Letters to the editor
1. Regarding alcohol quantities, it is good for heart as per your research article in emedinews , but due to its high potential for addiction , I think one should avoid even small quantities , there are many good drinks like apple juice , orange juice and vegetable juices , why researches are not doing any research on that. Alcohol is a medicine , that should be used in making of drugs . Similarly is the case of caffeine and nicotine , that should also be used in the making of drugs. Anything which has a high addiction potential and is not good for health , should be avoided completely, because prevention is better than cure. (Dr Pankaj Budhiraja)
2. Please convey to Dr.Vivek Chhabra the following refrences for intracardiac adrenaline injection in the 21st . century
Harrison's Principles of Internal Medicine 17th edition(latest) Critical care medicine- cardiac arrest secondary to bradyarryhthmias and asystole is managed differently.Epinephrineand/or atropine are given intravenously or by an intracardiac route.
American Heart Association -Advanced Cardiac Life Support - In desperate clinical situations whne an iv cannot be started or an endotracheal tube placed,Intracardiac injections can be used to administer epinephrine to treat ventricular fibrillation,asystole,or PEA. Anecdotal evidence suggest that intracardiac epinephrne may have been effective in restoring cardiac contractions in asystole or electomechanical dissaociation when IV epinephrine was ineffective. Whether the needle stick or drug itself was effective has not been resolved.
Transfusion reactions:Treatment&Medication-eMedicine Heamatology- In overt shock, epinephrine as a1:1000 aqueous solution may be administered as an intracardiac injection.
Epinephrine(PF)Inj:AHFS Detailed Mongraph-In exxtreme cardiac emergencies, diluted injections of epinephrine hydrochloride also may be given intracardiacally, via an endotracheal tube or by intraossous infusion.
JAMA vol.244no.10,september5,1980 -Intracardiac injections during cardiopulmonary resuscitation- a low risk procedure.
Interstingly the topic was discussed in a meeting of family physicians who said they would do nothing except refer a patient to hospital if he suffers cardiac arrest outside their clinic. They were at a loss as to what they will do if it happened in their clinic, as Iv would not be available, intubation is ruled out, monitor/defibrillatotrs are not available in clinics, now even long needles for intracardiac injections are also not available and the ambulance/ emergency services are pathetic and will not reach in time even if CPR is started.
An important point for IV drugs to be effective, after the Iv injection the iv line has to be flushed with 20-0ml saline and the CPR has to be effective to distribute the drug in the system. Vinay Bhasin
emedinews commnets: use intracardiac only when others routes are not available. Infact in clinic practice just only compression chest CPR is sufficient.
News to use (Dr G M Singh)
1. Obesity is characterized by the accumulation of excess body fat and can be conceptualized as the physical manifestation of chronic energy excess. Using the analogy of oedema, the consequence of positive fluid balance or fluid retention, obesity can be seen as the consequence of positive energy balance or calorie retention. Just as the assessment of oedema requires a comprehensive assessment of factors related to fluid balance, the assessment of obesity requires a systematic assessment of factors potentially affecting energy intake, metabolism and expenditure. Rather than just identifying and describing a behavior (this patient eats too much), clinicians should seek to identify the determinants of this behavior (why, does this patient eat too much?).
2. SPORT is a major study which compared outcomes after surgical vs non operative treatment of lumbar disk herniation in patients with lumbar radiculopathy. It consisted of randomized and observational patient cohorts. Surgery remained superior in these outcomes at 2 years, although there was some attenuation of the benefit associated with surgery.
3. There is an intimate link between mental health disorders and depression, as more than 90% of people who have committed suicide have such disorders. Majority of these individuals are untreated for mental health disorders at the time of the suicide, although there has been some question as to whether treatment of psychiatric illness such as depression might actually increase the risk for suicide.
4. There are several steps that people with diabetes should take to fight against 2009 H1N1 flu. CDC recommends that all people with all types of diabetes who are 6 months through 64 years of age get vaccinated with the 2009 H1N1 and seasonal flu shot. People with diabetes also should talk with their health care provider about getting a pneumonia (pneumococcal) vaccine as part of their diabetes management plan.
5. Hot flashes are reported by most perimenopausal and postmenopausal women, and night sweats are reported by half of them and may be associated with impaired sleep. Recent studies have suggested an adverse association between hot flashes and CVD mortality, suggesting that vasomotor symptoms may be a marker for a more hypoestrogenic state.
6. Dosing for morphine sulfate must be adjusted for each patient with consideration of factors such as age, body mass, physical status, prior experience with opiate analgesics, risk factors for respiratory depression, and medications to be coadministered before or during surgery. Caution is advised in elderly patients and patients with seizure disorders.
7. Cyclosporine may increase the plasma concentrations of repaglinide and thereby increase the risk for hypoglycemia. Pharmacokinetic data suggest that concomitant use of cyclosporine increases the maximal and total exposure to repaglinide by 1.8 and 2.4 fold, respectively. Caution and close monitoring of glucose levels are recommended.
8. Post marketing cases of nephrolithiasis have been reported in patients receiving treatment with fosamprenavir calcium. Temporary interruption or discontinuation of therapy should be considered for patients in whom signs or symptoms of kidney stones develop. Fosamprenavir and ritonavir therapy has been linked to increases in triglyceride and cholesterol levels; regular monitoring is recommended.
9. Heart failure is the leading cause of hospitalization in people older than 65 years in India. High coffee consumption may increase the risk for heart failure, and coffee consumption also increases risk for hypertension. However, coffee consumption has also been associated with a reduced risk for diabetes, so the 2 effects may neutralize one another.
10. The CDC guidelines issued October 16, update those from September 22, 2009, aims to help clinicians prioritize use of antiviral medications for hospitalized patients and those at higher risk for influenza complications during the 2009 to 2010 season. Updates since the September 22, 2009, guidelines include the following: Expanded considerations for treatment and chemoprophylaxis in persons vaccinated with the 2009 H1N1 and seasonal influenza vaccines; a new recommendation that women up to 2 weeks postpartum or after a miscarriage should be considered to be at increased risk for complications from 2009 H1N1 influenza; additional oseltamivir dosing instructions for children younger than 1 year.
11. The new CDC guidelines contain dosing recommendations for antiviral treatment (for 5 days) or chemoprophylaxis (for 10 days) with oseltamivir for children younger than 1 year. Because of limited data on use of oseltamivir in infants younger than 3 months, prophylaxis is not recommended in this age group unless the situation is judged to be critical.
12. Both EPA and DHA are fish oils that have been used as supplements to reduce the risk for cardiovascular disease. A significant reduction in deaths from cardiovascular disease and all cause mortality rates has been shown in clinical trials, but it is uncertain if this reduction is because of a reduction in arrhythmias, although both types of fish oil have been proposed to stabilize membranes of cardiocytes.
13. Fish oil supplementation with EPA and DHA is associated with a reduction in the risk for cardiac death.
14. Individuals diagnosed with either type 2 diabetes or OSA should be screened for the other condition. Those with OSA should be routinely screened for metabolic syndrome and type 2 diabetes with inexpensive, easily performed screening tests, followed by a glucose tolerance test when these test results are positive.
15. Most diverticular bleeding is self-limited. Resuscitative measures and intravenous fluid replacement should be given urgently, as well as packed red cell transfusions in patients with ongoing bleeding. Colonoscopy is the initial diagnostic procedure of choice, and therapeutic maneuvers may also be performed if the bleeding source is visualized. Surgery is seldom required. To prevent progression of diverticular disease, patients should increase dietary fiber intake or take supplements, increase physical activity levels, and avoid aspirin and NSAIDs. Avoiding certain nuts, corn, or popcorn is no longer recommended.
16. Bullying refers to repetitive aggressive acts characterized by an imbalance of power and inability of the victims to defend themselves. Bullying and victimization have been linked to poorer family functioning, interparental violence, and parental maltreatment. Children who are both bullies and victims appear to be the most dysfunctional in outcomes. To date, however, no prospective, population-based study has evaluated predictive associations between childhood bullying behavior and long-term mental health outcomes in both boys and girls.