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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


12th May, Wednesday, 2010

Binge eating disorder

Binge eating disorder involve binge eating (eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances) two days per week for a six month duration. Its a new epidemic of the society.

Binge eating is associated with a lack of control over the eating, and with distress over the binge eating. The binges associated with binge eating disorders must have at least three of the following five criteria

  1. Eating much more rapidly than normal

  2. Eating until uncomfortably full

  3. Eating large amounts of food when not feeling physically hungry

  4. Eating alone because of embarrassment

  5. Feeling disgusted, depressed, or very guilty after overeating

(American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed, American Psychiatric Association, Washington, DC 1994.)

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file)

According to Heart Care Foundation of India, health check up of a VIP and releasing the photo to the public can increase the possibilities of adaptation of this healthy practice among general public by many folds. It is important to involve people who count, such as a public figures with a dignified position in society to promote health check ups among people at largePhoto from file: Former VP of India Sh B S Shekhawat getting his BP Check up done and releasing a health message later.

Dr k k Aggarwal

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

Vitamin D

Two studies have addressed the benefits of treating vitamin D deficiency and insufficiency. (BMJ 2009;339:b3692 and Arch Intern Med 2009;169(6):551–561)

 

Guest editorial

Does the pharmaceutical industry manufacture only drugs or diseases as well?

Many may not have heard of metabolic syndrome – but this is about to change. Once known as Syndrome X, the condition, a precursor to heart disease and type 2 diabetes, is about to be transformed into a household name by the pharmaceutical industry and its partners in the medical profession. A society dedicated to addressing the condition has been organized, a journal has been started, and an education campaign launched. Patients are already being tested for metabolic syndrome.

Pharmaceutical Executive says: "A new disease is being born" it further says: "In the pursuit of profits, companies are in league with medical doctors and patient advocacy groups to ‘disease monger’…

Twenty–five years ago, physicians were not concerned about the effects high cholesterol might have on heart disease. Today, thanks to efforts by pharmaceutical companies, high cholesterol levels are now recognized as a major health problem.

Both these conditions can be managed by diet and exercise alone!

The late medical journalist Lynn Payer addressed the issue in the early 1990s in her book Disease–Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick. She coined a new term ‘Disease–mongering’. "Disease–mongering—trying to convince essentially well people that they are sick, or slightly sick people that they are very ill—is big business… Disease mongering is the most insidious of the various forms that medical advertising, so–called medical education, and information and medical diagnosis can take."

Some other newly invented diseases by pharma companies

  • Obsessive compulsive shopping disorders: recommended drugs – anti depressants
  • Nomophobia (No Mobile Phobia – when you forget to carry or misplace your cell phone and the world seems to come to an end): recommended drugs – anxiolytics i.e. antianxiety drugs
  • Adult attention deficit disorder: recommended drug – atomexetine
  • Post traumatic stress disorder: recommended drug – sertraline
  • Social anxiety, the psychiatrists name for shyness! Recommended drug – paroxetine

Payer and Caplan say that the routine human condition…is increasingly being re–defined as disease… Say the pharmaceutical industry and the medical profession in unison: "For every cure they (pharma industry) discover we (doctors) will find a disease". Today, they create new diseases, patients, risks and "awareness campaigns" faster than ever before. And finally, watch out for 'Faceoffobia’ – the fear of not knowing what our Facebook friends are doing at this very moment. The medical profession and pharma industry may soon find a cure for it!

Reference

  1. Disease mongering and drug marketing. Does the pharmaceutical industry manufacture diseases as well as drugs? EMBO reports 2005;6(7):612–4.

Dr Reshma Aggarwal

DMC Update

Can DMC take unsubstantiated complaints?

A: No. In DMC/DC/F.14/ Comp. 683/2/2010/ dated 20th April2010 order the DMC examined a complaint of Shri VB from Shahdara against Dr. PG forwarded by Medical Council of India. On perusal of the complaint, the Council observed "that the complainant has leveled vague and unsubstantiated allegations against Dr. PG hence, the same does not merit any consideration and stands rejected".

News and Views (Dr Brahm and Monica Vasudeva)

Herpes zoster vaccine safe and effective, but cost may hinder its use

The herpes zoster vaccine is safe and effective, but financial considerations may keep clinicians from administering it, according to a study in the may 4 issue of the Annals of Internal Medicine.

HPV testing more sensitive than conventional screen

Testing for human papillomavirus (HPV) DNA is a more sensitive means of detecting cervical cancer and pre-cancerous lesions than conventional Pap testing, a Finnish screening program has found. The study  concluded that HPV testing compared well with conventional testing and did not cause too much burden to patients, at least in women aged 35 or older. They noted that the high rate of positive HPV tests among women under 35 makes HPV screening challenging and indicates the need for better triage tests. They recommended that primary HPV screening be piloted in additional programs, in Finland as well as elsewhere in the world.

Biomarkers may aid treatment decisions in DCIS

Certain biomarkers may help predict risk for and severity of recurrent disease in women with ductal carcinoma in situ (DCIS). In a study published online in the Journal of the National Cancer Institute, the 8–year risk for subsequent invasive cancer was higher in women in whom either DCIS was detected on palpation or lesions were positive for p16, cyclooxygenase–2 (COX–2) and Ki67 antigen (19.6%; 95% CI, 19.0% to 21.3%) than in women whose DCIS was detected on mammography and in which the same three biomarkers were negative (4.1%; 95% CI, 3.4% to 5.0%).

Many stent patients delay taking clopidogrel with adverse results

Patients who delay filling their clopidogrel prescription for even a day after discharge post–implantation of a drug–eluting stent (DES) have a higher risk of death or myocardial infarction (MI). (May issue of Circulation: Cardiovascular Quality and Outcomes.)

Mnemonic of the Day (Dr Prachi): Signs of Niacin (B3) deficiency – 4 Ds

Dementia
Dermatitis
Diarrhea
Death

Quote of the Day: USED vs LOVED

While a man was polishing his new car, his 4–year–old son picked up a stone and scratched lines on the side of the car.
In anger, the man took the child's hand and hit it many times not realizing he was using a wrench. At the hospital, the child lost all his fingers due to multiple fractures.

When the child saw his father..... with painful eyes he asked, ‘Dad when will my fingers grow back?’ The man was so hurt and speechless; he went back to his car and kicked it a lot of times.
Devastated by his own actions..... . sitting in front of that car he looked at the scratches; the child had written ‘LOVE YOU DAD.

Anger and Love have no limits; choose the latter to have a beautiful, lovely life & remember this: Things are to be used and people are to be loved… The problem in today’s world is that people are used while things are loved.

Let’s try always to keep this thought in mind:
Things are to be used, People are to be loved.

Question of the Day: (Dr GM Singh)

Should the newer and more cardioselective ß-blockers be avoided in patients with PAD?

The use of b–blockers for the treatment of hypertension in patients with peripheal arterial disease (PAD) was earlier discouraged due to the risk of drug–induced peripheral vasoconstriction which further aggravated ischemia in the leg leading to worsening of symptoms of claudication. In a Cochrane review of treatment of hypertension in PAD, no strong evidence could be found to exclude the use of b–blockers.

The additional cardioprotecting action of ß–blockers may be especially helpful in patients with PAD who also have concomitant coronary disease. These drugs can therefore be used when treating high BP in patients with both PAD and CHD. Perioperative use of b-blockers is also possibly associated with reduced cardiovascular risks of surgery. In the absence of contraindications, use of ß–blockers may be considered in PAD patients undergoing vascular surgery in order to improve prognosis.

eMedinewS Try this it Works: Alleviate pruritus with ice

Patients who can’t help scratching itchy skin lesions, ask them use ice cube instead of their fingers. The ice is nearly frictionless, and the cold helps to relieve the itch.

International Vaccines recommendations

Yellow fever vaccination is sometimes recommended 10 days before travel

Dr Good Dr Bad

Situation: An elderly with NSAID–induced GI bleed came to ICU.
Dr Bad: Don’t worry it carries no mortality.
Dr Good: It can carry high mortality.
Lesson: Elderly users of aspirin and NSAIDs, especially women, are at increased risk of fatal peptic ulcer complications.

Make Sure

Situation: A patient met with an accident while driving.
Reaction: Oh, my God! I forgot to inform the patient that he should not drive while taking the antihistamine.
Lesson: Make sure that when prescribing drugs with sedative side effects, the patient is cautioned against driving and hazardous machine work.

IMADNB Joke of the Day (Dr Tarun Gupta)

BURGLARY

A young couple that had received many valuable wedding presents established their home in a suburb. One morning they received in their mail, two tickets for a popular show in the city, with a single line:

"Guess who sent them."

The pair had much amusement in trying to identify the donor, but failed in the effort. They duly attended the theatre, and had a delightful time. On their return home late at night, still trying to guess the identity of the unknown host, they found the house stripped of every article of value. And on the bare table in the dining–room was a piece of paper on which was written in the same hand as the enclosure with the tickets:

"Now you know!"

Formulae in clinical practice

eGFR (estimated glomerular filtration rate) = 14 – age (years) × Weight (Kg)/72 × S. creatinine

Milestones in Diabetology

129–200 A.D. Galen: Greek physician Galen of Pergamum mistakenly diagnosed diabetes as an ailment of the kidneys.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Insulin–like Growth Factor – 1

To identify diseases and conditions caused by deficiencies and overproduction of growth hormone (GH), to evaluate pituitary function, and to monitor the effectiveness of GH treatment.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Calamine 8% + Liquid Paraffin10% lotion

As antipruritic and smoothening agent

26.02.09

 

Public Forum (Press Release for use by the newspapers)

Keep fasting sugar lower than 90 mg%

People with a fasting blood sugar level of 100–125 mg/dl had an adjusted nearly 300% increase higher risk of having coronary heart disease than people with a level below 79 mg/dl, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

A fasting blood sugar level of more than 125 mg/dl is the current threshold for identifying patients with diabetes.

But, a cross–sectional study of nearly 2500 people suggests that patients with high levels of blood sugar in the nondiabetic range face a substantial risk of coronary heart disease.

The Cleveland Clinic Foundation now uses a fasting blood sugar of 90 mg/dl or higher as a biomarker of coronary heart disease risk. These patients need intervention with exercise, diet and weight control.

The previous cutoff of 125 mg/dl was based on the incidence of diabetic retinopathy, but physicians now increasingly focus on the diabetes–related risk of coronary heart disease. As evidence continues to grow in this area it is likely that the definition of diabetes will change.

The Heart Care Foundation of India recomends keeping fasting blood sugar below 80 mg%.

Readers Responses

  1. Congratulations Sir. May Almighty shower upon you the success? madhu Gurung

  2. Dear Dr KKA; Your emed news: At last, some state association has taken the bold step of organizing the meeting to discuss the present unexpected situation. The question is not to run a blame game but to see IMA STANDS TALL & UNITED and as an organization with moral authority and is concerned solely with the welfare of the profession, the doctors and the association. Hope the committee existing of Drs Vinay & Sanjeev along with yourself & Dutta shall work out a nice formula. Be Bold Think positively & take effective steps. We do not need to support MCI as it is now. Our main aim is to see that there is no third time repeat of the same scenario in MCI who ever comes to power there especially our brotheren from medical profession.. It is ok for politicians to be blamed for corruption and favoritism.. Not for doctors like us. Please pass this on to your members and members of DMA with my regards Yours: Rtn. PHF. Dr. L V K MOORTHY. President IMA Tamil Nadu (2008-2009)
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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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