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

 

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 …

29th October 2011, Saturday

Today is World Stroke Day

Common mistakes in managing strokes

  1. Failure to diagnose intracerebral hemorrhage or subarachnoid hemorrhage in time.
  2. Not ensuring airway protection and not assessing swallowing and preventing aspiration.
  3. Not optimizing position of head end of the bed with respect to the risk of elevated intracranial pressure, aspiration, and the presence of comorbid cardiopulmonary disease. One should keep the head in neutral alignment with the body and elevating the head of the bed to 30 degrees. For patients in the acute phase of stroke who are not at risk for elevated intracranial pressure, aspiration, or worsening cardiopulmonary status, keep the head of bed flat (0 to 15 degree head–of–bed position).
  4. Not obtaining emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.
  5. Not checking serum glucose and correcting hyperglycemia or hypoglycemia.
  6. Not starting insulin in time in patients who have serum glucose concentrations >180 mg/dL.
  7. Not evaluating and treating the source of fever. In acute stroke one should maintain normothermia for at least the first several days.
  8. Lowering blood pressure in patients with acute ischemic stroke who are not treated with thrombolytic therapy. In these patients one should treat high BP only if the hypertension is extreme (systolic BP >220 mmHg or diastolic BP >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre-eclampsia/eclampsia). When treatment is indicated, one should follow cautious lowering of blood pressure by approximately 15% during the first 24 hours after stroke onset.
  9. Not lowering blood pressure in patients with acute ischemic stroke who will receive thrombolytic therapy. Antihypertensive treatment is recommended so that systolic BP is ≤185 mmHg and diastolic BP is ≤110 mmHg.
  10. In both intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), the approach to BP lowering must account for the potential benefits (e.g., reducing further bleeding) and risks (e.g., reducing cerebral perfusion).
  11. Not considering thrombolytic therapy for patients with acute ischemic stroke.
  12. Not starting antithrombotic therapy within 48 hours of stroke onset.
  13. Not starting prophylaxis for deep venous thrombosis and pulmonary embolism.
  14. Not continuing statins in patients receiving statin therapy prior to stroke onset.

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

Today is World Stroke Day

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011

Heritage – An Inter Dancing School Health Festival at Perfect Health Mela was organised in the 18th MTNL Perfect Health Mela. The Focus was on Science behind Rituals.

 
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

In rare case, tapeworm egg cysts in heart

MUMBAI: Tapeworms are parasites that usually reach people’s intestines with unclean food and result in complications. In cases, one has heard of them reaching the liver or lungs. But Rehana’s case at Nair Hospital, Mumbai Central, made the doctors reach for their textbooks. An open heart surgery on the woman from Jalgaon helped extricate three tiny crystal–like balls from her left ventricle. "These are cysts containing eggs of tapeworms," said Dr Kanak Nagle, who heads the cardiothoracic surgery department. If they had burst, their protein could have triggered an allergic reaction and stopped the heart within minutes. "It’s extremely rare to have such a cyst in the heart," said Dr Anil Patwardhan, former head of KEM Hospital’s cardiac surgery department. Rehana’s has many such cysts lodged in her brain too. It’s suspected she got the infection from a pet dog. (Source: TOI, Oct 27, 2011)

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)

Could additives in hot dogs affect incidence of colon cancer?

The addition of vitamin C or erythorbate, and the reduced amount of nitrite added in hot dogs, mandated in 1978, have been accompanied by a steep drop in the death rate from colon cancer, according to data presented at the 10th AACR International Conference on Frontiers in Cancer Prevention Research, held Oct. 22–25, 2011. (ScienceDaily)

For comments and archives

Linezolid toxic with SSRIs, FDA warns

The FDA has issued an updated statement on the potential for serious central nervous system toxicity when patients taking serotonergic psychiatric drugs are treated with the antibacterial agent linezolid.

For Comments and archives

Insomnia linked to heart attacks

People who struggled to fall asleep almost every night were 45% more likely to have an acute heart attack compared with those who never experienced this sleep problem. Trouble staying asleep nearly every night was associated with 30% elevated risk.

For comments and archives

News snippets

  • Patients with hypertension should watch sugar as well as their salt. Data from more than 2,600 patients found that those with the highest intakes of sugar–sweetened beverages like soda and fruit juices seemed to have higher blood pressure readings, Ian J. Brown, MD, of Imperial College London, and colleagues reported in Hypertension.
  • A team of Danish researchers reported that long–term data do not support a link between use of mobile phones and risk of brain cancer.
  • Accurate blood pressure assessment requires multiple measures regardless of whether it is measured at home, in a clinic, or in a research setting, according to findings from a study of more than 400 veterans. (June 21 issue of Annals of Internal Medicine).

For comments and archives

 
  Twitter of the Day

@DrKKAggarwal: Of all forms of caution, caution in love is perhaps the most fatal to true happiness.

@DeepakChopra: Each of us is a unique strand in the intricate web of life and are here to make a contribution.

 
    Spiritual Update

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

Annakoot emphasizes the importance of eating mixed vegetables

Annakoot festival is observed on the day of Govardhan Pooja after Diwali. There are many mythological scientific descriptions for this pooja.

  1. On this day, with the change in the season, there is a change in the availability of fruits and vegetables in the market. On the day of Annakoot, people cook all types of outgoing and incoming vegetables and eat them. It reminds people that this is the last day for eating these outgoing vegetables for health reasons.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Never Give Up

"You are never given a wish without also having been given the power to make it come true." Richard Bach.

What you need is patience, perseverance, and a burning desire that constantly needs to be fueled. The quest for the realization of your dreams is like waging a momentous battle during which you might encounter severe setbacks. But success comes to those who turn adversities into opportunities, overcome their limitations and bounce back with renewed vigor.

If you have fallen down, get up and brush the dust off your knees and move on. A temporary setback is not a defeat. For that matter, there’s no such thing as defeat. Nothing is impossible in this world. If you have the will to win, you can achieve anything. And always remember that the whole world will help you when you want to achieve something.

Just imagine a young girl who learned dancing when she was three–years old and whose greatest passion remains dancing. She loses one of her legs in an accident. Read on this true incident that took place almost 20 years ago and find out whether she gives up dancing or fights back to realize what she believes in:

Sudha Chandran, a classical dancer from India, was cut off in the prime of her career – quite literally – when her right leg had to be amputated after a car accident. Though the incident brought her bright career to a halt, she didn’t give up.

In the painful months that followed, she met a doctor who developed an artificial limb made from vulcanized rubber filled with sponge. So intense was her desire that she decided to go back to dancing after she had been fitted with an artificial leg. Sudha knew that she believed in herself and could fulfill her dream, She began her courageous journey back to the world of dancing – learning to balance, bend, stretch, walk, turn, twist, twirl and finally dance.

After every public recital, she would ask her Dad about her performance. "You still have a long way to go" was the answer she use to get in return.

In January 1984, Sudha made a historic comeback by giving a public recital in Bombay. She performed in such a marvelous manner that it moved everyone to tears while catapulting her to the number one position again. That evening when she asked the usual question her dad, he didn’t say anything. He just touched her feet as a tribute to a great artiste.

Sudha’s comeback was such heart–warming that a film producer was inspired to capture the incident into a celluloid box office hit, ‘Mayuri.’ When someone asked Sudha how she had managed to dance again, she said quite simply, "YOU DON’T NEED FEET TO DANCE."

For comments and archives

 
  Fitness Update

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

Arteries: Young, Apparently Healthy – and at Risk of Heart Disease

"The proportion of young, apparently healthy adults who are presumably 'the picture of health’ who already have atherosclerosis is staggering," says Doctor Eric Larose, an interventional cardiologist and professor at Université Laval. Atherosclerosis can eventually lead to serious problems including heart disease, stroke, or even death.

The study enrolled 168 young adults (age 18 to 35) – half male and half female – who had no known cardiovascular disease or risk factors such as family history of premature heart disease, diabetes, smoking, high blood cholesterol, or high blood pressure. The team took complete body measurements, including height, weight, body–mass index and waist circumference. They also measured, through magnetic resonance imaging (MRI), various body fat deposits including subcutaneous fat (fat under the skin that you can measure with callipers) as well as fat within and around the abdomen and chest including the amount of intra-abdominal or visceral fat. Ultimately, they measured atherosclerosis volumes of the carotid arteries by MRI. The researchers found that although a large proportion of subjects didn't have traditional risk factors for atherosclerosis, they did have discrete signs: greater waist circumference, and visceral fat covering the internal organs within the chest and abdomen. He says their message is that beyond simple weight and BMI, measures of fat hidden within (visceral fat) are greater predictors of atherosclerosis. The people with greater visceral fat will have greater atherosclerosis, even if they are young and apparently healthy – and could benefit from preventive lifestyle measures.

For comments and archives

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    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?

People who snore in the night should have medical fitness before they can become commercial drivers.

For comments and archives

 
    Malaria Update

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

What the National Drug Policy of India says

What should not be done when managing a case of severe malaria?

You should not use corticosteroids, intravenous mannitol, heparin as anticoagulant and adrenaline and the patient should not be overhydrated.

For comments and archives

 
    Medicine Update

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

How can one diagnose primary hypothyroidism in setting of acute illness?

Hypothyroidism is a strong possibility if TSH is >25–30. (will be above 20 only 3% of the time in NTI)

  • Subnormal free T4 in the absence of treatment with agents that suppress TSH (dopamine, corticosteroids, phenytoin, carbamazepine) is strongly suggestive of hypothyroidism.
  • Presence of goiter and anti–thyroid antibodies (peroxidase, thyroglobulin) favor primary hypothyroidism.
  • Elevated rT3 in the setting of TSH >10 renders diagnosis of hypothyroidism unlikely.

For comments and archives

 
    Legal Question of the Day

(Dr M C Gupta, Advocate)

I am a senior oncologist facing great difficulty in managing serious patients because the blood bank refuses to give blood without a donor having been arranged. What is the solution? What will be my defence if somebody takes me to court for medical negligence if a patient dies due to lack of blood?

Ans.

  1. It is possible that the blood bank might be acting as per proper guidelines and discretion. Availability of blood is a great problem in many blood banks. Blood banks alone cannot do much in this direction.
  2. My personal view is that the initiative and incentives should come from the hospital itself. Every hospital with a blood bank should have a Blood Donation Committee headed by the medical superintendent and members should include the clinical HODs from surgery, gynae, medicine etc. This committee can promote blood donation by relatives of patients and staff members and others by giving incentives and recognition to staff who donate themselves or motivate others to donate blood. Such incentives can be of various sorts including, for example, prizes, medals, felicitation at functions, nomination to appropriate committees/training courses/some extra allowance as per rules etc.
  3. Doctors, in general, should try to promote voluntary blood donation through various means at their disposal. For example, relatives of patients treated by clinicians often want to show gratitude towards them by various means, including gifts. Clinicians can tell them that if they really want to show their gratitude, they should donate blood. Things like this will go a long way in creating awareness about the need for blood donation in the minds of doctors themselves, which, I think, is necessary.
  4. As regards possible litigation against you for medical negligence, it is unlikely to succeed against you as long as your records are complete. The real litigation will be against the hospital, not against you.

For comments and archives

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum calcium

Increased: Primary hyperthyroidism, parathyroid hormone secreting tumors, vitamin D excess, metastatic bone tumors, chronic renal failure, milk–alkali syndrome, osteoporosis, thiazide drugs, Paget’s disease, multiple myeloma, sarcoidosis.

Decreased: Hypoparathyroidism, insufficient vitamin D, hypomagnesemia, renal tubular acidosis, hypoalbuminemia, chronic renal failure (phosphate retention), acute pancreatitis.

For Comments and archives

 
    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.

For comments and archives

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.

For comments and archives

 
    Rabies Update

(Dr. AK Gupta, Author of "RABIES – the worst death")

Can unvaccinated pet dog/cat pose danger to the family?

As rabies is enzootic (prevalent in stray dogs) if pet unvaccinated dog is bitten by a stray rabid dog it will develop rabies and later pose threat at home to all family members.

Can Human ARVs viz. NTV or TCVs (PCEC, PVRV, HDCV) be given to animals?

Though human ARVs may not be harmful to animal, there is no dose–weight correlation of immune response nor their efficacy known in animals. Besides the incubation period of rabies in animals is long. Hence, it is advisable to reserve.

 
  Quote of the Day

(Dr GM Singh)

In my mind, there is nothing so illiberal and so ill bred as audible laughter.

 
  IDIOMS

Twenty three skidoo: To be turned away

 
    Mind Teaser

Read this…………………

The most common extraintestinal manifestation of Crohn’s disease of small intestine is:

a) Ankylosing spondylitis
b) Erythema nodosum
c) Iritis
d) Ureteral obstruction

Yesterday’s Mind Teaser: 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.

Answer for Yesterday’s Mind Teaser: a) Its infectivity is highest in developed world.

Correct answers received from: Dr BB Aggarwal, Dr Sathiyamoorthy Veerasamy, Dr Neelam Nath,
Dr Chandresh Jardosh, Dr K Raju, Anil Bairaria, Dr Kirat, Dr Kaayush, Dr Abir, Dr Aayush,
Dr Satyanarayana Akupatni, Dr Sukla Das, Dr PC Das.

Answer for 27th October Mind Teaser: A little on the large side
Correct answers received from: Dr Sudipto Samaddar, Dr Aayush, Dr Paragriti, Dr Prosha, Dr Kaya.

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

At the cocktail party, one woman said to another, "Aren’t you wearing your wedding ring on the wrong finger?" The other replied, "Yes, I am, I married the wrong man."

 
    Medicolegal Update

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

No Narco test without valid informed consent, rules Supreme Court of India

The most exhausting/frustrating and laborious part of a criminal investigation for agencies like CBI or FBI is extracting information from an uncooperative alleged accused and suspects by investigators in India as well as abroad. No individual should be forcibly subjected to any of these techniques/method of interrogation in question, whether in the context of investigation in any criminal cases or otherwise. The narcoanalysis test began to be used with the presumption that it provides a simply, nonviolent method of finding out the truth. In a world where until quite recently, torture was employed in criminal cases, perhaps narcoanalysis is a simple, civilized way of conducting criminal investigation

  • The Supreme Court of India said that the so–called narcoanalysis, brain mapping and polygraph tests cannot be conducted on any person without their consent.
  • The Apex Court further said the confession of guilt during the course of the tests cannot be treated as evidence in court.
  • The results of narco test provided clues and did not have any evidentiary value. There is no scientific literature to prove truth serum works, human rights groups have held the tests to be mental torture.
  • "The compulsory administration of any of these techniques is an unjustified intrusion into the mental privacy of an individual. It would also amount to ‘cruel, inhuman or degrading treatment’ with regard to the language of evolving international human rights norms," said a Bench comprising Chief Justice K G Balakrishnan and Justices R V Raveendran and J M Panchal.
  • The police, instead of collecting real evidence, relied on these tests to spread rumors about the suspect, and selective leaks were made to the media that a particular suspect has made confession during the tests."

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)

Today is World Stroke Day

Today is World Stroke Day (Oct. 29) and all doctors should revise their ABCs of stroke said Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

ABC for stroke prevention is

1. Aspirin for people at risk
2. Blood Pressure control
3. Cholesterol management.

Most people are not taking the precautions.

a. Less than 50% of those who should be taking daily aspirin take it
b. Less than 50% of those with high blood pressure have it under control.
c. Less than 33% of those with high cholesterol are on effective treatment
d. Less than 25% of those who smoke get help to quit when they see their doctor.

World Stroke Day is part of the Million Hearts campaign. The goal of the campaign is to cut the rate of heart attacks and stroke by one million over the next five years.

Someone in the U.S. alone has a stroke every 40 seconds. Stroke is one of the country’s leading causes of death.

For comments and archives

 
    Readers Response
  1. I read the paper first time today. Good work sir. Suraj Gohain
 
    Forthcoming Events

A Heart Care Foundation of India Initiative

Camp Name: Ask Dr KK
Heart Checkup Camp
Organizer: Maheshwari Club in association with Heart Care Foundation of India and World Fellowship of Religions.
Sunday, 30th October, 2011
Venue: Aggarwal Dharamshala, Kalkaji Extention, behind Punj Factory 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

 
    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

 
    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