emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

6th March 2010, Saturday

New guidelines for PSA

Since 1997, the American Cancer Society (ACS) has not routinely recommended the PSA test, but most doctors have done it. Now the Society says that you need to have a conversation between you and your doctor before this test is done.

New guidelines emphasize that physicians should better educate men about both the risks and benefits of using PSA test for screening.

The new guidelines follow recent findings that the PSA test may lead to unnecessary treatment for many men, because ‘the test cannot clearly indicate whether a cancer is aggressive or harmless.’

PSA blood tests can lead to false readings that require additional tests and biopsies.
If patients do choose to be screened with PSA blood tests, those with low levels can safely be screened every other year instead of every year as suggested previously.
The guidelines also urge doctors to make the digital rectal exam (DRE) an option rather than using it as a standard screening tool.

Dr KK Aggarwal
Chief Editor


News and Views

News and views (Dr Monica and Dr Brahm Vasudeva)

Sanofi drug may boost prostate cancer survival A new drug being developed by Sanofi–Aventis extended the lives of men with advanced prostate cancer in a clinical trial and could become a new last–ditch treatment.
Cabazitaxel is the first drug shown to break down tumors and prolong life after patients have been treated with Paris–based Sanofi’s Taxotere (docetaxel), a standard chemotherapy for prostate cancer.

Sleep affects belly fat accumulation

Researchers have found, after assessing more than 1,000 black and Hispanic individuals that in participants ages 40 and younger, that sleeping fewer than five hours per night or more than eight hours per night was associated with higher concentrations of abdominal fat and increased body mass index during the five–year study period compared with participants who slept six to seven hours per night. There was, however, no correlation between sleep duration and belly fat among participants over age 40.

BPH may be best treated with combination of drugs

A combination of drugs is better than either one alone for treating benign prostatic hyperplasia or BPH. After randomizing 4,800 patients to either tamsulosin alone, dutasteride alone, or a combination of the two, researchers at the University of Texas Southwestern Medical Center found that patients taking the combination were 67% less likely to have acute urinary retention and 70% less likely to require surgery than those taking tamsulosin alone. Patients taking the combination also reported fewer side effects and were less likely to drop out of the study.

High temperatures, humidity may degrade vitamin C supplements

Keeping vitamin C supplements in the bathroom or kitchen may expose them to humidity and high temperatures that may seriously degrade them, according to a study published online in the Journal of Agricultural and Food Chemistry.

FDA alerts about noncirrhotic portal hypertension with didanosine

The FDA has issued a warning about the danger of noncirrhotic portal hypertension occurring in patients who have received didanosine (Videx and Videx EC). Didanosine is a synthetic purine nucleoside analogue active against HIV–1 virus.

Baseline atherosclerosis parameter could gauge risk of bone loss with pioglitazone

Baseline parameters like intima media thickness (IMT), urinary N–terminal cross–linked telopeptide of type I collagen (uNTX), and serum insulin–like growth factor–I (IGF–I) can assess the risk of decrease in bone mineral density (BMD) in diabetic patients treated with pioglitazone. (Source: Osteoporos Int. 2010 Feb 4).

Vitamin C supplements may up risk of age–related cataract

A population–based prospective cohort study published in the February issue of American Journal of Clinical Nutrition has concluded that the use of vitamin C supplements may be associated with higher risk of age–related cataract among women. Use of vitamin C supplement increased the risk of cataract by 38% in women above 65 years of age. The HR for the duration of >10 Years of use before baseline was 1.46 (95% CI: 0.93, 2.31). The hazard ratio (HR) for the use of multivitamins containing vitamin C was 1.09 (95% CI: 0.94, 1.25). Out of the 24,593 women included in the study, there were 2497 cataract extraction cases. (Source: Am J Clin Nutr 2010;91:487–493)

Conference Calendar

IPHA 2010 (52nd National Conference of Indian Public Health Association)
Date: March 7–9, 2010
Venue: Dept. of Community Medicine, Maulana Azad Medical College, New Delhi

Quote of the Day

Prayer may not change things for you, but it for sure changes you for things. (Samuel M. Shoemaker)

Diabetes Fact

Incretin effect: Same dose of oral and IV glucose do not lead to same rise in insulin levels.

Public Forum (Press Release)

Give your child a chewable deworming tablet

All school going children should be given a single dose of albendazole (400 mg). It is effective in almost 100 percent of cases of worm infestations including round worm and hookworms, said Dr K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

The cure rate of round worm infection is 97.4% and egg reduction after treatment is 99.9%. The cure rate for hookworm infection is 93.1% with 96.6% egg reduction.

The drug needs to be repeated every four months as the reinfection rate at 4 months after treatment is 54.5% and 10.3% for round worm and hookworm infection, respectively.

Four–monthly targeted periodic treatments with 400 mg single–dose albendazole in highly endemic areas can have a significant impact on intensity of round worm and hookworm infection.

Although round worm infection occurs at all ages, it is most common in children 2 to 10 years old, and prevalence decreases over the age of 15 years. Infections tend to cluster in families, and worm burden correlates with the number of people living in a home.

Mass treatments with single dose albendazole or mebendazole for all school–age children every 3 to 4 months have been used in some communities. This serves the dual function of treating children and reducing the overall worm burden in the community.

In a large randomized trial of school–based deworming performed in Zanzibar, single dose mebendazole, given either twice or three times a year, decreased intensity of round worm infection by 63 and 97 percent, respectively, compared to control children who received no mebendazole.

Question of the day

Which antibiotic is safe to use for a dental abscess or pneumonia in a patient with Crohn’s colitis?

The primary condition should determine whether you’ll use an antibiotic at all and, if so, what the appropriate drug would be. One antibiotic is better than any other in preventing C. difficile infection in patients with Crohn’s colitis. Watch for the onset of any diarrhea, however, investigating it promptly and discontinuing the antibiotic right away. Could there be a role for ‘prophylactic’ use of Lactobacillus in such situations? It’s sometimes recommended in the actual management of difficult-to-eradicate C. difficile infections, so it may be worth trying.

eMedinewS Try this it Works

Pocket salt shaker

One of my heart patients carries his salt substitute in the chamber of a disposable plastic pen. He removed the ink cartridge and inserted plugs in each end, leaving one end partially out. He perforated the sides of the partially extended plug, and then capped the pen with the usual pen cap. He can now ‘salt’ his food as he wishes

Dr Good Dr Bad

Situation: A diabetic patient’s A1C after 3 months of lifestyle modification and metformin was 7.8%.
Dr Bad: Continue same for another three months.
Dr Good: Add another drug.
Lesson: The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend addition of a second medication when the treatment goal of A1C <7 percent with metformin plus lifestyle intervention is not achieved within three months. (Source: Diabetologia 2008;51:8.)

Make Sure

Situation: A smoker hypertensive on atenolol had high homocysteine levels.
Reaction: Oh my God! You should have given nebivolol and not atenolol
Make sure that all smoker hypertensives who need a beta–blocker are put on nebivolol. It results in a significant reduction in plasma PAI–1, fibrinogen and homocysteine. (Source: Am J Hypertens 2004;17(7):582–9.)

Medi Finance
(BUDGET 2010–2011)

Direct Taxes Individual

Deduction of an additional amount of Rs. 20,000 allowed, over and above the existing limit of Rs.1 lakh on tax savings, for investment in long–term infrastructure bonds as notified by the Central Government

Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
Nestle
 
nuspera
 
Docconnect

Laughter the best medicine

An Old Story (Dr Suman Sinha)

The Ant works hard in the withering heat all summer building its house and laying up supplies for the winter.
The Grasshopper thinks the Ant is a fool and laughs & dances & plays the summer away. Come winter, the Ant is warm and well fed. The Grasshopper has no food or shelter so he dies out in the cold.

The Indian Version

The Ant works hard in the withering heat all summer building its house and laying up supplies for the winter. The Grasshopper thinks the Ant’s a fool and laughs & dances & plays the summer away. Come winter, the shivering Grasshopper calls a press conference and demands to know why the Ant should be allowed to be warm and well fed while others are cold and starving. NDTV, BBC, CNN show up to provide pictures of the shivering Grasshopper next to a video of the Ant in his comfortable home with a table filled with food.

The World is stunned by the sharp contrast. How can it be that this poor Grasshopper is allowed to suffer so? Arundhati Roy stages a demonstration in front of the Ant’s house. Medha Patkar goes on a fast along with other Grasshoppers demanding that Grasshoppers be relocated to warmer climates during winter. Mayawati states this as ‘injustice’ done on Minorities. Amnesty International and Ban–Ki moon criticize the Indian Government for not upholding the fundamental rights of the Grasshopper.

The Internet is flooded with online petitions seeking support to the Grasshopper (many promising Heaven and Everlasting Peace for prompt support as against the wrath of God for non–compliance). Opposition MPs stage a walkout. Left parties call for ‘Bengal Bandh’ in West Bengal and Kerala demanding a Judicial Enquiry. The CPM in Kerala immediately passes a law preventing Ants from working hard in the heat so as to bring about equality of poverty among Ants and Grasshoppers.

Mamta Banerjee allocates one free coach to Grasshoppers on all Indian Railway Trains, aptly named as the ‘Grasshopper Rath’. Finally, the Judicial Committee drafts the ‘Prevention of Terrorism Against Grasshoppers Act’ (POTAGA), with effect from the beginning of the winter.

Kapil Sibal makes ‘Special Reservation’ for Grasshoppers in Educational Institutions & in Government Services. The Ant is fined for failing to comply with POTAGA and having nothing left to pay his retroactive taxes; its home is confiscated by the Government and handed over to the Grasshopper in a ceremony covered by NDTV.

Arundhati Roy calls it ‘A Triumph of Justice’. Mamta Banerjee calls it ‘Socialistic Justice’. CPM calls it the ‘Revolutionary Resurgence of the Downtrodden’. Ban–Ki moon invites the Grasshopper to address the UN General Assembly.

Many years later.....

The Ant has since migrated to the US and set up a multi–billion dollar company in Silicon Valley, Hundreds of Grasshoppers still die of starvation despite reservation somewhere in India , and...............

…… As a result of loosing lot of hard working Ants and feeding the grasshoppers, India is still a developing country !!!

Formulae in Critical Care

Clearance of a drug from body
Formula: CL = CL renal + CL hepatic
CL = Clearance

Milestones in Neurology

Ugo Cerletti (1877–1963) was an Italian neurologist who discovered the method of electroconvulsive therapy in psychiatry. In his long career as a psychiatrist and neurologist, Cerletti published 113 original papers, about the pathology of senile plaques in Alzheimer’s disease, on the structure of neuroglia, the blood–brain barrier, syphilis, etc. In 1950 he received a honorary degree by the Collège de Sorbonne at the University of Paris, in addition to a long list of other awards and degrees.

Mistakes in Clinical Practice

Written prescriptions must be legible; printing is usually best.

11th March World Kidney Day (Dr N P Singh)

Kidney diseases are Treatable

Detection: Kidney disease can be detected early. Simple laboratory tests are done on small samples of blood (to measure creatinine content and estimate GFR) and on urine (to measure creatinine and albumin excretion). The majority of individuals with early stages of CKD (chronic kidney disease) go undiagnosed, particularly in the developing world. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or cardiovascular problems occur.

Screening: Screening must be a priority for those people considered to be at high risk of kidney disease, namely:

  1. Patients with diabetes mellitus and hypertension

  2. Individuals who are obese or smoke

  3. Individuals over 50 years of age

  4. Individuals with a family history of kidney disease, diabetes mellitus or hypertension

Current kidney protective treatments should now be extended to those with early stages of CKD.

Key preventative measures have been defined and proven successful in protecting against both renal and cardiovascular disease, such as:

  1. Reduction of high blood pressure: the lower the blood pressure, the slower the GFR decline

  2. Specific medications to reduce proteinuria as well as lower blood pressure – ACE inhibitors/ARBs

  3. Reduce salt intake to lower blood pressure

  4. Control of glucose, blood lipids and anemia

  5. Smoking cessation

  6. Increased physical activity

  7. Control of body weight

     

Treatment: Clinical research over the last decade has shown the potential benefit of blockade of the renin–angiotensin system by angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) to significantly reduce the burden of disease from cardiovascular disease (CVD), diabetes, hypertension and CKD at relatively low cost.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

Associated urinary infection with BPH can cause burning in urination and hematuria.

Lab test (Dr Navin Dang)

The American Diabetes Association has recommended HbA1C as the diagnostic test for diabetes.

List of Approved drug from 1.01.2009 to 31.10.2009

    Drug Name

    Indication

    Approval Date

    Naratriptan (as HCl) Tablets 1/ 2.5mg

    For the acute treatment of migraine with or without aura in adults.

    18.7.2009


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen Immune Power – a known immunity booster with ability to help reduce absorption of aluminum from the GI tract and enhance excretion through kidneys and is a key to eliminate aluminum toxicity and the related systemic involvement.

Advertising in eMedinewS

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

eMedinewS–PadmaCon 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April)

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2pm onwards) and Sunday 18th April (7am–4pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome.

For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs

Indian Stroke Association and International Stroke Conference are organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for the first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

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Readers Responses

  1. Congratulations on your receiving Padma Shri: Pushpa Sodani

  2. Heartiest congratulations. Well deserved and long overdue: Dr H Jauhari

  3. Congrats on receiving the Padma Shri award. Regards: Archana DD

  4. Congratulations Sir for getting Padma Shri, one of India’s most prestigious award: Dr. K Kumar

  5. Heartiest congratulations for recognition of a long holistic journey on the road of health for all by a doctor with a difference. God Bless you and your efforts: 9871098841



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