emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
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 Workshop on Stress Management and How to be Happy and Healthy

 
  Editorial …

28th April 2012, Saturday

An Indian Malaria drug

Ranbaxy Laboratories has launched a new drug, Synriam, for the treatment of uncomplicated falciparum malaria. Clinical trials in India, Tanzania, and Thailand have suggested that the drug yields a cure rate of over 95 percent. The drug would be made available in India at Rs 130 for three tablets, and treatment would involve taking a single tablet for three days

The drug is a combination of two molecules – arterolane and piperaquine, an antimalarial. Arterolane is a short–acting antimalarial molecule and piperaquine is a long–acting molecule. Salt structure of arterolane was changed a tosylate salt to a maleate salt, increasing its solubility. Early treatment reduces the risk of complicated malaria. In India, 1000 people die from malaria each year. Indian Council of Medical Research is assessing a revised estimate of about 35,000 deaths per year made by a panel of experts set up by the health ministry

The standard therapy for uncomplicated falciparum malaria involves artemisinin–based drugs which are substances derived from plants whose availability hinges on crop output. However, arterolane production can be scaled up whenever required because of its synthetic origin.

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

One can predict acute lung injury

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day organized at DPS Mathura Road

World Earth Day was celebrated by Heart Care Foundation of India jointly with Delhi Public School and Ministry of Earth and Sciences to mark the World Earth Day on 22nd April 2012

 
Dr K K Aggarwal
 
    National News

India accounted for 47 percent of global measles deaths in 2010

"Delayed implementation of accelerated disease control in India" has led the country to account for "47 per cent of estimated measles mortality in 2010" stated a paper published today (April 24) in The Lancet. At 36 per cent, even the World Health Organisation (WHO) African region accounted for lesser mortality than India. The high number recorded in India stands out, as the global measles mortality had decreased by 74 per cent in 2010. Except for the Southeast Asia WHO region, all the other WHO regions recorded a reduction in mortality by more than three–quarters during 2000–2010. Even in the case of WHO Southeast Asia region, except for India, the other countries in the region had reported a reduction. Though India achieved 26 per cent reduction in measles mortality between 2000 and 2010, its contribution to the percentage of global measles deaths increased from 16 per cent in 2000 to 26 per cent in 2010. (Source: The Hindu, April 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

U.S. FDA says nanotech may need extra safety tests

U.S. health regulators said consumer products that use nanotechnology may have unknown effects on the human body, and advised food and cosmetic companies on Friday to further study the safety of these tiny particles. Nanotechnology involves designing and manufacturing materials on the scale of one-billionth of a meter – so small it cannot be seen with a regular light microscope. It is used in hundreds of products in areas ranging from stain–resistant clothing and cosmetics to food additives, but the health effects of nanoparticles are still poorly understood. Nanoparticles may be able to penetrate the skin, or move between organs, and scientists do not always understand what effect this will have. (Source: Medscape)

For comments and archives

Urolithiasis in renal grafts becoming less common

The rate of urolithiasis after kidney transplantation in France dropped significantly over the past three decades to less than 1%, researchers there have found. Dr. Gerard Benoit and colleagues from Paris South University in Le Kremlin Bicêtre, France, point out that this rate is lower than the 20% reported in the general population. Still, they were curious to know whether the incidence and management of the condition in renal transplant patients had changed over the years. (Source: Medscape)

For comments and archives

New migraine guidelines rank Rx, OTC efficacy

Seven different drugs are proven to be effective for preventing episodic migraine attacks and another half–dozen are probably helpful, according to new guidelines released here by the American Academy of Neurology (AAN). An evidence review by the AAN and the American Headache Society also identified several over–the–counter (OTC) products, including herbal supplements, with either proven or probable efficacy. The announcement accompanied publication of two practice guidelines on prevention of episodic migraine –– one for prescription products and another for nonsteroid anti–inflammatory drugs and "complementary" therapies –– in the April 24 issue of Neurology. (Source: Medpage Today)

For comments and archives

Dual-chamber ICD use varies widely

The likelihood of receiving a dual–chamber implantable cardioverter–defibrillator (ICD) varied as much as four–fold among patients without an indication for permanent pacing, a review of national hospital data showed. (Source: Medpage Today)

For comments and archives

 
  Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Two or more drugs may interact with each other…: via @youtube

@DeepakChopra: When you blame and criticize others, you are avoiding some truth about yourself

 
    Spiritual Update

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

Chaar Dham Yatra

Chaar Dham ‘Yatra’ is observed every year in the month of April/May and is open to visitors for next six months. It usually begins from the day of Akshay Tritya till the day of Diwali. Chaar Dham ‘Yatra’ involves covering Yamunotri, Gangotri, Kedarnath and Badrinath.

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 Sanjay Chaudhary, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre)

How quickly should the corneas/eyes be removed after death?

Corneas/eyes should be removed within 6 hours of demise.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

The Secret Ears

"Can I see my baby?" the happy new mother asked. When the bundle was nestled in her arms and she moved the fold of cloth to look upon his tiny face, she gasped.

The doctor turned quickly and looked out the tall hospital window. The baby had been born without ears. Time proved that the baby’s hearing was perfect. It was only his appearance that was marred.

When he rushed home from school one day and flung himself into his mother’s arms, she sighed, knowing that his life was to be a succession of heartbreaks. He blurted out the tragedy. "A boy, a big boy… called me a freak."

He grew up, handsome for his misfortune. A favorite with his fellow students, he might have been class president, but for that. He developed a gift, a talent for literature and music.

"But, you might mingle with other young people," his mother reproved him, but felt a kindness in her heart. The boy’s father had a session with the family physician. Could nothing be done? "I believe I could graft on a pair of outer ears, if they could be procured," the doctor decided.

Whereupon, the search began for a person who would make such a sacrifice for a young man. Two years went by. Then his father said, "You are going to the hospital, son. Mother and I have someone who will donate the ears you need. But, it’s a secret who it is."

The operation was a brilliant success, and a new person emerged. His talents blossomed into genius, and school and college became a series of triumphs. Later, he married and entered the diplomatic service.

"But, I must know!" He urged his father, "Who gave so much for me? I could never do enough for him." "I do not believe you could," said the father, "but, the agreement was that you are not to know… not yet."

The years kept their profound secret, but the day did come. It was one of the darkest days that ever pass through a son. He stood with his father over his mother’s casket. Slowly, tenderly, the father stretched forth a hand and raised the thick, reddish–brown hair to reveal that the mother had no outer ears.

"Mother said she was glad she never let her hair be cut," he whispered gently, "and nobody ever thought mother less beautiful, did they?"

Real beauty lies not in the physical appearance, but in the heart. Real treasure lies not in what can be seen, but in what cannot be seen. Real love lies not in what is done and known, but in what is done and not known.

For comments and archives

 
  Cardiology eMedinewS

Less than 1% Indians know cardiopulmonary resuscitation Read More

Statin therapy prior to CABG reduces the risk of postoperative AF
Read More

 
  Pediatric eMedinewS

Text messaging program may increase flu vaccination rate Read More

RV dominance predicts worse survival after single–ventricle palliation
Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient came with an eGFR value of 15.
Dr. Bad: You need immediate dialysis.
Dr. Good: Hold on till proper investigations are done.
Lesson: A study published on December 6th in the Canadian Medical Association Journal shows that starting dialysis too soon can be associated with high mortality.

Make Sure

Situation: A rape victim developed HIV infection.
Reaction: Oh my God! Why was she not given post exposure ART prophylaxis?
Lesson: Make sure all rape victims are counseled for HIV post exposure ART prophylaxis.

 
    How Long It Takes To Decompose !!!!!

(Dr GM Singh)

Just think about the below list before you throw something on the soil.

Paper Towel – 2–4 weeks
Banana Peel – 3–4 weeks
Paper Bag – 1 month
Newspaper – 1.5 months
Apple Core – 2 months
Cardboard – 2 months
Cotton Glove – 3 months
Orange peels – 6 months
Plywood – 1–3 years
Wool Sock – 1–5 years
Milk Cartons – 5 years
Cigarette Butts – 10–12 years
Leather shoes – 25–40 years
Tinned Steel Can – 50 years
Foamed Plastic Cups – 50 years
Rubber–Boot Sole – 50–80 years
Plastic containers - 50-80 years
Aluminum Can – 200-500 years
Plastic Bottles – 450 years
Disposable Diapers – 550 years
Monofilament Fishing Line – 600 years
Plastic Bags – 200–1000 years

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    Legal Question of the day

(Prof. M C Gupta, Advocate & Medicolegal Consultant)

Q. I am a doctor. My relative bit his wife. She went to a government doctor. He treated her as an OPD case. OPD Medical notes were given to the patient as per practice. The injury was minor/simple. Moreover, the woman gave in writing under her signature that she did not want a medicolegal case. No MLC was made. The woman later filed a police complaint against the husband. The doctor came to know about it but still did not make an MLC. The doctor was produced in the magistrate’s court as an expert witness and deposed as above. He produced in the court the photocopy of the OPD register containing the details about womans treatment. He told the court that MLC could/should have been made but was not made because the woman did not want so. The magistrate found the husband guilty and awarded 2 years imprisonment and Rs. 10,000/– fine.

My questions are:

a. Was the doctor bound to make an MLC?
b. What are the implications of two contradictory statements/approaches by the doctor? (he said MLC was not made because it was a minor simple injury and later said MLC could have been made but was not made because the woman did not want).
c. Can the medical officer entertain any settlement about medicolegal case?
d. Why was the doctor summoned? What is his role when he has no documentary support?
e. Can the following complaints be made against the doctor:
i) A criminal complaint for violation of section 39 CrPC and sections 177/201, IPC
ii) Medical council complaint;
iii) His employer (Health department)?

Ans.

  • The doctor was not bound to make an MLC. Making or not making an MLC depends upon the discretion of the doctor and upon the rules of the organisation where he works. He has used his discretion correctly here.
  • The court is unlikely to read an malafide contradiction in the alleged "contradictory statements".
  • Nobody is allowed to arrive at a settlement for not making an MLC if it should have been made. This will amount to interference in the course of justice.
  • The doctor was most likely summoned to corroborate the accusation of cruelty manifested in the act of biting. It is wrong to say that he had no documentary support. The OPD register is a document.
  • All the three types of complaint mentioned by you are likely to be of no use.

For comments and archives

 
    Microbial World: The Good and the Bad They Do

(Dr Sunil Sharma, Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

What can be done to prevent and control multidrug resistance?

  • Infection prevention: Prevention is better than cure. Preventing infections should be the primary aim of any community. Balanced diet, daily exercises and taking appropriate vaccines is the golden triad of preventing infections. These when supplemented with personal hygiene and clean environment can bring down infections tremendously. In healthcare setting, emphasis now is on implementing ‘care bundles’ to prevent healthcare associated infections. Care bundles are a set of activities done together 100% of times. There are specific care bundles for preventing Urinary tract infections, Respiratory tract infections, Intravenous lines infections, Surgical site infections and preventing Multidrug resistant organisms (MDROs).
  • Accurate and prompt diagnosis and treatment: For proper treatment, it is imperative to have an early and accurate diagnosis. Technological advances in health care industry has resulted in many newer diagnostic techniques, including CT scan, MRI, automated biochemistry and rapid culture techniques. The future of prompt identification of infectious agents lies in molecular methods, like multiplex PCR and Maldi-tof.
  • Prudent use of antimicrobials: WHO figures tell us that over 50% of antibiotics prescribed are either inappropriate or unnecessary. Apart from doctors prescribing antibiotics when it is not necessary, there is also the issue of access to over–the–counter antibiotics in India. Either the law is not strictly implemented or there are no laws. In healthcare setup, one should confirm daily if the antibiotic can be stopped or deescalated in ICUs.
  • Prevention of transmission: Once an infection occurs, steps should be taken to prevent its spread. Mass vaccination program and chemoprophylaxis are good ways to prevent transmission in the community setting as well as healthcare setting. Isolation of patients and universal precautions are the backbone of preventing transmission of infections. The single most important factor to prevent transmission of infections is frequent hand washing. All health care workers should wash hands according to WHO’s 7 steps and 5 Moments of hand washing.
 
  Quote of the Day

(Dr GM Singh)

Someone has defined genius as intensity of purpose; the ability to do; the patience to wait … put these together and you have genius and you have achievement.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Polycythemia

Polycythemia is defined as an increase in total body erythrocyte mass. As opposed to the situation with anemias, the physician may directly measure RBC mass using radiolabeling by 51chromium, so as to differentiate polycythemia (absolute erythrocytosis, as seen in polycythemia vera, chronic hypoxia, smoker’s polycythemia, Ectopic erythropoietin production, methemoglobinemia and high O2 affinity hemoglobins) from relative erythrocytosis (as seen in stress polycythemia and dehydration)

 
    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Exercise, inflammation and aging

It has been well documented that inflammation increases as people age. Inflammation can increase risk for chronic disease, poor level of function, and death. Several strategies have been suggested to reduce inflammation in older adults, including medication, diet, and exercise. A recent article published in Aging and Disease reviewed the research on these strategies. The authors found that, while medications could be helpful, some barriers such as access and cost could prevent many elderly people from getting the drugs they need.

Several studies found that nutritional changes such as decreased energy intake to promote weight loss, intake of plant sterols and stenols (components of plant cells that have been shown to mimic cholesterol and block its uptake from food), using prebiotics, and increasing certain types of fats have been shown to reduce inflammation. In addition, both cardio and resistance training have been shown to reduce markers of age related inflammation in both observational and intervention studies. One of the main theories to explain this is that exercise and dietary changes promote fat loss, and fat tissue is known to contain more pro–inflammatory substances.

Exercise can cause inflammation in the short term in people who begin working out after a long period of inactivity. However, studies have shown that the body will adapt and exercise will begin to reduce inflammation, build muscle mass, and improve quality of life. To promote optimal health, adults, especially older adults, should engage in regular physical activity, consume a healthful diet low in saturated fat and moderate in unsaturated fats, which are found in salmon, avocado, and nuts. Adults should also avoid highly processed foods and consume plenty of fruits and vegetables.

 
    Mind Teaser

Read this…………………

How much exercise do you really need?

A. 45 minutes twice a week.
B. 30 minutes three or four days a week.
C. 60 minutes at least three or four days a week.
D. 30 minutes at least four or five days a week.
E. It depends on your age and overall physical-fitness level.

Yesterday’s Mind Teaser: What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories.
E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Answer for Yesterday’s Mind Teaser: C. About 30 percent of your total calories should be from fat.

Correct answers received from: Dr BB Aggarwal, Dr Chandresh Jardosh, Raju Kuppusamy, Dr Avtar Krishan.

Answer for 26th April Mind Teaser: Albert
Correct answers received from: YJ Vasavada, Dr Amol Hartalkar, Dr SK Verma, Dr KV Sarma,
Dr DEEPALI CHATTERJEE, Sudipto Samaddar, Rajiv Kohli, Raju Kuppusamy.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr Chandresh Jardosh)

Don’t trust Money
because
It gives bed but not sleep.
It gives books but not mind.
It gives luxuries but not happiness………

So…

Transfer it to my account and relax…………!!!!!

 
    Medicolegal Update

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

Dilemmas in legal inquiry over antemortem and postmortem injuries

Injuries, other than antemortem in nature, may appear due to various other reasons and sources such as deliberate mutilation of a body by a murderer, predation by wild animals, or handling in transportation leading to cause confusion over the manner and cause of death. It is important to distinguish between antemortem, perimortem and postmortem injuries.

  • One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed.
  • After death, the body usually does not bleed. However, there are exceptions. For e.g. when a person drowns, the body usually floats face downwards resulting in the head becoming congested with blood. If the cadaver receives a head injury by being buffeted around in the water and colliding with boats or propellers, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood.
  • It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration (cuts or scrapes) to the head and scalp which may be very hard to interpret.
  • After death, the blood stays liquid in the vessels and no longer clots. Careless handling of a cadaver may produce some postmortem bruising, which may need to be distinguished from antemortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as lividity. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with ante–mortem bruising.

Recent research has focused on improved techniques for distinguishing between an antemortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Chinese scientists have found that tissue from antemortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help the pathologist classify injuries more accurately.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Elderly Beware

Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities, said Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Two reports from Wake Forest University School of Medicine support findings that anticholinergic drugs – used to treat acid reflux, Parkinson’s disease and urinary incontinence – may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells. Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine, and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drug

 
    Readers Response
  1. Sir, the decision of Himachal Pradesh Govt should be welcomed by all. There is nothing wrong. Ayurvedic students are also well qualified and aware of all medicines of so called ‘allopathy’ too. Few professionals related to IMA are always against ayurvedic docs, they treat them as quacks, where it is a fact that in many areas and at many places ayurvedic docs are doing better then IMA people. Sometimes few members of IMA work as Trade Union of workers related to a particular trade and issue statements as complexed people. I wish Govt. of India should pass such orders instead of trying to start Rural Medical Practitioners Course which will produce referring docs for big shots. Dr. Harimohan Goel, Mussoorie.
 
    Forthcoming Events
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
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

 
    eMedinewS Special

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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