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
 
  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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eMedinewS Presents Audio News of the Day

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

Photos of 1st Mega Ajmer Health Camp 2012

 
  Editorial …

25th March 2012, Sunday

BP mismatch between arms signals risk

Patients with hypertension who have more than 10 mmHg digit differences in blood pressure between arms appear to be at risk for cardiovascular events and premature death.

The risk of all–cause death over a follow-up of about 10 years was more than three–fold higher for patients with inter arm systolic blood pressure differences of 10 mm Hg and 15 mm Hg according to Christopher Clark, PhD, of the University of Exeter in England, and colleagues. Similar relationships were seen for cardiovascular death and combined cardiovascular and cerebrovascular events, the researchers reported online in BMJ.

The findings are consistent with a meta–analysis published by Clark’s group in January, which showed that the same interarm differences were associated with peripheral vascular disease, as well as cardiovascular and all–cause death.

Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care.

Authors examined data from 230 patients treated for hypertension. One in five had pre–existing ischemic heart disease or peripheral vascular disease. At baseline, 24% of the patients had an interarm difference in systolic blood pressure of 10 mm Hg or more and 9% had a difference of at least 15 mm Hg. During 9 years follow–up, 44% of the patients had a cardiovascular or cerebrovascular event, or died. (MedPage)

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Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

Stay Tuned with Dr Rashmi Singh

Crime Against Women - part 2

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

First Mega Ajmer Health Camp – Checkups

Both general and specialty consultations were available incorporating all pathies.

 
Dr K K Aggarwal
 
    National News

New form of TB gives doctors sleepless nights

MUMBAI: Fifteen–year–old Vina’s diagnostic report looks dismal. The lab report shows that the tuberculosis (TB) bacillus in her lungs is only sensitive to two drugs and resistant to eight others. "The world may debate whether to call her TB an extremely, extensively or a totally drug–resistant form but the fact is how does one treat a child with only two drugs?" says Ghatkopar–based Dr Amol Manerkar, who is treating Vina. "For all practical purposes," he adds, "the child’s disease is totally resistant to drugs." In the last two months, Mumbai has gained in terms of government attention (a special TB programme), money (the city’s TB budget may increase 6 times) and infrastructure (new labs, machines), but the ground reality is grim, say doctors on World TB Day. (Source: TOI, Mar 24, 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

WHO consensus: Don’t use TDR–TB label

MUMBAI: It’s not yet time to use the label of totally drug–resistant tuberculosis. This is the consensus that emerged on Friday at the World Health Organization’s (WHO) special meeting in Geneva to discuss a new nomenclature for the new, severely drug–resistant TB forms emerging in parts of the world. The consensus, a day before World TB Day, also called for clinical trials of ‘salvage drugs’ (or compassionate drugs) which are a last–ditch therapy for patients now. Hinduja Hospital reported 12 cases of TDR–TB in January, triggering a worldwide debate on whether the TB bacillus had become deadlier and immune to known drugs. The hospital’s research team, led by Dr Zarir Udwadia, published a letter in the ‘Clinical Infectious Diseases’ journal highlighting the plight of four patients who were on salvage therapy after TB drugs failed. The media then reported eight other cases, three of whom died. Dr Udwadia was invited to present his data at the WHO meeting, but the conclusion was categorical. "There is currently insufficient evidence to adopt new case definitions for drug–resistant TB," said the WHO press release. (Source: TOI, March 24, 2012)

For comments and archives

TB rates still dropping in U.S.

For the 19th year in a row, tuberculosis cases in the U.S. fell in 2011, according to the CDC. The 6.4% decline from 2010 – to just 10,521 new TB cases – yielded an incidence rate of 3.4 cases per 100,000 population, the lowest rate recorded since national reporting began in 1953, the agency reported in the March 23 issue of Morbidity and Mortality Weekly Report. The good news comes the day before World TB day. But there is also some bad news, the agency said: the U.S. did not reach its goal of eliminating TB in 2010, the rate of new cases among foreign–born people remained strikingly higher than among native–born Americans, and some subgroups still have high rates of TB, opening the door for local outbreaks. (Source: Medpage Today)

For comments and archives

TNKase tops activase for ischemic stroke

A genetically engineered clot–buster improved clinical outcomes compared with standard thrombolytic therapy in a selected population of people with ischemic strokes, researchers reported. (Source: Medpage Today)

For comments and archives

Gene may play role in frequent diarrhea

Chronic diarrhea could be the result of a genetic mutation that ultimately ramps up chloride and water secretion in the intestine, researchers found. Members of a Norwegian family who were affected by chronic diarrhea had a mutation in the GUCY2C gene, Torunn Fiskerstrand, MD, PhD, of Haukeland University Hospital in Bergen, Norway, and colleagues, reported online in the New England Journal of Medicine. (Source: Medpage Today)

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    Twitter of the Day

@DrKKAggarwal: #AJD HbA1c 5.7% as Pre diabetes Screen Setting the hemoglobin A1c threshold to 5.7% when screening for pre… http://fb.me/1zEvZZjxV

@DeepakChopra: The path of love is everywhere. There is no place you can go that is devoid of love and no place you can leave that is not already love.

 
    Spiritual Update

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

1st Chaitra Navratri: Shailputri Worship

"Spiritual summary: On the first day we control (riding), our desires (bull) by balancing (Trishul) the mind with cool thoughts (moon) and practicing detachment (lotus). This can be assisted by chanting LAM focusing on sacral chakra"

Navratri is the detoxification of body, mind and soul. The nine-day purification process is observed twice in a year, at the start of summer and winter. Chaitra Navratri is observed at the start of the summer for preparing the body to tolerate summer.

Body detoxification involves special Navratri diet principles of eating less, once a day with no cereals.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are Intrauterine Adhesions?

Trauma to and/or infection of the uterine lining (endometrium) may damage the endometrial lining and may lead to partial or total destruction of the endometrium in severe cases. Intrauterine adhesions (scar tissue) can form between the inner walls of the uterus. Asherman’s Syndrome is the term used to describe intrauterine adhesions.

For comments and archives

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

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

Blood Donation – Gift of Liquid Love

Blood Transmitted Diseases

  • Blood is a double–edged weapon. On one hand where it is life saving, on the other hand, blood is endowed with the dangers of transmitting deadly diseases. Fortunately the public is becoming more and more aware about this danger.
  • The infections that may be transmitted through transfusion are Hepatitis B, Hepatitis non–A and non–B, HIV, CMV, Syphilis, Malaria, E.B. virus and HTLV infection.
  • The discovery of post transfusion Hepatitis in 1968 led to mandatory testing of blood for Hepatitis B antigen (HbsAg). This led to decline in incidence of post–transfusion hepatitis.
  • But it was found that many other organisms like non–A non–B hepatitis virus (called as Hepatitis C and D viruses), Cytomegalovirus (CMV), EB virus, were also responsible for post transfusion hepatitis.
  • Besides these viruses, the transmission of HIV I & II through transfusions resulted in overall changes brought about in blood banking.
  • The role of blood in transmitting Treponema causing Syphilis and Plasmodium resulting in malaria too have been highlighted.
  • Hence it has been made mandatory that every donor must be tested for these.
  • HTLV implicated in endemic T–cell leukemia are other viruses transmitted in blood that can cause serious and fatal diseases.

For comments and archives

 
    Celiac Disease Update

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

What is celiac disease ?

Celiac disease, is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. Celiac disease is a digestive disease that damages the small intestine. Patients of Celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Symptoms include chronic diarrhea, failure to thrive and fatigue, but these may be absent, and symptoms in other organ systems have been described.

For comments and archives

 
    Medi Finance Update

(Tarun Kumar, Chartered Accountant)

Budget Overview

Personal taxation

  • Basic exemption limit enhanced from Rs.180,000/– to Rs. 2,00,000/–.
  • No differentiation for basic exemption limit for women. Earlier Rs. 1,90,000/– now Rs. 2,00,000/–.
  • No change in basic exemption limits for senior citizens (above 60 years). Earlier Rs. 2,50,000/– now Rs. 2,50,000/–.
  • No change in basic exemption limits for Super senior citizens (above 80 years). Earlier Rs. 5,00,000/– now Rs. 5,00,000/–.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Credibility

We all know the story of the shepherd boy who cried wolf. The boy decided to have some fun at the expense of the villagers. He shouted, "Help, help, the wolf is here." The villagers heard him and came to his rescue. But when they got there, they saw no wolf and the boy laughed at them. They went away. The next day, the boy played the same trick and the same thing happened.

Then one day, while the boy was taking care of his sheep he actually saw a wolf and shouted for help. The people in the village heard him but this time nobody came to his rescue. They thought it was another trick and didn’t trust him anymore. He lost his sheep to the wolf.

The moral of the story is – When people tell lies, they lose credibility. Once they have lost credibility, even when they tell the truth, no one believes them.

Make yourself an honest man and then you may be sure there is one rascal less in the world. Thomas Carlyle

Source: http://great–motivational–stories.blogspot.in/2008/06/credibility.html

For comments and archives

 
    Cardiology eMedinewS

High–Fat Meals May Increase Inflammation in Diabetics Read More

Patients With Diabetes, High HbA1c Have Higher Endoscopic Abnormalities. Read More

The NIH Urges Women to Protect Their Heart Health Read More

Antidepressants Only Marginally Better than Placebo Read More

 
    Pediatric eMedinewS

Hold Off On Antibiotics For Sinus Infection, Guidelines Urge Read More

Fewer Kids Dying From Leukemia: Study Read More

Early Exposure To Smoking May Predict COPD 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

The resident skin flora prevents or limits colonization by pathogenic microbes. This is done by different mechanisms: by competing for nutrients, physically blocking the sites for adherence of microbes (competitive exclusion), by secreting chemicals which damage some microbes and by stimulating the skin’s immune system. Pseudomonas aeruginosa, part of normal skin flora produces pseudomonic acid, an antibacterial substance working against Staphylococci and Streptococci. This is commercially exploited to prepare Mupirocin active against infections produced by these bacteria. Pseudomonas produces other substances which inhibit the growth of many yeasts and moulds on the skin.

Moreover, our natural body defense also favors colonization with the commensal resident flora by limiting colonization by pathogenic microbes. These mechanisms include: fatty acids produced by skin glands which limit the colonization by many pathogenic microbes and the sweat contains a natural antibiotic known as dermicidin to which normal skin flora is tolerant but pathogenic bacteria are not.

Skin bacteria also generate body odors. For example the strong foot odor is due to Bacillus subtilis. Propionibacteria in adults and adolescents present in the sebaceous glands produce propionic acid from amino acids giving peculiar odor to normally odorless sweat. Staphylococcus epidermidis produces isovaleric acid, which is responsible for yet another type of body odour.

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with inflammation was being regularly followed up.
Dr. Bad: Do sequential ESR.
Dr Good: Do sequential CRP.
Lesson: As patient’s condition worsens or improves, the ESR changes relatively slowly but the CRP concentrations changes rapidly.

For comments and archives

Make Sure

Situation: A patient’s blood pressure was not responding on Arkamin.
Reaction: Oh my God! Why was the patient given Artamin?
Lesson: Make sure when writing the prescription that the drug name spelled clearly.

For comments and archives

 
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    Quote of the Day

(Dr GM Singh)

Be noble minded! Our own heart, and not other men’s opinions of us, forms our true honor. Schiller, Johann Friedrich

 
    Legal Question of the Day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. Please answer the following questions related to the PC & PNDT Act, 1994.

a. What is the difference between PNDT rule 9(1) & rule 9(4)?
b. Is it against law to keep Form F not as a hard bound register but in an electronic form? (I maintain electronic record as per rule 9(7). I have also taken hard copies of "FORM F" & signed the same arranged them in the form of a box file and submitted the same to the PNDT authority but the authority does not accept it and insists that I must maintain a regular hard bound register).

Ans.

  • Rule 9(1) of the Pre–Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Rules, 1996, is reproduced below:
    "(1) Every Genetic Counselling Centre, Genetic Laboratory, Genetic Clinic, Ultrasound Clinic and Imaging Centres shall maintain a register showing, in serial order, the names and addresses of the men or women given genetic counselling, subjected to pre–natal diagnostic procedures or pre–natal diagnostic tests, the names of their spouse or father and the date on which they first reported for such counselling, procedure or test.";

    Please note that this rule is mandatory and no excuses/exemptions are permissible. Please also note that it specifically talks of a register which is serially numbered.
  • Rule 9(1) is a general rule and asks for maintaining a record only in respect of the following:
    • Serial no.
    • Date
    • Name of the patient
    • Name of the spouse/father
  • The record/report that is expected to be maintained by the ultrasound clinic is described in Rule 9(4) as follows:
    "(4) The record to be maintained by every Genetic Clinic, in respect of each man or woman subjected to any pre–natal diagnostic procedure/technique/test, shall be as specified in Form F.";
  • An ultrasound clinic is a genetic clinic as per definition of the genetic clinic given in Section 2 (d) of the Act.
  • An ultrasound clinic is required to maintain a register in terms of Rule 9(1) and also to fill up Form F in terms of Rule 9(4) . The title of the form reads—
    "FORM F–– Form for maintenance of record in respect of pregnant woman by genetic clinic/ultrasound clinic/imaging centre"

    The foot note in Form F clearly states as follows:

    “Person conducting ultrasonography on a pregnant woman shall keep complete record thereof in the clinic/centre in Form – F and any deficiency or inaccuracy found therein shall amount to contravention of provisions of section 5 or section 6 of the Act, unless contrary is proved by the person conducting such ultrasonography".
  • Nowhere in the PNDT Act or Rules is there a mention of an "F form register". As a matter of fact, the serial no. (which can be reasonably expected to be associated with a register) is a requirement in respect of Rule 9(1) but not Rule 9(4).
  • Rule 9(7) reads:
    "(7) In case the Genetic Counselling Centre or Genetic Laboratory or Genetic Clinic maintains records on computer or other electronic equipment, a printed copy of the record shall be taken and preserved after authentication by a person responsible for such record."

    Please note that this rule talks of records in genera and not Form F in particular. It cannot include Form F because it needs the following three signatures:
    • Name, Signature and Registration number of the Gynaecologist/Radiologist/Director of the Clinic
    • Signature/Thumb impression of pregnant woman
    • Name and signature of the person conducting ultrasonography/image scanning/Director or owner of genetic clinic/ultrasound clinic/imaging centre.
      The above signatures/thumb impression cannot be obtained in an electronic record.
  • As per the PNDT Rules, it can be concluded:
    • There is nothing like a hard bound Form–F Register
    • Form F is not supposed to be maintained an electronic form.

For comments and archives

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Prostate specific antigen (PSA)

Ejaculation can increase PSA levels by upto 0.8 ng/mL, though levels return to normal within 48 hours.

There is no need to ask men to abstain from sexual activity prior to PSA measurement. However, if an initial measurement is high enough to potentially prompt an intervention (i.e., biopsy), but close to a borderline value, it is appropriate to repeat the PSA measurement after having the man abstain from ejaculation for at least 48 hours

 
    Mind Teaser

Read this…………………

Which is not true regarding portacaval shunts?

a) Used for intractable ascites.
b) It can be made selective by using 8 mm interposition graft.
c) It is a partial shunt.
d) Distal splenorenal shunt does not involve splenectomy.

Yesterday’s Mind Teaser: All are precancerous for carcinoma colon except:

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

Answer for Yesterday’s Mind Teaser: d. Carotene

Correct answers received from: Dr shashi saini, Raju Kuppusamy, Dr Thakor Hitendrsinh G,
Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Anil Bairaria, Dr Valluri Ramarao, Atul Soreng.

Answer for 23rd March Mind Teaser: a) Complete proctocolectomy and Brook’s ileostomy
Correct answers received from: Dr Valluri Ramarao.

Send your answer to ijcp12@gmail.com

 
   Laugh a While

(Dr GM Singh)

Child Rearing FAQs

Q: Should I have a baby after 35?
A: No, 35 children is enough.

Q: I’m two months pregnant now. When will my baby move?
A: With any luck, right after he finishes college.

 
    Medicolegal Update

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

Who is a surrogate medical decision maker for patient?

Studies suggest that spouses and other family members generally do not know the preferences of patients regarding the termination of life–sustaining treatments; therefore, they may not reach the same decision that the patient would have reached. 1 One study found that even though patients believed both their family (87%) and doctors (90%) could accurately represent their wishes, neither family members nor doctors were able to adequately predict patient wishes on scenario testing with agreement ranging from 59 to 88%. 2 This discrepancy emphasizes the importance of patient/surrogate discussions about preference prior to a loss of capacity. Unfortunately, these proactive discussions are rare and clinicians are usually left relying on the family for decisions.

References

  1. Emanuel EJ, Emanuel LL. Proxy decision making for incompetent patients: An ethical and empirical analysis. JAMA 1992;267:2067.
  2. Shalowitz D, Garrett–Mayer E, Wendler D. The accuracy of surrogate decision–makers. Arch Intern Med 2006;166:493.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

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

Paracetamol can cause Asthma

Several studies have noted a dose–dependent relationship between the regular use of paracetamol and the risk of developing allergic disease in general and asthma in particular, said Dr. K.K. Aggarwal, Padma Shri and Dr B C Roy National Awardee and President, Heart Care Foundation of India.

The effect has been noted in both adults and in offsprings of mothers taking regular paracetamol during pregnancy.

Paracetamol use has been postulated to be a risk factor for asthma as it induces depletion of the antioxidant glutathione in lung tissue. As a result, oxidative damage occurs, prostaglandin E2 production increases, and Th2 processes are promoted.

Cockroach allergens: In studies of inner city asthma, sensitization to cockroach allergens has been shown to be a significant risk factor in the development of asthma.

In addition, morbidity from asthma in inner–city children is associated with the presence of cockroach allergy and exposure to high levels of cockroach allergen in bedroom dust.

 
    Readers Responses
  1. I fully agree with Dr Sandeep Nigam. He has expressed what the ground reality is. The worst part is that at some places you have to give attendance at local thana, your family is not safe. Aur batein badi badi ki doctors gaon mein nahi jaana chahate. Yeh bureaucrats ek din khud in conditions mein rah kar dikhayen. Vivek Kumar, Varanasi.
 
    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
http://www.heartcarefoundation.org

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

 
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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, Dr Usha K Baveja