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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08c); 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

 

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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

ASAR Aamir Khan & Dr KK Aggarwal on Satyamev Jayate

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
    Dr KK Aggarwal on Social Media …

DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan
ASAR–Aamir Khan And Dr KK Aggarwal on Satyamev Jayate

 
  Editorial …

13th June 2012, Wednesday

Diabetes Update

  • Morbidity from diabetes involves both macrovascular (atherosclerosis) and microvascular disease (retinopathy, nephropathy and neuropathy).
  • Smoking cessation is essential for patients who smoke.
  • Cardiovascular morbidity can also be significantly reduced with aggressive management of hypertension, cholesterol (goal LDL less than 80 mg/dL and use of aspirin (8o mg/day) in patients with or at high risk for cardiovascular disease.
  • Glycemic control can minimize risks for retinopathy, nephropathy and neuropathy in both type 1 and type 2 diabetes, and has been shown to decrease the risk for cardiovascular disease for type 1 diabetes.
  • A1C goal is <7% for most patients.
  • More stringent control (A1c <6%) may be indicated for individual patients with type 1 diabetes and during pregnancy.
  • A higher target A1c (i.e., <8%) may be preferable for some type 2 patients with comorbidities or with an anticipated lifespan, owing to advanced age or other factors, that is too brief to benefit from the effects of intensive therapy on long–term complications.
  • The appropriate target for A1c in fit elderly patients who have a life expectancy of over 10 years should be similar to those developed for younger adults (<7.0%).
  • The risk of hypoglycemia, which may lead to impaired cognition and function, is substantially increased in the elderly. Thus, avoidance of hypoglycemia is an important consideration in establishing goals and choosing therapeutic agents in elderly adults.
  • In the absence of specific contraindications, start with metformin as initial therapy for all patients with diabetes including the elderly. Start with metformin at the time of diabetes diagnosis, along with consultation for lifestyle intervention. Titrate metformin to its maximally effective dose (usually 2000–2500 mg/day in divided doses) over 1 to 2 months, as tolerated. Metformin should not be administered when conditions predisposing to lactic acidosis are present.
  • In patients with contraindications and/or intolerance to metformin, a short–acting sulfonylurea (e.g., glipizide) is an alternative option.
  • In patients who are intolerant of or are not candidates for metformin or sulfonylureas, repaglinide is a reasonable alternative, particularly in a patient with chronic kidney disease (CKD) at risk for hypoglycemia.
  • Start lifestyle intervention first, at the time of diagnosis. The weight gain that accompanies a sulfonylurea will presumably be less if lifestyle efforts are underway. However, if lifestyle intervention has not produced a significant reduction in symptoms of hyperglycemia or in glucose values after one or two weeks, then the sulfonylurea should be added.
  • DPP4–inhibitors can be given as monotherapy in elderly patients who are intolerant of or have contraindications to metformin, sulfonylureas, or repaglinide. They are weak agents and only lower A1c by 0.6%. They are given when the A1c level is relatively close to the goal level. DPP–4 inhibitors have no risk of hypoglycemia and are weight-neutral, when used as monotherapy. Sitagliptin or saxagliptin are the choices but more expensive and less potent in lowering glycemia than repaglinide.
  • Insulin can also be considered a first–line therapy for all patients with type 2 diabetes, particularly patients presenting with A1c >10%, fasting plasma glucose >250 mg/dL, random glucose consistently >300 mg/dL, or ketonuria.
  • Another alternative is a thiazolidinedione, which may be considered in patients with lower initial A1c values or if there are specific contraindications to sulfonylureas.
  • Patients who are initially thought to have type 2 diabetes may actually have type 1 diabetes, and therefore require insulin as initial therapy. In patients in whom it is difficult to distinguish type 1 from type 2 diabetes, initial treatment with insulin is required.
  • Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1c result (and the results of home glucose monitoring).
  • If inadequate control is achieved (A1c remains >7.0%), another medication should be added within 2 to 3 months of initiation of the lifestyle intervention and metformin.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
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Diabetes Update

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

4th Asia Pacific Vascular Intervention Course

Inauguration of the 4th Asia Pacific Vascular Intervention Course

 
Dr K K Aggarwal
 
    National News

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to re build the image of the medical profession.

For Comments and archives

India’s oldest granny Sowmi Akka

While women in India normally have a lifespan of 60–65 years, Sowmi Akka, the oldest grandmother in the country is 120 years old and still seems in pink of health. Interacting with reporters, Sowmi Akka said that eating healthy diet helped her to live longer and a problem free life. She also mentioned that she is self–reliant to perform all kind of domestic work such as cooking, cleaning the house and buying vegetables from the market. Meanwhile, her granddaughter, Amarawathy said that Sowmi Akka’s eldest daughter is 95 and the entire family participated in the family reunion. (Source: The Indian Express, June 12, 2012)

For Comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Ambient temperature tied to kidney stone production

In patients with nephrolithiasis, higher ambient temperatures are associated with increased excretion of agents linked to stone production, new research shows. "Several previously published studies have shown that hotter weather is associated with increased rates of stone formation. In this study, we examined a group of stone formers who completed 24–hour urine studies for the purposes of prevention. We found that those who collected their urines on hotter days excreted more calcium," Dr. Brian H. Eisner said. (Source: Medscape)

For comments and archives

Early menopause may hold risk of brain aneurysm

The younger a woman is at menopause, the higher her subsequent risk may be of cerebral aneurysm, an observational study suggested. (Source: Medpage Today)

For comments and archives

Study confirms link between androgen deprivation therapy and sarcopenia

Lean body mass (LBM) declines significantly among men on androgen–deprivation therapy (ADT) for prostate cancer, a new prospective study confirms. And while the decline was sharpest when men started ADT, it continued for up to 36 months of treatment, according to Dr. Matthew R. Smith of the Massachusetts General Hospital Cancer Center in Boston and his colleagues. At all time points, men 70 and older showed a steeper drop in LBM than younger men. (Source: Medscape)

For comments and archives

Why travelling by air causes headache

Researchers have argued that ‘airplane headache,’ a form of pain that flares up during landing, should get more recognition in the medical world. Travelling is a headache for many people, whether it’s by train, plane or automobile. But Italian researchers say the pain is apparently more acute when travelling by air for some people, the Daily Mail reported. The head pain, which can be characterised by its severity and position on one side of the head and near the eye, was first reported in medical literature in 2004, with several dozen more cases documented in the following years. The researchers are now suggesting that the ailment should be considered a new subtype of headache, putting forward a list of criteria doctors can use to diagnose it. Lead researcher Federico Mainardi, of Giovanni e Paolo Hospital in Venice, called it "a recently described headache disorder that appears exclusively in relation to flights, in particular during the landing phase." (Source: TOI, Jun 9, 2012)

For comments and archives

 
    Twitter of the Day

@DrKKAggarwal: #AJPP New treatment for acute asthma in children According to a randomized controlled, double–blind study by… http://fb.me/1UL7O7QpD

@DeepakChopra: If you are secure within yourself you will never feel the need to attack anyone

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Mind Body Pregnancy

Intra Uterine Experiences

1. Hearing: The first indication of a developing acoustic apparatus is seen in human embryos as soon as 22 days of development. By the seventh week, the precursors of the three small middle ear bones are fairly well developed.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How is male and female fertility preserved before cancer treatment?

Men: Semen samples may be frozen at a sperm bank or fertility center before starting chemotherapy or radiation therapy. Sperm counts may be low or absent as a result of the underlying cancer. If sperm counts are low and/or the supply is limited from the frozen sample, the sperm can be used for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

Women: If time and circumstances allow, women may be treated with IVF. Embryos created by IVF are then frozen and may be stored for years. If radiation will be administered to the pelvis, the ovaries may be repositioned surgically out of the radiation ?eld. This will reduce the risk that radiation will damage the eggs.

For comments and archives

 
    Fitness update

(Contributed by Rajat Bhatnagar)

More than 60 million Americans are considered 'Couch Potatoes'

More than 60 million people in the US are totally inactive. This is one of the key findings of the Physical Activity Council, which analyzes overall participation in sports, fitness, and recreational endeavors. With all the publicity and attention being paid to the current obesity crisis in the US, the need to get people away from their computer screens and television sets in order to get more active has never been more important.

“While the study shows there are 245 million active Americans, it also finds that close to 61 million are totally inactive. What’s most alarming about this situation is that 34% of the inactive people are between 6 and 34 years of age,” said Tom Cove, president/CEO of the Sporting Goods Manufacturers Association (SGMA), the managing partner of the Physical Activity Council. “The study also shows that the number of inactive 6 to 12 year olds has more than doubled since 2008.”

“Everyone knows that daily physical activity is an essential part of a healthy lifestyle, yet a dangerously large portion of our society is totally sedentary. It’s obvious our country cannot sustain these trends of inactivity, especially for people under 35,” stated Cove. “The good news is the data shows many people want to be more active. This is a clarion call for our society -- industry, communities, government and the non-profit sector -- to be more committed and creative in providing sports, fitness and recreation opportunities for every American.”

This year’s study also asked respondents to provide insight into those activities that they would like to play in the future, but just don’t right now for one reason or another.

For comments and archives

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Needles and Catheters

Many venous access devices can be used for blood transfusion. Selection depends on the integrity of the patient’s veins and the totality of expected intravenous therapy. Considerations include volume and timing of the administration; the possibility of interactions among parenteral material; and expected duration of intravenous therapy.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Genghis Khan and his Hawk

One morning Genghis Khan, the great king and warrior, rode out into the woods to have a day’s sport. Many of his friends were with him. They rode out gaily, carrying their bows and arrows. Behind them came the servants with the hounds.

It was a merry hunting party. The woods rang with their shouts and laughter. They expected to carry much game home in the evening.

On the king’s wrist sat his favorite hawk, for in those days hawks were trained to hunt. At a word from their masters they would fly high up into the air, and look around for prey. If they chanced to see a deer or a rabbit, they would swoop down upon it swift as any arrow. All day long Genghis Khan and his huntsmen rode through the woods. But they did not find as much game as they expected.

Toward evening they started for home. The king had often ridden through the woods, and he knew all the paths. So while the rest of the party took the nearest way, he went by a longer road through a valley between two mountains. The day had been warm, and the king was very thirsty. His pet hawk left his wrist and flew away. It would be sure to find its way home.

The king rode slowly along. He had once seen a spring of clear water near this pathway. If he could only find it now! But the hot days of summer had dried up all the mountain brooks. At last, to his joy, he saw some water trickling down over the edge of a rock. He knew that there was a spring farther up. In the wet season, a swift stream of water always poured down here; but now it came only one drop at a time.

The king leaped from his horse. He took a little silver cup from his hunting bag. He held it so as to catch the slowly falling drops. It took a long time to fill the cup; and the king was so thirsty that he could hardly wait. At last it was nearly full. He put the cup to his lips, and was about to drink. All at once there was a whirring sound in the air, and the cup was knocked from his hands. The water was all spilled upon the ground.

The king looked up to see who had done this thing. It was his pet hawk. The hawk flew back and forth a few times, and then alighted among the rocks by the spring. The king picked up the cup, and again held it to catch the trickling drops.

This time he did not wait so long. When the cup was half full, he lifted it toward his mouth. But before it had touched his lips, the hawk swooped down again, and knocked it from his hands. And now the king began to grow angry. He tried again, and for the third time the hawk kept him from drinking. The king was now very angry indeed.

"How do you dare to act so?" he cried. "If I had you in my hands, I would wring your neck!" Then he filled his cup again. But before he tried to drink, he drew his sword. "Now, Sir Hawk," he said, "that is the last time."

He had hardly spoken before the hawk swooped down and knocked the cup from his hand. But the king was looking for this. With a quick sweep of the sword he struck the bird as it passed. The next moment the poor hawk lay bleeding and dying at its master’s feet. "That is what you get for your pains," said Genghis Khan.

But when he looked for his cup, he found that it had fallen between two rocks, where he could not reach it. "At any rate, I will have a drink from that spring," he said to himself. With that he began to climb the steep bank to the place from which the water trickled. It was hard work, and the higher he climbed, the thirstier he became.

At last he reached the place. There indeed was a pool of water; but what was that lying in the pool, and almost filling it? It was a huge, dead snake of the most poisonous kind. The king stopped. He forgot his thirst. He thought only of the poor dead bird lying on the ground below him.

"The hawk saved my life!" he cried, "and how did I repay him? He was my best friend, and I have killed him." He clambered down the bank. He took the bird up gently, and laid it in his hunting bag. Then he mounted his horse and rode swiftly home. He said to himself, "I have learned a sad lesson today, and that is, never to do anything in anger."

For comments and archives

 
    Cardiology eMedinewS

Heart disease, cancer top killers in U.S. Read More

CDC: VTE toll remains high Read More

Score predicts risk for death in heart failure Read More

 
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Preterm birth may significantly increase bipolar risk Read More

Eculizumab restores renal function in atypical HUS patients Read More

Long-term outcomes of CMV show low progression after age 2 Read More

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    IJCP Special

Dr Good Dr Bad

Situation: A hypertensive patient was found to have high morning blood pressure.
Dr. Bad: Increase your medicine.
Dr. Good: Take your medicine in the evening.
Lesson: The morning period has been recognized as the highest risk period of the day for cardiovascular events, particularly stroke and is also associated with a rapid surge in blood pressure. Hypertensive people have an exaggerated rise in morning blood pressure as well as a greater rate of rise (Clin Exp Pharmacol Physiol 2008 Apr;35(4):516–21)

For comments and archives

Make Sure

Situation: A rape victim developed HIV infection.
Reaction: Oh my God! Why was she not given post exposure ART prophylaxis?
Lesson: Make sure that all rape victims are counseled for HIV and given post exposure ART prophylaxis.

For comments and archives

 
  Quote of the Day

(Dr GM Singh)

A successful man is one who can lay a firm foundation with the bricks others have thrown at him. David Brinkley

 
  Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Critical value

A critical value is defined as a value that represents a pathophysiological state at such variance with normal (expected values) as to be life–threatening unless something is done promptly and for which some corrective action could be taken. Note: The critical values do not necessarily correspond with normal reference ranges, toxic ranges or therapeutic ranges.

 
    Mind Teaser

Read this…………………

A 65–year–old female is experiencing flare up of pruritus. Which of the client’s action could aggravate the cause of flare ups?

a. Sleeping in cool and humidified environment.
b. Daily baths with fragrant soap.
c. Using clothes made from 100% cotton.
d. Increasing fluid intake.

Yesterday’s Mind Teaser: Which of the following is true about ulcerative colitis with malignancy?

a) It has a better prognosis.
b) It is related to disease activity.
c) It is related to duration of ulcerative colitis.
d) Malignancy is more in anorectal ulcerative colitis.

Answer for yesterday’s Mind Teaser: d) Malignancy is more in anorectal ulcerative colitis.

Correct answers received from: Dr Mrs S Das, Dr PC Das, Dr Kanta Jain, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Avtar Krishan, Anil Bairaria.

Answer for 11th June Mind Teaser: a. Propranolol

Correct answers received from: Anil Bairaria.

Send your answer to ijcp12@gmail.com

For comments and archives

 
    Laugh a While

(Dr Chandresh Jardosh)

Think big, Think smart, Think positive, Think beautiful, Think great, I know this is too much for u, so here is a shortcut. Just think about ME!…

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Triage in medical care & emergency treatment – Can a doctor ignore a routine appointment if a serious patient arrives?

The term ‘triage’ is a French word used in military medical services, which refers to the process of sorting injured/sick patient on the basis of urgency/priority of treatment. Triage in trauma care/emergency department is a very quick/necessary decision to first evacuate those with best chance of survival and to leave for later evacuation those who had little or no chance of survival. The doctors’ right to decide the issue of priority of attending the patients has been upheld by the Consumer Disputes Redressal Agencies (CDRAs).

The right of medical doctor is an important aspect of medical practice as often the patient’s perception of emergency differs from that of Doctors. In BS Hegde v Dr Sudhanshu Bhattacharya, the National Commission held that a doctor has the absolute right to decide which patient he would examine first and even out of turn depending on the condition of the patient. There is nothing improper or unreasonable if the doctor gives precedence to patients with active/acute cardiac problem/other medical/surgical condition where urgent medical attention of doctor is called for in preference to the routine consultation. In addition, it cannot be held that the patients must be examined at the appointed time irrespective of the time he may have to spend in examining the previous patients. (George, James E, Law and emergency care, The CV Mosby Co, St.Louise,1980 pp 66–67)

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Over 50 focus only on upper blood pressure

For patients over 50, doctors only need to monitor the upper systolic blood pressure, and can ignore the lower diastolic blood pressure reading, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Systolic blood pressure – the top number in a blood pressure reading – is the pressure exerted at the beginning of the heart’s pumping cycle, while diastolic pressure records the lowest pressure during the resting cycle of the heart. Both pressures are routinely measured when recording the blood pressure.

As per a report published in the journal The Lancet, there is such an emphasis on diastolic pressure that the patients are not getting their systolic blood pressures adequately controlled. The fact is that people over the age of 50 probably do not even need to measure diastolic – it’s only the systolic blood pressure that should be the focus.

Generally, systolic blood pressure continues to increase with age, while diastolic pressure starts to drop after age 50, which is the same time when cardiovascular risk begins to rise. Therefore, there is an increased prevalence of systolic hypertension past age 50, whereas diastolic hypertension is practically nonexistent. Rising systolic pressure is the most significant factor in causing stroke and heart disease.

For people under 50, the scenario may be different. About 40 percent of adults under 40 years of age have diastolic hypertension, and about a third of those between 40 and 50 have the problem. For these patients, a continued emphasis on both systolic and diastolic blood pressures is needed. However, controlling systolic blood pressure, even among these younger patients, almost always results in adequate control of diastolic blood pressure, too.

For people 50 or older, systolic pressure is high if it is 140 mmHg or above.

 
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    Forthcoming Events

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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