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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

  Editorial ...

29th October 2010, Friday

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

New variant of H1N1 virus reported

Researchers have reported that the H1N1 flu virus is beginning to show mutation, with a slightly new form of the virus becoming predominant in Australia, New Zealand and Singapore.

Ian Barr of the World Health Organization Collaborating Center for Reference and Research on Influenza in Melbourne, Australia and co researchers have described a number of genetically distinct changes in the pandemic H1N1 influenza virus. This new form of the virus has been found to be associated with several vaccine breakthroughs in teenagers and adults vaccinated in 2010 with monovalent pandemic influenza vaccine (protecting against only H1N1) as well as a number of fatal cases from whom the variant virus was isolated. It was first detected in Singapore in early 2010 and then subsequently spread through Australia and New Zealand.

They further state that further study is required to determine if the new strain could be life-threatening and whether the present vaccine could provide complete protection against this new form of the virus. The authors report in the online publication Eurosurveillance that it may represent the start of more dramatic antigenic drift of the pandemic influenza A (H1N1) viruses that may require a vaccine update sooner than might have been expected.

It is likely that the variant virus is more lethal and may also infect people who have been vaccinated. But there is insufficient data to identify if other factors were also at play in making the patient more susceptible. According to the authors, it remains to be seen whether this variant will continue to predominate for the rest of the influenza season in Oceania and in other parts of the southern hemisphere and then spread to the northern hemisphere or merely die out.

The H1N1 pandemic was declared to have ended in August by the WHO. H1N1 has now taken over as the main seasonal flu strain circulating almost everywhere but South Africa, where H3N2 and influenza B are more common. The current seasonal flu vaccine protects against H1N1, H3N2 and the B strain.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

 17th Perfect Health Mela 2010
Culture Feast


A lively cultural show was organized by Punjabi Academy in the ongoing Perfect Health Mela.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Immunization Practices: ACIP recommendations

In 2010, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices expanded the recommendation for influenza vaccination to include all individuals 6 months of age and older.

(Ref: CDC’s Advisory Committee on Immunization Practices (ACIP) recommends universal annual influenza vaccination. www.cdc.gov /media/ pressrel /2010 /r100224.htm.)

  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

DNB degree–holders can now teach medicine

Doctors with a Diplomate of the National Board of Medical Examinations (DNB) degree can now teach in medical colleges. In a major decision, the Union health ministry has approved the Medical Council of India’s (MCI) proposal to allow doctors, who have a DNB degree, to teach just like those with a MD/MS degree. The move will help the nation to 3,000 new medical teachers who obtain a DNB degree in 54 subjects. Till date, DNB was never recognized on a par with other PG medical degrees like MD/MS. The latest rule will allow those DNB degree–holders, who have been teaching for several years to be automatically recognized as faculty members. Those doctors who pass out with a DNB degree from a medical college will get the same status. However, DNB degree–holders who have passed out from private or non– MCI recognized medical colleges will have to have experience of an additional year of senior residency in a teaching medical institution to be on a par with a qualified MD/MS candidate. (Source: The Times of India)

  International News

(Dr Monica and Brahm Vasudev)

Patients with advanced incurable cancer still routinely screened for additional malignancies

Patients with advanced incurable cancer are still routinely screened for additional types of malignancies, causing anxiety and no benefit for most, researchers at Memorial Sloan–Kettering Cancer Center found.

Children may suffer the most from food allergies

About 2.5% of Americans, nearly eight million suffer from food allergies, and children suffer the most, according to research published in the Journal of Allergy and Clinical Immunology.

Moderate drinking boost breast cancer’s return

Drinking even moderate amounts of alcohol may increase the chances of recurrence of breast cancer in some women, according to a study published in the Aug. 30 issue of Journal of Clinical Oncology. However, moderate intake of alcohol (about 3 to 4 drinks per week) was not linked to increased risk for all–cause death, and may in fact lower the risk for dying from a non–breast cancer–related health issue.

Prostate biopsy can cause urinary, erectile problems

According to findings from a new study reported in the Journal of Urology, biopsies taken to diagnose prostate cancer commonly cause temporary erectile dysfunction. In some cases, persistent urinary problems may occur.

  Gastro Update

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

What is the clinical presentation of Crohn’s disease?

Initial symptoms are more subtle and diverse in nature. Abdominal pain, diarrhea and weight loss present in combination constitute the classic presentation of CD. However, 45% of the patients have never had diarrhea. Systemic symptoms and extraintestinal symptoms are more common in CD. Symptoms of upper GI involvement suggest CD rather than UC. Anal pain on defecation and anal tags are the characteristic features.

  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is Endometriosis?

In Endometriosis, the endometrium (tissue from the lining of the uterus) forms and grows in places outside the uterus. These growths may cause pain and infertility. Up to 50% of women who have endometriosis may experience infertility.

These lost endometrial cells respond to the body’s hormones in a similar manner as they would inside the uterus. Normally, the endometrium within the uterus thickens to prepare for an embryo. When pregnancy does not occur, the extra lining breaks down and is shed during menstruation

  Diabetic Update: Question of the Day

What is the treatment of diabetic peripheral neuropathy? (Dr RM Bhoopathy)

Diabetic neuropathy can be prevented by controlling blood glucose at an optimal level.Myoinosital and aldose reductase inhibitors use failed to produce convincing clinical improvements. Use of nerve growth factor also did not change the course of the disease.

  • Alpha–lipoic acid: Relieves sensory symptoms
  • IV methyl prednisolone and high-dose IV immunoglobulin: Under investigation for patients with diabetic lumbosacral radiculoplexopathy
  • Tricyclic antidepressants (TCAs): Amitryptaline 25 mg at bed time gives significant symptomatic relief. In resistant cases, the dose can be stepped upto 75 mg/day gives symptomatic relief and minimal side effect. The newer antidepressant duloxetin is a better drug currently used to get relief from the neuropathic pain and is approved by US FDA.
  • Anticonvulsants: Gabapentin 300 mg–1,200 mg in divided dose gives excellent relief from pain with minimal side effects.
    Other anticonvulsants such as phenytoin, sodium valporate and carbamazipine are also used; but their use in peripheral neuropathy is limited by their potential side effects. The newer anticonvulsant pregabalin is now being used for neuropathic pain. It provides significant relief from pain with minimal side effects.
  • Lomotrigine: Acts by blocking sodium channels and inhibiting the presynaptic release of glutamine. Dose is 200–400 mg daily.
  • Tramadol: A non–narcotic analgesic around 200–400 mg/day can also be used.
  • Topical agents: Act via local skin absorption. Capasaicin (an extract of chillipeppers) relieves pain through the depletion of substance P in small fibers.
  • Transcutaneous electrical nerve stimulation (TENS) has been tried with modest success.
  • Acupuncture has also been reported to be beneficial.
  • In intractable cases surgical sympathectomy, spinal cord stimulation and central neuroaxial blockade have also been reported to be useful.
  Medicolegal Update

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

What is a patterned bruise?

The examining doctor must document the dimension /shape/size of bruise in the medicolegal report as it may connect the victim and the object or weapon used in the specific case, e.g., chain, cane stick, rifle butt, boots, ligature, vehicle etc.

The age of injury can be detected by the status of color of bruise; the extent and severity of violence or force used may be determined from the size and swelling of bruise; character and manner of the injury may be known from its distribution over the body.

  • Bruising of the arm may indicate restraining of the victim.
  • Bruising of the shoulder blades indicate firm pressure on the body against the ground or other resisting surface.
  • In manual strangulation the position and number of bruises and nail marks may indicate the method of attack and the position of the assailant.
  • Pattern bruises on chest/neck and mouth are very important in diagnosing resuscitative injury in medicolegal cases which may be invariably misconstrued by the doctor as indicative of manual strangulation/smothering.
  • Pattern bruises are an important tool to diagnose torture injury and very commonly appreciated in sole/flexor aspect of hands/buttock and back of thighs by doctors.
  Medi Finance Update

Stock Market

  • Law of Economics, when the bank interest rate reduces, then stock market has to rise and vice versa. When the interest rate reduces, the profit increases.
  • Even a genius in stock market will be wrong in 3 out of 10 innings.
  • Do not invest in stock market directly, take the mutual funds route.
  Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

The patent and proprietary medicines of fixed dose combinations of essential oils with alcohol having percentage higher than 20% proof except preparations given in the Indian Pharmacopoeia

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Uric acid

  • To detect high levels of uric acid, which could be a sign of gout
  • To monitor uric acid levels when undergoing chemotherapy or radiation treatment
emedinews 3D echocardography
  IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was found to have high ESR and elevated CRP.
Dr Bad: You are suffering from an inflammatory disease.
Dr Good:  It may be a part of diabetes.
Lesson: In diabetes, both ESR and CRP can be high at the same time and this can be due to IL–6 secretion by adipose tissue.

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminium toxicity.
Reaction: Oh my God! You should have put him on magaldrate preparations?
Lesson: Make sure to remember that Magaldrate preparations do not cause aluminium toxicity in patients undergoing dialysis.

Quote of the Day (Dr GM Singh)
"He who learns but does not think, is lost! He who thinks but does not learn is in great danger." Confucius

Mind Teaser

Read this…………………

yards yards yards yards yards
yards yards yards yards  

Answer for yesterday’s Mind Teaser: "dinner’s on the table "

Correct answers received from: Dr Rashmi Chhibber,  Dr. Rajiv Dhir, Dr S. Uupadhyaya, Dr K. P. Rajalakshmi, Dr.K.Raju, Dr Sudipto Samaddar, Dr Muthumperumal Thirumalpillai

Answer for 27th October eQuiz: "Correct answer is A."
Correct answers received from: Dr Ekta Sharma, Dr.G.Padmanabhan, Dr Muthumperumal Thirumalpillai, Dr K. P. Rajalakshmi

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)

Patient: I always see spots before my eyes.
Doctor: Didn’t the new glasses help?
Patient: Sure, now I see the spots much clearer.

An Inspirational Story

(Contributed by Dolly Aggarwal)

10 virtually instant ways to improve your life

Many of our problems come from within our own minds. They aren’t caused by events, bad luck, or other people. We cause them through our own poor mental habits. Here are 10 habits you should set aside right away to free

Don’t over–generalize

One or two setbacks are not a sign of permanent failure. The odd triumph doesn’t turn you into a genius. A single event—good or bad—or even two or three don’t always point to a lasting trend. Usually things are just what they are, nothing more.

  Readers Responses
  1. Dear Dr Aggarwal, I read with interest a lead story on Single Dose Azithromycin in the treatment of Cholera in "Emedinews dated 28th Oct 2010". I would like to inform you that similar RCT study was done in our institution in 2007 by Dr Kaushik JS, MD (Ped) student. The paper was also presented in the National IAP Conference held at Bhuvneshwer in January 2008 and was given an award. The study has been since been published online in 2009 and in print in 2010 in Indian Pediatrics which is indexed in Pubmed. The single dose therapy is very effective and superior to Ciprofloxacin. The abstract is as below. Thanks and regards: Dr M.M.A. Faridi

    Objective: To compare the clinical and bacteriological success of single dose treatment with azithromycin and ciprofloxacin in children with cholera. Design: Randomized, open labelled, clinical controlled trial. Setting: Tertiary care hospital. Participants: 180 children between 2-12 years, having watery diarrhea for < or = 24 hr and severe dehydration, who tested positive for Vibrio cholerae by hanging drop examination or culture of stool. Intervention: Azithromycin 20 mg/kg single dose (n=91) or Ciprofloxacin 20 mg/kg single dose (n=89). Dehydration was managed according to WHO guidelines. Main Outcome Measures: Clinical success (resolution of diarrhea within 24 hr) and bacteriological success (cessation of excretion of Vibrio cholerae by day 3). Secondary outcome variables included duration of diarrhea, duration of excretion of Vibrio cholerae in stool, fluid requirement, and proportion of children with clinical or bacteriological relapse.
    Results: The rate of clinical success was 94.5% (86/91) in children treated with Azithromycin and 70.7% (63/89) in those treated with Ciprofloxacin {RR (95% CI)=1.34 (1.16-1.54); P< 0.001}. Bacteriological success was documented in 100% (91/91) children in Azithromycin group compared to 95.5% (85/89) in Ciprofloxacin group {RR (95% CI) =1.05 (1.00 -1.10); P=0.06}. Patients treated with Azithromycin had a shorter duration of diarrhea {mean (SD) 54.6 (18.6) vs 71.5 (29.6) h; mean difference (95% CI) 16.9 (9.6 -24.2); P<0.001} and lesser duration of excretion of Vibrio cholerae {mean (SD) 34.6 (16.3) vs 52.1 (29.2) h; mean difference (95% CI) 17.5 (0.2 -24.7), P<0.001} in children treated with Azithromycin vs Ciprofloxacin. The amount of intravenous fluid requirement was significantly less among subjects who received Azithromycin as compared to those who received Ciprofloxacin {mean (SD) 4704.7(2188.4) vs 3491.1(1520.5) mL; Mean difference (95% CI) 1213(645.3 - 1781.9); P<0.001}. Proportion of children with bacteriological relapse was comparable in two groups {6.7% (6/89) vs 2.2% (2/91); RR (95% CI) 0.95 (0.89 -1.01); P=0.16}. None of the children in either group had a clinical relapse. Conclusion: Single dose azithromycin is superior to ciprofloxacin for treating cholera in children.
    (Ref: Kaushik JS, Gupta P, Faridi MM, Das S. Single dose azithromycin versus ciprofloxacin for cholera in children: a randomized controlled trial. Indian Pediatr 2010 Apr 7;47(4):309-15. Epub 2009 May 2)
  Public Forum

(Press Release for use by the newspapers)

Over 3000 children performed in Harmony at MTNL Perfect Health Mela

The star attraction of the sixth day of 17th MTNL Perfect Health Mela was the participation by over 3000 children in ‘Harmony’interschool festival. The competitions included aerobics, folk dance, street play, poster making, slogan writing, painting, model display etc.
Noted fashion designers Nainika Karan and Gauri Karan were the star attractions of the Mela.

A seminar was organized on Fake Doctors, Fake Drugs, Fake Cosmetics and Fake Fruits and Vegetables. The panelists included Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal; Dr.  SS Aggarwal, Director DIPSAR; Dr. Girish Tyagi, Registrar Delhi Medical Council; Dr. U.K. Katna, Former Spl. Commissioner of Police; Shri Chetan Chauhan, former cricketer; Dr. Vartika Nanda, Media Analyst and Dr. Vandana Chadha, Expert.
The panelists said that buying cosmetics, drugs etc. from authorized dealers with cash memo can reduce the problem of fake products.
Another seminar on lifestyle was organized by Dr. KK Aggarwal; Senior Homeopathy Doctor, Dr. Harish Chandra; Dr. Mridula Pandey and Dr. Shashi Bala were the participants. The main message was that eating cheeni, chawal and maida can cause heart diseases.
A meditation workshop was organized on Yoga and a practical demonstration was given on rope jumping.
Food adulteration stall attracts general public
Department of Science & Technology, Govt. of India and Department of Prevention of Food Adulteration, Govt. of Delhi are demonstrating practically how to detect adulteration at home. This stall is attracting a large crowd at the Mela
Free Unani treatment at the Mela
Unani doctors in the Mela are giving live demonstration of Leech Therapy, the traditional form of therapy which has been accepted as a medical device though not yet accepted in the US.
Over 2000 nurses to attend Mela today
The attraction of the Mela tomorrow will be presence of over 2000 nurses participating in various events. It will be followed by a lively cultural evening with Dr. Arthi Pathak.

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists
17th MTNL Perfect Health Mela 2010 day programme
Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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