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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

  Editorial …

25th January, 2011, Tuesday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

FDA to limit amount of paracetamol in prescription pain killers

The FDA this week launched a major crackdown against use of one of the most popular painkillers in the market Paracetamol. As per the FDA, prescription pain pills may contain no more than 325 mg paracetamol. The drug also will carry a boxed warning of liver risk.

The most common paracetamol dose for prescription and over the counter drug is 500 mg. The FDA is taking this action to make prescription combination pain medications containing paracetamol safer for persons to use. Overdose from prescription combination products containing paracetamol amount nearly for ½ of all cases of paracetamol related liver failure and many of which result in liver transplant or death. Most doctors worry about liver damage from the drug, particularly, when taken in excess of 4 gm daily or with alcohol.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  2nd eMedinewS revisiting 2010

Revisiting the year 2010 with Dr KK Aggarwal
‘Drug Warnings’

Audio PostCard
  SMS of the Day

(By Dr GM Singh)

Failure is only postponed success as long as courage "coaches " ambition. The habit of persistence is the habit of victory.

    Photo Feature

Global Healthcare Industry Meet

HH Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai and UAE Minister of Finance, accompanied by Simon Page, Divisional Director of the Life Sciences Division of organisers IIR Middle East, after inaugurating Arab Health 2011.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

6–year post–MBBS course is back

NEW DELHI: The National Board of Examination (NBE) has re–introduced the direct six–year, post–MBBS super speciality programme. The courses will be conducted in neuro surgery, plastic surgery, cardio–thoracic surgery and paediatric surgery. A Speciality Advisory Board in the respective specialities is looking into the existing curriculum and assessment scheme for the direct course. Introduced on the recommendations of the M.K. Bhan Committee, the students will have to qualify the Central Entrance Test (CET) conducted by the NBE to enter the programme. The results of this academic year’s CET were declared a few days ago and the admission process is under way. The courses will begin in March. The super speciality courses will be conducted in 40 NBE–accredited hospitals across the country, including the Lok Nayak Jaya Prakash Hospital in New Delhi and the Narayana Hrudayalaya hospital in Bangalore. "We had discontinued the direct six years post–MBBS course in 2006 as it did not take up as expected as the students wanted to opt for more lucrative areas but have re–introduced it and the response has been very encouraging. The course has been re–structured and a fresh curriculum has been prepared," Dr. Bipin Batra, NBE Executive Director told The Hindu. (Source: The Hindu, Jan 24, 2011)

    International News

Global healthcare industry meets in Dubai HH Sheikh Hamdan bin Rashid Al Maktoum inaugurates 36th edition of Arab Health Exhibition and Congress, the Middle East’s largest healthcare event

The Arab world’s largest gathering of healthcare professionals was inaugurated today (Monday 24 January 2011) by HH Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai and UAE Minister of Finance. The four–day Arab Health Exhibition and Congress, which runs until Thursday 27 January 2011, is the biggest event of its kind in the Middle East and has taken all available exhibition space at the Dubai World Trade, featuring more than 2800 exhibiting companies from 60 countries covering 85,000 square metres. "The global healthcare profession has come together at Arab Health 2011 which has again confirmed its positioning as one of the world’s most important healthcare events," said Simon Page, Divisional Director of the Life Sciences Division of organisers IIR Middle East, who accompanied Sheikh Hamdan on a tour of the show."Arab Health provides over 65,000 visiting healthcare professionals a unique opportunity to bring their knowledge and understanding up to date with over 480 hours of continuing medical education (CME). Working closely with Cleveland Clinic, the content in all 18 conferences is approved by the American Medical Association," added Page. Today six concurrent conferences were taking place, with topics ranging from gastroenterology and anaesthesia to orthopaedics. One of the highlights was undoubtedly the opening remarks by Dr. Samer H. Ellahham, Chief Quality Officer, Senior Consultant, Sheikh Khalifa Medical City, Cleveland Clinic in Abu Dhabi, at the opening of the Quality Management (QM) in Healthcare Conference. QM is seen as integral to lowering healthcare costs, which are estimated to rise fivefold in the region over the next 15 years.

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC http://www.isfdistribution.com)

Children do benefit from weight training

A major new review published in Pediatrics finds that weight training for children can be beneficial and even essential. According to the New York Times, researchers concluded that, "regardless of maturation age, children generally seem to be capable of increasing muscular strength." In the review, researchers with the Institute of Training Science and Sports Informatics in Cologne, Germany analyzed 60 years worth of studies of children and weightlifting. Young people of any age who participated in resistance training at least twice a week for a month or more showed greater strength gains than those who worked out only once a week or for shorter periods. Children gained strength differently than adults, not gaining muscle mass but instead the muscles and nervous system interacted more efficiently.

(Dr Monica and Brahm Vasudev)

Population–wide reduction in salt consumption recommended

The American Heart Association issued a call to action for the public, health professionals, the food industry and the government to intensify efforts to reduce the amount of sodium (salt) consumed daily. In an advisory, published in Circulation: Journal of the American Heart Association, the association sets out the science behind the American Heart Association’s recommendation for the general population, which is to consume no more than 1500 mg of sodium a day because of the harmful effects of sodium – elevated blood pressure and increased risk of stroke, heart attacks and kidney disease.

Smoking scenes in movies light up smokers’ brains

Seeing a character in a movie light up a cigarette triggers smokers’ brains to plan the same motions. In the study, functional MRI was used to monitor brain activity in 17 smokers and 17 nonsmokers as they watched movie scenes that featured smoking. When they saw those scenes, the smokers’ brains showed increased activity in areas involved in movement of the hand they use to smoke. The researchers, led by senior investigator Todd Heatherton of Dartmouth College, published their findings in the Jan. 19 issue of the Journal of Neuroscience.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How important is IVF if infertility is diagnosed?

Firstly, it is very important to diagnose the reason behind inability of a female to conceive. For those suffering with severe tubal block in females and very low sperm count in males, IVF is the only solution. Sometimes, if infertility is not treated at proper time through proper procedure the lady grows older, the number and quality of her eggs goes down and also chances of conception.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

Effects of Secondhand Smoke in children

Secondhand smoke relates to many illnesses in children including sudden infant death syndrome (SIDS), asthma, respiratory diseases like bronchitis, pneumonia, colds and other respiratory infections. The incidence of these diseases are higher in children exposed to secondhand smoke than those living in smoke–free environments. Secondhand smoke exposure can cause the buildup of fluid in the middle ear. In the United States, 21 million children (35%) live in homes where residents or visitors smoke in the home on a regular basis. Affected children have detectable levels of cotinine, a product of nicotine, in their blood.

    Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What are the factors governing the maximum range of tattooing?

The larger the caliber, greater the distance to which the powder is discharged

In a fire arm missile wound, the amount of tattooing and the maximum distance to which the powder particles can be discharged depend upon the barrel length and the nature of the cartridge, both in its caliber and in its power load. I have seen during the postmortem examination of a fire arm missile victim that the larger the caliber, the greater the distance to which the powder is discharged. Tests to determine the maximum possible distance to which the powder particles can be discharged are done by ballistic experts and not doctors in all cases where it is important to ascertain the range of fire with the weapon used at the crime and with similar ammunition. The range of fire of a firearm cannot be scientifically determined in cases where the weapon is discharged beyond the range of powder grain deposit.

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. A friend of mine has the following qualifications: BHMS; PG diploma in clinical pathology; Msc in clinical Pathology from a Recognized University. Can he run a Pathology Lab?

A. Running a pathology lab amounts to practicing pathology which is a specialty of Allopathy/modern medicine. Nobody who is not a graduate in modern medicine can be a specialist in an Allopathic/modern medicine specialty. Your friend is not legally competent to run a pathology lab.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Hypophosphatemia can be seen in a variety of biochemical derangements, incl. acute alcohol intoxication, sepsis, hypokalemia, malabsorption syndromes, hyperinsulinism, hyperparathyroidism, and as result of drugs, e.g., acetazolamide, aluminum–containing antacids, anesthetic agents, anticonvulsants, and estrogens (incl. oral contraceptives). Citrates, mannitol, oxalate, tartrate, and phenothiazines may produce spuriously low phosphorous by interference with the assay.

    Medi Finance Update

Understanding Mutual Funds

Balanced funds invest in a mix of stocks, bonds, and cash investments. The mix will change as market conditions change, but it usually stays within predetermined ranges. (For example, stocks 40–60%, bonds 30–50%, cash 0–30%).

    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
DCI Approval Date
Raltegravir (as Potassium) film coated Tablets 400mg
In combination with other anti retroviral agents for the treatment of human immunodeficiency virus (HIV–1) infection in treatment experienced patients with evidence of HIV–1 replication despite ongoing retroviral therapy.
    IMSA Update

International Medical Science Academy (IMSA) Update

Daily chest radiographs on mechanically ventilated patients (to check endotracheal tube position) are routine in many clinical centers. A trial randomly assigned 21 intensive care units (ICUs) to perform routine daily or as–needed chest radiographs on mechanically ventilated patients’. The number of chest radiographs was significantly lower in the as–needed group without worsening clinical outcomes including mortality, length of ICU stay, or duration of mechanical ventilation.

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with black stools.
Dr. Bad: It is lower GI bleeding.
Dr. Good: It is upper GI bleeding.
Lesson: Black stools usually indicate upper GI bleeding.

Make Sure

Situation: A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to avoid painkillers in renal failure as most painkillers (barring nimesulide, paracetamol) are not kidney–friendly drugs.

Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Parvesh Sablok)

An eagle was sitting on a tree resting, doing nothing. A small rabbit saw the eagle and asked him, ‘Can I also sit like you and do nothing?’ The eagle answered: ‘Sure, why not.’ So, the rabbit sat on the ground below the eagle and rested. All of a sudden, a fox appeared, jumped on the rabbit and ate it.

Moral of the story: To be sitting and doing nothing, you must be sitting very, very high up.


Mind Teaser

Read this…………………

What goes up and down, but doesn’t move?

Yesterday’s Mind Teaser: e a v e s
Answer for Yesterday’s Mind Teaser: "eaves dropping"

Correct answers received from: Dr Neelam Nath, Dr Anil Bairaria, Dr.K.Raju, Dr. Snupam Sethi Malhotra,Dr Maneesh Gupta, Dr Sudipto Samaddar

Answer for 23rd January Mind Teaser: Equal rights
Correct answers received from: Dr Vijay Kansal, Dr A. P. Rao

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr. G.M.Singh)

Saying Grace

A Sunday School teacher was trying to explain about saying grace before meals. One of the pupils was the young son of the minister of that church, so she started the discussion by asking him, "Jerry, what does your father say when the family sits down to dinner?" Jerry answered, "Dad says, ‘Go easy on the butter, kids, it’s three dollars a pound!’"

    Readers Responses
  1. Dear Sir, Thanks a lot for providing the nominations list of Padma Awardees doctors. Regards: Dr Prachi
    Public Forum

(Press Release for use by the newspapers)

Stop all herbal medicines seven day before any surgery

Herbal medications are frequently used by patients undergoing surgery. Some of these agents have physiologic effects that could be deleterious in the perioperative period, including precipitation of clotting disorders and interactions with anesthetics.

Most patients do not disclose this during the preoperative assessment, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Since there is no evidence that herbal medications improve surgical outcomes, and there are theoretic reasons that these agents may increase perioperative morbidity, they must be stopped before surgery.

  1. Ephedra (ma huang) may increase the risk of heart attack and stroke and should be discontinued at least 24 hours prior to surgery.
  2. Garlic may increase bleeding risk and should be discontinued at least 7 days prior to surgery.
  3. Ginkgo may increase bleeding risk and should be discontinued at least 36 hours prior to surgery.
  4. Ginseng lowers blood sugar and may increase bleeding risk and should be discontinued at least 7 days prior to surgery.
  5. Kava may increase the sedative effect of anesthetics and should be discontinued at least 24 hours prior to surgery. The Food and Drug Administration has issued a safety alert about an association between kava use and fatal hepatotoxicity.
  6. St. John’s wort may diminish the effects of several drugs by induction of cytochrome p450 enzymes and should be discontinued at least 5 days prior to surgery.
  7. Valerian may increase the sedative effect of anesthetics and is associated with benzodiazepine–like withdrawal. There are no data on preoperative discontinuation. Ideally it is tapered weeks before surgery; if not, withdrawal is treated with benzodiazepines.
  8. Echinacea is associated with allergic reactions and immune suppression. There are no data on preoperative discontinuation.

Take Home Message: Herbal agents should be stopped at least one week before surgery.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Conference Column

Workshop on Fetal and Paedatric Echocardiography Pre and perinatal management of heart disease

13th February 2011, Sunday, Moolchand Medcity

  1. Fetal Echocardiography–How to get it right: Dr Vandana Chaddha
  2. Fetal Cardiac Spectrum– abnormal cases with interactive session: Dr Vandana Chaddha
  3. Neonatal Cardiac Cases– Hits and misses inetractive session: Dr Savitri Srivastava
  4. Intima Media Thickness and Plaque Volume, New Marker for Atherosclerosis Regression: : Dr KK Aggarwal

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