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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

 

eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

 
  Editorial …

28th October 2011, Friday

Do not eat bitter bottle gourd (lauki)

  1. Bottle gourd belongs to the cucumber or cucurbitaceae family. Lauki or bottle gourd (Lagenaria siceraria) fruit juice is advocated as a part of complementary and alternative medicine. If the bottle gourd juice becomes bitter it is considered toxic. The Indian Journal of Gastroenterology has reported 15 patients, who developed toxicity due to drinking bitter bottle gourd juice. Patients presented with abdominal pain, vomiting, blood in vomit, diarrhea and hypotension within 15 min to 6 hours after ingestion of the bottle gourd juice. (Indian J Gastroenterol 2011 Oct 11. Epub ahead of print)
  2. First, slice a piece from bottle gourd, taste if it's bitter. If it's bitter, discard it immediately, as per ICMR.
  3. Dr S K Sharma, Head, Dept. of Medicine at AIIMS: Lauki juice should not be mixed with any other juice.
  4. Like other members of the gourd family, the bottle gourd contains the tetracyclic triterpenoid cucurbitacins compound, which is responsible for the bitter taste that can cause serious side-effects and even death.
  5. Boiled and cooked bottle gourd has no risk.

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 on

Do not eat bitter bottle gourd (lauki)

Audio PostCard
 
    Photo Feature (From HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011 – Anmol – festival for children with special needs.

The special children are not disabled but differently abled. Students of Balwant Rai Mehta Vidya Bhavan, Masjid Moth in a Skit completion organised by Heart Care Foundation of India in the recently concluded 18th MTNL Perfect Health Mela.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook – Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

Abolish service fee from healthcare

The Planning Commission's high-level expert group on universal health coverage has suggested abolition of user fees for healthcare services. The group says "as a practical and political issue, increasing official user fees would be politically and practically difficult to justify….” The group feels fees have not proven to be an effective source of resource mobilization since global experience suggests its imposition in many countries has increased inequalities in access to healthcare. (Source: TOI, Oct 27, 2011)

For comments and archives

Seven-billionth baby to be born in Uttar Pradesh on October 31?

The world's 7 billionth person, who the UN says will be born on October 31, will join a population more aware than ever of the challenges of sustaining life on a crowded planet but no closer to a consensus about what to do about it. No one knows what circumstances the baby will be born into, but Uttar Pradesh, with a population that combines that of Britain, France and Germany, provides a snapshot of the challenges it could face. How do we know for sure that it will be born in UP? Well, India has the highest number of babies born every minute, at 51. So the probability of Baby 7 Billion being an Indian is highest. And UP alone has about 11 babies born every minute. (Source: TOI, Oct 27, 2011)

For comments and archives

Medical gossip: Indian cricketer and NHL??

In May this year one of the Indian cricketers was detected with small patch of left pneumonia with enlarged mediastinal lymph nodes. He said to have recovered after a FNAC done was reported to be negative. There is some unconfirmed news in the medial circle that he is still under investigations for the mediastinal lymph nodes and the doctor’s are suspecting NHL.

About NHL: The clinical presentation of NHL varies tremendously depending upon the type and the areas of involvement. Some behave indolently with lymphadenopathy waxing and waning over years. Others are highly aggressive, resulting in death within weeks if left untreated. Aggressive ones commonly present acutely or sub acutely with a rapidly growing mass, systemic B symptoms (fever, night sweats, weight loss), and/or elevated levels of lactate dehydrogenase and uric acid. Indolent ones are often insidious, presenting only with slow growing lymphadenopathy, hepatomegaly, splenomegaly, or cytopenias.

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

(Dr Monica and Brahm Vasudev)

CDC Committee backs HPV vaccine for boys

CDC’s Advisory Committee on Immunization Practices has approved routine vaccination of 11- and 12-year-old boys with Gardasil to protect against human papillomavirus (HPV).

For comments and archives

Sepsis drug pulled from market

Eli Lilly is withdrawing drotrecogin alfa from all markets worldwide after a major study failed to show a survival benefit for patients taking the drug.

For comments and archives

Studies fail to find health benefits of multivitamins

Vitamins B-6 and B-12, both hyped as offering heart benefits, do not really reduce one's likelihood of developing heart disease, according the NIH's Office of Dietary Supplements.

For comments and archives

Women with HPV may have increased heart attack, stroke risk

Women infected with the human papillomavirus, or HPV, are two to three times as likely as uninfected women to have had a heart attack or stroke, according to a study published in the Journal of the American College of Cardiology.

For comments and archives

 
   Twitter of the Day

@DrKKAggarwal: Thursday is a day to think differently. Instead of saying you are 48 years old, say you are 18 years old with 30 years of experience.

@DeepakChopra: Meditation at #OccupyWallstreet http://bit.ly/veJJZw

 
    Spiritual Update

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

What is the importance of Govardhan pooja?

The mistake of the Intellect is responsible for the disturbed state of mind. Even if the mind is under control, the intellect can disturb the mind. It is the discriminative faculty of the mind and can be very destructive. It is the main cause of ignorance. External desires and the uncontrolled five senses are responsible for it. Kama, Krodha, Lobha, Moha are the causative factors

For comments and archives

 
   An Inspirational Story

(Ms Ritu Sinha)

Never give up

Life is how you want it to be, open your eyes, and you will see
No matter what, you can have fun, and always remember, when it's done.
The memories of what has been, the mistakes, so you won't make them again
The good times, but the not-so-good times too, because these memories will see you through.
Never forget friends who've come and gone, Sing life's praises as a beautiful song
Loving and being loved are the greatest gifts, Close your heart, and these you'll miss
Life is how you want it to be, Open your eyes, and this you'll see...
Just one note: NEVER GIVE UP!

For comments and archives

 
    Fitness Update

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

Preeclampsia: Early detection and immediate treatment

Preeclampsia is the most common of the dangerous pregnancy complications. It is characterized by elevated blood pressure, protein in the urine and accumulation of excess fluid beneath the skin. If not treated in time, preeclampsia may progress to eclampsia, characterized by tonic-clonic seizures which can possibly result in maternal and infant death. Doctor Stefan Verlohren from the Department of Obstetrics and his team examined a total of 630 pregnant women. 388 of those were having a normal pregnancy whereas 164 suffered from preeclampsia. The scientists closely observed the remaining time of pregnancy in patients with preeclampsia. In cases where the concentration of two certain placenta-derived growth factors, so-called sFlt-1 and PlGF, exceeded a certain value the duration of pregnancy was significantly shorter. In patients with especially high test results, delivery resulted within 48 hours.

“With this test we can assess the severity of preeclampsia and give a short-term prognosis of the disease course”, explains Verlohren. Further studies will have to evaluate the test's validity in women who have an elevated risk of developing preeclampsia.

For comments and archives

 
    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Who is not Fit to Drive?

Patients suffering from diabetes on insulin should not be allowed to drive commercial vehicles.

For comments and archives

 
    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What the National Drug Policy of India says

Chemotherapy of severe and complicated malaria

After parenteral artemisinin therapy, patients will receive a full course of oral ACT for 3 days. Those patients who received parenteral quinine therapy should receive oral quinine 10 mg/kg body weight thrice-daily for 7 days (including the days when parenteral quinine was administered) + Doxycycline 3 mg/kg body weight once daily or Clindamycin 10 mg/kg body weight 12-hourly for 7 days (Doxycycline is contraindicated in pregnant women and children under 8 years of age) or ACT as described.

Note:

  • Pregnant women with severe malaria in any trimester can be treated with artemisinin derivatives, which, in contrast to quinine, do not risk aggravating hypoglycaemia.
  • Parenteral treatment should be given for minimum of 48 hours.
  • Once the patient can take oral therapy, give:
    • Quinine 10 mg/kg thrice-daily with doxycycline 100 mg once-daily or clindamycin in pregnant women and children under 8 years of age, to complete 7 days of treatment, in patients started on parenteral quinine.
    • Full course of ACT to patients started on artemisinin derivatives.
    • Use of mefloquine should be avoided in cerebral malaria due to neuropsychiatric complications associated with it.

For comments and archives

 
    Medicine Update

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

How can asthmatic medications be delivered to a child?

In pediatric asthma, inhaled treatment is the cornerstone of asthma management. Inhaler devices currently used broadly fall into the following four categories:

  • Pressurized metered dose inhaler (pMDI): Propellant used to dispense medication when canister is pressed manually.
  • Dry powder inhaler (DPI): Does not require hand–breath coordination to operate.
  • Breath–actuated pMDI: Propellant used to dispense medication when patient inhales.
  • Nebulized solution devices

In pediatrics, the inhaler device must be chosen on the basis of age, cost, safety, convenience, and efficacy of drug delivery.

  • The preferred device for children younger than 4 years is a pMDI with spacer and age–appropriate mask.
  • Children aged 4–6 years should use a pMDI plus a valved holding chamber or spacer.
  • Children older than 6 years can use either a pMDI, a DPI, or a breath–actuated pMDI.

For all three groups, a nebulizer with a valved holding chamber (and mask in children younger than 4 years) is recommended as alternate therapy.

For comments and archives

 
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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Amylase

  • Increased: Acute pancreatitis, pancreatic duct obstruction, alcohol ingestion, mumps, parotitidis, renal disease, cholecystitis, peptic ulcers, intestinal obstruction, mesenteric thrombosis, postop abdominal surgery.
  • Decreased: Liver damage, pancreatic destruction (pancreatitis, cystic fibrosis)

For comments and archives

 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

A lymphoma patient with serum albumin 1.2 g. needed ALBUDEC, a parenteral preparation that costs Rs. 3000/- per bottle. The hospital administrator is some MD in medicine but no experience in oncology and who has been given so much power that he can reject prescriptions of even senior consultants and faculty members like me. He was reluctant to provide the preparation. I talked to him on phone and his response was..." Have you read the guidelines for infusing ALBUDEC? There was no mention of BP, pulse and pedal edema in the case record provided by you”. He asked many other such silly questions from consultant like me as if I was appearing in an undergraduate examination. I asked him as to

1. Who has laid the guidelines?
2. How come the guidelines were laid without consulting the Oncology Department?
3. Has he seen the WHO guidelines?
4. What is his experience in oncological sciences?
5. How dare he doubt and question the integrity of a senior consultant?
6. If this is so, he should stop me from working in this hospital.
7. If he has some doubt, he can send his investigator to the ward and find out about pedal edema.

I also gave him suggestions like attending oncology-related meets, CMEs and conferences that are in plethora in Delhi, free registration and free five star food and fluids of his choice (alcoholic if he may wish). It took him three days to recommend an essential medication while the condition of the patient deteriorated. He might even have died. What would be my fate if the relatives go to court and charge me with negligence?

Ans: I hope you do not mind my frank response.

  1. It is clear that you have a superiority complex because you are an oncologist and he is not and is merely “some MD in medicine”. You have mocked him by suggesting that he may attend oncology CMEs for free and, in addition, have free drinks. You are piqued that he does not quiver with reference and awe when he comes across a prescription by a senior person like you. You have not provided essential information that he reasonable expects you to provide while requisitioning a costly preparation to be given free to a patient.
  2. Just as you are doing your job, he is doing his job. His job is not to routinely give approval when senior doctors prescribe something and to ask explanations only from junior doctors. There can be old fools and bright youngsters.
  3. Please rest assured that he knows he is a mere MD while you are a superspecialist and he is not trying to prove that he knows more oncology than you. Please also rest assured that hospital administrators are not appointed on the basis of their knowledge of oncology. You may rest assured there would have been solid reasons for his “silly” questions. For example, the literature insert with ALBUDOC or the hospital guidelines which have been given to him might require certain information before such drug is administered. If such guidelines are breached and the patient dies after such drug administration and the relatives file a complaint, the music will be faced by him as hospital in-charge and not by you.
  4. As regards your specific question, your fate will be secure if the relatives go to court. No negligence will be provable against you. You as a consultant prescribed a necessary medicine but the supply of the same was blocked by the hospital administrator. No stigma attaches to you.

For comments and archives

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and stop low–dose aspirin.
Lesson: In dengue, lose–dose aspirin needs to be stopped.

For comments and archives

Make Sure

Situation: A patient after receiving 40 units of insulin developed severe hypoglycemia.
Reaction: Oh my God! The order was 4 units.
Lesson: Make sure that 4 unit is not written as 4.0 units as it may be incorrectly read as 40.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

The most beautiful discovery true friends make is that they can grow separately without growing apart. Elisabeth Foley

 
    IDIOMS

The ball is in your court: It is your decision this time.

 
    Mind Teaser

Read this…………………

Helicobacter pylori (H. pylori) is a known cause of peptic ulcer disease. It was discovered in Australia in 1987. Which of the following statements regarding it is not true?

a) Its infectivity is highest in developed world.
b) Person to person transmission is common.
c) It is seen in populations with low socioeconomic status.
d) H. pylori is a gram-negative microaerophilic bacteria.

Yesterday’s Mind Teaser: little LARGE
little LARGE
little little
little LARGE

Answer for yesterday’s Mind Teaser: A little on the large side

Correct answers received from: Dr Sukla Das, Dr PC Das, Dr Neelam Nath, Dr K Raju, Dr Chandresh Jardosh, Dr Amit Raj.

Answer for 26th October Mind Teaser: 1. The bulk of water reabsorption occurs secondary to Na+ reabsorption.
Correct answers received from: DR Anil Kumar Jain, Dr K Raju, Dr Sukla Das, Dr PC Das, Dr Surendra Bahadur Mathur, YJ Vasavada, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Anil Bairaria,
Dr Satyoban Ghosh, Dr KV Sahasranam

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM SINGH)

Letter home from school...

Dear Dad, $chool i$ really great. I am making lot$ of friend$ and $tudying very hard. With all my $tuff, I $imply can't think of anything I need, $o if you would like, you can ju$t $end me a card, a$ I would love to hear from you. Love, Your $on.

A week later..... a letter from "home"

Dear Son, I kNOw that astroNOmy, ecoNOmics, and oceaNOgraphy are eNOugh to keep even an hoNOr student busy. Do NOt forget that the pursuit of kNOwledge is a NOble task, and you can never study eNOugh.
Love, Dad.

 
    Medicolegal Update

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

DOES & DON’T DOES IN CASE OF SEXUAL ASSAULT?

The offence of sexual assault is a brutal, dirtying, demoralizing assault on a woman, and if fully proven demands the most rigorous penalties allowed by law. Equally, the allegation of rape is easy to make, and the man accused falsely of the offence may shatter his life as well as the family he belong.

  • The doctor should concentrate on what is the truth and on view of that what are the biological evidences available and can/required to be collected.
  • The history of previous sexual intercourse of the female victim, Physical signs of injury to corroborate the history of incidence should be recorded after Medical examination with followingDOES & DON’T DOES
  • Detailed and consistent history about time, place and circumstances of occurrence. The examination of scene of incidence, collection of various evidences, like, spot of blood, semen, bed sheet etc should be recorded.
  • Doctor should neither act as detective nor as curtain for law
  • Police should be informed only with the consent of the victim or her parents; otherwise, it will be a violation of professional secrecy. Sometimes, the victim may not give the correct history and alleged cause of injuries as due to rape.
  • Doctors have no role of a detective. Even if the findings are suggestive of a sexual assault, he should not interrogate the victim to ascertain the veracity of the history.
  • The version of the woman should be recorded verbatim and necessary treatment should be given if the victim is unconscious or unable to give a coherent version of the history, the police should be notified.
  • Whatever be the case, all the details should be entered in the register, collect necessary samples and keep them in safe custody. Victim may change her/his mind and file a complaint before the police at a later date. Then the doctor has to disclose all the information to the Police.

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)

Give BP drugs at night

Blood pressure drugs should be taken at night said Padmashri and Dr B C Roy National Awardee and President heart Care Foundation of India.

Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most attacks occur in the early morning hours. Pulse, blood pressure, thickening of platelets all are higher in early morning hours. Controlling early morning blood pressure can reduce cardiovascular mortality.

According to new research published in October 24 in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure taking at least one anti-BP drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events.

The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti-BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least one BP-lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening. A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5-mm-Hg decrease in mean sleep-time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow-up.

Potential explanation for the benefit of nighttime treatment may be associated with the effect of nighttime treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

For comments and archives

 
    Readers Responses
  1. Dear Dr. KK Aggarwal, Wishing you, your family and your associates A VERY HAPPY, HEALTHY DEEPAWALI SEASON AND A PROSPEROUS NEW YEAR. You are doing an excellent job of expelling darkness from your readers’ minds by enlightening them on various issues and strengthening them with spiritual knowledge/explanations. This is Deepawali in true sense. May God bless you all with health, stamina and a lot more years to carry on with this great work. Dr. Damodar Raiker, Goa.
  2. Dear Sir, very interesting Editorial, enjoyed. Diwali Greetings! Regards, Prof M E Yeolekar.
 
    Forthcoming Events

A Heart Care Foundation of India Initiative

Camp Name: Ask Dr KK
Health Checkup Camp
Organizer Maheshwari Club in association with Heart Care Foundation of India Sunday, 30th October, 2011
Venue: Aggarwal Dharmsala, Kalkaji, Near Govind Puri Metro Station
Time: 9 Am to 1 Noon

The camp includes consultation with Dr K K Aggarwal and team.
Facilities available: ECG, BP, Height, Weight, Abdominal Circumference, Neck circumference and Colour Doppler Echo screening where necessary. Special Yoga Classes.
On Spot Registration

FOGSI International Conference on Preventing Pregnancy Wastage

Hotel Hilton Janakpuri on 29th and 30th October 2011. Conference website:
www.noblehospital.com/ppwconference and e mail ppwoctober2011@gmail.com

 
    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