emedinews
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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

 

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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 …

31st May 2012, Thursday

Osteoporosis (Part 2)

Excerpts from a programme moderated by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India

Panelists: Dr. Rajesh Malhotra, Professor, Dept. of Orthopedics, AIIMS; Dr. Ambrish Mithal, Chairman, Dept. of Oncology and Metabolic Disorders, Medanta Medicity and Dr. Alka Kriplani, Professor, Dept. of Obstetrics and Gynecology, AIIMS.

  1. Exercise: Walking, jogging, cycling are all good exercises. Indian traditional dances like Kathak, Bharatnatyam and Odissi are all good exercises. The traditional skiing, rope skiing are also good exercises.
  2. Three yoga exercises namely, Surya Namaskar, Tadasana and Vrakshasana, which involve standing on your toes or weight bearing on your toes, are good for osteoporosis.
  3. A low BMI is a risk factor for osteoporosis and high BMI is a risk factor for osteoarthritis. Therefore, a balance has to be maintained.
  4. In India, menopause occurs earlier and in the west, menopause occurs late. Therefore, in the west it is said that bone mineral density (BMD) should be checked at age 65 and in India it should be checked at age 50.
  5. It is recommended that everybody in India should take adequate vitamin D.
  6. Indians are deficient in vitamin D and iron. Therefore, everybody should take one tablet of iron (60 mg) per week and one sachet of vitamin D every month. The whole family should take these. Apart from that everybody should take a tablet of albendazole 400 mg to deworm every 3 months.
  7. There is a calcium paradox. People think that taking calcium can cause renal stones but this is not correct. In fact low calcium is responsible for formation of renal stones.
  8. Calcium citrate is better than calcium carbonate when there is history of renal stones in the family.
  9. To prevent postmenopausal osteoporosis, prevention must start as early as school going age.
  10. The mid-day meal should have enough calcium and vitamin D. The mid-day meal must be fortified with vitamin D. It must have calcium rich and iron rich diet.
  11. Government is thinking of fortifying foods with both iron and vitamin D.
  12. If a female is postmenopausal, she needs an osteoporosis evaluation. In premenopausal women, in presence of risk factors, osteoporosis evaluation should be done; more the risk factors, more the chances of developing osteoporosis in future.
  13. The risk factors for osteoporosis include advancing age, past history of fractures, history of steroids intake, weight less than 40 kg, family history of hip fracture, intake of alcohol, smoking, 1.5” loss in the height in the past and height less than 145 cm.
  14. The markers of osteoporosis can be checked by x-ray, CT scan and ultrasound but bone densitometry (BMD) is the best. It should be done on hips, radius and spine.
  15. In patients of osteoporosis, lifestyle should involve regular exercise, no smoking, no alcohol intake and taking precautions to prevent falls.
  16. Soft drinks, if taken more than once-daily, can accelerate the osteoporosis process.
  17. One must do 30 minutes of resistance weight-bearing exercise three days in a week.
  18. In BMD test, one standard deviation of 't' value can double the risk of fracture.
  19. Spine BMD may not be reliable in the elderly because of presence of osteophytes and calcification.
  20. If you are taking calcium carbonate, it should be taken with meals but if you are taking calcium citrate, it should be taken on a fasting state.
  21. Oral vitamin D rarely causes toxicity.

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

Doctors are a soft target in Satyamev Jayate

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

World No Tobacco Day – HCFI campaign

Heart Care Foundation on India (HCFI) educate the public about the dangers of smoking.

 
Dr K K Aggarwal
 
    National News

Driving to Thailand from India could be a reality by 2016

NAY PYI DAW: As India sought to expedite its infrastructural projects in Myanmar, PM Manmohan Singh and President U Thein Sein for the first time set a deadline, 2016, for trilateral road connectivity which will make it possible to drive right up to Thailand from India via Myanmar. After the PM's "restricted" meeting with Thein Sein, who received Singh at his resplendent palace wearing the traditional Burmese gaung baung head gear, foreign secretary Ranjan Mathai announced that "efforts would be made to establish seamless trilateral connectivity by 2016".(Source: TOI, May 29, 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

(Contributed by Dr Monica and Brahm Vasudev)

Short course of drug fails in vent-associated pneumonia

A short course of high-dose doripenem (Doribax) for ventilator-associated pneumonia did more harm than good, and a clinical trial testing the approach was stopped early, a researcher said reported at the annual meeting of the American Thoracic Society. (Source: Medpage Today)

For comments and archives

Chronic use of NSAIDs may decrease the risk for skin cancer

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) may decrease the risk for developing squamous cell carcinoma (SCC) or malignant melanoma (MM), according to a new population-based, case-control study published online May 29 in Cancer. (Source: Medscape)

For comments and archives

HRT for primary prevention of chronic conditions reviewed

Menopausal hormone therapy (HRT) reduced risk of fractures but increased risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence, according to a systematic review of articles published after 2002. Whereas estrogen alone decreased the risk for breast cancer, estrogen plus progestin increased risk for probable dementia and breast cancer. This new review, published online May 29 in the Annals of Internal Medicine, will be used to update the US Preventive Services Task Force recommendations. (Source: Medscape)

For comments and archives

Breast screening in 40s proposed based on risk

Breast cancer screening starting at age 40 may have an acceptable balance of risks and benefits for women with extremely dense breasts or a family history of the disease, two studies suggested. (Source: Medpage Today)

For comments and archives

Office desk can jeopardise your health

Office desks put workers at risk of serious illness because they are crawling with germs, experts have warned in a new study. Workplace kitchens and break rooms are also at risk, particularly sinks where staff clean their cups and plates and also microwave door handles. In a US study, hygienists collected nearly 5,000 swabs from buildings including law firms, insurance offices, call centres and healthcare companies. It found office workers unwittingly spread bugs around on a daily basis. "No one can avoid it entirely," the Daily Express quoted Richard Millard, of Kimberley-Clark Professional which carried out the research, as saying. But he added that rigorous hygiene habits and cleaning could reduce office rates of colds, flu and stomach illness by up to 80 per cent. "This demonstrates that contamination can be spread throughout the workplace when office workers heat up lunch, make coffee or simply type on their keyboards," Study consultant Charles Gerba, professor of microbiology at the University of Arizona, said. (Source: TOI, May 28, 2012)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: Low BP not good in later life

@DeepakChopra: We are fictional characters in a fictional enterprise

 
    Spiritual Update

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

Science behind Regrets

In one of the US based study, dying people were asked about their regrets, if any. The top five regrets were:

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the disadvantages of minimally invasive surgery?

Minimally invasive surgery is more risky for patients who are obese or who have had previous "open" surgery in the upper or lower part of their belly or other medical problems. Surgeons need special training and lots of practice before they can perform minimally invasive surgery; therefore, not all doctors are qualified to do these types of procedures. Also, not all hospitals have the special equipment necessary to do these kinds of surgeries.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Virus ‘Inactivated’ Plasma

Description

  • Plasma treated with methylene blue/ ultraviolet light inactivation to reduce the risk of HIV, hepatitis B and hepatitis C.
  • The cost of this product is considerably higher than conventional fresh frozen plasma.

Infection risk

  • The ‘inactivation’ of other viruses, such as hepatitis A and human parvovirus B19 is less effective

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

A Dancer Story

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 used 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.'

Nothing is impossible in this world. If you have the will to win, you can achieve anything.

For comments and archives

 
    Cardiology eMedinewS

ACE inhibitor Plus ARB does not prevent diabetic nephropathy Read More

Usual tools underestimate CVD risk in RA Read More

Prediction and prevention of type 1 diabetes Read More

 
    Pediatric eMedinewS

Delhi Budget: Lifeline For 10,000 Poor HIV Patients Read More

Overweight children at higher risk for liver cancer as adults Read More

Antibiotics often given in ED to children with sore throat Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A prediabetic with mild hypertension came with mild cognitive dysfunction.
Dr Bad: It’s unrelated to diabetes.
Dr Good: There is an association between the two.
Lesson: Cognitive dysfunction in type 2 diabetes is related to the cumulative effects of long–term exposure to hypertension, even in prediabetic stage. Patients with poor cognition had a 14–18 mmHg higher systolic blood pressure than patients with good cognition (Diabetes Metab Res Rev 2009;25(7):657–64).

For comments and archives

Make Sure

Situation: A 50–year–old patient, highly stressed at work and a hypertensive as well, complained of acid eructations and indigestion
Reaction: Oh my God! He has hyperacidity. Put him on magaldrate
Lesson: Make sure that patients who are suffering from stress, diabetes and/or hypertension and who have hyperacidity/GERD/peptic ulcers are put on magaldrate, which is safe and effective as an antacid.

For comments and archives

 
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    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

What is the solution to the long waiting period at AIIMS for treatment and diagnostic procedures as reported by the TOI recently?

Ans.

  1. You are obviously referring to the following report dated 9 October 2011.
  2. Some salient points in this report are as follows: a. It could take as long as two years to get
    a date for a simple MRI scan.
    b. The waiting period for a CAT scan is more than four months while it may be up to two years in case of an MRI.
    c. Patients requiring a total hip replacement or a total knee replacement may have to wait for no less than 5 months.
    d. A waiting list - ranging from 2 months to a year or more - is the case with almost every department in the institute, according to an internal analysis.
    e. According to a study, 453 faculty members and 1,200 resident doctors handled 15.28 lakh outpatients, 84,000 admissions and 78,000 surgeries, teaching 1,661 students, investigating 381 projects and publishing 1,424 scholarly papers in 2009-10 alone.
    f. According to Dr Shakti Kumar Gupta, head of the department of hospital administration, who carried out the study, "The waiting time for procedures can range from months to years right now. This is mainly because the work load is tremendous for doctors - nearly 10,000 patients a day in OPDs alone while we can handle a maximum of 6,000,".
    g. Those who need a surgery to remove a malignant tumour have to wait six months while those suffering a benign tumour will get a date of surgery 24 months later. A gynecological procedure for cancers will have to wait 6 months and double that time for benign conditions. A corneal transplant has a waiting period of half a year while a retinal surgery could take at least four months. For a modified radical mastectomy (removal of the breast affected with cancer), patients might have to wait 24 months. For correction of a stricture urethra - narrowing of a section of the urethra that causes blocked or reduced flow of urine - the department of urology has no date before 6-8 months.
    h. According to Dr. Shakti Gupta, a big factor behind the backlog is the cost. A patient in the general ward has to pay only Rs 35 per day for the diet, medicines, surgery and consumables. In contrast, the cost borne by the AIIMS for patient care is as follows: Inpatient care………. Rs 2,100 a day ICU care…… Rs 6,900 per day Laparoscopic surgery…… Rs 50,000 Renal transplant …. Rs 2 lakh
  3. The news report is incomplete in the sense that the AIIMS spokesman, who is a professor of hospital administration, has refrained from giving any solution to the problem.
  4. In my opinion, the solution should be along the following lines:
    a. AIIMS and other government medical colleges should stop the practice of providing free treatment except to those who are too poor to pay. A system of user charges should be introduced. AIIMS had announced such a system about 3 years ago but the faculty and other doctors’ groups opposed it and the scheme had to be scrapped. In the circumstances, I have little sympathy for the doctors at AIIMS who are undoubtedly overworked. Being intelligent and hardworking does not mean lacking wisdom to appreciate the simple fact that those attending the AIIMS come in cars and everybody buys drinking water at Rs. 12 per bottle, medical treatment cannot come free. These doctors are assured of their monthly salary and status by virtue of being government servants in a premium hospital but they do not realise that their salary and patients’ treatment cost don’t pour from the heavens.
    b. Resident Doctors Associations and Medical Teachers Associations in government medical colleges should seriously deliberate upon the issue of user charges for those seeking medical services. There needs to be a consensus at least at the state level. The ultimate aim should be a national consensus. Such user charges need to be imposed in such a manner that the poor do not suffer and that no discretionary beneficiary powers are given to the politicians and bureaucrats in this regard. The implementation of such a policy will have the following benefits:
    i). Work load upon doctors will be reduced because the withdrawal of free treatment facility to those who can pay will induce the well to do to consider getting treatment at private hospitals. ii). More funds will be generated and be available for improving the working conditions in government medical college hospitals.
    iii). Better working conditions will reduce the frequent instances of strikes by doctors in medical colleges.
    c. A working paper on “The need and desirability of user charges in government medical college hospitals” should be prepared after appointing a working group and holding a conference etc. This can and should be done at the below-listed various levels simultaneously without waiting for the government to take the initiative:
    i) National hospital administration associations / Departments of hospital administration and public health in various medical colleges.
    ii) Institutes of management
    iii) IMA

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

One of the basic differences between GOD and humans is that, GOD gives and forgives and humans get, get and forget. Be thankful in life.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Procalcitonin helps to diagnose sepsis, to determine the risk of sepsis leading to septic shock and to distinguish bacterial from non bacterial infection.

 
    Mind Teaser

Read this…………………

What is not true for HNPCC?

a) It is the most common hereditary colorectal cancer syndrome in USA.
b) It is associated with MMR gene mutation.
c) It is associated with APC mutation.
d) It is associated with carcinoma colon and extraintestinal cancers.

Yesterday’s Mind Teaser: A male client’s left tibia was fractured in an automobile accident, and a cast is applied. To assess for damage to major blood vessels from the fracture tibia, the nurse in charge should monitor the client for:

a. Swelling of the left thigh
b. Increased skin temperature of the foot
c. Prolonged reperfusion of the toes after blanching
d. Increased blood pressure

Answer for Yesterday’s Mind Teaser: Prolonged reperfusion of the toes after blanching

Correct answers received from: Dr Prabha Sanghi, Dr. P. C. Das, Yogindra Vasavada, Shirish Singhal, Dr. B. B. Aggarwal, Dr. L. C. Dhoka, Raju Kuppusamy, Dr.Chandresh Jardosh, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, dr ajay Gandhi, Dr Avtar Krishan, Dr Gopal M Shinde, Anil Bairaria, Dr. Arvind khanijo

Answer for 29th May Mind Teaser: a. Accurate dose delivery

Correct answers received from:
Dr.shashi saini

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr Anupam Sethi Malhotra)

A Priest was being honored at his retirement dinner after 25 years in the parish. A leading local politician and member of the congregation were chosen to make the presentation and to give a little speech at the dinner.

However, he was delayed, so the Priest decided to say his own few words while they waited:

I got my first impression of the parish from the first confession I heard here. I thought I had been assigned to a terrible place. The very first person who entered my confessional told me he had stolen a television set and, when questioned by the police, was able to lie his way out of it. He had stolen money from his parents, embezzled from his employer, had an affair with his boss's wife, taken illegal drugs and gave VD to his sister. I was appalled. But as the days went on I learned that my people were not all like that and I had, indeed, come to a fine parish full of good and loving people.

Just as the Priest finished his talk, the politician arrived full of apologies at being late. He immediately began to make the presentation and gave his talk:

"I'll never forget the first day our parish Priest arrived", said the politician. "In fact, I had the honor of being the first person to go to him for confession."

Moral: Never, Never, Never Be Late

 
    Medicolegal Update

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

Instruments for shooting, stabbing, cutting are dangerous weapons

  • The doctor is not required to make speculation about weapon of offence in a MLC case.
  • According to the Section 324 of IPC, any instrument for shooting, stabbing, cutting or any instrument used as a weapon of offence likely to cause death or by means of fire or any heated substance or by means of poison or any corrosive substance or by means of any explosive or by means of any substance, which is deleterious to the human body to inhale, to swallow, or to receive into the blood or by means of any animal - are all considered as dangerous weapons.

The duty of the attending doctor is to record all the injuries, their dimensions as far as possible, and the body parts where the injuries are located the nature of injury, whether simple or grievous, caused by sharp/blunt object, age or duration of injury along with the vital parameters like blood pressure, pulse, respiration and the mental status of the patient. When an investigating officer comes to the hospital, he needs some specific answers for his legal investigation and to book a case under law of the land.

  • Are the injuries present self–inflicted or fabricated? If yes, please mention the forensic justification.
  • Is there any sign, symptom or smell of alcohol or any drug intoxication? If yes, please opine about his mental status due the influence of intoxication; also preserve a blood sample.
  • Please opine if the injured or intoxicated patient is fit to record his statement? If no, please give due reasons and an approximate time interval for medical evaluation for his/her fitness for statement.
  • Is the condition of patient is critical, severe or serious? If so, the dying declaration must be recorded by the attending doctor in the presence of one or two witnesses.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Smoking leads to cardiovascular ageing

Consuming tobacco can increase the cardiovascular age of a person which can be much higher than the biological age said Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India. He said that the cardio vascular ageing in chronic smokers can be 10 years more than the biological age and that cardiovascular age can be calculated by measuring the wall thickness of the carotid neck artery supplying blood to the brain.

Apart from that, one can also measure the endothelial functions of the brachial artery supplying blood to the hand. Cardiac age of a person is calculated by measuring the relaxation functions of the heart. With age the heart fails to relax properly.

This relaxation abnormality usually comes after the age of 60. If the same is seen at the age of 40, one knows what the biological age and cardiac age is.

The good news is that cardiovascular age of a person can be regressed by quitting smoking and tobacco with proper lifestyle including diet and exercise. Graying of the hairs may not be sufficient to know the age of a person. In today’s era, it is the cardiovascular age which is important.

 
    Readers Responses
  1. Dear Dr Aggarwal, Your comments on ‘Satyamev Jayate’ are true facts. What I feel that people like Aamir Khan are just trying to increase their personal clout by appearing in such programmes and it was very unfortunate that someone from our fraternity supported him, most of our Indian people are educated illiterates and programmes like this will further increase the trust deficit between doctors and patients. If Aamir Khan genuinely wants to help our country then he should come up with practical solutions to the problems he has highlighted, do something about them like Anna Hazare did, show some programmes against the blunders our government at centre is doing. To me it was just a TRP stunt by the channel airing that program and one should ask him how much money he made by appearing on this show, or is he doing this for free. Thanks, Dr Puneet Wadhwa.
 
    Forthcoming Events
Dr K K Aggarwal

4th Asia Pacific Vascular Intervention Course (APVIC-IV)

Date: June 8-10-2012

THE OBEROI, Dr. Zakir Hussain Marg, New Delhi
In association with 'International Society of Endovascular Specialists' 'Vascular Society of India' 'Society of Cardiovascular Angiography & Interventions'

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

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

 
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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