emedinews
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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

15th April, 2010 Thursday

Fermented Milk and Chronic Gastritis

Gastritis induced by acetyl–salicylic acid is common. Probiotics ameliorates different gastrointestinal tract diseases such as inflammatory bowel disease, diarrhea, irritable bowel syndrome, etc. However, its role in gastric disease is not clear.

The health benefits of probiotics or fermented foods arise both from the bacteria and the metabolites produced during fermentation such as exopolysaccharides (EPS). These polymers modulate the immune response and display anti–ulcer activities.

A research article published on April 7, 2010 in the World Journal of Gastroenterology indicates that milk fermented with S. thermophilus CRL 1190 and/or its EPS was effective in the treatment of chronic gastritis by modulating the immune response of the mice and by increasing the thickness of the gastric mucus gel layer. The fermented milk showed a similar protective effect to omeprazole.

Curd is one form of fermented milk.  Ayurvrda for centuries have been talking about usefulness of buttr milk in gastritis.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo feature

Padma Shri and Dr B C Roy Awardee, Dr. KK Aggarwal and Dr. NN Khanna, Chairman of the Asia Pacific Vascular Society and Advisor, Apollo Group of Hospitals releasing a poster highlighting early intervention as key to save limbs from amputations at a press conference organized to bring the excerpts of the 2nd Asia Pacific Vascular Interventional Course of importance to the public.

Dr k k Aggarwal


News and views

1. FDA new approvals (generic)

The FDA has approved generic versions of two antihypertensives: losartan potassium and the combination drug losartan potassium and hydrochlorothiazide.

The two drugs are the first generic angiotensin receptor blockers to win FDA approval. Both drugs are indicated as stand alone therapy for hypertension and stroke prevention in patients with a history of hypertension and left ventricular hypertrophy. The losartan-hydrochlorothiazide combination is not indicated as initial therapy except in severe cases. The drugs are contraindicated in patients with hypersensitivity to any of their components, and the combination is contraindicated in patients with anuria or hypersensitivity to other sulfonamide derivatives.

2. New treatment for glioblastoma- interferon–beta injections

Paula Oertel’s brain tumor disappeared for nine years while she was on a drug not approved for her condition. The tumor returned when Medicare denied coverage for the experimental treatment. Now Medicare officials have decided she will be allowed to go back on the drug. Oertel, 40, was giving herself interferon–beta injections, which is approved for treating multiple sclerosis, but not brain cancer. She was first diagnosed with glioblastoma multiforme 12 years ago at the age of 29 years.

3. Bone cysts signals worse prognosis

The presence of subchondral bone cysts in knee osteoarthritis signals worse cartilage loss, disease progression, and increased risk of total joint replacement, a longitudinal study found. During the course of two years, patients who had cysts at baseline had a higher rate of cartilage loss compared with patients who had smaller bone marrow lesions and those who had neither (9.3% versus 6.3% and 2.6%, respectively), according to Stephanie K. Tanamas of Monash University in Melbourne, Australia, and colleagues.

4. Smoking withdrawal can lead to agitation in ICU

Smokers forced to abstain from nicotine because of admission to an intensive care unit are at an increased risk for agitation. The rate of agitation was doubled for active smokers compared with their nonsmoking counterparts (64% versus 32%) as reported by Dr Damien du Cheyron, of Caen University Hospital, France, in the journal Critical Care.

5. Mobilizing early to reduce the heavy sedation and bed rest

Early mobilization to reduce the heavy sedation and bed rest that were once synonymous with critical care improves patients’ outcomes. When a Johns Hopkins Medical ICU instituted these strategies, it reported a lower incidence of delirium (21% versus 53%) and greater functional mobility at discharge (56% versus 78%) than it found with usual care before the intervention.

Mnemonic of the Day (Dr Prachi Garg)

Extra–colonic manifestations of Ulcerative colitis & Crohn’s disease – A PIE SACK

Aphthous ulcers

Pyoderma gangrenosum

Iritis (uveitis)

Erythema nodosum

Sclerosing cholangitis

Ankylosing spondylitis & Arthritis

Clubbing

Kidney (nephritic)

What’s New: Preoperative transvaginal sonography

Preoperative transvaginal sonography had a reasonable sensitivity and specificity (83 and 85% respectively) for the diagnosis of adenomyosis, in a meta–analysis of 14 studies in which women underwent hysterectomy with pathologic confirmation of adenomyosis. (Meredith S. Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and metaanalysis. Am J Obstet Gynecol 2009;201:107.e1–6)

eMedinewS Fact about rheumatoid arthritis

Among patients with early oligo–or polyarthritis, anti–CCP testing appears to be of predictive value in the IgM–RF negative subgroup. Anti–CCP testing is a clinically useful tool in diagnosis or exclusion of RA in patients with polyarthritis.

Quote of the day (Dr Santosh Sahi)

Health is the greatest possession, Contentment is the greatest treasure, Confidence is the greatest friend. Non–being is the greatest Joy.

Diabetes Fact

Causes of increased anion gap acidosis: Diabetic Ketoacidosis, lactic acidosis, salicylates, uremia; mortality 50%


Public Forum
(Press Release for use by the newspapers)

Soya good for diabetics

A diet rich in soya protein has a lasting beneficial effect on the heart, blood vessels and kidneys of people with type 2 diabetes and kidney disease.

Quoting a study from Iranian researchers in the journal Diabetes Care, Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India said that soya protein consumption has a significant positive impact on cardiovascular risk factors and kidney related biomarkers among type 2 diabetic patients with kidney disease.

In the study at Isfahan University of Medical Sciences compared with controls, patients who ate soya protein showed significantly lower levels of fasting blood sugar, total cholesterol, "bad" LDL cholesterol, and triglycerides.

In addition, circulating C-reactive protein levels, which signal inflammation in the body, were reduced as were levels of well– known urinary markers of kidney disease.

Short–term studies have indicated such benefits with soya protein, but the report points that these effects remain "stable with long–term consumption."

Tomato may not prevent cancer

Lycopene, the much–touted cancer fighting antioxidant found in tomatoes and ketchup, is ineffective in preventing prostate cancer, added Dr Aggarwal. In fact, higher intake of another antioxidant found in many vegetables, beta–carotene, appears to increase the risk for aggressive prostate cancer. A study published in the journal Cancer Epidemiology, Biomarkers & Prevention involving more than 28,000 men, has shown that tomatoes, and tomato found in ketchup and pizza, do not reduce the risk for prostate cancer.


Question of the day

What are the recommended therapies for androgenetic alopecia?

Only two drugs are approved by FDA for male pattern baldness (MPB) or male pattern hair loss (MPHL): 2% and 5% Minoxidil and oral Finasteride. The patients should realize that they need to continue treatment on a long term basis. A minimum period of 6 to 12 months trial should be encouraged before declaring that these drugs are not effective. The drugs do not reverse baldness and grow back all the lost hair. They retard further thinning of hair and this preserves the existing density of hair.

Finasteride given as 1 mg per day given to men above 18 years achieves appreciable growth of hair by the end of 12 months. By the end of first year, more than 50% of men show increase in hair growth and it rises to 66% by 24 months. Side effects are few and disappear on continuation of the drug. Reversal of hair growth occurs within a year on stoppage of the drug.

Topical minoxidil 5% has consistently proved to be better than 2% solution. Twice–daily application is the key to good results. Overall success rates are pegged to around 50 to 60% over a period of 1 year.

Combination of topical minoxidil and oral finasteride has shown additive effects in a study on an animal model. The combination could be tried in the initial months and later one of the drugs continued on a long term basis for maintenance of the results achieved.

In women, only 2% minoxidil solution is FDA–approved for female pattern hair loss (FPHL). Minoxidil is effective in women, pre or post menopausal with or without hyperandrogenism. This is reversible within few months.

Women with hyperandrogenism need oral drugs like oral contraceptive pills, spironolactone and cyproterone acetate in addition to the topical drug.

eMedinewS Try this it Works

Listening for the cause of leg pain

Always place the stethoscope over the superficial femoral arteries on the anteromedial surface of the hip. Although bruits are unusual at this site, they are specific for peripheral vascular disease.


Dr Good Dr Bad

Situation: A diabetic patient with early neuropathy came for prevention of foot ulcer advice.

Dr Bad: Take 10 mg atorvastatin

Dr Good: Take 80 mg atorvastatin

Lesson: High–dose atorvastatin may protect against the development of diabetic foot ulcers (DFUs) through its pleiotropic effects. In a small pilot study, 6 months treatment with high–dose (80 mg) atorvastatin resulted in a reduction of the recurrence and the development of new neuropathic DFUs in patients presenting with a DFU compared with treatment of patients with a low dose (10 mg) of atorvastatin. (J Diabetes 2009;1:182–7)


Make Sure

Situation: A hypertensive patient with microalbuminuria showed progression to CKD

Reaction: Oh my God! Why was he not given the renoprotective drug (telmisartan) not given?

Lesson: Make sure that all patients with hypertension at risk for CKD are given the renoprotective drugs. 

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Docconnect

Laughter the best medicine

Doctor: Did you know that there are more than 1,000 bones in the human body?

Patient: Shhh, doctor! There are three dogs outside in the waiting room!


Formulae in Critical Care

Concentration of H+

Formula: H+ (nmol/L) = 24 × PaCCL

Comment: For every 1 mmHg PaCO2, there are
0.7 mmol/L of H+ and with every 1 mmHg fall in PaCO2,
H+ fall by 0.3 mmol/L and pH increases by 0.003.

Milestones in Medicine

1946 – Yale–New Haven Hospital was the First U.S. hospital to allow healthy newborns to stay in rooms with their mothers

Lab Test (Dr Arpan Gandhi and Dr Navin Dang) 

Body Fluid Analysis

For pleural, pericardial, and peritoneal fluids, it is important to test to determine whether the fluid is transudate or exudate because it can help diagnose the disease or condition present.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Cefovecin (as sodium) 80mg/ ml Lyophilised powder for injection (Veterinary)

For the treatment of skin bacterial infections in dogs and cats.

03.10.09


(Advertorial section)

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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 500 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. Sir, Congratulations for the mammoth effort in bringing out a daily for Doctors. It makes a good educational everyday habit for many. I have few comments to make on the editorial on 12th April 2010 that to be Indian itself is a risk factor. That Indians are at more risk of coronary artery disease (CAD) became known from studies in USA on Asian Indians who constitute migrants from India, Pakistan, Bangladesh and Sri Lanka. These data were extrapolated for native Indians. The so–called ‘Asian Indians’ differ from native Indians in their economic status, food habit, physical activity and social status. About 70% of native Indians live in villages and 30% of urban Indians live in slums. Some studies in India subsequent to studies in USA were published in similar lines the authenticity of which is unknown. That the Indian studies are copies from USA studies are apparent as they mention their cohort as Asian Indians although they do research in India itself.

    Do we know our cholesterol levels? Are NCEP ATP III (of USA) targets are applicable to all Indians, rural, urban, middle class, vegetarian and so on? In the scenario where CAD is decreasing in developed countries, are multinational giants targeting the huge Indian markets? Can we get carried away by studies involving few westerners or involving some patients attending corporate hospitals in India? Well, I leave the answer to the esteemed readers of this e–magazine. Thanks for the opportunity to express my views. With best regards: Dr BR Mishra
    eMedinewS Answers: In India, we have two types of population ‘Bharatiya’ and ‘Indian’. ‘Indians’ live the western lifestyle and ‘Bharatiya’, the Indian lifestyle. The ones who live a western lifestyle are at increased risk of CAD

  2. Sir, we are proud to be associated with you. Hearty congratulations for Padma Shri: Samir

  3. Congrats: Dr. V T Shah, Mumbai

  4. Congratulations for Padma Shri award: Dr S K Jain