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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 ...

6th November 2010, Saturday

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

Know the signs of stroke

Everyone should learn the following warning signs of stroke.

  • Weakness in an arm, hand, or leg
  • Numbness on one side of the body
  • Sudden dimness or loss of vision, particularly in one eye
  • Sudden difficulty speaking
  • Inability to understand what someone is saying
  • Dizziness or loss of balance
  • Sudden, lasting, excruciating headache

What to do when stroke happens

The National Stroke Association has devised the FAST checklist to help determine whether a person is having a stroke.

If the answer to any of the questions below is yes, there’s a high probability that the person is having a stroke.

  • Face: Ask the person to smile. Does one side of the face droop?
  • Arms: Ask the person to raise both arms. Does one arm drift downward?
  • Speech: Ask the person to repeat a simple sentence. Are the words slurred? Does he or she fail to repeat the sentence correctly?
  • Time: If the answer to any of these questions is yes, time is important. Get to the hospital fast. Brain cells are dying.

One of the main clot–dissolving drugs, recombinant tissue–plasminogen activator (tPA), must be given within three hours of the start of stroke symptoms, but earlier is better.

Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

"Happiness is not the absence of conflict, But the ability to cope with it."

    Photo Feature (from the HCFI Photo Gallery)


Eco–fest, an inter School Eco Club Festival in the 17th MTNL Perfect Health Mela saw a huge participation of School Participation.

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

Bio–tech gets nod for pre–medical entrance

The Union Health and Family Welfare Ministry has approved the proposal for inclusion of bio–technology as an eligible subject for the common pre–medical entrance test. The subject is expected to be included in the entrance examination from the next academic year. (Source: The Hindu)

On Nov 14, Delhi will turn blue for diabetes awareness

Joining the global movement aimed at creating awareness about diabetes, Delhi will be lit up in blue — universal symbol of diabetes is a blue circle — on the eve of World Diabetes Day on November 14. HEAL Foundation with support from Union ministry of health and family welfare is organizing Diabetes Blue Fortnight in which selected monuments, government buildings, malls, hospitals, etc, will be lit up in blue. This is a part of the global movement in which 660 monuments in nearly 72 countries have been lit so far. "It has been happening in western countries for nearly a decade now. This is the first time we have attempted something like this in India," said Dr Subhash Wangnoo, chairman of Diabetes Blue Fortnight and president of Delhi Diabetic Forum. (Source: The Times of India)

    International News

(Dr Monica and Brahm Vasudev)

Latuda approved for the treatment of schizophrenia

Latuda (lurasidone hydrochloride) for the treatment of adults with schizophrenia has been approved by the US FDA. Latuda is a once–daily, first–line atypical antipsychotic medication.

Concern over accelerated release of active ingredient in some fentanyl patches sparks recall

Actavis has voluntarily recalled (wholesale and retail levels only) 18 lots of Fentanyl Transdermal System 25–μg/hour C–II patches manufactured for Actavis by Corium International in the US. These fentanyl patches (Control/Lot# 30349) shipped to market that contained 1 patch that released its active ingredient faster than the approved specification in laboratory testing. The Fentanyl patches are indicated in unrelenting moderate–to–severe chronic pain that requires continuous, round–the–clock opioid administration for an extended period of time and cannot be managed by other medications viz. nonsteroidal analgesics, opioid combination products, or immediate–release opioids.

Extended release Gabapentin effective for hot flashes in postmenopausal women

The results of Breeze 2 study presented at the annual meeting of the North American Menopause Society point out that gabapentin–extended release 1,800 mg/day may be effective and well tolerated for the treatment of moderate to severe hot flashes in postmenopausal women. ER gabapentin releases over a period of 8 hours, potentially decreasing peak adverse events and allowing once–daily or twice–daily dosing.

Clinical variables may predict subarachnoid hemorrhage in patients with headache

A study published online in the BMJ reports that certain clinical characteristics can help to assess the risk of subarachnoid hemorrhage among neurologically normal adults with non traumatic acute headache. Data on around 2000 patients were analysed prospectively. A wide range of clinical variables were associated with subarachnoid hemorrhage, including 13 variables from the history and 3 from the physical examination. Seven factors were strongly and reliably associated with subarachnoid hemorrhage: arrival by ambulance, age 40 years or older, neck stiffness or pain, headache onset with exertion, vomiting, witnessed loss of consciousness, and elevated blood pressure. According to the researchers, patients with any one or more of the seven findings should be evaluated carefully for subarachnoid hemorrhage and undergo rapid and thorough investigation to exclude this potentially fatal condition. They formulated 3 clinical decision rules using these variables in different combinations. All 3 rules had 100% sensitivity, with specificity ranging from 28.4% to 38.8%.

DRE helps to diagnose dyssynergia

Digital rectal examination (DRE) had a highly positive predictive value for diagnosing dyssynergia in patients with chronic functional constipation, as per findings from a study in the November issue of Clinical Gastroenterology and Hepatology. In the study, patients who fulfilled Rome III criteria underwent both a DRE and anorectal manometry, with the latter considered the gold standard for the diagnosis of dyssynergia. The study noted an overall sensitivity of DRE for dyssynergia diagnosis of 75% and a specificity of 87%, with a positive predictive value of 97%.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

Q: We were told that we need IVF treatment. What is our chance of achieving a live birth?

A. The overall live birth rate per treatment cycle is in the region of 20–30%.

Q: Is infertility more common in any particular group? For example, IT industry, BPO sector, highly competitive and career minded people or any other group.

A. People in the cities are definitely more prone to it as the stressful life style and long working hours do not allow them to have contact at the right time with the desired frequency. Most cases are from people working in the BPO industry.

For queries contact: banerjee.kaberi@gmail.com.

    Gastro Update

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

What are the challenges in treating IBD?

The challenge in treating each child or adolescent with IBD is to employ pharmacologic, nutritional, and where appropriate, surgical interventions, not only to decrease mucosal inflammation and alleviate symptoms but also to optimize growth, normalize pubertal development, facilitate normal social development and avoid long term disease related complications.

    Medicolegal Update

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

Antiquity of Indian medicine & medical education– Charak Samhita

Acharya Charak has been crowned as the Father of Medicine. His renowned work, the "Charak Samhita" is considered as an encyclopedia of Ayurveda. His principles, diagnoses, and cures retain their potency and truth even after a couple of millennia. In Europe, when the science of anatomy was confused with different theories, Acharya Charak revealed through his innate genius and enquiries the facts on human anatomy, embryology, pharmacology, blood circulation and diseases like diabetes, tuberculosis, heart disease, etc. In the "Charak Samhita" he has described the medicinal qualities and functions of 100,000 herbal plants. He has proved the correlation of spirituality and physical health and contributed greatly to diagnostic and curative medical sciences. He has enumerated the ethical charter for medical practitioners two centuries prior to the Hippocratic Oath.

    Pediatrics Update: Question of the Day

What are safer alternatives to baby walker? (Dr. Alok Gupta)

  • "Stationary walkers" – with seats that rotate and bounce. But NO WHEELS
  • Play pens – give a great safety zone for children as they learn to sit, crawl, or walk.
  • High level chairs – older children often enjoy sitting up in a high chair and playing with toys on the tray.

In USA on July 1, 1997, new safety standards were implemented for baby walkers. Walkers are made wider so they cannot fit through most doorways and can stop at the edge of a step. However these new walker designs will not prevent all injuries from walkers because they still have wheels; so children can still move fast and reach higher. The American Academy of Pediatrics and the National Association for Children’s Hospitals and Related Institutions (NACHRI) have called for a ban on the manufacture and sale of baby walkers with wheels.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Only tissue diagnosis is conclusive. Where tissue diagnosis is not possible, clinical correlation along with radiology findings is mandatory

    Medi Finance Update

Minor Children

If your child is less than 18 years of age, the income is added to father’s or mother’s income, whosoever’s income is higher. If the daughter is less than 18 years of age, you can start a 100% specific beneficiary trust in her name. This can be a separate file and assessed separately (100% specific beneficiary trust of minor child). There will be no clubbing of income tax; no money will be spent till the minor becomes major.

    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combination of centrally acting, antitussive with antihistamine, having high atropine like activity in expectorants

    IMSA Update

International Medical Science Academy (IMSA) Update

STAR trial

At 81–month follow–up, randomized STAR trial found raloxifene to be less effective than tamoxifen in reducing the risk of invasive breast cancer, but maintained its toxicity advantage.

(Ref: Vogel VG, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing breast cancer. Cancer Prev Res (Phila Pa) 2010;3:696)

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant female had glucose intolerance.
Dr Bad: It will not affect your child.
Dr Good: Your child may be susceptible to type 2 diabetes.
Lesson: Maternal glucose intolerance may impair fetal insulin sensitivity (but not beta cell function), and consequently ‘program’ the susceptibility to type 2 diabetes.

Make Sure

Situation: A patient who had blood in the urine one month back was found to have large bladder cancer.
Reaction: Oh My God! Why was a cystoscopy not done at that time?
Lesson: Make sure that all painless bleeding in the urine are investigated for cancer at the first diagnosis.

    Lighter Side of Reading

An Inspirational Story

The Flow of Life

If the sky above seems cloudy, And you are left out in the rain, If you are searching for a rainbow,
But the colors bring you pain, If your world is not revolving, And there is no end in sight,
If you are looking for the sunshine, But all you see is night, If all around are smiling,
But all you can do is frown, If you are tired of all this living, When life just brings you down,

Then look beyond your teardrops, at the wonders of this land, The beauty of a flower,
Like velvet in your hand. Feel the air around you, The smell of new mown hay,
Laughing children in the park, The innocence there at play,

Imagine floating with a butterfly, As she flutters between the trees, Or the whispers of the ocean,
On warm hot summer’s breeze, Think of the taste of candy floss, As it melts upon your tongue,
Or the melody of morning birds, As they greet each day with song, Remember words of beauty,
Told in your mother's embrace, Feel the gentleness of her touch, As she softly kissed your face,

Seek the good within you, Cast the clouds from your sky, Don’t look toward the pavement,
But hold your head up high, Think not what life owes you, But of all you have to give,
Forget about tomorrow, Then you can start to live.

So Bless this age your are living in, With the gifts you can bestow, Don't disregard the stream of life,
Go gently with the flow.

Humor Section

Joke (Dr GM Singh)

Smart Dog

As a butcher is shooing a dog from his shop, he sees $10 and a note in his mouth, reading: "10 lamb chops, please." Amazed, he takes the money, puts a bag of chops in the dog’s mouth, and quickly closes the shop. He follows the dog and watches him wait for a green light, look both ways, and trot across the road to a bus stop. The dog checks the timetable and sits on the bench. When a bus arrives, he walks around to the front and looks at the number, then boards the bus. The butcher follows, dumbstruck.

As the bus travels out into the suburbs, the dog takes in the scenery. After awhile he stands on his back paws to push the "stop" button, then the butcher follows him off.

The dog runs up to a house and drops his bag on the stoop. He goes back down the path, takes a big run, and throws himself –Whap! against the door. He does this again and again. No answer. So he jumps on a wall, walks around the garden, beats his head against a window, jumps off, and waits at the front door. A big guy opens it and starts cursing and pummeling the dog.

The butcher runs up screams at the guy: "What are you doing? This dog’s a genius!"

The owner responds, "Genius, my butt. It’s the second time this week he’s forgotten his key!"

Mind Teaser

Read this…………………

working time  

Answer for yesterday’s Mind Teaser: "Generation gap"

Correct answers received from: Dr Jainendra Upadhyay, Dr AK Sharma, Dr. Naorem Sharat Kumar, Dr Shirish Singhal, Dr.K.Raju, Dr.  Manjesha, Dr.Parvesh Sablok, Dr. T. Samraj, Dr Harinder Miglani, Dr. Suman Kumar Sinha, Dr Nageshwar Rao, Dr B Marak, Dr Avdhesh Shukla, Dr K P. Rajalakshmi, Dr S.Upadhyaya, Dr Chandresh Jardosh, Dr.A.K.Gupta, Dr.Satish Gunawant, Dr Muthumperumal Thirumalpillai, Dr N C Prajapati, Dr G.Padmanabhan, Dr Neelam Nath, Dr Apurva Koirala

Answer for 4th November Mind Teaser: "Good intentions"
Correct answers received from: Dr U.C.vasavasda, Dr. Alok Deb, Dr.Satish Gunawant, Dr.Susheela Gupta, Dr U Gaur, Dr. Hiren Shah, Dr Sudipto Samaddar

Send your answer to ijcp12@gmail.com

    Readers Responses
  1. Dear Sir, May This Diwali be as bright as ever. May this Diwali bring joy, health and wealth to you?  May the festival of lights brighten up you and your near and dear ones lives.  May this Diwali bring in u the brightest and choicest happiness and love you have ever wished for. May this Diwali bring you the utmost in peace and prosperity. May lights triumph over darkness. May peace transcend the earth.
    "WISH U and entire emedinews team A VERY HAPPY DIWALI"
    Public Forum

(Press Release for use by the newspapers)

Heart Patients: Come November, time to get flu shot

Flu vaccine should be prescribed to all heart patients as death from flu is more common among people with heart diseases than any other chronic condition, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. K K Aggarwal, President, Heart Care Foundation of India. The American Heart Association (AHA) and American College of Cardiology (ACC) also recommend that all heart disease patients get flu shots.

Influenza or "the flu," is a highly contagious viral infection of the respiratory tract, which occurs from November to April, with most cases occurring between late December and early March.

Annual vaccination against seasonal influenza prevents cardiovascular morbidity and all–cause mortality in patients with cardiovascular conditions.

The AHA and ACC recommend inactivated influenza vaccination as a component of secondary prevention for persons with heart disease unless they have a contraindication to receiving the vaccine). Patients with cardiovascular disease should only receive the flu vaccine by injection and not the live, attenuated vaccine given as a nasal spray. The live vaccine has not been approved for use in cardiovascular patients.

Flu complications include bacterial pneumonia, dehydration and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes.

October or November is the best time to get a flu shot, but getting a shot in January or even later can still be beneficial. Flu season can start as early as October and last as late as May. It takes one to two weeks for the flu shot to take effect. Each September, a new flu vaccine is introduced. The vaccine is approximately 70 to 90 percent effective for healthy adults.

The FLUVACS study has shown that influenza vaccination reduces the risk of death and ischaemic events in patients suffering from infarction and post–angioplasty during flu season. Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood pressure control and other modifiable risk factors for cardiovascular disease.

    Forthcoming Events
eMedinewS Events: Register at emedinews@gmail.com

November 29, 2010, Monday, 9 AM – 1PM, Moolchand Medcity – “Update on Kidney Transplant”. No Fee. Entry by Invitation.  Contact: emedinews@gmail.com
eMedinewS Revisiting 2010

The 2nd eMedinewS  – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6PM – 9PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6PM – 2nd eMedinewS revisiting 2010, A Medical Update

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