American College of Gastroenterology (San Diego, CA • October 23 - 28, 2009)
1. A fixed-dose combination of naproxen and the proton pump inhibitor esomeprazole reduced the incidence of gastric ulcers by as much as 82% compared with enteric-coated naproxen during six months of treatment. The combination drug significantly reduced the frequency and severity of dyspepsia as assessed by two different standardized scales. (Dr Jay Goldstein, University of Illinois, Chicago)
2. Hepatitis C infection almost doubles the risk of chronic kidney disease and significantly increases progression to end-stage renal disease. The association remained significant regardless of whether chronic kidney disease was defined in terms of creatinine clearance, proteinuria, GFR or a combination of the parameters. (Dr Sanjaya Satapathy, New York Medical College and Metropolitan Hospital Center, New York City)
3. Use of the acne medication isotretinoin is associated with an increased risk of inflammatory bowel disease. Patients who used the medication were 1.68 times more likely to develop the disease. (Dr Seth Crockett, University of North Carolina, Chapel Hill)
4. Use of ACE inhibitors may confer a risk of hepatotoxicity. The review identified 52 cases of ACE inhibitor-associated hepatotoxicity. However, the most detailed study was published in 1993. Given the widespread, chronic use of ACE inhibitors, the frequency could be greater than currently recognized. (Dr Saurabh Sethi)
5. Even at low doses, naproxen may increase the risk of upper gastrointestinal complications. Patients taking a 500 mg/day dose had a 2.5-fold increased risk of hospitalization from complicated gastric or duodenal ulcer, while those on the 750 mg/day dose had almost a threefold increased risk. (Dr Gurkirpal Singh, Stanford University)
Warning signs: Failure to Thrive in children
1. Showing a lack of interest in the environment and what's around
2. Avoiding eye contact with others.
3. Showing fussiness and irritability.
4. Missing certain developmental milestones at their respective
ages, including speaking, sitting and walking.
Dr Good Dr Bad
Situation: A patient with high BP and family history of diabetes came for a prescription.
Dr Bad: Start beta-blockers.
Dr Good: Start calcium channel blockers.
Lesson: Calcium channel blockers may be associated with reduced odds of developing new-onset type 2 diabetes compared to diuretics and beta-blockers. (Source: Curr Med Res Opin 2007;23(6):1239-44.)
Situation: A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.
Reaction: Oh my God! Why was the anti-platelet agent started?
Make Sure to check BP before starting intergrilin. Severe hypertension (systolic BP more than 200 mmHg or diastolic BP more than 110 mmHg) not adequately controlled on antihypertensive therapy is a contraindication for intergrilin therapy.
Laughter the Best Medicine
A man goes to the eye doctor. The receptionist asks him why he is there.
The man complains: I keep seeing spots in front of my eyes.
The receptionist asks: Have you ever seen a doctor? The man replies: No, just spots.
Medilaw: General Principles of Medical Negligence
The basic principle relating to medical negligence is known as the Bolam rule. This was laid down in the judgment of Justice McNair in Bolam vs Friern Hospital Management Committee (1957) 1 WLR 582 as follows: "Where you get a situation which involves the use of some special skill or competence, then the test as to whether there has been negligence or not is not the test of the man on the top of a Clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill….. It is a well-established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art." Bolam's test has been approved by the Supreme Court in Jacob Mathew's case.
Formula to Know
LDL cholesterol= Total cholesterol (HDL cholesterol + Triglycerides/5)
This poem, written by an African child, was nominated by UN as the Best Poem of 2006
When I born, I black
When I grow up, I black
When I go in Sun, I black
When I scared, I black
When I sick, I black
And when I die, I still black
And you white fellow
When you born, you pink
When you grow up, you white
When you go in sun, you red
When you cold, you blue
When you scared, you yellow
When you sick, you green
And when you die, you gray
And you calling me colored?
Milestones in Orthopedics
In 1948, Knut Lindblom from Stockholm published his technique of direct injection of the lumbar intervertebral discs with radio-opaque dye. This reproduced the symptoms, if done at the level of the lesion and showed the nature of the rupture
Question of the day
Which is better: 5-ASA or steroid enema?
A meta-analysis of seven trials concluded that 5-aminosalicylic acid (5-ASA) enemas were significantly superior to corticosteroid enemas for inducing remission of symptoms and improving endoscopy and histology (odds ratio 2.4, 1.9 and 2.0, respectively) in mild-to-moderate ulcerative colitis. Rectal 5-ASA was significantly better than conventional rectal corticosteroids for inducing clinical, endoscopic and histologic remission. Another potential advantage of 5-ASA enemas is that with steroid enemas, steroid side- effects can occur as 10-20 percent of rectally delivered steroids are absorbed. Absorption is increased during treatment of active disease due to loss of mucosal integrity. However, steroid-induced side effects decrease as the patient’s disease improves and the number of enemas is reduced. (Source: Gut 1997;40:775-81).
Mnemonic to know: Hypersensitivity reactions : ACID
Type I Anaphylaxis
Type II Cytotoxic - mediated
Type III Immune - complex
Type IV Delayed hypersensitivity
A man who has committed a mistake and doesn't correct it, is committing another mistake… Confucius
eMedinewS Try this- It Works: New-onset insomnia and BPH
Whenever an elderly man comes in complaining of new-onset insomnia, ask about nocturia. Men with benign prostatic hypertrophy (BPH) often present first with insomnia. The latter resolves when BPH is treated.
Letters to the editor
1. Dear Dr K.K.Aggarwal:You are an encyclopedia of medfical knowledge and an apostle of service with humility and love, wihout any craving for award, a master in administration and a fountain of new ideas for further improving services in health care. Please accept my heartiest congratulations for beng conferred the T P Juunjhanawala foundation XX1 national excellence award for your outstanding contributions in the field of services in health care D.K.Kanwar
2. Dear Dr. KK, Kindly accept our congratulations for being awarded the National Excellance Award for providing best health care services to the Nation. Dr. asha joins me in sharing this happy news and congratulates you. Keep doing the good work and the Almighty will award you on every step you take in life. God bless you. Ashok Ahooja
3. Dear Dr Aggarwal,Thanks for sending emedinews everyday. Its an outstanding information for all physcians.
I wish to inform you that we are organizing 2nd Indian National Radiosurgery conference on 27th and 28th February. Its a joint meeting of gamma knife and linac group. Both Indian and international faculty will attend. Its good for neurosurgeons and radiation oncologist and physicist. www.indianradiosuregry.org.Dr. Maheep Singh Gaur