From the Desk of Editor in Chief
13th February 2010, Saturday
Coronary artery disease: Primary prevention is the key
On Thursday, Former US President Bill Clinton underwent angioplasty. He had complained of chest discomfort and subsequently had two stents placed at New York Presbyterian Hospital. Six years ago, President Clinton had undergone a successful quadruple bypass surgery after angiography revealed significant blockages in four coronary arteries. One of the bypass grafts out of the four was blocked. Hence, the native coronary artery at the site of the graft was opened and two stents were placed. In a similar case, Dr Manmohan Singh had had a bypass surgery as well as angioplasty. Last year, he underwent a Re-do or repeat bypass surgery after he complained of chest.
What are the options available after a bypass surgery?
On an average, bypass or angioplasty do not last for more than 6 to 8 years. Patients often require another procedure as the graft may re-obstruct . Also, new blockages tend to develop on account of the progressive nature of the disease. A regular and close watch is crucial.
The answer is primary prevention. Healthy lifestyle choices like eating judiciously, regular exercise, maintaining optimal body weight, not smoking can help prevent coronary artery disease. These drug-free approaches can avoid heart disease by improving risk factors like blood pressure, fats, blood sugar etc. Preventing steps taken at the right time are a much better option than altering lifestyle after a heart attack.
Dr KK Aggarwal
News and Views
Valentine Day Special–14th February
Danger signals of heart attack during the act are a feeling of pressure, pain or discomfort in the jaw, neck, arm, chest or stomach; marked shortness of breath; and excessively rapid or irregular heartbeats. Researchers from St Thomas Hospital, London, have shown that couples in long–term relationship were far less likely to have heart attack while having sex compared to those having affairs or one–night stands.
Stopping Statins may not stop statins induced muscle pains
Patients getting muscle pains and weakness with statins may continue to suffer symptoms long after stopping statins. Almost a third of patients who stopped statin treatment because of neuromuscular symptoms still showed myalgia six months later, and creatine kinase levels above 200 units/L persisted in 17%, according to Dr Andoni Echaniz-Laguna, of Hopitaux Universitaires in Strasbourg.[Feb New England Journal of Medicine]. Creatine kinase measurements at the start of statin therapy could help identify patients with underlying neuromuscular diseases.
Question of the day
Is it advisable to give hematinics in malaria?
WHO guidelines recommend that iron and folic acid supplementation should be targeted to those who are anemic and at risk of iron deficiency. They should receive concurrent protection from malaria and other infectious diseases through prevention and effective case management. Children in regions of the world where malaria transmission is intense and infectious disease are highly prevalent, should be given supplements. (Suggested reading: Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. WHO statement. April 2004)
Dr Good Dr Bad
Situation: A diabetic child failed on lifestyle therapy and metformin.
Dr Bad: Add another oral drug.
Dr Good: Add insulin.
Lesson: In children initially treated with both non pharmacologic therapy and metformin who fail to achieve glycemic targets, use insulin glargine, a long–acting insulin analogue, as the next therapeutic agent. Although others have suggested that sulfonylureas can be considered as an alternative to insulin therapy. Sulfonylureas are not currently FDA approved for use in pediatric patients. (Source: Plotnick L. Diabetes Mellitus. In: Principles and Practice of Pediatric Endocrinology, Kappy, SM, Allen, DB, Geffner, ME (Eds), Charles C. Thomsa, Springfield, 2005. p. 635.)
A patient with community acquired pneumonia (CAP) developed diarrhea after 3 weeks of antibiotics.
Reaction: Oh my God! Why was the antibiotic given for 3 weeks?
Make sure that CAP patients are treated for five days (Infectious Diseases Society of America/American Thoracic Society Guidelines)
Laughter the Best Medicine
You don’t want to hear during Gyne surgery: Damn! Page 84 of the manual is missing!
Formulae in Imaging
A common bile duct greater than 11 mm in diameter on USG is strongly suggestive of obstruction by stone or tumor. (Source: Radiology 1979;133:703–7)
Myringotomy with tympanostomy tubes may be considered for persistent symptomatic effusions at 12 weeks, and earlier for selected patients with need for immediate pressure equalization.
In the elderly, target hemoglobin level should be in the range of 10 to 12 g/dL.
Milestones in Neurology
Sir James Crichton–Browne (1840–1938) was a British psychiatrist known for the scientific study of brain tissue in cases of psychiatric disorder, for his concepts of mental illness in relation to evolutionary theory and for the development of medical psychology in public health and education.
Mistakes in Critical Care
Never use ‘&’ for ‘and’ as it can be misread as ‘2’. Instead write ‘and’
Zen Immune - facts
Zen Immune XP: is a unique product with quality ingredients to boost the immune system, alleviate fatigue, provide a feeling of well being and give extra energy for extra pleasure.
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