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

18th April, 2010 Sunday

Smoking may cancel stroke benefit of moderate alcohol intake

Moderate drinking may protect against stroke, but not if the drinker is also a smoker. An analysis of stroke incidence in a long–running cohort study showed that both nondrinkers and heavier drinkers are at higher risk than moderate drinkers, an effect known as U–shaped curve, according to Yangmei Li, at Cambridge University at the Annual Meeting of American Academy of Neurology.

The reason, may be the impact of smoking. She looked at data from the European Prospective Investigation into Cancer (Norfolk) study was examined, which also included information on cardiovascular outcomes.

Volunteers aged 39 through 79 began taking part in the study between 1993 and 1997. At baseline, they were free of heart attack, stroke, and cancer and were followed up for incident stroke until 2008. They looked at the relationship between alcohol and stroke in 10,171 men and 12,353 women. Over the follow–up period –– 12 years on average –– there were 876 strokes. The analyses showed that, compared with nondrinkers:

  • Those who drank between one and three units of alcohol a week had a hazard ratio for stroke of 0.72.

  • Weekly drinking of 3.1 through seven units yielded a hazard ratio of 0.56.

  • The hazard ratio for 7.1 through 14 units was 0.55.

  • Weekly drinking of 14.1 through 21 units yielded a hazard ratio of 0.71.

  • The hazard ratio for 21.1 through 28 units was 0.82.

  • And weekly drinking of more than 28 units yielded a hazard ratio of 0.96. But smoking had a statistically significant interaction with alcohol. People who combined drinking and smoking, had 75% greater risk of stroke than nondrinking nonsmokers

     

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


 

Photo feature

Dr KK Aggarwal being felicited by the IMA Janakpuri branch, on 16th April 2010, for being awarded the Padma Shri award.

Dr k k Aggarwal


News and views (Dr Monica and Brahm Vasudeva)

BNP–guided therapy helps heart failure outcomes

Therapy guided by B–type natriuretic peptide (BNP) reduces all–cause mortality in patients with chronic heart failure compared with usual clinical care, especially in patients younger than 75 years, even if it doesn’t reduce hospitalizations or increase hospital–free survival. Researchers did a meta–analysis of eight prospective randomized, controlled trials of 1,726 outpatients with a history of heart failure. Results were reported in the March 22 issue of Archives of Internal Medicine. There was a significantly lower risk of all–cause mortality {relative risk (RR), 0.76} in the BNP–guided therapy group compared with the control group. Patients younger than 75 years in the BNP–guided group had significantly lower all–cause mortality (RR, 0.52; 95% CI, 0.33 to 0.82). However, patients 75 years or older had no reduction in mortality with BNP–guided therapy (RR, 0.94; 95% CI, 0.71 to 1.25).

More patients in the BNP groups had their doses of angio-tensin–converting enzyme inhibitors and β –blockers titrated up to reach target levels (21% and 22% in the BNP group vs. 11.7% and 12.5% in the control group, respectively).

High dose of simvastatin poses muscle injury risk

Patients taking high doses of simvastatin face an increased risk of myopathy, according to a new FDA warning. The warning highlights the greater risk of rhabdomyolysis, for patients who take the 80–mg dose of this drug. Rhabdomyolysis is the most serious form of myopathy and can lead to severe kidney damage, kidney failure, and sometimes death.

Don’t use Rotarix vaccine, FDA warns

FDA warning: Doctors should temporarily suspend the use of Rotarix, one of the vaccines used to prevent rotavirus disease. The suspension is being taken as a precaution after DNA from porcine circovirus type 1 (PCV1) was found in Rotarix. PCV1 is not known to cause disease in humans and the FDA reports no evidence of a safety risk. No medical follow–up is recommended for patients who have been vaccinated with Rotarix, according to the FDA safety alert. However, use of the other licensed rotavirus vaccine, RotaTeq, is currently advised. In children who have received one dose of Rotarix, clinicians can complete the series with RotaTeq for the next two doses, according to the CDC.

Some FAQ's on depression (Dr G M Singh)

Is there still a place for the use of electroconvulsive therapy (ECT) in patients with severe depression?

Unquestionably yes. It is generally safer than high-dose drug treatments and it is effective in many treatment-resistant cases. Its disadvantage is that its effects tend to last only a couple of months and so it is important to establish a robust regime of antidepressants within that time to maintain any improvements. Again, in this context, the terms 'severe' and 'treatment-resistant' should not just refer to profound depression but also to chronic and disabling depression of more moderate severity.

Can you outline the red-flag features that might help us recognise severe depression or a high risk of attempted suicide?

Estimates vary, but about a quarter to a third of suicides are thought to be preventable. If a patient has thought through the method they would use and the practicalities surrounding their death, the risk of suicide should be taken seriously. There are groups that are at higher risk: the elderly, the widowed, the recently separated and the physically ill - particularly those with chronic pain. There has been a relatively recent upsurge of suicides in younger men that may be related to changing patterns of substance misuse. Substance misuse is generally associated with higher rates of successful suicide attempts. Misuse can be masking depression and may lead to reckless behaviour. Loss of appetite sufficient to cause weight loss is relatively rare and often indicates profound depression. And naturally, a family history of suicide should also be taken seriously.

Conference Calendar

3rd World Congress of Pediatric Surgery (WOFAPS)

Day: October 21-24, 2010,

Venue: Hotel Taj Palace, New Delhi

The Online Registration and Abstract submission are now open. The Early Bird Registration closes on April 30.

Post Congress "Live Operative Workshop" on Hypospadias, Intersex and UGS.

Date: October 25-26, 2010

Venue: AIIMS, New Delhi.

Mnemonic of the Day (Dr Prachi Garg)

Chronic Renal Failure – GLAD SHOP

Glomerulonephritis

Lupus

Analgesics

Diabetes

Systemic vascular disease

Hypertension

Obstruction

Polycystic kidney disease


What’s New

Traditional vaginal repairs, sacrocolpopexy and vaginal mesh kits for apical prolapse A meta–analysis compared traditional vaginal repairs, sacrocolpopexy and vaginal mesh kits for apical prolapse. Vaginal mesh kits had the highest rates of severe complications (12.9 %) and reoperations (8.5 %). (Diwadkar GB, Barber MD, Feiner B, et al. Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 2009;113:367.)

eMedinewS Fact about rheumatoid arthritis

Acute phase reactants, particularly the ESR and CRP are often useful for distinguishing inflammatory conditions, of which RA is one, from noninflammatory disorders that present with musculoskeletal symptoms (e.g, osteoarthritis or fibromyalgia).


Quote of the day

"Success is not measured by what you accomplish but by the opposition you have encountered, and the courage with which you have maintained the struggle against overwhelming odds." ...Orison Swett Marden.


Diabetes Fact

The role of TNF–α in metabolic control has been of major interest. When the balance of energy uptake and consumption shift toward accumulation of triglycerides in adipocytes, adipocytes grow in size. Increased adipocyte volume is associated with enhanced adipose tissue secretion of TNF–α, which in turn inhibits insulin signaling in adipocytes, skeletal muscle, and hepatocytes. This cascade of events results in insulin resistance.


Public Forum
(Press Release for use by the newspapers)

Anger recall is as bad as Anger itself

Conducting a workshop on Stress Prevention, on the second day, at Aum Shanti Retreat Centre near Manesar Padma Shri and Dr BC Roy Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India said that even recall of anger is dangerous.

Anger recall causes sympathetic over activity. The resulting increased adrenaline and noradrenaline levels lead to plaque rupture and consequently a heart attack or myocardial infarction (MI).

Anger recall is as bad as anger itself. Anger can be expressive or suppressive. Both are dangerous. Expressive anger causes plaque to rupture leading to heart attack or MI, while suppressive anger causes chronic sympathetic over activity that helps plaque formation.

The answer is anger management and not expression nor suppression of anger.

Those people how get angry and are heart patients should not miss their aspirin dose as aspirin takes away the bad effects of anger.

The workshop was held as part of the two–day National Seminar on Stress Prevention –and Prevention of Lifestyle Disorders – held at Om Shanti Retreat Centre, near Manesar. And was organised by Heart Care Foundation of India in association with Brahma Kumaris, IMA New Delhi and Janakpuri Branches, IMSA (Delhi), IIHP (Delhi).  

Others who spoke at the workshop included BK Asha, BK Sapna and BK Brij Mohan Ji from Om Shanti Retreat Centre.


Question of the day

What are the alternative and experimental treatments of hair loss?

Dutasteride: 5–alpha reductase inhibitor: Dutasteride is similar to finasteride in that it is also a 5–alpha reductase inhibitor. It is effective in inhibiting both type I and type II 5–alpha reductase, though it is unclear if this provides additional benefits in the treatment of male pattern hair loss. Dutasteride is FDA–approved to treat enlarged prostate glands in men, but it is not yet marketed or approved for treatment of hair loss. Dutasteride is currently being tested for the treatment of male pattern baldness (MPB). Side effects include decreased libido, decreased amount of semen during ejaculation, and breast tissue tenderness or enlargement. Dutasteride is known to cause birth defects in developing male fetuses. Hence it should not be taken by women who are pregnant or who may become pregnant.

Herbal/vitamin treatments:
There are numerous herbal/vitamin hair loss products on the market today; whether and to what extent those products are effective in treating MPB is difficult to say. This is not to imply that vitamin or herbal remedies cannot be effective in treating hair loss- indeed, some people have had success with such treatments, and some studies exist that indicate successful results for certain substances.

Spironolactone:
Spironolactone is an antiandrogen that works in two ways. Primarily it slows down the production of androgens in the adrenal glands and ovaries. Secondly it blocks the action of androgens in part by preventing dihydrotestosterone from binding to its androgenetic receptor.

Cimetidine:
Cimetidine has been used to treat hirsutism in women and has been studied in women with androgenic alopecia showing promising results. Because of the high doses needed to achieve its hair raising results, men should not take cimetidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.

Cyproterone acetate:
Cyproterone acetate is used to reduce sex drive in men who have excessive sex drive and for the treatment of pronounced sexual aggression. It is also prescribed to treat severe hirsutism in woman of childbearing age and also androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of DHT dihydrotestosterone to its receptors.

Wigs: Whether one is seeking a wig out of necessity or simply to change the look, there are a wide variety of wigs available today. Wigs are simply hair (human or synthetic) attached to a cap and worn to look like natural hair.

Prosthetic hair: Prosthetic hair are of two types synthetic fibers
(such as monoacrylic, polyacrylic, and polyester); and natural fibers (such as processed human hair). They are implanted into the galea by a knot through an implanter device. The advantages are the relative ease of the procedure, relatively bloodless technique, and immediate cosmetic results. These fibers do not grow and hence cannot be cut or shaven.1

Reference

  1. Mysore V. Synthetic hairs: Should they be used?. Indian J Dermatol Venereol Leprol 2006;72:5–7

 
eMedinewS Try this it Works

Puffing out the penlight

When listening to the lungs have them "blow out" your penlight.


Dr Good Dr Bad

Situation: A diabetic on exercise protocol came for blood sugar check up.

Dr Bad: Get fasting sugar done.

Dr Good: Get fasting and post prandial sugar done.

Lesson: The 2–hour plasma glucose level is more sensitive than fasting plasma glucose level to the beneficial effects of physical activity. These beneficial effects are apparent across the waist circumference spectrum. (Diabetes Care 2006;29:2598–2604.)


Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.

Reaction: Oh my God! His HbA1C is very high?

Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

IJCP
 
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Laughter the best medicine

A man was brought in to the hospital intensive care ward, put in a bed, tubes coming out everywhere. A week later, another man was admitted, in a similar condition. Both lay there, machines pinging, tubes poking etc. A couple more weeks before one of them had the strength to raise his hand and point to himself and say: "Scottish".

The other signalled he had heard, raised his own hand, and said "Irish".

This act tired them out so badly it was a week before the first summoned up the strength to say: "Glasgow".

Again the second replied in a weedy frail voice "Dublin".

Once more, the strain was too much for them both and they passed out. Days passed before the first man managed to again point to himself and say: "Jimmy".

Replied the other: "Paddy".

A few hours later, Jimmy managed to point to himself again and rasp out weakly: "Cancer".

Paddy responded: "Sagittarius".


Formulae in Critical Care

Calculation of dose of a drug in renal insufficiency

Formula: Doseri = dose × CLri

CL ri – renal insufficiency

CL – clearance from whole body CLri = CL renal × measured CL + CL non-renal 100 ml/min


Milestones in Medicine


Albert Hofmann (1906 – 2008) was a Swiss scientist best known for having been the first to synthesize, ingest and learn of the psychedelic effects of lysergic acid diethylamide (LSD). Hofmann authored more than 100 scientific articles and wrote a number of books, including LSD: My Problem Child. On January 11, 2006, Hofmann became a centenarian, and the occasion of his 100th birthday was the focus of an international symposium on LSD.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Antidiuretic Hormone

Also known as – Vasopressin; Arginine Vasopressin; AVP is done to help detect, diagnose, and determine the cause of antidiuretic hormone (ADH) deficiency or excess; to investigate low blood sodium levels (hyponatremia); to distinguish between the two types of diabetes insipidus

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Milnacipran 100mg (additional Strength)

same as approved

16.7.2009


(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: Last day today 

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris is being 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), IIHP (Delhi) 

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

Timings: Sunday 18th April (7 am–4 pm). There are no registration charges. Food (satvik) provided. Voluntary contributions welcome. SMS to Dr KK Aggarwal: 9811090206, BK Sapna: 9811796962, bksapna@hotmail.com

Suggested Programme

Saturday 17th April 2010

2.00 pm – 4.30 pm : Dr K K Aggarwal

4.30 pm – 5.00 pm : Tea

5.00 pm – 6.00 pm : Brahma Kumaris

6.00 pm – 7.00 pm : Inauguration

7.00 pm – 8.30 pm : Brahma Kumaris

8.30 pm : Dinner

Sunday 18th April 2010

7.00am – 8.30am : Meditation Session

8.30am – 9.00am : Breakfast

9.00am – 11.00am : Dr KK Aggarwal

11.00am – 11.30am : Tea Break

11.30 am – 1.30 am : Session by Brahma Kumaris

1.30pm : Prasad, Blessings followed by Lunch

......... Farewell for a New Beginning

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Readers Responses

  1. Congratulations once again. I was delighted to see the live telecast. Wish you all the best for future: Satish Goell.
     
  2. Padmashri Dr K K Aggarwal. wah kya baat. badhai hai. maza aa gaya: Sanjiv batra.
     
  3. Congratulations Gij. We are so proud of you. Anupam.
     
  4. Congratulaitons Sir on your Padmashri Swati & Prashant Sarogi.
  5.  Dear reader: Ptosis Spectacles take care of the drooping upper lid, in cases where the oculo-plastic surgeon advises against ptosis surgery. Dr Narendra Kumar.