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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

3rd February 2010, Wednesday

Practice Changing Updates: Daunorubicin dose for acute myeloid leukemia induction

When cytarabine and daunorubicin are used as a 'seven plus three' regimen for induction therapy in patients with acute myeloid leukemia, the daily dose of daunorubicin should be 60 to 90 mg/m2 for three days, rather than 45 mg/m2 for three days.

Two randomized phase III trials of patients with AML compared daunorubicin 45 or 90 mg/m2 for three days (plus continuous infusion of cytarabine 100 mg/m2 daily for seven days), patients who received the higher dose of daunorubicin had higher complete remission rates with no significant increased toxicity. Also, younger patients receiving the higher daunorubicin dose had longer median overall survival rates.

1. Fernandez HF, Sun Z, Yao X, et al. Anthracycline dose intensification in acute myeloid leukemia. N Engl J Med 2009; 361:1249.
2. Lowenberg B, Ossenkoppele GJ, van Putten W, et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med 2009; 361:1235.

Dr KK Aggarwal
Chief Editor

New drug to improve walking in multiple sclerosis patients
On January 22, 2010, the US FDA approved Ampyra, an oral drug used to help improve walking in patients with multiple sclerosis (MS). Ampyra, a potassium channel blocker, is an extended-release tablet formulation of dalfampridine (4-aminopyridine, 4-AP). In laboratory studies, dalfampridine was found to improve impulse conduction in nerve fibers in which myelin had been damaged.

FDA issues safety notice for sibutramine
On January 21, 2010, the US FDA issued a statement about sibutramine (Meridia) to follow up regarding earlier concerns that use of the drug may elevate the risk of adverse cardiovascular events. Meridia is FDA-approved for the management of obesity, including weight loss and maintenance of weight loss, along with a reduced-calorie diet.
The notification was based on data from the Sibutramine Cardiovascular Morbidity/Mortality Outcomes in Overweight or Obese Subjects at Risk of a Cardiovascular Event (SCOUT) study. A new contraindication is being added to the sibutramine product label stating that sibutramine is not to be used for patients with CVD, including those with the following:

  • history of coronary artery disease (e.g., myocardial infarction, angina)
  • history of stroke or transient ischemic attack 
  • history of cardiac arrhythmias
  • history of congestive heart failure 
  • history of peripheral arterial disease 
  • uncontrolled hypertension (e.g. with BP >145/90 mm Hg)

Actemra approved for rheumatoid arthritis
Actemra (tocilizumab), a new drug for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have experienced an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies received FDA approval on January 11, 2009. Actemra is an interleukin-6 (IL-6) receptor-inhibiting monoclonal antibody. It may be used alone or in combination with methotrexate or other disease-modifying antirheumatic drugs (DMARDs).

Asthmatic patients are at increased risk for depression
According to a study, primary care patients with asthma, a chronic illness, face a significantly increased risk of developing depression than those who do not have the disease. The findings of the study were presented at the annual meeting of the North American Primary Care Research Group. During a 10-year follow-up period, the incidence of depression was significantly higher in the group with asthma, compared with controls (22.4 vs 13.8 per 1,000 person-years). The odds ratio for depression among asthmatic patients remained elevated (1.5) even after adjustment for age, sex, chronic illness, and smoking. The authors suggest that family physicians should screen their asthmatic patients for depression. (Dr. Paul Walters, Institute of Psychiatry, King’s College, London)

Readers Responses
1. Dear Dr Aggarwal, On the basis of one study, it would be premature to state decisively as you have done: News: Do not give statins in asthma. In much smaller font, you yourself have mentioned that more studies are needed. Regards, Anju Virmani.

2. Many Many Many Many Many Congratulations for receiving PADMASHRI award. Dr. Pramod Lokegaonkar, Manager, Medical Cell, Sandu Pharmaceuticals Ltd.

3. Hardwork, dedication, selfless services and of course your intelligence has been recognized. We feel proud of you. Congrats: Dr. Arti Pathak & J C Pathak.

4. Full of great achievements and experience, a meaningful chapter is written by you in a fabulous 2010 that makes us feel proud. Heartiest congratulations. Anshu Aggarwal.

5. Dear Sir: This is to enquire about any proposals that the DMC has or may have about abolishing the fee for a re-registration/renewal at DMC. I understand that the policies made at DMC are governed by many factors and people and not individuals, but I fail to understand who gives the candidates (in run for the various posts at DMC elections) the right to make promises of abolishing the fee for re registration People are reluctant to get a re-registration probably because many other similar councils do not charge their members a fee for re-registration. A late fee for renewal will only further demoralize many from applying for a renewal. My mailbox is flooded by many emails from the now elected members from the practitioners in Delhi but none has ever addressed to the promises made on this issue that was an important highlighted issue by many candidates in the run for the member post then. SILENCE IS GOLDEN... probably. I request you to look into this and provide some information on the website which incidentally has no link like "contact us" or "Your Queries" thanks and regards, Dr Pradeep Saini, drps7777@gmail.com, drpradeepsaini@aol.com

Conference Update
In contrast to some previous studies that found no benefit with newer chemotherapy regimens in elderly colorectal cancer patients, a randomized phase 3 trial showed better outcomes with adjuvant capecitabine and oxaliplatin (CapOx) than with standard 5-fluorouracil and leucovorin (5-FU/LV). The results came from a subanalysis of the NO16968 study, which compared adjuvant CapOx with standard chemotherapy in stage III colon cancer patients. (Daniel G. Haller, MD, University of Pennsylvania's Abramson Cancer Center, Philadelphia; 2010 Gastrointestinal Cancers Symposium (GICS): Abstract 284)

Conference Calendar

IInd CME in Pathology - Thymic Lesions, Renal Biopsy Interpretations and Histopathology Slide Seminars –

February 5-7,
MVJ Medical College & Research Hospital
Hosakote, Bangalore, Karnataka

Punjab & Sind Bank
Central Bank of India

Question of the Day
Is intrarectal quinine as effective as intravenous or intramuscular quinine?
One systematic review of eight trials detected no difference in effect on parasites, clinical illness between the rectal group and either IM or IV groups. Some studies however excluded patients with severe malaria.
Suggested reading
Eisenhut M, Omari AA. Intrarectal quinine for treating plasmodium falciparum malaria. Cochrane Database Syst. Rev. 2005;25(1):CD004009.

eMedinewS Try this it Works
"Birthday candles" help auscultation
When auscultating chest in an uncooperative child, ask him or her to pretend to blow out candles on a birthday cake. Use your fingers as the candles, folding them down as the child blows and repeating as many times as needed for adequate auscultation.

Dr Good Dr Bad
Situation: A patient came with A1C of 11%.
Dr Good: Start insulin.
Dr Bad: First try oral drugs.
Lesson: Insulin is considered a first-line therapy for all patients with type 2 diabetes, particularly patients presenting with A1C >10 percent, fasting plasma glucose >250 mg/dL (13.9 mmol/l), random glucose consistently >300 mg/dL (16.7 mmol/l), or ketonuria.

Make Sure
A patient with community-acquired pneumonia (CAP) developed diarrhea after 3 weeks of antibiotic regimen
Reaction: Oh my God! Why was the antibiotic given for 3 weeks.
Make sure that CAP patients are treated for five days (Infectious Diseases Society of America/American Thoracic Society guidelines)

Laughter the Best Medicine
Shortly after the 911 emergency number became available, an elderly and quite ill lady appeared in a hospital emergency room, having driven herself to the hospital and barely managing to stagger in from the parking lot.

The horrified nurse said, "Why didn't you call the 911 number and get an ambulance?" The lady said, "My phone doesn't have an eleven."

ENT Facts
Other symptoms of a viral upper respiratory infection, such as cough and nasal discharge or stuffiness, often precede or accompany acute otitis media (AOM.)

SMS Anemia
Serum ferritin is the best noninvasive test for the diagnosis of iron deficiency anemia at all ages.

Milestones in Neurology
Morris Bender (1905 -1983) was an American neuroscientist and professor of neurology at the Mount Sinai School of Medicine. Bender was among the most widely published neurologists of his generation, publishing more than two hundred peer-reviewed articles. His textbook, Disorders in Perception (1952), remains highly influential.
He was a leading researcher on the ocular motor system. His work clarified how the brain sends signals that move the eye and resulted in significant advances in therapy for brain tumors.
Bender is best known today for pioneering non-surgical treatments for subdural hematomas.

Prayer is the spirit speaking truth to Truth. (Philip James Bailey)

LIST OF APPROVED DRUG FROM 01.01.2009 TO 31.10.2009
  DRUG NAME                                INDICATION                       APPROVAL DATE
  Misoprostol Tablet 600mcg            Addl. Strength                               09.01.09

Public Forum
Press Release
Most uncontrolled asthmatics think they are controlled

Two-thirds of patients with uncontrolled asthma think their disease is well under control, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS. Asthmatics on proper medicines can not only live a normal life but also reduce their future complications.

Uncontrolled asthmatics invariably end up with right heart complications due to persistent lack of oxygenation in the blood.

Dr. Eric van Ganse, of University of Lyon, France, in a study published in the Annals of Allergy, Asthma, and Immunology, examined 1,048 subjects with inadequate asthma control. When asked how they would rate their asthma control over the past 14 days, over 69 percent considered themselves to be completely or well controlled. Failure to perceive inadequate asthma control was more likely to be found in patients between the ages of 41 and 50 years.

The reasons are
1. Most asthmatics fail to perceive their level of disease control and with an uncontrolled state, they often feel that their asthma is under control.
2. In severe asthma, low blood oxygen levels might impair a person's ability to assess their own breathing difficulty.
3. The notion of asthma control seems poorly understood by asthmatic patients.
4. Mild to moderate asthma limits the activities of a person and they, over a period of time, take that as their normal limits.

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