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  From the desk of editor in chief
Dr KK Aggarwal

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; Chairman Ethical Committee 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

 
  Editorial ...

25th November 2010, Thursday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Global risk assessment best for predicting heart failure in asymptomatic patients

A global risk assessment rather than extensive testing is the best way to predict heart disease in asymptomatic patients aged 20 or older, according to new guideline from the American College of Cardiology Foundation/American Heart Association. The expert panel reviewed over 400 studies to arrive at their recommendations to be published in the Dec. 14/21 JACC and the Dec. 21 Circulation. 

  • High risk: Global risk for CHD events of 20% or higher over 10 years
  • Intermediate risk: 10–20% risk of CHD events

The guideline recommended that global risk scoring including factors such as cholesterol, blood pressure, age, sex, diabetes and smoking (e.g., the Framingham Score) should be used to assess cardiovascular risk in all adults, and that family history should always be examined. The following tests may be done in certain subgroups of asymptomatic patients:

Intermediate risk patients

  • CRP men age 50 and younger and women age 60 and younger
  • Coronary artery calcium scoring in diabetics who are over 40 years old, in low to intermediate risk;
  • Ankle–brachial index
  • Carotid intima–media thickness
  • Exercise ECG stress test in previously sedentary adults who are about to start a vigorous exercise program
  • Lipoprotein–associated phospholipase A2
  • Urine for microalbuminuria

Regardless of risk

  • CRP for determining the appropriateness of statin therapy in certain older people
  • Resting ECG for patients with high blood pressure or diabetes
  • Urine for microalbuminuria in patients with high blood pressure or diabetes
  • Conventional echocardiography in hypertensive patients
  • Nuclear stress testing in patients who have diabetes or a strong family history of heart disease or if previous tests suggest a high heart disease risk
  • HbA1c, regardless of patients’ diabetes status

The following lack benefit in asymptomatic patients:

  • Genetic testing
  • Lipid parameters besides a standard profile, including lipoproteins, apolipoproteins, particle size and density
  • Natriuretic peptide levels
  • CT angio
  • MRI for detection of vascular plaque
  • Stress echocardiography
  • Flow–mediated dilation; and
  • Measures of arterial stiffness, such as pulse wave velocity
Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr GM Singh)

"If I could say it in words there would be no reason to paint. Edward Hoppe"

 
    Photo Feature (from the HCFI Photo Gallery)

 Eco–fest 2010

Dear Sir, I find the column ‘Photo Feature’ to be very interesting. It’s great to see students participate in such large numbers in the various events organized in the Perfect Health Mela. Participation in such extracurricular activities not only gives a sense of accomplishment but also promotes academic performance. Regards Dr Anupam.

 
Dr K K Aggarwal
 
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Free treatment proposed for acid attack victims

Concerned over the increasing number of ‘acid attack’ cases in the country and the huge expenses involved in treating the victims, the Union government has come out with a proposal of providing free treatment to the victims and launching an insurance scheme that would cover reconstructive surgery. The proposal, moved by Minister of State for Health and Family Welfare Dinesh Trivedi also suggests that the government consider including acid attack–burn cases and plastic surgery for financial support from the Health Minister’s Discretionary Grant or the Rashtriya Arogya Nidhi, to support the financially needy victims. (Source: The Hindu, Nov 23, 2010)

 
    International News

(Dr Monica and Brahm Vasudev)

A warning sign for cognitive decline

Two new studies show that small amounts of urinary protein (albuminuria) are associated with cognitive decline.

E. coli could have long term effect on heart

People who develop gastroenteritis from E. coli–contaminated drinking water are at increased risk for high blood pressure, kidney problems and heart disease later in life. Canadian researchers analyzed data from the Walkerton Health Study, which evaluated the long–term health of adults in an Ontario town who developed gastroenteritis (commonly known as stomach flu) in May 2000 after the municipal water system was contaminated with E. coli O157:H7 and Campylobacter bacteria. (BMJ)

Medicare panel backs vaccine for advanced prostate cancer

A federal advisory committee said that there was adequate evidence that the drug Provenge (Sipuleucel–T) prolongs the lives of men with advanced prostate cancer.

Lasers may make cataract removal surgery safer

According to a study published Nov. 17 in the journal Science Translational Medicine, lasers guided by 3–D imaging for cataract surgery on the eye may be more precise and safer than manual cutting in the prevailing treatment.

Surgical procedure destroying certain kidney nerves may reduce drug–resistant hypertension

A simple surgical procedure destroying certain nerves in the kidney can sharply reduce blood pressure in patients whose hypertension cannot be controlled with conventional medications," according to research presented Nov. 17 at the American Heart Association meeting and simultaneously published online in The Lancet.

Women in their 40s with moderate family risk of breast cancer should undergo yearly mammograms

Women in their 40s with a moderate family risk of breast cancer should get annual mammograms, according to a paper in Lancet Oncology.

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are the precautions one should take after an IVF procedure?

The procedure demands no special precautions, but strenuous activity should be avoided. We advise the patients to be mentally and physically relaxed as much as possible. You can return to work if you wish, but first prefer to have a few days rest.

For queries contact: banerjee.kaberi@gmail.com

 
    Hepatology Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

What effect does the liver disease have on the child?

The abnormality of the bile ducts causes chronic cholestasis which means reduced amounts of bile are produced and passed from the liver into the bowel. This can range from mild to severe. This causes:

  1. Jaundice: The degree of jaundice varies between children and also in the individual child at different times.
  2. Pale stools (bowel motions)
  3. Malabsorption: May occur particularly with fatty foods and result in diarrhea. Also vitamins are poorly absorbed by the body.
  4. Pruritis (itching): Due to build up of bile salts in the skin, which are usually excreted in the bile. This often starts at around five months of age, and may be persistent in the early years despite fluctuating jaundice.
  5. Xanthelasma or Xanthomata: These look like very pale warts and appear particularly in skin creases of children with severe cholestasis due to high levels of cholesterol in the blood. Xanthomata usually appear by 2 years of age.
  6. Bleeding: More likely to occur and is more difficult to stop in the untreated child because vitamin K is poorly absorbed by the body when bile output is reduced.
  7. The liver may be enlarged and firm. In some cases, this causes portal hypertension.
  8. If the child’s spleen is very enlarged it is advisable for them to avoid sports where a hard direct blow to the abdomen could occur.
 
    Medicolegal Update

Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

What is difference between antemortem and postmortem bruises?

In some cases, which are brought dead or are dead on arrival, the doctor attending the case in emergency gets confused or is not be able to differentiate between antemortem bruise and postmortem artefact and the postmortem bruise is often entered in MLC as injuries. I have seen several such cases in AIIMS during the conduction of autopsy. However, with closer examination, it is possible to differentiate between the two.

In antemortem bruises, there is swelling and damage to epithelium, coagulation and infiltration of the tissues with extravasated blood and color changes. These signs are always absent in postmortem bruises.

Contusions and abrasions produced immediately after death show a very low degree of changes. Appreciable bruising does not occur after 2–3 minutes of death due to arrest of heart and blood circulation; but, small bruises can be produced up to 3 hours after death by using great force where the tissue can be forcibly compressed against the bone or if the body is dropped on the ground from a height or from transport trolleys or running vehicle. Some of the evidences of bleeding are seen without history of trauma due to tearing of small veins in the skin when the body is lifted from the scene of death and transportation handling and the same is called postmortem artifact.

 
    Inf Update: Question of the Day

What are the diagnostic tests for identification of malaria parasite species?

  • In areas where two or more species of malaria parasites are common, only a parasitological method will permit a species diagnosis.
  • Where monoinfection with P. vivax is common and microscopy is not available, it is recommended that a combination rapid diagnostic test (RDT), which contains a pan–malarial antigen is used. Alternatively, RDTs specific for falciparum malaria can be used.
  • Treatment for vivax malaria is given only to cases with a negative test result but a high clinical suspicion of malaria.
  • Where P. vivax, P. malariae or P. ovale occur almost always as a coinfection with P. falciparum, an RDT detecting P. falciparum alone is sufficient.
  • Antirelapse treatment with primaquine should only be given to cases with confirmed diagnosis of vivax malaria.
 
    Lab Update

(Dr. K Raghu, Sr Consultant Hematologist, Coimbatore)

Hematology Tips

When to suspect a bleeding disorder

  • Bleeding disorders should be suspected when a patient complains of abnormal bleeding from multiple sites, for example bleeds in gums, nosebleeds, skin bleeds, prolonged menstrual bleeds (in women) and prolonged bleed after dental extraction or tooth fall.
  • Basic tests to be done in these cases are platelet count and blood smear examination, Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT).
  • It is also better to do these tests all patients prior to elective surgery.
  • Patients with abnormal readings require more elaborate tests to identify specific problems and proper management.
 
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    Medi Finance Update

(Contributed by Dr GM Singh)

What is the difference between bonds and debentures?

Bonds are IOUs between a borrower and a lender. The borrowers include public financial institutions and corporations. The lender is the bond fund, or an investor when an individual buys a bond. In return for the loan, the issuer of the bond agrees to pay a specified rate of interest over a specified period of time. Typically bonds are issued by PSUs, public financial institutions and corporates. Another distinction is SLR (Statutory liquidity ratio) and non–SLR bonds. SLR bonds are those bonds which are approved securities by RBI which fall under the SLR limits of banks.

A debenture is a debt security issued by a corporation that is not secured by specific assets, but rather by the general credit of the corporation. Stated assets secure a corporate bond, unlike a debenture, but in India these are used interchangeably.

 
    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

List of drugs prohibited for import

Practolol

 
    IMSA Update

International Medical Science Academy (IMSA) Update

Fasting blood sugar in pediatric age group

Even mild elevations in fasting blood sugar values during childhood predict a risk for developing type 2 diabetes mellitus. In the Bogalusa heart study, children with fasting blood sugar values in the upper half of the normal range (between 86 and 99 mg/dL (4.8 to 5.5 mmol/L)) have 2.1 times the risk for developing diabetes during adulthood, and 3.4 times the risk for developing pre–diabetes, independent of the child’s weight status.

(Ref: Nguyen QM, et al. Fasting plasma glucose levels within the normoglycemic range in childhood as a predictor of prediabetes and type 2 diabetes in adulthood: the Bogalusa Heart Study. Arch Pediatr Adolesc Med. 2010;164(2):124–8)

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with acute pulmonary edema had a blood pressure of 240/140.
Dr. Bad: It is due to heart damage.
Dr. Good: It is due to diastolic heart failure.
Lesson: Patients with significant elevation of blood pressure have mostly preserved left ventricular systolic function.

Make Sure

Situation: A patient with chest pain with normal ECG died half an hour later.
Reaction: Oh my God! Why was an acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

 
    Lighter Side of Reading

An Inspirational Story
(Contributed by Major V V Narayanan)

What to give?

It is not only money that can be given. It could be a flower or even a smile. It is not how much one gives but how one gives that really matters. When you give a smile to a stranger that may be the only good thing received by him in days and weeks!

"You can give anything but you must give with your heart!"

………………………………

Mind Teaser

Read this…………………

|……| ome  

Yesterday’s Mind Teaser: "Either weigh or whey"
Answer for yesterday’s Mind Teaser:
"One way or another"

Correct answers received from: Dr Sudipto Samaddar, Dr N C Prajapati, Col (Dr) Narendra Kotwal

Answer for 23rd November Mind Teaser: "Easy on the eyes"
Correct answers received from: Dr Rashmi Chhibber

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr G M Singh)

A man was in his front yard mowing grass when his attractive blonde neighbor came out of the house and went straight to the mailbox. She opened it then slammed it shut and stormed back into the house. A little later she came out of her house again, went to the mailbox and again opened it, and slammed it shut again. Angrily, back into the house she went.

As the man was getting ready to edge the lawn, she came out again, marched to the mailbox, opened it and then slammed it closed harder than ever. Puzzled by her actions the man asked her, "Is something wrong?" To which she replied, "There certainly is!"

My stupid computer keeps saying, "You’ve got mail!"

 
    Readers Responses
  1. Dear Sir, Thanks a lot for providing updated information daily. eMedinews is very helpful to me. Regards Dr Prachi.
 
    Public Forum

(Press Release for use by the newspapers)

Carotid neck ultrasound the only way to check regression of heart blockages

In people with type 2 diabetes, intensive drug therapy can significantly lower bad LDL cholesterol and reduce the thickness of the neck carotid arteries supplying oxygen to the brain, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India

He was interacting with the public at the Heart Care Foundation of India stall in the Ministry of Health and Family Welfare pavilion at the IITF, Pragati Maidan.

Quoting a study published in Journal of the American College of Cardiology, Dr Aggarwal said that every effort should be made to bring down the bad LDL cholesterol to less than 80mg/dL.

The Stop Atherosclerosis in Native Diabetics Study (SANDS) trial tested the value of aggressively lowering bad LDL cholesterol to 70 mg/dL or lower, and non HDL cholesterol to 100 mg/dL or lower, versus lowering levels of these harmful lipids merely to standard goals (i.e., 100 mg/dL or lower for LDL and less than 130 mg/dL for non HDL C). The study involved 427 type 2 diabetic Native Americans who were aged 40 or older and who had no history of heart attack or other heart–related event. There were 204 people in the standard treatment group and 223 in the aggressive treatment group. Ultrasound tests showed that neck artery thickness got worse, or progressed, in the standard treatment group and regressed in the aggressive treatment groups.

The test called intima media thickness of the carotids is the only cost–effective test to know whether or not the heart blockages are shrinking or progressing as the thickening in carotids goes hand in hand with the thickening in the heart arteries.

 
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November 2010
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani
9.00 – 9.30 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Medicity
9.30 – 10.00 AM: Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
10.00 – 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 – 11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion

Panelists:
1. Dr. (Prof.) S C Tiwari
2. Dr. K K Aggarwal
3. Dr. S V Kotwal
4 .Dr. Ambar Khaira
5. Dr. Saurabh Misra
6 All Speakers

12.00 Noon: Lunch

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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