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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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; Member 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


3rd July, 2010, Saturday

Statins reduce recurrence risk after radical prostatectomy

Statins may reduce the risk of biochemical prostrate cancer recurrence after radical prostatectomy. Researchers used data from five Veterans Administration Medical Centers to examine whether statin use was associated with outcomes in men who had had radical prostatectomy. Time to prostatespecific antigen (PSA) recurrence was compared in men who were taking statins (n=236) and those who were not (n=1,083). The study results will be  published in the July 15 Cancer.

Statin users were followed for a median of 24 months, while nonstatin users were followed for a median of 38 months. Men taking statins were older and heavier and had recently undergone radical prostatectomy than those not taking statins. They were also diagnosed with prostate cancer at a lower clinical stage and with lower PSA levels but had higher Gleason scores at biopsy. Thirtyseven statin users (16%) and 267 nonusers (25%) had biochemical recurrence during followup.

Risk for PSA recurrence was 30% lower in statin users compared with nonusers. This lowered risk was found to be dose-dependent, with hazard ratios of 1.08 for the equivalent of less than 20 mg of simvastatin, 0.57 for the equivalent of 20 mg of simvastatin, and 0.50 for the equivalent of more than 20 mg of simvastatin.

Statins were associated with a dosedependent lower risk for PSA recurrence in men who had had a radical prostatectomy.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Green CitiesPlan for the Planet

Delhi Medical Association with all its 12 branches and Heart Care Foundation of India jointly organized a Pre Event Press Conference on May, 27th 2005 at Chemsford Club New Delhi to create awareness about environmental issues and to announce the activities planned for the World Environment Day June, 5 2005 based on the theme ‘Green CitiesPlan for the Planet’.

 

Dr k k Aggarwal
Actor Milind Gunaji, during a PreEnvironment day press conference. Also in the photo Padama Shri and B C Roy Awardee Dr K K Aggarwal, President HCFI

 

News and views

mTOR inhibitors may not halt decline in renal function associated with ADPKD (Dr Monica and Brahma Vasudeva)

The mTOR inhibitors, everolimus and sirolimus, failed to stop the decline in renal function associated with autosomal dominant polycystic kidney disease (ADPKD), as reported in studies published in the New England Journal of Medicine.

Try another statin (Dr G M Singh)
  • Rechallenge with a lipophilic statin is warranted in cases of statin myalgia.

  • Other causes of underlying myalgia/myositis need to be considered in patients with multiple drug intolerances.

  • Ezetimibe or bile acid sequestrants are alternative methods of lowering LDL.

  • Niacin and some fibrates also lower LDL.

  • It is usually necessary to resort to combination therapy in cases of statin intolerance.

Prasugrel cancer concerns gain momentum

Potential cancer risks associated with the antiplatelet drug prasugrel (Effient) should raise clinical concerns –– and may even warrant a boxed warning. Unpublished data from the pivotal TRITON-TIMI 38 trial that tested the drug against clopidogrel, suggested that the risk of new or worsened solid-tumor cancers was increased more than 60% with prasugrel (relative risk 1.62, P=0.001). The findings, published in the June 28 issue of the Archives of Internal Medicine, pointed to a greater risk than was apparent from the published results from TRITONTIMI 38 or the FDA's own analysis, presented at a February 2009 advisory committee meeting.

Univ of Michigan to reject industry sponsors for CME

Industry funding for CME programs will no longer be welcome at the University of Michigan come next January, its medical school announced. A statement signed by James O. Woolliscroft, MD, dean of the UM medical school, and Raymond J. Hutchinson, MD, associate dean for regulatory affairs said that the decision "was based on a review of literature about the influence on clinical faculty of industryfunded CME." Jan. 1, 2011 has been selected as the date for the policy to go into effect. The University spokeswoman Mary Masson said the full policy was still in development and should be completed by this fall. University of Michigan appears to be the nation's first major medical school to formally reject commercial sponsorship of CME activities.

 

MCI Update

The case of Dr Desai did not come for thebaila s the Judge was no leave. CBI lawyer came with the charge sheet but the same was not submitted. The next hearing is on 6th inn the CBI lower court and on  onday ? in the high court.

 

Legal Column

Forensic Column

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

Drunken Driving

The offense of driving whilst under the influence of alcohol is one for which there is no defense because more than ta housand of death due to road traffic accident from south Delhi alone are brought to AIIMS every year.

Motor vehicle driving under the intense influence of alcohol is common on the roads of Delhi. I still remember the day, almost a decade back, when I conducted the autopsy of the victims of BMW hit and run case of Lodhi Road, the alarming case of road rage a decade ago in Delhi at AIIMS.

The scenario of drunken driving has worsened keeping in view driving under the combined influence of alcohol and other narcotic drugs. Literature has shown that illegal drug levels in blood are a common finding in almost a quarter in road traffic accident (RTA) cases. There is a rising incidence of RTAs where the presence of drugs in a driver's body may have been a contributory factor to the cause of the crash.

Drug driving is most common among 20 to 24 yearolds, with clubbers being the most likely to take control of a car in a chemically altered state. In a survey by the Scottish Executive’s Road Safety Campaign, 81% of clubbers had driven after recreational drug use, with many believing that cannabis had little or no impact on their driving skills, and some thinking that amphetamine use actually improved their driving skills.

Unfortunately, ignorance is far from bliss when it comes to getting behind the wheel while under the influence.

 

Experts’ Views

Interesting tips in Hepatology & Gastroenterology

Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi

Dr Neelam Mohan delivered a lecture on 'Do not ignore a child with abdominal pain' at a Seminar organised by the Indian Academy of Pediatrics (IAP) at Kanpur. Click on the link to read the Press Clipping.

 

Public Forum (Press Release for use by the newspapers)

Deworm your child now

During monsoon, humidity levels are high; houseflies, mosquitoes and other disease-carrying organisms flourish under these conditions. All fruits and vegetables should be washed with clean water; potassium permanganate can be added if available. Leafy vegetables and cauliflower often contain worms, cautioned Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Roundworms or the Ascaris are abundant in soil. Good sanitation to prevent fecal contamination of soil is required which may not be possible in the monsoon season.

A Sri Lankan study has shown that even in the setting of poor sanitary facilities, washing hands before meals and drinking boiled water significantly reduces the risks of Ascaris infection.

However, this alone may not be sufficient. This is the time to give your child a tablet of deworming if it has not been given and then to repeat three to four times a year said Dr Aggarwal.

Mass treatment for all schoolage children with single dose mebendazole or albendazole every three to four months has been advocated in most countries. This serves the dual function of treating the children and also reducing the overall worm burden in the community.

To support this, he cited a large randomized trial of schoolbased deworming performed in Zanzibar, where single dose mebendazole, given three times a year, decreased intensity of Ascaris infection by 97 percent, compared to those children who received no mebendazole.

 

International Medical Science Academy Update (IMSA)

The ESCAPE trial in 385 children with chronic kidney disease found that intensified blood pressure control with a targeted goal of a 24hour mean arterial pressure below the 50th percentile, compared with conventional blood pressure control (target MAP between the 50th and 90th percentiles), results in slower progression of CKD. (Wuhl E, Trivelli A, Picca S, et al. Strict bloodpressure control and progression of renal failure in children. N Engl J Med 2009;361:1639)

Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Glatiramer Acetate Injection (20mg/ ml) & Pre–filled syringe (20mg/ml)

For the reduction of the frequency of relapses in patients with Relapsing–Remitting Multiple Sclerosis.

3.06.2009

Medi Finance

Individual-Mediclaim Policy: Salient features of the policy

1.1 The policy covers expenses incurred as a result of hospitalization/domiciliary hospitalization expenses for illness/diseases or injury sustained.

Lab Medicine

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

TSH estimation by CLIA technology

Chemiluminescence Immunoassay (CLIA) detection using Microplate luminometers provides a sensitive, high throughput, and economical alternative to conventional colorimetric methodologies, such as Enzymelinked immunosorbent assays (ELISA).Recently, chemiluminescent immunoassay has been shown to be more sensitive than the conventional colorimetric method(s), and does not require long incubations or the addition of stopping reagents, as is the case in some colorimetric assays.

IJCP
IJCP
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nuspera
Docconnect
IJCP
 

An Inspirational Story (Anuj Goyal)

Albert Einstein was often asked to explain the general theory of relativity.

"Put your hand on a hot stove for a minute, and it seems like an hour," he once declared.

"Sit with a pretty girl for an hour, and it seems like a minute. That’s relativity"

 

IJCP Special

Question of the Day

What are the symptoms of diabetic retinopathy?

Prof. Dr Samar Banerjee, Howrah

Until the case is far advanced, patients are mostly asymptomatic and diagnosed much late (retention of good vision in one eye may mask diagnosis in the affected eye).

Symptoms attributed to diabetic retinopathy are:

  • Gradual loss of vision due to maculopathy

  • Sudden painless loss of vision due to:

    • Vitreous hemorrhage from rupture of retinal vessels

    • Retinal vascular thrombosis both arterial and venous

    • Retinal detachment

  • Appearance of floaters, due to small vitreous hemorrhages

  • Chronic pain and redness

  • Field defect and improved night vision developing after laser photocoagulation

Suggested reading

  1. Rajendran V, Battu R, Raizada S, et al. Eye disorders and diabetes. In: RSSDI Text Book of Medicine. Ahuja MMS, et al (Eds.), RSSDI, Hyderabad 2002:57187.

  2. Yamashita H, Akanuma Y. Diabetic retinopathy. In: Natural History and Progression, Diabetes in the New Millennium. Turtli JR (Ed.), The Endocrinology and Diabetes Research Foundation of the University of Sydney, Australia 1999:37785.

Dr Good Dr Bad

Situation: A patient with severe secondary MR came with refractory end-stage heart failure.
Dr Bad: Go for mitral valve repair.
Dr Good: You should try biventricular pacing.
Lesson: According to the 2009 focused update of the 2005 ACC/AHA heart failure guidelines effectiveness of mitral valve repair or replacement for severe secondary mitral regurgitation in refractory end-stage heart failure is not established. (Circulation 2009;119:e391)

Make Sure

Situation: A 4yearold girl with rickets was unresponsive to high doses of vitamin D.
Reaction: Oh my God! Why didn’t you advise alfacalcidol?
Lesson: Make sure to advise alfacalcidol in patients unresponsive to calcium/vitamin D therapy. Alfacalcidol, in numerous studies, has been found to be effective in refractory cases of rickets.

Mistakes in Clinical practice

Do not write "HS" bed time: it can be mistaken for hours of sleep or half strength or mistaken as ‘N’ or intrajugular.

Mnemonic of the Day (Dr Varesh Nagrath)

Drugs which can cause serotonin syndrome with SSRIs

LOST LCM

Ltryptophan
Opioid
SNRI
Triptans

L
ithium
Cloimipramine
Mirtazepine

Quote of the Day: Dr. Santosh Sahi

"Decision is the spark that ignites action, until a decision is made nothing happens." Winifred A. Peterson

Milestones in Dermatology

Psoriasis: The name is derived from the Greek word ' psora' which means 'to itch.' Psoriasis is a disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. In 1841, the condition was finally given the name psoriasis by the Viennese dermatologist Ferdinand von Hebra.

 

Humor Section

Funny Definitions

Dilate…………………………To live long

Medical bloopers on medical charts!

Healthyappearing, decrepit 69 year old male, mentally alert but forgetful.

 

Forthcoming Events

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

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

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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