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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 

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  Editorial …

3rd August 2011, Wednesday

Will the Banned Rosiglitazone be reintroduced for Neuropathic Pain?

Banned drugs are in the news these days. Many drugs have been banned recently by the Drug Controller of India. DCI banned gatifloxacin for systemic and oral use. Gatifloxacin eye drops were approved after the systemic use was banned.

Now, rosiglitazone, the anti–diabetes drug that was banned last year is being explored as a short–term pain medication in the US.

In patients who take rosiglitazone for glucose control, there is abundant evidence that rosiglitazone can increase the risk for heart failure, myocardial infarction, or death compared with its cousin, pioglitazone.
In some patients this drug is the best bet. The US FDA recently released a rosiglitazone risk management strategy which limits the drug to patients already successfully treated with it or those for whom it’s a last resort to control blood glucose medically.

The European Medicines Agency and the India DCI went further than its US counterpart by putting a complete halt on the sale of medications that contain rosiglitazone.

According to new findings, development of nerve damage–induced neuropathic pain can be prevented by controlling peripheral acute inflammation. The study will be published in the August issue of Anesthesia and Analgesia.

The preliminary exploration is based on a mouse model. Only 3–day administration of rosiglitazone immediately after nerve injury was sufficient to inhibit the development of chronic pain. So, patients would not need to take their medication daily to manage pain, like those with diabetes and might experience less risk because of it.

Local injection of rosiglitazone also produced similar effects as systemic administration. The side effects on the cardiovascular system can be avoided by local administration and by limiting duration for treatment to the acute phase.

(Source: Anesth Analg 2011;113:398–404)

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Will the Banned Rosiglitazone be
reintroduced for Neuropathic Pain?

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issue

Dr Rajesh Chawla presenting his views in the National Conference on Insight on Medicoleagl Issues held on 10th July, 2011.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

70% lose temper due to jam: Study

NEW DELHI: Delhi’s choked roads and poor traffic management are largely responsible for the violent outbursts and cases of road rage, an AIIMS study shows. The study, based on the psychosocial analysis of 200 car drivers, including cases identified by the police, was conducted recently. About 70% people lost temper due to a traffic jam. The pent–up frustration often erupted in the form of road rage. Honking, incorrect parking, overtaking from the other side and bad roads were other factors. Dr Manju Mehta, clinical psychologist who led the study funded by the ministry of health and family welfare, said women were found to be high on aggression and exhibited feelings of irritability while driving. "But their expression of anger was different from men. Women generally responded by verbal abuses and showed irritability, while men were more apt to take to violent measures," said Mehta.

(Source: The Times of India, Jul 30, 2011)

For Comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Dr Monica and Brahm Vasudev)

We’re eating less sugar –– but still far too much

According to research published online July 13 in the American Journal of Clinical Nutrition, Americans are cutting back on the amount of added sugar they’re eating, from about 3.5 ounces a day in 2000 (25 teaspoons, or 375 calories) to 2.7 ounces a day in 2008 (19 teaspoons, or 285 calories). The term "added sugars" was promoted by the U.S. Department of Agriculture to help people make the distinction between sweetened foods with low nutritional contents – items like soft drinks and candy bars – and naturally sweet foods such as fruits and some vegetables.

For comments and archives

US Guidelines for consumption of sugar may be too high

According to a study to appear in the Oct. issue of the Journal of Clinical Endocrinology & Metabolism, adults who consumed 25% of their daily calories as fructose or high–fructose corn syrup beverages (a percentage within current government guidelines) for two weeks experienced increases in serum levels of cholesterol and triglycerides.

For comments and archives

South Asians more vulnerable to diabetes, coronary artery disease

A new study led by an Indian–origin scientist has revealed that South Asians are more likely to add dangerous organ–hugging fat that can lead to diabetes and coronary artery disease. The team at McMaster University led by Dr. Sonia Anand found that these ethnic groups tend to add dangerous fat onto their internal organs like their liver when they gain weight, while others just add it to their waistline. "The new study showed South Asians have less space to store fat below the skin than white Caucasians," said Dr. Anand, a professor of medicine and epidemiology at McMaster University. "Their excess fat, therefore, overflows to ectopic compartments, in the abdomen and liver where it may affect function," she said. This visceral fat, she added, is associated with metabolic problems such as elevated glucose and abnormal lipids, which are risk factors that ultimately lead to coronary artery disease. (Source: http://www.newstrackindia.com/newsdetails/232949, 31 Jul 2011)

For comments and archives

 
    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Inadequate exercise is a leading cause of increased medical costs

You’ve heard it before – exercise contributes to employee productivity, and it decreases absenteeism and employer medical costs. A study recently published in the Journal of Occupational and Environmental Medicine shows that among nearly a dozen risk factors, employees not getting enough exercise is a leading cause of increased medical costs for employers.

Researchers examined health–related behaviors and characteristics deemed as health risks for employees at a large (anonymous) company. They then compared employees’ risk profiles with their medical records and sick time, and performed analyses to find out which employee risks were more costly. The study researchers evaluated employees for the following risks: overweight/obesity, high blood pressure, high blood glucose, high alcohol consumption, tobacco use, poor safety practices, high triglycerides, poor emotional health, poor nutrition, inadequate exercise, and high cholesterol. They determined that several risks were far more costly for employers, having the greatest impact on absenteeism and medical costs for the company. These risks were obesity, high blood pressure, high blood glucose, and inadequate exercise. It’s also important to note that exercise impacts all of the aforementioned most risk factors; it decreases blood glucose and blood pressure and reduces the risk of obesity.

The study authors encourage the company to implement health promotion initiatives and employee exercise programs with incentives to participate in exercise.

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    Twitter of the Day

@DrKKAggarwal: #IJMD: Comparative Study of Manual Cephalometric Tracing and Computerized Cephalometric Tracing in Digital (cont) http://tl.gd/c3e50g

@DeepakChopra: Be a passionate lover in life and you will be a lover in death a lover in the tomb a lover on the day of resurrection a lover forever– Rumi

 
    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

What is the treatment of pruritus in renal failure?

Patients with end–stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis is unknown, but improving the quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Broadband ultraviolet phototherapy can be extremely beneficial. Gabapentin has been recently discovered as an effective agent for the patient with ESRD pruritus (Berger TG, Steinhoff M; Semin Cutan Med Surg 2011 Jun;30(2):99–100).

For comments and archives

 
    Spiritual Update

Science behind Kanwar Yatra in the Shravan Month

In the month of Shravan Saffron–clad kanwarias congregate at the celestial town Haridwar to collect holy ganga jal from Har–ki–Pauri and return home traversing barefoot to offer the Gangajal to Lord Shiva Lingam on the occasion of Shivratri

For comments and archives

 
    An Inspirational Story

(Dr Maj Prachi Garg)

11 Things you didn’t learn in school

–– By Charles Sykes, from his book "Dumbing Down our Kids"

Rule 1: Life is not fair – get used to it.
Rule 2: The world won’t care about your self–esteem. The world will expect you to accomplish something BEFORE you feel good about yourself.
Rule 3: You will NOT make 40 thousand dollars a year right out of high school. You won’t be a vice–president with a car phone, until you earn both.
Rule 4: If you think your teacher is tough, wait until you get a boss. He doesn’t have tenure.
Rule 5: Flipping burgers is not beneath your dignity. Your grandparents had a different word for burger flipping – they called it opportunity.
Rule 6: If you mess up, it’s not your parents’ fault, so don’t whine about your mistakes, learn from them.
Rule 7: Before you were born, your parents weren’t as boring as they are now. They got that way from paying your bills, cleaning your clothes and listening to you talk about how cool you are. So, before you save the rain forest from the parasites of your parents’ generation, try delousing the closet in your own room.
Rule 8: Your school may have done away with winners and losers but life has not. In some schools they have abolished failing grades and they’ll give you as many times as you want to get the right answer. This doesn’t bear the slightest resemblance to ANYTHING in real life.
Rule 9: Life is not divided into semesters. You don’t get summers off and very few employers are interested in helping you find yourself. Do that on your own time.
Rule 10: Television is NOT real life (nor are video games). In real life people actually have to leave the coffee shop and go to jobs.
Rule 11: Be nice to nerds. Chances are you'll end up working for one.

For comments and archives

 
    Idioms

(By Ritu Sinha)

Can’t cut the mustard: Someone who isn’t adequate enough to compete or participate.

 
    Pediatric Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

How does one investigate a case of croup ?

  • DO NOT DISTURB the baby unnecessarily.
  • Radiographs should be used only if diagnosis is uncertain.
  • Neck radiographs or blood tests cause anxiety in the child which may precipitate further distress and obstruction in those significantly obstructed.
  • X–ray PA view of the soft tissues of the neck reveals a tapered narrowing (steeple sign) of the subglottic trachea instead of the normal shouldered appearance.
  • Radiographic imaging does not reliably reflect the severity of airway obstruction.

For comments and archives

 
    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

Why are Tetanus–Diphtheria–Pertussis (Tdap) and Tetanus–Diphtheria (Td) vaccine important?

A tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) was approved by the ACIP in 2005 (still under CDC and HHS review) and was recommended for adults (19 to 64 years of age) who have or who anticipate having close contact with an infant less than 12 months of age. Any woman who might become pregnant or is immediately postpartum is encouraged to receive a single dose of Tdap. Although pregnancy is not a contraindication to Tdap or Td vaccination, guidance on the use of Tdap during pregnancy is still under ACIP review. In the interim, women who received their last tetanus toxoid–containing vaccine more than 10 years earlier should receive Td, not Tdap, during pregnancy.

For Comments and archives

 
  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Calcitonin

The test is primarily used

  • To help diagnose C–cell hyperplasia and medullary thyroid cancer
  • To evaluate the effectiveness of treatment
  • To monitor patients for recurrence
  • To screen for medullary thyroid cancer in family members of patients with multiple endocrine neoplasia type 2 (MEN 2)

With successful treatment for medullary thyroid cancer (removal of the thyroid gland and often some surrounding tissues), calcitonin levels will usually fall to very low levels. If the values stay low over time, then it is likely that the treatment was effective. In some cases, calcitonin levels will fall but remain moderately elevated after treatment. This means that some calcitonin–producing tissue remains. Doctors will monitor calcitonin and watch for increases over time. If calcitonin levels begin to rise, then it is likely that there is a recurrence of medullary thyroid cancer.

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    IJCP Special

Dr Good Dr Bad

Situation: An alcoholic 66–year–old diabetic male with pneumonia was not responding.
Dr Bad: It is routine pneumonia.
Dr Good: This is a case of drug–resistant S. pneumoniae.
Lesson: Risk factors for drug–resistant S. pneumoniae in adults include: Age >65 years; beta–lactam, macrolide, or fluoroquinolone therapy within the past 3 to 6 months; alcoholism; medical comorbidities; immunosuppressive illness or therapy and exposure to a child in a day care center (Chest 2005; 127:1752; Clin Infect Dis 2005;40:1288; Clin Infect Dis 2006;43:432 and Clin Infect Dis 1998;26:1188)

For comments and archives

Make Sure

Situation: A child died of a seizure while swimming.
Reaction: Oh my God!! Why was he allowed to swim?
Lesson: Make sure that patients with uncontrolled epilepsy are not allowed to swim.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

Humor is a rubber sword – it allows you to make a point without drawing blood. Mary Hirsch

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Firearm injuries of the head

In most firearm injuries of the head, the bullet passes completely through the skull. As it enters the skull, the bullet produces a clean cut hole in the outer table and a larger hole in the inner table. At its point of exit, these conditions are reversed and the hole in the outer table is larger than the hole in the inner table.

  • These facts are often of importance in determining the direction of fire in bullet injuries of the head. The track of a bullet through the brain tissues varies greatly, depending on the range and stability of the bullet.
  • On the other hand, if it remains high velocity at the time that it impacts with the skull, there may be considerable damage from the cavitation effect within the skull. Fissured fractures often radiate through the vault and base of the skull from the bullet entrance and exit holes.
  • In certain bullet injuries of the head, the bullet may fail to emerge from the skull and in these cases an area of bony comminuting is often found at the site of lodgment.
  • When a bullet strikes the head at a tangent, penetration of the skull may final to occur, but the force of the bullet may be sufficient to fragment the inside table at the site of impact.

For comments and archives

 
    Mind Teaser

Read this…………………

A blood stained discharge from the nipple indicates one of the following:

1. Breast abscess
2. Fibroadenoma
3. Duct papilloma
4. Fat necrosis of breast

Yesterday’s Mind Teaser: Lumbar sympathectomy is of value in the management of:

1. Intermittent claudication
2. Distal ischemia affecting the skin of the toes
3. Arteriovenous fistula
4. Back pain

Answer for yesterday’s Mind Teaser: 2. Distal ischemia affecting the skin of the toes

Correct answers received from: Dr.Ragavan, Dr Priyanka Sharma, Dr.Sukanta Sen, Dr. Prabha Sanghi, Dr Valluri Ramarao, Dr. M.C.Sarmah, Dr Chandresh Jardosh, Dr Surendra Bahadur Mathur, Dr Jainendra Upadhyay, Dr Neelam Nath

Answer for 1st August Mind Teaser: 4. Acanthamoeba does not depend upon a human host for the completion of its life cycle.
Correct answers received from: Dr.K.Raju, Dr Surendra Bahadur Mathur

Send your answer to ijcp12@gmail.com

 
    Laugh a While

(Dr GM Singh)

Repairs

When a guy’s printing on his printer began to grow faint, he called a local repair shop where a friendly man informed him that the printer probably needed only to be cleaned. Because the store charged $50 for such cleanings, he told him he might be better off reading the printer’s manual and trying the job himself.

Pleasantly surprised by his candor, he asked, "Does your boss know that you discourage business?" "Actually, it’s my boss’s idea," the employee replied sheepishly. "We usually make more money on repairs if we let people try to fix things themselves first."

For Comments and Archives

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name

Indication

DCI Approval Date

Calf lung surfactant Intratracheal Suspension containing

Phospholipids… 35mg (containing 26 mg phosphatidylcholine of which 16mg is disaturated phosphatidylcholine)

Proteins…0.65mg (including 0.26mg of surfactant associated proteins B) per ml

(a). As a prophylaxis therapy for premature infants <29 weeks of gestational age at significant risk for respiratory distress syndrome (RDS)
(b). For the treatment of infants <72 hours of age with RDS (confirmed by clinical and radiologic findings) and requiring endotracheal intubation.

17.02.11

 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

A mix of exercise protocol is better

A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease.

Only aerobic exercise is also as good as it reduces weight and inches off the waistlines. Just weight lifting alone has very little benefit, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

According to a study published in the July 7th issue of American Journal of Cardiology, people in the weight–training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists.

Those who did both weight and aerobic training dropped about 4 pounds and 1 waistline inch. This group also saw a decrease in diastolic lower blood pressure and in a metabolic syndrome score. Both the aerobic–only group and the combined–exercise group also lowered their levels of bad triglycerides.

For comments and archives

 
    Readers Responses
  1. Dear Sir, Thanks a lot for providing useful information on Carotid artery blockages. Regards: Dr Priya
 
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.

...more

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