medinews december 2011 by IJCP

Vol. 11, No. 12, December 2011

ISSN 0971-880X

Single Copy Rs. 100/-

Pages 12

Dr KK Aggarwal Gr. Editor-in-Chief, IJCP Group

d i t o r i a l

Member The Indian Newspaper Society

Official Voice of Doctors of India

Cut Daily Salt Intake to 1,500 mg • Daily intake of salt should be limited

to 1,500 mg according to an advisory statement from the American Heart Association (AHA). • The 2020 goal of the AHA is to improve the cardiovascular health of all by 20% while continuing to reduce deaths from (cardiovascular Dr KK Aggarwal Padma Shri and Dr BC Roy National Awardee disease) and stroke by 20%. Sr Physician and Cardiologist, Moolchand Medcity, New Delhi (Dr Lawrence J Appel, of Johns President, Heart Care Foundation of India Group Editor-in-Chief, IJCP Group Hopkins, and colleagues wrote online Editor-in-Chief, eMedinewS in Circulation.) Chairman Ethical Committee, Delhi Medical Council Director, IMA AKN Sinha Institute (08-09) • Two key components of improving Hony. Finance Secretary, IMA (07-08) Chairman, IMA AMS (06-07) cardiovascular health are populationPresident, Delhi Medical Association (05-06) emedinews@gmail.com wide lowering of blood pressure below http//twitter.com/DrKKAggarwal 120/80 and reducing sodium chloride Krishan Kumar Aggarwal (Facebook) intake below 1,500 mg/day. • The evidence includes more than 50 trials assessing the blood pressure effects of salt, as well as a meta-analysis showing that cutting salt intake by about 1,800 mg/day lowered blood pressure by 5 mmHg systolic and 2.7 mmHg diastolic. • Reducing salt consumption also can help prevent the blood pressure increases that come with age, ultimately affecting 90% of adults.

63rd Annual Conference of Cardiological Society of India

• Salt also has pernicious effects aside from blood pressure

•

• •

•

increases, including left ventricular hypertrophy and renal damage, including interference with the renin-angiotensinaldosterone system. Excess sodium also can result in abnormalities in mineral metabolism, fibrosis in several organs including the heart, and endothelial and arterial dysfunction. Benefits of lowering sodium intake by 1,200 mg/day could lead to: Upto 1,20,000 fewer coronary heart disease events; as many as 66,000 fewer strokes; almost 1,00,000 fewer heart attacks; upto 92,000 fewer deaths. The previous recommendation was that salt intake should be below 2,300 mg/day but advised that people at risk - those with hypertension, blacks, and older individuals - lower their intake to 1,500 mg. Processed foods are a main contributor, as these foods contain three-quarters of the sodium consumed. Naproxen increase the risk of death or recurrent heat attack by 76% after a week but for treatments lasting 30-90 days the risk increased risk was 15%. Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less. Source: Medpage Today

Make Sure

During Medical Practice A diabetic patient went to the physician to seek advice regarding an exercise programme.

Oh My God! He has lost his vision

Cardiology Update 2011 Released Coordinated and Published by IJCP Group

Make sure that before advising exercises to a diabetic patient an eye check-up is performed to rule out proliferative retinopathy, otherwise the patient can have retinal detachment leading to loss of vision. KK Aggarwal

Medicolegal Update 3 Case Report

Fitness Update

Legal Column

News & Views

Conference Calendar 9

Our Editors

Dr KK Aggarwal CMD, Publisher and Group Editor-in-Chief

Dr Veena Aggarwal MD and Group Executive Editor

Anand Gopal Bhatnagar Editorial Anchor

Dr Alka Kriplani Dr VP Sood Dr Praveen Chandra Dr Swati Y Bhave Dr Vijay Viswanathan Dr M Paul Anand Dr CR Anand Moses

Dr Sidhartha Das Dr Wiqar Sheikh Dr Ajay Kumar Dr Hasmukh J Shroff Dr A Ramachandran Dr Samith A Shetty Dr SK Parashar

Dr Thankam Verma Dr Georgi Abraham Dr V Nagarajan Dr Kamala Selvaraj Dr KMK Masthan Dr KMK Masthan

IJCP Publications Ltd.

E - 219, Greater Kailash, Part - 1, New Delhi - 110 048 Tel.: 40587513 E-mail: editorial@ijcp.com, emedinews@gmail.com, drveena@ijcp.com Subscription Office: Flat 5E, Merin Estate, Geetanjali, 25/8 diamond Harbour Road, Kolkata - 700 008 Mob.: 9831363901, E-mail: subscribe@ijcp.com, Website: www.ijcpgroup.com

Medicolegal Update The doctor must preserve broken fragment of weapon if found in wounds to identify the weapon or connect the accused person with the crime. • Death due to sharp force violence is most common cause

of homicide in India, in many parts of Europe, as well as in Africa and Asia. It also accounts for 30% of fatal and non-fatal family assaults in the USA. • The doctor conducting the postmortem examination must keep in mind that the shape and size of the wound suggests the width and type of weapon, whether it is single-edged or otherwise. The depth of the wound will indicate the length of weapon, the directions and dimensions of the wound indicate the relative position of the assailant and the victim, and the position, direction and number of wound may indicate manner of production, i.e., suicide, accident or homicide. • I have conducted medicolegal postmortem of 29 cases of deaths due to stab wound from South Delhi in the year 2010.

• A stab wound is produced by long narrow instruments

with blunt or pointed ends such as knife, dagger, nail, needle, spear, arrow, screw driver, etc. into the depths of the body; the wound is deeper than its length and width on the skin.

• The wound is caused by driving the object into the body

or from the body’s pressing or falling against the object and object penetrate due to the momentum of the body.

• The wound is called punctured wound when it enters a

body cavity only one way; when the weapon enters the body on one side and comes out from the other side, it is called perforating wound.

• The entry wound is larger and the exit wound is smaller

due to tapering of the blade in stab wounds which is contrary to fire arm missile entry and exit wounds.

• The doctor must preserve for police, broken fragment of

weapon if found; it will identify the weapon or connect the accused person with the crime.

Music may Help Relieve Pain in Cancer Patients Music can have a powerful effect on our emotions and even our sense of well-being. Now, a research shows it also may help treat cancer. A new meta-analysis evaluating 30 randomized controlled trials (RCTs) with 1,891 patients showed that music interventions may have beneficial effects on anxiety, pain, mood and quality of life in people with cancer (Cochrane Database Syst Rev 2011;8:CD006911). The investigators searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, www.musictherapyworld.net, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials and the National Research Register from their start date to September 2010. They included all RCTs and quasirandomized trials of music interventions for improving psychological and physical outcomes in patients with cancer. Seventeen RCTs used listening to pre-recorded music and 13 RCTs used music therapy interventions that actively engaged the patients. Overall, music produced a moderate pain-reducing effect in 391 participants with cancer (standardized mean difference [SMD], –0.59; 95% confidence interval [CI], –0.92 to – 0.27; P = 0.0003) and significantly reduced anxiety (95% CI, –19.59 to –2.82; P = 0.009). One of the studies found that music therapy resulted in greater pain reduction (mean change score [MCS], –0.44; SD = 2.55) than standard care (MCS, 0.45; SD = 1.87) (J Music Ther 2006;43:247-

265). Several of the trials suggested that music had a positive impact on mood (SMD, 0.42; 95% CI, 0.03-0.81; P = 0.03), but not depression (SMD, –0.07; 95% CI, –0.40 to 0.27; P = 0.69). Listening to music also was associated with small reductions in heart rate, respiratory rate and blood pressure. Two of the trials showed that music therapy significantly improved patients’ quality of life (SMD, 1.02; 95% CI, 0.58 to 1.47; P = 0.00001). In another trial, music therapy resulted in a greater improvement in quality of life (MCS, 2.0; SD = 4.6) than standard care (MCS, –0.4; SD = 3.65), but this difference was not significant (J Soc Integr Oncol 2006;4:116-124). Several researchers speculated on possible mechanisms by which music produces analgesia, including distracting the mind, evoking pleasurable emotional states, stimulating endogenous pain and stress reduction mechanisms, or providing a soothing and familiar world for patients. The authors concluded that music appears to help alleviate symptoms and treatment side effects in cancer patients, but the results “need to be interpreted with caution.” Because of the small number of trials analyzing each outcome, the authors could not compare the effectiveness of music medicine and music therapy interventions. Additionally, the trials using pre-recorded music included limited information about the music selections, and the frequency and duration of the treatment interventions varied across the trials. Source: Pain Medicine News. November 2011.

Healthy Driving Visual acuity and peripheral vision are evaluated in most states as part of the driver’s license renewal process. Retesting visual acuity between the renewal periods is required only if there has been a driving incident. The most common acceptable requirements are a visual acuity of 20/40 in the better eye and 120° of horizontal peripheral vision. —Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi

Case Report Giant Ependymoma of the Cauda Equine Amit Agrawal

Abstract Ependymomas are the commonest tumors of glial origin found in the spinal cord. However, giant ependymomas of cauda equina, extending from the conus medullaris to the sacrum, are rare. Radical surgical excision while taking care to preserve the neural structure is the treatment of choice. Because of the risk of recurrence, long-term follow-up is recommended.

pendymomas are the commonest tumors of glial origin found in the spinal cord, including the conus

medullaris, filum terminale and cauda equina.1 Giant ependymomas of cauda equina, extending from the conus medullaris to the sacrum, are rare tumors.2,3

Case Report A 20-year-old gentleman presented with complaints of low back pain radiating to both lower limbs of one month duration, loss of sensation over both lower limbs and progressive weakness of both lower limbs. Now he was bed ridden. There was no history of sphincter disturbances. His general and systemic examination was unremarkable. Higher mental functions and cranial nerves were normal. Upper limbs were normal. There was paralysis with wasting of both lower limbs (Grade 0/V) with sensory loss below L1. He was investigated with magnetic resonance imaging (MRI) dorsolumbar spine and it showed isointense lesion extending from the conus region to the sacral region, was filling the whole lumbar canal. The lesion was of mixed intensity on T2 images and was enhancing after contrast administration (Fig. 1 [A-C]). Patient underwent D12-L5 laminectomy and near total excision of the moderately vascular tumor. Histopathology was suggestive of ependymoma. Motor power in the lower limbs had improved to Grade III/V distally and Grade II/V proximally. He had transient bladder dysfunction that also improved. At one year follow-up he was walking with support and doing well.

Discussion Typical presentations of ependymomas involving the cauda equina region include pain, lower extremity weakness and, occasionally, bladder dysfunction.2,4 Presence of urinary difficulties at the time of diagnosis is a relatively poor prognostic sign.4 Surgery is the mainstay of the treatment and the aim of surgery is gross total resection of the tumor at the initial operation without compromising the neurological function.1,2,4,5 Radiation therapy is reserved after biopsy, in high grade lesion and in cases after recurrences.1,2,4-6 Because

Figure 1. MRI showing giant ependymoma extending from conus medullaris region to the sacral region (A) T1 image, (B) T2 image and (C) post-contrast image.

of the possibility of late recurrence, prolonged follow-up is recommended.4

References 1.

Yoshii S, Shimizu K, Ido K, et al. Ependymoma of the spinal cord and the cauda equina region. J Spinal Disord 1999;12(2):157-61.

Rivierez M, Oueslati S, Philippon J, et al. Ependymoma of the intradural filum terminale in adults. 20 cases. Neurochirurgie 1990;36(2):96-107.

Linssen WH, Davies GA. A giant cauda equina ependymoma. J Neurol Neurosurg Psychiatry 1998;65(1):71.

Schweitzer JS, Batzdorf U. Ependymoma of the cauda equina region: diagnosis, treatment, and outcome in 15 patients. Neurosurgery 1992;30(2):202-7.

Guyotat J, Fischer G, Remond J, et al. Giant ependymoma of the cauda equina. Long-term development apropos of 7 cases. Neurochirurgie 1993;39(2):85-91.

Celli P, Cervoni L, Cantore G. Ependymoma of the filum terminale: treatment and prognostic factors in a series of 28 cases. Acta Neurochir (Wien) 1993;124(2-4):99-103.

Headache Common after Kidsâ&#x20AC;&#x2122; Brain Injury Chronic headaches are a common occurrence after traumatic brain injury in young people, particularly for girls and those in their teenage years, a prospective study found. Three months after the head injury, 59% of girls were troubled

by headache compared with 24% of controls, for a relative risk of 2.4 (95% CI 1.4-4.2), according to Heidi K Blume, MD, of the University of Washington in Seattle, and colleagues. (Source: Medpage Today)

Fitness Update Women who are Active have a Lower Risk of Colon Disease New research from Sweden shows that physical activity may lower the risk of diverticular disease - a form of colon disease - while obesity and inactivity make people more susceptible to the condition. According to the National Institute of Diabetes and Digestive and Kidney Diseases, diverticular disease occurs when abnormal pouches form on the lining of the large intestine. Sometimes, these pouches become inflamed, which worsens the condition. The study, published in the American Journal of Gastroenterology is the largest to assess the relationship of weight and lifestyle with colon disease. Researchers administered a comprehensive

survey to a group of over 36,000 Swedish women in 1997, and then followed the group of women for 12 years. The questions in the survey asked about exercise, diet, television watching, smoking and other lifestyle choices. They found that overweight and obese women were 29 and 33% more likely to be hospitalized, respectively, than women who had normal BMIs. Similarly, women who were inactive (which researchers defined as exercising <30 minutes/day), had a much greater risk of being hospitalized and suffering complications related to diverticular disease.

Exercise has the Power to Defy Genetics Researchers have found several genetic factors that make a person predisposed to - or more prone to - developing obesity. Some experts believe that when these genetic factors are present, people are powerless against gaining excess weight. However, a new, exciting study published in the most recent issue of the journal PLoS Medicine shows strong evidence that this view is wrong. The results show that despite having this gene, people who exercise are still able to maintain a healthy weight. Researchers at the Medical Research Council Epidemiology Unit in Cambridge, United Kingdom, and Harvard Medical School, reviewed data from multiple research studies that, together,

included over 218,000 adults. They included studies that measure activity and investigated one specific gene that is frequently associated with increasing the risk for obesity. Adults were defined as being ‘inactive’ when they had a sedentary occupation and/or if they reported <1 hour of moderate-to-vigorous leisure–time or commuting physical activity per week. All other adults in the study were defined as ‘physically active.’ The meta-analysis of the data found that adults who exercised regularly and were ‘physically active’ according to the study standards had 33% lower odds of being obese compared to nonactive adults. Hopefully, the study authors conclude, their results will encourage more people to become physically active.

Exercise Frequency and Intensity Matters when it Comes to Diabetes Prevention Physical activity is considered by medical experts to be a key factor for the prevention and treatment of type 2 diabetes. However, research has not yet clarified how much exercise is needed to have an effect, or whether the effect on insulin resistance is dose-dependent, meaning that an increase in the amount of exercise performed would equal to an improvement in insulin resistance. Researchers from the University of Pittsburgh set out to investigate whether exercise - and at which dose - would help prevent type 2 diabetes and improve outcomes. For their study, which was published in the journal Medicine and Science in Sports and Exercise, researchers recruited 55 healthy volunteers. These volunteers participated in a 16-week supervised endurance exercise program with screenings before and after the

intervention. Insulin sensitivity, peak oxygen uptake and body composition were all assessed using laboratory methods. The exercise program involved 3-5 sessions/ week, and sessions lasted 45 minutes. The researchers were able to measure exercise dose by calculating the average energy (calories) expended per week. They also measured exercise intensity, duration and frequency. The results clearly showed that exercise improved insulin sensitivity, and there was a significant dose response relationship. Thus, more frequent and intense exercise sessions led to improved insulin sensitivity. Those who did not exercise as frequently or as intensely did reduce their risk of developing type 2 diabetes, but to a lesser degree.

Exercise Increases Bone Mass in Adolescents It’s commonly accepted that adults should perform resistance training and other forms of exercise to increase bone density and prevent osteoporosis. A new research from the University of Zaragoza in Spain set out to investigate whether adolescents who exercise are increasing their bone mass. A total of 373 Spanish teenagers under the age of 18 participated in the study. They were divided into two groups based on their exercise habits: nonactive (<60 minutes of moderate activity per day) or active

(>60 minutes). Their bone mineral content was measured by DXA machines and physical activity was assessed with accelerometers. Then, each participant’s fitness level was measured through a series of speed, agility, strength and cardiorespiratory tests. After all the data was collected, researchers performed statistical tests to find their results. Adolescents with lower fitness and lower activity levels were much more likely to have lower bone mineral content when compared to their more active, more fit counterparts.

—Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com

Expert’s Opinion What are the Treatment Options in Cystic Fibrosis Liver Disease? In addition to UDCA (ursodeoxycholic acid) treatment, treatment of cystic fibrosis liver disease includes supplementation of fat-soluble vitamins. Treatment of complications of portal hypertension and associated hypersplenism include variceal banding, portosystemic shunting, transjugular portosystemic shunt (TIPS), splenectomy and liver transplant. Given that respiratory disease is the main contributor to CF mortality; however, liver transplantation is rarely required and is generally not indicated unless there are additional features of liver decompensation.

How is GERD diagnosed? The diagnosis of gastroesophageal reflux disease (GERD) is often made clinically based on the bothersome symptoms or signs that may be associated with GER symptom descriptions are unreliable in infants and children younger than 8-12 years of age, and many of the purported symptoms of GERD in infants and children are nonspecific. There is a continuum between GER and GERD with no cutoff separation between the physiological reflux (GER) and pathological reflux (GERD). A third type of GER exists which is the Secondary to pyloric stenosis, neurological impairment, nasogastric tubes, and food allergy.

What are the Precautions to Prevent an Asthmatic Attack? An essential component in asthma treatment is the control of factors contributing to asthma severity. Clinicians should evaluate patients with persistent asthma for allergen exposures and sensitivity to seasonal allergens. Some common precautions especially in children are: • Keep the house clean. • The child should avoid places where there is a lot of • •

•

• •

smoke and pollution. Compliance of asthmatic drugs must be monitored and children must carry an inhaler on them. Make sure that the school of child is asthma-friendly. Parent’s must discuss the child’s condition with their teacher and explain to them the action plan to be followed if the child has an attack. Avoid active and passive cigarette smoking. Passive smoke can be one of the triggers of asthma, which is usually ignored as an advice to parents. Make sure that child’s toys and other playthings are hypoallergenic. Even the clothes that parents buy for the child should be hypoallergenic so that child does not get allergic to their stuffed animals or clothes.

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

Inspirational Story Life is 10% what you make it and 90% how you take it One day I hopped in a taxi and we took off for the airport. We were driving in the right lane when suddenly a car jumped out of a parking space right in front of us. My taxi driver slammed on his brakes, skidded and missed the other car by just inches! The driver of the other car whipped his head around and started yelling at us. My taxi driver just smiled and waved at the guy. And I mean he was really friendly. So I asked, ‘Why did you just do that? This guy almost ruined your car and sent us to the hospital!’ This is when my taxi driver taught me what I now call ‘The Law of the Garbage Truck.’ He explained that many people are like garbage trucks. They run around full of garbage, full of frustration, full of anger, and full of disappointment. As their garbage piles up, they need a place to dump it and sometimes they’ll dump it on you. Don’t take it personally. Just smile, wave, wish them well, and move on. Don’t take their garbage and spread it to other people at work, at home or on the streets. The bottom line is that successful people do not let garbage trucks take over their day. Life’s too short to wake up in the morning with regrets, so…… ‘Love the people who treat you right. Forgive the ones who don’t.’ Life is 10% what you make it and 90% how you take it!

Lab Update Porphyrin Tests: Indications When a patient has symptoms that suggest an acute neurologic/psychiatric porphyria, such as abdominal pain, tingling in hands or feet, and/or confusion or hallucinations, or a cutaneous porphyria, such as reddening, blistering or scarring on sun-exposed skin. —Dr Arpan Gandhi and Dr Navin Dang

Trust to Plant 10 L Trees Across Gujarat by Diwali 2012 Surat: The quest for green Gujarat is on for Harikrishna Charitable Trust that plans to plant 10 lakh new trees in the state in a span of one-year till Diwali 2012. The charitable trust run by the Rs 1,500 crore diamond group Harikrishna Exports started the campaign “Our Gujarat Green Gujarat” by gifting a sapling to all the well-wishers and friends on Diwali and economically valuable trees to their staffers at their native place in Saurashtra. (Source: TOI, Dec 6, 2011) Failure is only the opportunity to begin again more intelligently. Henry Ford

Legal Column Is it Necessary for the Treating Hospital to Disclose all the Information to Patient? The patient has a legitimate right to determine what medical/surgical, diagnostic or therapeutic intervention has to be done with his/her own body and the doctor has to obtain a valid consent after giving full information of medical procedure to be done to the patient. When two or more persons agree upon the same thing in the same sense, it is a valid consent as per the definition of the consent given in Section 13 of the Indian Contract Act. The Doctor who performs an intervention without the patient’s consent commits an offense for which he is liable as per law. Consent may be express or implied. • Express consent in an oral or written authority by

the patient to render the proposed medical/surgical treatment. • Consent may be implied to conduct medical examination from the conduct of the patient who voluntarily submits to treatment under circumstances which would indicate awareness of the planned treatment impliedly authorizes the treatment, even without express consent. A patient who presents himself or herself at the doctor’s clinic/ hospital after appointment/purchasing OPD Card/paying doctor’s fee for consultation/routine medical procedure/ examination by way of palpation/auscultation implies his/her consent to treatment by the doctor/hospital. • It is now recognized that the patient has the right to full information in patient as consumer terms, concerning his diagnosis, treatment and prognosis. He/she should also be informed about the alternative treatments/methods and its possible complications.

• Informed means the consent of a patient to the

performance of the health care services provided by a registered medical practitioner, that prior to be the consent having be given, the doctor/team of/hospital authority has informed the patient of the nature of the purposed procedure or treatment of those risks and alternative treatment or diagnosis that a reasonable patient would consider material to the decision whether or not to undergo treatment or diagnosis. • In standard ethical/prudent practice of medicine the doctor’s duty to disclose the information/complete information is subject to the two exceptions: No disclosure is required, if the patient indicates a preference not to be informed; or if the physician or surgeon believes in the exercise of sound medical judgment, that the patient personality is so anxiety prone or disturbed that the information would not be processed rationally or that it would probably cause significant psychological harm/not in the interest of his/her mental and physical health or it will cause adverse effect on good prognosis of patient health of the patient. • This exception to the legal duty of full disclosure to patient as informed consent in medical care delivery is called the ‘therapeutic privilege’ of a doctor. Consultation or sharing the information with legal heirs by another physician familiar with the patient/family doctor, with a close relative or friend of patient, or all is advisable for a treating doctor in good faith and must be documented as an extended informed consent under heading of therapeutic privilege. —Dr Sudhir Gupta, Additional Professor Forensic Medicine & Toxicology, AIIMS

Spiritual Update The 99 Club Once upon a time, there lived a King who, despite his luxurious lifestyle, was neither happy nor content. One day, the King came upon a servant who was singing happily while he worked. This fascinated the King. Why was he, the Supreme Ruler of the Land, unhappy and gloomy, while a lowly servant had so much joy? The King asked the servant, “Why are you so happy?” The man replied, “Your Majesty, I am nothing but a servant, but my family and I don’t need too much - just a roof over our heads and warm food to fill our tummies.” The king was not satisfied with that reply. Later in the day, he sought the advice of his most trusted advisor. After hearing the King’s woes and the servant’s story, the advisor said, “Your Majesty, I believe that the servant has not been made part of The 99 Club.””The 99 Club? And what exactly is that?” the King inquired. The advisor replied, “Your Majesty, to truly know what The 99 Club is, place 99 Gold coins in a bag and leave it at this servant’s doorstep.” When the servant saw the bag, he took it into his house. When he opened the bag, he let out a great shout of joy... So many gold coins! He began to count them. After several counts, he was at

last convinced that there were 99 coins. He wondered, “What could’ve happened to that last gold coin? Surely, no one would leave 99 coins!” He looked everywhere he could, but that final coin was elusive. Finally, exhausted, he decided that he was going to have to work harder than ever to earn that gold coin and complete his collection. From that day, the servant’s life was changed. He was overworked, horribly grumpy, and castigated his family for not helping him make that 100th gold coin. He stopped singing while he worked. Witnessing this drastic transformation, the King was puzzled. When he sought his advisor’s help, the advisor said, “Your Majesty, the servant has now officially joined The 99 Club.” He continued, “The 99 Club is a name given to those people who have enough to be happy but are never content, because they’re always yearning and striving for that extra 1 telling to themselves: “Let me get that one final thing and then I will be happy for life.” We can be happy, even with very little in our lives, but the minute we’re given something bigger and better, we want even more! We lose our sleep, our happiness, we hurt the people around us, all these as a price for our growing needs and desires. That’s what is called joining The 99 Club!.

News & Views ACR: Drug brings Relief Longterm in Fibromyalgia

ASN: Diabetes plus Dialysis Equals Glycemic Control Dilemma

Patients diagnosed with fibromyalgia who remain on therapy can achieve long-term pain relief - to at least three years - from treatment with the selective serotonin and norepinephrine reuptake inhibitor milnacipran (Savella), researchers said here. (Source: Medpage Today)

There is a sweet spot for glycemic control among patients with end-stage renal disease, such that treatment that is either too intensive or too lax is associated with higher mortality, two studies showed. (Source: Medpage Today)

Study: Xarelto Cuts Heart Attack Mortality

Asthma Exacerbations can Last a Week or Longer

Adding the oral anticoagulant rivaroxaban (Xarelto) to standard therapy after a myocardial infarction or unstable angina significantly reduced the risk of death, researchers reported here. (Source: Medpage Today)

Episodes of asthma worsening, when symptoms become more severe or frequent, commonly last for a week or more and can seriously affect a patient’s quality of life, according to a study presented in a poster session here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting. (Source: Medscape Medical News)

TCT: New Pressure index is FFR minus Adenosine A new pressure-based index to measure the severity of coronary lesion stenosis without adenosine compared favorably to fractional flow reserve (FFR) with adenosine, researchers found (Transcatheter Cardiovascular Therapeutics meeting). (Source: Medpage Today)

Contractile Reserve Predicts Death in HIV Cardiomyopathy The absence of inotropic contractile reserve (ICR) predicts the risk of cardiac death in patients with HIV-associated cardiomyopathy, researchers reported. (Source: Medpage Today)

BHU Celebrates Terra Madre day Varanasi: The Institute of Agricultural Science, Banaras Hindu University (BHU), celebrated Terra Madre Day that is eating locally to popularise the concept of Slow Food on Monday. The BHU is one of the 2,000 Terra Madre Community Food Centers. Slow Food celebrates Terra Madre Day around the world on December 10 every year. It was founded in 1989 to promote the concept of ‘Good Clean and Fair Food’ available locally in Italy. To counter the fast growth of fast food, the foundation has got the people together under umbrella of Slow Food on December 10, under the banner of the Terra Madre Day. (Source: TOI, Dec 13, 2011)

Cardiology Updates which may Change Day-to-day Cardiology Practice Hyperglycemia and heart failure in type 1 diabetes: A study of 20,985 adults with type 1 diabetes found that each one percent increase in HbA1C was associated with a 30 percent increased relative risk of heart failure during followup (Lancet 2011;378(9786):140-6). Sirolimus versus paclitaxel stents - SIRTAX LATE: There was no significant difference in the rates of major adverse cardiac events at five years (Circulation 2011;123(24): 2819-28). Predictors of bleeding with antiplatelet drugs: The known risk factors for bleeding include age greater than 75 years, female sex, baseline anemia and chronic kidney disease. In the TRITONTIMI, additional major predictors of serious bleeding were use of a glycoprotein IIb/IIIa inhibitor, duration of intervention, assignment to prasugrel, ST-elevation myocardial infarction and hypercholesterolemia (Circulation 2011;123(23):2681-9). Enoxaparin versus heparin in acute STEMI: In the ATOLL trial, which randomly assigned over 900 STEMI patients to enoxaparin or UFH before PPCI, there was a

nonsignificant reduction in the rate of the primary outcome of death (Lancet 2011;378(9792):693-703). Intra-aortic balloon counterpulsation (IABC) in acute MI: The CRISP AMI trial randomly assigned 337 patients, who presented within six hours of acute anterior STEMI but who did not have cardiogenic shock, to either IABC or no IABC prior to primary PCI and showed no significant difference between the groups (JAMA 2011;306(12): 1329-37). Colchicine in recurrent pericarditis: Patients with recurrent pericarditis should be treated with aspirin or another NSAID plus colchicines (CORP trial) (Ann Intern Med 2011;155(7):409-14). Cardiac resynchronization therapy for functional mitral regurgitation: The impact of CRT on moderate-to-severe to severe mitral regurgitation was evaluated in a study of 98 patients. Nearly half showed a significant improvement in mitral regurgitation (reduction by at least one grade).

Cardiology in 2020 Dr Ashok Seth: Hybrid labs with surgery, cath and 3D echo will be the future. Bioabsorbable stents are in the horizon. Biodegradable polymers can last for six months. Biomime, an Indian stent study, was included in the MERIT study. Polymer-free stents are now available (Yukon Choice PC). Bioresorbable stents which degrade over period of time are the future. A 100-patient Indian arm is complete and the data will be ready in next six months. It is radiolucent stent. Robotics are now in the cath labs and will help to prevent radiation hazards. Dr Blasé Carabello: With the availability of TAVI, surgeons will not disappear. In fact in the US, surgical AVR cases have increased since introduction of TAVR. Transcatheter valve replacements are only for inoperable cases and via femoral approach only. How long will TAVR last; delivery and stroke issues, valve issues are also the current challenges. Remember, PCI has been present since 34 years and CABG has not reduced. Dr Jagat Narula: CT/MR should replace cadaveric dissections; ultrasound stethoscope should be a part of physical exam and one should shift from genotype to phenotype approach. Dr Mandeep Mehra: India has a huge number of end-stage HF patients and organ transplant is a problem. Thirdgeneration LV assist devices are now available: Reduced RHF, increased durability, reduced infections but with similar CVA rates (12%). The aim is to shift from bridge to recovery. The Torrent GUASP helical heart will shape the future. Transplantation of cells, tissues and organs between individuals of different species is referred to as xenotransplantation, which will be the future.

Medicine Update How is a patient of chronic hepatitis B treated? • Consensus guidelines for the treatment of chronic

•

hepatitis B Virus (HBV) in children have not been established, and indications for antiviral therapy in adults with chronic HBV infection may not be applicable to children. Factors that are predictive of a positive response to interferon (IFN) or nucleoside analogs include high pretreatment levels of aminotransferase (>2 × ULN), low pre-treatment HBV DNA levels (<105 copies/ml or 20,000 IU/ml), late acquisition of HBV infection and higher hepatocellular inflammation. Treatment should be considered if patients have persistently elevated ALT levels >2 × ULN and evidence of active viral replication (HBeAg seropositive, and/or HBV DNA levels >105 copies/ml or 20,000 IU/ ml in their serum) for more than three months. Treatment aims to achieve long–term remission so that the chance of hepatocellular carcinoma and chronic liver disease is decreased. Symptomatic children with ongoing viral replication and active liver disease need treatment. Therapy aims to prevent HBV replication and decrease inflammation and normalize transaminases. According to the American guidelines, pediatric patients should be referred to pediatric liver specialist for development of strategy for monitoring, treatment and/or cancer evaluation.

Prevention of diarrhea in children with HIV infection or who were born to an HIV-infected mother Diarrhea is a common cause of illness in children, especially in low and middle-income countries where it accounts for nearly 2.5 million deaths per year. Infants and children with HIV infection or maternal exposure through birth or breastfeeding to HIV infection may be more vulnerable to diarrhea due to weakened immune systems, nutritional deficiencies or from having other infections. A review evaluated three interventions to assess whether they can prevent death or illness from diarrhea in infants and children with HIV infection or exposure: Vitamin A, zinc and cotrimoxazole. Vitamin A and zinc may correct micronutrient deficiencies that are prevalent in children with HIV infection or exposure, as well as prevent other infections. Cotrimoxazole is an antibiotic that helps prevent opportunistic infections in immunocompromised hosts, and may also prevent other infections. This review found nine studies that addressed these interventions in infants or children with HIV infection. It indicated that vitamin A shows reduction of mortality and morbidity due to diarrhea in children with HIV infection and a trend in lower illness from diarrhea. Zinc prevented visits due to watery diarrhea and cotrimoxazole decreased death and respiratory infections.

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

Once you have mastered time, you will understand how true it is that most people overestimate what they can accomplish in a year and underestimate what they can achieve in a decade!

—Anthony Robbins

Conference Calendar Date: 22nd January, 2012

3rd eMedinewS Revisiting 2011

Venue: Maulana Azad Medical College, New Delhi The one-day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak. 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

Maulana Azad Medical College at 5 pm. It will be a part of the entertainment program being organized at the venue. If you know of any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

Dear Colleague, The 3rd eMedinewS “Doctor of the Year Award” function will be held on 22nd January, 2012 at

Dr Ajay Kriplani (Surgical Management of Diabetes); Dr N K Bhatia (What’s New in Transfusion Medicine); Dr Kaberi Banerjee (Fertility update); Dr Amit Bhargava (Cancer Update 2011), Onco Radiation Update (Rajiv Gandhi Cancer Institute); Dr Ambrish Mithal (Vitamin D Update), Dr Praveen Chandra (Interventional Cardiology Update); Revisiting 2011 (Dr K K Aggarwal), Portfolio Management (Central Bank of India); Insurance update (LIC India); General Insurance (Doogar Associates)

IMSCON 2012

Laugh a While

3rd eMedinewS Doctor of the Year Award

Date: 17-19 February, 2012

Too Drunk

Venue: Hotel The Claridges, Surajkund, Faridabad Annual conference of Indian Menopause Society is multidisciplinary approach to the problems of Mid life onwards Women. This conference has participation of British Menopause Society and South Asian Federation of Menopause Societies and opportunity to hear from international faculties. Early Registration till 30th Dec 2011. Website: http://indianwoman35plus.com/ Indianmenopausesociety.org or http://fogsi.org/

Clinical Trials: ICH, GCP Rules, Regulatory (EMEA, FDA) GCP Inspections Date: 25 January, 2012 Venue: Kiev, Ukraine Website: http://www.nbscience.com/reestre.html

Pediatrics - Focus on Adolescent Medicine and Young Adults Date: December 28-30, 2011 Venue: New York Westin, New York City, NY, United States Website: http://www.mceconferences.com/conferencedetail.php?conf_id=PAR-16

Pediatrics Review 2012 Date: 8-15 January, 2012 Venue: Tampa, Florida, United States Website: http://www.continuingeducation.net/coursedetails. php?program_number=1014

A police officer pulls over this guy who had been weaving in and out of the lanes. He goes up to the guy’s window and says “Sir, I need you to blow into this breathalyzer tube.” The man says, “Sorry officer I can’t do that. I am an asthmatic. If I do that I’ll have a really bad asthma attack.” “Okay, fine. I need you to come down to the station to give a blood sample.” “I can’t do that either, I am a hemophiliac. If I do that, I’ll bleed to death.” “Well, then we need a urine sample.” “I’m sorry officer I can’t do that either. I am also a diabetic. If I do that I’ll get really low blood sugar.” “Alright then I need you to come out here and walk this white line.” “I can’t do that, officer.” “Why not?” “Because I’m too drunk to do that. As an English professor, my father would often write little notes on student essays. Often he worked late, and as the hours passed, his handwriting deteriorated. One day a student came to him after class with an essay that had been returned. “Mr. McDonald,” he said, “I can’t make out this comment you wrote on my paper.” My father took the paper and, after studying it, sheepishly replied, “It says that you should write more legibly.” Doctor, Doctor! I keep getting pains in the eye when I drink coffee! Doc: Have you ever tried taking the spoon out FIRST?

Pioneer in Medical Journalism

IJCP GROUP OF PUBLICATIONS Dr Sanjiv Chopra Prof. of Medicine & Faculty Dean Harvard Medical School Group Consultant Editor Dr Deepak Chopra Chief Editorial Advisor

Humor Dr. Good and Dr. Bad Situation: Following a clean operation a patient comes for wound dressing.

Dr KK Aggarwal CMD, Publisher and Group Editor-in-Chief Dr Veena Aggarwal MD and Group Executive Editor Anand Gopal Bhatnagar Editorial Anchor

Take prophylactic antibiotics

There is no need for antibiotics. you need sterile dressings only

Dr Alka Kriplani Asian Journal of Obs & Gynae Practice Dr VP Sood Asian Journal of Ear, Nose and Throat Dr Praveen Chandra Asian Journal of Clinical Cardiology Dr Swati Y Bhave Asian Journal of Paediatric Practice Dr Vijay Viswanathan The Asian Journal of Diabetology KMK Masthan Indian Journal of Multidisciplinary Dentistry Dr M Paul Anand, Dr SK Parashar Cardiology Dr CR Anand Moses, Dr Sidhartha Das Dr A Ramachandran, Dr Samith A Shetty Diabetology Dr Ajay Kumar Gastroenterology Dr Hasmukh J Shroff Dermatology Dr Georgi Abraham Nephrology Dr Sidharth Kumar Das Rheumatology Dr V Nagarajan Neurology Dr Thankam Verma, Dr Kamala Selvaraj Obs and Gyne

ÂŠ IJCP Academy

EDITORIAL BOARD

Lesson: Prophylactic antibiotics are not needed following routine clean surgery and unnecessarily increase the costs.

Dr KK Aggarwal

Illusion

Marketing board Sr. Business Managers Ritu Saigal (Kolkata) Chitra Mohan (Chennai) H Chandrashekar (Bangalore) P Venugopal (Hyderabad) Advisory Bodies Heart Care Foundation of India Non-Resident Indians Chamber of Commerce & Industry World Fellowship of Religions CORPORATE OFFICE E - 219, Greater Kailash, Part - 1 New Delhi - 110 048 Telefax: 40857513 E-mail: editorial@ijcp.com emedinews@gmail.com Kolkata: Ph.: 24452066; 9831363901 Chennai: Ph.: 22650144, 22652652; 9841213823 Mumbai: Ph.: 9811036687 Bangalore: Ph.: 25586337; 9845232974 Hyderabad: Ph.: 65454254; 9849083558

RNI No - DELENG/2002/6786 Date of Posting 18-19 Same Month

REGISTRATION NO. DL(S)-01/3136/2009-2011 POSTED IN NDPSO NEW DELHI

Subscription Form (Jan-Dec 2011)

Save

Subscribe to all Journals ` 1000/You Pay ` 13,500/-

Special Discount on Institutional Packages

Yes, I am interested in subscribing to the *Institutional Combo Package for one year (Institutional) Yes, I am interested in subscribing to the following journal(s) for one year (Institutional) JOURNALS

ISSUES/YEAR

INSTITUTIONAL (` Amount)

(Individual) INDIVIDUAL (` Amount)

3,500/-

1,650/-

1,200/-

550/-

3,500/-

1,650/-

1,200/-

550/-

1,200/-

550/-

1,200/-

550/-

Asian Journal of

Ear, Nose Throat

1,200/-

1,500/-

Payment Information:

550/-

750/-

Total `14,500/- for 1 Year

Name: ............................................................................................

Pay Amount: ......................................................................................

Speciality: ...................................................................................... Address: ........................................................................................

Dated (dd/mm/yyyy): ..........................................................................

........................................................................................ Country: ..................................... State: .......................................

Cheque or DD No.: .............................................................................

Pincode: .................................... Telephone: ............................... Mobile: ......................................

Drawn on Bank: ................................................................................

E-mail: ...........................................................................................

Cheques/DD should be drawn in favor of “M/s IJCP Publications Pvt. Ltd.” We accept payments Mail this coupon to : IJCP Publications Pvt. Ltd. by Cheque/DD only, Head Office: E - 219, Greater Kailash, Part - 1, New Delhi - 110 048 Payable at New Delhi. Telefax: 40587513 Mob.: 9891272006 Do not pay Cash. Subscription Office: 5E, Merlin Estates, 25/8 Diamond Harbour Road, Kolkata - 700 008 Tele No.: 033-24452066 Mob.: 9831363901, E-mail: subscribe@ijcp.com, Website: www.ijcpgroup.com

© Copyright 2011 IJCP Publications Ltd. All rights reserved. The copyright for all the editorial material contained in Medinews, in the form of layout, content including images and design, is held by IJCP Publications Pvt. Ltd. No part of this publication may be published in any form whatsoever without the prior written permission of the publisher. Owner, Published, Printed and Edited by Dr KK Aggarwal, on behalf of IJCP Publications Ltd. and Published at E - 219, Greater Kailash, Part - 1, New Delhi - 48. Printed at: IG Printers Ltd., New Delhi Note: IJCP’s Medinews does not guarantee, directly or indirectly, the quality or efficacy of any product of service described in the advertisements or other material which is commercial in nature in this issue. E-mail: editorial@ijcp.com, emedinews@gmail.com Website: www.ijcpgroup.com