unconsciousness is more likely to be due to hyperglycemia, since chances of metformin nor thiazolidinediones were used alone. A patient on regular insulin therapy is unlikely to present with a sudden loss of consciousness due to hyperglycemia; it is more often likely to be due to hypoglycemia. In fact, from an epidemiological perspective in the modern world where multiple forms of therapy are available for a patient with diabetes, unconsciousness in the emergency room is far more likely to be due to hypoglycemia than hyperglycemia.

  Medicolegal Update

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

Dr Crippen murder case: After 100 years forensic science shows that the body was not of Cora Crippen

Foran’s laboratory has devised methods to extract and isolate mitochondrial DNA. Unable to break through the sap seal, David Foran, a forensic biologist and director of Michigan State University’s forensic science program, chipped away at the slide’s glass cover slip to get at the tissue sample. One of his graduate students recently studied ways to work around formaldehyde fixation to isolate DNA. The goal: To compare the mitochondrial DNA in the slide that convicted Crippen with that of a maternal relative of Cora Crippen. If Hawley Crippen indeed killed his wife and buried some of her remains in the cellar, those remains would share specific DNA characteristics with Cora Crippen’s current day relatives. Beth Wills, a genealogist, spent some seven years pouring through genealogical records and taking on the somewhat nontraditional task of finding living female relatives of Cora Crippen’s mother. Genealogy usually works backwards, but in this case, it went forward and Wills ultimately located three grandnieces. David Foran said, the DNA in the sample is different from the known relatives of Cora Crippen. Crippen was not convicted just of murder – but the murder of Cora Crippen." To paraphrase the famed attorney in the O.J. Simpson murder trial, Johnnie Cochran, if the DNA doesn’t fit, you can't convict.

  Medi Finance Update

Investment tips

An investment in bank’s fixed deposits (FDs) has low risk but minimum gain. A bank gives 6% interest with inflation of 5%; the yield is only 1%. Company FDs can be invested in only after thorough analysis of the company.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date

Notification

Rofecoxib

Dec 13,2004

GSR 810(E)
dt. 13.12.04

  Lab Update

Complete blood count (CBC)

CBC measures the amount of various types of blood cells in a sample of your blood. Blood cancers like AML, ALL, CML, CLL may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found.
(Contributed by Dr Arpan Gandhi and Dr Navin Dang)

  IJCP Special

Dr Good Dr Bad

Situation: A patient with chronotropic insufficiency (i.e. the inability of the sinus rate to accelerate) was to undergo pacing.
Dr Bad:
DDD pacemaker can be used.
Dr Good: Either WIR or DDDR pacemaker should be used.
Lesson: Chronotropic insufficiency is a contraindication for DDD pacemaker. In these situations, a rate–adaptive or "physiologic" pacemaker is indicated (WIR or DDDR).

Make Sure

Situation: An asthmatic patient became worse after receiving a painkiller.
Reaction: Oh my God! Why was he not put on zafirlukast?
Lesson: Make sure that a patient with asthma is not given aspirin or he is put on zafirlukast or montelukast.

Quote of the Day

Let it be, let it be, let it be, let it be…
Simple words of wisdom - let it be
(Contributed by Dr GM Singh)

Hypertension Alert

One should reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride). It can alone reduce blood pressure by 2–8 mm Hg.

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  Mind Teaser

Read this…………………

CUS TOM

The answer for yesterday’s Mind Teaser: "All in all"

Correct answers received from: Dr Chandresh Jardosh,   Dr Kalpana Mohan, Dr Kamlesh Kanodia, Dr.Susheela Gupta, Dr. Susheela Gupta, Dr Muthumperumal Thirumalpillai, Dr. Naorem Sharat

Answer for 21st Sept Mind Teaser is: "Odds and ends".
Correct answers received from: Dr Anurag Jain, Dr Bajaj, Dr. Dinesh Kumar S

Send your answer to ijcp12@gmail.com

  Humor Section

Interesting aspect of mathematical calculation in human life

Study mathematics
Learned teacher + studious student = first
Lazy teacher + studious student = second
Learned teacher + lazy student = third
Lazy teacher + lazy student = fail
(Contributed by Dr Dewat Ram Nakipuria)

Important laws which the great Newton forgot to state

Law of the Alibi

If you tell the boss you were late for work because you had a flat tyre, the next morning you will have a flat tyre. (So do not lie to your boss)
(Contributed by Dr. Chandresh Jardosh)

  An Inspirational Story

A Ten–Cent Idea

When young F. W. Woolworth was a store clerk, he tried to convince his boss to have a ten–cent sale to reduce inventory.
The boss agreed, and the idea was a resounding success. This inspired Woolworth to open his own store and price items at a nickel and a dime. He needed capital for such a venture, so he asked his boss to supply the capital for part interest in the store.
His boss turned him down flat. "The idea is too risky," he told Woolworth. "There are not enough items to sell for five and ten cents." Woolworth went ahead without his boss’s backing, and he not only was successful in his first store, but eventually he owned a chain of F. W. Woolworth stores across the nation. Later, his former boss was heard to remark, "As far as I can figure out, every word I used to turn Woolworth down cost me about a million dollars."

  Readers Responses
  1. MCI is going to introduce the new BRMS course for creating substandard doctors to treat  village people. The same eccentric MCI is going to introduce exit test for MBBS before starting practicing so as to keep the uniform standard. What a Paradox? The new MCI has proposed:-    "Those intending to become doctors and treat patients may soon have to clear a common exit test after getting the MBBS degree from medical colleges. The regulating body, Medical Council of India (MCI), has given a statutory recommendation for a mandatory exit test, which is under active consideration of the health ministry, the Supreme Court was informed on Friday. Considering the sensitive nature of the profession –– dealing with life and death –– and keeping in mind varying standards of education in medical colleges, MCI has proposed a common exit examination for MBBS pass–outs intending to become doctors and treat patients, (At the same time MCI is recommending substandard BRMS doctors for treating village populations): Dr.Alex Franklin.
  Public Forum

(Press Release for use by the newspapers)

Tips for a healthy heart: Walk more and drink less soda

The forthcoming BSNL Dil Ka Darbar on Sunday being organized to commemorate the World Heart Day at Maulana Azad Medical College will focus on tips for a healthy heart said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal; President Heart Care Foundation of India. Following are few tips and ways to implement them

Take a 10-minute walk as part of a larger plan to exercise.
1. Find your comfortable walking shoes or buy a pair.
2. Choose days and times to walk, and then pencil them on the calendar.
3. Plan a route.
4. Think about possible obstacles and solutions. For example If it’s raining hard, do 10 minutes of mixed marching, stair climbing, and jumping rope before dinner.

Drink more water, less soda
1. Find a water bottle (or buy one).
2. Wash out the bottle, fill it up, and put it in the refrigerator at night.
3. Put a sticky note on the front door, or on your bag as a reminder to carry the water bottle along with you.
4. At work, take a break in the morning and one in the afternoon to freshen up your water bottle. This is a good time to notice how much (or little) you are drinking.
5. When you get home from work, scrub out the water bottle for the following day and repeat.

  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
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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