News and Views (Dr Monica Vasudeva)
Anticipation of a meal can be a diabetes risk factor
Alterations in our response to the taste or smell of food is another culprit responsible for Type 2 diabetes, according to scientists at Duke University Medical Center. When we anticipate or smell a meal, the parasympathetic nervous system triggers salivation and increases insulin production in response to the expectation that glucose will be entering the blood stream. This parasympathetic response is potentially important in type 2 diabetes.There is a novel mutation in the gene encoding ankyrin–B, which increases the risk of type 2 diabetes. This happens through an impairment of the insulin secretion that is added by the parasympathetic nervous system. The study is being released online March 16 in Science Signaling.
Sutent failed in clinical trials
The cancer drug sunitinib failed to halt the progression of advanced breast tumors in two studies. The drug is already sold as a treatment for advanced kidney cancer and gastrointestinal stromal cancer. Another trial of the drug figitumumab in patients with late-stage lung cancer, was discontinued with citing a lack of effectiveness.
FDA approves Boston Scientific stent for iliac-artery disease
International regulators have already approved the stent for use in the biliary duct and in the pelvis.
Merck says it will continue study of Vytorin effectiveness
Researchers will continue a study of a controversial Merck & Co. cholesterol drug,Vytorin (ezetimibe and simvastatin), after safety monitors decided data so far indicate the drug is safe and effective.
FDA approves six–month dose of Trelstar
Watson Pharmaceuticals Inc. said the FDA approved a six–month dose of the prostate cancer drug Trelstar (triptorelin pamoate), which was already available in one–and three–month doses.
Hip fractures increase mortality five – to eightfold, more so in men
Older adults are five to eight times as likely to die for any reason in the first three months after hip fracture, and although excess annual mortality decreases in the next two years, it does not return to the rate of age–matched peers even after 10 years of follow–up. Also, at any given age, mortality after hip fracture is higher in men than in women, concluded a meta–analysis. Researchers conducted the meta–analysis of 578,436 women and 154,276 men with hip fracture. (March 16, 2010 Annals of Internal Medicine)
Save A Life Give A Life (SAGA) (Target Audience – General Public)
Date: March 27, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.
Depression drugs in combination better
A randomized trial in patients with psychotic depression found that the combination of an antipsychotic plus an antidepressant was superior to an antipsychotic alone. (Meyers BS, Flint AJ, Rothschild AJ, et al. A double–blind randomized controlled trial of olanzapine plus sertraline vs olanzapine plus placebo for psychotic depression: the study of pharmacotherapy of psychotic depression (STOP–PD). Arch Gen Psychiatry 2009;66:838.)
Quote of the Day
If you only do what you know you can do – you never do very much. (Tom Krause)
On May 5, the Food and Drug Administration (FDA), approved bromocriptine mesylate 0.8–mg tablets as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It may be used as monotherapy or as adjunctive therapy to metformin/sulfonylurea and single or dual oral hypoglycemic agent therapies. It should not be used to treat type 1 diabetes or diabetic ketoacidosis. There is limited efficacy data in combination with thiazolidinediones and efficacy has not been confirmed in combination with insulin.
Public Forum (Press Release)
Ideal sleep time: Eight hours
People who sleep less than 7 hours or more than 9 hours a night gain more weight over time and become obese than individuals who log 8 hours every night.
People who want to lose weight or prevent weight gain not only should exercise and eat well, but also sleep well said Dr K K Aggarwal, President, Heart Care Foundation of India and Editor, eMedinewS.
In a study by Dr. Angelo Tremblay, of Laval University in Quebec City, published in Journal Sleep the researchers followed 276 men and women for 6 years. During that time, people who averaged 5 to 6 hours of sleep a night gained 1.98 kilograms more than those who slept 7 to 8 hours, while those who slept for 9 to 10 hours gained 1.58 kilograms more than the average–length sleepers.
Short and long sleepers also showed greater gains in fat mass and waist circumference than average–length sleepers, and were significantly more likely to gain 5 kilograms or more.
Getting too much or too little sleep somehow disrupts appetite control by causing a reduction in leptin, a hormone that dampens appetite, while increasing secretions of the appetite–stimulating hormone ghrelin.
Short and long sleepers were also more prone to hypoglycemia, or low blood sugar, than average sleepers, which could increase appetite as well.
Question of the day
How effective is phototherapy in psoriasis?
Exposure to sunlight to treat psoriasis has been utilized for a long time.
Psoralen plus ultraviolet A (PUVA): Approximately 90% of patients achieve significant improvement or clearing with 20–30 treatments of PUVA.
Narrowband UVB (NB–UVB): Parrish and Jaenicke found that the most therapeutic wavelengths in resolving psoriasis are between 300–313 nm; those longer than 313 nm are not as beneficial in clearing lesions, and wavelengths less than 300nm resulted in erythema but were ineffective. Although a quicker time to clearance has been shown with NB treatments, there is no clear evidence that demonstrates any difference in duration of resmission for NB and BB–UVB. Narrowband UVB is effective in low doses.
NB–UVB combined with calcipotriol ointment has shown varying results. NB–UVB, combined with acitretin showed, like the combination of this drug with BB–UVB, that the time to clinical improvement appeared earlier compared to cases in which each agent was used separately1–6.
Spuls PI, Rozenblit M, Lebwohl M. Retrospective study of the efficacy of narrowband UVB and acitretin. J Dermatol Treat 2003;14 (Suppl. 2):17–20.
Ibbotson SH, Bilsland D, Cox NH, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol 2004;151:283–97.
Zanolli M. Phototherapy treatment of psoriasis today. J Am Acad Dermatol 2003;49:S78–86
Honigsmann H. Phototherapy for psoriasis. Clin Exp Dermatol 2001;26:343–50.
Dawe RS. A quantitative review of studies comparing the efficacy of narrow–band and broad–band ultraviolet B for psoriasis. Br J Dermatol 2003;149:669–72.
Matsumura Y, Ananthaswamy HN. Toxic effects of ultraviolet radiation on the skin. Toxicol Appl Pharmacol 2004;195:298–308.
eMedinewS Try this it Works
Helping baby burp
When it is difficult to get air out of a baby’s stomach, try this.
Hold the calm (not crying) baby upright, with legs extended and head supported.
Lean the baby 30° to 45° to the left. A spontaneous burp often comes up immediately.
If step 2 did not trigger a burp, maintain the left lean and try leaning the child forward or backward up to about 30°.
Dr Good Dr Bad
Situation: A patient came for routine evaluation.
Dr Bad: Let the nurse first check your BP and pulse.
Dr Good: Let the nurse first check your BP, pulse and abdominal girth.
Lesson: Hip and extremity circumferences also exert an independent influence on the risk of diabetes and may offer additional means of assessing diabetes risk and improving risk stratification towards the prevention and treatment of this mounting public health burden. Larger extremity circumferences are associated with a lower risk of incident diabetes after adjustment for overall and abdominal adiposity, highlighting the potential value of these measures above and beyond the routine measurement of BMI and WC. (Can J Diabetes 2009;33(2):86–92.)
Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.
Medi Finance: Corporate
No capital Gain on transfer of assets on conversion of small companies into Limited Liability Partnerships,.
The Centralized Processing Centre at Bengaluru is now fully functional and is processing around 20,000 returns daily. This initiative will be taken forward by setting up two more Centers during the year.
Dear Dr.Aggarwal, It is very informative to go through emedinews. My day in my office starts with your news. Congratulations to you for your effort to keep everyone abreast with new information in healthcare. Warm regards, Anuradha Soni, Shantha Biotechnics, Part of the Sanofi–Aventis Group
Dear Colleagues, The Nephrology Board Review Course, has been officially endorsed by Dr. Adeera Levin, the Secretary General of the International Society of Nephrology. ApEx 2010 will now appear in the ISN Gateway Conference Calendar: Dr.V. Billa, Course Director.
Home made saline: A salt table mixed in distilled water provides freshly made normal saline when needed. The "Salt Tablets" pack comes with a measuring bottle suitable for dispensing of drops: Dr. Narendra Kumar,New Delhi 110058 Phone No. 25599839
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, firstname.lastname@example.org BK Sapna: 9811796962, email@example.com
Laughter the best medicine
GP Referral: Dear Sir, Big heart. Second opinion please.
Formulae in Critical Care
Blood Pressure (BP)
Formula: BP = CO × PR or (SV × HR) × PR
CO – Cardiac output
PR – Pulse rate
SV – Stroke volume
HR – Heart rate
Normal value: <120/80 mmHg.
Milestones in Orthopedics
Nicholas Andry coined the word "orthopaedics", derived from Greek words for orthos ("correct", "straight") and paideion ("child"), when he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children in 1741.
Mistakes in Clinical Practice
Blood sampling if done incorrectly can lead to several complications like thrombosis, thrombophlebitis, pain, etc. Hence, it is very important to remember the basic rules of sampling:
Preferred site for venous sampling (cubital fossa)
Tourniquet at level of mid arm
Clean the site of the vein, should be seen or palpated.
Insert the needle at an angle of 15°.
Open the tourniquet.
Take the sample.
Apply pressure at the site for 1 min. with spirit swab.