emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

14th April, 2010 Wednesday

New daily persistent headache

NDPH is a primary headache disorder in which headache begins one day and does not remit, in an individual without a headache history. The pathophysiology is poorly understood. Onset of NDPH can be triggered by certain events, such as infection.

The incidence and prevalence of NDPH is unknown, but is rare. It is more frequent in children than in adults, and affects women more often than men. The headache starts abruptly and is daily and unremitting from. The diagnosis is clinical and requires ruling out secondary causes. Current diagnostic criteria exclude patients with predominant migrainous features. 

For patients with recent onset of suspected NDPH, neuroimaging should be done at the time of presentation. A lumbar puncture is indicated if features suggest a possible infection or idiopathic intracranial hypertension.

The differential diagnosis includes cerebral venous sinus thrombosis, headache secondary to spontaneous cerebrospinal fluid leaks, idiopathic intracranial hypertension (pseudotumor cerebri), and giant cell arteritis.

NDPH may be either be  a self–limited one, or a persistent form which can last years or decades and is challenging to treat.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


News and views

1. Smoke tax could pay for prevention programs

If one continues to increase taxes on cigarettes and use the new revenue for smoking cessation programs, smoking rates could be drastically reduced as per CDC. Increasing excise taxes on cigarettes, at the federal, state, or local level, has the potential to substantially reduce smoking and discourage young people from starting. A 10% increase in the price of cigarettes can reduce consumption by nearly 4% among adults, according to a new analysis in the April 9 issue of CDC’s Morbidity and Mortality Weekly Report.

2. Apnea stroke link

Severe obstructive sleep apnea almost tripled stroke risk in men. Among men with mild or moderate apnea, each one–unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine.

3. Lung problems do not stop kids from ‘Huffing’

About one of every 20 adolescents with a history of lung disease used an inhalant to get high, commonly called huffing, within the preceding 12 months. The numbers indicate that inhalant use is just as common in young people with lung disease as in the general population of adolescents, estimated at about 4.1%, according to the survey, sponsored by the Substance Abuse and Mental Health Administration (SAMHSA). No one should engage in huffing; the consequences can be deadly, SAMHSA administrator Pamela S. Hyde, JD, said in a statement.

4. Low–dose aspirin fails to prevent RA

The use of low-dose aspirin did not reduce women's risk of developing rheumatoid arthritis (RA), despite biologic plausibility that the drug could do so. After an average of 10 years of follow-up, the relative risk of definite RA among women who had taken 100 mg aspirin every other day was a nonsignificant 0.83 (95% CI 0.56 to 1.21, P=0.33). (Dr Nancy A. Shadick, Harvard Medical School, Boston)

5. Rabies: new guidelines for autopsy 

The CDC has issued new guidelines for medical examiners intended to minimize the risk of rabies transmission during autopsy. The recommendations, published in the April 9 Morbidity and Mortality Weekly Report, call for use of full protective gear, including N95 respirators, face shields, and heavy gloves, as well as manual dissection techniques and equipment to reduce aerosol generation. Personnel performing autopsies do not need rabies vaccinations beforehand. Postexposure prophylaxis of autopsy personnel is recommended only if contamination of a wound or mucous membrane with patient saliva or other potentially infectious material (e.g., neural tissue) occurs during the procedure.

Mnemonic of the Day (Dr Prachi Garg)

Anti–epileptic Side Effects ABCDEFGH

Ataxia

Blood dyscrasia

Cleft lip

Dupuytrens / vit D def

Exfoliation of skin & Stevens Johnson Syndrome

Fits

GI upset / gum hypertrophy

Hepatitis / hairy

What’s New: Undiagnosed endometrial cancer

In a retrospective study, previously undiagnosed endometrial cancer was found less frequently in women who underwent a follow–up curettage after office endometrial biopsy than in those who had a repeat biopsy or no repeat sampling. (Obstet Gynecol 2009;114:523.)

eMedinewS Fact about rheumatoid arthritis

ELISA testing for anti–CCP may be useful in the differential diagnosis of early stage RA, particularly in the ability to distinguish RA from primary Sjogren's syndrome or SLE. It may also be valuable in identifying those patients with early RA who are at increased risk of progressive joint damage.

Quote of the day (Dr Santosh Sahi)

If one speaks or acts with cruel mind, misery follows, as the cart follow the horse

If one speaks or acts with pure mind, happiness follows, as shadow follows its source. (The Dhammapada)

Diabetes Fact

TNF–α new modalities for treatrment: inhibits hepatic glucose production and insulin–mediated peripheral glucose utilization.


Public Forum
(Press Release for use by the newspapers)

 

ASIA PACIFIC VASCULAR SOCIETY GUIDELINES

New Delhi Wednesday 14th April: The 2nd Asia Pacific Vascular Interventional Course was organized in New Delhi from 3rd to 4th April and participated by more than 500 experts from all over the world participated in the conference.

9 lac amputations can be saved in India

Addressing a press conference here Dr (Prof.) N N Khanna Chairman of the Asia Pacific Vascular Society and Advisor, Apollo Group of Hospitals said that 11 lac amputations take place in India every year and with advances in technology it is now possible to save 80% of them. He pointed out that the key to success in saving limbs is early recognition and treatment by specialized endovascular techniques of subintimal angioplasties and below knee interventions.

Co-addressing the press, Padma Shri and Dr B C Roy National Awardee, Dr KK Aggarwal said that attempts are being made to educate both doctors and patients about the recent advances in the field of peripheral interventions, a field often neglected and includes diseases like dilated leg veins, leg clots, arterial abnormal dilations called aneurysms and narrowing of aortic valve of the heart.

Following were the conclusions of the conference

Critical limb ischemia (Lack of blood supply to the arm or leg leading to amputation or limb loss)

  1. According to the 2007 Inter-Society Consensus for the Management of Peripheral Arterial Disease, acute limb ischemia (reduced blood supply) is defined as a sudden decrease in limb blood perfusion that causes a potential threat to limb viability (manifested by ischemic rest pain, ischemic ulcers, and/or gangrene) in patients who present within two weeks of the acute event.

  2. Patients with similar manifestations who present later than two weeks are considered to have critical limb ischemia, which is by definition chronic.

  3. Signs of severe peripheral arterial disease on noninvasive testing include an ankle-brachial (arm-leg) blood pressure index less than 0.4, a flat waveform on pulse volume recording, and absent pedal (foot artery) flow on duplex Doppler ultrasound.

  4. Limb-threatening (amputations) ischemia (lack of blood supply) occurs in 1 to 2 percent of patients with peripheral artery disease who are 50 years of age or older. These patients presents with claudication (pain in legs on walking), non-healing ulcer, cold limb

  5. If not treated the natural history of critical limb ischemia usually involves inexorable progression to amputation unless there is an intervention that results in the improvement of arterial perfusion.

  6. If not treated what happens in the next one year:
    1. Alive with two limbs — 50 percent;
    2. Amputation — 25 percent and
    3. Cardiovascular mortality — 25 percent.

  7. Such cases if reach for medical help in time can have their limb saved using the interventional therapies

ACC/AHA guideline summary: Prevention of critical limb ischemia (CLI): Prevention of critical limb ischemia

  1. Patients at risk of CLI, defined as a diabetic patient with known lower extremity peripheral arterial disease or an ankle brachial index less than 0.4 in a nondiabetic patient, should undergo regular inspection of the feet to detect objective signs of CLI.

  2. The feet should be examined with shoes and socks removed.

  3. Patients who have been successfully treated for CLI are at relatively high risk for recurrence. They should be evaluated at least twice yearly by a vascular specialist and be given verbal and written instructions for self-surveillance for recurrence.

STEM CELL THERAPY: Is now a reality in India.

Autologous bone marrow cells of the patient are now used (mesenchymal cells) to rebuild the damaged vessels and tissues. Patient’s own bone marrow is aspirated and the mesenchymal stem cells are then separated and then reimplanted in the muscles of the leg. New blood vessels are then formed and have a potential to improve the blood supply and save the limb from amputation.  It has a potential to save many limbs.

The techniques was demonstrated and discussed in detail in the 2nd Asia Pacific Vascular Intervention Course.

WHAT THE DOCTORS WOULD HAVE DONE IF SOME ONE GETS A DISEASE WHAT ALBERT EINSTEIN OR PANDIT NEHRU HAD BEFORE DEATH

Albert Einstein died of abdominal aortic aneurysm with rupture on April 1955 at the age of 76 years. Pt Nehru alod died of thoracic aorta aneurysm rupture. Patients with untreated large ascending or descending thoracic aneurysms die of complications associated with their aneurysms. Aneurysm rupture occurs in 32 to 68 percent of medically treated patients and rupture accounts for 32 to 47 percent of deaths; the one, three, and five year survival of unoperated thoracic aneurysms is 65, 36, and 20 percent, respectively.

The median diameter at the time of rupture or dissection is 59 mm for ascending aneurysms and 72 mm for descending aneurysms. A diameter greater than 60 mm increases the risk of rupture or dissection by 25 percent for an ascending aneurysm, while a diameter greater than 70 mm increases the risk by 37 percent in a descending aneurysm. Aneurysm diameter increases by 10 mm per year.

It is now possible to treat such cases n India without surgery by Thoracic endovascular aortic repair (TEVAR) which refers to the percutaneous placement of a stent graft in the descending thoracic or thoracoabdominal aorta to improve long-term survival in patients with aortic aneurysms. The complications of elective thoracic aneurysm repair using an open surgical (OS) technique are higher than most elective surgical procedures, given anatomic constraints and operative complexity. TEVAR was initially developed to treat patients who were considered to not be surgical candidates but is now considered a suitable alternative to OS in most cases.

ONE CAN REPLACE THE HEART VALVE WITHOUT OPEN HEART SURGERY

Serious patients of aortic valve disease (blockage or leakage) can now be treated successfully without open heart surgery by the technique like angioplasty.

Two catheter-based techniques for replacing the aortic valve are available: percutaneous implantation and direct apical puncture.

  1. Antegrade approach — Percutaneous transcatheter implantation of a prosthetic aortic valve via the femoral vein with transseptal puncture.

  2. Retrograde approach — a retrograde femoral arterial approach via the aortic arch and through the stenotic valve.

  3. Transapical approach — direct left ventricular apical puncture via a small anterolateral thoracotomy without cardiopulmonary bypass or sternotomy.

LASER THERAPY FOR VARICOSE VEINS

  1. It is a day care walk-in and walk-out procedure.

  2. Varicose Veins are dilated veins which are seen in leg as a result of leakage of valve of the vein.

  3. This leads to pain, swelling, discolouration and ulceration in the leg.

  4. Varicose veins are common in India and present in 10% of the population.

  5. Symptomatic patients should undergo further evaluation with venous duplex to identify the presence of superficial or deep venous insufficiency, which alters treatment options.

  6. Laser therapy is now a viable option and surgery is not considered necessary.

  7. Lasers emit a single, coherent wavelength of light. Advances in laser technology have enabled the treatment of veins up to four millimeters in diameter. Laser therapy is becoming competitive with sclerotherapy and surgery in the treatment of lower extremity varicose veins.

  8. Dr. N. N. Khanna has performed more than 1000 endovenous laser treatment in India. Many patients are now coming from abroad as they find it cheaper and safer in India. This therapy is may be a big boost in medical tourism.

DEEP VEIN THROMBOSIS (DVT) IS A LIFE THREATENING CONDITION

This is clotting of blood in the veins of leg especially in patients during long travels especially air travel and car travel or in bed ridden patients or in patients of fracture, trauma, stroke or malignancy. Rarely, deep vein thrombosis can occur in normal people.

It is now possible to treat and prevent clots in the deep veins of the legs (DVT) which if not detected and treated in time can cause sudden death. The clots can be anticipated, prevented, early diagnosed and treated medically by catheter techniques without surgery. Now with non surgical invasive interventions it is now possible to remove the clots effectively.

 

CHAIRMAN’S MESSAGE

Dr K K Aggarwal, Padma Shri and President of Heart Care Foundation congratulated Dr N N Khanna, Chairman of Asia Pacific Vascular Society, Sr Interventional Cardiologist and Coordinator of Vascular Services at Apollo Hospital, New Delhi for successfully organizing the 2nd Asia Pacific Vascular Intervention Course at New Delhi, India. There was huge international participation. He congratulated Dr N N Khanna for his endeavor and mission of saving LEGS AND LIVES and bringing in newer cutting edge technology in India.

Dr N N Khanna who is an ace interventional cardiologist has expanded the horizon of interventional cardiology by bringing in advanced non-surgical techniques of treating aortic aneurysms, critical limb ischemia (preventing amputation) and brain artery blockages (carotid / vertebral stenosis) for prevention of stroke.

Dr K K Aggarwal and Dr N N Khanna thanked the media for their tremendous contribution for public education and prevention of cardiac and vascular diseases


Question of the day

What is MesoBotox and what is it indicated for?

Meso Botox also known as Intradermal Botox is the use of Botox for Mesotherapy.

This is not officially recommended and is currently under evaluation and trial. It would be therefore considered as an "off–label indication".

Mesobotox is the use of Botox for superficial injections. It is a new technique which uses micro–doses of Botox deposited into your skin i.e. intradermal not intramuscularly and helps contract sweat and sebaceous (oil) glands so that skin tightens and has a wrinkle–free smoothness – sans the stiffness. For skin tightening, Mesobotox is the latest mesotherapy technique for refining and rejuvenating faces. Microinjections of very small doses of Botox with generous doses of vitamins and hyaluronic acid are distributed superficially all over the face to diminish fine wrinkles without muscle paralysis and to improve sheen of the skin. Patients report that their pores are visibly smaller, their skin less oily and more translucent after the treatment.
Patients also feel that their face looks "lifted" and firmer and their skin texture more refined after a session of this innovative treatment.

Theoretically, it is a treatment where the Botox used is in smaller quantities with much higher dilutions.

Currently there are no recommendations for Mesobotox at the time of press and it is not officially approved until it has been evaluated through clinical trials, and safety and efficacy have been demonstrated and established.

References

  1. Carruthers, J, et al. Consensus Recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg 2004;114(6 Suppl):1S–22S.

  2. Jankovic J, Brin MF.Therapeutic uses of botulinum toxin. N Engl J Med 1991;324:486–93.

  3. Simpson LL.The origin structure and pharmacological activity of botulinum toxin. Pharmacol Rev 1981;33:155–88.

eMedinewS Try this it Works

Check septum after trauma to nose

After blunt trauma to the nose, be sure to carefully examine the nasal septum for septal hematoma. A hematoma can usually be treated by simple aspiration, but if left untreated it may lead to permanent nasal deformity and nasal obstruction caused by necrosis of the nasal septal cartilage.


Dr Good Dr Bad

Situation: A diabetic hypothyroid came with weakness.

Dr Bad: Take B complex vitamins.

Dr Good: Get blood sugar test done.

Lesson: There is an increased risk of recurrent hypoglycemia in a diabetic individual with hypothyroidism as the synthesis and release of insulin is decreased. (Int J Diab Dev Ctries 2003;23:120–3.)


Make Sure

Situation: A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.

Reaction: Oh My God! Why was aspirin given 

Lesson: Make sure to remember that aspirin is contraindicatd in children. 

IJCP
 
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nuspera
 
Docconnect


Laughter the best medicine

Do you find it difficult passing water, Mr. Sozzle?

No, doctor. But I do find it hard to pass a pub!


Formulae in Critical Care

Anion gap

Formula: Na+ - (Cl- + HCO3)
All units mmol/L

Comments: For use in determining the cause of an acidosis.
When unmeasured anions like phosphate, sulphate,
organic anions and acid anions increase, anion gap increases.

Normal value: 10–12 mmol/L.

Milestones in Medicine

1896 – Arthur Wright produced first X–ray in the U.S. at Yale University.

Lab Test (Dr Arpan Gandhi, Dr Navin Dang)

Platelet Count: Also known as thrombocyte count: The test is done as a part of routine complete blood count (CBC); for evaluation of unexplained or prolonged bleeding; to diagnose/monitor a bone marrow/blood disease; in evaluation of fever (especially dengue); and management of immuno-inflammatory disorders (where the count is increased).   .

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Octinoxate 7.5% + Avobenzone 3% + Oxybenzone 3% + Titanium dioxide 2% lotion

As sunscreen lotion for prevention of sunburn skin

23.02.09


(Advertorial section)

ZEN IMMUNE SUPER

A Product from NUSPERA INTERNATIONAL INC. USA Helps IMPROVE INTEGRITY OF BONES, JOINTS, LIGAMENTS AND TENDONS, RESULTING IN SMOOTHER JOINT MOBILITY.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month.

Contact: drkk@ijcp.com or emedinews@gmail.com

eMedinewS–PadmaCon 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.

NATIONAL SEMINAR ON STRESS PREVENTION (17 – 18 April). Over 400 registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

Readers Responses

  1. Dear Dr. Aggarwal, Please do not scare people who have normal blood cholesterol levels and do not promote the interests of the drug companies. As you very well know, cholesterol is the building block of cell membranes and many steroidal hormones. Kindly present your balanced medical point of view, and let the people know about the physiological roles and functions of cholesterol in the body as well as the adverse effects of statins: Harpal S. Buttar, D.V.M., M.Sc., Ph.D. Senior Scientist & Adjunct Professor Reproduction and Urology Division Therapeutic Products Directorate.
    eMedinewS answers: Science is based on facts. Not all patients with normal choelsterol levels need drugs. Only those with high CRP needs them. High CRP is itself a low grade inflammation disease and needs treatment. If CRP is normal and Cholesterol is normal no drugs are needed.

  2. Dear Dr KK Aggarwal, an institute in himself
    Specific indication for using statin in persons with non-diabetic status; even normal cholesterol level and LDL < 130 mg% is level of highly sensitive(hs CRP) more than 2mg%. Statins not only lower lipids but also act in various different ways like endothelial cell lining modulators, platelets inhibiters and four more ways.(As narrated by Dr Sanjay Mittal, Director Clinical Cardiology, Medanta Institute, Gurgaon in a recent CME held at Rohtak under the aegis of API). With regards: Dr Satish Chugh

  3. Dear Krishan Congratulations for being Padma Shri awardee & also for starting eMEDINEWS, a very interesting daily news magazine. We are proud of you: Danny & Swaraj