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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


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  Editorial …

24th March 2012, Saturday

World TB Day

Even singing can spread TB

  1. Person–to–person transmission of TB occurs via inhalation of droplet nuclei (airborne particles 1 to 5 microns in diameter).
  2. Coughing and singing facilitate formation of droplet nuclei.
  3. Persons with active untreated respiratory tract disease (pulmonary or laryngeal) are contagious, particularly when cavitary disease is present or when the sputum is AFB smear–positive.
  4. Patients with sputum smear–negative, culture–positive lung TB can transmit infection.
  5. Extra pulmonary TB is not contagious unless the person also has lung TB.
  6. Many procedures can result in the dispersal of droplet nuclei like endo–tracheal intubation, bronchoscopy, sputum induction, aerosol treatments, irrigation of a TB abscess, and autopsy.
  7. Suspect TB if there is persistent (>3 weeks) cough and constitutional symptoms (fever, drenching night sweats, unintentional weight loss).
  8. In HIV, the clinical and X–ray presentations of TB are often atypical. Such patients have an increased frequency of extrapulmonary TB and can have pulmonary disease despite a normal chest x–ray.
  9. Results of acid–fast smears should be available within 24 hours.
  10. Suspected or confirmed cases of TB should be reported promptly to the local public health department in order to expedite contact investigation and to help plan outpatient follow–up.
  11. Suspicion of active pulmonary TB should prompt placement in an AII room. Such patients should be educated about the purpose of such isolation and instructed to cover their nose and mouth when coughing or sneezing, even when in the room. Whenever possible, procedures should be performed in the AII room to minimize exposure to the rest of the hospital. If the patient must leave the room, a surgical mask must be worn. All other persons entering the room must use respiratory protection, usually an N95 mask.
  12. Anti–TB treatment administered during hospitalization should be directly observed therapy (DOT).
  13. TB isolation rooms: Negative pressure is employed to prevent the escape of droplet nuclei. To accomplish this goal, doors must be kept closed and negative pressure should be verified daily. There must be 6–12 six air exchanges per hour. If recirculation to general ventilation is unavoidable, HEPA filters must be installed in the exhaust ducts.
  14. Respiratory protection masks must filter particles 1 micron in diameter with at least 95% efficiency (N95) given flow rates up to 50 L per minute, must fit to a person’s face with less than 10% seal leakage. Health care workers should use these masks.
  15. N 95 mask is designed to filter air before it is inhaled; thus, patients with known or suspected TB should not wear these masks. For the surgical masks are sufficient.
  16. A patient may be transferred from an AII room once TB is ruled out or on treatment 3 consecutive sputum samples, obtained on different days, are smear–negative for AFB.
  17. For patients with initially positive AFB smears, at least 2 weeks of TB treatment should be administered before isolation is discontinued.
  18. For patients with MDR–TB, maintaining isolation throughout hospitalization is prudent.
  19. Ideally a TB OPD clinic should be an AII room. If unavailable, an enclosed area should be used and a surgical mask (not an N95 mask) should be placed on the patient. The patient should be instructed to cover the mouth and nose with tissues when sneezing or coughing. If an area other than an AII room is used, it should not be used again for one hour once the patient has left.
  20. An individual with AFB smear–positive involving the respiratory tract is generally considered to have been contagious starting three months before the first smear–positive sputum or onset of pertinent symptoms, whichever is earlier.
  21. For persons with AFB smear–negative disease, the contagious period is considered to have begun one month before the onset of symptoms.
  22. HCWs and patients with potential exposure should be screened (by symptoms and, unless positive at baseline, TST or IGRA) as soon as possible after the exposure. If initial screening is negative testing should be repeated 8 to 10 weeks following the end of the exposure.

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

World TB Day

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Yadien, the musical concert was organized in the memory of Legendary Ghazal Maestro Shri Jagjit Singh Ji. The evening was organized by Heart Care Foundation of India, Humkhayal and eMedinewS. Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal interacting with the Audience

Dr K K Aggarwal
    National News

Says WHO: India has highest number of multidrug–resistant TB in South East Asia

India had an estimated 63,000 cases of notified multi–drug resistant tuberculosis (MDR–TB) in 2010, the highest in the South East Asia region, the World Health Organisation (WHO) has said.

The MDR–TB prevalence is estimated to be 2.3 per cent among new cases and 12–17 per cent among re–treatment cases. However, due to the size of the population and the number of TB cases reported annually, India ranks second among the 27 MDR–TB high–burden countries worldwide after China. Extensively drug–resistant TB (XDR–TB) cases have also been reported from India, Bangladesh, Indonesia, Nepal and Thailand from the region. Considerable efforts are required to expand capacity for quality–assured drug susceptibility testing in the region in order to more accurately estimate the extent of drug–resistant TB. Given the widespread availability and use of second–line drugs, and as laboratory capacity to conduct second–line drug susceptibility testing increases, additional number of patients with XDR–TB are likely to be identified, the report warns. The estimated percentage of the MDR in new TB cases in India is 2.1 (1.7–2.5) per cent, while the percentage of MDR among previously treated cases was 15 (13–17) per cent. By the end of 2009, treatment services for the MDR–TB patients were available in sites of 10 States. (Source: The Hindu, March 23, 2012)

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

FDA Panel backs drug for rare type of leukemia

An FDA advisory committee has tepidly endorsed vincristine sulfate liposomal injection (Marqibo) to treat adults with a rare type of acute lymphoblastic leukemia. The FDA’s Oncologic Drugs Advisory Committee voted 7–4, with two panelists abstaining, that the benefits outweigh the risks for vincristine sulfate liposomal injection for the treatment of adult patients with Philadelphia chromosome negative (Ph–) acute lymphoblastic leukemia (ALL) in second or greater relapse or who have failed at least two prior treatments with other anti–leukemia drugs. There is currently no FDA–approved drug treatment for this specific group of patients. (Source: Medpage Today)

For comments and archives

BP mismatch between arms signals risk

Patients with hypertension who have double–digit differences in blood pressure between arms appear to be at risk for cardiovascular events and premature death, a small study showed. (Source: Medpage Today)

For comments and archives

Ibuprofen may KO altitude sickness

If you long for a "Rocky Mountain high" but not the headache, fatigue, dizziness, nausea, and vomiting that sometimes accompany a climb, fear not. A randomized placebo–controlled trial found that ibuprofen reduces the incidence of mountain sickness, according to Grant Lipman, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues. The nonsteroidal anti–inflammatory also appeared to reduce the severity of illness, Lipman and colleagues reported online in Annals of Emergency Medicine. (Source: Medpage Today)

For comments and archives

MSM at high risk for anal lesions but most won’t progress

Anal human papillomavirus (HPV) infection and associated precancerous lesions are common in men who have sex with men (MSM), according to a meta–analytic review of relevant research published online March 23 in the Lancet Oncology. The data also suggest that most high–grade anal intraepithelial neoplasia (AIN) will never progress to anal cancer, and AIN progression seems to occur less often than it does for high–grade cervical intraepithelial neoplasia (CIN) in women. (Source: Medscape)

For comments and archives

Heavy sedation not needed for ICU vent patients

A lighter sedative without respiratory depressive effects was as effective as standard agents in mechanically ventilated patients and shortened the time patients spent on ventilators, researchers said. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: #IJCP Knowledge attitude and practice of blood donation among II phase medical students: A cross sectional study… http://fb.me/1HDWPuUl4

@DeepakChopra: Freedom lies in separating yourself from your story. My

    Spiritual Update

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

The Art of Controlling Anger

Cynicism is one of the recognized major risk factors that cause coronary artery disease (blockages in the channels supplying blood to the heart). And anger, jealousy and irritability form the triad responsible for this.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

Is pregnancy after endometriosis a good option?

Although it has not been proven that pregnancy is therapeutic, endometriosis often regresses during pregnancy. However, endometriosis often returns some time after pregnancy. A woman must carefully consider her immediate and long–term goals before choosing pregnancy as a treatment for endometriosis.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity Hospital, Gurgaon)

Pediatric Liver Transplantation

Indications of liver transplantation in children and adolescents

The indications for liver transplantation are:

Chronic liver failure

  • Cholestasis: Biliary atresia, progressive fulminant intrahepatic cholestasis, Alagille’s, neonatal hepatitis
  • Metabolic: Wilson’s disease, Galactosemia, Hereditary Fructose Intolerance, Tyrosinemia, Alpha1 anti trypsin, Bile acid disorders, Storage Disorders (Glycogen storage disorders), Chronic hepatitis (Hepatitis B & C, Autoimmune disease, Non alcoholic fatty liver disease (NAFLD))

Acute liver failure

  • Fulminant hepatitis: Viral hepatitis (A, E, B, C, others), Autoimmune hepatitis, Drugs and poisoning (including paracetamol poisoning)
  • Metabolic liver disease: Tyrosinemia, Wilson’s disease, fatty acid oxidation defects, neonatal hemochromatosis, Galactosemia

Inborn errors of metabolism

  • Criggler–Najjar syndrome type 1
  • Organic acidemias
  • Urea cycle defects like MSUD (Maple syrup urine disease)
  • Primary oxalosis, maple syrup urine disease

Hepatic tumors

  • Benign tumors that have replaced the whole liver
  • Unresectable malignant, without extrahepatic metastasis

Certain rare conditions such as factor VII deficiency, Protein C and protein S deficiency

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Why are Goals Important?

On the best sunny day, the most powerful magnifying glass will not light paper if you keep moving the glass. But if you focus and hold it, the paper will light up. That is the power of concentration.

A man was traveling and stopped at an intersection. He asked an elderly man, "Where does this road take me?" The elderly person asked, "Where do you want to go?" The man replied, "I don’t know." The elderly person replied, "Then take any road. What difference does it make?"

How true. When we don't know where we are going, any road will take us there.

Suppose you have all the eleven football players, enthusiastically ready to play the game, all charged up, and then someone took the goal post away. What would happen to the game? There is nothing left. How do you keep score? How do you know you have arrived?

Enthusiasm without direction is like wildfire and leads to frustration. Goals give a sense of direction. Would you sit in a train or a plane without knowing where it was going? The obvious answer is no. Then why do people go through life without having any goals?

For comments and archives

  Cardiology eMedinewS

No benefit of vitamin E in heart failure Read More

Food categories contributing the most to sodium consumption Read More

Postural hypotension linked to heart failure Read More

  Pediatric eMedinewS

More kids in England living with serious diseases: Study Read More

Tight glycemic control slows preemies’ growth Read More

Food categories contributing the most to sodium consumption Read More

    Microbial World: The Good and the Bad they do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity)

Normal flora of the skin

We human beings are covered with about 2 square meters of skin. As you know there is the keratin layer, the epidermis and dermis. The superficial layers of skin are being constantly shed and replaced. There are areas of skin which are moist like axillae, groin and areas between the toes. These areas have high density of bacteria. Other areas have relatively less moisture content so the growth of bacteria is less in these areas. Many, many species of Microbes, in high numbers inhabit skin, mostly epidermis, upper part of the hair follicles and sebaceous areas. These bacteria are mostly commensals, harmless but sometimes they can become pathogenic and cause skin infections and serious blood stream infections also. Some of us can also carry pathogenic bacteria, not suffer from any infection ourselves, but can transmit these bacteria to other vulnerable individuals who may develop infections. The bacteria present on skin include Gram–positive cocci like Staphylococci and Micrococci, various Corynebacteria, various Propionibacteria, many anaerobic bacteria, some fungi and rarely some Gram negative bacilli (Acinetobacter and Pseudomonas).

Molecular studies involving 16S ribosomal RNA revealed the presence of Staph epidermidis + Staph aureus (5%), Actinobacteria (50%), Firmicutes (24.4%), Proteobacteria (16.5%) and Bacteroides (6.3%). Next we will discuss how these populations of bacteria benefit/harm us or may have symbiotic/parasitic relationship with us.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: An asymptomatic patient came with erectile dysfunction.
Dr Bad: You can start taking Viagra drug.
Dr Good: Rule out CAD first.
Lesson: Patients with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of coronary or other vascular disease, should be screened for cardiovascular disease prior to initiating therapy for their sexual dysfunction, as there are potential cardiac risks associated with sexual activity in patients with heart disease.

For comments and archives

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminum toxicity.
Reaction: You should have put him on magaldrate preparations.
Lesson: Magaldrate preparations do not cause aluminum toxicity in patients undergoing dialysis.

For comments and archives

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  Quote of the Day

(Dr GM Singh)

Love is much like a wild rose, beautiful and calm, but willing to draw blood in its defense. Mark Overby

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests to diagnose Hashimoto’s thyroiditis

Anti–thyroid peroxidase antibody (anti–TPO) in addition to thyroid function tests (TSH, T4, T3). Anti–TPO test detects autoantibodies against a protein found in thyroid cells. These antibodies are not normally present, so a high value usually indicates autoimmune damage to the thyroid due to disorders such as Hashimoto’s thyroiditis and Graves’ disease.

    Mind Teaser

Read this…………………

All are precancerous for carcinoma colon except:

a. Crohn’s disease
b. Bile acids
c. Fats
d. Carotene

Yesterday’s Mind Teaser: In ulcerative coilitis with toxic megacolon lowest rate of recurrence is seen in

a) Complete proctocolectomy and Brook’s ileostomy
b) Ileo rectal anastomoses
c) Koch’s pouch
d) Ileo anal pull through procedure

Answer for Yesterday’s Mind Teaser: a) Complete proctocolectomy and Brook’s ileostomy

Correct answers received from: Dr Ragavan Sivaramakrishnan Moudgalya, Dr Mrs S Das, Dr PC Das, Dr Thakor Hitendrsinh G, Raju Kuppusamy, Anil Bairaria, Dr Chandresh Jardosh, Dr Jainendra Upadhyay.

Answer for 22nd March Mind Teaser: c) Is related to duration of ulcerative colitis
Correct answers received from: R K Sahoo, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Leave Application by a Student

"As I am studying in this School I am suffering from headache, I request you to leave me today"

    Medicolegal Update

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

Is it necessary to disclose all information to patient? What is ‘Therapeutic Privilege?

The patient has a right to full information, concerning diagnosis, treatment , prognosis, alternative treatments and its possible complications. ‘Informed’ means the consent of a patient to the performance of the health care services provided by a registered medical practitioner. There are 2 exceptions: No disclosure is required, if the patient indicates a preference not to be informed; or if the physician or surgeon believes that the patient is so anxiety prone or disturbed that the information would not be processed rationally or that it would probably cause significant psychological harm or it will cause adverse effect on patient’s health. This exception to the legal duty of full disclosure to patient is called the ‘therapeutic privilege’ of a doctor.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Do not ignore anxiety attacks

Do not ignore attacks of anxiety or irritability as these may be an indication of underlying hyperfunctioning of a thyroid, a butterfly–shaped gland in the middle of the neck, located below the larynx (voice box) and above the clavicles (collarbones), said Dr. K.K. Aggarwal, Padma Shri and Dr B C Roy National Awardee and President, Heart Care Foundation of India.

The thyroid produces two hormones, triiodothyronine (T3) and thyroxine (T4) that regulate how the body uses and stores energy (also known as the body’s metabolism). Thyroid function is controlled by a gland in the brain, known as the pituitary. The pituitary produces thyroid stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4. When the thyroid hyper functions, it produces too much thyroid hormone. When this occurs, the body’s metabolism is increased, which can cause a variety of symptoms.

Most people with hyperthyroidism have symptoms, including one or more of the following:

  • Anxiety and irritability
  • Weakness (in particular of the upper arms and thighs, making it difficult to lift heavy items or climb stairs)
  • Tremors (of the hands)
  • Perspiring more than normal
  • Difficulty tolerating hot weather
  • Rapid or irregular heartbeats
  • Fatigue
  • Weight loss in spite of a normal or increased appetite
  • Frequent bowel movements.
  • In addition, some women have irregular menstrual periods or stop having their periods altogether. This can be associated with infertility.
  • Men may develop enlarged or tender breasts, or erectile dysfunction, which resolves when hyperthyroidism is treated.
    Readers Response

I read the column – Tat Tvam Asi – on heart transplant. May I correct some of the information (statistical figures) quoted in the column. I am a member of CSI (Cardiac Surgeons of India – comprising 492 cardiothoracic surgeons of India as its members), which is also well represented by the IACTS (Indian Association of Cardiovascular & Thoracic Surgeons), I could get the updated statistical information on the heart transplant status in our country as follows:

About 104 heart transplants have been done so far in the country.

  1. Frontier lifeline, Chennai–31 cases.
  2. AIIMS, New Delhi–28 cases
  3. Madras Medical Mission, Chennai–12 cases
  4. Apollo Chennai–8 cases.
  5. Global Hyderabad–7 cases
  6. Army Hospital, Delhi-3 cases
  7. Narayana Hrudayalaya, Bangalore-3
  8. Ramachandra, Chennai–3
  9. Medical Trust Hospital, Ernakulam, Kerala–2
  10. Care hospital, Hyderabad, AP–2
  11. Nizam’s institute of Medical Sciences, Hyderabad, AP–2
  12. Global Hospital, Chennai–1
  13. Gangaram Hospital–Delhi–1
  14. Madras Medical College, Chennai–1

Regards: Dr. BV Sai Chandran MCh (CTVS), DNB (CTS)

    Forthcoming Events
Dr K K Aggarwal

BSNL Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

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

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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 Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta