Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
President, Heart Care
Foundation of India
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)
FIRST NATIONAL DAILY MEDICAL NEWSPAPER OF INDIA
20th November Friday
Should all cardiologists should say no to PPI?
May increase mortality in patients undergoing PCI
Rabeprazole and pantoprazole may increase the risk of death for patients undergoing PTCA a study has found. Patients taking rabeprazole who had an angioplasty with a drug coated stent to reopen a clogged artery had a 72 percent higher risk of death than those not on the medications, while the risk of death was 54 percent greater in patients taking pantaprazole. Study author Dr. Joseph Sweeny, of the Mount Sinai Medical Center, said that there is an overall increased mortality in this patient population that takes a PPI with clopidogrel. (Source AMA Newsletter)
In the mean time the FDA has also issued a public health advisory warning patients and physicians that concomitant use of clopidogrel and omeprazole blunts the anti platelet effect of clopidogrel, thus increasing the risk of myocardial infarction and stroke. The combination reduces the activity of clopidogrel by about half.
Lab tests from 150 healthy volunteers provided evidence that omeprazole, which inhibits CYP2C19, reduces the pharmacological activity of clopidogrel if given concomitantly or if given 12 hours apart.
There is no evidence that H2 blockers (except cimetidine, a CYP2C19 inhibitor) or antacids interfere with the anti platelet activity of clopidogrel.
Other CYP2C19 inhibitors should also not be used in combination with clopidogrel i.e. esomeprazole, cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, Serafem, fluvoxamine, and ticlopidine.
Patients who need an antacid should switch to antacids or ranitidine, famotidine until more clarifications or guidelines comes. (Source FDA News)
Dr KK Aggarwal
Finally the four DMC nominations by Delhi Govt. are likely to be announced today. The nominated members as per emedinews sources are Dr Purshottam Lal, Dr Ashok Seth, Dr Navin Dang and Dr Arvind Chopra. See detailed news in tomorrow's emedinews.
News to use
1. As per a meta analysis report published in Journal of Hypertension, November 2009 issue, Cox 2 inhibitors induce greater hypertension than NSAIDS.
2. 10 gm of alcohol per day increases overall risk of cancer by 6%. (JNATL Cancer INST 2009; 101:296).
3. Drinking 10 gm of alcohol per day increases the risk of cancers of oropharynx, esophagus, larynx, rectum, liver and breasts.
4. Use of chlorohexidine impregnated sponge in intravenous catheter dressings reduces catheter related infarctions.
5. As per new guidelines from American Heart Associations and America Stroke Association, TIA is defined as a transient episode of brain dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarctions.
6. Ischemic stroke is now defined as infarctions of central nervous diseases.
7. Proton pump inhibitors do not improve asthma outcome in patients who do not have GERD.
8. As per the new guidelines women should try to be within the normal body mass index range when they conceive.
9. As per new IOM guidelines, the lower limit of weight gain in pregnancy is 5 kg and upper limit is 9 kg.
10. Studies show no increased risk of esophageal cancer with use of oral Bisphoshonates for osteoporosis.
11. Intravenous 5 mg zoleodronic acid is as effective as daily oral 5 mg risedronate. (LANCID 2009; 373:1253).
12. As per new guidelines smokers should be given pneumococcal vaccination.
Funny Clinical Notes (Dr. Minakshi)
She has no rigors or shaking chills, but her husband states she was
very hot in bed last night.
H1N1 pandemic : no transmission via blood
No case of H1N1 has been so far transmitted through a blood transfusion anywhere in the world, according to a draft guidance issued by the FDA. Nevertheless studies are ongoing, because there is always a theoretical concern with a new (infectious) agent. Remember dengue can be transmitted via blood.
Low levels of vitamin D linked with CAD, stroke, heart failure
According to research presented Nov. 16 at the American Heart Association conference, people who are not getting enough of vitamin D may be getting affecting their heart health. After examining data on 27,686 healthy adults 50 and older whose vitamin D levels had been measured during routine checkups, researchers found that those who had extremely low levels of the vitamin were almost twice as likely to have died or suffered a stroke than those with adequate amounts. In addition, they had more coronary artery disease and were twice as likely to have developed heart failure.
Some adults may have protective immunity from current H1N1 strain.
US researchers have discovered some adults may have protective immunity to the current H1N1 strain due to exposure to seasonal H1N1 viruses circulating in the population in the past 20 years.
A study conducted at the La Jolla Institute of Allergy and Immunology determined that the current virus shares molecular similarities with earlier strains that may give adults enough resistance to lessen the severity. As per Alison Deckhut Augustine, program manager with the NIAID the findings may explain why the pandemic has not been as severe as expected. The new H1N1 strain shared 49 percent of its epitopes with older viruses.
Will this explain why H1N1 has not gone into an epidemic in India. Or it is the dengue epidemic which is preventing H1N1.
Can semen allergy be a cause of infertility?
People are known to be allergic to proteins in their partner's semen. Semen allergy is not a direct cause of infertility but using a condom, one of the most effective ways to prevent the allergic reaction, also prevents pregnancy. Allergic symptoms can be local redness, burning, swelling in the outer genital area or systemic including hives, itching and difficulty breathing. If the allergic reaction is severe, to get pregnant one may have to go for artificial insemination using sperm washed free of semen proteins or through in vitro fertilization.
Clinical Context (Dr G M Singh)
Some studies have shown higher rates of adverse birth outcomes in women who have stress and anxiety during pregnancy. Possible mechanisms underlying the association between stress and anxiety during pregnancy and birth outcomes may include increased substance use and/or poorer diet, increased fetal exposure to maternal glucocorticoids, increased uterine artery resistance, and/or compromised utero placental blood flow activating the fetal hypothalamic-pituitary-adrenal axis. Anxiety at the third trimester is associated with lower gestational age.
"Doctor, doctor, I keep thinking I'm a dog.
Lie down on the couch and I'll examine you.
I can't. I'm not allowed on the furniture."
Letter to the editor
1. Dear Dr. Agarawal: At the outset I wish to thank you for the nice publication. I wish to seek you opinion regarding two things. 1. How do we ensure that the medicines are not substituted at pharmacy? 2. As per the medical ethics what is you opinion regarding charging for consultation or treatments from doctors, their family members & relatives, medical representatives, nearby chemists, etc. (firstname.lastname@example.org)
A: Dear Umesh One can only ensure that by reporting about it. It's a crime. It's professional ethics that we should not charge our colleague doctors. The policy is not clear about others. Also insurance reimbursements will make a difference in this issue.
2. I fully agree with Dr Dibendu Joy regarding request to Dr K.K. Aggarwal sir to start online CME with due accreditation from esteemed Delhi Medical Council. Dr Prashant
A: Thanks. We will try for that.
3. It gives me immense pleasure to mention that emedinews is a very good and handy resource of rich knowledge. No doubt this e journal is impeccable. I wish it a very long and prosperous life. Dr. Neeraj Gupta, Specialist (Psychiatry), Latrobe Regional Hospital, Traralgon, Victoria, Australia.
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