HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com 

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)


2nd November Monday

Dear Colleague,

 Penicillin injections not available?

Dr Brijesh Sharma emailed a concern that most Rheumatic Heart Disease patients are unable to get Long acting Penicillin 12 lac. What can any body do about it? This is a problem faced by all of us. What is IMA or any council doing about this? Till we deal with the officials I thought or revisiting the subject for the alternatives.
Get injections from smaller chemists they may be storing it. As we know that injections are better than oral. The preferred antibiotic approach for secondary prevention of recurrent rheumatic fever is administration of long acting benzathine penicillin G intramuscularly every 4 weeks. In India where the incidence of rheumatic fever is particularly high, administration every 2 to 3 weeks is appropriate. The long term benefits of intramuscular penicillin prophylaxis outweigh the risk of allergic reaction, as life threatening allergic reactions are rare.
Shift to oral: Options for oral prophylaxis include penicillin V, penicillin G (twice daily, available as pentids 400), sulfadiazine, (once daily) and macrolides (once daily). Success with oral prophylaxis depends on patient adherence, so clear communication regarding the importance of prophylaxis and how antibiotics should be taken is critical. Even with optimal adherence, the risk of recurrence is higher in individuals receiving oral prophylaxis than those receiving intramuscular penicillin. Therefore, parenteral prophylaxis is preferred for patients at high risk for rheumatic fever recurrence; oral agents are appropriate for patients at lower risk for rheumatic fever recurrence. Switching from intramuscular to oral prophylaxis once patients have reached young adulthood and have remained free of rheumatic attacks is appropriate.
How long to give prophylaxis: 1. Administer secondary prophylaxis in the setting of suspected post streptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.
2. In general, prophylaxis for in the setting of carditis should continue until the patient is a young adult (18 years of age), which is usually 10 years from an acute attack with no recurrence.
3. In the setting of persistent valvular heart disease it should be given for minimum 10 years or until 40 years of age (whichever is longer). Sometimes it can be lifelong prophylaxis.
4. In the setting of rheumatic fever with carditis but no residual heart disease it should be given for 10 years or until 21 years of age (whichever is longer)
5. In the setting of rheumatic fever without carditis it should be given for 5 years or until 21 years of age (whichever is longer)
Oral Alternatives: Penicillin G benzathine intramuscular: 12 LA every 3 weeks (6LA in children); Penicillin V tablets 250 mg BD; Penicillin G (Pentids) 400 BD (400,000 units); Sulfadizine 1000 mg OD ( 500 mg children) and Azithromycin 250 mg orally daily (5mg/kg children up to 250 mg) or  Erythromycin, 250 mg orally twice daily. Dosing for children: 20 mg/kg/day divided twice daily (maximum 500 mg per day).
 Dr KK Aggarwal

Correct genome reading key to good diagnosis

The life of a five-month-old Turkish child, critically ill, was saved after scientists timely deciphered his genome and deduced that an incorrect diagnosis had been made. The case was reported in the journal, Proceedings of the National Academy of Sciences. The scientists completed the patients blood analysis in just 10 days using a new method were all the genes in the genome could be studied at the same time and discovered a mutation on a gene that coded for a gut disease - congenital chloride diarrhea. He was not able to absorb water or electrolytes through his gastrointestinal tract. The major clinical symptom is continual watery diarrhea which causes dehydration and other metabolic disorders. Untreated patients can develop kidney disease, inflammatory bowel disease and even fertility problems. The gene can be traced back to the invertebrate ancestors.

 FDA grants EUA to IV antiviral peramivir for certain cases of H1N1 flu

On October 23, to a request from the CDC, the US FDA issued an emergency use authorization (EUA) for the investigational antiviral drug peramivir, a neuraminidase inhibitor. It specified that peramivir may be given intravenously (IV) to certain adult and pediatric hospitalized patients with confirmed or suspected H1N1 influenza. The FDA has specified three criteria to determine suitability of IV peramivir viz. patient's condition not responding to antiviral therapy, either oral or inhaled; if drug delivery by a route other than IV route is not likely to be dependable or feasible; and when IV therapy, for adult patients only, is indicated because of other circumstances, according to clinical judgment. At least one of these 3 criteria must be fulfilled before IV peramivir may be administered under the EUA. The standard adult dose of peramivir is 600 mg IV once daily for 5 to 10 days.

EU approves Ilaris, a drug to Treat a Rare but potentially fatal inflammatory disease 

The European Union has given its nod to Ilaris to treat patients who suffer from CAPS or cryopyrin-associated periodic syndrome. Ilaris is manufactured by Novartis. Studies have shown Ilaris to produce rapid and sustained remission of symptoms in most children and adults with this disease. CAPS is a rare but potentially fatal inflammatory disease, which presents as incapacitating tiredness, fever, rash, headaches, joint pain and chronic anemia from infancy. Complications of the disease include hearing loss and visual and intellectual impairment to renal failure. Ilaris or canakinumab is a fully human monoclonal antibody.

Green diet during pregnancy shields babies from diabetes

Swedish scientists say pregnant women who consume vegetables (except root vegetables) everyday seem to give birth to kids who are lesser chances of developing type 1 diabetes. The study was published in Paediatric Diabetes. In type 1 diabetes, some cells in pancreas begin to produce less insulin, leading to insulin deficiency. Those kids at risk of developing type 1 diabetes had antibodies in their blood that attack these insulin-producing cells. The study analyzed blood samples of 6000 children, aged 5 years. Three percent of these children had either elevated levels of these antibodies or fully developed type-1 diabetes. The risk was twice more common in children whose moms rarely ate vegetables during pregnancy.

Excess body fat puts you at risk of DVT

According to a study published in the journal Circulation pear shaped women, who carry excess weight on the hips and thighs, and apple-shaped men who carry it on the waist, face the hazard of blood clots. The 10 year study followed more than 50,000 men and women to observe how many suffered a deep vein thrombosis (DVT) or a pulmonary embolism (PE) and reported 641 such cases. Researchers noted a pattern between body shape and clot risk after ruling out known risk factors like smoking, diabetes and cholesterol, independent of body weight alone. Pear shaped women with big hips and thighs were at higher risk of dangerous clots, even if they had an ideal body weight. According to Dr Marianne Tang Severinsen, all types of obesity increase the risk for venous thromboembolism, but the location of body fat also plays some unknown role.

Cautious eating and regular exercise can delay diabetes

A period of watchful eating and regular exercise can delay diabetes for a decade, says a study in the Lancet. Researchers followed up 3,000 overweight individuals who had participated in a 3-year diabetes prevention program. The participants were assigned to three groups, either to a diet and exercise program, oral metformin or a placebo. In seven years rate of diabetes fell in both the drug and placebo groups, however, individuals who had begun with a diet and exercise regime reaped the most benefits; their risk reduced by one-third compared to placebo group.


Clinical recommendations for practice, and their accompanying level of evidence rating, are as follows: Children should be evaluated for severity of dehydration as determined by physical examination findings (level of evidence, C). For mild to moderate dehydration in children, ORT is the preferred treatment (level of evidence, C). Electrolyte disturbances in children resulting from gastroenteritis may be corrected and prevented by use of an appropriate ORT solution (level of evidence, C). For children with dehydration, a single dose of ondansetron may facilitate ORT by reducing the incidence and frequency of vomiting, thereby avoiding the need for intravenous fluid therapy (level of evidence, B). ( Sent by Dr G M Singh)

This is Life

1. If you do little things well, you'll do big ones better. 
2. You won't get a second chance to make the first impression
3. If you are not failing you're not taking enough risks.
4. All progress has resulted from unpopular decisions. 
5. Change your thoughts and you change your world

Thought of the Day

People who are unable to motivate themselves must be content with mediocrity, no matter how impressive their other talents. Andrew Carnegie

Conference Calendar

1. IOACON 2009, Nov 24-29, KIIT University Campus, Bhubaneshwar nkp@ioacon2009.net
2. 61st Annual Conf Cardiological Society of India; Dec 3-6, 09; Kochi, Kerala; csi@cal2.vsnl.net.in

Funny one-liners

? Multitasking means screwing up several things at once.
? Hard work has a future payoff. Laziness pays off now.
? Give a man a fish and he will eat for a day. Teach him how to fish, and he will sit in a boat and drink beer all day.
? Friends may come and go, but enemies tend to accumulate.
? Never test the depth of the water with both feet.

Advertising in emedinews

emedinews is a new venture of IJCP Group and is the first daily emedical newspaper of the country. One can advertise with a singe insertion or with 30 insertions in a month. For details contact drkk@ijcp.com.

emedinews: revisiting 2009
IJCP Group is organizing emedinews: Revisiting 2009, a day-long medical conference on 10th January, 2010 at Maulana Azad Auditorium. It will be attended by over 1000 doctors. Topics will be top happenings in the year 2009. There will be no registration fee. Advanced registration required.  Top experts will deliver lectures. It will be followed with lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com

Letters to the editor

1. Let science first manufacture blood ,then arises the need of anything else. [Dr. Vinita]
2. Many of us, who are regular user of net and have some love left for academics eagerly await for e-Medinews like so many wait for TV serial at prime time. I want to add A few things regarding Important India statistics:  Many things depend upon economic factors. Recently World Human Development Report was released. An important indices is Human development Index (HDI); consisting of Life expectancy+Education( 1/3 enrollment/3 Adult literacy rate)+ per capita income divided by 3. Ideal score is 1. 0 to 0.499 is low, 0.5 to 0.799 is medium and 8 to 1 is high. As per that report in relation to India HDI- 2009 we are at poor 134 out of 182 countries sandwiched between Laos and solomon Islands.Even Bangladesh,  Sri Lanka, Nepal, and Myanmar are higher in step ladder and of course china. 77.6% of indian live on less than or up to 2 $ per day as their total income. A committee appointed by our revered Prime Minister and headed by Arjun Sen Gupta (TOI Report) about 77% of Indian survive on < Rs 20/ day for their total nutritional needs. Medical fraternity has to sit and seriously think of some ways to dispense a pathy vis-a-vis cost for those 77% of people who really need our expertise say cheap innovative methods like Home made stents, Cheaper surgery packages as being envisaged in Rural Health Mission and an empathy towards economically deprived people. [Dr S Chugh] 

3. This is regarding rise in Diptheria reported from muzafa nagar. Possible causes: 1. DPT vaccine not taken, The vaccine was ineffective due to exposure to heat or freezing
regards. Dr Anil Varshney

4. Nice Educative interesting presentation with a SMILE thrown in. Dr. H.L. Kapoor   

5.   I am Dr. K.M. Abul Hasan the Editor of NHB Express, official Newspaper of Nursing Home Board of IMA Tamil Nadu. I am really amazed to see your efforts to give lot of news daily, keep it up. Please send across any news item relevant to Hospital management, Biomedical waste, Man power shortage, etc. 

Site to watch

16 Girls + 1 Bicycle = Awesome. It is an excellent 4 minutes video. To enjoy more, watch it on full screen.http://www.flixxy.com/chinese-bicycle-acrobatics.htm ( sent by Dr Ravi Tuli)


A waiter suddenly became ill and was rushed to the hospital emergency room. He was lying on the operation table in great pain when he saw an intern walk by.Doctor, you have to help me, the waiter pleaded. Sorry, the intern said. This is not my table.

Bedside Formula to know

If in peripheral smear, platelets are present in clumps the count is more than 1 lac.



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