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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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


21st June, 2010, Monday

Certain NSAIDs May Increase Heart Risks

Certain nonsteroidal anti–inflammatory drugs (NSAIDs) may increase heart risks, according to research published online in Circulation, Cardiovascular Quality and Outcomes. Based on registry data from more than a million users of nonsteroidal anti–inflammatory drugs (NSAIDs) from 1997 through 2005, the two NSAIDs with the greatest increased risk of cardiovascular events were diclofenac and rofecoxib (withdrawn from the market in September 2004). The use of diclofenac was "associated with 91% increase in the relative risk of a fatal heart attack or stroke in healthy adults, and the risk was greater at higher doses. Although low doses of ibuprofen seemed to lower the risk of heart attack, the study found a trend toward increased heart attack risk with high doses.The study found no increased risk of cardiovascular problems –– indeed, a slightly lower risk of death –– associated with naproxen.

All NSAIDs except for celecoxib were linked to a substantial increase in risk of serious bleeding, a well–known adverse effect of NSAIDs.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From HCFI file)


Seasonal Fruits and Vegetables for better Health


Recent researches link diets rich in seasonal fruits and vegetables with reduced risk of stroke, heart disease, high blood pressure, certain cancers and type 2 diabetes. Diets rich in fruits and vegetables may also aid and/or maintain weight loss by helping to increase fullness with fewer calories. Heart Care Foundation of India has repeatedly upheld nutrient-rich diet as a major part of its campaigns and it has repeatedly released health messages promoting daily intake of seasonal fruits and vegetables.

 

INVITATION (Wednesday, 23 June 2010, 07:00PM)

6th International Widows Day is being observed on 23rd June jointly by Heart Care Foundation of India and The Loomba Foundation at India Habitat Center. The Chief Guest of the occasion will be Prof. (Smt.) Kiran Walia, Hon’ble Minister of Health and Family Welfare, Women and Child Development, Languages, Govt. of NCT of Delhi.

Also, present on the occasion will be Mrs. Aruna Oswal Trustee, The Loomba Foundation, Padamshree Dr. K K Aggarwal President, Hear Care Foundation of India and Mr. Lalit Mansingh Trustee, The Loomba Foundation.

The event will involve sharing of experience by widowed Mothers and their Children who have been beneficiary of The Loomba foundation. Also children of the widows who participated in various competitions will also be awarded worth prizes and certificates.

Date and Timing: June 23, 2010 at 07:00pm onwards
Venue: The Theatre, India Habitat Center, Lodhi Road New Delhi

Dr k k Aggarwal

In the photo: Dara Singh, Actor and famous wrestler signing a health message promoting daily intake of seasonal fruits and vegetables

International Medical Science Academy Update (IMSA): New Vaccine Update

HIV vaccine

Autism and MMR — The Lancet has fully retracted the 1998 paper that suggested an association between the measles–mumps–rubella vaccine (MMR), enterocolitis, and autism.1,2 The claims in the original article that the children were "consecutively referred" and that the investigations were "approved" by the local ethics committee were proven to be false. Subsequent large, well–designed epidemiologic studies3–6 and systematic reviews have failed to find any association between MMR and autism.7–8

Reference

  1. Wakefield AJ, Murch SH, Anthony A, et al. Ileal–lymphoid–nodular hyperplasia, non–specific colitis, and pervasive developmental disorder in children. Lancet 1998;351:637.

  2. Retraction––Ileal–lymphoid–nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 2010.

  3. Dales L, Hammer SJ, Smith NJ. Time trends in autism and in MMR immunization coverage in California. JAMA 2001;285:1183.

  4. Madsen KM, Hviid A, Vestergaard M, et al. A population–based study of measles, mumps, and rubella vaccination and autism. N Engl J Med 2002;347:1477.

  5. Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: No epidemiological evidence for a causal association. Lancet 1999;353:2026.

  6. Farrington CP, Miller E, Taylor B. MMR and autism: further evidence against a causal association. Vaccine 2001;19:3632.

  7. Immunization Safety Review: Vaccines and Autism. A report of the Institute of Medicine. The National Academy Press, Washington, DC 2004.

  8. Wilson K, Mills E, Ross C, et al. Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence. Arch Pediatr Adolesc Med 2003;157:628.

Mnemonic of the Day (Dr Varesh nagrath)

Medical treatment of mitral valve prolapse

A2D2 P3

Aspirin
ACE Inhibitors

D
iuretic
Digoxin

P
rophylaxis of infective endocarditis
Prophylactic penicillin for rheumatic fever (in MVP of rheumatic origin)
Propranolol or other beta blockers

News and views

3D–Echo can identify MI scars

A study published online in Circulation: Cardiovascular Imaging reports that Contrast–enhanced 3D–Echocardiography may be another option to detect and measure scars left on heart muscle after a myocardial infarction (MI). Jean–Louis J. Vanoverschelde, MD, PhD, of Cliniques Universitaires Saint–Luc, in Brussels, and co–authors evaluated 50 patients whose MIs had been healed for longer than three months. There were 10 controls (without heart disease). The contrast–enhanced 3D–Echo had a sensitivity of 78% and a specificity of 99% when measured against the cardiac magnetic resonance findings, with an overall accuracy of 94%. When analyzed on a per–vascular–territory basis, the sensitivity and specificity of was 95% and 100%, respectively, in the inferior and posterior walls, 68% and 98% in the anterior, anteroseptal and septal walls, and 48% and 100% in the lateral wall.

Drug to improve wakefulness during the night shift

Kenneth P. Wright, PhD, of the University of Colorado in Boulder, and colleagues report that when treated with armodafinil (Nuvigil), night shift workers, who complained of excessive sleepiness felt more awake throughout their shift. Whereas, those workers who were administered modafinil (Provigil), the older, shorter–acting drug felt more awake only during the first half of the night shift. These findings were presented at the 2010 Associated Professional Sleep Societies meeting. Armodafinil is the R isomer of modafinil, and both drugs are approved to treat excessive sleepiness in shift workers.

New diagnostic criteria for late–onset hypogonadism

A study published online June 16, 2010 in the New England Journal of Medicine states that late–onset hypogonadism (LOH) can be defined by the presence of three symptoms, combined with low testosterone. These 3 symptoms include: poor morning erection, low sexual desire, and erectile dysfunction. Total testosterone level < 11 nanomoles per liter and a free testosterone level of < 220 picomoles per liter plus these 3 symptoms makes a diagnosis of LOH. These findings were from an analysis of data from 3,219 men taking part in the European Male Aging Study, who were divided randomly into a training set and a validation set. All men had a single testosterone measurement.

HbsAg + HBV DNA can differentiate between active and inactive carriers

A new Italian study has found that it may be possible to differentiate active from inactive carriers of hepatitis B virus (HBV) genotype D by measuring hepatitis B virus (HBV) DNA and surface antigen (HBsAg) levels. Measuring both HBsAg and HBV DNA in serum provides the highest diagnostic accuracy in the identification of inactive carriers even at a single–point evaluation, said Dr Maurizia Brunetto of the University Hospital of Pisa. The two give complementary information; HBV DNA levels reflect HBV replication, while HBsAg levels reveal transcription of intrahepatic covalently closed circular DNA. The study is reported online May 7th in Gastroenterology involving 209 HBeAg–negative/anti–HBe–positive chronic HBsAg carriers infected with HBV genotype D.

THE BHAGAWAD GITA SIMPLIFIED

Why do you worry without cause?
Whom do you fear without reason?
Who can kill you?
The soul is neither born, nor does it die.
Whatever happened, happened for the good;
whatever is happening, is happening for the good;
whatever will happen, will also happen for the good only.

You need not have any regrets for the past.
You need not worry for the future.
The present is happening…
What did you lose that you cry about?
What did you bring with you, which you think you have lost?

What did you produce,
which you think got destroyed?
You did not bring anything,
whatever you have, you received from here.
Whatever you have given, you have given only here.
Whatever you took, you took from God.
Whatever you gave, you gave to Him.
You came empty handed, you will leave empty handed.

What is yours today,
belonged to someone else yesterday, and
will belong to someone else the day after tomorrow.
You are mistakenly enjoying the thought that this is yours.
It is this false happiness that is the cause of your sorrows.

Change is the law of the universe.
What you think of as death, is indeed life.
In one instance you can be a millionaire, and
in the other instance you can be steeped in poverty.

Yours and mine, big and small
erase these ideas from your mind.
Then everything is yours and
you belong to everyone.
This body is not yours, neither are you of the body.
The body is made of fire, water, air, earth and
ether, and will disappear into these elements.
But the soul is permanent – so who are you?

Dedicate your being to God.
He is the one to be ultimately relied upon.
Those who know of his support are forever
free from fear, worry and sorrow.
Whatever you do, do it as a dedication to God.
This will bring you the tremendous experience of
joy and life–freedom forever.

Let us try to implement the same in our day-to-day life.

 

Interesting Tips in Hepatology & Gastroenterology (

Dr Neelam Mohan, Consultant Pediatric Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician, Sir Ganga Ram Hospital, Delhi)

Yesterday, I wrote on "Advantages & disadvantages of living related liver transplantation over cadaveric transplantation." Today I shall address the following issues

Living related transplant surgery

  • Both donor and recepient surgery are carried out simultaneously in 2 different OTs.

  • Donor surgery is started first.

  • While the donor graft is being resected, simultaneously the recipients unhealthy liver is being taken out in the other OT.

  • Often bench surgery is required on the graft removed from the donor for vascular reconstruction or in small children to suit the graft according to the patients need.

  • Then the graft is implanted into the recipient and vascular anastomosis is carried out first followed by ductal anastomosis or roux–en–y anastomosis especially in biliary atresia cases and young babies.

  • Ultrasound doppler is carried out intraoperatively after the vascular anastomosis and before the ductal anastomosis to check for adequacy of blood flow into the new liver.

  • The surgery takes approx. 8–10 hours.

Tomorrow I’ll write on "Is Rejection a major issue in liver
transplantation ?

Conference Calendar

Basic Assessment and Support in Intensive Care (BASIC)
Trauma Evaluation And Management – Basic (TEAM – B)
Target Audience – Doctors & Nurses Only
Date: June 29, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Forensic Legal Medicine (Dr Sudhir Gupta MBBS (Gold Medal), MD, DNB, MNAMS (Associate Professor, Dept. of Forensic Medicine & Toxicology, AIIMS)

Forensic medicolegal examination needs application of medical sciences knowledge, experience of medical practice with exercise of common knowledge, and the comparative information received in discussion with the concerned persons of the case as well as the observations of investigating officer. The main motive is to find out or make nearest approximation of the factual truth by way of medical examination for the furthering and administration of justice for legal system of land.

Question of the Day

How should one choose the first–line drug for hypertension?

Currently the definition of HT has undergone improved understanding, more so with the concept of cardiovascular risk being tackled effectively. The importance of target organ is now better understood. It is now well known that every mm of Hg rise of BP exerts a deleterious effects on the vasculature of the organ in question. If patient is not suffering from any coexisting condition (e.g., CAD, diabetes, pregnancy, etc.) along with HT, any of the five classes of antihypertensives can be used e.g., diuretics, β–blockers, calcium channel blockers, ACE inhibitors, ARBs. It is reasonable to start treatment with a low dose of single agent or with low dose combination of two agents. Once–a–day formulations are preferred, due to their sustained actions and good patient compliance.

If HT is associated with common co–existing conditions, then the following approach should be undertaken:

  • In patients with CAD, preferred drugs are β–blockers (atenolol, metoprolol, bisoprolol, etc.), ACE inhibitors (e.g., enalapril, ramipril, etc.), ARBs (losartan, telmisartan) or long-acting CCB (e.g., amlodipine).

  • In patients with diabetes, the combination of two or more drugs (diuretics, ACE inhibitors, ARBs, β–blockers, CCBs) is preferred

  • In post–myocardial infarction patients, β–blockers, ACE inhibitors as first–line drugs followed by ARBs, CCBs and diuretics are preferred

  • In patients with heart failure, loop diuretics e.g., frusemide 40 mg o.d. followed by ACE inhibitor, and β–blockers like Carvedilol 3.125 mg b.d are preferred

  • In pregnant females, methyldopa, labetalol, CCBs (dihydropyridine group) and β–blockers for short–term control can be used.

The drug choice needs to be consistent with the probable pathophysiology in a given patient. The basic equation that the BP is a product of cardiac output and peripheral vascular resistance cannot be ignored. At the
same time, 24 hour control of BP is equally essential. The drug treatment may require initial titration, but once stabilized, further monitoring is fairly easy in most patients.

eMedinewS try this it works

Can we call for a followup?

Curious about patient satisfaction? A good time to call patients is the day after an office visit. This allows you to start by asking them if they have any questions. Patients often appreciate the follow–up.

SMS of the day

Two places are the most valuable in the world, the nicest place to be in is someone’s thought and the safest place to be in is someone’s prayer. You are in both.

IJCP
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nuspera
Docconnect
 
 

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Contact: drkk@ijcp.com emedinews@gmail.com

 
 
 

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 .

 

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Dr Good Dr Bad

Situation: A patient was found to have CRP of 0.8 mg/dl.
Dr. Bad: It is normal.
Dr. Good:It may reflect inflammation.
Lesson: Values between 0.3–10 mg/dl may reflect minor degree of inflammation but may also reflect obesity, cigarette smoking, diabetes, uremia, hypertension, low physical activity, hormone replacement therapy, sleep disturbance, chronic fatigue, alcohol consumption, depression, ageing, periodontal disease or other apparently inflammatory states.

Make Sure

Situation: Sir, he collapsed after sublingual nifedipine was given.
Reaction: Oh, my God! I forgot to check for LVOT obstruction.
Lasson: Make sure that before giving sublingual nifedipine that the patient does not have LVOT obstruction.

Humor Section

IMANDB Joke of the Day

When Gopal’s wife ran away he got so depressed that his doctor sent him to see a psychiatrist. Gopal told the psychiatrist his troubles and said, "Life isn’t worth living."

"Don’t be stupid, Gopal," said the psychiatrist. "Let work be your salvation. I want you to totally submerge yourself in your work. What do you do for a living?"

"I clean out septic tanks
." Gopal replied.

Funny Definitions

Cesarean Section………A neighborhood in Rome

Formulae in Clinical Practice

Decreased productivity

The annual loss in productivity that results when an employee leaves their work area to have a cigarette is calculated by:
Formula: Cost prod = CIGS × Time/Minutes × Wage Average × (1 + Benefits) × Days Worked

Milestones in Dermatology

Fournier’s Gangrene

First described by Baurienne in 1764, and named after a French venereologist, Jean–Alfred Fournier, It is a type of necrotizing fasciitis usually affecting the male genitals.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Amylase

Amylase (the pancreatic enzyme responsible for digesting carbohydrates) is the most common blood test for acute pancreatitis. It increases from 2 to 12 hours after the beginning of symptoms and peaks at 12 to 72 hours. It may rise to 5 to 10 times the normal level and will usually return to normal within a week. Amylase also may be monitored with chronic pancreatitis, it will often be moderately elevated until the cells that produce it are destroyed.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Risperidone long acting injection (Addl. Indication)

Indicated as monotherapy or as adjunctive therapy in lithium or valproate for the maintenance treatment of Bipolar–1 disorder.

29.08.2009


 

Public Forum (Press Release for use by the newspapers)

The health hazards of cigarette smoking in the general population are well–known. In patients with diabetes mellitus, smoking causes a substantial increase in risk for both macrovascular (cholesterol deposition) and microvascular (eye, kidney involvement) disease said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. The HCFI has released a few guidelines in this regard.

  1. Smoking is an independent risk factor for all–cause mortality, largely due to cardiovascular disease.

  2. There is a dose–response relationship between current smoking status and risk of coronary disease in women with diabetes. The risk is 1.7 and 2.68 for 1 to 14 and >15 cigarettes per day, respectively.

  3. The risk returns to baseline in those who have stopped smoking for more than 10 years.

  4. The risk of mortality in diabetic women also increases with the number of cigarettes smoked per day. The risk is 1.4 and 2.1 for 1–14 and >35 cigarettes/day, respectively. The risk decreases substantially 10 years after quitting smoking (risk 1.1)

  5. Smoking is associated with increases in the serum concentrations of total cholesterol and very–low–density lipoprotein cholesterol, a decrease in serum high–density–lipoprotein cholesterol concentrations, and a greater degree of insulin resistance

  6. Smokers, via an uncertain mechanism, have poorer glycemic control.

  7. In patients with type 1 diabetes, smoking is independently associated with an increase in urinary albumin excretion and nonproliferative retinopathy; the degree of albuminuria falls to the level of nonsmokers if smoking is discontinued.

  8. Smokers with either type 1 or type 2 diabetes are at increased risk for neuropathy, an effect that persists after adjusting for glycemic control.

  9. Smoking is associated with an increased risk of end–stage renal disease and with decreased survival once dialysis is commenced.

(Advertorial section)

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day–long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd 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.

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If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses INSPIRATION

"Paid in full with one glass of milk". Dr Howard Kelly – a true story

This is a story about a poor boy, named Howard who used to sell goods from door to door to pay his way through school. One day he was hungry and decided that he would ask for a meal at the next house. However, he lost his nerve when a lovely young woman opened the door. Instead of a meal, he asked for a glass of water. She thought he looked hungry, so she brought him a large glass of milk. He drank it slowly and then asked, "How much do I owe you?" "You don’t owe me anything," she replied and added.

"Mother has taught us never to accept pay for a kindness." He said… "Then I thank you from my heart." As Howard left that house, the act of kindness made him feel stronger physically. He had been ready to give up and quit. Now his faith in God and man had further strengthened. He grew up to become a doctor. Years later that young woman became critically ill. The local doctors were baffled. They finally sent her to the big city, where they called in the specialists to study her rare disease. Dr Howard Kelly was called in for the consultation. When he heard the name of the town she came from, a strange light filled his eyes. Immediately, he went in to see her. He recognized her at once. He went back to the consultation room determined to do his best to save her life. After a long struggle, the battle was finally won. Dr Kelly requested the accounts office to pass the final bill to him for approval. He looked at it, and then wrote something on the corner and the bill was sent to her room. She feared to open it, for she was sure it would take the rest of her life to pay for it all. Finally she looked, and something caught her attention on the side of the bill. She read these words…
"Paid in full with one glass of milk".

Dr Howard Kelly was a distinguished Gynecologist who, in 1895, founded the Gynaecologic Oncology division at Johns Hopkins University. He was one of the four great men who made Johns Hopkins famous. He devised the Kelly’s clamp, Kelly’s stitch for incontinence, Kelly’s red rubber pad for labour patients & medical illustrations etc. (Dr G.M. Singh)