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  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



25th November Wednesday

Dear Colleague,

Revisiting diabetes: what is new in diabetes so far?

Sitagliptin can cause pancreatitis: However there have been 88 post marketing case reports of acute pancreatitis in patients on sitagliptin. Pancreatitis should be suspected in all patients with persistent severe abdominal pain (with or without nausea), and sitagliptin (or sitagliptin with metformin) should be discontinued in such patients.

Glargine is safe: There has been a confusion recently regarding a link between insulin glargine and cancer however until more data is available, there is insufficient evidence to make a recommendation against glargine.

NPH twice daily as effective: In a five year trial in over 1000 patients with type 2 diabetes previously treated with oral hypoglycemic agents, insulin, or both, there was no difference in the risk of retinopathy progression (defined as an increase in three steps or more on the early treatment of diabetic retinopathy study [ETDRS] scale) in patients randomly assigned to twice daily NPH versus once daily glargine.

Low carb diet of choice in diabetic hypertensives: In a four-year trial of a low carbohydrate Mediterranean-style diet (< 50 percent complex carbohydrates, > 30 percent mono and polyunsaturated fat) versus a low fat (<30 percent) diet in 215 overweight patients with newly diagnosed type 2 diabetes, patients randomly assigned to the Mediterranean diet were significantly less likely to require anti hyperglycemic drugs (44 versus 70 percent).

Saxagliptin New approval: Saxagliptin, a new DPP IV inhibitor that reduces hemoglobin A1C by app. 0.5 percentage, is now approved as initial therapy for type 2 diabetes or as a second agent in those who do not respond to a single agent, such as a sulfonylurea, metformin, or a thiazolidinedione.

DR KK Aggarwal




Omega 3 reviews
1. Half a gram needed for heart benefits: Compelling evidence from studies involving almost 40,000 participants supports daily EPA plus DHA intakes of at least 500 mg per day for healthy individuals, while people with known heart disease or heart failure should aim for up to 1,000 mg daily, according to a review published in the Journal of the American College of Cardiology.

2. Omega 3 fish oils linked to better semen quality: Infertile men have lower levels of omega 3 fatty acids in their sperm than fertile men, suggests new research that opens up the possibility for supplements to boost sperm quality. The ratio of omega  to omega  was also found to be higher in infertile men, according to findings from a study with 150 men in Iran in the peer reviewed journal Clinical Nutrition.

3. More omega 3 less omega 6 for colorectal protection: Increasing the intake of omega 3 fatty acids, and decreasing intakes of omega 6, could reduce the risk of colorectal cancer, suggests a new study from China. The highest dietary ratio of omega 6 to omega 3 was associated with a 95 per cent increase in the risk of women developing colorectal cancer, according to results of a study with 73,242 Chinese women participating in the Shanghai Women's Health Study.  The study, published in Cancer Epidemiology Biomarkers & Prevention, adds to a small but growing body of evidence supporting the importance of balance between omega 3 omega 6 fatty acids.

 4. Omega 3 may improve blood pressure in kidney disease patients: A combination of omega 3 fatty acids and coenzyme Q10 (CoQ10) may decrease blood pressure and heart rate in kidney disease patients. People with chronic kidney disease (CKD), which increases the risk of heart disease two to 50 fold, experienced improvements in both blood pressure and heart rate following supplementation with four grams of omega 3 fatty acids, according to findings published in the Journal of Hypertension.  Furthermore, when take in combination with coenzyme Q10 the blood pressure reducing benefits were enhanced, despite CoQ10 alone not being associated with any improvements on its own, report researchers from University of Western Australia and Royal Perth Hospital.

5. Omega 3 may protect diabetics from heart failure: Increased intakes of omega 3 fatty acids may protect diabetics from heart failure, according to a new study from the Netherlands.  A protective effect of high intakes of omega 3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) was also observed in women, but this was only a tendency, according to findings published today in the European Journal of Heart Failure.  Non diabetic men, however, and the study population in general, did not receive any benefits from high intakes of the omega 3 fatty acids.

Intra arterial injection by mistake
In the operating room the patient was being induced by the anesthesiologist with thiopentone when suddenly the patient developed intense pain down the injection site followed by pallor, cyanosis, edema and finally gangrene of the limb.

This is a very dreadful combination, which arose due to intra arterial injection of thiopentone especially when it is injected in ante cubital vein. Because of its high alkalinity it gets precipitated in blood leading to thrombus formation and ischemia. Therefore, intravenous injections with such drugs should be given at sites where the vein is not in close proximity to the artery.

Letter to the editor

Observation: How could the nurse give 100 tablets of alprazolam without cross checking with the doctor? She is a qualified nurse she should know the doses as well. 100 tablets are not prescribed for any medicine. This example does not seem real. Could u please check? If it is true what action was taken against the nurse? Dr Suman Sinha

A: Thanks. Alprazolam IR is available in 0.25 mg, 0.5 mg, 1 mg and 2 mg strength oral, orally disintegrating tablets.  Alprazolam Extended Release is available in 0.5 mg, 1 mg and 2 mg 3 mg strength oral.

This was a real happening. The COPD patient was a NRI and the nurse was a private nurse hired from an agency. The patient personal drug box had a supply of alprazolam 2 mg strength which was prescribed to him earlier in Argentina. He was given 12 tablets of the drug by an error. He later recovered. It is also a common mistake that regular nurses do not do their work when a personal private nurse is hired by the patient. And also most private agency nurses are B grade nurses.

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Advertising in emedinews emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact drkk

A guy is walking past a high, solid wooden fence at the insane asylum and he hears all the residents inside chanting, "Thirteen! Thirteen! Thirteen!" He continues walking along the long fence, but, being a curious person, he can't help but wonder why they are chanting "Thirteen!" over and over. Could it be that they are chugging beer? Are they perhaps taking turns beating one of the inmates? Maybe they are counting the number of patients that have leapt off of the roof thus far.

His curiosity peaks and he frantically searches for a hole in the fence so that he may see what is going on. Finally, he spots one a few feet ahead. The hole is low in the fence and he has to kneel down to peer inside.

He moves into position and peeks into the hole. As he looks in, someone inside pokes him in the eye! Then everyone inside the asylum starts chanting, "Fourteen! Fourteen! Fourteen!"

Make Sure

Mistake: A 55 year old diabetic woman with no previous evidence of CHD is admitted to the hospital with a first attack of MI.

Reaction: Why didn't you start cholesterol lowering drugs, when the patient had LDL levels of  164 mg/dl

Make Sure: According to NCEP guidelines, in patients without CHD but with two or more risk factors, cholesterol lowering drug therapy should be initiated when LDL C levels are ≥160 mg/dl.

Clinical Tip:

Steroid creams, selenium, salicylic acid and coal tar preparations, and pyrithione zinc are frequently used to treat dandruff. Am. Fam. Physician 1995 July;52(1):149 155,
159 160.

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emedinews: revisiting 209

IJCP Group is organizing emedinews: Revisiting 2009, a day long conference on 10th Jan  2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts will deliver lectures. CME will be followed by lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com. We have crossed 800 registrations.



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