emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
emedinews is now available online on www.emedinews.in or www.emedinews.org
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


YOU CAN DOWNLOAD EMEDINEWS AT www.emedinews.in

Dear Colleague

23rd march 2010, Tuesday

Do financial interests result in positive results in scientific research?

I recently came across an interesting peace of information in Science Daily as to how researches are done in the United States. I thought of sharing the same with you all.

Over 94% of the researchers who provided positive results for the anti–diabetic drug rosiglitazone had financial relationships with pharmaceutical companies, as per a research published online in the British Medical Journal. However, the article acknowledges that financial relationships may not necessarily be the reason for positive research results.

In 2007, a large scale review of rosiglitazone showed that use of the drug led to a significant increased risk of heart attacks. This led to further studies and policies were also developed to encourage disclosure of such financial conflicts of interest.

Researchers at the Mayo Clinic assessed over 200 articles on rosiglitazone to explore a possible link between authors’ financial conflicts of interest and their views on the safety of the drug. They found that 45% of the study authors had financial conflicts of interest and 23% of these did not disclose this information.

Almost all (94%) authors who had favourable views on the safety of rosiglitazone were more likely to have a financial conflict of interest with a pharmaceutical company than were authors who had unfavourable views.

The study concluded that disclosure rates for financial conflicts of interest were unexpectedly low, and there was a clear and strong link between the orientation of authors’ expressed views on the rosiglitazone controversy and their financial conflicts of interest with pharmaceutical companies. The researchers further stated that these findings, while not necessarily causal, underscore the need for further progress in reporting in order for the scientific record to be trusted.

Dr KK Aggarwal
Chief Editor


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.

Dr k k Aggarwal

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.

Punjab & Sind Bank
 
action
docconnect
 
Central Bank of India
 
Nestle
 
nuspera
 
Docconnect

Laughter the best medicine

Actual medical record

The patient has no past history of suicides.

Formulae in Critical Care

Stroke index (SI)
Formula: SI = SV/BSA
Comment: Volume of blood, pumped by heart during
each contraction relative to body size.
Normal values: 30–50 ml/beat/cm2

Milestones in Orthopedics

George S. Phalen (1911–1998) was an American hand surgeon remembered for his work on carpal tunnel syndrome (CTS) including his description of Phalen’s maneuver. Although it had been described previously by James Paget in 1854 and James Jackson Putman in 1880, Phalen improved the understanding of the etiology of CTS. The condition became widely known among the general public in the 1990s because of the rapid expansion of office jobs.

Mistakes in Clinical Practice

Lack of leading zero (.X mg) Decimal point may be missed. Instead write as 0.X mg

Lab Test (Dr Naveen Dang)

5–HIAA is used to help diagnose and monitor treatment for a serotin secreting carcinoid tumor.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name

Indication

Approval Date

Tranexamic Acid Tab SR 750mg

For the treatment of menorrhagia

20.02.09


(Advertorial section)

ZEN IMMUNE–FACT SHEET

Zen Immune Beauty helps improve the brittleness of nails and increase the hair tensile strength, thus preventing hair loss. It stimulates regeneration of hair roots, helps prevention of comedone formation and post comedone skin scarring in acne vulgaris.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month. Contact: drkk@ijcp.com or emedinews@gmail.com

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

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.

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, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards

Readers Responses

  1. Dear Dr. K K Aggarwal, Greetings from Saudi Arabia! emedinews is really very useful for doctors working in foreign countries as it provides information about our profession in our country and some latest developments. Wish you many more laurels and success in your future public service endeavours: Dr. C P Gupta, Specialist in Gen. Medicine, King Saud Medical Complex, Riyadh, KSA.

  2. Dear Dr. Aggarwal, This is a great initiative and Congratulations for receiving such a Prestigious award. Please keep marking me a copy at ph_hemant@rediffmail.com . With Regards: Hemant Pachpute, Group Product Manager, Zydus Oncosciences, Ahmedabad–380015, India, Phone No. +91–79–26868297, Mobile No : +91–9974051277