eMedinewS18th September 2014, Thursday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group; Senior National Vice President & Honorary Secretary General Elect IMA; Member Ethics Committee MCI; Chairman Ethical Committee DMC; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) IMSA (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMAAMS (06–07); President DMA (05–06); President IMA New Delhi Branch (94–95, 02–04).
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Beware of tamoxifen in dietary supplements

Tamoxifen, an antiestrogen is an unlabeled ingredient in dietary supplements marketed to enhance athletic performance.

Bodybuilders and athletes who take exogenous testosterone frequently take tamoxifen (10 to 20 mg/day) to prevent gynecomastia.

Tamoxifen in one supplement has been reported to be as high as 7.6 mg/day.

The therapeutic dose is 10 to 20 mg/day for painful gynecomastia and male breast cancer. This dose is associated with venous thromboembolism.

In people using androgens and tamoxifen, inadvertent use of additional tamoxifen from dietary supplements could precipitate venous thrombosis.

News Around The Globe

  • A large intake of high–fat dairy products may be associated with a reduced risk for type 2 diabetes; however, low–fat dairy products do not appear to show the same effect, suggests a new study presented at the European Association for the Study of Diabetes 2014 Meeting.
  • Kegel exercises to strengthen pelvic floor muscles, bladder training, and weight loss and exercise appear to be effective nonsurgical treatment options for women with urinary incontinence (UI), according to new, evidence–based clinical practice guideline from the American College of Physicians (ACP). The new recommendations were published in the September 16 issue of the Annals of Internal Medicine.
  • A new blood test can possibly identify major depressive disorder (MDD) in adults, and may assist clinicians in predicting which patients with the disorder are likely to respond to cognitive-behavioral therapy (CBT), suggests new research published online September 16 in Translational Psychiatry.
  • A simple urine test for human papillomavirus (HPV) seems to be a more acceptable alternative to conventional screening methods that require a cervical smear, and could increase uptake in hard–to– reach subgroups, suggested a meta–analysis published online September 16 in BMJ.
  • Postmenopausal women with a more diverse population of gut microbes may be more efficient at breaking down estrogen, suggests a new study. The findings suggest that a healthy bacterial population may lower the risk for breast cancer since estrogen is known to play a role in causing breast cancer. The study is published online in the Journal of Clinical Endocrinology and Metabolism.

Rabies News (Dr A K Gupta)

What should be done with a patient who has had exposure but goes for treatment after considerable delay (weeks to months)?

An early and correct administration of modern anti–rabies vaccine is life–saving. The vaccination must be started immediately irrespective of the status of the biting animal. Patients who seek treatment after a delay of 48 hours or even months after having been bitten should be dealt in the same manner as if the exposure occurred recently.

Cardiology eMedinewS

  • Patients who already have hypertension and then develop diabetes do not have increased risk of death as compared to those who do not have diabetes, suggested a new study presented at the American Heart Association (AHA) High Blood Pressure Research Scientific Sessions 2014.
  • A recent study comparing a drug–eluting balloon (DEB) and a drug–eluting stent (DES) in patients with DES in–stent restenosis (ISR) reported that for both the primary end point of in–segment minimum lumen diameter at eight months and major adverse cardiac events (MACE) at 12 months, the Xience Prime stent was superior to a paclitaxel–coated balloon. The study was presented at the TCT 2014.

Pediatrics eMedinewS

  • The American Academy of Orthopaedic Surgeons (AAOS) recently released new guidelines to assist physicians in the management of pediatric patients with supracondylar humeral fractures. The Appropriate Use Criteria were recently published online.
  • Magnesium sulfate given intravenously to pregnant women at risk of very preterm birth was not associated with benefit on neurological, behavioral, growth, or functional outcomes in their children at school age, suggested a new study published in JAMA.

Dr K K Spiritual Blog

Thinking Differently

There are three ways to manage stress. One is to think opposite, second is to think different and the third is to think positive.

Thinking opposite was advocated by Patanjali, thinking differently by Adi Shankaracharya and thinking positive by Gautam Buddha. Out of three approaches, the Indian Vedic philosophy focuses on thinking differently. Thinking positive and thinking opposite may not be feasible at the time of any adversity.

Thinking differently has been emphasized in mythology at multiple places. Ten heads of Ravana, five heads of Brahma, elephant head of Lord Ganesha, Fish incarnation of Lord Vishnu and third eye of Lord Shiva remind us of the principle of thinking differently.

We can see or analyze a person or a situation with the eyes of our physical body (physical eye) or eyes of the mind (thinking and analyzing) and eyes of the soul (conscious based decision).

Lord Buddha once said that a good action should be based on truth, should be necessary and bring happiness both for the person doing it and the society.

The 3H principle advocated in the West is also based on the same which means before any action think from your Head and from multiple options available, choose from the Heart and then order the Hands to do the job.

The first incarnation of Lord Vishnu Fish indicates the capacity of swimming against the stream. The third eye of Lord Shiva means thinking from the mind and choosing the right answer from the heart. The ten heads of Ravana and five heads of Brahma also indicate thinking to get multiple options.

The example of thinking differently comes from the dialogue between Urvashi and Arjuna. Once Urvashi in a mind full of Kama went to Arjuna and said "If you are not going give me a son like you today, I am going to give you a curse". Arjuna was in a dilemma but he thought differently and said – "Why do you want to wait for 25 years to get a son like me from today I am your son, Mother."

Wellness Blog

Avoid Drunk or Drugged Driving

The dangers of drinking alcohol and driving are well known to all. But, it is also important to recognize that taking drugs and driving too can be as dangerous. Drunken driving or driving under the influence of any drug that acts on the brain can adversely affect your vision, reaction time and judgment and driving skills. This not only endangers your life but also of your co-passengers as well as others on the road.

Tips for safe driving

  • All through the year, especially during the holiday season, take steps to make sure that you and everyone you celebrate with avoid driving under the influence of alcohol or other drugs.
  • Always designate a non–drinking driver before any holiday party or celebration begins.
  • Arrange for someone to pick you up
  • Do not let a friend drive if you think that they are under the influence of alcohol or other drugs. Take the car keys.
  • Stay overnight at your friend’s place, if possible and drive back home in the morning.

Inspirational Story

My Little Miracle

I had just turned 19 when I was told I could not have children. I was devastated. Ever since I was a small child, I had prayed for a beautiful blonde haired, blue eyed baby girl. I used to pray to God that before He decided to come back for His children, He would allow me to have a baby girl.

I was in a serious relationship at the time that I thought would last forever. He told me that he would love nothing more than to have a child to care for and love. I prayed that the doctors were wrong and that maybe if I prayed hard enough, God would prove them wrong.

Every night I would pray, "God, please let me be a mother. Let me have the honor of caring for one of your children." Just three months later, I found out I was pregnant. I had a very hard pregnancy. High blood pressure kept the doctors on alert. I found out I had Strep B, which could be fatal to the baby. I was scared. I didn't want to lose her. Every day I prayed that she would be OK.

At only 33 weeks, she attempted to be born. "No," I prayed. "Not this early. Please. Just one more week at least. She needs to gain more weight." I was immediately hospitalized and put on total bed rest. I was given nothing to eat or drink for three days. On the fourth day, the doctors finally said I could eat and drink, that my body was doing what it was supposed to in preventing the birth.

Just a couple of days later, when I had reached 34 weeks, the doctors decided it was safe enough for me to have her. I was induced, and at 4:57 pm on September 18, 1998, I had the most beautiful blonde haired, blue–eyed baby girl. I named her Jessie–Mae Marie. She is now two–years–old and the best thing to ever happen to me. A real gift from God.

No, her father and I are no longer together. He decided being a father was not for him. I am not sad about that. I am sad for him. He is missing out on her growing up and will probably always regret it.

So, if any of you are told there is no chance for you to have children, remember this. God still works miracles. He worked a big one in my life and I will always be grateful for that.

ePress Release

Long term use of painkillers can cause kidney cancer

A study published in the journal Archives of Internal Medicine has shown that people who regularly take painkiller drugs like ibuprofen or naproxen are 51 percent more likely to develop kidney cancer. There is no increased risk from taking aspirin or paracetamol, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

The mechanism through which painkillers could cause kidney disease is the inhibition of prostaglandin synthesis with resulting papillary and tubular injury, and ultimately damage to DNA.

The study analyzed data from 77,525 women in the Nurses’ Health Study and from 49,403 men in the Health Professionals Follow–up Study. The risk was related to the duration of use of the painkillers. There was a decrease in the risk by 19 per cent if the painkiller was used for less than four years. There was a 36 per cent increase in risk of kidney cancer for people who used them regularly for 4 to 10 years. The risk increased almost three times for those who used these drugs regularly for 10 years or more.

The good news is that kidney cancer is uncommon so the risk is small for average users.

Two other important causes of kidney cancer are obesity and smoking. So people on painkillers should not smoke and should also keep their weight under control to prevent kidney cancer.

eMedi Quiz

All of the following statements regarding bioavailability of a drug are true except:

1. It is the proportion (fraction) of unchanged drug that reaches the systemic circulation.
2. Bioavailability of an orally administered drug can be calculated by comparing the Area under Curve after oral and intravenous (IV) administration.
3.Low oral bioavailability always and necessarily means poor absorption.
4.Bioavailability can be determined from plasma concentration or urinary excretion data.

Yesterday’s Mind Teaser: Presence of food might be expected to interfere with drug absorption by slowing gastric emptying, or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not a correct example?

1. Absorption of digoxin is delayed by the presence of food.
2. Concurrent food intake may severely reduce the rate of absorption of phenytoin.
3. Presence of food enhances the absorption of hydrochlorothiazide.
4. Antimalarial drug halofantrine is more extensively absorbed if taken with food.

Answer for yesterday’s Mind Teaser: 3. Presence of food enhances the absorption of hydrochlorothiazide.

Correct answers received from: Dr K V Sarma.

Answer for 16th September Mind Teaser: 3. Low oral bioavailability always and necessarily means poor absorption.

Correct answers received from: Chandra Pal, Dr P C Das, Dr K Raju, Raghavendra H Gobbur, Dr Jainendra Upadhyay, Dr Avtar Krishan, Najib Khatee, Dr Rohini Dhillon, Dr Bitaan Sen, Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com

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Make Sure

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, came for follow up.
Reaction: Oh My God! Why didn’t you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

eMedinewS Humor

A group of expectant fathers sat nervously in the hall. A nurse beckoned to one of them and said, "Congratulations, you have a son!"

Another man dropped his magazine, jumped up and said, "Hey, what’s the idea? I got here two hours before he did!"

Quote of the Day

Sunbeams out of the clouds Faith out of all my doubt. Terri Guillemets

Twitter of the Day

Dr KK Aggarwal: Eating refined sugar can cause diabetes
http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra: Why do you stay in prison When the door is so wide open–Rumi

   
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  1. Good points on relaxation therapy, particularly on side effects. One of my friends went into acute psychosis after hypnotherapy in first session!! Dr Suresh Amin MD. IFCAP Consultant Pathologist 25 Alkapuri Society, Vadodara (Guj) 390005

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