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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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,

29th January, Friday 2010

 Practice Changing Updates: Statins before vascular surgery

All patients undergoing elective, urgent or emergent major vascular surgery and not on statins should receive it as soon as possible before surgery.

Patients with vascular disease (carotid or peripheral arterial disease) are considered to have a coronary equivalent and should receive statin therapy, unless it is not tolerated.
Patients on statins should continue them while undergoing elective or emergent vascular surgery.
In DECREASE III trial, 500 such patients were randomly assigned to either 80 mg of extended release fluvastatin daily or placebo at least 30 days before the procedure.

The primary end point of myocardial ischemia, defined as release of troponin T and/or transient electrocardiographic abnormalities within 30 days of surgery, occurred significantly less often in the fluvastatin group (10.8 versus 19.0 percent)

In fact all such patients in routine life also should receive statins.

Reference
  Schouten, O, Boersma, E, Hoeks, SE, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009; 361:980.

 

Dr KK Aggarwal
Chief Editor


News
1.Transmitting ECG results from the field to the emergency department dramatically improved door-to-balloon time for patients with ST-elevation myocardial infarction. The strategy cut a half hour from the process, from 90.5 minutes to 60.2 minutes, well within the recommended 90-minute window. (Dr Shukri David, Providence Hospital and Medical Center, Southfield, Mich)

2. A novel emergency contraceptive is effective and well tolerated up to 120 hours after unprotected sexual intercourse. The finding makes ulipristal acetate the first emergency contraceptive to be effective for such a long period of time. The study is published in the feb. issue of Obstertics & Gynecology. (Dr Paul Fine, Planned Parenthood of Houston & Southeast Texas) Obstetrics & Gynecology). The only FDA-approved similar medication is Teva's levonorgestrel (Plan B One-Step), which is indicated for use up to 72 hours after unprotected sex.

3. A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas. The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls. (Sarah Kraus, Tel Aviv Souraski Medical Center, Israel).

4. Cutting daily salt intake by 3 grams a day, about 30% of the current average, could prevent 32,000 strokes and 54,000 myocardial infarctions a year, if a computer model developed by researchers at the University of California, San Francisco accurately depicts the clinical impact of salt reduction. The results of the analysis, which used a computer simulation of heart disease in US adults ages 35 to 84, also suggest that even a one gram per day reduction in salt over the next decade would be a more cost-effective strategy for treating hypertension than use of even the cheapest antihypertensive. (Dr Kirsten Bibbins-Domingo, University of California, San Francisco).

5. Chronic lung disease begins to affect cardiac function at even mild levels of emphysema, data from a large prospective cohort study showed. A 10-point increase in percent emphysema by lung CT had a linear inverse relationship with left ventricular end-diastolic volume, stroke volume, and cardiac output (P<0.001 for all parameters). The study is published in the Jan. 21 issue of the New England Journal of Medicine. (R. Graham Barr, Columbia University, New York).

6. Middle-aged patients with early knee osteoarthritis can benefit from either a self-managment program or strength training, but a combination of the two did not provide additional gains. During a two-year trial, roughly two-thirds of participants randomized to one of three groups achieved clinically meaningful improvements in functioning, defined as a 26% change from baseline. The study is reported in the Jan. 15 issue of Arthritis Care & Research. (Patrick E McKnight, George Mason University, Fairfax, Va).

7. FDA has approved dalfampridine to improve walking in patients multiple sclerosis.

8. Drug combination may protect against IV, rectal transmission of HIV. Researches at the University of North Carolina-Chapel Hill have discovered that administering antiretroviral drugs to mice prior to HIV exposure protected against intravenous and rectal transmission of the virus. Interestingly, the rodents used in the study were humanized, meaning they were transplanted with human bone marrow, liver and thymus cells, which results in a functioning human immune system.

9. Half of patients with metastatic esophageal cancer responded to a regimen of conventional chemotherapy and erlotinib. Fifteen of 30 patients had objective responses, including one complete response, when the targeted agent was added to oxaliplatin and 5-FU. The response rate exceeded prespecified efficacy criteria, which called for a 10% absolute improvement in historical response rates to oxaliplatin-based chemotherapy.

10. Putting nutrition labels on fast food may lead parents to pick lower-calorie meals for their children. In a small waiting room study, published in the journal Pediatrics. Parents ordered about 20% fewer calories for their kids when they chose from a menu with nutrition information on it. (Pooja Tandon, University of Washington).

11. Patients with progressive pancreatic neuroendocrine tumors lived twice as long without progression when treated with sunitinib compared with placebo, data from a French clinical trial showed. Median overall survival had not been reached in the sunitinib arm, but sunitinib treatment was associated with a 60% reduction in hazard ratio compared with placebo. More than 90% of patients in the sunitinib group remained alive at six months. (Dr Eric Raymond).

12. According to a study published in the Jan. 25 issue of Pediatrics, rashes from toilet seats can afflict children, and the rare condition is often misdiagnosed, which may delay proper treatment.

13. The FDA has approved the Melody Transcatheter Pulmonary Valve and Ensemble Delivery System, the first heart valve designed for implantation through a catheter in a leg vein. The device gives congenital heart defect patients with poorly functioning pulmonary valve conduits new treatment options without requiring open heart surgery. The valve does not cure the condition and may wear to the point of needing replacement over time, but a tissue valve in the device maintains proper blood flow-direction, which allows the valve to function longer than usual.

14. Dietary polyamines may represent a modifiable risk factor for colon cancer. High intake of polyamine-rich foods increased the risk of large, high-grade, and advanced colonic adenomas by 40% to 65% compared with low intake. High dietary polyamine levels correlated with high polyamine levels in rectal tissue. (Dr Kavitha P. Raj, University of California Irvine, Gastrointestinal Cancers Symposium).

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Our HIP's

Question of the Day: What is indoor residual spraying?

Indoor residual spraying (IRS) is the application of small amounts of insecticide to the interior walls of houses to kill or sometimes repel malaria-transmitting mosquitoes. IRS is a highly effective, proven malaria prevention strategy that saves lives.

The use of the insecticide DDT for IRS is very different from the massive agricultural applications. If used correctly for this purpose, it poses no known risk to human health. Malaria, on the other hand, kills more than one million people each year, the vast majority of whom are African children.

DDT is one of the WHO-approved insecticides for IRS. DDT is more effective and less expensive than many other insecticides in many situations; as a consequence it is a very 'competitive' choice for IRS programs.(Source:USAID's Support for Malaria Control in Countries Using DDT.)

Dr Good Dr Bad
Situation: A diabetic patient on aspirin was to undergo cataract surgery.
Dr Bad: Discontinue aspirin
Dr Good: Continue aspirin

Lesson: The 2008 anticoagulation guidelines from the American College of Chest Physicians (ACCP) recommend that patients on aspirin and who are undergoing cataract removal continue aspirin around the time of the procedure.
(Source:Chest 2008;133:299S).

Make Sure
Situation: A patient with antibiotic-associated diarrhea was not responding to metronidazole. Vancomycin was not affordable.
Reaction: Why was he not given Nitazoxanide.
Make sure such patients are given a trial Nitazoxanide. It is as effective as vancomycin.

Formulae in Imaging
In upright patients, the accumulation of pleural gas occurs primarily in an apicolateral location. As little as 50 mL of pleural gas can be visible.

Mistakes in Critical Care
Never write MS for morphine sulfate. It may be mistaken for magnesium sulfate
.

Emedinews Try this It Works
Crossover test can detect temperature differences

The crossover test is a bedside test that can help reveal subtle differences in temperature between two body parts. Place one hand on the body part to be tested for warmth and the other hand on the contralateral body part. After 30 to 60 seconds, cross each hand over to the opposite side. Even subtle temperature differences can be discerned in this manner.

This test is especially useful for examining patients with suspected inflammatory arthritis. Of course, if there is an equal amount of warmth bilaterally, there will be no discernible difference in temperature.

Milestones in Neurology
Ernst von Fleischl-Marxow was an Austrian physiologist and physician who became known for his important investigations on the electrical activity of nerves and the brain.

Laughter the Best Medicine
Late one night, the Gynecologists' wife was home alone, after her husband had been called to the hospital for an emergency. The doorbell rings, and she answers.

"Is the doctor at home?" asks the man at the door, in a very hoarse and quiet voice due to his aching throat.

"No, c'mon in!" whispers the doctor's wife in return.

SMS Anemia
The combination of anemia, thrombocytopenia, and neutropenia is termed pancytopenia.                  

Quote
Prayer is the coin paid to Gratitude. (Jessi Lane Adams)

Readers Response
1. Dear Dr Aggarwal: Please accept our heartiest congratulations on winning the prestigious award. Hard work always pays. May God bless you. With best wishes. Dr. Shashi Saini & V.K. Saini

2. Dear Dr Aggarwal, Congratulations to you and your family. This was really well deserved. Wish you all the best. Dr Vivek Batra

3. I wish to extend the heartiest congratulation to Dr KK Aggarwal on being bestowed the very distinguishing honor of 'Padmashri'. I congratulate him on having brought the medical fraternity something to be proud of. I wish the best for DR KK Aggarwal and I hope he keeps doing something for medical fraternity in same vigour. Dr Shailesh Gupta, IMS,BHU. Formerly at Safdarjung Hospital, Delhi and King Georges Medical College, Lucknow.

4. Dear Dr. K. K. Aggarwal,You have a right to feel that your accomplishment has been recognized at the highest level. Surely it must be encouraging to continue to do great work in public service and hopefully achieve higher accolades ! Those of us, who know you closely, feel proud to have a Padmashree amongst us. That there are only sixteen doctors who have been recognized with Padmashree puts you and the OTHERS on a very different pedestal vis--vis all other doctors. At the early age of 52, you have received many awards including Dr. B. C. Roy award last year and the Padmashree award this year. I am sure many more will follow. Regards, Narayan Gad, PANACEA BIOTEC.

5. Dear Sir, Many Many Congratulations on this highly significant and distinguished achievement of having conferred with the Padma Shri Award. May you have many more such noteworthy achievements in the times to come. With warm Regards, Arvind Madan, Pain Management Division, Modi-Mundipharma.

6. Dear Sir, Heartiest congratulations! on getting very prestigious Padma Shri award. I wish you more and more grand awards in future. Regards, Hena Vasdeva.

7. Dear Doctor, Hearty congratulations to you from all of us at The Himalaya Drug Company on being conferred the prestigious Padma award. Regards, Sudheer S, Group Product Manager-Pharmaceutical Division, The Himalaya Drug Company.

8. My Hearty Congratulations to you Sir for being awarded the coveted Padmashree. This is a true award for the person who deserves it who stood for the cause of continuous medical education and who is an Idol for other young doctors in India and abroad. Congratulations once again. Dr. C. Mazumdar.

9. Dear Dr Aggarwal, Many congrats on getting prestigious Padma Shree award: Dr Anil kumar Gupta

10. Dear Dr KK Aggrawal: I congratulate you for receiving the prestigious Padma award. I value your contributions in medical education. Best wishes, K K Deepak

11. Respected Sir, I am an ardent follower of your emedinews. I must confess that it has added to new dimensions to my knowledge. This award is well deserved for a person of your calibre. May you be blessed with many more awards in near future. Keep up the good work. Dr. Chandan Parashar

12. Sir, Congratulations for recieving one of the highest national award . This is for your hard work, vision,and dedication for medical profession.You are inspiration for us. I would like to work with you if i ever got a chance in future. with best wishes Dr S P Chaudhry/Sr Divisional Medical Officer/New Delhi

13. From: Dr. A. K. Merchant, National Trustee, Lotus Temple and Baha'i Community of India; General Secretary, The Temple of Understanding--A global interfaith association; Senior Faculty, Sai International Centre for Human Values.To: Dr. K. K. Aggarwal, President Heart Care Foundation, et al. It is with great joy I send my hearty congratulations to you for being bestowed the honour of Padma Shri.  It is yet another expression of the nation's and its people's gratitude for the yeomen services you have been rendering for the past several decades. With season's greetings and kind regards. AK Merchant

14. Heartiest Congratulatons on being conferred the Padma shree!! Dr Bhatnagar


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