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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague,

23rd January, Saturday, 2010

Pre clinical diastolic dysfunction increases risk for heart failure in diabetics

According to a study published in the Journal of the American College of Cardiology, pre clinical diastolic dysfunction is common in patients with diabetes and increases the risk for subsequent heart failure.

In the study, after identifying 1,760 diabetics who underwent tissue Doppler imaging echo assessment of diastolic function and then following them for an average period of 2.9 years, doctors found that presence of diastolic dysfunction increased the relative risk for heart failure by 61 percent.

The cumulative five-year probability of developing heart failure was 36.9 percent for those with diastolic dysfunction, compared with 16.8% for those without such dysfunction.

The lesson is that all diabetics should be evaluated for presence of diastolic dysfunction by advising them to undergo tissue Doppler echo. Simple echo does not fully evaluate diastolic functions. The earliest clinical symptom may be exertional breathlessness with diastolic dysfunction.

 Dr KK Aggarwal
Chief Editor

NHS and Health Sector News
(Dr Vivek Chhabra)
Fears of a 'brain drain' in the NHS have been raised after the Indian government appealed for 15,000 doctors based in Britain to work in new medical centers. Dr Ramesh Mehta, the president of the British Association of Physicians of Indian Origin, gave warning that thousands of doctors in Britain will leave in the next few years to work in India. 

Exercise to lose weight
If you are vowing to lose weight this year, consider adding a regular exercise program while you are cutting calories. Combining the two results in better health outcomes, such as lower blood pressure and cholesterol levels, than simply cutting calories alone.
(Dr. Enette Larson-Meyer, University of Wyoming)

New research suggests that the drug ipratropium bromide used widely among patients who have chronic obstructive pulmonary disease (COPD) may raise the risk of heart attack and heart failure, while a separate study of the COPD drug tiotropium shows it may well lower the risk of heart problems and death.  The inhaled medications are the most commonly prescribed daily treatments for COPD. The two studies are published in the January issue of Chest.

Surgical mask as good as N95 mask
Nurses from 8 hospitals in Canada participated in a randomized trial. The nurses worked full time during the 2008-2009 influenza season on 9 medical units, 7 emergency departments, and 6 pediatric units, and all passed fit test certification for the N95 respirator.

Participants included 225 nurses in the surgical mask group, and 221 in the N95 respirator group. The population was primarily women (94%), with a mean age of 36.2 years. Only 30% of the surgical mask nurses and 28% of the N95 nurses had received a seasonal influenza vaccine that year. In the surgical mask group, 50 nurses (23.6%) experienced laboratory-confirmed influenza during the study period compared with 48 (22.9%) in the N95 group. The absolute risk difference was -0.73%, with a 95% confidence interval of -8.8% to 7.3%. Therefore, the surgical mask was considered non inferior to the N95 respirator. Eight percent of the surgical mask nurses and 11.9% of the N95 nurses experienced at least a 4-fold rise in titers to 2009 novel H1N1 (swine flu), and this risk difference was also non significant. Of note, >65% of the nurses who were diagnosed with influenza via serology reported no symptoms during the study period (and therefore had no nasal swabs obtained). Physician visits were almost identical between the 2 groups (6.1% and 6.2%) as were work absences (19.8% and 18.6%) for surgical mask and N95 groups, respectively, and they had similar household exposures as well. The authors conclude that surgical masks are not less effective in preventing influenza when compared with N95 respirators. (JAMA. 2009; 302:1865-71)

Thoracoabdominal predicts cardiac mortality
Thoracoabdominal calcifications on radiography predict cardiovascular and total mortality, according to the results of an 18-year follow-up study reported online in the December 15, 2009, issue of Diabetes Care. Vascular calcification is initiated by metabolic, mechanical, infectious, or inflammatory injury to vasculature. Its progression is mainly determined by inflammatory response to vascular injury. It may precede cardiovascular disease morbidity and mortality by years or decades in subjects with type 2 diabetes and in general population. (Dr Auni Juutilainen, Kuopio University Hospital, Kuopio, Finland)

 Letters to the editor
1. Press Watch: Daily Express: Swine flu pill left girl of 19 nearly blind
A teenage girl almost lost her sight after being wrongly prescribed swine flu treatment Tamiflu by the controversial NHS helpline. Samantha Millard, 19, suffered a severe allergic reaction and within 72 hours of taking three tablets she was put on life support. The student spent a month in hospital after developing life-threatening Stevens Johnson syndrome, which causes the skin to peel off. She later developed toxic epidermal necrolysis syndrome, which damaged her sight. (Dr Vivek Chhabra)

2. Dear Dr.K.K.Aggarwal: Greetings.My hearty greetings and applause for your efforts to make the knowledge percolate down to our people across the country daily through the e Medinews. I appreciate the contents and one among the thousands who reads it regularly. I personally feel as this covers almost entire specialities it will be a great help to our General practitioners. I will be happy to publish about your E-MEDINEWS in our college journal and i seek your permission and if possible a write up about this. with regards. jayalal (Editors comments: kindly go ahead and give acknowledgment to www.emedinews.in.

3. The flu shot protects against influenza, which isn't the same thing as the stomach flu (gastroenteritis). Gastroenteritis is an infection caused by a variety of viruses, including rotaviruses and noroviruses. Although it is often called the stomach flu, it is not caused by influenza viruses. Real flu (influenza) attacks your respiratory system your nose, throat and lungs causing fever, muscle aches, coughing and congestion. Gastroenteritis, on the other hand, attacks your intestines, causing signs and symptoms such as watery diarrhea, nausea, vomiting and stomach cramps. No vaccine is available for gastroenteritis with the exception of a newly released rotavirus vaccine called RotaTeq, an oral vaccine for infants. However, you can reduce your risk of gastroenteritis by frequent and thorough hand washing. The flu vaccine is the most effective way to reduce your risk of getting influenza. DR.G.M.SINGH

4. Safe drinking guidelines for diabetics
a. Consult your physician and follow his/her advice: alcohol can worsen diabetes complications.
b. Monitor your blood sugar before, during, and after drinking alcohol. Remember to check before going to bed.
c. Never drink alcohol on an empty stomach: food slows down the absorption of alcohol into the blood stream.
d. Avoid binge drinking: The American Diabetes Association suggests men have no more than two drinks a day, and women one, the same guidelines as for those without diabetes.
e. Be prepared: Always carry along glucose tablets or another source of sugar. Glucagon shots will not work in this case.
f. Don't mix alcohol and exercise: physical activity and alcohol will increase your chances of getting a low blood sugar.
g. The symptoms of too much alcohol and low blood sugar can be very similar, i.e. sleepiness, dizziness, and disorientation. You don't want others to mistakenly confuse hypoglycemia for drunkenness.
h. Alcohol and diabetes is another reminder that it's always a good idea to wear a diabetes medical I.D. (DR.G.M.SINGH)

5. We always love to hear from our members about EMEDINEWS, or any other topics at DR.K.K.AGARWAL medinews buletten. We occasionally select reader comments to feature in future newsletters. All readers featured in the newsletter will receive a free COPY OF NEWS BULLTITEN DAILY AT YOUR E-MAIL. PLEASE TAKE 10 MINUTES OF YOUR VALUEABLE TIME TO READ THIS e-medinews REGULARLY TO UPDATE YOUR KNOWLEGDE ON DIFFERENT TOPICS  & to the premium product of YOUR choice.DR.G.M.SINGH. (DR.GURINDER MOHAN SINGH)  

Punjab & Sind Bank
Our HIP's

Question Of the day
What is the treatment of respiratory acidosis in children diagnosed with severe malaria?
Deep breathing, with indrawing (recession) of the bony structures of the lower chest wall, in the absence of localizing chest signs suggests metabolic acidosis, frequently lactic acidosis. Indrawing (recession) of the intercostal spaces is a less useful sign. Respiratory distress (acidosis) commonly accompanies cerebral malaria or anemia but it may develop in a child without impaired consciousness. In either case it is associated with an increased risk of death. A systolic blood pressure below 50 mmHg (6.67 kPa) indicates a state of shock.

Management: Correct any reversible cause of acidosis, in particular dehydration and severe anemia. Intravenous infusion is best, using the most accessible site, including the femoral vein. If this is impossible, give an intra-osseous infusion. Take care not to give excessive fluid, as this may precipitate pulmonary edema.
Because convulsions may contribute to lactic acidosis, prevention of further seizures may be beneficial.

If the hematocrit is more than 15% or the hemoglobin concentration is more than 5 g/dl, give 20 ml/kg of body weight of isotonic saline, by intravenous infusion over 30 minutes.
If the hematocrit is <15% or the hemoglobin concentration is <5 g/dl in a child with signs of metabolic acidosis, give screened whole blood, 10 ml/kg of body weight over 30 minutes and a further 10 ml/kg of body weight over 1-2 hours without diuretics. Monitor response by continuous clinical observation supported by repeated measurement of acid - base status, hematocrit or hemoglobin concentration, and glucose, urea and electrolyte levels.

Dr Good Dr Bad
Situation: A CAD patient was on low-dose aspirin and came with joint pains.
Dr Bad: Take any painkiller
Dr Good: Take only paracetamol
Lesson: The beneficial effects of aspirin are attenuated by prior or ongoing administration of a nonselective NSAID, such as ibuprofen or naproxen. Thus, regular NSAID use should be avoided, if possible, in patients taking low-dose aspirin for cardiovascular protection.

Make Sure
Situation: A patient with prosthetic heart valves (bioprosthetic) developed infective endocarditis.
Reaction: Oh my God! Why was he not given infective endocarditis prophylaxis?
Make sure that all patients with prosthetic heart valves (bioprosthetic or homograft) are given infective endocarditis prophylaxis.

Formulae in Imaging
On CT scans, less than 10 mL, and possibly as little as 2 mL of pleural fluid can be identified. (Source: Radiology 1973;109:33).

Mistakes in Clinical Practice
A step-wise approach to prescribing for older adults should include: periodic review of current drug therapy; discontinuing unnecessary medications; considering non-pharmacologic alternative strategies; considering safer alternative medications; using the lowest possible effective dose; including all necessary beneficial medications.

ENT Facts
Group A beta-hemolytic streptococcus, Staphylococcus aureus, and Moraxella catarrhalis are less frequent causes of sinusitis.

Emedinews Try this It Works
Chew aspirin
Chewing a tablet of 300 mg water-soluble aspirin at the onset of acute chest pain can reduce cardiac mortality by 20%.

Milestones in Neurology
Candace Beebe Pert is an American neuroscientist who discovered the opiate receptor, the cellular bonding site for endorphins in the brain.

Laughter the Best Medicine
Neurotic - a woman who likes a psychiatrist's couch better than a double bed.

SMS Anemia
The most common causes of microcytic anemias are iron deficiency, thalassemia and the anemia of chronic disease.

Is any profit received from sale of property held for personal use taxable as per Income Tax Act?
Any profit from sale of personal property held for personal use is taxable as per Income Tax Act.

What is 'Implied Consent'?
An implied consent is not written, but is legally effective. It implies consent to medical examination in a general sense i.e. when a patient approaches the doctor for treatment, it is presumed that there is a consent for routine physical examination e.g. examination of pulse, BP, temperature, rate of respiration etc.

DocConnect Milestones
DocConnect: Allows a doctor to receive his list of appointment over a simple SMS message.
Emedinews Calculator
To convert from a conventional unit to a SI Unit, multiply by the conversion factor listed. To convert from SI Units to conventional units, divide by the listed conversion factor.

Agent                           Conventional Unit            Conversion Factor               SI Unit
Acetone                                mg/dL                              0.172                        mmol/L

We have to pray with our eyes on God, not on the difficulties (Oswald Chambers).


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