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Dr KK Aggarwal

From the Desk of Editor in Chief
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 October 2010, Thursday

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

Talking on a mobile while driving is more distracting
than talking to a passenger

Over eighty percent people who own mobile phones use them while driving. People talking on mobile hones while driving cause about one–third of traffic accidents all over the world. One US study using a driving simulator showed that drivers conversing by mobile phone were more likely than those talking to passengers to drift between lanes and to miss an exit they were instructed in advance to take. Drivers and passengers tended to modulate their speech in response to external traffic cues. They stopped talking when a traffic problem developed, or the passenger would offer advice to help the driver navigate. But conversations taking place by mobile phone, on the other hand, did not vary much in response to changing traffic conditions. Switching to hands–free cell phones did not eliminate the physical distraction of trying to hold onto a cell phone while steering the car. A review of studies has shown that hands–free cell phones are just as distracting as handheld models. While people can multitask, cognitive research suggests that the brain tends to focus on one major activity at a time, while slowing the processing of other external cues. That is why talking on a cell phone may cause inattention blindness to anything else going on at the same time.

Another study showed that any mobile cell phone use causes impairments similar to those observed in drunk drivers. In the study, both intoxicated drivers and cell phone drivers performed differently from baseline. Drivers under the influence of alcohol  exhibited a more aggressive driving style, following closer to the vehicle immediately in front of them, necessitating braking with greater force. The mechanisms underlying the impaired driving in the alcohol and cell phone conditions clearly differ. On one hand, intoxicated drivers hit the brakes harder and had shorter following distances. On the other hand, cell phones drivers had slower reactions, had longer following distances, took longer to recover speed lost following a braking episode, and were involved in more accidents. In the case of the cell phone driver, the impairments were attributable, in large part, to the diversion of attention from the processing of information necessary for the safe operation of a motor vehicle. These attention–related deficits are relatively transient (i.e., occurring while the driver is on the cell phone and dissipating relatively quickly after attention is returned to driving). By contrast, the effects of alcohol persist for prolonged periods of time, are systemic, and lead to chronic impairment. The driving impairments associated with handheld and hands-free cell phone conversations were not significantly different.

In another similar British study, scientists involved 20 subjects using a driving simulator to test reaction times and driving performance. They tested how driving impairment was affected when drivers were talking on a handheld mobile phone or a hands–free phone, and when drivers had consumed enough alcohol to register above the legal blood–alcohol limit. Drivers reaction times were, on average, 30% slower when talking on a handheld mobile phone than when legally drunk and 50% slower than under normal driving conditions (no alcohol). Drivers talking on phones were less able than drunk drivers to maintain a constant speed, and they had greater difficulty keeping a safe distance from the car in front. Using a handheld mobile phone had the greatest impact on driving performance. On average, it took handheld mobile phone users half a second longer to react than normal and a third of a second longer to react compared to when they were drunk. At 70 mph, this half–second difference is equivalent to traveling an additional 46 feet before reacting to a road hazard, researchers said. Hands-free mobile was no safer.

Clearly the safest course of action is to not use a cell phone while driving. Talking on a cell phone while crossing a street can be disastrous for children. A study, by Katherine Byington, from University of Alabama at Birmingham, being published in the February 2010 issue of the Pediatrics has shown that 10– and 11–year–olds are less attentive to traffic and are involved in more collisions and near misses with traffic when using a cell phone while crossing a street in simulated road crossings. The children who were on the cell phone and were distracted during crossing were significantly more likely to get hit by a car in the virtual environment.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from The Net)

Weird X-rays

X-ray is one of the most useful medical advancements in history. But as these images show they can also reveal some of the most gruesome and bizarre results. An X-ray of the foot of a patient who stood on a fork 

(Contributed by Dr Mukul Tiwari)

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

American Academy of Neurology updated guidelines for driving risk in patients with dementia

Mild dementia increases the likelihood, but does not establish that a patient is an unsafe driver. A score of 24 or less on the Mini Mental Status Examination (MMSE) is useful in identifying patients at increased risk for unsafe driving

(Reference: Iverson DJ, et al. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74:1316)

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

Harm–reduction strategies proving successful

Manipur is the only State in India to have a policy on harm reduction to prevent the spread of HIV/AIDS, and the strategy seems to be yielding positive results. According to the Annual Report of the Manipur State AIDS Control Society for 2008–2009, the prevalence rate of HIV infection among injecting drug–users has shown a decrease from 76.9 per cent in 1997 to 17.9 per cent in 2007. Today, HIV/AIDS has become a household word in Manipur, with the knowledge of HIV/AIDS among adults, women and men being nearly universal (99 per cent) as per the National Family Health Survey–111 (2205–2006). The State has the highest prevalence of HIV among the six high prevalence states of Maharashtra, Tamil Nadu, Karnataka, Andhra Pradesh, Manipur and Nagaland. The prevalence is four times higher, as against the national prevalence of 0.28 per cent. The cumulative reported number of HIV positives in Manipur until March 2009 was 31,972 while full blown AIDS (patients) is 4,363 and the number of recorded deaths due to AIDS is 625. (Source: The Hindu)

  International News

(Dr Monica and Brahm Vasudev)

Just as when they were pregnant, breast–feeding moms need to monitor the drugs they take, which could reach their infants.

The American Academy of Family Physicians offers these medication guidelines for breast–feeding mothers:

  • If you must take medications orally, take them just after breastfeeding, to give the medications time to travel through your system.
  • Generally, acetaminophen and NSAIDs are safe painrelievers for nursing women, but always check first with your doctor.
  • Don’t take aspirin while breastfeeding, as it may lead to bleeding and skin rash in babies.
  • Don’t take antihistamines long–term while breastfeeding.
  • Carefully monitor your baby for any side effects from your medications. Be especially aware of symptoms such as trouble breathing or skin rash.

Mammography significantly lowers death rate in women aged 40–49

The landmark breast cancer screening study of women 40–49, published online in Cancer, has proven that annual mammography screening of women in their 40s reduces the breast cancer death rate in these women by nearly 30%. The results confirm that the use of the age of 50 as a threshold for breast cancer screening is scientifically unfounded. Women should begin getting annual mammograms at age 40.

CRP update

In the recent Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), researchers evaluated the efficacy of statins using a risk cut-point for CRP at values more than 2mg/L. Based on JUPITER’s findings, the US FDA recently licensed the use of rosuvastatin to prevent cardiovascular disease in men over 50 years and women over 60 years who have one other risk factor and CRP greater than 2mg/L.

HbA1c not an assured tool for diabetes dx

Although the American Diabetes Association (ADA) recently recommended using it as a diagnostic tool, and the WHO may soon follow, some argue that a cutoff of 6.5% misses too many cases of the disease.

  Hepatology Update

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

What is the role of imaging studies in neonatal cholestasis?

Role of HIDA Scan

Hepatobiliary scintigraphy basically rules out total from partial cholestasis. Basically there are 3 Tc 99m Iminodiacetic acid analogs (IDAAs): Tc 99m lidofenin(HIDA), Tc 99m disofenin (DISIDA) and Tc 99m mebrofenin (BrIDA). Tc 99m mebrofenin has a very good hepatic uptake (98%) and clearance half–life (17 min) and therefore is mostly preferred. It is a sensitive (approx 97%) test for diagnosis of EHBA (extra hepatic biliary atresia) but  is not very specific for it (50 – 80%) i.e. failure of excretion of dye in biliary tree could result from EHBA or marked intrahepatic cholestasis, but visualization of the tracer in intestinal tract (esp. within 4 hours) virtually rules out biliary atresia.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

Is IVF very expensive?

IVF is not as expensive as perceived in general. The cost of IVF cycle usually depends upon the dose of drugs that would be needed for ovarian stimulation. It is only as expensive as perhaps gall stone removal or removal of uterus surgery.

Do one need to get admitted in the IVF process?

A patient undergoing IVF does not require admission. However, one should visit the center 3–5 times during monitoring cycle. On the day of egg collection, the patient would need to fast for 6 hours and come to the clinic (the procedure takes about 30 min). Patients can go home after the effect of anesthesia wears off which takes about 2–3 hours. The next scheduled visit is after 2–3 days for the embryo transfer, which again takes about half an hour and patients are free to go home after resting for one hour.

  Diabetes Update: Question of the Day

What is the treatment of type 2 diabetes mellitus in young? (Dr Shaila Bhattacharyya)

Treatment of type 2 diabetes mellitus in young involves not only control of hyperglycemia, but also hyperlipidemia and blood pressure. Most of these can be achieved with reduction in weight and control of diet and lifestyle modifications. Encouraging more physical activity and changing dietary habits may blunt the increasing prevalence of type 2 diabetes in the young.

  • Treatment in asymptomatic children with type 2 diabetes is to start with intervention approaches to diet and exercise and then to add oral hypoglycemic agents (OHAs).
  • For symptomatic children, with blood glucose >300 mg/dl or when ketoacidosis is present, start with insulin then taper it and substitute metformin. The goal is to maintain an HbA1C of <7% in the young. Diet, exercise and weight control with lifestyle changes is the cornerstone of management.

During acute episode short–acting insulins can be used to control high sugars. Later on change to biphasic insulins 30/70 and then wean off insulin and treat with OHAs. Metformin is approved for pediatric use. It is safe in 10– to 16–year–old obese children and administered as 500–1,000 mg in divided doses with or after food to prevent gastrointestinal side effects. Sulfonylureas are used sparingly in postadolescent children but care about hypoglycemia should be taken. Thiazolidinediones are not approved in children.

  Medicolegal Update

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

What is a medico–legal case?

A medico–legal case is a case of injury, ailment, hurt or illness or death due to evident criminal cause or where the attending doctor, on examining the patient, concludes that criminal force/weapon has been used against human body and an inquiry/investigation by law agencies is required in accordance with the prevailing law of the land. It is a legal duty of the treating doctor to inform a medicolegal case to the nearest police station as soon as after completing primary lifesaving medical care. In accordance with Section 39 of Criminal Procedure Code of India, the treating doctor is duty bound to inform the nearest police station as soon as he/she completes his primary medical care. Phones/mobile phones can be used for informing the police in this era of modern advancement in telecommunication. An acknowledgement of receipt of such a message should be taken for future reference. If the intimation is given orally or on phone, the diary number (DD or the Daily Docket number/name and designation of police officer) should be taken down as proof of intimation and should be properly documented in the patient’s records. The idea is to initiate legal proceeding at the earliest so that the maximum evidence can be collected by the police officer with minimum destruction of evidences, site of occurrence, knowingly or unknowingly by any party. There is a quote in Bernard Knight Text Book of Forensic Medicine that ‘the doctor dealing with medico–legal cases should not act /behave like a detective; equally the doctor should never act like curtain between police and patient involved in crime.'

  Medi Finance Update

Gift Tax

A married daughter/major girl can receive gifts from her father, mother, uncle, brother, etc.

  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 combinations of antihistamine with anti–diarrheals

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

The American Diabetes Association (ADA) has recommended HbA1C as the diagnostic test for diabetes.

  IJCP Special

Dr Good Dr Bad

Situation: A female with Rheumatoid Arthritis became pregnant while taking Leflunomide.
Dr. Bad: Continue it.
Dr. Good: Stop it immediately.
Lesson: In women with rheumatoid arthritis who become pregnant while taking leflunomide, healthy pregnancy outcomes usually occur, if the drug is discontinued at the earliest and a cholestyramine drug elimination procedure is done. (Arthritis Rheum 2010;62:1494)

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction: Oh my God! Why was flu vaccine not given?
Lesson: Make sure that all diabetics are given flu vaccine every year.

Quote of the Day (Dr. G M Singh)

"Humor is tragedy plus time." Mark Twain

  Mind Teaser

Read this…………………


Answer for yesterday’s Mind Teaser: "Three strikes and you're out."

Correct answers received from: Dr Anurag Jain, Dr. Hiren Shah, Dr Virender Prakash Gautam, Dr.K.P.Rajalakshmi,

Answer for 5th October Mind Teaser is: "The aftermath"

Correct answers received from:
Dr Muthumperumal Thirumalpillai, Dr Rashmi Chhibber, Dr.Susheela Gupta, Dr Kalpana Mohan, Dr Aruna

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr. G M Singh)
A man writing at the post office desk was approached by an older fellow with a postcard in his hand. The old man said, "Sir, I’m sorry to bother you but could you address this postcard for me? My arthritis is acting up and I can’t even hold a pen." "Certainly, sir," said the younger man. He wrote out the address and also agreed to write a short message and sign the card for the man. Finally, the younger man asked, "Now, is there anything else I can do for you?"

The old fellow glanced at the card a moment and said, "Yes, at the end could you just add, ‘PS: Please excuse the sloppy hand–writing?’"

You are an Indian if (Anuj Goel)
All your children have pet names, which sound nowhere, close to their real names.

  An Inspirational Story

The World is a Puzzle
There was a man who had a little boy that he loved very much. Everyday after work the man would come home and play with the little boy. He would always spend all of his extra time playing with the little boy.
One night, while the man was at work, he realized that he had extra work to do for the evening, and that he wouldn’t be able to play with his little boy. But, he wanted to be able to give the boy something to keep him busy. So, looking around his office, he saw a magazine with a large map of the world on the cover. He got an idea. He removed the map, and then patiently tore it up into small pieces. Then he put all the pieces in his coat pocket.
When he got home, the little boy came running to him and was ready to play. The man explained that he had extra work to do and couldn’t play just now, but he led the little boy into the dining room, and taking out all the pieces of the map, he spread them on the table. He explained that it was a map of the world, and that by the time he could put it back together, his extra work would be finished, and they could both play. Surely this would keep the child busy for hours, he thought.

About half an hour later the boy came to the man and said, "Okay, it’s finished. Can we play now?" The man was surprised, saying, "That’s impossible. Let’s go see." And sure enough, there was the picture of the world; all put together, every piece in its place. The man said, "That's amazing! How did you do that?"

The boy said, "It was simple. On the back of the page was a picture of a man. When I put the man together the whole world fell into place."

  Readers Responses
  1. Dear Dr Agarwal, I missed earlier issues. PLEASE EDUCATE ME ON WHAT IS "The CHADS2 score "Thanks, Dr Rozario Menezes, GOA
    Emedinews responds: CHADS2 score, thromboembolic risk, and effect of warfarin in 11,526 patients with nonvalvular atrial fibrillation and no contraindications to warfarin therapy

    Clinical parameter                                                        Points
    Congestive heart failure (any history)                                   1
    Hypertension (prior history)                                                 1
    Age ≥75 years                                                                  1
    Diabetes mellitus                                                               1
    Secondary prevention in patients with a
     prior ischemic stroke or a transient ischemic
    attack; most experts also include patients
    with a systemic embolic event                                            2

      Events per
    100 person-years*  
     CHADS2 score Warfarin
    No warfarin
      0 0.25 0.49 417
      1 0.72 1.52 125
    1.27 2.50 81
      3 2.20 5.27 33
      4 2.35 6.02 27
      5 or 6 4.60
    6.88 44

    NNT: number needed to treat to prevent one stroke per year with warfarin. * The CHADS2 score estimates the risk of stroke (TIA not included). Patients are considered to be at low risk with a score of 0, at intermediate risk with a score of 1 or 2, and at high risk with a score ≥3. One exception is that most experts would consider patients with a prior ischemic stroke, transient ischemic attack, or systemic embolic event to be at high risk even if they had no other risk factors and therefore a score of 2. However, the great majority of these patients have some other risk factor and a score of at least 3. [JAMA 2001; 285:2864]
  2. Dear KK Aggarwal, I congratulate the IMA Kerala Chapter about the step taken to oppose the BRMS course launched by MCI and Govt. of India. There are many more facts which the Qualified Doctor must take cognizance of viz. to oppose the menace of Quackery. Concerted efforts will definitely stop Quackery, but allopathic Practitioners are not united. So, the Govt. of India regularly imposes different rules on us rather than Quacks, who continue to practice with free mind without the fear of law. Future is not far when we would be in minority and quacks will supercede us. So, I request all Practitioners to fight against quackery and stop encroachment on our ‘pathy’. Sir, kindly send my address and Phone no. to Kerala Branch so that we may join hands together. Thanks to Kerala Branch. Dr. Ghanshyam A. Umre, Ganeshpur Road, Wani Dist: Yavatmal 445304 Mobile no.9423435558
  Public Forum

(Press Release for use by the newspapers)

Specialty OPDs at the 17th MTNL Perfect Health Mela

Specialty OPDs will be conducted from 8 am to 6 pm everyday during the forthcoming MTNL Perfect Health Mela being organized by Heart Care Foundation of India jointly with Health Department, Govt. of Delhi, MTNL, NDMC, MCD, LIC, Deptt. Of Science & Technology, Govt. of India, Coca Cola India Ltd. etc. from 23rd to 31st October at NDMC Grounds, Laxmi Bai Nagar.

Giving the details Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President HCFI said that specialists from fields like Cardiology, Medicine, Pediatric, Orthopedics, Skin, Neurology, Brain, Kidney, Liver etc. would be available for free on–the–spot consultations. Free Homeopathy, Ayurveda, Unani, Naturopathy physicians would also be available for free consultation.

  Forthcoming Events

CPLD 2010: Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

Dr. Sood Nasal Research Foundation Announces
Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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