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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,

24th January, Sunday 2010

Women who have migraine with aura RE at risk of stroke

The relationship between headache, migraine, and stroke is complex.

1. Headache may be coincidental with stroke

2. Headache may be a consequence of stroke

3. Stroke and cerebrovascular lesions may have clinical features of migraine

4. Headache or migraine may increase the risk of stroke

5. Migraine may have clinical features of stroke

There is an increased risk of stroke associated with migraine, particularly in women who have migraine with aura. Stroke risk appears to be highest in women of child-bearing age who have migraine with aura and either smoke, use oral contraceptives, or have high blood pressure.

Several studies have found an association between migraine with aura and silent infarct-like lesions on brain MRI located mainly in the posterior circulation white matter or cerebellum.

Women who have migraine without aura and no other risk factors for stroke may use a contraceptive pill with low-dose estrogen (less than 50 mcg).

Women who have migraine with aura should be encouraged to stop smoking, control their blood pressure, and use an alternative method of contraception.

Dr KK Aggarwal
Chief Editor

1. In general, rigorous data on combination therapy in schizophrenia are rare and further randomized controlled trials, naturalistic trials and head-to-head-trials are necessary. Some evidence supports a combination of antipsychotics and antidepressants for negative symptoms and comorbid major depressive episodes. The add-on of lithium and mood stabilizers lacks compelling evidence, but might be beneficial for specific subgroups. For treatment-resistant cognitive symptoms, antipsychotic medication should be combined with cognitive remediation, as no pharmacological add-on strategy has gained convincing evidence so far. Treatment-emergent positive and/or negative symptoms under clozapine monotherapy might benefit from adding a second atypical substance. (Current Opinion in Psychiatry, Jan 2010)

2. Researchers from Boston University School of Medicine (BUSM) have found that angiotensin receptor blockers (ARBs) -- a particular class of anti-hypertensive medicines -- are associated with a striking decrease in the occurrence and progression of dementia. These findings appear in the January issue of the British Medical Journal.

3. Being obese could lead to a greater risk of developing the most common form of renal cell cancer, according to research in the January issue of the UK-based urology journal BJUI.

4. Forensic pathologists have shown that over three percent of all sudden deaths in south-west Spain are related to the use of cocaine. They believe their findings can be extrapolated to much of the rest of Europe, indicating that cocaine use is a growing public health problem in Europe and that there is no such thing as "safe" recreational use of small amounts of the drug. (January 13, European Heart Journal)

5. Blocking the function of an enzyme in the brain with a specific kind of vitamin E can prevent nerve cells from dying after a stroke, new research suggests. In a study using mouse brain cells, scientists found that the tocotrienol form of vitamin E, an alternative to the popular drugstore supplement, stopped the enzyme from releasing fatty acids that eventually kill neurons.(Ohio State University Researchers)

6. Ask anyone who suffers from migraine headaches what they do when they're having an attack, and you're likely to hear "go into a dark room." And although it's long been known that light makes migraines worse, the reason why has been unclear. Now scientists at Beth Israel Deaconess Medical Center (BIDMC) have identified a new visual pathway that underlies sensitivity to light during migraine in both blind individuals and in individuals with normal eyesight. The findings, published on January 10 in the advance online issue of Nature Neuroscience, help explain the mechanism behind this widespread condition.

Question Of the day
How is hypoglycemia managed in children with severe malaria?
Hypoglycemia is particularly common in children under 3 years and in those with convulsions or hyperparasitemia or in a profound coma. It is easily overlooked clinically because the manifestations may be similar to those of cerebral malaria.

Management: Unconscious children should be given dextrose regularly to prevent starvation hypoglycemia. It is most conveniently provided as 5% dextrose in saline infusion, but if this would be likely to lead to fluid overload, smaller volumes of more concentrated dextrose may be given at regular intervals. If hypoglycemia occurs, give intravenous 50% dextrose in a dose of 1.0 ml/kg of body weight (0.5 g/kg) diluted in approximately the same volume of IV. fluid slowly over several minutes. If only 25% or 10% dextrose is available, give appropriately more to provide the same amount of dextrose (0.5 g/kg). This should be followed by a slow IV infusion of 5% or 10% dextrose to prevent recurrence of hypoglycemia. If the intravenous route is impossible, intra-osseous access should be tried. If this fails, 1 ml/kg of body weight of 50% dextrose – or of any sugary solution – may be given through a nasogastric tube. The duration and amount of dextrose infusion will be dictated by the results of blood glucose monitoring (which should be done in blood taken from the arm opposite to that receiving the infusion), using a "stix" method.

Readers Column

Respected Dr KK: Thanks for keeping us so updated. Read with interest relationship of diastolic dysfunction and diabetes. In this regards may I share a few points : Mild diastolic dysfunction (Abnormal relaxation ) is very common in middle age persons,so much so ,that many echocardiographers mention it as normal.In the study you referred to ,there must be a cutoff in e/e prime ratio ,above which the likelihoof of landing into heart failure is increased.MAy I know  what  was that cutoff value? The cutoff we take as echocardiographers are Normal e/e prime = < 8; Borderline =8-15 AND Significant diastolic dysfunction  = >16. tHIs value has a direct linear corelation with LVEDP. Moreover, many experts take diastolic dysfunction as a precursor to / as an early stage of systolic dysfunction in most heart failure  cases. Dr.Varesh Nagrath   M.D.Guru -kripa  Clinic, Opposite S.B.I.Raghav Nagar, Deoria Sadar, U.P.

A: the parameters are same. When we ask for echo we must ask for both systolic and diastolic functions. Many echo machines may not have facilities for doing diastolic TDI functions.

Punjab & Sind Bank
Our HIP's

Dr Good Dr Bad
Situation:A CAD patient on low-dose aspirin was to be prescribed a NSAID.
Dr Bad: You can take it anytime.
Dr Good: Take aspirin 2 hours before
Lesson: In patients using NSAIDs on an occasional short-term basis, aspirin should be taken at least two hours before the NSAID.

Make Sure
Situation: A child with completely repaired tetralogy of Fallot (TOF) with prosthetic material developed infective endocarditis (IE).
Reaction: Oh my God! Why was IE prophylaxis not given.
Make sure that all patients with congenital heart disease repaired with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure are given IE prophylaxis.

Formulae in Imaging
For quantitation of pleural effusion on decubitus views: small effusions are thinner than 1.5 cm, moderate effusions are 1.5 to 4.5 cm thick, and large effusions exceed 4.5 cm

Mistakes in Clinical Practice
'U' and 'IU' - The 'U' can easily be mistaken as the number "0", particularly when the "U" is written too closely after the number. This can lead to ten-fold overdoses. Always write 'units'

ENT Facts
Respiratory viruses have been isolated from a quarter of middle ear fluids sampled from children with acute otitis media.

Emedinews Try this It Works
Slick suturing
When preparing scalp wounds for suturing, use sterile K-Y jelly to slick the surrounding hair down.

Milestones in Neurology
Sir Andrew Fielding Huxley is an English physiologist and biophysicist, who won the 1963 Nobel Prize in Physiology or Medicine with Alan Lloyd Hodgkin for his work on the basis of nerve action potentials, the electrical impulses that enable the activity of an organism to be coordinated by a central nervous system.

Laughter the Best Medicine
A Marvelous Answer

A mechanic was removing the cylinder heads from the engine of a car when a famous heart surgeon entered his workshop.
The mechanic straightened up, wiped his hands on a rag and asked argumentatively, "So doctor, look at this. I also open hearts, take valves out, grind 'em, put in new parts, and when I finish, this will work as a new one... So how come you get the big money, when you and me are doing basically the same work? "

The doctor leaned over and whispered to the mechanic.....

Doctor said: "Try to do it when the Engine is RUNNING"

SMS Anemia
Macrocytic anemias are characterized by an MCV above 100 fL

Can a doctor claim any tax rebate on the tax calculated?

Yes, he can claim

1. Tax rebate u/s 88 up to Rs. 20,000 or 20% of the gross qualifying investments in case is one lakh fifty thousand rupees or less. Rs.15,000 or 15%, if income is more than Rs. 1,50,000 but does not exceed Rs. 5,00,000.
2. Under section 88 B, if the person is above 65 years of age, then up to Rs. 20,000.
3. Under section 88 C, in case of a female below 65 years of age, then up to Rs. 5,000.

What is 'Expressed Consent' (tacit Consent)?

Expressed consent is one, the terms of which are stated in distinct and explicit language. It is a must in any examination beyond routine physical examination e.g. giving injection; examination of private parts; examination for determining age, potency and virginity; giving anesthesia or any surgery etc.

1. Oral or verbal consent: when the patient expresses his consent verbally
2. Written expressed consent: when the patient express in writing
Expressed consent is obtained in the presence of a disinterested party. Oral expressed consent, when properly witnessed, is as valid as written expressed consent; written expressed consent has the advantages of easy proof and permanent record.

DocConnect Milestones
DocConnect: Provides a discussion forum for doctors to discuss topics, bounce ideas and keep abreast with news amongst themselves.
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
Albumin                                g/dL                              10                                    g/L

If we could all hear one another's prayers, God might be relieved of some of his burdens (Ashleigh Brilliant).

Letters to the Editor
Dear Sir, Thanx to ur webcast, I could go thro the lectures delivered at MAMC thou I couldn't make it to MAMC on 10th Jan. Many-2 thanx 4 the webcast initiative. Plz arrange similar facilities in future also. I don't know if viewing webcasts can be made login based and thus be considered towards CME credits. Dr. Gurdev Singh

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Zen Immune - facts
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