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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


14th June, 2010, Monday

Gout Drug Effective for Angina

Dear Colleague

The gout drug may be an effective treatment for patients with chronic stable angina, as per a small placebo–controlled study. Exercise tolerance tests revealed that patients randomized to high-dose allopurinol for six weeks significantly improved time to ST depression (P=0.002), total exercise time (P=0.003), and time to chest pain (P=0.001) compared with placebo, Awsan Noman, of the University of Dundee in Scotland reported online in The Lancet.

Allopurinol, a xanthine oxidase inhibitor has been shown to reduce oxygen consumption by the heart during exercise in animal studies. Decreasing myocardial oxygen demand during exercise might increase exercise tolerance.

The study enrolled 65 patients with angiographically documented coronary artery disease and a history of stable angina. The majority of patients were men (83%) and the average age was 65. Patients underwent baseline exercise tolerance tests and were then evenly randomized to allopurinol (600 mg daily) or placebo on top of standard antianginal therapy. After six weeks, patients again underwent exercise testing and were then crossed over to the comparator arm. Compared with baseline, 85% of patients given allopurinol (n = 51) improved their time to ST depression; just 58% of patients given placebo (n = 35) showed improvement. More patients taking allopurinol than those taking placebo showed an improvement in total exercise time {(78%) versus 27 (45%)}, and times of chest pain {45 (75%) versus 33 (55%)}. Alopurinol reduced concentrations of the biomarker brain natriuretic peptide from baseline but did not change levels of C-reactive protein, both of which are biomarkers used to assess atherosclerosis.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Additional Efforts to Reduce Risks Related to Health

People burdened with lifestyle disorders need to put in extra efforts to maintain healthy mind and soul. Heart Care Foundation of India (HCFI) recommends walking 80 min in a day, wherever possible with a speed of 80 steps per minute and/or addition of other activities like cycling and dancing etc. Adopting these activities can reduce the risk and one’s vulnerability to serious health problems by several folds.

Ms. Vaijayanti Mala, Actress, with her message "When I do not dance I walk to keep myself fit" promoting dance and walking for good health. Also in the photo: Padma Shri and Dr BC Roy Awardee Dr. K K Aggarwal, President HCFI

Dr k k Aggarwal

International Medical Science Academy Update (IMSA): New FDA Drug Update

Anabolic steroids

A study of ten patients identified from the archives of the Columbia Renal Pathology Laboratory reported an association between focal and segmental glomerulosclerosis with the long term use of anabolic steroids. All patients engaged in weightlifting for the purpose of bodybuilding or strength competitions and used at least one anabolic androgenic steroid for a number of years. Most patients presented with nephrotic range proteinuria (>3.5 g/day) and renal insufficiency that stabilized or improved upon stopping steroids.

References

Herlitz LC, Markowitz GS, Farris AB, et al. Development of focal segmental glomerulosclerosis after anabolic steroid abuse. J Am Soc Nephrol 2010;21:163.

Dr Desai admitted at AIIMS

Dr Ketan Desai former President MCI underwent surgery for Anorectal Abscess at AIIMS and is being admitted in the private surgical ward (501) under Dr Arvind. As per the sources many IMA office bearers (including member of the election commission IMA) met him on Sunday.  As per some of the state IMA office bearers the topic of discussion was planning for the forthcoming IMA elections being held in July. 

Mnemonic of the Day (Dr Varesh Nagrath)

Contraindications to the use of Anti TNF Biologics

MALTI RADHA

Malignancy within 10 years (apart from fully resected basal cell carcinoma more than five years before)

Arthritis (Septic arthritis within 12 months)

Lactation & Pregnancy

Tuberculosis (Koch's disease)

Indwelling urinary catheter

Recurrent chest infections/bronchiectasis

Artificial device/Prosthesis Infection

Demyelinating Illness

Heart Failure

Abscess or ulcer chronic (but not pyoderma gangrenosum)

News and views (Dr Monica and Brahm Vasudeva)

1. Some supplements may impact warfarin’s effectiveness

Patients who are on warfarin are at a greater risk of too much bleeding or blood clots when they use supplements containing gingko, garlic, and fish oil. The study was presented at the annual meeting of the Heart Rhythm Society

2. Sprycel may be better than Gleevec for patients with newly diagnosed CML

According to results of a clinical trial published online in the New England Journal of Medicine, Sprycel (dasatinib) may be more effective than Gleevec (imatinib) in treating patients with newly diagnosed chronic myeloid leukemia (CML). The study was presented at the American Society of Clinical Oncology 2010 meeting.

3. Hyaluronic acid does not eliminate wrinkles when used topically, dermatologist explains

Norwell Solish, MD, FRCP (C), a cosmetic dermatologist has pointed out that while hyaluronic acid works well as an injectable dermal filler, it doesn’t eliminate wrinkles when used topically on the skin. Hyaluronic acid is an oft added chemical in variety of products including lip gloss, eye shadows and moisturizers. It is the major component of a number of injectable wrinkle fillers and is able to draw moisture from the air. It is said to hold up to 1000 times its weight in water.

Someone with depression might think or say any of the following (Dr G M Singh)

"I feel sad all the time and just don't feel like myself."
"I don't enjoy being with my friends or doing any of the things I usually love to do."
"I’ve been having a lot of trouble sleeping lately."
"Sometimes I feel like my life is not worth living anymore."
"I feel like I don’t have any energy."
"I’m not really interested in eating."
"Even after a long day, I still feel restless."
"I feel so indecisive and that I can’t make any decisions."
"I just feel so worthless."

Evidences point out that about two–thirds of people diagnosed with depression talk to their family doctors first about physical symptoms.

Interesting tips in Hepatology & Gastroenterology (Dr Neelam Mohan)

Who needs a liver transplant?

Indications

  • Any patient with end stage / chronic liver failure (any etiology)

  • Fulminant hepatic failure (any etiology)

  • Certain inborn errors of metabolism such as Crigler–Najjar syndrome type–1, Familial hypercholesterolemia, Organicacidemia, Urea cycle defects, Primary oxalosis, Maple syrup urine disease.

Common indications of liver transplantation in children

  • Biliary atresia

  • Metabolic liver diseases like Wilson’s disease, tyrosinemia, α–1 anti–trypsin deficiency

  • Fulminant hepatic failure

  • Autoimmune hepatitis

  • Other cholestatic disorders like progressive familial intrahepatic cholestasis, Alagille’s syndrome, sclerosing cholangitis etc.

In children, biliary atresia is the commonest indication of liver transplantation. In children < 2 years, cholestatic disorders constitute two–thirds of the indications of the liver transplantation. In children > 2 years, cholestatic disorders constitute 45% followed by metabolic liver disease (24%).

Common indication of liver transplantation in adults

  • Chronic hepatitis B and C

  • Alcoholic liver disease

  • Cholestatic liver disease like Primary biliary cirrhosis, Primary sclerosing cholangitis

  • Fulminant hepatic failure

  • Autoimmune hepatitis

  • Metabolic liver disease

In adults, the major indications for liver transplantation would be chronic viral hepatitis, alcohol-induced liver damage and hepatocellular cancer.

Conference Calendar

Indomedicon 2010
Conference in Antiaging, Aesthetic and Regenerative Medicine
Date: June 19–20, 2010
Venue: Imperial Palace, Royal Palms, Mumbai, Maharashtra.

Quote of the day (Dr Santosh Sahi)

"There is no end. There is no beginning. There is only the infinite passion of life" Federico Fellini

Question of the Day

What are the different drugs used for GERD? (Dr. Manu Tandon, Hyderabad)

There is a long list of drugs used for the treatment of GERD. These include:H2RA, PPIs, antacids and prokinetics.

  1. Antacids: Calcium and magnesium containing compounds with/without alginic acid.

  2. H2RA: Cimetidine, Famotidine, Ranitidine.

  3. PPIs: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole and Rabeprazole.

  4. Prokinetic agents: Domperidone, Metoclopramide, Cisapride, Mosapride, Itopride and Erythromycin.

The following algorithm can be followed in the drug management of GERD.

  • Mild GERD: H2RA/PPI once a day.

  • Moderate GERD: PPI + prokinetics once a day

  • Severe GERD: PPI twice a day + prokinetics.

  • Severe GERD with nocturnal symptoms: PPI twice a day + H2RA once at night + prokinetics.

Maintenance therapy: Once the acute symptoms subside, continue as follows:

  • Mild GERD: H2RA once a day

  • Moderate/severe GERD: PPI once a day

Antacids, preferably those containing alginic acid are used as rescue medication only and are not the primary drug of choice in GERD.
Though acid production in GERD is normal; PPIs are the single most effective group of drugs and form the cornerstone of drug therapy in GERD.

MedinewS Try this it Works

Extend that leg

To save time when examining a patient, demonstrate the seated straight leg–raising test or mimic your own dorsiflexion and plantar flexion of the foot.

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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 .

 

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Dr Good Dr Bad

Situation: A patient with heart failure had low total cholesterol levels.
Dr Bad: Do not worry.
Dr Good: It is of concern.
Lesson: A low serum cholesterol in patients with heart failure is associated with higher mortality. Whether low cholesterol has a causative role or is simply a marker of more severe debilitation (i.e. cardiac cachexia, liver dysfunction, and inadequate nutrition), has not been determined. (J Card Fail 2002;8:216)

Make Sure

Situation: A patient of pulmonary Koch’s on anti tubercular Treatment (ATT) complained of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lesson:Make sure that in patients talking ATT (including INH), B–complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

Humor Section

IMANDB Joke of the Day (Sanjay Bhargava)

Student Vs Professor

After having failed his exam in "Logistics and Organization ", a student goes and confronts his lecturer about it.

Student: "Sir, do you really understand anything about the subject?"

Professor: "Surely I must. Otherwise I would not be a professor!"

Student: "Great, well then I would like to ask you a question.

If you can give me the correct answer, I will accept my mark as it is and go. If you however do not know the answer, I want you to give me an "A" for the exam.

"Professor: "Okay, it’s a deal. So what is the question?" Student: "What is legal, but not logical, logical, but not legal, and neither logical, nor legal? "

Even after some long and hard consideration, the professor cannot give the student an answer, and therefore changes his exam mark into an "A", as agreed.

Afterwards, the professor calls on his best student and asks him the same question. He immediately answers:

"Sir, you are 63 years old and married to a 35 year old woman, which is legal, but not logical. Your wife has a 25–year–old lover, which is logical, but not legal. The fact that you have given your wife’s lover an "A", although he really should have failed, is neither legal, nor logical."

Funny Definitions

Psychologist – a man who watches everybody else when a pretty girl enters the room

Formulae in Clinical Practice

Calculation of lean body mass in men

Formula: Lean body weight (men) = {1.10 × weight (kg)} – 128
{weight2/(100 × height in m2)}

Milestones in Orthopedics

Edward Hallaran Bennett (1837–1907), an Irish surgeon, was professor of anatomy and surgery at Trinity College from 1873–1906. He is best remembered for describing eponymous fracture Bennett’s fracture (intra–articular fracture of base of first metacarpal) at the British Medical Association meeting in Cork in 1880. He is said to have introduced antiseptic technique to Dublin.

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Complete blood count (CBC)

This common blood test measures the amount of various types of blood cells in a sample of your blood. Blood cancers like leukemia (AML, ALL, CML. CLL) may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found.

MCI News

CBI raids medical college in Moinabad for violating MCI norms

CBI  conducted raids on a private Bhaskar Medical College in Moinabad here for allegedly violating Medical Council of India (MCI) rules in admissions reports PTI. After Dr Desai was arrested, the CBI in Delhi had identified that one college in Hyderabad had obtained permission to start admission allegedly in violation of the MCI rules. And hence, we had registered a case. During the search operations, the investigating officials have seized some documents from the college premises, however no one has been arrested so far.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Zoledronic Acid Solution for Infusion Addl. Indication

Prevention of clinical fractures after hip fracture in men and women

1.08.2009



Public Forum (Press Release for use by the newspapers)

Patients with acidity should avoid chocolates and peppermint

Persistent acidity is usually due to reflux of acid from the stomach into the food pipe. Mild cases of acidity reflux can usually be managed with lifestyle and dietary modifications along with antacids, H2 blockers and proton pump inhibitors.

However, patients in whom lifestyle management together with empirical treatment is unsuccessful or those who have symptoms suggestive of complicated diseases should undergo endoscopy to rule out cancer of the food pipe, a condition linked with persistent acidity. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

He said that symptoms that may suggest complicated disease include loss of appetite, loss of weight, difficulty in swallowing food, bleeding and signs of systemic illness.

Lifestyle changes for reflux involve elevation of head and of the body, avoidance of food before sleep and avoidance of food which makes the food pipe valve lax. Examples of such foods include fatty food, chocolates, peppermint and excessive intake of alcohol.

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Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Response

Dear Dr. Aggarwal:  Greetings from Washington DC. Thanks for the emedinews. At the Embassy of India in Washington DC on May 20th we have initiated a Indo US physician exchange program. This voluntary and mutually agreed reciprocal visits will improve the medical education and health care in India and will also avail an opportunity to  the US visitors to learn about the Indian health care system. In addition it will promote  joint projects benefitting both the countries. India has  700,000 allopathic physicians ,including some 70000 specialists. Of 950,000 US physicians about 45000 are of India origin.  Many of the US physicians would like to provide their expertise and service to India and many of the specialists from India would like to visit the US to gain  state of the art knowledge and practice in their specialties. www.apxamembers.com, provides the access the the program. I thought of sharing this information  with emedinews readers and you. Under this program, hosts provide free lodging, board, and professional interactions to their visiting guests.  Thanks to emedinews and you the editor for the detailed news on the MCI. Hope this restructuring  will help improve the medical education in our Motherland. With kindest regards,Navin C. Shah, M.D. M.S., F.A.C.S., F.I.C.S., F.A.C.I.P, Diplomate American Board of Urology, Diplomate American Board of Quality Assurance and Utilization Review Physicians, 4404 Queensbury Road, Suite 240 Riverdale, Maryland 20737. Phone 301-699-3192, Fax 301-779-0082, Home 301-983-8597, Mobile 301-775-0699, drnavinshah@hotmail.com