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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


25th July, 2010, Sunday

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

Teaching in Medical Schools in India: effectiveness of lecture basesd learning 

The best prescription of how to teach comes from ancient Indian Shastra where Saraswati has been shown as the mother of education. She is shown wearing a white Sari, sitting on a swan with four hands, one hand containing small Vedic book, the second a rosary and in the other two with a large Veena.

The basic meaning is that to be a good teacher, you need to be like a mother who concentrates more on the weaker child than on the one who is stronger and intelligent. The white sari depicts teaching based on truthfulness and facts and not on myths and fears. Sitting on a swan indicates teaching the power of discrimination to the students, i.e. differentiating between good and bad and swan has the power to do. A swan can suck milk from milk-water solution. 


Small Vedic book in one hand indicates that reading books are important but alone not sufficient to gain knowledge. Small rosary in one hand also indicates that one need to read a subject repeatedly but that can not be the main tool. The main tool, as depicted in Ma Saraswati is the two hands with a large Veena representing practice or Abhyas. In Bhagwad Geeta also, Krishna describes the characteristics of a good teacher and a good student. The same can be summarized as ‘to hear’, “to understand’, ‘to know’ and ‘to do’. The most important of them is ‘to do’. Even a recent US research has shown that attending lectures are only 5% effective; reading is 10% effective and the audio-visual teaching is 20% effective. The main tools in teaching are demonstrations (30%), group discussions (50%) and practice by doing (75%). The whole Western teaching nowadays in every discipline is based on practical and group discussions.

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Editor in Chief

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Photo Feature (From HCFI file)

BSNL Dil ka Darbar

BSNL Dil ka Darbar, An interaction with top Cardiologists, a unique public forum was organized by Heart Care Foundation of India at MAMC Auditorium, Maulana Azad Medical College, on September 6, 2009

In This Photo: Padma Shri and Dr B C Roy National Awardee Dr. K K Aggarwal presenting his book ‘Alloveda’ to Dr Kiron Walia, Health Minister, Delhi

Dr k k Aggarwal


News and views

National

Sunny Deol's back problem returns

There seems to be no end to Sunny Deol’s troubles. He’s back again in bed for a prolonged rest with his chronic back problem. And to compound his woes this time stones in his kidney were also detected.

Mumbai in malaria grip

Central Mumbai has emerged as a hotspot of this latest health crisis. The city has already logged 8,549 cases of malaria. Over 1,600 cases have been registered in the month of June alone. The government is now more worried about malaria. Research clearly indicates that malaria is deadlier than H1N1. Accumulated rain water at construction sites has become breeding ground for mosquitoes.

International

Increasing rates of hypertension among people 18 and younger

The incidence of hypertension in people aged 18 years or less has increased in the past three decades. Data show that this rate has increased from one percent to five percent in this age group, putting young people at risk for heart attacks and strokes. The risk is greater especially for those who are overweight, although the risk is higher overall. (Journal of the American College of Cardiology)

Most physicians attribute overtesting to protect themselves from malpractice lawsuits

Findings of a survey published in the Archives of Internal Medicine note that 90% of doctors overtest and overtreat to protect themselves from malpractice lawsuits. This perception is more prevalent among male doctors than female doctors.

Regional, paired-kidney transplants have proved to be successful

According to John Friedewald, chair of the United Network for Organ Sharing’s committee for kidney paired donation, rgional paired–kidney exchanges have had enough success to inspire the creation of a national pool.

Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival

Previous studies of acute decompensated heart failure have demonstrated a strong association between worsening renal function and increased mortality. Similarly, high–dose loop diuretics have been associated with decreased survival, and aggressive diuresis has been proposed as a possible cause for worsening renal function. However, it has also been suggested that incomplete relief of congestion during acute decompensated heart failure may contribute to heart failure disease progression and worse survival. The aim of this study was to examine the relationship between aggressive decongestion, worsening renal function, and survival in relation to hemoconcentration. Hemoconcentration occurs when the rate of diuresis exceeds the refill rate of extravascular fluid into the intravascular space, causing concentrations of hemoglobin and plasma proteins to increase. This study demonstrated that hemoconcentration was associated with higher doses of loop diuretics, greater rates and quantities of diuresis and weight loss, greater reductions in cardiac filling pressures, and worsening renal function. However, patients who developed hemoconcentration had substantially improved survival despite a higher incidence of worsening renal function. These observations suggest that aggressive decongestion of patients with acute decompensated heart failure may improve survival, even when high diuretic doses are required or renal function deteriorates. The study is published in the July 20, 2010 issue of Circulation.

(Contributed by Dr V Nagrath)

 

 

Legal Column

Forensic Column (Dr Sudhir Gupta, MBBS (Gold Medal), MD (BHU), DNB, MNAMS, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Summon from court of law (part 2)

The word ‘Summon’ is derived from ‘subpoena’ which means under penalty.

Summon is a court document/order compelling the attendance of any witness including doctor as medical witness, in a Court of law on a particular day, time and place, for the purpose of giving evidence. It may also require him to bring with him the medicolegal report/clinical sheets/register, any medical books, medical documents etc, that he is bound by law to produce in evidence. The summon is issued under Section 61 of Criminal Procedure Code by the Court in writing, in duplicate, signed by the presiding officer of the Court and bears the seal of the Court. It is served on the witness by a police officer, by an officer of the Court or other public servant. The person should sign a receipt on the back of the other copy. It can also be served by registered post, or fixed on some conspicuous part of his residence.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Gastroesophageal Reflux Disease in Children (Contd…)

Diagnosis of GERD

Various tests available for diagnosis of GERD and their advantages and disadvantages are summarized as below.

Study

Advantages

Disadvantages

Upper GI (Barium)

Readily available Evaluates upper GI structures

Inadequate screen for GERD
Results: operator–dependent

24 hr pH probe

Quantification of reflux; Evaluates atypical symptoms;Monitors medical treatment

Requires overnight hospitalization, special equipment and personnel

Endoscopy with biopsy

Evaluates persistent GERD H.pylori infection, allergic enteropathy.

Invasive and requires sedation

Technetium

More sensitive than pH probe; Detect smaller volumes; Picks up pulmonary aspirations

Non physiologic settings; Does not rule out anatomic obstructions

Manometery

Most helpful in understanding more about the pathophysiology

Cannot quantify GER; Mainly a research tool

Question of the Day

Which groups of children with juvenile arthritis are at risk of developing uveitis? (Dr Sujata Sawhney)

Children with oligoarticular disease, who are most often young preschool girls under five years of age, are at the highest risk of developing uveitis. It is this group of children, which is most often ANApositive. On an average, uveitis is found in 20% of children with oligoarthritis. It is very rare in patients who have systemiconset disease or in those who are rheumatoid factorpositive. The onset of chronic uveitis is usually insidious, often entirely asymptomatic. In up to 10% of children it may occur before the arthritis and is usually undetected. Most children develop uveitis within 7 years of onset of arthritis. It is bilateral in 80% of children. The uveitis in juvenile idiopathic arthritis is usually anterior; posterior uveitis suggests sarcoidosis and not JIA. The uveitis that accompanies ERA (Enthesitis related arthritis) is acute, painful, presents with a red eye and seldom leaves sequelae.

 

Public Forum (Press Release for use by the newspapers)

Obsessively yours: Signs That You May Have OCD

Obsessivecompulsive disorder (OCD) is a disabling and potentially chronic anxiety disorder and is characterized by anxietyprovoking intrusive thoughts and repetitive behaviors, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Obsessions may consist of aggressive thoughts and impulses, fears of contamination by germs or dirt, or fears of harm befalling someone. Compulsions such as washing, checking, or counting are rituals whose purpose is to neutralize or reverse the fears. OCD occurs in 2 to 3 percent of the population. People with OCD have uncontrolled thoughts that compel them to develop habits or rituals to ease their anxiousness.

The Anxiety Disorders Association of America offers this list of potential warning signs of OCD:

• Persistent irrational fears or concerns, commonly about being dirty or getting sick.
• Obsessing about things being in order or arranged a certain way.
• Being afraid that your thoughts or actions will cause harm to you or someone else.
• Hoarding objects with no value.
• Irrational doubts or fears that you will harm someone else.
• Impulsively and repeatedly cleaning your body or your home.
• Repeatedly checking something, such as if the doors are locked, appliances are unplugged or the stove is turned off.
• Habits such as repeatedly saying a word or a name, or walking in the same place or in the same way.
• Constantly reliving conversations, repeating words or counting.

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Commonwealth Medical Association

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

Commonwealth Secretariat is located in the powerhouse of UK Marlborough House, Pall Mall London and was established in 1965 to facilitate consultation and cooperation among member Governments and countries. http://www.thecommonwealth.org

 

An Inspirational Story

One day, a Maths teacher asked her students to list the names of the other students in the room on two sheets of paper, leaving a space between each name.

Then she told them to think of the nicest thing they could say about each of their classmates and write it down.

It took the remainder of the class period to finish their assignment, and as the students left the room, each one handed in the papers.

That Saturday, the teacher wrote down the name of each student on a separate sheet of paper, and listed what everyone else had said about that individual.

On Monday she gave each student his or her list. Before long, the entire class was smiling. ‘Really?’ she heard whispered. ‘I never knew that I meant anything to anyone!’ and, ‘I didn’t know others liked me so much,’ were most of the comments.

No one ever mentioned those papers in class again. She never knew if they discussed them after class or with their parents, but it didn't matter. The exercise had accomplished its purpose. The students were happy with themselves and one another. That group of students moved on.

Several years later, one of the students was killed in 'Kargil' war and his teacher attended the funeral of that special student. She had never attended Funeral of a serviceman before. He looked so handsome, so mature.

The place was packed with his friends. One by one those who loved him took a last walk. The teacher was the last one to bless.

As she stood there, one of the soldiers who acted as pallbearer came up to her. ‘Were you Sanjay’s math teacher?’ he asked. She nodded: ‘yes.’ Then he said: ‘Sanjay talked about you a lot…’

After the funeral, most of Sanjay’s former classmates were there. Sanjay’s mother and father were there, obviously waiting to speak with his teacher.

‘We want to show you something,’ his father said, taking a wallet out of his pocket 'They found this on Sanjay when he was killed. We thought you might recognize it.’

Opening the billfold, he carefully removed two worn pieces of notebook paper that had obviously been taped, folded and refolded many times. The teacher knew without looking that the papers were the ones on which she had listed all the good things each of Sanjay’s classmates had said about him.

‘Thank you so much for doing that,’ Sanjay’s mother said. ’As you can see, Sanjay treasured it.’

All of Sanjay’s former classmates started to gather around. Arjun smiled rather sheepishly and said, ‘I still have my list. It’s in the top drawer of my desk at home.’

Prithviraj’s wife said, ‘Prithviraj asked me to put his in our wedding album.’

'I have mine too,' Rashmi said. 'It's in my diary'

Then Deepali, another classmate, reached into her pocketbook, took out her wallet and showed her worn and frazzled list to the group. ‘I carry this with me at all times,’ Deepali said and without batting an eyelash, she continued: ‘I think we all saved our lists.’

That’s when the teacher finally sat down and cried. She cried for Sanjay and for all his friends who would never see him again.

The density of people in society is so thick that we forget that life will end one day. And we don’t know when that one day will be.

So please, tell the people you love and care for, that they are special and important. Tell them, before it is too late.

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with fever was found to have SGOT > SGPT.
Dr Bad: Its due to alcohol.
Dr Good: Rule out dengue.
Lesson: SGOT levels can also be more than SGPT in dengue.

Make Sure

Situation: A 62yearolddiabetic with coronary artery disease, on treatment for the same, comes for follow up.
Reaction: Oh my God! Why did not you put him on antioxidants!!
Lasson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

Quote of the Day

"Your imagination is your preview of life’s coming attractions" Einstein

Are you fit to fly?

Respiratory infection

  1. Active or contagious respiratory infections (eg, TB, Pneumonia) are a contraindication to air travel, until there is objective evidence of effective treatment (ie, negative cultures) and the patient is clinically stable.

  2. A sore throat, upper respiratory infection, cold, can cause blockage of the eustachian tube making it difficult to equilibrate the air pressure in the middle ear during descent. This can lead to a number of problems including pain, vertigo, and tympanic membrane rupture.
 

International Medical Science Academy Update (IMSA)

Autism prevalence

The prevalence of autism spectrum disorders (ASD) among eightyearold children in the United States increased from approximately 1 in 150 children in 2000 to 2002 to approximately 1 in 111 in 2006. 13

References

  1. Prevalence of autism spectrum disorders––autism and developmental disabilities monitoring network, six sites, United States, 2000. MMWR Surveill Summ 2007;56:1.
  2. Prevalence of autism spectrum disorders––autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveill Summ 2007;56:12.
  3. Prevalence of autism spectrum disorders – Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveill Summ 2009; 58:1.
 

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Amphotericin B Emulsion 5mg/ml (Addl. Indication)

Febrile Neutropenia in cancer patients

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)

HIV Genotypic Resistance Testing

HIV genotypic resistance testing may be ordered when you are first diagnosed to determine whether you are infected with a strain of HIV that is known to be resistant to certain antiretroviral drugs regardless of whether you will begin treatment right away. It may also be ordered immediately before the start of therapy if a drugresistant virus is suspected, so that immediate, appropriate therapy is possible.

 

Humor Section

Jokes

Why did the proctologist use two fingers?
In case the patient wanted a second opinion.

Medical bloopers on medical charts!

By the time he was admitted, his rapid heart had stopped, and he was feeling much better.

 

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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