emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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


6th May, 2010, Thursday

Complete Revascularization Improves Outcomes for
Coronary Artery Disease Patients

Dear Colleague

A 3–year, retrospective study by cardiologists from the Minneapolis Heart Institute Foundation and the University of Minnesota determined that 28.8% of patients with significant coronary artery disease (CAD) who did not undergo complete revascularization had a higher mortality rate than patients completely revascularized.

Dr Timothy Henry, reviewed 493 patients treated at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis, between July 2005 and August 2005.

Patients were categorized based on angiographic results and initial treatment:

  1. Normal coronaries
  2. CAD <70%
  3. CAD >70% with complete revascularization (CR) by PCI or CABG
  4. CAD >70% with partial revascularization (PR) by PCI or CABG
  5. CAD >70% without revascularization treated with medical therapy
  6. CAD >70% with no revascularization options despite optimal medical therapy

The prevalence of treatment options for groups 1-6 was 14.8%, 19.5%, 36.9%, 12.8%, 9.3% and 6.7%, respectively.

Patients with incomplete revascularization (groups 4 to 6) had a risk of mortality more than double that of completely revascularized patients. After 3 years, study participants with incomplete revascularization had a 14.8% mortality risk compared with 6.6% in patients with complete revascularization. Patients with incomplete revascularization were older, more often male, and more likely to have hypertension, diabetes, peripheral arterial disease, previous history of CAD including heart attack, PCI, and CABG.

Patients in the "no option" group had more than one reason for no further revascularization including chronic total occlusions (70%), diffuse disease (46%), and collateral dependent perfusion (42%). The "no–option" patients had an annual mortality of 3–5%, similar to patients with incomplete revascularization. Researchers speculate the reasons for improved morality could be associated with advances in medical therapy for patients with CAD.

Reference:

  1. Williams B, Menon M, Satran D, et al.. Henry. Patients with coronary artery disease not amenable to traditional revascularization: Prevalence and 3–year mortality. Catheterization and Cardiovascular Interventions, 2010;75(6):886-91.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (Health awareness modules)

President can sign a message issued in public interest


Heart Care Foundation of India believes that involving the President of India in Health advocacy increases the efficacy of the message and increases its deliverability since the President is a role model to most of the people in the country. People may follow the footsteps of the president and follow the message if the find the president applying it in his/her life. President is the representative of the country and people listen to him/her. It is thus a powerful method with higher impact.

Dr k k Aggarwal

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

Blood pressure control in children with chronic kidney disease

Intensified blood pressure control with a targeted goal of a 24–hour mean arterial pressure (MAP) below the 50th percentile, compared with conventional blood pressure control, results in slower progression of chronic kidney disease in children.

The ESCAPE trial in 385 children with chronic kidney disease (CKD) found that intensified BP control with a targeted goal of a 24–hour mean arterial pressure (MAP) below the 50th percentile, compared with conventional BP control (target MAP between the 50th and 90th percentiles), results in slower progression of CKD. In patients with ambulatory BP monitoring, targeting MAP to a 24–hour mean <50th percentile is recommended because of the significant benefit that was noted on CKD progression using this goal. However, it remains unclear how to extrapolate this goal to patients in whom 24–hour mean blood pressure measurements are not available.

(Wuhl E, Trivelli A, Picca S, et al. Strict blood–pressure control and progression of renal failure in children. N Engl J Med 2009;361:1639.)

DMC Update

Can a vague complaint be entertained by the state medical council?

No. It is clear from DMC/DC/F.14/Comp. 684/2/2010 order dated 20th April, 2010. DMC wrote to MCI, in reference to their letter No. MCI–211(2)(121)/2010–Ethics/81944 dated 22nd March, 2010 "on perusal of the complaint of Lt. Col. Balbir Singh (Retd.), H–82, Kapil Vihar, Sector–21/C, Faridabad–121001, forwarded by MCI, the DMC has observed that the same is vague, hence, does not merit investigation".

News and views ( Dr Brahm and Monica Vasudeva)

Two kinds of rice may reduce risk of heart disease, high blood pressure

Two kinds of rice; brown and half–milled rice; may reduce the risk of heart disease and high blood pressure, according to a study scheduled to be presented at the Experimental Biology annual conference. An ingredient in brown rice appears to combat a protein known as angiotensin II that contributes to high blood pressure and clogged arteries. The ingredient is in a layer of rice that is stripped away when brown rice is converted to white rice. This layer can be preserved in half–milled (Haigamai) and incompletely milled (Kinmemai) rice.

Eating grapes may lower blood pressure, improve heart function

Eating grapes could reduce heart disease and diabetes, according to research to be presented at the Experimental Biology convention. Working with rats, the investigators found that eating grapes lowered blood pressure, improved heart function, and reduced other risk factors for heart disease and metabolic syndrome. This could be due to phytochemicals, naturally occurring antioxidants, present in grapes.

Nurses may make more medication errors when they are interrupted

Nurses make more medication errors when they are interrupted during the task, according to a study published in the Archives of Internal Medicine. Interruptions occurred during more than half (53.1 percent) of all administrations, and each interruption was associated with a 12.1 percent increase, on average, in procedural failures and a 12.7 percent increase in clinical errors.

Some UK patients not being offered heart scans

The National Institute for Health and Clinical Excellence (NICE), ruled that for the majority of patients with chronic chest pain or shortness of breath which is suspected to be heart–related, a treadmill test is out of date. Tests such as CT scanning, MRI and nuclear scanning are slightly more expensive – but when you factor in effectiveness, they are better value for money.  

Mnemonic of the Day (Dr Prachi ): ECG: T wave inversion–causes– INVERT

Ischemia
Normality (especially young, black)
Ventricular hypertrophy
Ectopic foci (eg calcified plaques)
RBBB, LBBB
Treatments (digoxin)

Quote of the Day: Prakash Rajpal

The third person never creates misunderstanding between two people but misunderstanding between two people creates space for third person.

DMA Update: 9th May is Mother’s Day

Woman who have overflow urinary incontinence, indicated by a postvoid residual of 100 mL or greater, should be referred to a subspecialist. In those with a positive stress test and a low postvoid residual, the presumed diagnosis is stress incontinence. Those with a negative stress test and a low postvoid residual are presumed to have detrusor overactivity.

Question of the Day: (Dr Rajiv Garg, New Delhi)

How is ARS diagnosed?

Acute rhinosinusitis (ARS) i.e. inflammation of the nasal cavity and paranasal sinuses lasting less than four weeks, is subdivided into acute viral rhinosinusitis (AVRS) and acute bacterial rhinosinusitis (ABRS). ABRS occurs in 0.5–2% of episodes. The diagnosis of ARS is based on the presence of: Purulent rhinorrhea Nasal congestion and/or facial pain Symptoms do not accurately distinguish viral from bacterial infection. ABRS is suggested by the presence of symptoms for seven or more days, especially if symptoms initially improve and then worsen. Cultures from nasal swabs or secretions are inaccurate. Radiography is generally not indicated in the initial evaluation of ARS.

Suggested readings

Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg 2004;131:S1.

Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007;137:S1.

Stupid Question: (drsooneita@gmail.com)

When a friend announces her wedding, and you ask...
Stupid Question Is the guy you're marrying good?
Answer: No,he's a miserable wife–beatingo, insensitive lout...it's just the money.

eMedinewS Try this it Works: GETTING THE BEST PAP SMEARS

Rotate the cytobrush in the direction opposite to that used to brush across the slide plate, you will get better results.

Dr Good Dr Bad

Situation: An epileptic patient is seizure free for one year and wants to drive.

Dr Bad: Do not drive

Dr Good: You may drive

Lesson: Epileptic patients can drive after seizure free interval (on or off medication) of 6 months to 2 years.

Make Sure

Situation: An afebrile neonate developed staccato cough 10 days after delivery. On chest auscultation, he was found to have diffuse rales, bilateral hyperinflation.

Reaction: Oh my God! Why did you not prescribe macrolides?

Lesson: Make sure to remember that pediatric patients with respiratory infection, when treated with macrolides, regardless of age and clinical diagnosis, show a significantly higher rate of clinical success than those receiving β–lactams or symptomatic treatment alone.

IMADNB Joke of the Day (Dr. Tarun Gupta) 

BIRTH

The little girl in the zoological park tossed bits of a bun to the stork, which gobbled them greedily, and bobbed its head toward her for more.

“What kind of a bird is it, mamma?” the child asked.

The mother read the placard, and answered that it was a stork.

“O–o–o–h!” the little girl cried, as her eyes rounded. “Of course, it recognized me!”

Formulae in obesity: Percentage Change in Waist Circumference

Changes in waist circumference over time can indicated an increase or decrease in abdominal fat. Increased abdominal fat is associated with an increased risk of heart disease.

Milestones in Derma

384–322 BC: Scabies Scabies was known to Aristotle (384–322 BC), who was the first to use the term ‘akari’ to designate a wood-dwelling mite. A description of scabies was found in an Arabian manuscript written by a physician called Abu el Hasan Ahmed el Tabari, of Tabaristan, who lived around 970. In the twelfth century, Saint Hildegard (1098–1179) wrote a book named ‘Physika’ which includes the first actual reference to the Acarus scabiei.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

CSF Analysis ( Spinal fluid analysis)

To diagnose a disease or condition affecting the central nervous system (CNS) such as bleeding within the brain or skull, cancer, autoimmune disorder or infection.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Valganciclovir Powder for Oral Solution 50mg/ml

For the treatment of cytomegalovirus (CMV) retinitis in AIDS patients and for prevention of CMV disease in solid organ transplant patients at high risk

9.10.2009


MCI Update

  1. The bail applicatoon of Dr Desai did not happen yesterday. It is likely to come in the high court by Monday.
     
  2. Ghulam Nabi Azad, health minister on Tuesday said that MCI creditability is under suspicion and government must take appropriate steps to regain its integrity and reliability for regulating medical education in the country. Government has to ensure that this body will be working in a fair and transparent manner. Azad replied to the calling motion in Rajya Sabha on MCI, that there should be a body like national council for human resources in health which should be responsible for everything. He also said that their prime objective is to re-establish trustworthiness of MCI and facilitate the council to work in a fair and objective manner. They must regain the confidence of all the people involved in medical education in the country. He said that he has discussed Desai proceedings with the law ministry.
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Contact: drkk@ijcp.com emedinews@gmail.com

 
 

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)

Take Care of your Mother

Over 60% of mothers believe their biggest health threat to be breast cancer but heart disease kills 6 times as many women as breast cancer, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Some risk factors are different for women than for men. Heart disease symptoms may be milder in women. Heart attacks often strike without warning. If a woman does not realize heart disease is a health threat, she will not make heart healthy changes or respond to symptoms once they occur.

The woman is at risk if:

1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.

2. She is over 55 years old. (After age 65, the death rate increases sharply for women)

3. She smokes or is exposed to secondhand smoke every day.

4. Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).

5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise with 60–90 minutes with moderate–intensity activity on most days. About 70% of American women don't exercise regularly.

6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.

7. Her HDL (High Density Lipo-protein or "good" cholesterol) is less than 50mg/dL. LDL Goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C<100mg/dL; HDL–C>50mg/dL; triglycerides <150mg/dL; and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3T of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.

8. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)

9. Either natural or through surgery, early menopause–before the age of 40 – is associated with increased risk for cardiovascular disease.

10. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.

11. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.

12. A healthy diet consists of eating fruits, vegetables and whole–grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily);

  • Eating fish, especially oily fish, at least twice a week
  • Limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL
  • Limiting alcohol intake to no more than 1 drink per day
  • Limiting sodium intake to <2.3 g/d (approximately 1 tsp salt)
  • Avoiding all trans–fatty acids (listed as "hydrogenated oil" in the ingredients section)

13. Pregnant and lactating women should avoid eating fish potentially high in methylmercury

14. Having at least three of a cluster of symptoms that are listed below put her at risk:

  • High blood sugar >100 mg/dL after fasting;
  • High triglycerides – at least 150 mg/dL;
  • Low HDL (<50 mg/dL in women);
  • Blood pressure of 130/85 or higher and Waist >35 inches. (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels 

MCI Update (Contd)

Complaints Against Medical Council of India (MCI) on CBI website:
http://www.cbi.gov.in/ events/ mci_complaint.php

This is what appears on the CBI website " CBI has registered a case related to corruption in Medical Council of India (MCI), which conducts inspections for permission to start new Medical Colleges or to introduce new medical courses including Post Graduate Course and also for renewal of permissions, etc. If you have any specific complaint regarding demand of money by MCI officials or giving approval/permission to any such college without having the required infrastructure due to corrupt practices by the Inspection Team or MCI officials, please contact: CBI, hobac3del@cbi.gov.in

Readers Responses

  1. Zinc decreases C–reactive protein, lipid peroxidation, and inflammatory cytokines in elderly subjects: a potential implication of zinc as an atheroprotective agent (American Journal of Clinical Nutrition, 04/30/10). Dr E A Farooquee