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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

2nd February 2010, Tuesday

Practice Changing Updates: PTU hepatotoxicity

Due to reports of severe PTU-related liver failure, the American Thyroid Association and the US FDA have published new recommendations for PTU use.
propylthiouracil (PTU) should not be prescribed as first line therapy for hyperthyroidism in children or adults. Methimazole (MMI) is the preferred drug for most non-pregnant patients.
Indications for PTU over MMI are in pregnant women during the first trimester, patients with life-threatening thyrotoxicosis or thyroid storm, and patients with adverse reactions to methimazole (other than agranulocytosis) who are not candidates for radioiodine or surgery.
When PTU is used, do liver function test in patients who develop symptoms possibly related to the liver. However routine liver function monitoring is not required.
Bahn RS, Burch HS, Cooper DS, et al. The role of Propylthiouracil in the Management of Graves' Disease in Adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid 2009;19:673.

Dr KK Aggarwal
Chief Editor

Photo feature

Dr KK Aggarwal receiving P.P. Jhunjhunwala XXI National Excellence Award from Sh. Sudarshan Aggarwal, Former Governer of Uttarakhand and Dr. Abhishek Manu Singhavi, eminent Parliamentarian and Legal Luminary.

Dr k k Aggarwal  get P.P. Jhunjhunwala XXI National Excellence Award

Catheter ablation may benefit patients with atrial fibrillation
Patients with atrial fibrillation should be referred for catheter ablation if an oral medication is not effective, said the authors of a study published in the Journal of the American Medical Association.

High PBDE blood levels linked to decreased fertility
Some flame-retardant chemicals known as polybrominated diphenyl ethers (PBDEs) may reduce fertility in women, according to researchers at the University of California Berkeley, The study findings are reported in Environmental Health Perspectives.

FDA approval of liraglutide

FDA approval of once-daily drug liraglutide to treat type 2 diabetes could open up a clearer path for other drugs within the GLP-1 class of diabetes treatments. Morphine sulfate solution for opioid tolerant patients The US FDA approved Roxane Laboratories' Morphine Sulfate oral solution for patients with moderate to severe chronic pain.

FDA revises information for bortezomib

The FDA has revised dosage and safety information for bortezomib (Velcade), the myeloma and mantle cell lymphoma drug, to reflect an increased toxicity risk. The new label includes a warning for patients with moderate-to-severe hepatic impairment and now recommends at-risk patients start at a lower dosage of 0.7 mg for the first cycle of treatment and escalate to 1.0 mg, or reduce further to 0.5 mg, in subsequent cycles.

FDA approves new First Response pregnancy test
US FDA has given consumer products manufacturer Church & Dwight Co. approval for a new pregnancy test. Its new First Response test can detect pregnancy up to six days before a woman misses her period -- one day earlier than other tests on the market.

Omega-3 fatty acids reduce the risk of heart disease
Omega-3 fatty acids have received a recent bump in popularity as the result of heavy marketing and a 2004 FDA ruling which determined that foods containing them may reduce the risk of one form of heart disease. Benjamin Caballero, a professor at the John Hopkins Bloomberg School of Public Health, however, cautioned that omega-3s can also thin the blood, and should not be used by stroke patients.

Running barefoot may avoid jarring impact
New research led by Harvard scientists and published in the journal Nature, shows that people who run barefoot or with minimal shoes, often land on their feet in a way that avoids a jarring impact. Whereas most shoe-clad runners strike the ground heel-first, jarring their bones, barefoot runners tend to land on the ball or middle of their foot.

All diabetics should undergo echo test as early-stage heart failure may be present in significant proportion of type 2 diabetes patients
A Swedish study of 153 patients published in the journal Cardiovascular Diabetology found that early-stage heart failure is present in a significant proportion of patients with type 2 diabetes with apparently normal cardiac function and should be looked for and treated more aggressively. Echocardiographic screening of asymptomatic diabetes patients may identify significant numbers of patients with asymptomatic left ventricular systolic and diastolic dysfunction.

Delay surgery after PCI to reduce risk of acute kidney injury Individuals undergoing cardiac surgery subsequent to a coronary intervention during the same hospital admission have a much higher risk of acute kidney injury than patients who are discharged after the PCI and come back later for their surgery, according to a study presented at the 2010 Annual Meeting of the Society for Thoracic Surgeons The incidence of acute kidney injury was 48 percent in the patients who had catheterization and surgery during the same cardiac admission and 38 percent in the patients who had cardiac catheterization during a previous admission (p=0.009).

Types of Ultrasounds (Dr G M Singh)
There are seven types of ultrasounds. 

1. Transvaginal scans: An ultrasound wand is inserted into the vagina to generate the images. This form is typically used in early pregnancy to provide detailed images of the uterus and ovaries.
2. Standard ultrasound: This is the traditional ultrasound that most women have sometime in their second trimester.
3. Advanced ultrasound: This exam is more comprehensive, typically using a higher-level machine that can provide more detailed pictures. It is typically performed in a high-risk center if a problem is suspected.
4. Doppler ultrasound: This ultrasound evaluates blood as it moves through blood vessels. It measures the speed of blood through the vessels and can also be used to identify any fetal heart defects and evaluate blood flow through the placenta.
5. 3-D,dynamic 3-D and 4-D ultrasound: Typically available in high-risk or research facilities, these scans provide incredibly detailed pictures of the fetus, including the face.
6. Fetal echocardiography: This test, which uses sound impulses to assess fetal heart function, is used to evaluate suspected heart defects in the fetus.

Dangers associated with a lack of physical activity: Excessive sitting can lead to increased risk of heart disease

According to a six year study of 8,800 Australians, every hour spent watching TV was associated with an 18 percent increase in heart disease deaths and an 11 percent increase in deaths. A similar Canadian study of 17,000 adults discovered a consistent link between chair time and deaths from heart disease.

Punjab & Sind Bank
Central Bank of India

Readers Responses

1. Best exercise during pregnancy: Although there's no evidence as to the ideal exercise during pregnancy, we suggest swimming. The water supports your belly, helps you feel lighter, reduces the risk of becoming overheated or falling and provides an excellent aerobic workout. (Dr.G.M.Singh)

2. Respected Dr Aggarwal: Congratulations on being awarded Padmashree. The new initiative of EMedical news is excellent and will help lot of people, I request you to please ensure a column of health tips. Thanks. With Regards: Dr Anil K Kothari (LIC)

3. Congratulations for prestigious award: Dr.B.P.Tyagi

4. Congratulations sir, another feather in your cap. Padmashree to u makes us all more proud: Dr Pawan Goyal

5. Dear Dr Aggarwal, Congratulations on the distinction conferred on you. Have been following your daily news bulletin and been enlightened a lot. Regarding how to know if a baby is hungry, I would like to share that babies normally like to put their hands into their mouth for oral stimulation also. This is often erroneously seen as hunger sign, raising doubts in the mother's mind regarding adequacy of her milk. This doubt paves the way for introducing other milk and unnecessary bottle feeding: Dr Premalatha Krishnan, MD DCH

6. Dear Dr KK Aggarwal, congratulations from all of us CGHS Mayur Vihar. Thanks And Regards: Dr. Sharda Varma, CMO I/C, CGHS Disp, Mayur Vihar,New Delhi

Conference Update
In the final analysis of an international randomized phase 3 trial, sunitinib, the multikinase inhibitor, was found to significantly prolong both survival and progression-free survival in patients with advanced progressive, well-differentiated pancreatic neuroendocrine tumors (NET). The study subjects were randomly assigned to continuous sunitinib 37.5 mg/d or placebo, along with best supportive care. (Eric Raymond, MD, professor of medical oncology, Beaujon University Hospital, Clichy, France; 2010 Gastrointestinal Cancers Symposium (GICS): Abstract 127)

Question of the Day
What is the choice of drugs for reducing the infectivity in malaria?
Artemisinin derivatives, as indicated earlier, have specific and significant activity against gametocytes. Effective treatment of a malaria blood infection with any antimalarial will, nevertheless, remove the source of new gametocytes by eliminating the asexual blood stages from which gametocytes derive. The faster the clearance of asexual blood parasites by a drug, the greater will be its impact on infectivity. In P. vivax, P. malariae and P. ovale infections, in which gametocytes have a short developmental period and are short-lived, effective treatment of the asexual blood infection alone (without the addition of gametocytocidal drugs) will be sufficient to abolish further infectivity to mosquitoes. P. falciparum is different because its gametocytes take longer to develop - about 12 days to mature from a young parasite (merozoite) - and the mature gametocytes may remain infective in the peripheral circulation for upto several weeks after the patient has been successfully treated for the asexual blood infection. In order to terminate infectivity of P. falciparum, the infection needs to be treated with drugs that have specific activity against gametocytes, i.e., either artemisinin-based combination treatments (ACTs) that destroy immature gametocytes, or by the addition of primaquine to the treatment regime to eradicate mature gametocytes. It is not known whether the use of primaquine with ACTs would result in a further suppression of infectivity, although it appears possible in principle, given that the two drugs act on different developmental stages of gametocytes.

eMedinewS Try this it Works
Help for unsteady hands

Freezing a small lesion with liquid nitrogen can prove challenging for physicians without steady hands. However, with use of the plastic earpiece normally reserved for the otoscope, liquid nitrogen spray can be funneled directly onto the lesion without fear of damaging the surrounding tissue.

Dr Good Dr Bad
Situation: A patient on 2 mg glimepiride was not responding.
Dr Good: Add metformin.
Dr Bad: Increase the glimeperide dose.
Lesson: Maximum doses of sulfonylurea rarely improve glycemic control if a somewhat lower dose was ineffective. (Ann Intern Med 1993;118:169.)

Make Sure
A patient was brought to the ICU in cardiogenic shock.
Oh my God! Why didn't you take him for emergency angiography and subsequent PTCA.
Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI-2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Laughter the Best Medicine (Sent by Ms Kamleshwari)
"My gynecologist said she would have me on my feet in two weeks." "And did she?" "Yes, I had to sell the car to pay the bill."

ENT Facts
A certain diagnosis of acute otitis media requires: rapid onset, presence of middle ear effusion and signs and symptoms of middle-ear inflammation.

SMS Anemia
Oral iron therapy is usually the first-line therapy for patients with iron deficiency anemia (IDA).

Milestones in Neurology
Nathan Weiss (1851-1883) was an Austrian physician and neurologist. He is remembered for pioneer systematic research of the spinal marrow, medulla oblongata and basal ganglia, and in 1881 showed a causal relationship between tetany and the removal of goitre. The eponymous 'Weiss' sign' is named after him, which today is usually referred to as 'Chvostek's sign'.

Formulae in Imaging
The most accurate signs of pleural effusion (PE) on supine chest X-ray are increased density of the hemithorax, blunted costophrenic angle, and loss of the hemidiaphragm silhouette. (Source: Eur Radiol 1997;7(1):57-60).

Avoiding mistakes in Critical Care
Include drug name, exact metric weight (i.e, grams, milligrams, micrograms, and milliliters), concentration, and dosage form.

Press watch (Dr Vivek Chhabra)
Scientists at the Stanford University School of Medicine may have taken the controversy out of the entire field of stem cell research. In a paper published online in the journal Nature, they report that they were able to transform mouse skin cells directly into functioning nerve cells without needing to go through a stem cell stage first. As they say in their paper, this "could have important implications for studies of neural development, neurological disease modeling and regenerative medicine."

The researchers accomplished this by applying just three genes to the skin cells in a laboratory dish. The entire process took just a week and worked about 20% of the time. The researchers are now trying the same experiments using human cells.
"This study is a huge leap forward," Irv Weissman, director of Stanford"s Institute for Stem'Cell Biology and Regenerative Medicine, said on its website. "Finally, we may be able to capture and study conditions like Parkinson's or Alzheimer's or heritable mental diseases in the laboratory dish for the first time." "I no longer think that the induction of iPS cells is a reversal of development," says Marius Wernig, MD, assistant professor of pathology and a member of Stanford's Institute for Stem Cell Biology and Regenerative Medicine. "It's probably more of a direct conversion like what we're seeing here, from one cell type to another that just happens to be more embryonic-like. This tips our ideas about epigenetic regulation upside."

Quote (Sent by Swapna C K )
Prayer is exhaling the spirit of man and inhaling the spirit of God. (Edwin Keith)

Public Forum
Press Release
Air Pollution Leads to Heart disease in Postmenopausal Women

Postmenopausal women who live in areas with higher air pollution levels have a higher risk of developing cardiovascular disease and of dying from it, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

The risks involved include heart attack, stroke, needing bypass surgery, or of dying of a cardiovascular cause.

Quoting a Washington-based study published in the New England journal of Medicine, Dr. Aggarwal said that very small particulate matter can penetrate into the lungs and cause damage over time.

Fine particulate matter is comprised of tiny particles of soot or dust carried in the air. They mostly come from combustion of fossil fuels, although vegetative burning has an impact. Most of the culprits are power plants, coal burning and motor vehicle exhaust, especially diesel exhaust. Reducing fine particulate air pollution could result in less cardiovascular disease and fewer deaths.

In the study, each increase of 10 micrograms of fine particulate matter per cubic meter was associated with a 24 percent increase in the risk of a cardiovascular event and a 76 percent increase in the risk of death from cardiovascular disease. Women having a higher long-term average exposure had a higher risk.

(Advertorial section)


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Management: There is no cure for Alzheimer's disease. However, many health supplements containing Silicic acid as a main constituent are known to help in reducing the absorption of Aluminium, a known factor in Alzeimer's disease, by reducing the uptake through digestive system and by enhancing the elimination of Aluminium through renal excretion.

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eMedinewS-PadmaCon 2010: 

Will be organised at MAMC on 3rd July Sunday to commomorate Doctors day. The speakers, chairpersons and panelists will be various past and present medical padma awardees of NCR.

eMedinewS-revisiting 2010

The second eMedinewS-revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on 2nd January 2011. The event will have a day-long CME, doctor of the year awards, cultural hangama and live webcast.  Suggestions are invited.

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