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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


24th July, 2010, Saturday

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

When to admit a patient with drug overdose

Clinical assessment in the emergency department can reliably identify patients who are at high risk for complications and require ICU care.

In a retrospective analysis of data on more than 200 overdose cases, the presence of any of the following eight clinical criteria predicted a complicated hospital course that could be best managed in an ICU:

  1. PaCO2 > 45 mmHg
  2. A need for emergency intubation
  3. The presence of post ingestion seizures
  4. Unresponsiveness to verbal stimuli
  5. A non–sinus cardiac rhythm
  6. Second–or third–degree atrioventricular block
  7. Systolic blood pressure < 80 mmHg
  8. QRS duration ≥ 0.12 seconds

Reference

Brett AS, Rothschild N, Gray R, Perry, M. Predicting the clinical course in intentional drug overdose: Implications for use of the intensive care unit. Arch Intern Med 1987;147:133.

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 HCFI file)

 

Health Parade for mother and children

To mark the WHO Day, the Heart Care Foundation of India (HCFI) organized a health parade in New Delhi, on March 25 2010, to highlight the care of mother and children.

 

In This Photo: Former Miss India Manpreet Brar and Padma Shri and Dr. B C Roy National Awardee Dr K. K. Aggarwal, President HCFI at the health parade

Dr k k Aggarwal

 

News and views

National

Diabetes, BP can't be cited to reject claim (TOI News)

A district consumer forum in Mumbai has decreed that a cardiac patient cannot be denied his insurance even if he has not mentioned hypertension and diabetes as pre-existing ailments. "We have taken the view that, in a large number of cases, diseases like hypertension and diabetes are so common and are always controllable. unless a patient undergoes a long treatment, including hospitalization and undergoes operation in the near proximity of taking the policy (s/he) cannot be accused of concealment of facts" the forum said, while asking the insurer to honour the policy holder's insurance claims and also pay him Rs 5,000 as compensation for mental agony.

In 2003, Karunakar Shetty underwent a HEART bypass surgery and DENIED A CLAIM ON THE GROUNDS that he was suffering from hypertension even before he took the policy and hid this from the insurance company. The insurance company stated that, when the papers were submitted, the third-party authority got documents from a hospital that said Shetty had told them he was suffering from diabetes for the past four years. The forum, while passing its order took into account, the hospital discharge card that Shetty had submitted following his treatment in July 2002. From the discharge card and the report submitted by the family doctor it was evident that Shetty was suffering from hypertension and diabetes and he got to know of it only in 2002. The forum observed that Shetty was unaware of the disease when he took the policy in 2000 and, even if he did not mention it in 2003 while renewing the policy, hypertension and diabetes could not be called "pre-existing diseases."

This is what will happen if new course BRHC course comes through

http://www.newkerala.com/news2/fullnews-5416.html

RMP doctors stage dharna; demand regularization of jobs!! (UNI) 

Thousands of Registered Medical Practitioners (RMP) doctors today staged a dharna here at Jantar Mantar demanding mainly regularization of their jobs. They also sought permission to open clinics for those who had worked under an MBBS doctor for than 20 years. President RMP Association D K Arora said in all states except Delhi, RMP doctors were allowed to open clinic. ''After working for some 20 years, any RMP doctor can give services equivalent to an MBBS doctor and if they can have their own personal clinics why can't RMP doctors?'' he asked. (Dr Arul Raj)

First dengue death in Delhi

The national capital reported the first dengue death of the season with a child succumbing to the disease at the AIIMS. An eight-year-old dengue patient died yesterday at AIIMS. He resides in Okhla area of Delhi.


High Court: Sexual relations on false promise of marriage not rape


The Bombay High Court has ruled that sexual relationship with a woman on a false promise of marriage does not amount to rape. Justice Ambadas Joshi set aside the Yavatmal Session Court order convicting SR under IPC section 376 (rape).
[PTI News]


 International

Adalimumab helps in Refractory Psoriatic Arthritis

A study reported online in the Journal of Rheumatology has found treatment with adalimumab (Humira) to be effective for both joint and skin manifestations of cases of psoriatic arthritis where the disease had not responded adequately to prior therapy. In the study, 78% of such patients had experienced at least a 20% improvement in symptoms as defined by the American College of Rheumatology (ACR20) after 12 weeks of therapy. The ACR20 response rates did not differ much between patients who had previously received a biologic drug and those who were biologic–naive; 70.3% vs 81.1%, respectively.

Start HIV Therapy Earlier, Panel Recommends

The guidelines panel of the International AIDS Society–USA has issued new recommendations. As a result, the number of people in the U.S. who are eligible for HIV therapy has increased. Treatment should be initiated when CD4–positive T cell count declines to or below 500 cells per microliter of blood. These recommendations are published in the July 21 issue of the Journal of the American Medical Association. According to Melanie Thompson, MD, of the AIDS Research Consortium of Atlanta, and colleagues, treatment can start earlier if the patient has any symptoms or if there are some specific comorbidities and conditions that require therapy.

‘Opt–Out’ HIV Tests Have Modest Success

The routine "opt–out" testing for HIV suggested by the CDC modestly increased the number of people identified with the virus when it was used in a large emergency department. More than three–quarters of eligible patients however, opted out of the testing, probably because they did not think they were at risk for HIV infection. Most new cases identified by the system involved relatively advanced disease. These observations were presented at the International AIDS Conference and also published in the July 21 issue of JAMA.

HIV Prevention Misses Half of Mothers, Kids

Jeffrey Stringer, MD, of the Centre for Infectious Disease Research in Zambia in Lusaka, and coauthors report that programs that work at preventing mother–to–child transmission of HIV in the developing world may be getting the job done only about half the time. In a study in four African countries, only 51% of HIV-exposed infants were given appropriate prophylaxis with the antiretroviral drug nevirapine (Viramune). Failure of coverage was predicted by younger maternal age and fewer antenatal check–ups. The study results are reported in the July 21 issue of the Journal of the American Medical Association and were also presented at a press conference held at the International AIDS Conference.

(Contributed by Dr Monica and Brahma Vasudeva)

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Summon from court of law

Few years back I realized the importance of punctuality in the court of Additional Session Judge Delhi when the honorable judge asked me to look at my watch to point out that I was late by two minutes…Why?…Is it not a contempt of court? I was appearing as a medical witness for the Delhi Police, in response to a summon, in the Sshivani Bhatnagar murder case, a journalist of Indian express, whose postmortem was conducted by me.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Gastroesophageal Reflux Disease in Children (Part 4)

Warning signals
or the ‘red flag’ signs that require investigation for GERD in infants are:

  • Regurgitation or vomiting
  • Bilious vomiting
  • Consistently forceful vomiting
  • Gastrointestinal bleeding – Hematemesis, Hematochezia
  • Onset of vomiting after 6 months of life
  • Failure to thrive
  • Diarrhea
  • Constipation
  • Fever
  • Lethargy
  • Hepatosplenomegaly
  • Bulging fontanelle
  • Macro/microcephaly
  • Seizures
  • Abdominal tenderness or distension
  • Documented or suspected genetic/metabolic syndrome
  • Cough and anorexia or feeding refusal are common in 1 to 5 years of age than in older children.

Question of the Day

What are the causes of exogenous hypoglycemia? (Dr Vishnupriya Reddy, Bangalore)

The causes of exogenous hypoglycemia include

  • Insulin
  • Oral antidiabetic agents
  • Alcohol
  • Other drugs like salicylate, monoamine oxidase (MAO) inhibitors, tetracycline
  • Prolonged and exhaustive exercise, especially in untrained person.
 

Public Forum (Press Release for use by the newspapers)

You are at risk for osteoporosis if…

Osteoporosis affects many women and men as they age, reducing bone density and increasing the risk of bone fractures, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.
 
Following features may put you at risk

• Being older or female.
• Having osteoporosis in the family.
• Having a small stature or thin frame.
• Being Indian
• Having a prior bone fracture.
• Having low sex hormone levels.
• Getting insufficient exercise.
• Getting insufficient dietary calcium and vitamin D.
• Eating a diet that is high in caffeine, sodium and protein.
• Using alcohol or tobacco.
• Having eating disorders or rheumatoid arthritis.
• Use of long-term drugs such as steroids.
• Staying indoor most of the times
• Bed-ridden for a long time

Four healthy habits
Dr Aggarwal said that it's not too late. If you make healthy changes now, it will have a tremendous impact particularly on the heart, even in middle age. Dana E  King, from Medical University of South Carolina, evaluated almost 16,000 men and women who were between the ages of 45 and 64 and specifically looked at four heart-healthy habits:

• Eating at least five servings of fruits and vegetables a day
• Exercising at least 2.5 hours a week
• Keeping a healthy weight and
• Not smoking.

During four years of follow-up, they found that those who adopted the four healthy habits were 40 percent less likely to die and 35 percent less likely to suffer heart problems than those who did not adopt the beneficial habits. The findings were published in The American Journal of Medicine. The diet should not only be rich in fruits and vegetables but also whole grains, omega 3 fatty acids, and other poultry and unsaturated fats -- like vegetable oils and nuts.

 

Commonwealth Medical Association 

(Dr. S. Arulrhaj, MD., FRCP (Glasg), President, Commonwealth Medical Association)

Commonwealth is an association of 53 independent countries consulting and cooperating in the common interests of their peoples and in the promotion of international understanding and world peace. The Commonwealth’s 2 Billion citizens are about 30% of the world’s population are drawn from the broadest range of faiths, races, cultures and traditions. The Commonwealth is often described as a “family” of nations & peoples. The sense of family is most apparent in the wide network of societies, institutions, associations, organizations, funds and charities which support the commonwealth. Half of Commonwealth is in India.

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An Inspirational Story

The Japanese master

A great Japanese master received a university professor who came to enquire about wisdom. The master served tea. He poured his visitor’s cup full, and then kept on pouring. The professor watched the overflow until he could no longer restrain himself. ‘It is overfull. No more will go in!’ ‘Like this cup,’ the master said, ‘you are full of your own opinions and speculations. How can I show you wisdom unless you first empty your cup?’

 

IJCP Special

Dr Good Dr Bad

Situation: A patient came with very high triglycerides.
Dr Good: Restrict carbohydrates.
Dr Bad: Restrict fat.
Lesson: High triglyclrides are due to excess of refined carbohydrates in diet.

Make Sure

Situation: A patient with prosthetic heart valves (bioprosthetic) developed infective endocarditis.
Reaction: Oh my God! Why was he not given infective endocarditis prophylaxis?
Lasson: Make sure that all patients with prosthetic heart valves (bioprosthetic or homograft) are given infective endocarditis prophylaxis.

Mnemonic of the Day (Dr Varesh Nagrath)

Symptoms of Fibromyalgi: FIBRO

F Fatigue and ‘fibrofog’ i.e. cognitive dysfunction
I Insomnia /nonrestorative sleep
B Blues (depression and anxiety)
R Rigidity (muscle and joint stiffness)
O Ow! (Pain and work disability)

Quote of the Day

"Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand." Albert Einstein

Are you fit to fly?

Pulmonary disease

  1. Patients with significant cardiopulmonary disease can be severely compromised by even the small degree of hypoxia (low oxygen) that occurs aboard commercial flights.

  2. Patients with severe, unstable asthma and those who have required recent hospitalization should not fly.

  3. Asthmatics who do fly should carry on their person, a beta–2 selective adrenergic agonist metered dose inhaler and spacer, and a course of oral steroids.
 

International Medical Science Academy Update (IMSA)

Neonatal hemochromatosis

In neonatal hemochromatosis, in a small case series, treatment with highdose IVIG, which was usually given in combination with exchange transfusion, led to substantially increased survival in treated infants (75 percent) as compared with historical controls (17 percent)

Reference

  1. Rand EB, Karpen SJ, Kelly S, et al. Treatment of neonatal hemochromatosis with exchange transfusion and intravenous immunoglobulin. J Pediatr 2009;155:566.
 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Nevirapine tablet 50 mg for oral suspension

For the treatment of HIV infection in combination with other anti retroviral agents

18.7.2009

 

Medi Finance

Q: To what extent is conveyance reimbursement exempted?

Ans. Expenditure on conveyance is exempted to the extent of actual amount incurred for official purposes. Proper documentation is required to be maintained.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Celiac Disease tests

The best initial laboratory test for diagnosis of celiac disease is antitissue transglutaminase antibody (antitTG), IgA. If this test is positive, it is likely that the patient has celiac disease. If the AntitTG is negative but the physician still suspects celiac disease, an intestinal biopsy may be done to determine whether there is damage to the intestinal villi.
Other tests to evaluate the severity of the disease and the extent of a patient’s malnutrition, malabsorption, and organ involvement include: CBC (complete blood count) to look for anemia, ESR (erythrocyte sedimentation rate) to evaluate inflammation, CRP (CReactive protein) to evaluate inflammation and Vitamin D, E, and B12 to measure vitamin deficiencies.

 

Humor Section

Jokes

Memory Test

Three elderly men visited the doctor for a memory test. The doctor asked the first one, "What’s three times three?"
"285!" the man replied.

Worried, the doctor turned to the second man. "How about you? What’s three times three?"
"Uh, Monday!" the second man shouted.

Even more concerned, the doctor motioned to the third man. "Well, what do you say? What’s three times three?"
"Nine!" the third man replied.

"Excellent!" the doctor exclaimed. "How did you get that?"
"Oh, it’s pretty simple," the man explained. "You just subtract the 285 from Monday!"

Medical bloopers on medical charts!

The patient left the hospital feeling much better except for her original complaints.

 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli 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

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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