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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

 

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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 Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

27th May 2012, Sunday

Cabergoline can restore normal orgasm

Anorgasmia can be improved or resolved completely in 70% of men treated with the dopamine receptor agonist cabergoline according to a small retrospective study. The duration of therapy and concomitant testosterone replacement therapy (TRT) predicted response to cabergoline, Tung–Chin Hsieh, MD, reported at the American Urological Association meeting.

Anorgasmia usually has a psychological origin but can occur after radical prostatectomy for localized prostate cancer or secondary to drug treatment.

Selective serotonin reuptake inhibitors and classic antipsychotics that are not prolactin sparing have been shown to cause disturbances in orgasmic function. Seventy–five percent of men report orgasmic dysfunction following radical prostatectomy.

Cabergoline has a direct inhibitory effect on prolactin–secreting cells in the pituitary and has a history of use as first–line treatment for hyperprolactinemia. The dose is 0.5 mg twice a week.

Mean treatment duration for men who responded to therapy was 296 days compared with 218 days for non responders (P=0.02). Concurrent testosterone replacement therapy was associated with an increased likelihood of response.

The drug has to be used with caution in patients with heart–valve disease, as some evidence of exacerbation with cabergoline has been reported.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Cabergoline can restore normal orgasm

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    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2012

Students of Delhi Public School presenting a beautiful skit on the occasion of the World Earth Day celebration at DPS Mathura school premises. The Event was jointly organized by Heart Care Foundation of India, Delhi Public School and Ministry of Earth Sciences.

 
Dr K K Aggarwal
 
    National News

Diagnosis of tuberculosis, typhoid starts at Institute of Medical Sciences

VARANASI: The department of microbiology under the Institute of Medical Sciences (IMS), BHU started the diagnosis and detection facilities to help in the treatment of tuberculosis and typhoid cases on Friday. Inaugurating the facilities in the department, BHU vice chancellor Dr Lalji Singh said a number of patients from east UP region and others would be benefited with the start of these facilities in the department. Later, the BHU VC also visited the PCR Lab, serological and virological lab in the department on the occasion. It may be mentioned here that with the recent restrictions imposed by WHO on ELISA tests, the accurate detection and treatment of TB cases had become difficult. The new detection and treatment facilities would bolster the process at IMS, BHU. A number of senior faculty members including director, IMS, Prof TM Mohapatra, head of department Prof Gopal Nath and others were also present on the occasion. (Source: TOI, May 26, 2012)

For comments and archives

CBSE launches new website for academicians

CHENNAI: In an attempt to bridge the communication gap between the board and students and schools, the Central Board of Secondary Education has launched a new website to highlight academic activities and information that it wants to pass on to the public and schools. In an open letter to all affiliated schools, CBSE chairman Vineet Joshi announced that a new website (www.cbseacademic.in) has been launched owing to a constant demand from various stakeholders within India and abroad. Similarly, the CTET (Central Teacher Eligibility Test) tab will be a one–stop destination for information on question papers of CTET for the previous year, CTET bulletin and schedule for examination, results of CTET 2012 and various advertisement notices. It also has details on structure, content and syllabus of CTET exam, important information at a glance etc. The new website will provide all necessary information that teachers, students and parents would require. It will include details about the board curriculum, teachers training, textbooks etc, all available at the click of a button. (Source: TOI, May 23, 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

(Contributed by Dr Monica and Brahm Vasudev)

Global warming: more killer heat waves

If climate change continues on its current course, the number of heat–related deaths will rise as temperatures climb during the summer, according to a report from the Natural Resources Defense Council (NRDC), an environmental advocacy group. (Source: Medpage Today)

For comments and archives

Single PSA test predicts prostate cancer risk

A baseline prostate–specific antigen (PSA) value of less than 1 ng/mL predicted a low risk of prostate cancer over the next 15 years in men younger than 50, none of whom developed intermediate– or high–risk cancer, data from a longitudinal cohort study showed. (Source: Medpage Today)

For comments and archives

9/11 Lung effects linger in local residents

Residents of lower Manhattan whose homes suffered damage in the 9/11 World Trade Center events reported respiratory symptoms even years later, a researcher said here at the annual meeting of the American Thoracic Society. Such things as broken windows and damage to home furnishings were associated with increased rates of wheezing, shortness of breath, and upper respiratory symptoms, according to Vinicius Antao, MD, PhD, of the Agency for Toxic Substances and Disease Registry in Atlanta. (Source: Medpage Today)

For comments and archives

IUDs, implants more effective than pills, rings, and patches

Long–acting reversible contraception methods (intrauterine devices (IUDs) and implants) were more than 20 times more successful in preventing pregnancy than other frequently used methods (oral contraceptives, vaginal ring, transdermal patch, and depot medroxyprogesterone acetate (DMPA) injection), according to results from a large, prospective cohort study. The results are published in the May 24 issue of the New England Journal of Medicine. (Source: Medscape)

For comments and archives

(Contributed by Dr SK Verma)

Hospital bugs hit one in 12 kids

According to a survey of more than 50 thousands paediatric patients admitted in more than 100 hospitals in UK, one in 12 kids got infection during their stay in hospitals. The infections, mostly respiratory, made them sicker rather than better. (Courtesy TOI)

 
    Twitter of the Day

@DrKKAggarwal: More evidence that physical activity protects the aging brain New data from the Rush Memory and Aging… http://fb.me/1EXzkdxnn

@DeepakChopra: The 4 most important qualities of a great leader are to inspire hope, trust, stability, compassion, and live up to them.

 
    Spiritual Update

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

Do not give health advices unless you are an expert

Once a foreigner visited India and when he returned back, somebody asked him to tell three things about India. He said – All time is tea time, all behave like doctors and every street wall can be used as a urinal.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is vanishing twin syndrome?

Sometimes, very early in a twin pregnancy, one of the fetuses "disappears." This is referred to as "vanishing twin syndrome." Even after ultrasound has shown heart movement in twins, spontaneous loss of one of the fetuses occurs in up to 20% of twin pregnancies. Spontaneous losses are even higher in triplet and quadruplet pregnancies. A fetal loss rate of 40% may occur in pregnancies with triplets or more. When a fetus is lost in the first trimester, the remaining fetus or fetuses generally continue to develop normally, although vaginal bleeding may occur.

For comments and archives

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

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

Immunoglobulins

Description: Concentrated solution of the IgG antibody component of plasma

Preparations: Standard or normal immunoglobulin: prepared from large pools of donations and contains antibodies against infectious agents to which the donor population has been exposed

Infection risk: Transmission of virus infection has not been reported with intramuscular immunoglobulin

Indications

  • Hyperimmune or specific immunoglobulin from patients with high levels of specific antibodies to infectious agents: e.g. hepatitis B, rabies, tetanus
  • Prevention of specific infections
  • Treatment of immune infectious

Administration: Do not give intravenously as severe reactions may occur.

For comments and archives

 
    An Inspirational Story

(Dr. Vasant G. Shenoy)

The Rain

It was a busy morning, about 8:30 a.m., when an elderly gentleman in his 80s arrived to have stitches removed from his thumb. He said he was in a hurry as he had an appointment at 9:00 am.

I took his vital signs and had him take a seat, knowing it would be over an hour before someone would to able to see him. I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound. On exam, it was well healed, so I talked to one of the doctors, got the needed supplies to remove his sutures and redress his wound.

While taking care of his wound, I asked him if he had another doctor’s appointment this morning, as he was in such a hurry. The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife. I inquired as to her health.

He told me that she had been there for a while and that she was a victim of Alzheimer’s disease. As we talked, I asked if she would be upset if he was a bit late. He replied that she no longer knew who he was, that she had not recognized him in five years now. I was surprised, and asked him, ‘And you still go every morning, even though she doesn’t know who you are?’ He smiled as he patted my hand and said, ‘She doesn’t know me, but I still know who she is.’

I had to hold back tears as he left, I had goose bumps on my arm, and thought, ‘That is the kind of love I want in my life.’ True love is neither physical, nor romantic. True love is an acceptance of all that is, has been, will be, and will not be.

With all the jokes and fun that are in e–mails, sometimes there is one that comes along that has an important message. This one I thought I could share with you. The happiest people don’t necessarily have the best of everything; they just make the best of everything they have. I hope you share this with someone you care about. I just did. ‘Life isn’t about how to survive the storm, but how to dance in the rain. We are getting older but only one day at a time

For comments and archives

 
    Cardiology eMedinewS

Low-dose aspirin linked to repeat GI bleed Read More

New guide on stroke prevention in HF Read More

Stroke scale’s Desi Avatar at All India Institute Of Medical Sciences
Read More

 
    Pediatric eMedinewS

Study shows cases of C. diff increased 12–fold among children Read More

Half of autism diagnoses made at school age Read More

Dimenhydrinate does not reduce vomiting in kids with gastroenteritis
Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A 24–year–old female suffered migraine attacks after physical exertion.
Dr. Bad: The two are unrelated.
Dr. Good: There is an association between the two.
Lesson: Migraines can be triggered by stress, worry, menstrual periods, birth control pills, physical exertion, fatigue, lack of sleep, hunger, head trauma and certain foods or drinks that contain chemicals such as nitrites, glutamate, aspartate, tyramine.

For comments and archives

Make Sure

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Reaction: Oh my God! Why was acetazolamide not started before the journey?
Lesson: Make sure all high risk patients are given acetazolamide before they go to mountains.

For comments and archives

 
    Legal Question of the day

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

A young man died in a hospital. The police requested the hospital for the following investigations: MRI scan, CT scan, Bone scan, Chemical test and Pathological test of the body to ascertain the cause of death. I have the following queries.

  • Does the police have any authority to do so?
  • Is the hospital bound to do as asked by the police (especially when the value/rationale of bone scan in such situation may be questionable)?
  • Who will pay for the tests that can be done in the hospital?
  • What should be done as regards the tests that cannot be done in the hospital?
  • Can the CT and MRI facility of a private diagnostic centre be used for this purpose?

Ans. My combined opinion for the above five queries is as follows:

The police has no authority over the hospital and cannot dictate that the tests should be done. The hospital’s job is to treat patients, including MLC cases; to carry out MLC examination/autopsy and prepare an MLC report/autopsy report and give the original of such report to the police, along with any specimens preserved for further examination; to appear in the court when asked by the court/police.

The expertise for treatment and MLC examination/autopsy lies with the hospital/Forensic Medicine & Toxicology specialist and not with the police. Such FTM specialist is expected to advise the police for any need for any further tests on the body. After death in an MLC case, the custody of the dead body lies with the police till the body is released to the relatives for cremation. The police are expected to have their own arrangements for doing any further necessary tests before releasing the body. All such tests are the duty and responsibility, including financial responsibility of the police department/state. They cannot transfer, by police orders, any such responsibility to others, including the relatives.

However, everybody is expected to help the police in investigation of crime. If the hospital is a government hospital, and if the hospital does not mind doing the tests asked for, it may do so after getting a written request from the police. If the govt. hospital concerned has reservations regarding doing certain tests, it is not bound to do the same but should record in writing the reasons/reservations. If the govt. hospital does not have facility for doing a certain test, it has no responsibility to get it done from anywhere else. If it is a private hospital, it has no duty to carry out the tests free and has no duty to perform these tests even otherwise, even if payment is offered, if there is no request from a doctor/FTM specialist. If the police feels that the tests must be done, it is for them to approach senior police officers who may ask the District Collector etc. for necessary help/instructions.

For comments and archives

 
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    Quote of the Day

(Dr GM Singh)

As human beings, our greatness lies not so much in being able to remake the world… as in being able to remake ourselves. Mahatma Gandhi

 
    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Considerations for vaccine administration

Proper administration of vaccines is extremely important to ensure efficacy of response and safety. The Healthcare provider must ensure the following when administering a vaccine.

  • Aseptic precautions should be taken while administering the vaccine.
  • The child should not have dermatitis/exanthematous lesions.
  • The vaccine should not be expired, should not be turbid/damaged in any way.
  • Vaccine manufacturers’ guidelines should be followed to reconstitute and administer.
  • Identify the child who is being vaccinated. The right vaccine in the right dosage should be administered to the right child.
  • Administer the vaccine at the recommended site, through the right route, at the right time, using the right recommended needle/equipment.
  • Document all the details of vaccination.

There have been reports of untoward reactions, beyond the usual side effects of vaccine wherein the child suffered grievous injury. Such incidents can be avoided simply by being vigilant and following the above checklist while administering a vaccine.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Low platelet counts

Surgical bleeding due solely to a reduction in the number of platelets does not generally occur until the platelet count is < 50,000/microL.

Clinical or spontaneous bleeding does not occur until the platelet count is < 10,000 to 20,000/microL.

 
    Mind Teaser

Read this…………………

Karina, a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it:

a. Promotes the removal of antibodies that impair the transmission of impulses
b. Stimulates the production of acetylcholine at the neuromuscular junction.
c. Decreases the production of autoantibodies that attack the acetylcholine receptors.
d. Inhibits the breakdown of acetylcholine at the neuromuscular junction.

Yesterday’s Mind Teaser: Which of the following signs and symptoms would Nurse Maureen include in teaching plan as an early manifestation of laryngeal cancer?

a. Stomatitis
b. Airway obstruction
c. Hoarseness
d. Dysphagia

Answer for Yesterday’s Mind Teaser: c. Hoarseness

Correct answers received from: Dr PC Das, Dr shashi saini, Yogindra Vasavada, Prof Chetana Vaishnavi, Dr Niraj Kumar, Dr KANTA JAIN, Muthumperumal Thirumalpillai, Raju Kuppusamy, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Avtar Krishan, Anil Bairaria, U Gaur Dr Thakor Hitendrsinh G.

Answer for 25th May Mind Teaser: b. Administering coumadin
Correct answers received from: Muthumperumal Thirumalpillai, Yogindra Vasavada, Dr Niraj Kumar.

Send your answer to ijcp12@gmail.com

 
   Laugh a While

(Dr GM Singh)

While I was working the other day, I saw a fly. I said to Wayne, ‘Spring is coming.’ Wayne said, ‘Yep…I killed 6 flies the other day; 4 males and 2 females.’ I laughed and asked how he knew the sex of each fly.

He said, ‘It’s easy, 4 were on my beer and 2 were on the phone!!’

 
    Medicolegal Update

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

Ordinary and extraordinary medical care

The Pope and Catholic teachings advocate a distinction between ordinary and extraordinary care, with ordinary care being mandatory, whereas extraordinary care may be withheld or withdrawn.*

One commentator explicated this distinction in the following way. According to him,

  • Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or inconvenience…
  • Extraordinary means of preserving life mean all medicines, treatments, and operations, which cannot be obtained without excessive expense, pain, or other inconvenience, or which, if used, would not offer reasonable hope of benefit.

Many ethicists and courts have concluded that this distinction is too vague and has "too many conflicting meanings" to be helpful in guiding surrogate decision makers and clinicians As one lawyer noted ordinary and extraordinary are "extremely fact–sensitive, relative terms…what is ordinary for one patient under particular circumstances may be extraordinary for the same patient under different circumstances, or for a different patient under the same circumstances". Thus, the ordinary/extraordinary distinction should not be used to justify decisions about stopping treatment.

*Pope Pius XII. The prolongation of life In: Ethics in medicine. Reiser SJ, Dyck AJ, Curran WJ (Eds), MIT Press, Cambridge 1997.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Cell Phone Elbow: a disease of mobile era

Nintendo thumb, Guitar Hero wrist and now cell phone elbow are all diseases of the new gadget era. Cubital tunnel syndrome or cell phone elbow is numbness, tingling and pain in the forearm and hand caused by compression of the ulnar nerve, which passes along the bony bump on the inside of the elbow.

Cubital tunnel syndrome results from prolonged flexing of the elbow.

In susceptible people, holding the bent-elbow position for extended periods can lead to decreased blood flow, inflammation and compression of the nerve. One of the causes of pressure on the ulnar nerve is excessive use of mobile phones, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India.

Prolonged flexing of the elbow occurs when you hold a cell phone to your ear. The first symptom patients often notice include numbness, tingling or aching in the forearm and hand.

As symptoms progress, they can include a loss of muscle strength, coordination and mobility that can make writing and typing difficult. In chronic, untreated cases, the ring finger and pinky can become clawed. Evans and colleagues note in a report in the Cleveland Clinic Journal of Medicine that most people who get cubital tunnel syndrome are middle–aged or older. Women get cubital tunnel syndrome more often than men.

Other causes may include sleeping with the elbows bent and tucked up into the chest, sitting at a desk with the elbows flexed at an angle greater than 90 degrees and driving with your elbow propped on the window for extended periods.

In most cases, minor lifestyle changes can help alleviate symptoms, including using a hands-free headset for your cell phone. If sleep position is the problem, an elbow pad to keep the arm straighter at night can help.

As treatment, the occupational therapist may use ultrasound to loosen the scar tissue that can form around the nerve as a result of the inflammation, as well as stretching, deep massage and "nerve–gliding" exercises to reduce pressure on the nerve. Doctors may also use anti–inflammatory injections or surgery.

 
    Readers Responses
  1. Dear Dr Kk, I deeply appreciate that ur idea of promoting insurance among patients..this has another side of the coin many doctors are doing multilevel marketing of amway products and also act as insurance agents. educating the public is different from promoting a product is different Dr.R.Manichennai
 
    Forthcoming Events
Dr K K Aggarwal

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

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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    Our Contributors

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