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  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

 
  Editorial …

7th January, 2011, Friday                                eMedinewS Presents Audio News of the Day

2nd eMedinewS – revisiting 2010 at http://www.docconnect.com on 9th January 2011

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Harvard Top 10 Health Stories of 2010 (Part II) (Harvard Health Letter)

  1. An anti–aging possibility: Researchers at the Harvard–affliliated Dana–Farber Cancer Institute reported results this year that kindled hopes for altering the fundamental biology of aging. Their experiment involved mice that had been genetically engineered so that an enzyme called telomerase that is known to be important in the aging of cells could be turned on and off. When the enzyme was turned off, the mice aged prematurely. When they reached the chronological equivalent of adolescence, they appeared to be biologically very old: their brains and other organs had shrunk and were starting to fail. Then the scientists turned on the enzyme. Promptly, the brain and other shrunken organs started to grow with new cells, and organ failure ceased. The animals recovered their sense of smell. You might say the mice became adolescents again. Of course, what works in mice doesn’t always work in humans. There are concerns that the activation of telomerase could cause cancer, although that didn’t occur in this particular experiment. And this is very much an experimental finding; at this point, all those products making anti–aging claims are way ahead of the game and not to be trusted. Still, along with other research, this study hints at a future when it might be possible to slow down biological aging and possibly prevent some of the diseases associated with it.
  2. CT scans for lung cancer screening: More urban Indians die from lung cancer than from any other type of cancer, yet there’s no accepted screening test for the disease. Study results reported this year may change that situation. The National Cancer Institute stopped the National Lung Screening Trial comparing CT scans to chest x–rays earlier than expected because the CT scans appeared to be so effective at reducing lung cancer deaths. The trial included 53,000 current and former heavy (30 pack years or more) smokers. Results released in October showed that over a five–year period, 354 of those screened with CT scans died from lung cancer (or about 1.4%) compared with 442 of those screened with chest x–rays (about 1.7%). Catching any cancer at an earlier, more treatable stage is an appealing idea, and especially lung cancer, because of its high mortality rate. But screening tests have become more controversial lately because of concerns that they lead to overdiagnosis and overtreatment. Almost one in every four people who were screened with CT scans in the National Lung Cancer Screening Trial had a false positive, the finding of an abnormality that turns out not to be cancer. There are also concerns about radiation exposure from CT scans and whether scans for lung cancer will add to that problem.
  3. New vitamin D guidelines: The Institute of Medicine issued new vitamin D guidelines. The Recommended Dietary Allowance is now 600 international units (IU) a day for people ages 1 to 70 and 800 IU a day for those 71 and older. The previous guidelines, set in 1997, recommended a daily intake of 200 IU through age 50, 400 IU between the ages of 51 and 70, and 600 IU for those 71 and older. The IOM panel also established a new safe upper limit of 4,000 IU a day, double the old limit of 2,000 IU. The new guidelines were criticized as being too conservative by many experts, who would have preferred an RDA closer to 1,000 IU a day and a blood level target of 30 ng/ml (75 nmol/l) for the vitamin, not the 20 ng/ml (50 nmol/l) set by the IOM panel. The difference of opinion stems, in part, from the fact that the IOM panel gave results from randomized clincial trials (RCTs) far more weight than results from other types of studies. As a result, the panel found evidence that vitamin D benefits bone and little else. If other kinds of studies are taken into account, a case can be made that blood levels of 30 ng/ml or even higher would result in optimal bone health and that the vitamin has a wide range of health benefits beyond bone, including protective effects against some cancers (especially colon cancer) and some autoimmune disorders. The debate about vitamin D is bound to continue. Soon after the IOM panel released its report, a different set of experts, the U.S. Preventive Services Task Force, came out with fall–prevention recommendations that include an endorsement of vitamin D.
  4. Alternatives to warfarin: The FDA approved one alternative to warfarin this year, a drug called dabigatran. Another alternative, rivaroxaban, seems to be waiting in the wings after largely favorable results were reported this year from trials testing the drug in patients with deep–vein thrombosis and atrial fibrillation. A third drug, apixaban, which is related to rivaroxaban, is also looking promising. Warfarin (Coumadin) has been the mainstay for preventing blood clots for decades, but it’s a tricky, high–maintenance drug that requires frequent blood tests to make sure the dose is producing the desired results: enough anti–coagulation to prevent blood clots but not so much as to cause bleeding. Warfarin also interacts with many foods and drugs. In contrast, these warfarin alternatives seem simple as pie: they can be given in fixed doses, don’t require blood monitoring, and don’t seem to pose interteaction problems. Cost, however, will be a barrier. Drug companies set high prices for new brand–name drugs. Warfarin, widely available as a generic, is relatively cheap. And there’s always the possibility of unforeseen side effects once the new drugs are more widely used. Still, millions of people stand to benefit if good alternatives to difficult–to–use warfarin pan out.
  5. Concerns about bisphosphonates: Bisphosphonates (Alendronate and risedronate) are prescribed to prevent and treat osteoporosis (makes fractures more likely). Most postmenopausal women take bisphosphonates. They are safe and effective and cut the risk of fractures by 50%. In October, the FDA issued a new warning about bisphosphonates increasing the risk of a rare kind of thighbone (femur) fracture. Two years ago, the agency issued a different warning about the bone drugs causing bone, joint, and muscle pain. There have also been reports about a small percentage of bisphosphonate users developing osteonecrosis in their jawbones, although most of those cases have occurred in cancer patients who have received high intravenous doses (bisphosphonates can relieve pain and strengthen bone if cancer has spread to the bone). Some doctors are now recommending "drug holidays" for people who take bisphosphontes for osteoporosis for extended periods. Other bone–building drugs, such as denosumab, which was approved by the FDA this year, may get a closer look because of concerns about the side effects of bisphosphonates. And perhaps the non pharmacological ways to strengthen bones will gain some adherents. Pill–free bone builders include a regimen of regular weight–bearing exercise and adequte intake of calicum and vitamin D.
Dr KK Aggarwal
Editor in Chief
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  Live Web Cast from DocConnect.com
DocConnect.com
 
  eMedinewS Audio PostCard

  MEDICON 2010, 26 December
53rd Annual Delhi State Medical Conference

Dr IPS Kochar speaks on "Growth Hormone and its uses in Clinical Practice"

Audio PostCard
 
  SMS of the Day

(By Dr GM Singh)

Chlorhexidine skin antisepsis has been proven to provide better skin antisepsis than other antiseptic agents such as povidone–iodine solutions.

 
    Photo Feature (from the HCFI Photo Gallery)

 MEDICON 2010

Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal presenting a memento to Dr BB Rewari, Nationalo Programme Officer (ART), NACO at the Annual Delhi State Medical Conference 2010

 
Dr K K Aggarwal
 
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

eMedinewS Revisiting 2010 to have a live webcast

eMedinewS Revisiting 2010 will have a live webcast on www.docconnect.com on 9th January, 2010. Those who will not be able to attend the conference can watch the proceedings live on the website. The webcast was a great success last year. The conference will have eminent speakers. Look out for the program details in the forthcoming editions of eMedinewS. We expect 1000 doctors to attend conference live and 1000 doctors to see it through the website.

"2nd eMedinewS revisiting 2010" is now DMC accredited 9 CME hours

1479/DMC/16C/2/2010                                                              6th January. 2011

Dr KK Aggarwal
Sr Consultant Physicians & Cardiologist
Daryacha, 39
Hauz Khas Village
New Delhi 110016

Sub: Accreditation of CME – "2nd eMedinewS Revisiting 2010" on 9th January, 2011 at MAMC, Bahadur Shah Zafar Marg, New Delhi

The Delhi Medical Council approves accreditation for the above–mentioned CME programme for 9 Hrs.

Participants are required to maintain a record of CME credit Hrs. in their CME Credit Passbooks which is available in the office of Delhi Medical Council and is also available on our website at www.delhimedicalcouncil.nic.in in a downloadable form.

Note: Please send the course content immediately after conclusion of the CME Programme

Dr Girish Tyagi
Secretary
DMC

Integrate medical knowledge: Kalam

JAIPUR: Calling for integration of medical systems, former President APJ Abdul Kalam on Monday stressed that it was time to unite the best of both Indian and American systems as they had failed to deliver in isolation. Kalam was delivering the keynote address at the inauguration of the three–day summit of Association of American Physicians of Indian origin (AAPI) in association with the Rajasthan government at the Birla auditorium. "Medicine is inherently borderless as it attends to human pain wherever it is felt. The experience gained in different settings are to be integrated." (Source: The Hindu, Jan 4, 2011)

Health ministry, MCI lock horns over notification for common med exam

NEW DELHI: The union health ministry and Medical Council of India (MCI) are now on a collision course over the proposed common entrance test for all MBBS and PG medicine courses in the country. Two days after TOI reported on MCI’s notification making the national eligibility–cum–entrance test (NEET) mandatory for admissions to all medical courses, the health ministry has directed MCI to withdraw the notification ‘with immediate effect’. But MCI has decided not to recall the notification saying it was issued based on the apex court’s nod on December 14 and the affidavit filed by the union health ministry in support of CET. MCI published the notification on December 21 amending regulations on graduate and post–graduate medical education, and introducing NEET as the sole admission requirement. Besides prescribing a certain cut–off percentage of NEET marks for various sections of candidates, the notification said it would also consider marks in mathematics for MBBS admissions. Though the notification claimed that it had the previous approval of the Centre, the health ministry in a letter to the MCI chairman dated January 3 said there was "no previous approval of the central government for amending the regulations." It had even termed the notification "invalid". It had directed the board of members to withdraw the notification forthwith. (Source: The Times of India, Jan 05, 2011)

Health Ministry has the last word on CET

NEW DELHI: Ending the confusion over common entrance tests for graduate and postgraduate courses in medicine, the Centre on Wednesday said the Health Ministry would have the last word in the matter and since the two notifications issued by the Medical Council of India had been declared "invalid" by the Ministry, these should be considered withdrawn. Rejecting the contention that the MCI Board of Governors was "overstepping" its brief, sources in the Ministry told The Hindu that it was probably "innocence and ignorance of the official processes" on the part of the Council that made it issue the notifications and refuse to withdraw them. In case the Centre at any point in future decided to hold such a test, the notifications could be revived, the sources explained. Source: The Hindu, 6 Jan, 2011)

 
    International News

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

Resveratrol may improve belly fat’s metabolic behavior

Fat can not only be unsightly, but if it’s sitting on your belly, may also contribute to overproduction of signaling hormones called adipokines, which are linked to metabolic changes that can worsen health. New research from Aarhus University has found that abdominal adipose tissue extracted from overweight adults, and then exposed to resveratrol, exhibited reduced adipokine production. According to these authors, "small interfering molecules such as resveratrol are, in this matter, hypothesized to possess beneficial effects and might improve the metabolic profile in human obesity." The scientists obtained the abdominal adipose tissue via liposuction from seven women and one man, ages 43–55, who had body mass indexes categorized as overweight. All subjects were Caucasian, healthy and not on any medication that could confound the results. Because previous studies in rodents have shown that calorie restriction reduces production of adipokines by activating an enzyme called Sirtuin 1, the scientists had hypothesized that resveratrol may act similarly. Resveratrol is well–known as a potent Sirtuin 1 activator. This most recent in vitro study, published in International Journal of Obesity, suggests that regular dietary intake of resveratrol may guard against the metabolic changes that occur when there is excess fat on the body – as it has with rodents and monkeys.

(Dr Monica and Brahm Vasudev)

New indication for Gardasil vaccine:FDA

Gardasil (human papillomavirus (HPV) quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant) is now approved by the FDA for the prevention of anal cancer caused by HPV types 16 and 18, and for the prevention of anal intraepithelial neoplasia (AIN) grades 1, 2, and 3 (anal dysplasias and precancerous lesions) caused by HPV types 6, 11, 16, and 18, in persons aged 9 to 26 years.

Certain injectable dexamethasone vials recalled due to particulate–matter contamination

The US FDA announced that American Regent is conducting a nationwide voluntary recall of certain lots of dexamethasone sodium phosphate injectionable products packaged in 30–mL (4 mg/mL) multidose vials. This recall was done as some vials of these lots either contain particulates or have the potential to form particulates before their respective expiration dates.

Patients who conceived during the first year post bariatric surgery had comparable short-term perinatal outcome: Study

A retrospective study that compared pregnancy outcome between patients who conceived during or after the first year following bariatric surgery observed that patients who conceived during the first postoperative year had comparable short–term perinatal outcome compared with patients who conceived after the first postoperative year. The findings are reported in the 2011 Jan issue of journal American Journal of Obstetrics and Gynecology.

Patients with concomitant IBD, PSC at risk for early colon cancer

Dr. Erin Withers Thackeray and coresearchers report in the January issue of Clinical Gastroenterology and Hepatology that patients who have both inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) often develop colon cancer soon after they are found to have the two coexisting diseases. According to the authors, the findings of their study support the current guideline of annual colonoscopies in this patient group and also emphasizes the need for counseling and education in this population, she added. Annual colonoscopies should begin when PSC is diagnosed in an IBD patient, or when IBD is diagnosed in a PSC patient

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

A couple has been trying to conceive for past 15 years. The lady is 38 years old and her menstrual cycles are now irregular and scanty. How can we help them?

At the age of 38 with irregular and scanty cycles, reduced ovarian reserve would be the first differential diagnosis. Basic infertility tests like semen analysis should have been done and ensured to be normal. A girl is born to release a fixed number of eggs by the time she reaches menopause which is about, 50 years of age, there are no viable eggs. About 15 years prior to menopause, the lady goes into a transition stage where her ovarian capacity falls drastically. The capacity of women to get pregnant is highest when she is less than 30 years of age. After 35 years, the fall in infertility is exponential. Certain tests like ultrasound, antral follicle count and blood tests like Follicle–stimulating Hormone and anti–Mullerian hormone will help in the diagnosis. High dose gonadotropin treatment may help this woman. Otherwise ovum donation is a viable option.

For queries contact: banerjee.kaberi@gmail.com

 
    Nutrition Update

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

Vitamin A supplementation to prevent disease and death in children aged 6 months to 5 years

Vitamin A deficiency (VAD) is a major public health problem in low and middle income countries affecting 190 million children under 5 years of age. VAD predisposes children to increased risk of a range of problems that can even lead to death, including respiratory diseases, diarrhea, measles and vision problems.

In a metanalysis published in the Cochrane database which included 43 randomised trials representing 215,633 children, showed that giving vitamin A capsules to children aged 6 months to 5 years can reduce death and some diseases. The results of 17 of the studies were summarized and indicate that vitamin A reduces the overall risk of death by 24%. Death due to measles, respiratory infections or meningitis was not specifically reduced, but vitamin A can reduce new occurrences of diarrhea and measles. When people take very large doses of vitamin A, they may be more likely to vomit within two days after taking it.

 
    Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

FORMAT FOR MEDICAL EXAMINATION OF DRUNK PERSON

Ref No……… Date……………Time…………… Name ………………Age …………… S/o, W/o,D/o ……………… Residence………………………… Brought By …………….. I am submitting and consenting for medical examination to………………. THE MEDICAL OFFICER……………………………………………………………………HOSPITAL

  • If the person is injured please provide the appropriate treatment and record the injuries in medico legal report.
  • If the apparatus is available please conduct breath analysis for alcohol
  • Please draw 10 ml of blood and 10 mg of sodium fluoride should be added in blood as preservative in a screw capped glass tube. The sample should be sealed and labeled with details of person
  • The saline swab/plain water swab not spirit swab should be used for wiping the area of skin from where the blood will be drawn.
  • Clothing’s and any other relevant samples should be preserved

The person is required to be examined and observed for smell of alcohol

  1. Mouth…………… Smell of alcohol from breath,
  2. State of clothing: Normal/Soiled/Torn
  3. Speech: Thick/Slurred/Over precise
  4. Muscular Co–ordination like finger to nose test is …… Positive or negative,
  5. Picking pencil from floor ……………positive or negative,
  6. Eye: Conjunctiva – Normal/Congested; Pupils – Normal/Contracted or dilated in size; Reaction to light – Normal/Sluggish/Absent
  7. Reflex: Present/Sluggish/Absent
  8. Knee reflex: Yes/No
  9. Orientation of time, place: Yes/No …………………………

Has the person consumed alcohol or not? If yes, on the basis of overall examination the doctor has to opine that,

  1. He/she can/cannot take care of himself including driving a car/vehicle due to alcohol consumption
  2. He is likely to prove public nuisance, crime or road traffic accident. due to alcohol consumption
  3. He is not likely to prove public nuisance, if kept at large due to alcohol consumption
  4. He is drunk and is unable to work or listen command and required hospitalization for medical care

SIGNATURE……………                                   NAME OF DOCTOR …………………

 
    Women’s Health: Preventing Top 10 Threats (Mayo Clinic)

Alzheimer’s disease

There’s no proven way to prevent Alzheimer's disease, but consider taking these steps:
  • Take care of your heart. High blood pressure, heart disease, stroke, diabetes and high cholesterol may increase the risk of developing Alzheimer’s.
  • Avoid head injuries. There appears to be a link between head injury and future risk of Alzheimer’s.
  • Maintain a healthy weight.
  • Include physical activity in your daily routine.
  • Avoid tobacco.
  • If you choose to drink alcohol, do so only in moderation.
  • Stay socially active.
  • Maintain mental fitness. Practice mental exercises, and take steps to learn new things.
 
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. I outsource samples to larger laboratories and give the test reports to the patients on my own letterhead. Sometimes the patients want me to provide the original report from the laboratories concerned but the latter do not want me to do so. Please let me know the legal implications.

A.

  • If you are a doctor and collect samples and give reports on your own letterhead without clearly stating that you are merely a collecting agent for the specified laboratory, giving out openly its name and contact details etc., you are apparently holding out that the test has been carried out directly or indirectly by you and, thereby, you assume the role of service provider to a consumer of services. The patient will be legally entitled to sue you for any perceived deficiency in service. He will also be entitled to sue the laboratory concerned.
  • If the laboratories concerned do not want you to give their details to the patients/consumers, it amounts to lack of transparency and deficiency in service. The patient has full right to know who carried out the tests and in what manner.
  • If you do not have a qualification in Pathology, you would be further compounding your fault.

In my opinion, your actions are likely to be held violative of the Consumer Protection Act, 1986, and the Code of Medical Ethics Regulations, 2002.

 
    Medilaw – Medicolegal Judgement

(Dr KK Aggarwal)

Can DMC take action some one not registered with DMC? (Part II)

HIGH COURT OF DELHI AT NEW DELHI: Subject: Jurisdiction in Disciplinary Issue against a Doctor: C.W.P. NO. 4414 OF 2003: Date of decision: 26.07.2004: DR. YASH NIGAM … PETITIONER vs DELHI MEDICAL COUNCIL RESPONDENT: MR. JUSTICE SANJAY KISHAN KAUL (Oral):

13. The aforesaid does not imply that there is no authority to deal with the matter of such misconduct or disciplinary issue in case a doctor operates in Delhi and is not registered with DMC. If such a doctor is registered with any other State Medical Council, then the complaint is liable to be referred to such State Medical Council where the doctor is registered. This may be done directly or through MCI. However, it is not necessary to deal further in this issue in view of the fact that the Hon'ble Supreme Court is ceased with the issue of appropriate directions and this is one of the issues to be considered by the Hon’ble Supreme Court in WP (C) No.317/2000 titled ‘Malay Ganguly v. Medical Council of India & Ors.’.

14. In the present case, the petitioner applied for registration with U.P. State Medical Council on 16.06.2003. However, the petitioner claims not to have received any response to the same as yet. It may be noted that this attempt of the petitioner to register himself with U.P. State Medical Council has arisen after the present complaint has been dealt with.

15. It is the contention of learned counsel for the petitioner that the petitioner should be either subject to jurisdiction of U.P. State Medical Council or MCI. A query was posed to learned counsel for the petitioner that when the petitioner was not registered or had not even applied with U.P. State Medical Council when the present complaint arose, how could the said Medical Council have jurisdiction in respect of this complaint. On this query being posed, learned counsel for the petitioner fairly concedes that in such a case, MCI can look into the complaint.

16. The petitioner is registered with MCI and, thus, there is no difficulty in MCI examining the complaint against the petitioner, especially since the petitioner was not registered with the State Medical Council as on the date when the complaint arose or the operation was performed.

17. Learned counsel for MCI has pointed out that by subsequent Regulations notified on 26.05.2004, provision has been made for appeal from the order of the State Medical Council to MCI. However, IMC Act also contains a provision under Section 24(2) for appeal to the Central Government from an order of MCI. As to whether there would be a second appeal in matters where the disciplinary authority is the State Medical Council is not for this Court to determine at this stage of time. Learned counsel for MCI states that possibly, the Hon’ble Supreme Court may be looking into this matter. This is so since in the present case the petitioner admits to the jurisdiction of MCI and, in fact, really cannot have any dispute about the said jurisdiction. Learned counsel further states that MCI is willing to look into the complaint against the petitioner through its disciplinary body de hors the impugned order dated 30.07.2003.

18. I am, thus, of the considered view that since the petitioner was not registered with DMC, DMC could not have proceeded against the petitioner and the complaint made against the petitioner was liable to be referred to MCI for necessary disciplinary action, if any. The impugned order dated 30.07.2003 is accordingly quashed and DMC is directed to forward papers to MCI to examine the complaint against the petitioner and proceed in accordance with law.

19. One other incidental issue, which has cropped up, is as to what would be the position of doctors, who may be predominantly practicing in Delhi, but may be registered with other State Medical Council. As noticed here–in–above, really speaking, this issue is also before the Hon’ble Supreme Court. The observations have been made by the Hon’ble Supreme Court in the Order dated 05.09.2003 in Malay Ganguly’s case (supra) in the following terms:– " Other question which requires consideration is if a medical practitioner is registered in one State and practise in some other State which State Medical Council can take appropriate action for negligence committed by him/her."

20. Be that as it may, in case the respondent is of the view that the petitioner is predominantly practicing in Delhi and is bound to be registered in Delhi, it is always open for the respondent to proceed in accordance with law in respect of the same for securing registration in Delhi. This would suffice in the present case since no order has been passed by the respondent in this behalf so as to call for any adjudication by this Court.

21. The writ petition is allowed in the aforesaid terms leaving the parties to bear their own costs. July 26, 2004: SANJAY KISHAN KAUL, J

 
    Rabies Update

Dr AK Gupta, APCRI, Author of "RABIES – the worst death"

Rabies and dog bites statistics in India

1. Can rabies be transmitted to doctor/assistants conducting postmortem of a person died of rabies?

Rabies cannot be transmitted to doctors/assistants conducting postmortem of a person died of rabies. This is because the virus is dead in a dead person within about 20–30 minutes in tropical conditions.

2. What are the factors responsible for rabies transmission in man from rabid animals?

Factors responsible for rabies transmission in man from rabid animals are:

  • Quantum of saliva and dose of virus and strain
  • The severity and site of bites; the actual distance that the virus has to travel from the site of inoculation to the CNS. Mortality is highest from bites on the face.
  • The extent of wounds
  • Nature of wound care
  • Delay or incorrect vaccine treatment and injection of vaccine in gluteal region
  • Non use of RIG (rabies immunoglobulin)
 
    Ethical earning

What is reimbursable to a doctor?

One can charge separately for anesthesia, anesthetist, operation theatre charges, surgical appliances, medicine and drugs apart from surgeons fees.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Prostate specific antigen (PSA)

  • Bacterial prostatitis may increase PSA levels, but they generally return to baseline 6 to 8 weeks after symptoms resolve.
  • Asymptomatic prostatic inflammation can also elevate PSA levels, but this diagnosis is made on biopsy and so cannot generally be used to defer screening tests.
 
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    Medi Finance Update

(By CA Arun Kishore, Arun Kishore & Co., Chartered Accountants)

Q. To what extent can a doctor deposit an amount to PPF?

A. Upto Rs. 70,000 in a financial year.

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
Indication
DCI Approval Date
Pramipexole dihydrochloride monohydrate ER Tablet 0.375/0.75/1.5/3/4.5 mg
For the treatment of the sign and symptoms of idiopathic Parkinson’s disease
13/3/2010
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Acute periorbital infections

In a retrospective cohort study of otherwise healthy children who had an orbital abscess, proptosis, pain with external ocular movement, and ophthalmoplegia were associated with the presence of an orbital abscess, although 51% of patients who had an abscess did not have these findings.

(Ref: Rudloe, TF, Harper, MB, Prabhu, SP, et al. Acute periorbital infections: who needs emergent imaging? Pediatrics 2010;125:e719.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim needed chemotherapy.
Dr. Bad: Get admitted for 24 hours.
Dr. Good: Take it has day care.
Lesson: Admission limit of 24 hours is not applicable for chemotherapy, radiotherapy etc.

Make Sure

Situation: A patient died after receiving 30 ml IV potassium chloride (KCl) bolus.
Reaction: Oh my God! Why was KCL given as bolus?
Lesson: Make sure that IV KCL is not given @ > 10 mEq per hour.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Only One Move

A 10–year–old boy decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training the master had taught him only one move. "Sensei,"(Teacher in Japanese) the boy finally said, "Shouldn’t I be learning more moves?" "This is the only move you know, but this is the only move you’ll ever need to know," the sensei replied. Not quite understanding, but believing in his teacher, the boy kept training.

Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match. Still amazed by his success, the boy was now in the finals.

This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a time–out. He was about to stop the match when the sensei intervened. "No," the sensei insisted, "Let him continue." Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion. On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind. "Sensei, how did I win the tournament with only one move?"

"You won for two reasons," the sensei answered. "First, you’ve almost mastered one of the most difficult throws in all of judo. And second, the only known defense for that move is for your opponent to grab your left arm." The boy’s biggest weakness had become his biggest strength. Sometimes we feel that we have certain weaknesses and we blame God, the circumstances or ourselves for it but we never know that our weaknesses can become our strengths one day.

Each of us is special and important, so never think you have any weakness, never think of pride or pain, just live your life to its fullest and extract the best out of it!"

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Mind Teaser

Read this…………………

What word, when written in capital letters, is the same forwards, backwards and upsidedown?

Yesterday’s Mind Teaser: What two words, when combined, hold the most letters?
Answer for yesterday’s Mind Teaser:
Post Office

Correct answers received from: Dr Avdhesh Shukla, Dr Manjesha, Dr Anupam Sethi Malhotra

Answer for 5th January Mind Teaser: Turned inside out
Correct answers received from: Dr. Anupam Sethi Malhotra

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr G M Singh)

There was this man driving along in his car when he suddenly got a flat tire. When he pulled over he was at the fence of a mental hospital. When he got out of the car one of the patients came to the fence and asked "Can I help you?" And the man said "No, I need to figure out how to make it home with only 2 lugs on this wheel." The patient asked again "Are you sure you do not need any help?" And the man said "No." The man tried to figure it out when all of a sudden the patient said "If I were you I would take one lug off the other 3 wheels and put them on that wheel and you should be able to get home." The man asked "How did you think of that?" The patient replied "I am in here because I'm crazy not because I'm stupid."

 
    Readers Responses

For a very long time I was at loss of words to express my liking and thankfulness for such an informative, quality compact magzine, touching all streams of medicine (right from pathology to GIT, obs and gynae, and the lesser remembered juris too), touching and inspiring your heart and then then tickling it to laughter as well, not forgeting the vitamin "M" (medifinance and tax).
"INCREDIBLE"
"STUPENDOUS"
"MARVELLOUS"

Hats off for such a voluminous work with consistency and continuity: Dr. Anupam Sethi Malhotra

 
    Public Forum

(Press Release for use by the newspapers)

Smoking in pregnancy can harm the thyroid

Smoking while pregnant can damage thyroid functions of both the mother and the baby, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

A new British study has shown that cigarette smoke causes babies to be born smaller. It makes newborns more likely to die of sudden infant death syndrome, and also affects the rates of cleft lips, heart defects and other problems.

Now it has been shown that smoking can also affect the thyroid gland of both mothers and babies. The study demonstrated that cigarette smoking at different stages of pregnancy –– first trimester and the third trimester –– is associated with changes in the mothers' thyroid hormone levels.

Good thyroid function is the key to maintaining a pregnancy, and some pregnant women suffer from thyroid imbalances. This, in turn, affects metabolism and the risk of miscarriage, premature birth, low birth weight and impaired brain development.

Published in the Journal of Clinical Endocrinology & Metabolism, the study measured the thyroid hormone levels in the umbilical cords of babies born to smoking mothers and found that smoking–related changes in thyroid function also affected the newborn.

But among women who quit while pregnant, thyroid hormone levels were comparable to levels found in nonsmokers.

 
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 9th 2011.

The one–day conference will revisit and cover all the new advances in the year 2010. There will also be a webcast of the event. The eminent speakers will be Padma Bhushan Dr Naresh Trehan (Cardiac Surgery); Padma Shri Dr KK Aggarwal (Revisiting 2010); Dr Neelam Mohan (Liver Transplant); Dr N K Bhatia (Transfusion Medicine); Dr Ambrish Mithal (Diabetes); Dr Anoop Gupta (Male Infertility); Dr Kaberi Banerjee (Female Infertility) and many more.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

2nd eMedinewS Doctor of the Year Award

Dear Colleague, The Second eMedinews Doctor of the Year Award function will be held on 9th January, 2011 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2010, send his/her biodata: Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee.

IMSA Workshop on Rheumatoid Arthritis

Date: Sunday, January 16, 2011 ; Venue: Moolchand Medicity, New Delhi; Time: 10–12 Noon

Speakers:

  1. Understanding Biologics: Dr Rohini Handa, Former Head Rheumatology, AIIMS
  2. All what a practitioner should know about rheumatoid arthritis: Dr Harvinder S Luthra, Chief of Rheumatology, Mayo Clinic, Rochester USA

No fee. Register emedinews@gmail.com or sms 9899974439

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    Programe Details

eMedinewS revisting 2010, 9th January MAMC Dilli Gate 8AM-8 PM
Also live at www.docconnect.com, www.emedinews.in

TIME SPEAKER TOPIC Moderator Panelist  
8.00 – 8.30 AM Dr K K Aggarwal Revisiting the year 2010 Dr N P Singh Dr A K Kansal Dr D D Arora
8.30 – 9.00 AM Dr N Subramanium Male Incontinance – What's New      
9.00 – 9.30  AM  Dr S C Tewari Acute Kidney Injury Dr Ramesh Hotchandani Dr U C Bansal Dr Savita
9.30 – 9.45 AM Dr Awadesh Pandey Thyroid Scan Dr Ambrish Mithal Dr Sundeep Khandelwal Dr Manisha Kukreja
9.45 – 10.15 AM Dr Jamal A Khan Stem Cell Therapy Dr Vandana Chadha Dr Rajiv Garg Dr Vijay Grover
10.15 – 10.45 AM LIC India Life Insurance Schemes Mr Arun Kishore Mr Pranay Kumar Dr N K Gupta
10.45 – 11.15 AM  Dr N K Bhatia Newer Tests in Transfusion Medicine Dr B B Rewari Dr Prachi Garg  
11.15 – 11.45 AM Dr Praveen Chandra What was New in 2010 in Interventional Cardiology Dr M Khalilullah Dr G M Singh  
11.45 – 12.15 PM Central Bank of India Financial Health Mr Anil Wadhwa Mr Pranay Kumar Dr Bimla Kapoor
12.15 – 12.30 PM Dr Naresh Trehan What’s was New in Cardiac Surgery in 2010 Dr O P Yadava Dr Sanjay Sood Dr Vinay Sanghi
12.30 –  1.00 PM Dr Ajay Kriplani Newer Advances in Obesity Surgery Dr B M L Kapoor Dr Satish Mehta  
1.00 N – 1.30 PM Dr Kaberi Banerjee What’s New in IVF Dr Anoop Gupta Dr Archna Virmani Dr Shashi Bala
1.30 – 2.00 PM Dr Anupam Sibal What’s New in Paedatric Gastroenterology Dr Neelam Mohan Dr Pooja Garg  
2.00 – 2.30 PM Dr D M Mahajan Newer Advances in Dermatology Dr J S Pasricha Dr Rajesh Kumar  
2.30 – 3.00 PM Dr Anoop Gupta Male Infertility Dr Ajit Saxena Dr Uday Kakroo  
3.00 – 3.15 PM Dr Sheh Rawat What’s New in Radiation Oncology Dr P K Julka Dr Vishnu Singhal Dr Srikant Sharma
3.15 – 3.30 PM Dr Neelam Mohan Paedatric Liver  Update  Dr A S Soin Dr Sudesh Ratan Dr A K Duggal
3.30 – 3.45 PM Dr Rohini Handa What’s New in Rheumatology   Dr V K Arora  
3.45 – 4.00 PM Dr Ambrish Mithal Newer Treatments in Diabetes Dr H K Chopra Dr Pavan  Dr Vinay Sanghi
4.00 – 4.15 PM Dr Sanjay Chaudhary Whats new in Eye Care Dr A K Grover Dr Dinesh Negi  
4.15 – 4.30 PM Dr Anil Goyal Whats new in urology      
4.30 – 4.45 PM Dr Rajiv Khosla What’s New in Gastroenterology Dr Ajay Kumar Dr Kirti Jain  
4.45 – 5.00 PM Dr Praveen Bhatia e patient relationship      
5.00 – 8.00 PM Doctor of the Year Award, Cultural Hangama