emedinews
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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
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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

10th April, 2010 Saturday

Radiation Injury Update : 


What are  radioactive materials?

A: Alpha emitters (eg, plutonium, americium, californium), and beta-gamma emitters (eg, cesium, cobalt, iodine)


What are the types of radiations?

Ionizing radiation (eg, x-rays, gamma rays, proton beams used for radiation therapy) and non-ionizing radiation (eg, microwaves, radio waves, infrared light).

Nonionizing radiation causes damage through direct or indirect transfer of thermal (heat) energy. The examples are  sunburn and microwave heating. Ionizing radiation acts at the cellular level and has the potential to cause structural and chemical damage to vital targets such as nucleic acids and proteins.


What is absorbed Dose?

The rad (radiation absorbed dose) is the traditional unit of absorbed dose, and is defined as the transfer of 100 ergs per gram of tissue. The rad has been superseded in the SI (Système International) by the Gray (Gy). One Gy, the unit most commonly used to measure radiation therapy dose, is equivalent to 100 rad (1 joule/kilogram), while one cGy is equivalent to 1 rad or 1000 mrad.

The rem has been superseded in the SI by the Sievert (Sv). One Sv is equivalent to 100 rem.

For most therapeutic radiation exposures (eg, x-rays, gamma rays) the Sievert and Gray are approximately equal. However, when there is exposure to highly ionizing particles (eg, neutrons, alpha particles) the radiation dose equivalent reflects resulting tissue damage better than the absorbed dose. As an example, the quality factor for x-rays, gamma rays, and beta particles is 1, while that for alpha particles is 20, and can range from 4 to 22 for neutrons, depending on neutron energy.


The "dose rate" refers to the amount of radiation delivered per unit of time and is most often measured in rads/hour or Gy/hour. Carcinogenic effect of radiations delivered at a lower dose rate is less than that of the same total dose delivered at a higher dose rate. Similarly, a dose of 1 Gy delivered over 1 minute might cause signs and symptoms of acute radiation injury, whereas the same dose delivered over 100 days would not.


What are the four main phases to the acute radiation syndrome?

1. The prodromal phase usually occurs in the first 48 hours following exposure, but may develop up to six days after exposure.

2. The latent phase is a short period characterized by improvement of symptoms. However, this effect is transient, lasting for several days to a month. The duration of this phase is inversely related to the dose of radiation received, and may be absent at the highest, fatal doses.

3. The stage of manifest illness may last for weeks, and is characterized by intense immunosuppression. It is the most difficult to manage. If the person survives this stage, recovery is likely.

4. Death or recovery phase — Those patients who recover will require close follow-up for the first year, owing to the risk for unusual infections, as aberrant immune reconstitution is probable in those with significant exposure. Survivors will require life-long follow-up to monitor for long-term complications, such as organ dysfunction and carcinogenesis.

The prodromal syndrome is often minimal in those exposed to doses of ≤1 Gy, while those exposed to doses of 10 to 20 Gy may have a rapid compression of phases and proceed from the prodromal phase to death in two days or less.


What a GP should look at?

Lymphopenia is common and occurs before depression of the other cellular elements, and may develop within the first 6 to 24 hours after exposure to a moderate or high dose.


A 50 percent decline in the absolute lymphocyte count within the first 24 hours after exposure, followed by a further more severe decline within 48 hours, characterizes a potentially fatal exposure in the range of 5 to 10 Gy.


An absolute lymphocyte count that remains within 50 percent of normal during the first week following exposure suggests an exposure of <1 Gy and a survival probability in excess of 90 percent.

There is a highly predictable relationship between the absolute lymphocyte count and absorbed dose.

The prodromal syndrome is generally mild or absent at total body doses of 1 Gy or less. Patients whose symptoms begin more than two hours after exposure are exposed to doses <2 Gy. They can be expected to fully recover within one month, although long-term sequelae may develop.

Onset of symptoms within the first two hours usually indicates significant and potentially lethal exposures exceeding 2 Gy. At these doses, sloughing of the gastrointestinal epithelium also occurs (ie, the gastrointestinal syndrome), adding to the symptomatology (see below). At doses between 2 to 10 Gy, it is difficult to establish a prognosis based solely on the existence and/or severity of the prodromal syndrome.

At high doses (eg, 10 to >20 Gy), prodromal symptoms occur in virtually all patients within minutes of exposure.
These gradually merge into loss of consciousness and hypotension, components of the cerebrovascular syndrome. Death often occurs within a few days to weeks after such exposures.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo feature

Shri Suresh Kalmadi, Chairman, Commonwealth Games 2010 flagging off the Perfect Health Parade 2010 on 8th April 2010, (organized by Heart Care Foundation of India and The Loomba Trust) Also in the picture Padma Shri Awardee Dr K K Aggarwal, Nalini Dancer and Dr P K Sharma MOH NDMC.  The main aim was to create health awareness in general and the health of widows and their children in particular.

Dr k k Aggarwal


News and views

Medpage Meeting Notes
American College of Cardiology
Atlanta, GA • March 14 – 16, 2010

1. Mixed results for intensive initial dosing for acute HF

More aggressive loop diuretic dosing early in the treatment of acute heart failure appears safe and may provide some clinical benefit. But continuous infusion provided no advantage over 12–hour boluses in a randomized clinical trial. (Dr G. Michael Felker, Duke University)

2. CABG data suggest ticagrelor benefit

Acute coronary syndrome patients randomized to an investigational antiplatelet noted for its quick–on, quick–off activity had a lower mortality rate following coronary artery bypass surgery than control patients. All antiplatelet therapy was discontinued prior to surgery, but patients who had been assigned to ticagrelor had a total mortality rate of 4.6% compared with 9.2% for the clopidogrel patients, even though there was no difference in the stroke or bleeding rate between the two groups. (Dr Claes Held, Uppsala Clinical Research Center and Department of Cardiology Uppsala University, Sweden)

In the news (Dr Brahm and Monica Vasudeva)

Millions of H1N1 vaccine doses may be discarded.

FDA conducting safety review of Parkinson’s drug

FDA said it is conducting a review of the safety of Stalevo (carbidopa, levodopa, entacapone), which is used to treat Parkinson’s disease, to see if it might be linked with the development of prostate cancer.

Orexigen seeking FDA approval for weight-loss drug

Orexigen Therapeutics Inc. said it has filed for Food and Drug Administration approval of its potential weight–loss drug Contrave (bupropion and naltrexone HC).

FDA approves injectable varicose vein drug

The FDA has approved the injectable varicose vein treatment polidocanol (Asclera).

One hour of daily moderate activity may help prevent weight gain in normal–weight women.

According to research published in the March 24/31 issue of The JAMA, an hour of moderate activity a day prevented women of normal weight from gaining more than five pounds over any three–year period.

What’s New: Migraine with aura

In a longitudinal study, subjects (mainly women) who had migraine with aura at an initial evaluation had an increased risk of infarct–like lesions on brain MRI 25 years later, compared with those not reporting recurrent headaches at baseline. (Scher AI, Gudmundsson LS, Sigurdsson S, et al. Migraine headache in middle age and late–life brain infarcts. JAMA 2009;301:2563)

eMedinewS Facts

rheumatoid arthritis

The sensitivity of enzyme-linked immunosorbent assays (ELISA) for anti–CCP antibodies is similar to that of testing for IgM RF (rheumatoid factor), but the specificity of a positive anti–CCP antibody assay is higher, in the range of 90–96%.

eMedinewS calculator

QT Interval:

QT Corrected = QT Interval (sec)/square root of R-R interval (sec)

Quote of the day

‘The greater the difficulty the more glory in surmounting it. Skillful pilots gain their reputation from storms and tempests.’ (Epictetus)

Celiac Disease (Dr Ishi Khosla)

Is celiac disease treatable?

Celiac disease is completely manageable with strict gluten–free diet. This has to be a life–long discipline, both while eating at home and eating out. 

Diabetes Fact

Diabetic ketoacidosis: sugar range 400–600, Nausea, vomiting, pain abdomen, medical acute abdomen (differential diagnosis: Addison’s, porphyria, inferior MI, basal pneumonia, sickle crises). Patient has Kussmaul breathing, tachycardia, dry mouth, dry tongue like wood, high TLC, (no fever). Dehydration is due to osmotic diuresis.


Public Forum
(Press Release)

Leech therapy

Blood–sucking leeches – used for thousands of years in ayurvedic medicine – also approved by US FDA are a tool for healing skin grafts or restoring circulation, said Padma Shri and Dr B C Roy Awardee Dr. K K Aggarwal, President Heart Care Foundation of India.

Doctors have used these small aquatic worms for several thousand years in the belief that bloodletting helps to cure a wide range of complaints from headaches to gout. They reached their height of medicinal use in the mid–1800s.

Today, doctors around the world use leeches to remove blood pooled under skin grafts for burn patients or to restore circulation in blocked veins by removing pooled blood. Leeches are particularly useful in surgeries to reattach body parts such as fingers or ears. The leeches can help restore blood flow to reconnected veins.

FDA has approved leeches as a medical device. When leeches begin feeding, they inject salivary components (e.g., hirudin) that inhibit both platelet aggregation and the coagulation cascade. This results in a marked relief of venous congestion. The anti–coagulant causes the bite to ooze for up to 48 hours following detachment, further relieving venous congestion. By feeding for 10 to 60 minutes, leeches consume from 1 to 2 teaspoons of blood. Results from clinical studies showed that the success rate of salvaging tissue with medicinal leech therapy is 70 to 80%.

Indications

  1. Poor venous drainage (venous congestion/venous outflow obstruction); or

  2. Salvage of vascularly compromised flaps (muscle, skin, and fat tissue surgically removed from one part of body to another).

  3. Salvage of vascularly compromised replants (limbs or other body parts re–attached after traumatic amputation).

  4. Knee osteoarthritis, inadequate arterial supply or tissue ischemia, and for all other indications.


Question of the day

Explain in brief the three major categories of radiosurgery?

The three main categories of radiosurgery are

  • Cutting
  • Cut and coagulation
  • Coagulation.

Cutting

In cutting mode of operation, 90% of the wave of electrons is in cutting mode and 10% in coagulation. So it is not 100% cutting. To produce this mode the radio waves are fully filtered. This means the radio waves are continuous and non–pulsating and micro smooth.

Cut and coagulation In this mode the waves does 50% cutting and 50% coagulation. To produce this mode the radio waves are fully rectified.

Coagulation Here the waves have 90% coagulating effect. This pattern of waves has intermittent or jerky high frequency current. This waveform is called partially rectified.


eMedinewS Try this it Works

Accurate blood pressure readings

Measuring diastolic blood pressure can be difficult in patients in whom the fifth Korotkoff sound is indistinct because of poor arterial turbulent blood flow.

Have the patient lift up his or her arm and clench the fist about 10 times. This drains the blood from the forearm.

Then, as the patient keeps the arm raised, inflate the occlusion cuff until the pressure rises above the systolic point.

Then have the patient lower the arm, and take the pressure. This makes the fifth Korotkoff sound much more distinct.


Dr Good Dr Bad

Situation: A diabetic elderly came with low HDL levels.

Dr Bad: In elderly it has no significance.

Dr Good: It is an important risk factor.

Lesson: Lower HDL cholesterol is an important risk factor for not only IHD but also CVD, especially in diabetic elderly individuals. (Diabetes Care 2009;32(7):1221–3.)


Make Sure

Situation: A 28 year old male presents with increased frequency and occasional blood in urine. Examination of urine shows sterile pyuria.

Reaction: Oh my God! Why didn't you check for TB?

Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria and sterile pyuria is the first clue to diagnosis.

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Laughter the best medicine

A man speaks frantically into the phone, "My wife is pregnant, and her contractions are only two minutes apart!" "Is this her first child?" the doctor queries. "No, you idiot!" the man shouts. "This is her husband!"


Formulae in Critical Care

Respiratory alkalosis

Acute HCO3 compensation

Formula: Acute HCO3 will decrease by 2 mmol/l
per 10 mmHg decrease in PaCO2

Chronic HCO3 compensation

Formula: HCO3 will decrease by 4.0 mmol/l per
10 mmHg decrease in PaCO2

Milestones in Medicine

1954 A.D. American surgeons transplanted a kidney, the first successful organ transplant.

Lab Test (Dr Naveen Dang)

Anti CCP levels are done to diagnose rheumatoid arthritis.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Dexketoprofen Trometamol Injection 50mg/2ml

Symptomatic treatment of acute pain of moderate to severe intensity, when oral administration is not appropriate such as post–operative pain, renal colic and low back pain.

22.10.2009


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen Immune Beauty helps improve the brittleness of nails and increase the hair tensile strength, thus preventing hair loss. It stimulates regeneration of hair roots, helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

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 or 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). Over 400 registrations already done.

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, IMSA (Delhi Chapter)

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

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). 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

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

Readers Responses

  1. Congratulations Sir. On receiving the Padma Shri award. Am proud to be associated with you: Dr. Ellora

  2. Heartiest congratulations to your sir on receiving the Padma Shri: Dr. Yatin

  3. Congratulations Sir: Dr. Neena Kwatra

  4. I am glad to know that hamare aziz doctor sahab is receiving the Padma Shri award from Rashtrapati ji. My sincere wishes are with you: D N Maan, Jhulewala

  5. Congrats. Congrats. Congrats: Dr. Prabha & K K Arora

  6. Congratulations on receiving Padma Shri: Gaurakh Khandelwal