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

20th March 2010, Saturday


Should everyone take an aspirin a day?

This is one question we are asked by our patients every day. Recently, Health Beat from Harvard School attempted to answer this question as follows.

In heart attack, chewing a full–strength aspirin tablet can be a lifesaving. If your patient has heart disease, have had a heart attack or stroke, or is at very high risk for having one, prescribing a low–dose aspirin every day is part of a proven strategy for preventing one of these life–changers. Aspirin makes blood platelets less sticky. This limits the formation of clots in the bloodstream, which can trigger heart attacks and strokes.

But what if one is relatively healthy? Will prescribing aspirin help keep away heart attack, stroke, and other forms of cardiovascular disease?

If taking aspirin was without side–effects and completely risk free, it might make sense for everyone with heart disease, or just worried about it, to take it. But aspirin does have risks. Reducing blood' s clotting potential can lead to hemorrhagic stroke (bleeding inside the brain). Aspirin can cause everything from a feeling of mild heartburn to bleeding ulcers in the stomach. Severe gastrointestinal bleeding can be lethal.


The benefit–risk balance

It’s the balance of benefits and risks that guides who should take aspirin for primary prevention i.e. preventing heart attack, stroke, or another manifestation of cardiovascular disease, in seemingly healthy people.

A meta–analysis of six large primary prevention trials of aspirin involving a relatively healthy group of 95,000 volunteers, the reduction in heart attacks and strokes in people taking aspirin was almost counterbalanced by major bleeding in the gastrointestinal system and the brain. The researchers concluded that for individuals without previously diagnosed cardiovascular disease, aspirin was of uncertain net value. Another meta–analysis showed only a modest overall benefit, if any, for aspirin among people with diabetes but no cardiovascular disease, and it had little impact on heart attack or stroke. When the researchers analyzed the data by sex, aspirin reduced the risk of heart attack in men but not women.

In November 2009, the editors of the British journal Drug and Therapeutic Bulletin reviewed and analyzed information from relevant primary prevention studies, and concluded that the benefits and harms ‘may be more finely balanced than previously thought, and aspirin should not be recommended as an across–the–board option to help healthy people prevent heart attack and stroke.


Finding the tipping point

Don’t give aspirin just because we have heard that it can help prevent a heart attack or stroke. It can, but it can also do some damage. There’s no exact tipping point at which it makes sense to start taking an aspirin a day. If one is healthy, has not been diagnosed with heart disease or other cardiovascular disease, and does not have risk factors for them, then aspirin probably is not for him. You’ll reap little benefit while exposing one to side effects you’d rather stay away from. The less healthy the heart and arteries, the more likely the advantages of consuming aspirin will outweigh any risks.


Dr KK Aggarwal
Chief Editor


News and Views

Saline, bicarb tie kidney safety

Sodium bicarbonate hydration is no better than the old standard, saline, in preventing kidney damage from use of radiology contrast agents in at–risk diabetes patients. The rate of contrast–induced nephropathy was 5.3% with sodium chloride solution infusion compared with 9.0% when using a sodium bicarbonate solution before and after injection of contrast. (PREVENT trial; in diabetic patients with pre–existing mild to moderately impaired renal function) (American College of Cardiology Meeting)


A new anticoagulant seems safe and effective

An investigational, selective factor Xa inhibitor –– betrixaban –– demonstrated apparent safety and efficacy in a phase II trial, making it yet another contender being developed as an alternative to warfarin


Drug combination better: slows recurrent ovarian cancer

Combination chemotherapy resulted in a longer, progression–free survival (PFS) than did sequential therapy in a randomized clinical trial of patients with recurrent, platinum–sensitive ovarian cancer. Median PFS was almost 14 months with combination therapy, while sequential administration of docetaxel and carboplatin was associated with a median PFS of about eight months. Overall survival did not differ between treatment groups. (Dr Angeles Alvarez–Secord, Society of Gynecologic Oncologists meeting)


Triglycerides decreased with rosuvastatin therapy

Rosuvastatin significantly reduced triglycerides than placebo. This may be the first study of statin therapy among patients with hypertriglyceridemia that has as it primary endpoint the reduction of triglycerides. (Dr Juan Talavera, Instituto Mexicano del Seguro Social, Mexico City)


Focused ultrasound for fibroids effective long–term

A year after treatment, focused ultrasound guided by MRI remained an effective approach to patients with uterine fibroids, bringing long–lasting pain relief. Only 8% of patients in a single–center trial needed to have a subsequent alternative procedure after 12 months according to Dr Gina K. Hesley, of the Mayo Clinic in Rochester, Minn, and colleagues. (Society of Interventional Radiology Meeting)


Old trumps new in stent comparison

For patients with chronic stable CAD, the first–generation sirolimus–eluting stent was better than the second–generation zotarolimus–eluting stent for preventing major adverse cardiac events, a randomized trial showed. Through nine months, the rate of cardiac death, myocardial infarction, and target vessel revascularization was doubled in the zotarolimus group compared with the sirolimus group (6.2% versus 2.9%). (American College of Cardiology, 59th Annual Scientific Sessions)


Sports account for half of ankle sprains in the US

About half of ankle sprains in the United States occur while patients are playing sports, with basketball taking most of the blame, according to the largest study of this common injury to date. Of the sprains that occurred during sports, 41.1% were sustained on the basketball court according to Dr Brian Waterman, William Beaumont Army Medical Center, El Paso, Tex. (American Academy of Orthopedic Surgeons Annual Meeting)


Conference Calendar

Central Line and Arterial Line Training (CART) (Target Audience – Doctors Only)
Date: March 20, 2010
Venue: 142, Bharathiyar Road, Papanayakan Palayam, Coimbatore, Tamil Nadu


What’s New

Depression diabetes link

A cohort study of people 65 years and older found that depressed individuals were more than twice as likely to develop diabetes compared to those without depression, regardless of antidepressant treatment. (Atlantis E, Browning C, Sims J, et al. Diabetes incidence associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA). Int J Geriatr Psychiatry 2009)


Quote of the Day

I believe in prayer. It’s the best way we have to draw strength from heaven. (Josephine Baker)


Diabetes Fact

Non diabetic use of insulin: Hyperkalemia, ant pituitary function, completeness of truncal vagotomy.


Public Forum
(Press Release)

Each one of us has a leader hidden within us: Sanjiv Chopra

Talking to a medical gathering of over 300 doctors, Faculty Dean for Continuing Medical Education at Harvard Medical School, Boston, Dr Sanjiv Chopra said that leaders are born only from amongst ordinary people.

The lecture was organized by Heart Care Foundation of India jointly with Delhi Medical Council, Delhi Medical association, eMedinewS, International Medical Science Academy (Delhi Chapter), World Fellowship of Religions and Maulana Azad Medical College.

The session was chaired by Padma Shri Awardee Dr KK Aggarwal and Dr A K Aggarwal, Dean Maulana Azad Medical College, New Delhi.

Dr Chopra defined the Leadership tenets under a Mnemonic LEADERSHIP:

L: Listening
E: Empathy
A: Attitude
D: Dreaming Big
E: Effectiveness
R: Resilience
S: Sense of Purpose
H: Humility and Humor
I: Integrity, Ideas, Imagination
P: People Skills, Pack others', Parachutes

  1. All Great Leaders are Great Listeners. "The true leader is a listener. The leader listens to the ideas, needs, aspirations, and wishes of the followers and then – within the context of his or her own well-developed system of beliefs – responds to these in an appropriate fashion." said James O’Toole who is recognized for his work in the areas of corporate culture and leadership.

  2. Great Leaders have Empathy and Compassion. "Be kind whenever possible. It is always possible." said His Holiness, The Dalai Lama. Florence Nightingale: Founder of the Modern Nursing Profession set an extraordinary example of compassion and commitment to patient care.

  3. Leaders possess an attitude that is upbeat and courageous. "Courage is rightly esteemed the first of human qualities, because it is the quality that guarantees all others." said Sir Winston. Great leaders lead with both heart and soul. Countries without great leaders – leaders without soul – will not only be economically and ecologically disadvantaged, they will also be spiritually bankrupt. Efficiency is doing things right; Effectiveness is doing the right things" said Peter F. Drucker.

  4. Leaders dream big. "Where there is no vision, the people perish" said King Solomon. "A journey of a thousand miles begins with a single step" said Lao Tsu.

  5. Leaders are effective: "If your actions inspire others to dream more, learn more, do more and become more, you are a leader" said John Quincy Adams.

  6. A Leader has resilience. "Nothing in the world can take the place of persistence. Great leaders are also resolute. Persistence and determination alone are omnipotent" said Calvin Coolidge.

  7. Leaders have sense of purpose. "Follow your bliss and doors will open where there were no doors before" said Joseph Campbell.

  8. Leaders live with humility and humor. Many Great Leaders possess a sense of humor. "It is not the mountain that we conquer, but ourselves." said Sir Edmund Hillary.

  9. Leaders have integrity.

  10. Leaders possess peoples skills. Leaders recognize that people are the most important assets.

Question of the day

What are the advantages of using tacrolimus and pimecrolimus in atopic dermatitis?

Tacrolimus is considered as a second line of therapy (topical steroid is the first line) in the treatment of moderate to severe atopic dermatitis (AD). It is recommended in 0.03% strength for children and 0.1% for adults with AD. It should be applied twice–daily over eczematous patches for 3 to 4 weeks. Treatment should be continued for one week after subsidence of eczema.

Tacrolimus has several advantages over topical steroid in the treatment of AD. Unlike topical steroid, tacrolimus does not impair dermal collagen synthesis and hence does not cause atrophy of skin or striae formation.1 It does not show tachyphylaxis.2 There is minimal systemic absorption even after its use over a long period of 3 years3. It is effective and safe for application over any part of the body including face, perigenital area, flexures etc. Topical tacrolimus, when applied in patients with moderate to severe AD, significantly alters the quality of life (QOL) of the patients.4

Pimecrolimus (SDZASM 981) is an ascomycin derivative and has been found effective in controlling eczematous lesions of AD when applied topically.5 It is applied as 1% cream twice–daily over the eczematous lesions. It reduces pruritus and controls flares and inflammation. It has been evaluated in randomized double blind vehicle controlled clinical trials in infants (aged 3 to 23 months), children (aged 2 to 17 years) and adults with mild to severe AD.6

References

  1. Reitamo S. Tacrolimus ointment does not effect collagen synthesis; results of a single centre randomized trial. J Invest Dermatol 1998;111;396–8.

  2. KOO JYM. Tacrolimus ointment safe in extended treatment study. American Academy of Dermatology, 61st Annual Meeting: 2003, Abstract P–22.

  3. Alaiti S. Tacrolimus ointment for atopic dermatitis: A phase 1 study in adults and children. J Am Acad Dermatol 1998;38:69–76.

  4. Drake L. The impact of tacrolimus ointment on health related quality of life of adult and paediatric patients with atopic dermatitis J Am Acad Dermatol 2001;44;565–72.

  5. Wellington K, Jarvis B. Spotlight on topical pimecrolimus in atopic dermatitis. Am J Clin Dermatol 2002;3:435–8.

  6. Novartis Pharma GMBH. Elidel (pimecrolimus) cream 1% prescribing information (online), available from URL:http//www.pharma.us.novartis.com/product/pi/paf/eridel.palf.


Quote of the Day

Enthusiasm is excitement with inspiration, motivation, and a pinch of creativity. Bo Bennett quotes


eMedinewS Try this it Works

Cut down on nasal irritation

First, have the patient use a saline spray to moisturize the mucosa. Then, have him or her spray the corticosteroid in an upward and outward direction, toward the ipsilateral maxillary sinus area. This gets the medicine where it needs to go and avoids septal irritation.


Dr Good Dr Bad

Situation: A diabetic elderly came with low HDL levels.
Dr Bad: In elderly it has no significance.
Dr Good: Its an important risk factor.
Lesson: Low HDL cholesterol is an important risk factor for not only ischemic heart disease IHD but also CVD, especially in diabetic elderly individuals. (Diabetes Care 2009;32(7):1221–3)


Make Sure

A patient with diabetes shows deteriorating kidney function.
Oh My God! His HBAIC is very high?
Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.


Medi Finance
Indirect Tax

  • Complete libComplete liberalization of pricing and payment of technology transfer fee and trademark, brand name and royalty payments.

  • External Commercial Borrowings to be available for cold storage or cold room facility, including for farm level pre–cooling, for preservation or storage of agricultural and allied produce, marine products and meat.
Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
IJCP Group
 
nuspera
 
Docconnect


Laughter the best medicine

Actual medical record

The patient left the hospital feeling much better except for her original complaints.


Formulae in Critical Care

Mean arterial pressure (MAP)
Formula: MAP = (2/3 diastolic BP) + (1/3 systolic BP)
Comments: All units in mmHg.

MAP = {(2 x diastolic) + systolic}/3
Diastole counts twice as much as systole because 2/3
of the cardiac cycle is spent in diastole. An MAP of
about 60 is necessary to perfuse coronary arteries, brain,
kidneys.
Usual range: 70–110


Milestones in Orthopedics

Arthroscopy was pioneered in the early 1950s by Dr. Masaki Watanabe(1911–1995) of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. He published the 1st edition of the "Atlas ofArthroscopy" together with his colleagues. helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, ‘open’ surgery. In 1974, he founded the International Arthoscopy Association (IAA). Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today and is often combined with meniscectomy or chondroplasty. The majority of orthopaedic procedures are now performed arthroscopically.


Mistakes in Clinical Practice

q.d" – The "q.d." means every day, and "q.o.d.", means every other day. "q.d." can be mistaken as "q.i.d.", if the period after the "q" or the tail of the "q" is misunderstood as an "i". And "q.o.d." can be mistaken for "q.d." or "q.i.d." if the "o" is poorly written. Instead, write out "daily" or "every other day".


SMS of the Day (Dr Ingole)

Comparision is the best way to judge your progress... ! But, don’t compare with others... Just compare your yesterday with your Today... !


List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Dexketoprofen Trometamol Injection 50mg/2ml

Symptomatic treatment of acute pain of moderate to severe intensity, when oral administration is not appropriate such as post–operative pain, renal colic and low back pain.

22.10.09


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen immune beauty helps improve the brittleness of nails, helps increase the hair tensile strength, thus prevents hair loss, and stimulates regeneration of hair roots. Helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

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 400 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

INVITATION

Heart Care Foundation of India
Jointly with


eMedinewS, World Fellowship of Religions, Delhi Medical Council,
Delhi Medical Association,
IMSA (Delhi chapter) and MAMC takes pleasure to cordially invite you to

A lecture by
World renowned Dr Sanjiv Chopra, M.D., MACP
Faculty Dean for CME, Medical School, Harvard Boston, USA
on
"Leadership for the 21st Century –Ten Tenets of Leadership"
on
Today, Saturday March 20, 2010

at
MAMC Anatomy Lecture Hall, Maulana Azad Medical College, Delhi Gate.

RSVP
Dr KK Aggarwal
Padma Shri Awardee 2010

N.B
Dr Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts. He has four books to his credit. His books have been translated into several languages including Portuguese, Japanese, Italian and Czech. He has given a number of Keynote addresses on the topic of Leadership – "Leadership for the 21st Century: The Ten Tenets of Leadership" to wide acclaim in the United States and several countries abroad

Learning Objectives

  • Discuss the qualities of great leaders.
  • Elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience.
  • Emphasize that we can all lead and can do so at many different levels
  • Explore what made or makes many lea22.10.09

     


Readers Responses

  1. Heartiest congratulations on being awarded Padma Shri: Vijay Srivastava, DGM P&S Bank

  2. Respected Sir, heartiest congrats on getting Padma Shri: Indu Jain

  3. Hearty congrats for this prestigious national award: Dr. Vinod Goel

  4. Congratulations and God bless you: Dr. Shabnam