eMedinewS
6th October 2014, Monday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

World's First Baby Born After Uterine Transplant

A 36-year-old woman who received a uterus transplant from a live donor in 2013 gave birth to a healthy baby boy in September 2014, as per a report published in The Lancet by Mats Brännström, MD, Professor of Obstetrics and Gynecology at the University of Gothenburg, Sweden.

The patient was born with congenital absence of the uterus, known as Rokitansky syndrome. She underwent a uterus transplant from a postmenopausal woman aged 61 years, who had previously born 2 children.

About Uterine Transplant
Successful revascularization of transplanted uteri has been reported in 70 percent of cases in nonhuman primates (Macaque monkey) and 80 percent of cases in dogs. Normal mating and pregnancy have also been described after successful uterine transplantation in these animal models. There have been only a few reports of human uterine transplantation. Donors were deceased or from mothers to daughters..
In one case, uterine necrosis developed 99 days after the transplant and required hysterectomy. In another case, a woman with Rokitansky syndrome who was the recipient of a cadaveric donor transplant had menarche 20 days after transplant surgery and 12 menstrual cycles -Fertil Steril. 2013;99(2):470.

There is one report of an intrauterine pregnancy documented by serum hCG and ultrasound evidence of a gestational sac, but the pregnancy was not viable. -Fertil Steril. 2013;100(5):1358 The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation was developed to guide clinicians and researchers in ethically carrying out uterine transplant -Transpl Int. 2012 Apr;25(4):439-47.

The present Case
The recipient had intact ovaries and was able to produce eggs, which were then fertilized using IVF" before the transplant. They had 11 cryo-preserved embryos.

After transplant the patient experienced her first menstruation 43 days later. She continued to menstruate regularly every 26 to 36 days (median 32 days).

The patient became pregnant 1 year after the transplantation, after her first single embryo transfer.

During pregnancy, the mother took "triple immunosuppression medications (tacrolimus, azathioprine, and corticosteroids). To avoid long-term damage from those medications they'll need to either try for another pregnancy or have the womb removed.

She experienced 3 episodes of mild rejection, 1 of which happened during pregnancy, and corticosteroid treatment reversed them all.

Blood flows of the uterine arteries and umbilical cord were within normal limits throughout the pregnancy, as were fetal growth parameters.

At 31 weeks and 5 days gestation, the patient was admitted to the hospital with preeclampsia.

The baby's heart rate was abnormal and the baby boy was delivered by cesarean section 16 hours later. The baby's birthweight was normal for gestational age (1775 g) and his Apgar scores were 9, 9, and 10.

The mother was discharged from the hospital on day 3, and the baby was discharged in good health on day 10.

Origin of the concept
The idea to transplant a uterus first came from a patient, Brannstrom remembers. Recalling a conversation that took place back in 1998, the doctor said he had removed a woman's uterus as part of treating her for cervical cancer. Brannstrom then explained to the woman that she still had ovaries, egg cells and hormones — but wouldn't be able to have a baby.

"But isn't it possible to transplant a uterus?" the woman asked. "My mother or older sister could give me a uterus."

"This patient is mad," Brannstrom recalls thinking. But he talked about the prospect with other doctors, and another transplant breakthrough the same year — that of a human hand — made him start working toward making the idea into a reality. -Sources various article on the net

Future
Dr Brannstrom and his team are working with another eight couples with a similar need. The results of those pregnancy attempts will give a better picture of whether this technique can be used more widely.

News Around The Globe

  • A novel, comprehensive lifestyle intervention, aimed at "tweaking" the network of imbalances in the brain responsible for cognitive decline, appears to be beneficial in reversing memory loss related to Alzheimer's disease (AD), suggests preliminary research. The study is published online in the journal Aging.
  • A 2010 rule originally designed to diagnose gout in the primary care population has now been shown to perform equally well in a secondary care population of patients with monoarthritis. The rule is used when joint fluid analysis is not an option, and it has been shown to improve the predictive value of the clinical diagnosis of gout under these circumstances. The findings are published in an article online in Rheumatology.
  • Primary surgery and primary radiotherapy yield similar outcomes in cervical esophageal cancer, suggests a new study published online in JAMA Otolaryngology Head and Neck Surgery. There was no significant difference for local failure-free survival, distant failure-free survival, regional failure-free survival, and overall survival between the two groups, and primary radiotherapy was recommended with respect to organ preservation.
  • Individual cognitive-behavioral therapy (CBT) may be more effective than pharmacotherapy for treating adult patients with social anxiety disorder, and appears to have fewer side effects and may be more cost-effective over the long-term, suggests new research published online in Lancet Psychiatry.
  • Long-acting reversible contraceptives should be the first-line option for sexually active teenagers, according to a new guideline on teenage pregnancy prevention from the American Academy of Pediatrics (AAP). The updated policy statement and accompanying technical report were published online September 29 in Pediatrics.

NATIONAL NEWS

Polio Scare

The polio scare is back with doctors in Hardoi suspecting that an 18-month-old boy could be suffering from it. On Saturday experts of the National Polio Surveillance Project (NPSP) sent samples of the boy's stool for tests after he showed signs of acute flaccid paralysis (AFP), which could be a symptom of polio. The samples were sent to the WHO-recognised polio testing lab at the Sanjay Gandhi Post Graduate Institute of Medical Sciences here after separate teams from UP government and NPSP met the boy's parents and doctors treating him in Hardoi, near Lucknow. The tests, which would take about two weeks, would confirm if there is any presence of polio-causing entero-virus. -TOI

Dr KK Spiritual Blog

Why do we burn camphor in any pooja?

No Aarti is performed without camphor. Camphor when lit burns itself out completely without leaving a trace of it.

Camphor represents our inherent tendencies or vasanas. When lit by the fire of knowledge about the self, the vasanas burn themselves out completely, not leaving a trace of ego.

Ego is responsible for a sense of individuality that keeps us separate from the Lord or consciousness.

In addition, camphor when burns, emits a pleasant perfume. This signifies that as we burn our ego we can only spread love and nothing else.

Inspirational Story

Nothing is Random

Nothing is random, nor will anything ever be, whether a long string of perfectly blue days that begin and end in golden dimness, the most seemingly chaotic political acts, the rise of a great city, the crystalline structure of a gem that has never seen the light, the distributions of fortune, what time the milkman gets up, the position of the electron, or the occurrence of one astonishingly frigid winter after another.

Even electrons, supposedly the paragons of unpredictability, are tame and obsequious little creatures that rush around at the speed of light, going precisely where they are supposed to go. They make faint whistling sounds that when apprehended in varying combinations are as pleasant as the wind flying through a forest, and they do exactly as they are told. Of this, one can be certain.

And yet there is a wonderful anarchy, in that the milkman chooses when to arise, the rat picks the tunnel into which he will dive when the subway comes rushing down the track from Borough Hall, and the snowflake will fall as it will. How can this be? If nothing is random, and everything is predetermined, how can there be free will? The answer to that is simple.

Nothing is predetermined; it is determined, or was determined, or will be determined. No matter, it all happened at once, in less than an instant, and time was invented because we cannot comprehend in one glance the enormous and detailed canvas that we have been given - so we track it, in linear fashion, piece by piece. Time, however, can be easily overcome; not by chasing light, but by standing back far enough to see it all at once.

The universe is still and complete. Everything that ever was, is; everything that ever will be, is - and so on, in all possible combinations. Though in perceiving it we imagine that it is in motion, and unfinished, it is quite finished and quite astonishingly beautiful.

In the end, or rather, as things really are, any event, no matter how small, is intimately and sensibly tied to all others. All rivers run full to the sea; those who are apart are brought together; the lost ones are redeemed; the dead come back to life; the perfectly blue days that have begun and ended in golden dimness continue, immobile and accessible; and, when all is perceived in such a way as to obviate time, justice becomes apparent not as something that will be, but as something that is.

Rabies News (Dr A K Gupta)

Can "major surgery" be conducted after the dog bite?

There is no contraindication for any surgery along with antirabies vaccination and a full course of antirabies immunization should be given, irrespective of the surgery or other procedures.

Cardiology eMedinewS

  • An intravenous bolus of andexanet alfa immediately and significantly reversed the anticoagulation of apixaban in the ANNEXA-A study, as per findings from the phase 3 study designed to test an antidote to the factor Xa inhibitor class of novel anticoagulants. The results of ANNEXA-A are slated for presentation on November 17, 2014 during the American Heart Association 2014 Scientific Sessions.
  • For low-risk patients with symptomatic paroxysmal or persistent atrial fibrillation not currently taking antiarrhythmic medication, a high-dose fish oil does not appear to prevent the recurrence of AF, nor does it reduce inflammation or oxidative stress, suggests a multicenter study published in the October 7 issue of the Journal of the American College of Cardiology.

Pediatrics eMedinewS

  • Children and adults with autism spectrum disorder (ASD) show a significantly increased risk for hip fracture as compared to those without autism, suggested a study presented at American Society for Bone and Mineral Research (ASBMR) 2014.
  • New research supports early initiation of highly active antiretroviral therapy (HAART) in children with HIV infection. The report is published online in Pediatrics.

Quote of the Day

A blind person asked Swami Vivekanand: “Can there be anything worse than losing eyesight?” He replied: “Yes, losing your vision.”

IMA NEWS

Stop corruption or other nations could turn away Indian doctors: Fiona Godlee

The British Medical Journal sparked off a furious debate in India's medical fraternity when it published an article in May titled 'Corruption ruins the doctor-patient relationship in India', followed by an editorial written by eminent gastro-intestinal surgeon Dr Samiran Nundy. Fiona Godlee, the journal's editor-in chief, spoke to Rema Nagarajan about their decision to launch a campaign against corruption in healthcare, starting with India

Why did you take up the issue of corruption in healthcare now? We are a medical journal but we are not a journal for doctors in the sense that we speak out for health, in the best interest of the patients and the public. And sometimes, doctors' interests are not aligned with patient interests. When Dr David Berger, who is a member of our editorial board, wrote of his experience of working in India we thought this is something we should pursue. We have a long-standing relationship with medicine in India. Also, we have high readership here and the likelihood of being able to make a difference seemed higher.

Is the problem particularly bad in India?
It is a global problem and not just limited to India. The problem in India is that there is a system where there is corruption in governance generally, and corruption in medicine is just one part. That created an additional challenge for doctors who might think we have got to behave this way in order to just exist. What we will be saying is that the doctors and their professional bodies need to stand up and say that this is not okay. The private medical schools burgeoning in India need to be properly overseen so that the new generation of Indian doctors has proper ethical and moral codes. And as said in the editorial, if that doesn't happen, other countries where Indian doctors want to go and practise can say we won't accept you unless your bodies make the necessary changes.

Why is healthcare more prone to corruption?
You have enormous pressure from the commercial world to give certain treatment. By pressure, I mean financial incentives. We know that doctors are paid to give certain treatment, paid to enter patients into certain trials, paid to speak and promote some treatments. A combination of the need for additional income, opportunity and inadequate oversight and regulation makes it possible for them to do this. And I think there is a tolerance of it within India because of the extent of corruption across the whole country in every field.

Does the system favour corrupt doctors?
A lot of it is to do with status. Doctors who get paid for providing treatments or speaking on platforms or giving advice to drug companies or helping them market drugs or devices end up getting the status. They end up being flown around the country to give talks and they are then seen as the experts in the field. So, the whole system rewards that kind of corrupt behaviour and what the BMJ (British Medical Journal) wants to do is to try and create a counter-balance to that. We want to find ways to reward people who keep themselves free of conflict of interest, to push the idea that they should be given positions of prominence in medicine.

So you believe the buck stops at the doctor?
Yes. Your professional duty is to avoid those conflicts and be very conscious of them. And also to declare these conflicts so that your patients and colleagues know that certain payments have been made and then that begins to shine a light — like the Sunshine Act in the US that's making public a database of payments to individual doctors. It ought to become a part of their duty, a part of their annual appraisal. I think very often even colleagues would be surprised by what their fellow doctors are being paid. And certainly patients should know this so they can question the treatments being given.

What happens when people declare conflict of interest and then go on to sit in decision making positions?
They ought not to be on those or boards of organizations or guideline panels. There is also the argument that declaration of conflict of interest has just normalized it. So, people say I have no conflict because I take money from everyone and that just makes everyone laugh and then they carry on and give that talk. But this isn't always how medicine was.

According to the health minister, three new Bills to regulate health research and facilitate clinical practices in areas like surrogacy and new systems of medicine have been finalised. These are: The Biomedical and Health Research Regulation Bill, 2014 – to regulate ethical aspects of health research; The Assisted Reproductive Technology (Regulation) Bill, 2014 which will oversee medical, legal and social issues linked to surrogacy; and, The Recognition of New Systems of Medicine Bill, 2014 to determine the distinctive characteristics of alternative systems of medicine.

Wellness Blog

Seven Behaviors Cut Heart Deaths Seven

heart-healthy behaviors can reduce the risk of death from cardiovascular disease.

In a prospective study, by Enrique Artero, PhD, of the University of South Carolina, and colleagues and published in the October issue of the Mayo Clinic Proceedings, those who met 3-4 of the American Heart Association's 'Simple Seven' heart-health criteria had a 55% lower risk of cardiovascular mortality than those who met no more than two of those practices over 11 years.

Four core behaviors

  1. No smoking
  2. Normal body mass index
  3. Engaging in physical activity
  4. Eating healthfully

Three parameters

  1. Cholesterol lower than 200 mg/dL
  2. Blood pressure lower than 120/80 mm Hg
  3. Not having diabetes

ePress Release

Avoid visiting a hospital for a formality

Avoid visiting a hospital for a formality. Do not visit health care settings unless necessary. Do not use hospitals as a hotel to stay. Healthcare-associated infections are common. The hospital environment is not safe and can cause infections in the visitors. About 5% of people visiting hospitals may end up with infections, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

Healthcare-associated infections are infections that occur in a non-hospitalized patient with extensive healthcare contact. Some people are more at risk and they are those who have had intravenous therapy, wound care, or intravenous chemotherapy within the prior 30 days or have attended a hospital or hemodialysis clinic within the prior 30 days or are resident in a nursing home or other long-term care facility or were admitted in an acute care hospital for two or more days within the preceding 90 days.

The US Center for Disease Control (CDC) estimates that healthcare-associated infections account for about 1.7 million infections and 99,000 associated deaths each year in American hospitals. Of these, 32 percent are urinary tract infections, 22 percent are surgical site infections, 15 percent are pneumonias (lung infections) and 14 percent are bloodstream infections.

He said that as compared to healthcare-associated infections, hospital-acquired (or nosocomial) infections are infections that occur 48 hours or more after admission and did not appear to be incubating at the time of admission. The risk of acquiring this infection is 5% for a visitor visiting a hospital environment.

Following are some guidelines for preventing hospital-acquired infections.

eMedi Quiz

All of the following drugs act on cell membrane, except:

1. Nystatin.
2. Griseofulvin.
3. Amphotericin B
4. Polymyxin B.

Yesterday’s Mind Teaser: A 64-year-old old hypertensive obese female was undergoing surgery for fracture femur under general anesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Answer for yesterday’s Mind Teaser: 2.Hypovolemia.

Correct answers received from: DR JAINENDRA UPADHYAY, Dr.K.V.Sarma, Najib Khatee,
Answer for 4th October Mind Teaser: 3.Pain sensation on the contralateral side.

Correct answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen

Send your answer to email

eMedinewS Humor

This lady was talking in to an envelope. I asked her what she was doing, she said ‘sending voice mail’.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at SGSS Vidyalaya, Chirag Dehli on 22nd September 2014

mela_brochure
Self-Assessment-Quiz

 

expert_choice
Zee News – Health Wealth Shows

Alcohol

press release

FDA panel recommends first drug for HIV prevention

video of day video of day

Other Blogs

Video Library

MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation: A 45–year–old came with first onset diabetes.
Dr Bad: Start pioglitazone.
Dr Good: Start metformin.
Lesson: Metformin is considered the first choice for oral treatment of type 2 diabetes in the absence of contraindications (Diabetes Care 2009;32:193).

 

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

Twitter of the Day

Dr KK Aggarwal: Diabetic drug metformin may have anti cancer effects
Dr Deepak Chopra: There is always a danger when someone holding personal beliefs dresses them up with science

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Can doctor–couple dispense drugs without license?

Dr P Kamalasanan, a private medical practitioner from Kollam in Kerala was punished last month for dispensing drugs without a license. Additional Sessions Judge, Kollam on August 7 sentenced Dr Kamalasanan of one–day "imprisonment" and also fined him Rs 1.20 lakh on the charges of running a pharmacy without a license from his clinic. Appearing before the court, Dr Kamalasanan reportedly served the sentence by remaining there till the rising of the court.

View1: Under the rules, only a single–doctor clinic is exempted from the process of obtaining a license before dispensing drugs and any clinic run with the help of more than one doctor falls under the category of hospital, for which it is mandatory to obtain a license to dispense medicines.

View 2: The Drugs & Cosmetics Act, 1940 & Rules, is very clear that private clinics, the place where professional activities of registered medical practitioners take place, are exempted from the drug licence. Private clinics are fully protected from harassment of drug controllers.

Clause–5 of Schedule–K of the Drugs and Cosmetics Rules allows a single doctor to stock, prescribe or dispense medicines without having a license; it does mandate a clinic run by more than one doctor to obtain a license.

A doctor cannot dispense medicines on the prescription given by another doctor; neither can a visiting doctor dispense medicines from that clinic. Item 5. Drugs supplied by a registered medical practitioner to his own patient or any drug specified in Schedule C supplied by a registered medical practitioner at the request of another such practitioner if it is specially prepared with reference to the condition and for the use of an individual patient provided the registered medical practitioner is not (a) keeping an open shop or (b) selling across the counter or (c) engaged in the importation, manufacture, distribution or sale of drugs in India to a degree which render him liable to the provisions of Chapter IV of the Act and the rules there under." (Excerpts from a news in IMT)

  • Do not visit the hospital environment unless essential.
  • Do not use hospital toilets as far as possible.
  • Do not sleep in the hospital corridors unless necessary.
  • Avoid crowded OPDs in a hospital. If there is no other alternative, use masks.
  • Do not use hospital premises as a hotel.
  • Avoid unnecessary stay in the hospital.
  • Choose day care procedures as much as possible.
medicolegal update
  1. Dear Sir, emedinews is very informative newspaper. Regards: Dr Shreya

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