HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
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)



You can download previous issues from www.emedinews.in

16th December Wednesday

Dear Colleague,

                                        Can an epileptic drive

             The seizure free interval is the most practical used measure of driving risk.  Seizure free intervals of 6-12 months are associated with reduced risk of seizure related motor vehicle accident. In some studies shortening seizure free intervals to three months has not been associated with increased motor vehicle accidents.

              Other factors may increase or decrease the risk of a seizure related crash and should be considered when making recommendations for driving.

1. High seizure frequency, medical noncompliance, a history of MVAs, and other factors increase the risk of seizure related MVA. These should be considered to extend the seizure free interval requirement for driving recommendations.

2. An established pattern of purely nocturnal seizures, consistent and reliable seizure auras, clear provocation, or acute symptomatic seizures in a condition that is not associated with epilepsy or is unlikely to recur may reduce the seizure free interval requirement.

3. Clinicians should also consider other neurologic contraindications for driving in their patients with epilepsy, including impaired cognition and visual field defects.

Dr KK Aggarwal



 FDA approves Kalbitor for acute attacks of hereditary angioedema
On December 1, 2009, the US FDA approved Kalbitor (ecallantide) for the treatment of acute attacks of hereditary angioedema (HAE) in patients aged 16 years and older. Kalbitor is a selective, reversible, plasma kallikrein inhibitor and is the first subcutaneous HAE treatment to receive FDA approval. According to Dyax, HAE is caused by low or dysfunctional levels of C1-esterase inhibitor (C1-INH), a naturally occurring molecule that inhibits plasma kallikrein (a key mediator of inflammation) and other serine proteases in the blood.

FDA cautions about risk of birth defects with valproate
In December, the US FDA announced a reminder to health care professionals about counseling women of childbearing potential taking sodium and related products (valproic acid and divalproex sodium) about the increased risk of major malformations, including neural tube defects, when the drug is taken during pregnancy. The risk of NTDs is especially higher in infants born to mothers treated with valproate during the first 12 weeks of pregnancy, with the risk increasing to 1 in 20 infants. The North American Antiepileptic Drug (NAAED) Pregnancy Registry data showed that infants born to women with epilepsy taking valproate (monotherapy) is almost 4 times higher than the rate of major malformations in infants born to women with epilepsy taking a different antiepileptic drug.

Useful link
Visit this website to calculate the QFracture Scores, two new fracture clinical risk scores to predict risk of osteoporotic fracture in your patients or for patient self-assessment. QFracture Scores provide precise and useful tools to predict long-term risk of osteoporotic fracture and hip fractures, without the need for bone density measurement or other laboratory tests. They incorporate the traditional variables already included in the FRAX (fracture risk assessment) algorithm and add other factors that enhance fracture risk viz. history of falls, type 2 diabetes, cardiovascular disease, asthma, use of hormone replacement therapy (HRT) and tricyclic antidepressants.

H1N1 virus attacks lungs unlike seasonal flu
As per a study published in the Archives of Pathology and Laboratory Medicine, the H1N1 flu virus damages the entire airway, from the upper respiratory tract down to the alveoli in the lungs. This is similar to the viruses that caused the deadly 1918 and 1957 influenza pandemics. Whereas, the seasonal flu causes most damage in the trachea and the bronchial tree, but not deep in the lungs, observed Jeffery Taubenberger, a researcher. The study findings also pointed out that compared to the seasonal flu, the H1N1 virus is affecting the younger age group more severely.

Warning Signs of Severely High Blood Pressure
Hypertension is usually silent and quite often, there may be no signs of hypertension at all. It is mostly detected accidentally. But symptoms of high blood pressure may appear when the condition is severe. High blood pressure is dangerous.

1. Feeling confused or other neurological symptoms
2. Nosebleeds
3. Fatigue
4. Blurred vision
5. Chest pain
6. Abnormal heartbeat

Silent or atypical GERD
Some of the most common symptoms of gastroesophageal reflux disease, or GERD, are heartburn and acid reflux. But not all people with GERD experience obvious heartburn. Intead, they report a wide variety of different symptoms. In these individuals, the disease is not actually silent; but it has an atypical presentation. Some of the symptoms reported by patients with silent GERD are:
1. Throat problems: Acid reflux into the back of the throat or pharynx can cause symptoms such as persistently sore throat; patients constantly need to clear their throat. They may also complain of difficulty in swallowing.
2.Hoarseness: As stomach acid comes up onto their voice box, or larynx, such patients may have a hoarse voice, especially in the morning.
3. Respiratory problems: such patients may have wheezing or difficulty in breathing due to airway irritation because of the acid reflux. Silent GERD can exacerbate underlying bronchial asthma.
4. Dental problems: Stomach acid that regurgitates into the mouth can erode the protective enamel of the teeth, causing teeth to become fragile and discolored.

Body clock disturbances linked to heart disease
Cardiovascular disease may be linked to disturbances in the body's 24 hour clock, called the circadian clock, says a new Japanese study. Working on mice, the scientists found a genetic risk factor for a type of high blood pressure influenced by 24 hour or circadian rhythms. The study is published in the journal Nature Medicine. This gene has an important role in the production of a hormone called ldosterone that prompts water retention in the kidneys.

Hepatitis C curable, soon
A trial drug called SPC3649 has been introduced by the Danish researchers to treat hepatitis C. They have successfully carried out a test on chimpanzees. The drug effectively subdued the virus in chimps. Hence the study team is optimistic that it could be applied to humans as well to treat progression of disease. A kind of nucleic acid by the name of 'locked nucleic acid' is used in the trial. The acid arrests the molecule, microRNA122, which the hepatitis C virus employs to multiply itself.

Only one lakh with AIDS every year, says NACO
According to an announcement on World AIDS Day, the National AIDS Control Organization (NACO) says the number of new infections in the country is down by one lakh every year. The number of people living with AIDS in 2002 was 27 lakh, but that was reduced to 23 lakh in 2007, showing a decline by 400,000 in the past five years. This was due to extensive AIDS campaign and use of condoms. A Red Ribbon Express Phase II was flagged off on that day to spread awareness among the rural of 10,000 villages in 141 districts and to help contain the spread of the disease. According to K Chandromouli, Director General, NACO, besides providing counseling, the train would also identify individuals who need to be tested and require antiretroviral treatment. Those requiring treatment would be referred to designated hospitals in the region by the doctors on board the train.

PANDAS, sneezing disease
A new disease called 'PANDAS' (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus) has been diagnosed by US doctors. Lauren Johnson, a 12 year old had been sneezing since November (after a bad cold) at a rate of 12,000 sneezes a day. She was sneeze free only when asleep. Doctors say PANDAS most commonly follows a strep throat infection. She has been put on antibiotics and reported to be getting better.

A little girl attending the school clinic started crying as the doctor approached her. "I'm only going to take your pulse," the doctor explained. "But don't I need it?" sobbed the little girl.

"Doctor, Doctor, You've got to help me - I just can't stop my hands shaking!" "Do you drink a lot?”"  “Not really - I spill most of it!"

Lessons in life
1. Life is too short to waste time hating anyone.
2. You don't have to win every argument.  Agree to disagree.
3. No one is in charge of your happiness except you.   
4. Bad officials are elected by good citizens who do not vote.
5. Remember, Life isn't tied with a bow, but it's still a  gift.

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 Sir William Osler, Father of Modern Medicine
Sir William Osler was a Canadian physician and professor of medicine who practiced and taught in Canada, the United States, and Great Britain. His book, 'The Principles and Practice of Medicine' has been a bible to both medical students and clinicians. Some of his most famous quotes include:

1. He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.
2. It is much simpler to buy books than to read them and easier to read them than to absorb their contents.
3. Soap and water and common sense are the best disinfectants.
4. The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.
5. There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man must be familiar with their manifestations in many organs.
6. The good physician treats the disease; the great physician treats the patient who has the disease.
7. Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.

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medinews: revisiting 2009
IJCP Group is organizing emedinews: revisiting 2009, 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 (Dr KK Aggarwal, Dr Naresh Trehan, Dr Ajay Kriplani, Dr Praveen Chandra, Dr Harsh Mahajan, Dr Kaberi Banerjee, Dr N K Bhatia, Dr V Raina, Dr Ajit Saxena, Dr S C Tewari, Dr Vanita Arora etc) will deliver lectures. CME will be followed by lively cultural evening (guest performances by noted singers Shabani Kashyap, Vipin Aneja and top singers of our medical profession), doctors of the year award, dance and dinner. For registration mail 
emedinews@gmail.com. We have crossed 1200 registrations.



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