HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



 emedinews is now available online on www.emedinews.in

12th December Saturday

Dear Colleague,

   Tamiflu: does it have any role?

There is not enough evidence that oseltamivir has any benefit for the complications of influenza in otherwise healthy patients. An updated Cochrane review of the drug, appearing online in BMJ has concluded the same. Tamiflu reduces symptomatology, at best, by one day. The vast majority of young healthy adults will do well with rest, fluids, and ibuprofen/paracetamol without Tamiflu. It is important not to extend these findings to high-risk individuals or people with severe illness for whom antiviral drugs are recommended. In these people, even a small benefit may be worth it. In severely ill patients admitted for pneumonia and influenza like illness, there is evidence demonstrating its benefit.

New analysis drastically reduces estimate of swine flu fatalities

A team of researchers from the USA and Britain has dramatically scaled back estimates of the severity of the swine flu epidemic. The death rate from the current wave of H1N1 flu cases probably will fall in a range that extends from far lower to slightly higher than the estimate of 36,000 deaths caused by seasonal flu in a typical year. The findings are a marked reduction from an August report by the President's Council of Advisors on Science and Technology which called for a death toll anywhere between 30,000 and 90,000. The study supports estimates released last month by the US Centers for Disease Control finding a similarly low death rate of about 1 of 5,600 sick patients. The new analysis was published in PLoS Medicine.

 Formula: do not see at the newspapers figures. Multiply every death with 5600 and you will get the number of swine flu cases in any state.

Dr KK Aggarwal 




Humor (krishan13629@yahoo.co.in)
Santa attending an interview in Software Company.
Manager: Do U know MS Office?
Santa: If U give me the address I will go there sir.

Funny clinical notes (Dr. Minakshi)
Patient had waffles for breakfast and anorexia for lunch.

Evidence Based Practice
The administration of a rabies immune globulin is generally recommended in conjunction with the first dose of the rabies vaccine, particularly in cases of severe bites. Drugs 1998 Nov.;56(5):801 809.

Make Sure
Mistake: A 60 year old patient with osteoarthritis developed GI bleed after NSAID
Reaction: Oh my god! Why was he give NSAID as a routine
Make sure that elderly patients with pain are prescribed NSAIDs sparingly.

Dr Good Dr Bad
Situation: A patient with chronic anemia needed blood
Dr Bad:  Give whole blood transfusion
Dr Good: Give pack cells

Lesson: In chronic anemia, packed red cell transfusion is the treatment of choice, as the hemoglobin level can be raised without overloading the circulation.

Health tip (Dr Prachi Garg)
Athlete's Foot
Athlete's foot is a fungal infection, usually causing itching and redness between the toes. It's commonly contracted in locker rooms and other moist, warm areas where fungi like to grow.
1. Topical antifungal creams, sprays or ointments.
2. Oral antifungal drugs.
3. Fungicidal chemicals may work, but may not penetrate deeply enough into the skin.
4. Washing the feet thoroughly and frequently, being sure to carefully dry between the toes.
5. Keeping feet dry with a powder inside shoes and socks.

Diabetes 2009 revisited
DPP4 inhibitors and pancreatitis:
There have been 88 post marketing case reports of acute pancreatitis in patients using Sitagliptin. Pancreatitis should be considered in all patients with persistent severe abdominal pain (with or without nausea) on sitagliptin alone or with metformin and the drug should be discontinued in such patients.

Twice daily NPH as good as single daily glargine
In a five year trial in over 1000 patients with type 2 diabetes previously treated with oral hypoglycemic agents, insulin, or both, there was no difference in the risk of retinopathy progression (defined as an increase in three steps or more on the early treatment of diabetic retinopathy study scale) in patients randomly assigned to twice daily NPH versus once daily glargine [Diabetologia 2009; 52:1778.]

Glargine not linked to cancers
Does insulin analogs is linked to cancer the results are conflicting. Until more data are available, there is insufficient evidence to make a recommendation against glargine. [Diabetologia 2009; 52:1732.]

Mediterranean diet good for the diabetes
In a four year trial of a low carbohydrate Mediterranean tyle diet (=50 percent complex carbohydrates, > 30 percent mono and polyunsaturated fat) versus a low fat (<30 percent) diet in 215 overweight patients with newly diagnosed type 2 diabetes, patients randomly assigned to the Mediterranean diet were significantly less likely to require anti hyperglycemic drugs (44 versus 70 percent) [Ann Intern Med 2009; 151:306.]

Saxagliptin, a new DPP IV inhibitor
Saxagliptin, a new DPP IV inhibitor that reduces hemoglobin A1C by approximately 0.5 percentage points, can be used as initial pharmacologic therapy for the treatment of type 2 diabetes or as a second agent in those who do not respond to a single agent, such as a sulfonylurea, metformin,  a thiazolidinedione [Diabetes Care 2009; 32:1649.]


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medinews: revisiting 2009

IJCP Group is organizing emedinews: Revisiting 2009, a day long conference on 10th Jan  2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts will deliver lectures. CME will be followed by lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com. We have crossed 1200 registrations.

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Letters to the edit
1. Thanks for sending daily emedinews, Its very important  & knowledgeable to me. Sir keep continuation of this emedinews. Sumat Singh

2. Primary percutaneous coronary intervention (PPCI) is the treatment of choice for patients with ST segment elevation myocardial infarction (STEMI). In the attempt to reduce the unfavourable effects of time delays before PPCI, the administration of thrombolysis has been advocated (facilitated-PCI), but this treatment was shown to be ineffective and harmful, and should be avoided in patients who can receive PPCI promptly.

 Fibrinolysis is still indicated when PPCI is not available within 90-120 min. About 1/3 of STEMI patients undergoing fibrinolysis does not show signs of reperfusion and even when reperfusion is achieved they have a considerable risk of death and recurrent MI. Thus invasive management with early PCI could be complementary to fibrinolysis both to obtain coronary reperfusion in those patients with failed thrombolysis (rescue-PCI) and to decrease the risk of further ischaemic events in patients with successful thrombolysis. This synergy has been supported by modern randomized control trials and meta analysis. (Dr G M Singh)



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