News: American College of Gastroenterology, San Diego, CA October 23-28,2009.
1. Inflammatory bowel disease (IBD) increases the risk of nonmelanoma skin cancer by 60%, most of which comes from patients treated with thiopurine drugs. The findings provide objective data to support speculation that patients with inflammatory bowel disease might have an increased risk of skin cancer. (Dr Millie D. Long, University of North Carolina, Chapel Hill)
2. Patients with nonalcoholic fatty liver disease (NAFLD) have a two-fold increased risk of hypothyroidism, including a five-fold greater risk among women. About one of every five patients with NAFLD had hypothyroidism. Although being female increased the odds, any history of alcohol consumption, no matter how modest, reduced the association between NAFLD and hypothyroidism.
(Dr Mangesh Pagadala, Cleveland Clinic)
3. Older age and a history of gastrointestinal bleeding or duodenal ulcer may put patients at increased risk of continued bleeding or rebleeding after an initial GI event. In a European study, patients with a history of bleeding had a 1.7-fold increased risk and having an ulcer almost doubled. (Dr Angel Lanas, University Hospital Zaragoza, Spain)
4. Adding colored dye to high definition colonoscopy does not help doctors detect more adenomas than they do with regular HD colonoscopy. The technique did modestly increase detection of flat and small adenomas, but not by enough to matter in practice. (Charles Kahi, Indiana University)
5. An investigational, four drug -regimen for the ulcer-causing Helicobacter pylori infection led to a significantly higher eradication rate than the current standard in previously untreated patients in a multicenter, randomized trial reported here. The new four-drug treatment, known as LOAD, comprises levofloxacin, omeprazole, nitazoxanide and doxycycline. It was tried against the normal three-drug regimen, known as LAC, which stands for lansoprazole, amoxicillin and clarithromycin. Seven-day and 10-day courses of the LOAD regimen led to eradication rates of about 90%, compared with 75% in patients treated with the LAC regimen. (Dr H. Patrick Basu, Columbia University).
Dr Good Dr Bad:
Situation: A diabetic patient with postprandial hyperglycemia was put on oat bran breakfast.
Dr Bad: It will not work.
Dr Good: It is good for diabetes.
Lesson: Oat bran flour is rich in high beta-glucan and has a low glycemic response. It acts as an active ingredient by decreasing postprandial glycemic response of an oral glucose load in subjects with type 2 diabetes.
(Source: Nutr Metab Cardiovasc Dis 2005;15(4):255-61.)
Situation: A 19-year-old presents with severe acne on face and back.
Reaction: Shall I prescribe only topical ointments.
No, prescribe doxycyline as well.
Make Sure: Doxycycline is very effective in the treatment of acne vulgaris.
Laughter the Best Medicine:
Two psychologists meet at their 20th college reunion. One of them looks like he just graduated, while the other looks old, worried and withered. The older-looking one asks the other, "What's your secret? Listening to other people's problems everyday, all day long, for years on end, has made an old man of me."The younger looking one replies, "Who listens?"
Principles of medical ethics
1. A doctor shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
2. A doctor shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report doctors deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
3. A doctor shall respect the law and also recognize a responsibility to seek changes in those requirements, which are contrary to the best interests of the patient.
4. A doctor shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
5. A doctor shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A doctor shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
7. A doctor shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
8. A doctor shall, while caring for a patient, regard responsibility to the patient as paramount.
9. A doctor shall support access to medical care for all people.
Formula to Know
Osmolar gap = Measured Posm - Calculated Posm
Question of the day
Which is the Best Artemisinin Combination Therapy?
The best artemisinin combinations are as listed below:
1. Artemether-lumefantrine (6 doses) compared with artemether -
lumefantrine (4 doses)
2. Artemether-lumefantrine (6 doses) compared with artesunate (3 days) + mefloquine
3. Artemether-lumefantrine (6 doses) compared with artesunate (3 days) + amodiaquine.
(Source: Lancet 2004;363:9–17.)
Mnemonic to know
Post op Fever - Formula of W
Wind: the pulmonary system is the primary source of fever in the first 48 hours.
Wound: there might be an infection at the surgical site.
Water: check intravenous access site for signs of phlebitis.
Walk: deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue.
Whiz: a urinary tract infection is possible if urinary catheterization was required.
Wonder drugs - drug fevers
Milestone in Neurology
Franz Joseph Gall was a neuroanatomist and physiologist and a pioneer in the study of the localization of mental functions in the brain. Around 1800, he developed 'cranioscopy', a method to define the personality, development of mental and moral faculties on the basis of the external shape of the skull.
The ability to convert ideas to things is the secret to outward success....Henry Ward Beecher
Emedinews try this it works
Green is better: Quite often diabetics want to know which fruits and vegetables have anti diabetic property.Except for sweet peas all green vegetables have anti diabetic property.
Letters to the editor
1. Dear Dr Aggarwal,You are a treasure trove of knowledge,eager to share it with your colleagues.Please accept my heartfelt congratulations for being confered the prestigious T P JUNJHANWALA FOUNDATION 22 NATIONAL EXCELLENCE AWARD for your outstanding contribution to healthcare services.Thanks for sending e-medi news daily.
Dr Hozie Kapadia Hon State Sec IMA Mah STATE
2. Dear Dr Aggarwal, Congratulations to you for the Jhunjhunwala Foundation Award. You deseve it and more. It has always been a pleasure to have een associated with you. What you are doing now in empowering people for threir own health is exactly what we recommended in the report of the Commission in Macroeconomics and Health and what we are supporting through WHO. All the very best for the future. Pofessor Ranjit Roy Chaudhury, Founder President, Delhi Medical Council, and National Professor of Phamacology NAMS