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



9th December Wednesday

Dear Colleague,

  AHA meeting

1.Over the long term, diuretics fight hypertension as well as newer, more expensive blood pressure medications. A 10   year analysis of the ALLHAT study confirmed continued lack of superiority of calcium channel blockers and ACE inhibitors over thiazide type diuretics (Dr William Cushman, of the VA Medical Center in Memphis, Tenn). Any differences between groups for mortality and major cardiovascular and renal outcomes initially seen in the main five   year analysis were lost by 10 years.  The only exception was a persistent 34% elevated heart failure risk with amlodipine.

2.The FDA has issued a public health advisory warning patients and physicians that concomitant use of clopidogrel and omeprazole blunts the anti platelet effect of clopidogrel, so the combination should be avoided. The agency said the combination reduces the activity of clopidogrel by about half. Such a reduction could theoretically increase the risk of myocardial infarction and stroke, although there are no clinical data to support that hypothesis.

3. Acute myocardial infarction patients pretreated with anticoagulants before percutaneous coronary interventions appear to fare better with fondaparinux or enoxaparin than unfractionated heparin. In fact, there was no apparent difference between unfractionated heparin and no pretreatment at all. (Dr Francois Schiele, of University Hospital Jean Minjoz in Besancon, France.

4.Overweight smokers have the greatest risk of a venous thrombotic event, according to a review of data from the Copenhagen City Heart Study.

5.Boosting HDL cholesterol with extended   release niacin is a more effective way of slowing atherosclerosis in high   risk patients on long   term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe. Compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean and maximal carotid intima   media thickness (CIMT) (P <0.001 for all comparisons), Allen J. Taylor, MD, of the Walter Reed Army Medical Center.

6.Pacing both ventricles of the heart, rather than just the right ventricle, may prevent declines in left ventricular function for patients with bradycardia but initially normal ejection fraction. Left ventricular ejection fraction was maintained with biventricular pacing but fell with right ventricular pacing for an absolute difference of 7.4 percentage points at 12 months (P<0.001) (Dr Cheuk   Man Yu, MD, of Chinese University of Hong Kong). Left ventricular end   systolic volume also worsened with right ventricular versus biventricular pacing (P<0.001), according to the randomized clinical trial. The findings add to a growing body of evidence that right ventricular pacing increases risk of left ventricular dysfunction and heart failure, according to an editorial published alongside in the New England Journal of Medicine.

7. Middle   aged men are about three times more likely to suffer sudden cardiac death than women. At age 40, the lifetime risk of sudden cardiac death through age 95 is 12.3% for men and 4.2% for women ( Dr Donald Lloyd   Jones, of Northwestern University in Chicago)

8. Nearly one obese person in 10 feels no need to lose weight or prevent further weight gain. Most obese people with these body size misperceptions thought their health was above average and their lifetime cardiovascular and diabetes risk low (Dr Tiffany M. Powell, of University of Texas Southwestern Medical Center)

9. A 60   milligram loading dose of prasugrel is now a recommended alternative to clopidogrel for patients with ST   elevation myocardial infarction who undergo primary PTCA, according to updated guidelines.  The guidelines from the American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions determined that the benefits of prasugrel outweighed its risk for bleeding and incorporated the drug into their recommendations. The FDA approved prasugrel in July, despite the same concerns.
Some of the other recommendations:

10. Stenting may be considered for the treatment of unprotected left main coronary artery disease. Bypass surgery has been the recommended treatment, but recent studies have shown stenting to be safe and effective if patients have a low risk of procedural complications from PCI and conditions that predict an increased risk of adverse surgical events.

11. Bivalirudin is now considered a useful anticoagulant for primary PCI in patients with STEMI, regardless of pretreatment with unfractionated heparin.

12. In the setting of dual   anti platelet therapy with unfractionated heparin or bivalirudin as the anticoagulant, adjunctive use of a glycoprotein IIb/IIIa antagonist such as abciximab, tirofiban, or eptifibatide can be useful at the time of primary PCI, with or without stenting. The new recommendation elevated tirofiban and eptifibatide to the level of abciximab.

13. The use of aspiration thrombectomy is reasonable in primary PCI.

14. The level of evidence was strengthened for the recommendation stating that drug   eluting stents may be considered for clinical and anatomic settings in which the efficacy and safety profiles appear favorable.

15. It is reasonable to use a drug   eluting stent as an alternative to a bare   metal stent for primary PCI.

16. The number of contrast agents that may be safely used during angiography in patients with chronic kidney disease was expanded to include low   molecular   weight contrast media other than ioxaglate  or iohexol.

17. Coronary pressure or Doppler velocimetry can be useful to determine whether PCI is needed for specific lesions.

18. Patients with unstable angina/non   STEMI who are selected for an
invasive approach should receive dual   anti platelet therapy, with aspirin at presentation and clopidogrel or prasugrel as the second agent.

Dr KK Aggarwal



 Snippets from Dr Brahm Vasudeva

Patients with renal stone disease, pancreatitis more likely to experience high radiation exposure
Medscape has reported that after looking at patterns of radiation exposure from computed tomography (CT) in the emergency department of a large urban level 1 trauma center, researchers at the University of California San Francisco found that patients who were diagnosed with renal stone disease and pancreatitis were the most likely to receive the highest exposure to radiation from CT scans.

Specifically, patients with renal stone disease were over 60 times more likely to undergo a CT scan than were patients with altered mental status, and those with pancreatitis were 20 times more likely.

Furthermore, patients with renal stone disease were nearly eight times more likely to receive more than 50 mSv over the study period. Lead author Amita Kamath, MD, attributed repetitive imaging to complications, such as pseudocysts or necrosis.

MVCCs in diabetes associated with lower productivity, higher healthcare costs.
According to a study published in Diabetes Care, patients with diabetes and macrovascular comorbid conditions (MVCCs) have significantly higher healthcare costs and miss more days of work than other diabetics.

Lower plasma CETP activity appears to be associated with increased cardiovascular disease risk.
Lower plasma cholesteryl-ester transfer protein (CETP) activity is associated with an increased risk of cardiovascular disease, according to Boston University investigators. In contrast, among individuals with plasma CETP activity values above the median, there was an approximate 25 percent lower risk of cardiovascular events. According to the paper published in the journal Circulation, the findings "challenge the investigational concept currently being tested with various CETP inhibitors designed to boost HDL levels.

New UK doctors may be more likely to make prescription errors.
Study by the General Medical Council found that newly qualified doctors are twice as likely to make a mistake in prescribing than a consult. The mistakes found included omitting drugs, wrong doses, not taking account of a patient's allergies, illegible handwriting or the orders were ambiguous.

Standard of Medical Care (JCI Team Moolchand Medcity)

1. While writing prescription, mention proper strength of medicine instead of XX or 00 for the number of dose.
2. Do not use abbreviations in medical records.
3. Never cross any notes
4. Never overwrite any notes
5. Always mention the strength of the drug
6. Make the patient sign in consent form on patientís case record.
7. Whenever writing notes document name, signature, time and date.
8. When doing surgery, document pre-operative and post-operative diagnosis.

 Winter Asthma

Any breathlessness after the age of 40, appearing for the first time in winter, is cardiac asthma unless proved otherwise.

Such patients should immediately have their blood pressure checkup done and if high, needs immediate medical attention. First onset breathlessness can also be an indication of angina or heart attack.

However, the more common is winter asthma or acute exacerbation of winter COPD (chronic bronchitis).
Asthma is reversible airway obstruction and COPD is irreversible airway obstruction. Sudden exposure to cold, humidity, pollution at lower levels in atmosphere can precipitate asthma in susceptible individuals. Winter is the time to increase the dose of asthma medicines.
If a person can speak a full sentence, the asthma attack is mild; if a person speaks broken sentences the asthma attack is moderate and if the person is able to speak only words then the asthma attack is severe. Severe attack of asthma needs immediate hospitalization.
An attack of asthma is due to inflammation, narrowing and collection of fluid in the wind pipe and needs medicines to widen the wind pipe and reduce the inflammation.
The need of asthma medicines can be intermittent and/or permanent. The formula of two becomes handy in such situations. A person who consumes more than two canisters of inhalers in a year or consumes asthma medicines more than twice in the night time in a month or more than twice in a day in a week, he or she needs continuous asthma and anti inflammatory medicines. Inhalers are the best choices. 

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 Humor (krishan13629@yahoo.co.in)

1. Lecturer: write a note on Gandhi Jayanthi
So Santa writes, Gandhi was a great man, but I don't know who is Jayanth!.

2. When Santa was traveling with his wife in an auto, the driver
adjusted the mirror. Santa shouted, "You are trying to see my
wife? Sit behind. I will drive.

Concentrate on this Sentence (hozie kapadia)

To get something you never had, you have to do something you never did.  When God takes something from your grasp, He is not punishing you but merely opening your hands to receive something better. The will of God will never take you where the Grace of God will not protect you.  Something good will happen to you, something that you have been waiting to hear. 

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medinews: revisiting 2009

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 1200 registrations.

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 Letter to the editor

Dear Editor, In Mondayís EYE CARE SNIPPETS, under the head Notation of Lenses 900 and 1800 need to be read as 90 degrees and 180 degrees. Regards. Dr. Narendra Kumar: OptometryToday@gmail.com 



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