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

Photo feature

Dr Sanjiv Chopra, faculty Dean for CME, Harvard Medical School, Boston interacting with the audience during his talk on March 20, 2010 He spoke on ‘Leadership for the 21st century – ten tenets of Leadership’. Also in the picture are Padma Shri Awardee Dr K K Aggarwal and Dr A K Aggarwal, President DMC.

News and Views

Meeting News: American Academy of Orthopaedic Surgeons: New Orleans, LA . March 10 - 13, 2010

Bisphosphonate may weaken bones in the long–term

In women who took oral bisphosphonates for four to five years, buckling ratio, a measure of structural integrity, improved significantly in the proximal femur from baseline, according to Anthony Ding, a medical student at Columbia University College of Physicians and Surgeons in New York City. However, those improvements started to erode and creep back toward pretreatment levels when bisphosphonate use lasted more than five years.

Off–label use of bone graft substitutes

The vast majority of spinal procedures involving bone morphogenetic protein (BMP) are off–label uses. BMP is widely used as a substitute for iliac crest bone graft and its use has been increasing at a rapid pace in recent years.

One can play sports after knee arthroplasty

Returning to participation in high–impact sports after a total knee replacement might not be so bad after all. In patients who underwent a total knee arthroplasty, there was no significant difference in the failure rate between those who went on to participate in high–impact sports and those who didn’t through a mean of 7.5 years.

Surgery does not improve Achilles tendon recovery

Surgical and nonsurgical treatment were equally effective for patients with acute rupture of the Achilles tendon, a randomized trial showed. Patient–reported functional outcomes and rates of re–rupture did not differ significantly between the two groups through 12 months, according to Katarina Nilsson Helander, MD, of Kungsbacka Hospital in Sweden.

List of common risk factors for melanoma (Dr G M Singh)

Melanoma is an often deadly form of skin cancer. Protecting yourself from sun damage can help protect your skin. The common risk factors for melanoma are as below.

1. Having fair skin or skin that is otherwise sensitive to the sun.
   
   
2. Having red or blond hair with blue or green eyes.
   
   
3. Having more than 50 moles.
   
   
4. Having abnormal or irregular moles, often that are typically large.
   
   
5. Having a history of using tanning beds or being sunburned frequently.
   
   
6. Having a family history of melanoma.
   
   
7. Having a weakened immune system.
   
   
8. Having a personal history of melanoma or other forms of skin cancer.
   
   
9. Being 50 or older.
   
   

Conference Calendar

RGCON 2010 (Strategies for Preservation of Organ Structure and Function in Cancer)
Date: March 26–28, 2010. Venue: India Habitat Centre, New Delhi

What’s New: Primary care cardiology: Dabigatran

The RE–LY (Randomized Evaluation of Long–term anticoagulant therapY) trial demonstrated that an alternative oral anticoagulant (dabigatran) may be superior in efficacy and safety to adjusted–dose warfarin in patients with atrial fibrillation. (Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139.)

Diabetes Fact

Morning plain insulin controls before lunch sugar; morning NPH insulin controls before dinner sugar; evening plain insulin controls bed–time sugar and evening NPH insulin controls fasting sugar.

Public Forum (Press Release)

‘Scratch and sniff’, smell check, a new test for Parkinson‘s disease

Olfactory dysfunction presenting as odor detection, discrimination, and identification is a common finding in patients with early nonvascular Parkinson’s disease said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor, eMedinewS.

As per a study of 2,267 men published in the Annals of Neurology an impaired sense of smell could be an early indicator of Parkinson’s disease, occurring up to four years before motor skill problems appear.

In the study, decreased odor identification was associated with older age, smoking, more coffee consumption, less frequent bowel movements, lower cognitive function and excessive daytime sleepiness, but even after adjusting for these factors, those with the lowest odor identification scores had a five times greater risk of developing Parkinson's than those with the highest scores.

Nerve loss and the formation of Lewy bodies –– abnormal clumps of proteins inside nerve cells that are thought to be a marker of the disease –– are known to take place in the olfactory structures of patients with the disease.

An impaired sense of smell could also be caused by impaired sniffing, which may be another motor symptom of Parkinson’s.

Early indicators of Parkinson’s disease are olfactory abnormality, constipation and sleep disturbances.

Apart from Parkinson’s disease, Obesity, diabetes, hypertension, malnutrition, Alzheimer’s disease, multiple sclerosis, and Korsakoff’s psychosis are all accompanied or signaled by smell disorders.

Question of the day

How do you manage palmoplantar, facial, scalp and nail psoriasis?

Facial psoriasis may respond initially to non–irritating moisturizers and petroleum jelly. Occasional use of mild topical steroids may be effective. Other treatments include calcipotriol, tazarotene, keratolytics and ultraviolet light (with protection to eyes). Tacrolimus and pimecrolimus are also helpful topical agents for treating psoriasis on the face or other sensitive areas. Many treatment options can help control scalp psoriasis and its symptoms. Tar products and salicylic acid are generally sufficient for treating very mild scalp psoriasis. Topical corticosteroids are effective against scalp psoriasis. Scalp psoriasis can get worse if the scalp becomes infected with bacteria or yeast. If crusting of the scalp along with scaling occurs and/or the lymph nodes in neck are enlarged, antimicrobial treatment is required. Mild scalp psoriasis also may respond to treatment with antifungal. It may require the use of an antifungal shampoo once or twice a week to maintain results. If moderate to severe psoriasis is present on other skin sites in addition to the scalp, it is an indication for systemic psoriasis medications.

Traditional topical treatment of palm and sole psoriasis includes tar, salicylic acid and steroids. Combinations of these three agents may be superior to each one used individually. Some topical medications may be used with occlusion. Soaking the hands or feet in warm water can reduce swelling, and should be followed by an application of medications or moisturizers. Calcipotriol can also be effective with psoriasis on the hands and feet, however, cotton gloves should be worn to prevent transfer of the medication to sensitive skin sites, such as the face or skin folds. A regimen alternating calcipotriol and potent topical steroids may be beneficial. Occlusion with tazarotene is not usually recommended but could be useful for palm/sole lesions.

If topical medications do not work one has to try PUVA, methotrexate, cyclosporine or acitretin. Because psoriasis affects the nail when the nail is being formed, it is difficult to treat. The matrix, where the nail is formed, is difficult to penetrate with topical medications. Injections of steroids into the nail bed or matrix area have been used with varying results. The pain of the injections must be weighed along with the possibility of the relief being only temporary.

The major treatments specifically for nail psoriasis are:

Topical treatments – tazarotene, calcipotriol, corticosteroids

Intralesional – injection of steroids into each affected nail

Phototherapy – PUVA

Cosmetic repair – nails deformed by psoriasis may be removed surgically or with a strong urea compound. Long, thick nails can be scraped and filed down. Color changes can be covered with nail polish, and pitted nails can be buffed and polished. In some instances, artificial nails may be warranted.

When patients have severe, generalized psoriasis, the nail treatment is determined by the treatments they are already receiving for other parts of the body. If a person's condition requires methotrexate, for example, nails are likely to improve. Similar results may be expected from other systemic psoriasis treatments.^1,2,3

References

1. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol 2001;45:487–98.
   
   
2. Lebwohl M, Ali S. Treatment of psoriasis. Part Systemic therapies. J Am Acad Dermatol 2001;45:649–61
   
   
3. Mehlis SL, Gordon KB. The immunology of psoriasis and biologic immunotherapy. J Am Acad Dermatol 2003;49(2 Suppl):S44–50
   

Quote of the Day

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

eMedinewS Try this it Works

Knife injuries can mimic thromboses

If you see a patient with unilateral swelling of an extremity, make sure to ask about a history of trauma with a knife. Such an injury can cause painful swelling resembling deep venous thrombosis, while the problem actually may be traumatic arteriovenous fistula. Careful auscultation over the site of old stab incisions may reveal continuous murmurs, suggesting the traumatic arteriovenous fistula. Diagnosis is confirmed by a Doppler ultrasound of the extremity. Correct diagnosis is important to prevent inappropriate use of heparin.

Dr Good Dr Bad

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

Make Sure

Situation: A 40–year–old  came with a blood pressure of 130/85 mm Hg.
Reaction: Oh my God! Why didn’t you advise lifestyle modification?
Make sure, to first advise lifestyle modifications like exercise, low salt diet, high fiber diet, decreasing stress etc. before advising antihypertensive medication, in essential hypertensives.

Drug Name

Indication

Approval Date

Tranexamic Acid Tab SR 750mg

20.02.09