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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 & 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

 

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–4 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

24th August 2012, Friday

2012 may be worst year yet for West Nile

According to the CDC Americans are facing what may be the largest outbreak of West Nile virus since the disease was first detected in the U.S. in 1999.

What is West Nile disease?

  1. West Nile virus, a member of the Japanese encephalitis virus antigenic complex.
  2. It can lead to a wide range of clinical symptoms from asymptomatic disease to severe meningitis and encephalitis.
  3. It causes neuroinvasive disease, particularly in the elderly or the immunosuppressed host.
  4. The usual presentation is a self-limited illness, called West Nile fever.
  5. The illness is indistinguishable from dengue fever and other viral grippes (acute febrile highly contagious viral disease).
  6. The illness is characterized by fever, headache, malaise, back pain, myalgias and anorexia persisting for 3 to 6 days.
  7. Despite the name "West Nile fever", some patients report very low grade or no fever at all.
  8. Eye pain, pharyngitis, nausea, vomiting, diarrhea, and abdominal pain can also occur.
  9. A maculopapular rash appears in approximately one-half of patients.
  10. It can present as encephalitis, meningitis, or an acute asymmetric flaccid paralysis.
  11. Encephalitis with muscle weakness and flaccid paralysis is particularly suggestive of WN virus infection.
  12. One can also have tremor, myoclonus, and parkinsonian features such as rigidity, postural instability, and bradykinesia.
  13. The disease occurs in mosquito season.
  14. Diagnosis can be confirmed by demonstrating either specific IgM antibody or viral nucleic acid in serum obtained within the first 8 days of illness.
  15. Convalescent–phase serum should be tested for IgM antibody if acute serum IgM antibody or NAAT tests are negative.
  16. Total leukocyte counts in peripheral blood are mostly normal or elevated.
  17. CSF should be tested for IgM antibody as well as serologic testing.
  18. CSF usually demonstrates a pleocytosis often with a predominance of lymphocytes as well as an elevated protein concentration.
  19. Birds are the primary hosts of the West Nile (WN) virus; the virus can be spread when a mosquito bites an infected bird and then bites a human or animal.
  20. The virus is not transmitted through person–to–person contact.
  21. Most cases develop after being bitten by an infected mosquito.
  22. Most people who contract WN virus do not develop any symptoms.
  23. About 25% of people develop mild illness, called West Nile fever, which usually resolves spontaneously.
  24. One in 230 infected people develop severe or neuroinvasive disease, which affects the central nervous system and can result in permanent neurologic dysfunction or even death.
  25. There is no treatment for WN virus.
  26. The best way to avoid becoming infected is by preventing mosquito bites with repellents containing DEET, picaridin, oil of lemon eucalyptus, or IR3535 and by wearing protective clothing while outdoors.
  27. Pregnant or nursing women, people over age 50, and people who have received organ transplants or have other conditions that weaken the immune system are especially encouraged to take preventive measures.
  28. There have been a limited number of cases of people who acquired WN virus after receiving donated blood or organs.
  29. In the USA all blood donations are screened for WN virus to identify infected blood.
  30. In India, this test is not done.

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

make a drain along side with yamuna

Audio PostCard
 
    Photo Feature (From HCFI Photo Gallery)

Seminar on Health and Happiness

A seminar was organized jointly by Heart Care Foundation of India and Bharatiya Vidya Bhavan.

 
Dr K K Aggarwal
 
    National News

Mumbai finds 1,407 patients with drug-resistant TB

Six months after a special plan to combat tuberculosis was introduced in the city, there is an estimate of just how widespread the deadly drug–resistant variety of the disease is in the community. Of 6,561 people screened for the disease across the city, 1,407 tested positive, said BMC officials on Tuesday. "The numbers are higher this year because of better diagnostic and treatment facilities introduced in the city," said additional municipal commissioner Manisha Mhaiskar. In 2011, only 354 people were tested, of whom 181 emerged positive. Ever since Hinduja Hospital, Mahim, made public in January 2012 its experience with 12 patients with extremely extensively drug–resistant TB, the spotlight has been on Mumbai’s TB epidemic. The Centre has given funds and special status to help check the spread of the disease.

A central team, along with experts from Centers of Disease Control (US) and UNAIDS, will begin a visit to the city on Wednesday to look at the progress made. The BMC, which has been partnering the Revised National Tuberculosis Control Programme (RNTCP), has in the interim got a TB control officer with 24 deputies in each ward. "We have increased treatment units in the city from 27 to 59. The Sewree TB Hospital will get extra beds and an improved laboratory," said a city health official. The BMC now plans to hold door–to–door surveillances every quarter. The next survey will begin on September 1. "If we cannot cover every ward, we will at least cover high–risk areas," said another official. The BMC also plans to enlist the help of counsellors in the TB control programme to ensure that people do not drop out of treatment; dropout has been traced as one of the reasons for the emergence of the drug-resistant strain. Mhaiskar said, "We have found drug–resistant patients who were previously not part of the healthcare system. This is because we increased diagnosis facilities." The city got a high–tech GeneXpert, which detects drug–resistant strains in two hours. The capacity of J J Hospital’s laboratory to test has increased from 15 to 60 a day. Another factor that helped the city is door–to–door surveillance for TB patients in all 24 wards. "We found 458 new patients of tuberculosis, of whom 452 have already been put under treatment," said Mhaiskar. (Source: TOI, Aug 22, 2012)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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 Dr Monica and Brahm Vasudev)

New drug–eluting stent works well in STEMI

A new–generation biodegradable drug–eluting stent had a lower rate of major cardiac events than similar bare–metal devices, researchers reported. (Source: Medpage Today)

For comments and archives

Delirium in hospital hastens decline in Alzheimer’s

Patients with Alzheimer’s disease who develop delirium while hospitalized –– a common and preventable occurrence –– saw worsening of their dementia, researchers found. (Source: Medpage Today)

For comments and archives

New markers predict progression in oral cancer

Researchers have made a possible breakthrough that could help curtail the rising incidence of oral cancer. A group of molecular markers has been identified that can differentiate which oral premalignant lesions have a high risk for progression to cancer. The prospective cohort study, published online August 21 in Cancer Prevention Research, is the largest longitudinal study of low–grade oral premalignant lesions from a population–based patient group. It confirms previously reported data and provides the first validated molecular model to differentiate low–grade oral dysplasia at low risk for progression from lesions at greater risk, the researchers note. (Source: Medscape)

For comments and archives

TB, Hep C, HIV Rates all higher in homeless population

The prevalence of tuberculosis (TB) among the homeless is an estimated 46 times higher than in the general US population, hepatitis C prevalence is 4 times higher, and HIV prevalence is also elevated, according to a survey of the medical literature published online August 20 in the Lancet. (Source: Medscape)

For comments and archives

 
   Twitter of the Day

@DrKKAggarwal: 20 Minutes Of Sunlight And A Glass Of Milk Can Keep Osteoporosis At Bay

@DeepakChopra: Never give up hope. Know that you are loved.

 
    Spiritual Update

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

13 Facts about Sikhism

  1. Sikhism is not a missionary religion: Sikhism believes in truth and the truth shall always prevail and Sikhism is the truth. Therefore there has never been and will never be Sikh missionaries actively pursuing conversions. Yet Sikhism still flourishes.
  2. Sikhism is a religion of equality: Sikhism stresses “universal equality” amongst all human beings. In Sikhism, everyone (men, women, all castes, religions and color) is able to carry out prayer rights.

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How is the egg donor evaluated?

  • Donors should have attained their state’s age of legal majority and preferably should be between the ages of 21 and 34. Both anonymous and known donors should complete an extensive medical questionnaire that details their personal and family medical history. Included in this questionnaire should be a detailed sexual history, substance abuse history and psychological history. For anonymous donors, the questionnaire should assess the donor’s motivation for donating her eggs and provide insight into the donor personality, her hobbies, educational background and life goals. This document ultimately will be shared with the recipient and provides her with insight into a donor she will never meet.
  • The laboratory testing of all donors should include screening and testing for syphilis, hepatitis B and C, HIV–1 and HIV–2, Neisseria gonorrheae and Chlamydia trachomatis, as well as screening for human transmissible spongiform encephalopathy and testing when risk factors for it exist. Donors should also have documentation of their blood type and Rh status, complete blood count, and rubella titer. Donors may be required to undergo drug testing. Genetic screening of donors should be based on ethnicity. Caucasian donors should be tested for the presence of a cystic fibrosis (CF) mutation. Donors of Asian, African, and Mediterranean descent should undergo a hemoglobin electrophoresis as a screen for sickle cell trait and thalassemias. If the donor is of Ashkenazi Jewish origin, CF mutation analysis, and screening for Tay–Sachs disease, Canavan disease, and Gaucher disease is indicated. Donors who are of French Canadian descent should be screened for CF as well as Tay–Sachs disease.

For comments and archives

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

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Venous access

  • It depends on integrity of the patient’s veins, volume to be transfused and expected duration of intravenous therapy
  • Steel needles or plastic catheters are commonly used for short–term transfusion therapy.
  • For medium and long–term therapy or for administration of solutions potentially toxic to the vein lining, central vein catheters are used.
  • The administration of fluids incompatible with blood is never encouraged in transfusion setting.
  • An 18–gauge needle is commonly used, but patients with small veins require much smaller needles.
  • Thin walled, 23–gauge needles may be used for transfusions for pediatric patients

Infusion sets

Blood and components must be administered through a filter designed to retain blood clots and particles those are harmful to the recipient.

Standard blood transfusion sets

  • These should have inline filters with pore size of 170–260 μ, drip chambers and tubing in a variety of configurations.
  • Filter should be fully wetted and drip chambers filled no more than half full.
  • In order to reduce the risk of bacterial contamination, a reasonable time limit for an infusion set is 4 hours.
  • Filter can be used for 2 to 4 units of blood provided maximum time does not exceed 4 hours and if the manufacturer permits.

Compatible IV solutions

  • It is advisable not to add medications to blood or components.
  • If red cells require dilution to reduce their viscosity or if a component needs to be rinsed from the blood bag or tubing, 0.9% normal saline is the product of choice. ABO–compatible plasma, 5% albumin, or plasma protein fraction can also be used with approval of the concerned clinician.
  • Lactated Ringer’s solution, 5% dextrose in water, and hypotonic sodium chloride solutions should not be used for addition to blood components or for simultaneous administration via the same intravenous line.

Suggested infusion rate for adults

  • Concentrate of Human Red Blood Corpuscles (Packed Cells): 100–200 ml/hour.
  • Fresh Frozen Plasma/Platelets: 200–300 ml/hour

Suggested infusion rate for pediatric patients

  • Concentrate of Human Red Blood Corpuscles (RBC): 2–5 ml/kg/hour.
  • Fresh Frozen Plasma: 1– 2 ml per minute
  • Platelet: As tolerated.

For comments and archives

 
   An Inspirational Story (Ms Rita Sinha)

Learn from mistakes

Thomas Edison tried two thousand different materials in search of a filament for the light bulb. When none worked satisfactorily, his assistant complained, "All our work is in vain. We have learned nothing."

Edison replied very confidently, "Oh, we have come a long way and we have learned a lot. We know that there are two thousand elements which we cannot use to make a good light bulb."

For comments and archives

 
   Cardiology eMedinewS

Statin review: No risk of cancer, memory loss Read More

Weight training or aerobics: both lower diabetes risk Read More

 
   Pediatric eMedinewS

When Elmo likes apples, kids want them too Read More

Vitamin D supplementation cuts respiratory infections Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.
Dr Bad: Do not worry.
Dr Good: Rule out diabetes.
Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).

For comments and archives

Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.

For comments and archives

 
  Quote of the Day (Dr GM Singh)

The reason angels can fly is because they take themselves lightly. G.K. Chesterton

 
    Legal Question of the Day (Dr M C Gupta)

Q. I think it is illogical that a microbiologist having his private lab should get his reports signed by a pathologist since, as per legal experts, such a report amounts to practice of pathology. It is common knowledge that microbiology and biochemistry reports in government medical college hospitals are openly signed by a microbiologist/biochemist. What action can be taken in this regard?

Ans.

  • The law as stated by medical experts is not of their own making. It flows from the affidavits and pleadings submitted by the MCI in various HC judgments.
  • According to the MCI, conducting lab investigations related to a patient amounts to practice of pathology. No distinction/exemption applies as regards biochemical, immunological or microbiological tests.
  • The above position holds irrespective of whether the tests are done in a private or government set up.
  • The actions to try to change the situation may be many. The simplest is as follows:
    • Complaints may be sent to the state medical council against microbiologists/biochemists issuing reports under their signature. The state medical council will do one of the two things—
      • It will hold the person not guilty. In that case, it is all well and good. Let such information be openly circulated on e mail lists for the benefit of others.
      • It will hold the person guilty. In that case, the person held guilty should file an appeal to the MCI. If the MCI confirms the order of the SMC, he should go to the HC by way of a WP against the order of the MCI.

For comments and archives

 
    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Phosphorus

Increased: Hypoparathyroidism, excess vitamin D, secondary hyperparathyroidism, renal failure, bone disease, Addison’s disease

Decreased: Hyperparathyroidism, alcoholism, diabetes, hyperalimentation, acidosis, hypomagnesemia, diuretics, vitamin D deficiency, phosphate–binding antacids

 
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

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    Mind Teaser

Read this…………………

An intravenous pyelogram reveals that Paulo, age 35, has a renal calculus. He is believed to have a small stone that will pass spontaneously. To increase the chance of the stone passing, the nurse would instruct the client to force fluids and to

A. Strain all urine.
B. Ambulate.
C. Remain on bed rest.
D. Ask for medications to relax him.

Yesterday’s Mind Teaser: Treatment with hemodialysis is ordered for a client and an external shunt is created. Which nursing action would be of highest priority with regard to the external shunt?

A. Heparinize it daily.
B. Avoid taking blood pressure measurements or blood samples from the affected arm.
C. Change the Silastic tube daily.
D. Instruct the client not to use the affected arm.

Answer for yesterday’s Mind Teaser: B. Avoid taking blood pressure measurements or blood samples from the affected arm.

Correct answers received from: Dr Avtar Krishan, Dr K Raju, Dr KV Sarma, YJ Vasavada, Dr Vinay Nambiar, Dr PC Das, Dr (Maj. Gen.), Anil Bairaria, Dr BB Aggarwal, Dr Thakor Hitendrsinh G, GV Premkumar, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Kanta Jain, Dr Parimal Shah, Muthumperumal Thirumalpillai, Drjella, Dinesh Yadav.

Answer for 21st August Mind Teaser: A. Hyponatremia
Correct answers received from: Drjella

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A bus driver is driving with a bus load of seniors down the road when he is tapped on his shoulder by a little old lady. She offers him a handful of peanuts, which he gratefully munches up. After about 15 minutes, she taps him on his shoulder again and she hands him another handful of peanuts. She repeats this gesture about five more times. When she is about to hand him another batch again he asks the little old lady: ‘Why don’t you eat the peanuts yourself? We can’t chew them because we’ve no teeth,’ she replied. The puzzled driver asks: ‘Why do you buy them, then?’ The old lady replied: ‘We just love the chocolate around them.

 
    Medicolegal Update

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

What is obsession?

  • In obsession, the sufferer constantly entertains an idea, without cause, in spite of all his efforts to drive the idea out of his mind. Obsession is a type of compulsive phenomenon. The classical example of this condition is, a person while going to bed at night, bolts the door of the room from inside, but after going to the bed he feels the necessity to verify and does so to see if he has bolted the door or not. He repeats this act again and again, in spite of his consciousness and in spite of his desire and efforts to stop the act.
  • Obsession is considered a borderline state between sanity and insanity. In the above case, a sane person will stop after repeating the act of verification for a few times. But an insane person may continue the act all throughout the night without sleeping.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Take care of your feet in the monsoons

Going barefoot in monsoon can be risky. People who take off their shoes and socks may suffer injuries such as cuts and puncture wounds. There may be sharp objects under the water that cause injury. In some cases, these injuries develop infections that may require surgery, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Safety tips

  • Get vaccinated against tetanus. Teenagers and adults should get booster shots every 10 years.
  • Wear sandals while walking in rains or around swimming pools. They'll help protect against cuts and abrasions and prevent contact with viruses and bacteria that can cause athlete’s foot, plantar warts and other foot problems.
  • Many worm infestations may occur through the infected water.
  • Fungal infections of the foot are very common.
  • Diabetics should never be barefoot, even indoors, because they may not "feel" a foot injury.
  • If you suffer a puncture wound in the foot, see a doctor within 24 hours. A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications such as tissue and bone infections or damage to tendons or muscles in the foot.
  • Regularly inspect your feet for signs of skin problems such as warts, calluses, ingrown toenails, suspicious moles, spots or freckles. The sooner they are detected, the easier they are to treat.
  • Keep your feet dry always.
 
    Readers Response
  1. Thanks doctor. Great information in the present context for all of us. Kursi ka nasha keeps people moving them higher and higher but their negative role brings them down and even breaks their chair. Let us all do our best. May God bless all. Kuldeep Dhatwalia
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal
Dr K K Aggarwal


Dr K K Aggarwal

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 public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org

TOGETHER WE CAN

RELAX *RECREATE* REJUVENATE

Weekend Retreat for Doctors on
Mind – Body – Medicine

8 (Sat) – 9 (Sun) September 2012 At Brahma Kumaris Om Shanti Retreat Centre NH–8, Bhorakalan, Pataudi Road, Bilaspur Chowk, Distt.-Gurgaon

There is NO REGISTRATION FEE but REGISTRATION is MUST
Visit us at: www.togetherwecan.in
Contact: BK Sister Sapna – M – 9650692204
E–mail: bksapna108@gmail.com

 
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