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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

5th February 2010, Friday

Practice Changing Updates: Molecularly–targeted therapy for non-small cell lung cancer
One should start initial treatment with an epidermal growth factor receptor tyrosine kinase (EGFR TK) inhibitor (e.g., gefitinib, erlotinib), for patients with metastatic non-small cell lung cancer whose tumor tissue is found to contain an EGFR mutation. This practice is termed molecularly–targeted therapy. Other examples include

  1. The monoclonal antibody trastuzumab for women with breast cancers that overexpress HER2
  2. Imatinib, a tyrosine kinase (TK) inhibitor for gastrointestinal stromal tumors with mutations in the KIT receptor TK
  3. monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in metastatic colorectal tumors lacking mutations in the K–ras oncogene.

Reference: (Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin–paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009; 361:947.)

 Dr KK Aggarwal
Chief Editor

News and Views

1. Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study. Advanced neoplasias were detected with CT colonography –– often called "virtual colonoscopy" –– in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of Radiology.

2. Septic shock patients treated with a corticosteroid get no survival advantage from tight glucose control or addition of a second corticosteroid to provide more mineralocorticoid activity, according to results of a randomized trial. Aiming for normoglycemia at 80 to 110 mg/dL rather than the standard 150 mg/dL, had no impact on in-hospital mortality rates (45.9% versus 42.9%), Djillali Annane, MD, of Höal Raymond Poincaré in Garches, France, and colleagues found. In–hospital mortality was likewise similar whether patients got hydrocortisone alone or with the addition of fludrocortisone (42.9% versus 45.8%). The study is reported in the Jan. 27 issue of the Journal of the American Medical Association.

3. Intensive treatment to achieve normoglycemia in type 2 diabetes may be almost as bad for survival and heart health as leaving glucose levels elevated, according to a study of real–world practice. A U–shaped link between all–cause mortality and glycosylated hemoglobin levels in which those at a median of 7.5% carried the lowest risk, was noted by Craig J. Currie, PhD, of Cardiff University in Cardiff, Wales, and colleagues.

4. A brief acceleration of the heart rate when a patient stands up quickly may help diagnose long QT syndrome, researchers found. The sudden movement provokes a short–lived tachycardia, which allows documentation of the characteristic QT prolongation on the electrocardiogram of affected patients, according to Sami Viskin, MD, of Tel–Aviv Medical Center in Israel, and colleagues.

5. Overall mortality for children with rheumatologic diseases is down, although the risk of death remains elevated in certain inflammatory disorders, analysis of data from a large registry found. The overall standardized mortality ratio was 0.65 (95% CI 0.53 to 0.78, P<0.001), Philip J. Hashkes, MD, of the Cleveland Clinic, and colleagues reported in the February issue of Arthritis & Rheumatism.

 Readers Responses

  1. Heatiest congratulations from J.P. Gupta and family: J.P. Gupta, 9811259523
  2. Padmashree is a logical culmination of the best wishes of lakhs of your well wishers and recognition of your selfless dedication: Dr. Sangeeta Bhagat, 9212201526
  3. Congratulations on your getting the recognition. Wish you good future and keep up the good work: Arun Kampani
  4. Aggarwal Sahab, apko Padmashree award ke bahut bahut badhai. Ramesh Thakur, 9390977016
  5. Congratulations for your achievement: Dr. JP Kapoor
  6. Wish you many more decorations for your services towards the suffering humanity: Dr. VP Kumra, 9811132221
  7. Congratulations. You are the one who deserves this victory: Prakash Rajpal
  8. Sir, Hearty congratulations. Your Hardwork, dedication, selfless service and your intelligence has been recognized. We feel so happy and proud of you. Yashpal Sharma, OSD to Minister for Health, Horticulture & Floriculture J&K.
  9. Dear Respected Dr K K Aggarwal. Congratulations for a well deserved award.The emedinews is a fantastic help to the entire medical fraternity.May you live long and keep up the good work. Dr DP Sarkar
  10. Dear Dr KK "Badhaai Ho" "Medical profession Jai Ho" You have added to the grace of profession that has been recently dwindling.
  11. Dear Sir, Hearty Congratulations. We are proud of you, Dr A Chakravarti, Professor ENT, LHMC New Delhi, 83 Batch MGIMS
  12. Dear Dr.K.K., Happy and proud that u got the Padmashree. I knew from 1st day I met u some 25 years back that u are a genius. Regards, Dr.Kalpana Gupta (Chakravarty). Kolkata

 Michael Jackson doctor set to surrender (Dr G M Singh)

The family of Michael Jackson is pressing for murder charges to be brought against the doctor who administered the injection of hospital anaesthetic that caused the pop-star’s death, their lawyer said Wednesday. The family’s Attorney Brian Oxman told CBS’ Early Show that reports that prosecutors planned to charge Dr Conrad Murray with involuntary manslaughter were ’just a slap on the wrist, and a slap on the face.’
Oxman argued that Murray should be charged with second degree murder because he was ‘reckless’ in administering the drug propofol as a sleeping aid to the frail singer. Michael Jackson was someone who we knew was in danger of being brought to his knees, brought (to) his death, by the use of these medications,’ Oxman said. His comments followed a statement from Murray’s attorneys that the controversial doctor was ready to surrender to authorities if charges were pressed. ‘I don’t have any specific information that leads me to believe he is going to be charged this week,’ Murray?s attorney Ed Chernoff told the Los Angeles Times. ‘But if he is, we’ve made it clear he's available to turn himself in.’ Murray, 56, has acknowledged giving Jackson propofol after other medications failed to help him sleep. Shortly after receiving the drug Jackson suffered a massive cardiac arrest and was pronounced dead June 25, 2009

 Conference Calendar
XV Annual Conference of Association of Medical Physicists of India – Northern Chapter

February 6–7, 2010
Venue: SN Medical College, Agra, Uttar Pradesh

 Public Forum
Press Release

Prevention–The best treatment to stay away from stress
Heart Care Foundation of India released tips for stress prevention for before, during and after the exams. The best treatment is prevention, said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

Before the exam: Plan, Prioritize and Practice; do what needs to be done first; prepare well, do timely rehearsals; review often, and test yourself as anxiety can lead to "blanking out"; be regular as its what you’ve studied through the year that will be useful, not what you do at the last minute; gather information about the exam; learn quick relaxation and breathing techniques; take compulsory rest for 10 minutes every hour, and do something different. Do not focus on any past experiences of blanking out or performing badly in exams. Instead, focus on the quality of your performance and not the outcome as this would only damage your concentration.

During the exam: Jot down hard to remember formulae; quickly scan the exam paper before answering; decide where to begin; decide how much time to spend on each question; read directions carefully; do easy questions first and relax.

After the exam: Reward yourself, keep practicing positive self–talk and analyze your exam.

Punjab & Sind Bank
Central Bank of India

Question of the Day
Is an initial blood transfusion effective for treating malarial anemia?

One systematic review found insufficient data to be sure whether routine administration of blood to clinically stable children (no respiratory distress or cardiac failure) with severe anemia in endemic malarious areas reduces death, or results in higher hematocrit measured at one month. The review found no significant difference between transfusion and no transfusion for the combined outcome of death or severe adverse events. No RCTs examining the effects of transfusion in adults with malaria.

Suggested reading: Meremikwu M Smith HJ. Blood transfusion for treating malarial anemia. Cochrane Database Syst Rev 2000;(2):CD 001475)

eMedinewS Try this it Works
Another approach to dermabrasion
Patient can treat their scaly feet at home with 120–grit drywall sanding screens. Have patients cut two 24–inch pieces, place them together, and brush them across the dead skin with short back–and–forth strokes. Patients intuitively learn the correct amount of force to apply and know when normal epidermis is exposed. When the mesh fills with debris, patients can tap the screens lightly to empty them and resume the abrading. The mesh can also be shaped for uneven areas. Patients should apply emollient cream to the abraded areas.

Dr Good Dr Bad
Situation: A diabetic patient was gaining weight on insulin.
Dr Good: Make insulin twice daily.
Dr Bad: Stop insulin and shift to oral drugs.
Lesson: The combination of insulin with metformin is also associated with significantly less weight gain than seen with twice-daily insulin injections or insulin combined with sulfonylureas. (Source: Lancet 1998;352:854).

 Make Sure
Situation: A patient with acute rheumatic fever was directly put on penicillin prophylaxis.
Reaction: Oh my god! Why was full initial course of penicillin not given.
Make sure that patients with acute rheumatic fever are initiated on antibiotic therapy as delineated for eradication of streptococcal pharyngitis, whether or not pharyngitis is present at the time of diagnosis.

 Laughter the best medicine (Dr Rajendra Kr Agrawal)
A visitor to doctor: Sir, mujhe aapke treatment se bahut faida hua.
Doctor: Mujhe to yaad nahi ki maine aapka treatment kiya thaa.
Visitor: Bilkul sahi, aapne mera nahi, mere dada ji ka treatment kiya thaa.

 Formulae in Imaging
Pleural thickening
On CT, circumferential pleural peels that involve the mediastinal pleura and have a nodular contour exceeding a thickness of one cm are more likely to be malignant, e.g., malignant mesothelioma or metastatic pleural carcinomatosis. (Source: AJR Am J Roentgenol 1990;154:487.)

 ENT Facts
Based on its acceptability and low cost, we typically use amoxicillin 500 mg three times a day for 5–7 days as initial therapy for acute otitis media (AOM) in patients without penicillin allergy.

 SMS Anemia
Anemia with a high reticulocyte count reflects an increased erythropoietic response to continued hemolysis or blood loss.

 Milestones in Neurology
Korbinian Brodmann (1868 – 1918) was a German neurologist who became famous for his definition of the cerebral cortex into 52 distinct regions from their cytoarchitectonic (histological) characteristics. These areas are now usually referred to as Brodmann areas. Some of these areas were later associated to nervous functions, such as areas 41 and 42 in the temporal lobe (related to hearing), areas 1, 2 and 3 in the postcentral gyrus of the parietal lobe (the somatosensory region), and the areas 17 and 18 in the occipital lobe (the primary visual areas).

 Mistakes in Critical Care
Give specific instructions. "Use as directed" is not appropriate.

God has editing rights over our prayers. He will… edit them, correct them, bring them in line with His will and then hand them back to us to be resubmitted. (Stephen Crotts)

(Advertorial section)

Say yes to dietary supplements

The health supplements play a supportive role in helping the body, by providing essential nutrients,and to boost various important functions at cellular level. Silicic acid in Zen Immune, as sodium meta silicate, is a complete revitaliser and nutritional supplement . it contains vital nutrients which increase BMD, prevent recurrent infections and rejuvenates the depleted immune system.

Advertising in emedinews
emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com 

eMedinewS-PadmaCon 2010 
Will be organized at MAMC on 4th?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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