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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


4th May, 2010, Tuesday

High doses of vitamin B is associated with increased decline in
kidney function for diabetics

 

Patients with diabetic nephropathy who received high dose vitamin B experience a more rapid decline in kidney function and have a higher rate of heart attack and stroke than patients who receive placebo, according to a study in the April 28 issue of JAMA.

Rarlier  studies have shown a significant association between high plasma homocysteine levels and the risk of developing diabetic nephropathy, retinopathy, and vascular diseases, including myocardial infarction and stroke. B vitamins (folic acid, vitamin B6, and vitamin B12) have been shown to lower the plasma concentration of homocysteine.

The researchers at University of Western Ontario, and at Robarts Research Institute, London, Ontario, examined whether B–vitamin therapy would slow progression of diabetic nephropathy and prevent vascular events in 238 patients with type 1 or 2 diabetes. Patients received single tablet of B vitamins containing folic acid (2.5 mg/d), vitamin B6 (25 mg/d), and vitamin B12 (1 mg/d), or matching placebo.

Patients given B–vitamins had a greater decrease in radionuclide GFR and a significantly greater number of cardiovascular and cerebrovascular events compared to placebo. The 36–month risk of a composite outcome, including heart attack, stroke, revascularization, and all–cause mortality was double in the B–vitamin group, compared to the placebo group. There was no difference in requirement of dialysis.

 

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature

Shri Buta Singh Former Union Home Minister alongwith Padma Shri and Dr B Roy Awardee Dr KK Aggarwal at the release function of the book "Sadhna Vidi" at 15th Environment Protection & Ethical Consciousness Conference on 25th (Sunday) April, 2010.

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): Practice Changing Updates

Newborn screening for Severe Combined Immunodeficiency (SCID)

In January 2010, the United States Advisory Committee for Heritable Disorders in Newborns and Children (ACHDNC) recommended adding a screening test for SCID and related T cell disorders to mandatory newborn screening. Earlier diagnosis by newborn screening should prevent infections associated with live virus vaccines, especially those given in early infancy before the diagnosis of SCID is suspected clinically.1 A blood test to screen for T cell lymphopenia in newborns was found to be cost-effective in pilot studies in two states. In January 2010, the United States Advisory Committee for Heritable Disorders in Newborns and Children (ACHDNC) recommended adding SCID and other disorders with T cell deficiency to the uniform newborn screening panel using this screening method.2 Recommendations for implementation of this recommendation, including surveillance, education, and quality control, are expected from the National Institutes of Health, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention, over the next six months.

References

  1. Patel NC, Hertel PM, Estes MK, et al. Vaccine-acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med 2010;362:314.
  2. www.geneticalliance.org/pr.scid.achdnc. (Accessed February 5, 2010).

DMC Update

Is the decision of MCI binding on state medical council?

There are conflicting orders to this effect.

1. Yes: As per DMC order, DC/F.14/Comp.652/2010 dated 12th April, 2010, "The Council examined a complaint of Brig. VSG against Dr. CDP New Delhi. The complainant filed a copy of MCI order dated 4.12.2009, as per which the Medical Council of India temporarily removed the name of Dr. CDP from the Indian Medical Register for a period of 6 months.The Delhi Medical Council in view of the MCI order also removed the name of Dr. CDP from the State Medical Register of Delhi Medical Council for a period of six months, as well i.e. w.e.f. 18.11.2009 to 18.5.2010.

2. NO: In one TN Medical Council case, the TN State Medical council did not accept the order of MCI in a similar judgment. "Two Tamil Nadu-based doctors debarred by the MCI, have been found eligible to practise medicine by the State Medical Council, which has decided not to remove their names from its registry. While MCI said the decision to debar them was taken after detailed investigation of offences, including "medical negligence" and "production of fake certificates", TN State Medical Council president. Dr K Prakasam said "unless we debar them, they don't have to stop practice. MCI did not consult us before removing their names and the exercise is illegal. It's not the first time they are doing this. Sometime ago, MCI debarred 13 doctors in TN. We let them continue their practice. We will do the same this time." (TOI News)

News and views

More than seven million Americans abuse prescription medications, says DEA

According to the US Drug Enforcement Administration more than seven million Americans are abusing prescription ‘medications,’ more than those who abuse cocaine, heroin, hallucinogens, Ecstasy, and inhalants combined.

There are no known preventive measures to stop onset of Alzheimer’s

With no cure yet for Alzheimer’s disease, the focus has been on what we can do to try to prevent it or at least slow it down.

Research may help determine which breast cancer patients need aggressive therapy

Researchers found that when three specific biomarkers, p16, COX-2 and Ki67, were present, or positive, a woman had a 20 % individual risk of developing invasive cancer over eight years. However, "when all the markers were negative, her risk of invasive cancer was only 4 %," according to a report published online Wednesday by the Journal of the National Cancer Institute.

Mnemonic of the Day (Dr. Varesh Nagrath): Causes of Vitamin B12 deficiency

A–Addisonian disease
B–Blind loop syndrome
C–Crohn's disease
D–Drugs like Metformin
E–Eats vegetarian food
F–Fish tape worm
G–Gastrectomy

What’s New

In a study of two–month–old infants with moderate unilateral hydronephrosis, 94 % of infants had resolution of their hydronephrosis (defined as two consecutive ultrasounds with a renal pelvic diameter ≤ 5 mm) by 12 to 14 months of age. (Mami C, Paolata A, Palmara A, et al. Outcome and management of isolated moderate renal pelvis dilatation detected at postnatal screening. Pediatr Nephrol 2009;24:2005.)

Quote of the Day: Prakash Rajpal

Life is more strict than a teacher. A teacher teaches a lesson first and then schedules an exam, but life schedules an exam first and then teaches a lesson.

DMA Update: 9th May is Mother’s Day: Incontinence

While making a diagnosis, the doctor should first address possible transient, reversible causes of incontinence as illustrated by the mnemonic DIAPERS: Delirium, Infection, Atrophic urethritis or vaginitis, Pharmaceuticals, Excess excretion, Restricted mobility, and Stool impaction. Treating these can completely cure incontinence in one–third of patients and alleviate it in the remainder.

Question of the Day: Dr. Rajesh Gupta

What is the optimal drug treatment of non–variceal upper GI bleed?

There is large data on role of PPIs in management of non–variceal bleeding. A meta–analysis of large number of trials shows that H2RAs (H2 receptor antagonists) are neither useful in controlling ulcer bleed nor in preventing rebleed. Based on current evidence, the use of high dose bolus followed by continuous infusion of PPI is recommended in patients who have undergone endoscopic hemostasis for high-risk bleeding peptic ulcer lesion as it is effective in decreasing re-bleeding episode and need for surgery. In patients awaiting endoscopy, empirical therapy with high dose PPI should be considered. The use of PPI is a cost–effective strategy following endoscopic therapy. The optimal route of administration and minimal dose required to have improved outcome remains uncertain. The improvements in outcome attributable to PPI appear more marked in Asian populations. There are very few head-to-head trials comparing various PPIs to recommend one over the another. Drugs like antacids, sucralfate or somatostatin have no role in management of non-variceal upper GI bleed.

Stupid Question: (drsooneita@gmail.com)

At a restaurant: When you ask the waiter
Stupid Question "Is the Butter Paneer Masala" good?"
Answer: "No, its terrible and made of adulterated cement. We occasionally also spit in it."

SMS of the Day (Dr. Ingole)

Don’t search around for a better person. Instead try to be a good person so that others can find you easily.

eMedinewS Try this it Works: Less painful percussion

The traditional technique is to strike the terminal phalanx of the middle finger of the nondominant hand with the tip of the middle finger of the dominant hand.

Try striking the nondominant middle finger with a reflex hammer, it offers several advantages over the traditional method. It is easier to perform, is more easily reproduced, provides more audible notes (especially important in a noisy setting such as the emergency department), and is less painful to the struck phalanx.

Do You know?

If Bill Gates stops his business and starts spending his money, Rs. 1 crore per day, he can do so for about 725 years.

Dr Good Dr Bad

Situation: A patient in ICU needed enteral hydration.

Dr Bad: Give 20 ml/kg of free water each day.

Dr Good: Give 30–35 ml/kg of free water each day.

Lesson: Adults with good renal function need 30–35 ml/kg of free water each day to maintain adequate hydration.

Make Sure

Situation: A class 12 student presented to casualty with wheezing stridor and on examination was found to have hypotension. On history, it was found that he had been prescribed amoxicillin.

Reaction: Oh my God! He has developed hypersensitivity reaction to penicillin. You should have prescribed a macrolide.

Make sure to remember that macrolides are a better option than penicillins in those who are hypersensitive to penicillins.

IMANDB Joke of the Day (Dr Maj Prachi Garg)

It is said that "Man is the head of the family" but be clear that the wife is the neck. The neck turns the head exactly the way it wants.

Formulae in Rural Practice: LDL Cholesterol

Calculation of LDL Cholesterol according to the Friedewald Formula:

LDLC = Total cholesterol – HDL Cholesterol – TG/5

Milestones in Gastroenterology

129 AD: Galen, one of the most prominent ancient physicians was born around 129 AD. Galen's concept of the stomach having four faculties was widely accepted upto modernity.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Antisperm Antibody Test

An antisperm antibody test looks for special proteins (antibodies) that fight against a man’s sperm in blood, vaginal fluids, or semen. The test uses a sample of sperm and adds a substance that binds only to affected sperm.

MCI Update

Dr. Ketan Desai president MCI was denied bail today by the Lower Court. He is likely to file a Bail Application in the High Court on Tuesday or Wednesday.


IMA Update

With the present MCI crisis, will the present leadership of IMA announce the due national IMA elections in time? Most of the stalwarts feel that the elections should be held and announced in time.

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eMedinewS-Padma Con 2010

Will be organized at
Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

 
 

eMedinewS-revisiting 2010

The second 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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Public Forum (Press Release for use by the newspapers) : Today is world asthma day

All that wheezes is not asthma

All that wheezes is not asthma. All asthmatics do not wheeze. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

To mark the World Asthma Day, the Heart Care Foundation of India released Formulae on Asthma. The theme for World Asthma Day this year is "You Can Control Your Asthma."

Formulae

Formula of 2

If you need asthma drugs
More than 2 times in a week during daytime,
More than 2 times in a month during night, or
You consume more than 2 inhalers in a year

...then you have persistent asthma and you need continuous inhaler drug

Speak Out Formula
If you are able to speak a sentence, then you have mild asthma and an outpatient (OPD) treatment is adequate.
If you break a sentence, you have moderate asthma and you may need hospitalization.
If you break words, you have severe asthma and you may need hospitalization in the ICU.

Readers Responses

  1. Dear Dr KK Aggarwal, Hearty congratulations for the Padma Shri Award and I wish your efforts of this kind of spreading the medical news for the benefit of mankind through recent updates in various specialities be further rewarded with the top most award of India. Your efforts cannot be weighed with words: Vishwanath Hiremath.
  2. Dear Dr Aggarwal, In the 3rd May edition of emedinews, Beta 2 Microglobulin has inadvertently been mentioned as a test to diagnose tuberculosis (TB) to monitor the effectiveness of treatment. Here is the correct text.

    Beta-2-M, B2M, β2-M. Beta-2-Microglobulin is an 11.6 kDa polypeptide with a length of 99 amino acids (Cunningham et al, 1973; Suggs et al, 1981), which is found in the serum of normal individuals and in the urine in elevated amounts in patients with Wilson disease, cadmium poisoning, and other conditions leading to renal tubular dysfunction (Gejyo and Arakawa, 1992). It is produced by many cell types. An antigenic determinant on β2-Microglobulin has been identified as the lymphocyte marker Ly-m11. The protein is found in association with the major histocompatibility complex (MHC) class I heavy chain on the surface of nearly all nucleated cells (Gussow et al, 1987). Arce-Gomez et al (1978) have shown that β2-Microglobulin is essential to expression of HLA.

    In patients on long-term hemodialysis, it can aggregate into amyloid fibers that deposit in joint spaces, a disease known as dialysis-related amyloidosis. Mice models deficient for the β2 microglobulin gene have been engineered. These mice demonstrate that β2 microglobulin is necessary for cell surface expression of MHC class I and stability of the peptide binding groove. In fact, in the absence of β2 microglobulin, very limited amounts of MHC class I (classical and non-classical) molecules can be detected on the surface. In the absence of MHC class I, CD8 T cells cannot develop. (CD8 T cells are a subset of T cells involved in the development of acquired immunity.) Levels of β2-microglobulin can be elevated in multiple myeloma and lymphoma,though in these cases primary amyloidosis (amyloid light chain) and secondary amyloidosis (Amyloid associated protein) are more common: Dr NP Singh (Nanu)
    eMedinewS responds: We sincerely regret the error.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Ciclesonide 200mcg + Formoterol 6mcg + Tiotropium 9mcg MDI

Indicated as third–line treatment of severe cases of COPD, when monotherapy and second line therapy with two drugs do not respond adequately.

13.04.2009