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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

7th October 2012, Sunday

Meningitis Outbreak Spreads to 7 US States

In US Fungal meningitis outbreak has involved 45 people in seven states with five deaths as per CDC.

Fungal meningitis has been linked to three lots of a steroid, preservative-free methylprednisolone acetate, used to control back pain. The steroid was manufactured by the New England Compounding Center in Framingham, Mass., and the three lots have now been recalled. But as par CDC doctors should avoid all products made by the company.

The recalled lots of methylprednisolone acetate are: Lot #05212012@68, BUD 11/17/2012, Lot #06292012@26, BUD 12/26/2012 and Lot #08102012@51, BUD 2/6/2013. The steroid is used in epidural injections aimed at relieving back pain.

FDA investigators reported finding foreign matter in an unopened vial of the substance at the company's plant. Under the microscope that substance was found to be a fungus.

Symptoms of the fungal meningitis include fever, new or worsening headache, nausea, and new neurological deficit consistent with deep brain stroke. Some patients may have only mild symptoms.

Cerebrospinal fluid obtained from patients typically shows an elevated white cell count (with a predominance of neutrophils), low glucose, and elevated protein. The delay between the injection of the steroid and the appearance of symptoms has been between 1 and 4 weeks. The condition is not contagious, unlike viral or bacterial meningitis.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Levocarnitine Update

Carnitine in Cardiomyopathy

Facts

  • Deficiencies in thiamine, selenium, and L-carnitine have been reported to produce HF and replacement therapy results in improvement in cardiac function.
  • Carnitine deficiency impairs the oxidation of fatty acids, resulting in lipid accumulation in the myocyte cytoplasm. This problem is reversed with L-carnitine replacement.

How is dilated cardiomyopathy diagnosed?

A diagnosis of DCM requires evidence of dilatation and impaired contraction of the left ventricle or both ventricles (LV ejection fraction <40% or fractional shortening < 25%).

For Comments and archives…

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Do not give citalopram more than 40mg

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th Perfect Health Mela in November (1st to 11th)

Addressing a press conference to announce the dates for 19th MTNL perfect Health Mela, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that focus of the Mela this year will be “Prevention of Non-Communicable Diseases”.

 
Dr K K Aggarwal
    National News

Dr Dang’s Lab, New Delhi, is conducting an Interactive Symposium on “Atopic Allergies: The Way Forward”on Sunday the 7th October,2012 at 10.30 a.m. Venue: Gulmohar Hall, India Habitat Centre.

Average Indian’s lifespan set to rise over next 10 years

NEW DELHI: The lifespan of an average Indian will continue to increase over the next decade.
By 2016, an average Indian male and female will live till 68.8 and 71.1 years, respectively. This will increase by one more year for an average male by 2021 (69.8 years) and by 1.2 years for an average female (72.1), according to Union health ministry's life expectation (LE) at birth projection released last week. When compared to the LE estimates of 2008 — to be announced by the Registrar General of India (RGI) this week and reported by TOI on Tuesday — the lifespan of an average Indian male will increase by 5.2 years and that of a female by 4.6 years between 2008 and 2021. Interestingly, the gap of LE between a male and a female will start to diminish by then. While an average Indian woman lives 3.1 years longer than her male counterpart, the LE difference will come down to 2.5 years by 2021.

However, some things won't change between now and 2021. The life expectancy of an average Indian male will continue to be highest in Kerala. While the RGI's data shows it is presently 71.5 years for an average male in Kerala, the Union health ministry National Health Profile 2011 released last week says it will be 75.2 years in 2021. As far as females are concerned, Kerala once again will take the top spot in 2021 with an average woman living as long as 78.6 years then as compared to 76.9 in Kerala now. The five states with highest LE for an Indian male in RGI's 2008 data are Kerala, Jammu & Kashmir, Maharashtra, Himachal Pradesh, Punjab and West Bengal. This list by 2021 will see J&K and Himachal Pradesh disappear to make way for Gujarat and Haryana. As far as LE of a female is concerned, the new entrants in the top five lists in 2021 will be Karnataka and Gujarat in place of J&K and Himachal.

The phenomenon of females living longer than their male counterparts will continue till 2021.
However, the states which will see the highest difference between the LE of a female against that of an average Indian male will be Karnataka (4.5 years), Andhra Pradesh (3.9 years), Maharashtra and Odisha (3.8 years), Rajasthan (3.5 years), Kerala and Tamil Nadu (3.4 years), West Bengal and Punjab (3.3 years) and Gujarat (3). The difference, however, won't be much in a few states like Bihar (0.8 years), Assam (1.7 years) and Madhya Pradesh (1.3 years).

According to the World Health Organization's health statistics 2011, the average life expectancy at birth stood at 68 years in 2009 — an increase by two years since 2000. The health statistics 2011 had said that an average Indian (both sexes) lived eight years longer in 2009, compared to what he did two decades ago. However, it was still three years less than the global average LE. (Source: TOI, Oct 3, 2012)

For comments and archives

My Profession My Concern

Include this in your practice

Acyclovir suppression for neonatal herpes simplex virus: Start oral acyclovir suppressive therapy for six months immediately following parenteral acyclovir for neonatal herpes simplex virus (HSV) disease, including skin, eye, and mouth disease; central nervous system disease; and disseminated HSV disease.

(Ref: Kimberlin DW, Whitley RJ, Wan W, et al. Oral acyclovir suppression and neurodevelopment after neonatal herpes. N Engl J Med 2011;365:1284).

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

Bicuspid aortic valve is also associated with coarctation of the aorta. Lesions less commonly associated with bicuspid aortic valve include ventricular or atrial septal defect, hypoplastic left heart syndrome, patent ductus arteriosus, bicuspid pulmonic valve and Ebstein’s anomaly.

(Experts: Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Dental health in children improves with 'sense of coherence'

A new study is the first to show that an intervention designed to teach children to be confident in the face of challenges can have a positive effect on their oral and dental health. The study was published online September 27 in the Journal of Dental Research. (Source: Medscape)

For comments and archives

Elective breast surgery safe according to national database

An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) indicates that breast surgery is safe, with little risk for life threatening complications and mortality. Reduction mammoplasty, however, is associated with elevated rates of morbidity. (Source: Medscape)

For comments and archives

MRI helps identify men for active surveillance

Endorectal magnetic resonance imaging (MRI) can help predict pathological upgrading on a second (confirmatory) prostate biopsy in men with low-risk cancer being considered for active surveillance, according to a new study. The visibility of the tumor is key to confirming risk. The study appears in the November issue of the Journal of Urology. (Source: Medscape)

For comments and archives

Member of new antibiotic class treats staph skin infections

A phase 2 trial has found brilacidin, a new drug in a novel class of antibiotics, to be effective and safe for acute bacterial skin and skin structure infections (ABSSSI) caused by Staphylococcus aureus. Daniel Jorgensen, MD, MPH, MBA, an infectious disease physician and senior vice president and chief medical officer of PolyMedix in Radnor, Pennsylvania, reported the results in a poster session at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy. (Source: Medscape)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: I posted 14 photos on Facebook in the album "19th Perfect Health Mela in November" http://fb.me/15Js1IjmN

@DeepakChopra: The candidate who inspires hope, stability, compassion & trust & specific action steps to achieve greatness deserves to win

 
    Spiritual Update

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

Merits and demerits of focused living

In the epic Mahabharata, Yudhishthir symbolizes a person who has learnt the art of being in balance in loss and gain and the one who practices righteous living.

For comments and archives

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is the menopausal transition?

This term describes the time period that links the reproductive years (regular menstrual cycles, fully functioning ovaries, highest chance for pregnancy) to menopause (no menstrual cycles for 1 year, lower ovarian hormone production, average age approximately 51 years). During the menopause transition, the length of menstrual cycles often changes and women may skip their menstrual periods more often.

For comments and archives

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

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

Blood Donation - Gift of Liquid Love

Blood donors

  • There has been increasing change in donors being accepted from professional donors to the voluntary donors.
  • It is due to the increased awareness of the risk of transfusion transmitted diseases especially through that of the professional donors.

For comments and archives

 
    Liver Abscess Update

(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

How long should treatment (antibiotics/antiamebic) be continued?

  • Currently, 4-6 weeks of antimicrobial therapy is recommended for solitary lesions that have been adequately drained.
  • Multiple abscesses may require up to 12 weeks of therapy.
  • The clinical and radiographic progresses of the patients are also used to define duration of antimicrobial therapy.

For comments and archives

 
    An Inspirational Story

How rich are we?

One day a father and his rich family took his son on a trip to the country with the firm purpose to show him how poor people can be. They spent a day and a night on the farm of a very poor family. When they got back from their trip, the father asked his son, “How was the trip?” “Very good, Dad!” “Did you see how poor people can be?” the father asked. “Yeah!” “And what did you learn?”

The son answered, “I saw that we have a dog at home, and they have four. We have a pool that reaches to the middle of the garden; they have a creek that has no end. We have imported lamps in the garden; they have the stars. Our patio reaches to the front yard; they have a whole horizon.” When the little boy was finished, his father was speechless. His son added, “Thanks, Dad, for showing me how ‘poor’ we are!”

Isn’t it true that it all depends on the way you look at things? If you have love, friends, family, health, good humor and a positive attitude towards life — you’ve got everything! You can’t buy any of these things. You may have all the material possessions you can imagine, provisions for the future, etc.; but if you are poor of spirit, you have nothing!

- Author Unknown

For comments and archives

 
    Cardiology eMedinewS

Cardiac care 'implied' in diabetes guideline Read More

Anemia pre-cardiac surgery predicts bad outcome Read More

 
    Pediatric eMedinewS

Enhanced feeding of preemies may cause electrolyte disturbance, septicemia Read More

Rapid genome sequencing diagnoses rare diseases in NICU Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and stop low–dose aspirin.
Lesson: In dengue, low–dose aspirin should be stopped.

For comments and archives

Make Sure

Situation: A patient died after receiving 30 ml IV KCL bolus.
Reaction: Oh my God! Why was KCL given as bolus?
Lesson: Make sure that IV KCL is not given at a rate of more than 10 mEq per hour.

For comments and archives

 
    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

ImmunoCAP: Gold standard in In-vitro testing for allergy

Skin prick test (SPT) is cumbersome and requires a trained physician to perform the same. This brings out the importance of in vitro testing (blood testing) for patients. It is very handy for general physicians and all physicians who are not very well trained to perform skin prick tests. Since the discovery of IgE in 1967, RAST was developed by Pharmacia Diagnostics in year 1974.

ImmunoCAP is the fourth generation of same test by Phadia (erstwhile Pharmacia Diagnostics). The ImmunoCAP technology is considered to be Gold Standard, with which other in vitro tests (mostly ELISA) are compared.

  • ImmunoCAP measures specific IgE, which notifies type 1 hypersensitivity (IgE mediated allergies). ImmunoCAP works with FEA (Fluoro Enzyme Immunoassay) technology. It has 3-dimensional cellulose polymer, which has very large inner surface area, is porous and elastic i.e. it binds more than 150 times to low levels of IgE (mean serum concentration 0.00005 mg/ml) and therefore gives a quantitative result from 0.1 KU/l to 100 Ku/l. We can get a result further by dilution.
  • ImmunoCAP is totally safe and can be conducted even in pregnancy (as only a blood sample needs to be withdrawn).
  • It is standardized and reproducible. There is no patient or procedure variation. Also, there are no drug interactions as false-negative results occur in SPT in case of histamines. Corticosteroids and anti-psychotic drugs affect SPT, whereas there is no such effect in ImmunoCAP testing. It is not dependent on skin conditions and quantitative-decision points are possible.
  • Though many physicians are still performing SPTs, it is believed that SPTs offer more false-positive results and definitely there is no patient acceptance. If patient is given a choice, patient will choose one prick (ImmunoCAP in vitro testing) over many pricks in SPT (which at times extend to 20 and more).
  • ImmunoCAP technology is calibrated as per WHO standards and is US FDA approved. There are around 700 specific allergens on ImmunoCAP.
  • ImmunoCAP also has a screening tool called Phadiatop. For a cost conservative country like ours, Phadiatop is a wonderful test. It’s sensitivity and specificity is more than 90% compared to that of total IgE which is around 50% i.e. total IgE is not a recommended test at least for allergy, as it is raised in almost all infections including helminth infections and other conditions. Phadiatop is a single qualitative test and is composed of most common allergens. Once it is positive, we can go for panel based on symptoms. So, when a general physician is in doubt, first test to be done is screening test-Phadiatop.

Allergy is a fast growing disease. One out of 3 eczema cases is allergic, 4 to 7 cases of rhinitis out of 10 are allergic and 2 out of 3 patients with wheeze are allergic. But to find out which one and which allergen, testing is really important. Diagnose at early stage, avoid same and get rid of it.

 
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    Quote of the Day (Dr GM Singh)

“You can have everything you want in life, if you just help enough people get what they want in life.” Zig Ziglar

 
    Mind Teaser

Read this…………………

siinformationde

Yesterday’s Mind Teaser: Which of the following signs and symptoms would Nurse Maureen include in teaching plan as an early manifestation of laryngeal cancer?

a. Stomatitis
b. Airway obstruction
c. Hoarseness
d. Dysphagia

Answer for Yesterday’s Mind Teaser: c. Hoarseness

Correct answers received from: Dr PC Das, Dr Ajay Gandhi, Suresh Kumar Verma, Drjella, Dr (Maj. Gen.) Anil Bairaria, Dr K Raju, Dr Chandresh Jardosh, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Prabodh Kumar Gupta, Dr Thakor Hitendrsinh G, Dr U Gaur, Dr Avtar Krishan, Dr B K Agarwal.

Answer for 5th October Mind Teaser: D. Progression from restlessness to confusion and disorientation to lethargy
Correct answers received from: Dr Prabodh Kumar Gupta, Dr Thakor Hitendrsinh G, Dr U Gaur,
Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

 
   Laugh a While (Dr GM Singh)

A man who surrenders when he’s WRONG, is HONEST.
A man who surrenders when he’s NOT SURE, is WISE.
A man who surrenders when he's RIGHT, is a HUSBAND

 
    Medicolegal Update

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

How can the firearm discharge residue on hands of accused be collected by the doctor?

Nitrate and nitrite residue may be found on medical examination and can be recovered from the skin by occlusion in a layer of melted paraffin during medical examination. Another test for skin residue involving paraffin as the collecting medium is for metallic elements in trace amounts, which result from primer residue. The analyses are made with neutron activation by ballistic expert.

  • The test is known as the ‘dermal residue test’ or ‘paraffin glove test’. The important factor is to place the responsibility of interpretation of results in the hands of the forensic scientist, not the doctor
  • Atomic absorption and x–ray dispersive energy spectrometry methods are also useful in identifying and quantifying metallic residues from weapon firing.
  • Currently, a screening technique is used to check the hands, clothing and other objects where circumstances warrant the examination. The main element examined for is lead, which appears to originate chiefly from the primer composition
  • Swabs are taken from appropriate areas on small clean cotton cloth squares moistened with a few drops of 1% lead–free hydrochloric acid and air dried.
  • A few drops of reagent are applied to the swab area on the cloth which is again dried. If the lead is present it is indicated by the development of a characteristic purplish–blue color.
  • The interpretation of such results should be left to an experienced examiner as positive results do not necessarily prove the subject fired a gun nor a negative result wholly precludes the firing.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

B12 deficiency can present with recent memory loss

If you are forgetting things, get your vitamin B 12 levels done instead of worrying that you might be developing dementia, said Padma Shri and Dr C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

Animal products (meat and dairy products) provide the only dietary source of B12 (cobalamin) for humans. Strict vegans avoid all animal products, and are at risk of developing nutritional cobalamin deficiency.

The usual western diet contains 5 to 7 micrograms of cobalamin per day, while the minimum daily requirement is 6 to 9 micrograms per day. Total body stores of cobalamin range from 2 to 5 milligrams and one-half of which are in the liver. It takes years to develop vitamin B12 deficiency after absorption of dietary B12 ceases.

There is a link between infection with Helicobacter pylori (as seen in peptic ulcer) and low serum B12 levels. Mild and usually subclinical cobalamin deficiency can also occur in 24% of the elderly. Ten to 30 percent of patients taking metformin (diabetics, obesity and polycystic ovarian disease) have impaired cobalamin absorption and lower B12 levels, which can be reversed with supplemental oral calcium. Prolonged use of omeprazole (given for acidity) can result in cobalamin deficiency.

Women who are only moderate vegetarians may develop cobalamin deficiency during pregnancy and lactation; their infants may also be cobalamin deficient.

 
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  1. Dear Sir, we enjoy reading emedinews. Regards: Dr Shipra Chawla, Dr Vinod Chawla
 
    Forthcoming Events
Dr K K Aggarwal

19th MTNL Perfect Health Mela

Heart Care Foundation of India and Depts. of Health & Family Welfare, Govt. of Delhi in association with World Fellowship of Religions, NDMC, MCD are organizing 19th MTNL Perfect Health Mela at Constitution Club of India Rafi Marg, New Delhi from 7th-11th November 2012 (8am-8pm). The focus this year will be Prevention of Non Communicable Diseases.

 
    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)

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    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, Dr Usha K Baveja