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Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



18th November Wednesday  

Dear Colleague,

 Breaking news: Treatment found for NASH?

Vitamin E and, pioglitazone may become the first effective treatments for nonalcoholic steatohepatitis or NASH, if the results of a new study are to be believed.

In a randomized, placebo-controlled trial 43% of NASH patients on vitamin E, 20% on placebo and 35% on pioglitazone, met the study’s primary endpoint : a composite of improved liver function, decreased ballooning, and stabilization of fibrosis, after about two years of treatment. The study was done by Dr Arun Sanyal, Virginia Commonwealth University in Richmond.

Pioglitazone was approximately as effective as vitamin E, with both agents superior to placebo. The key finding was that vitamin E was clearly an effective treatment for active NASH. There is currently no approved therapy for NASH.

The two agents were chosen for the study because earlier research suggested that both insulin resistance and oxidative damage are involved in NASH.

Patients were randomized to receive placebo, 30 mg/day of pioglitazone, or 800 IU/day of vitamin E, for 96 weeks, at which point a liver biopsy was obtained. Other outcomes were measured at week 120.

Just over half of both the vitamin E and pioglitazone groups showed resolution of NASH, compared with about 25% of the placebo group.
About 55% of vitamin E patients showed improvement in steatosis, as did some 70% of those taking pioglitazone. In the placebo group, 30% improved.

As expected, pioglitazone had two effects not seen with the other treatments. Patients on the drug showed significant weight gain, About 5 kg on average during the study, compared with less than 1 kg for placebo and vitamin E, and a lessening of insulin resistance as measured by HOMA  IR scores.

In the past several studies have evaluated pioglitazone, alone, in combination with dietary therapy or with vitamin E in patients with NASH. These have shown biochemical and histologic improvement with Pioglitazone but the improvements appear to reverse upon discontinuation. Pioglitazone has been shown to decline serum aminotransferase levels, increase hepatic insulin sensitivity, and improve histology. 

Dr K K Aggarwal


 Question of the day: Can penis fracture?

Yes. A penis fracture can occur when there is trauma to the erect penis.
During an erection, the penis is engorged with blood. If the penis is bent suddenly or forcefully while it's engorged, the trauma may rupture corpus cavernosum responsible for erections - resulting in a penis fracture. The trauma is usually related to aggressive or acrobatic sexual intercourse or, in some cases, aggressive masturbation.
A penis fracture is a painful injury that's often accompanied by an audible cracking sound, followed immediately by dark bruising of the penis.
In some cases the tube that drains urine from the body (urethra) may be damaged as well, and blood may be visible at the urinary opening of the penis.
A penis fracture requires urgent medical attention. A penis fracture can usually be diagnosed with a physical exam, and prompt surgical repair is typically recommended. Left untreated, a penis fracture may result in deformity of the penis or the inability to have or maintain an erection.

Cancer a marriage risk

Cancer can put an enormous strain on a marriage, and couples are much more likely to fall apart if the woman is the patient. In fact, the odds of separation or divorce are six times higher compared to when the man is the one with the illness, a new study shows in Nov. 15 issue of the journal Cancer.

Leave renal artery stenosis alone

People suffering from blocked renal arteries fare just as well when treated with medication as they do by having the narrowed artery opened and a stent implanted, British researchers report. In asymptomatic people with chronic kidney disease, people with severe hypertension, there is no benefit from subjecting them to a risky procedure of revascularization, or restoring the blood flow via artery-opening surgery, said Dr. Philip A. Kalra, a consultant nephrologist at Salford Royal Hospital Trust and the University of Manchester in England and a co-author of the study, published Nov. 12 in the New England Journal of Medicine. Taking a combination of blood pressure lowering drugs, cholesterol lowering drugs such as statins, and aspirin or another anti clotting drug can control the condition without the risks associated with revascularization surgery.

Elderly at risk of death with swine flu

A study of H1N1 swine flu in Mexico finds that while babies and people under the age of 40 are most likely to get sick, elderly people have the highest death rates. The research, published online Nov. 11 in The Lancet, analyzed medical records of patients at clinics in the Mexican Institute for Social Security network, who became sick with flu-like illnesses between April 28 and July 31, 2009.

No jalneti for long periods

Rinsing sinuses with a saline solution might have soothing short-term benefits, but it could actually make you more prone to infections in the long run by stripping your nose of critical immune soldiers. By washing the nose, we are removing the bad mucus but, unfortunately, we are also removing the good mucus that contains the antimicrobial agents as well, said Dr. Talal Nsouli, lead author of new research on the issue. And, by depleting the nose of its immune elements, we expose the patient to more sinus infections. Avoid using nasal saline irrigation on a long-term basis, limiting its use only to when an infection is present. The research was to be presented Sunday in Miami Beach at the annual meeting of the American College of Allergy, Asthma & Immunology. But other experts are split on how to interpret the findings.

Stroke can break marriages

Although many wedding vows include the phrase "in sickness and in health," a stroke can put that promise to the test by causing major relationship problems for married couples, according to British researchers. The researchers found that the stroke significantly affected sexual activity, led to blurred relationship roles, and feelings such as anger and frustration were confounded by persistent fatigue and lack of independence.

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 Genius: Only great minds can read this ( By Smit Chugh)  

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Situation:  A diabetic patient comes with a foot infection.

Dr Bad: Get a CT done
Dr Good: Get a plain X-ray done

Lesson:  Obtain a plain X-ray. If normal, treat for soft tissue infection for two weeks. Repeat plain X-ray in two to four weeks. If repeat radiograph remains normal, osteomyelitis is unlikely.

Make Sure

Mistake: A patient of TB taking ATT complains of numbness in fingers and toes.

Reaction: Oh My God! I Forgot To Prescribe Vitamin B Complex

Make Sure:  That in patients taking ATT (including INH), B-complex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boosts the immune system.

Clinical News to Use

Diagnosis of dandruff is generally straightforward, but the differential diagnosis includes a variety of conditions, such as psoriasis vulgaris (sebopsoriasis), atopic dermatitis, tinea capitis and candidiasis, as well as other, more rare conditions. Am. Fam. Physician 1995 July;52(1):149-155, 159-160.

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emedinews: revisiting 2009

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