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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

6th February 2010, Saturday

Practice Changing Updates: Post exposure rabies vaccine
For unvaccinated patients who require post exposure rabies vaccination, the new recommendation is adherence to the revised dose schedule of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP), in which the previously recommended five–dose schedule for post exposure prophylaxis has been changed to four doses, eliminating the last dose.

A four–dose series is now recommended (on days 0, 3, 7, and 14); the previously recommended fifth dose on day 28 has been eliminated.

Reference: (ACIP provisional recommendations for the prevention of human rabies. Available at: www.cdc.gov/VACCINES/pubs/ACIP–list.htm. (Accessed on October 5, 2009.)

 Dr KK Aggarwal
Chief Editor

News and Views

1. Serial measurement of a natriuretic peptide predicted the risk of heart failure and cardiovascular death in older patients who were initially free of heart failure, data from a longitudinal cohort study showed. An increase of more than 25% in levels of N–terminal pro1. Serial measurement of a natriuretic peptide predicted the risk of heart failure and cardiovascular death in older patients who were initially free of heart failure, data from a longitudinal cohort study showed. An increase of more than 25% in levels of N–terminal pro–B type natriuretic peptide (NT–proBNP) doubled the risk of heart failure and cardiovascular death. In contrast, a more than 25% decrease in NT–proBNP was associated with a greater than 40% reduction in the risk of both end points. ‘NT–proBNP levels frequently change over time, and these fluctuations reflect dynamic changes in cardiovascular risk,’ Christopher R. deFilippi, MD, of the University of Maryland in Baltimore, and co–authors concluded in an article in the Feb. 2 issue of the Journal of the American College of Cardiology.

2. So–called silent strokes, visible on cerebral MRI scans, predict kidney failure in patients with type 2 diabetes, Japanese researchers. After an average follow–up of 7.5 years, diabetic patients with evidence of small cerebral infarctions at baseline later suffered death or kidney failure at more than twice the rate seen in patients who had not had silent strokes, reported Takashi Uzu, MD, of Shiga University of Medical Sciences in Shiga, Japan, and colleagues.

3. A little excess weight after age 70 could do the body some good, according to results of a study involving 9,000 older patients. Overweight participants in the cohort study had the lowest 10–year mortality. Normal–weight and obese participants ages 70 to 75 had a similar and slightly higher risk of death, Leon Flicker, PhD, of the Western Australian Center for Health and Aging in Perth, and colleagues found. The findings add to evidence suggesting that being overweight in older age is not such a bad thing and might even be beneficial. The results of the study lend further credence to claims that the body mass index [BMI] thresholds for overweight and obese are overly restrictive for older people. The study is published in the Journal of the American Geriatrics Society.

4. When New York City public schools made the switch from whole milk to skim or low–fat milk, students cut their annual fat and total calorie consumption. Milk–drinking students consumed 5,960 fewer calories and 619 fewer grams of fat per year after they made the switch. This was reported by Philip M. Alberti, PhD, of the New York Department of Health and Mental Hygiene, and colleagues in the Jan. 29 issue of CDC’s Morbidity & Mortality Weekly Report. At 3,500 calories per pound, the reduction would be the equivalent of 1.7 pounds of body weight over the course of a year.

5. Using computed tomography (CT) to diagnose appendicitis may reduce the likelihood of removing healthy organs in women under 45, but not among other groups, a retrospective study showed. Over a 10–year period, the use of preoperative CT increased from 18.5% of patients who ultimately had their appendices removed to 94.2%, according to Courtney Coursey, MD, of Duke University Medical Centeri, and colleagues. During the same time period, the rate of negative appendectomy (removal of a healthy organ) declined, although the trend was significant only among women 45 and younger the researchers reported in the February issue of Radiology.

6. People with non–alcoholic fatty liver disease (NAFLD), a condition that often accompanies obesity and type 2 diabetes, have higher mortality rates than the general population, a new Swedish study found. Patients with NAFLD were 69% percent more likely to die than the general Swedish population (standardized mortality ratio 1.69, 95% CI 1.24 to 2.25), according to a report in the February issue of Hepatology.

Readers Responses

  1. Dear Dr KK, you are a trendsetter, a phenomenon, a legend, most hardworking man with a smile on your face. Padma award conferred upon you is most befitting. God bless you, your family & your activities: Dr O P Sharma. National Prof. Geriatrics
  2. Congratulations from the four chambers of my heart with bucket full of love: Mohit Aggarwal. 9810607999
  3. Heartiest congratulations for honour bestowed upon you. We are all indeed proud of you, your talent and contibution to the society in most humble way: Satnam Chawla
  4. Hardik badhaiyan: Dr. A K Tyagi, 9868867012
  5. Congratulations for receiving Padmashree award: Dr. Shashi, 9810113925
  6. My heartiest congratulations on receiving Padmashree award: Dr. Bhilwar, 9810437028
  7. Congratulations on getting Padmashree: Mrs. Pillai, 9818244394
  8. Dear Editor (For Dr KK Aggarwal) :
    Greetings from B Braun Medical India Pvt Ltd :
    We acknowledge receipt of enewsletter , we thank you for enrolling us for this updates, Considering the error in formatting as all lines are getting justified it distorts alignment in reading, Moreover in lotus notes we can not view attached images as it appears as blank box. A small suggestion is to attache newsletter as attachment as if we want we can archive in folder for letter ref .
    J N Mody. Manager-Corp Com: B Braun Medical (I) Pvt Ltd
    Emedinews response: Thanks. From today we will also attach a file.

Conference Calendar
DIPSI 2010
Diabetes in Pregnancy Study Group India–5th National Conference of Diabetes in Pregnancy February 6–7, 2010
Kolkata, West Bengal

Public Forum
Press Release

Stay away from stress during examination days

Exam stress can lead to depression and suicide. During exam days, prescriptions for anti depressant drugs, so called ‘happy drugs’, increase amongst teenagers, said Dr. KK Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

The fear of failure and fear of letting down are the two most common factors leading to suicide and depression.

Also, children indulge in drugs to keep awake during the exam and end up in addictions. Some use commonly available cough syrups, anti fit drugs, while others indulge in smoking, tobacco, alcohol, tea, coffee, and drugs like LSD, etc. Few take memory enhancing pills. Some children go to the extent of even eating lizard tail to beat exam stress. Some eat junk food so that they do not waste time in eating food.

Anticipatory anxiety peaks before exams resulting in adverse affects on the body and mind and therefore, a sub optimal performance. Stress not only causes palpitations and tense muscles but also reduces the ability to make decisions, act or express oneself including organization of thoughts.

Stress during exams can makes it difficult to read and understand questions and even to recall terms and concepts.

A recent study has shown that 45 minutes of afternoon nap improves the declarative memory. Declarative memory is the memory of events learnt and understood earlier during the year. Not taking afternoon nap or the night sleep may end up in transient loss of declarative memory. Yoga exercises like pranayam maybe done to relax oneself. Deep breathing exercises should be followed before the exam. One should learn quick relaxation & breathing techniques.

Punjab & Sind Bank
Central Bank of India

Question of the Day
What are WHO recommendations for malaria treatment in HIV infected patients?

WHO makes the following recommendations:
HIV–infected pregnant women in areas with stable malaria should–depending on the stage of HIV infection–receive either intermittent preventive treatment for malaria with atleast three doses of sulfadoxinepyrimethamine or daily cotrimoxazole prophylaxis for HIV/AIDS opportunistic infections. Malarial illness in HIV–infected pregnant women who are receiving cotrimoxazole prophylaxis should be managed with non–sulfa antimalarials.
In areas with stable malaria and a high prevalence of HIV infection, use of a fever–based malaria case definition may result in febrile illnesses caused by opportunistic infections being misdiagnosed as malaria, leading to overtreatment of malaria. Confirmatory parasitological testing for malaria should be applied with high priority in patients at risk of HIV/AIDS (in particular in older children and adults). In addition, health providers should offer HIV testing and counselling.
In countries with generalized HIV/AIDS epidemics, routine monitoring of antimalarial drug efficacy or effectiveness should include assessment of the effect of HIV on antimalarial treatment outcomes.
Further research should be undertaken to evaluate possible interactions between antimalarials and antiretrovirals, and pharmacovigilance should be introduced to monitor adverse drug reactions for both the new antimalarials and antiretrovirals.

Suggested reading: Report of a technical consultation: Malaria and HIV interactions and their implications for publichealth policy: Geneva, Switzerland, 2004 June 23–25. Geneva, WHO, 2004.

eMedinewS Try this it Works
Waiting room tools can calm kids
1. Placing old stethoscopes, patella hammers, and other ‘discarded’ tools of the trade in the waiting room helps to calm kids. As young patients get acquainted with these instruments, they are less fearful when the doctor uses such tools on them during physical examinations.
2. Shedding of the white coat during pediatric consultations, is tremendously helpful to children who are prone to the ‘white coat’ or ‘doctor’s office’ syndrome.

Dr Good Dr Bad
Situation: A diabetic came with TIA (Transient ischemic attack)
Dr Good: We need to mange your risk.
Dr Bad: TIA is routine in diabetics.
Lesson: During the first year after a TIA, the risk of developing stroke increases by 13–14 fold. During the first 5 years, a 7–fold increase in stroke is seen.)

Make Sure
Situation: A patient with rheumatic carditis relapsed after five years of stopping penicillin prophylaxis.
Reaction: Oh my god! Why was prophylaxis not continued for ten years.
Make sure that prophylaxis in the setting of carditis should continue until the patient is a young adult (18 years of age), which is usually 10 years from an acute attack with no recurrence.

Laughter the best medicine
A man who thought he was John the Baptist was disturbing the neighbourhood, so for public safety, he was committed. He was put in a room with another crazy, and immediately began his routine, "I am John The Baptist! Jesus Christ has sent me!" The other guy looked at him and declared, "I did not!"

Formulae in Imaging
Lung abscess: Large cavity size >6 cm in diameter require unusually prolonged therapy or empyema, which necessitates drainage.

ENT Facts
A macrolide (erythromycin combined with sulfisoxazole, or azithromycin, or clarithromycin) is the preferred drug for penicillin allergic patients.

SMS Anemia
A stable anemia with a low reticulocyte count is strong evidence for deficient production of RBCs (i.e., a reduced marrow response to the anemia).

Milestones in Neurology
Donald Brian Calne, a Canadian neurologist, is a leading Parkinson‘s disease researcher. He was the first researcher who used synthetic dopamine to treat Parkinson‘s disease. He showed that latent damage occurs in the brain even before the symptoms of Parkinson‘s disease appears.

Mistakes in Critical Care
The Institute for Safe Medication Practices has compiled a list of "high–alert" drugs. These medications require extra precaution because they can cause serious patient harm when used in error. These are amiodarone (IV); colchicine injection; heparin, low molecular weight, injection; heparin, unfractionated (IV); insulin (subcutaneous and IV); lidocaine, IV; magnesium sulfate injection; methotrexate (oral), non–oncologic use; nesiritide; nitropr usside sodium for injection; potassium chloride for injection concentrate; potassium phosphates injection; sodium chloride injection, hypertonic (more than 0.9% concentration) and warfarin.

LIST OF APPROVED DRUG FROM 01.01.2009 TO 31.10.2009

Drug Name Indication Approval Date
Selamectin Tropical solution (for verterinary use.) 60mg/120mg per ml
(I) For the treatement and lasting prevention of flea infestations, treatment and control of flea allergy dermatitis, prevention of heartworm disease, treatment and prevention of ear mites in dogs and cats
(II) For the treatement and prevention of sarcoptic mange, roundworms and for control of tick infestations in dogs


(Advertorial section)

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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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