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Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
President, Heart Care
Foundation of India
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)
FIRST NATIONAL DAILY MEDICAL NEWSPAPER OF INDIA
22nd December Tuesday
Private Government Collaboration in National Board of Examination: Dr. Srikant Reddy
Dr. Srikant Reddy, President National Board of Examination while inaugurating Medicine Update at Maulana Azad Medical College said that all doctors should be taught Epidemiology. There should be a merger of clinical sciences with epidemiological science. Regarding National Board of Examination, he said that DNB centers must collaborate with each other whether they belong to government medical colleges or private hospitals running DNB courses.
Present on the occasion, Dr. A K Aggarwal, Dean Maulana Azad Medical College and Dr. Banerjee, Medical Superintendent, offered Maulana Azad Medical College facilities to all the DNB students of NCR to attend classes, lectures and clinical discussions. Dr. N.P Singh, the organizer of the conference, said that this will help improving standards of DNB education in the country.
Following are a few of the excerpts of the conference:
1. Anti retroviral treatment has changed the scenario of AIDS from a death sentence to a chronic manageable disease. HIV has three letters and requires 3 tests to diagnosed. Similarly ART also has three letters and requires minimum three drugs to treat. If HIV is treated inadequately, resistance can develop within years requiring second line drugs which cost minimum Rs. 1 lakh per year per patient (Dr. B B Rewari).
2. The carrier rate of HBsAg is 1.5 to 2% in India. In adults, 90% hepatitis B virus infection clears but in children, 85% ends up in chronic liver disease. In Hepatitis B infection, acute viral hepatitis is seen in 15 to 40% cases. (Dr. P. Kar).
3. Opportunistic infections in HIV- AIDS must be detected and treated early as they may lead to rapid progression of HIV-AIDS and fall of CD4 count.
4. All HIV patients must be given primary prophylaxes if the CD4 count is less than 250. The drug of choice is Septran DS one daily. Fluconazole is only given as secondary prophylaxes if the patient has suffered from Cryptococcus Meningitis in the past. CD4 count can predict opportunistic infections. Infections like Oral Candida, H Zoster indicates a CD4 count of more than 300, and diseases like PML and Cryptosporidiosis means a CD4 count of less than 50. (Dr. S. Anuradha). (Dr. S. Anuradha).
5. In HIV nephropathy, there is no hypertension, no edema. 4D [Dyslipedemus, Dementia, Diabetes and Drugs (ART)] are 4 non communicable diseases seen in HIV-AIDS.
6.Patients on antiretroviral therapy for HIV AIDS have 3.1 times more chances of developing diabetes. (Dr. Suresh Kumar)
DR KK Aggarwal
We should practice High Touch practice and not high tech practice.
Rules: High touch practice means a careful history, examination and a critical analysis to decide which tests needs to be done and then selecting the simpler tests first. Dr A P Jain (MGIMS).
What is new in CAD? (Revisiting cardiology 2009)
1. In July 2009 the USFDA approved the oral anti platelet agent prasugrel for use (along with aspirin) in patients with acute coronary syndromes (ACS) undergoing PCI. TRITON-TIMI 38 trial in covered 13,000 patients with ACS who underwent PCI and randomly assigned to either prasugrel or clopidogrel [N Engl J Med 2007; 357:2001]. Patients with non-ST elevation ACS received anti platelet treatment after coronary angiography, while those with ST-elevation myocardial infarction received them before coronary angiography. At 15 months the primary endpoint, cardiovascular death, non-fatal myocardial infarction, or non fatal stroke, occurred significantly less often with prasugrel (9.9 versus 12.1 percent).
2. A number of peri operative factors influence the rate of operative mortality after CABG. The ACEF (Age, Creatinine, Ejection fraction) score has been developed and includes only three variables and is derived from a population that underwent elective open heart surgery [Circulation 2009; 119:3053.]. ACEF was able to predict mortality.
3.The randomized PLATO trial compared ticagrelor, an anti platelet drug with clopidogrel in 18.000 patients with ACS. [N Engl J Med 2009; 361:1045]. At 12 months, the death from vascular causes, MI, or stroke occurred significantly less often in patients receiving ticagrelor (9.8 percent versus 11.7 percent with clopidogrel). There was no significant difference in major bleeding.
4. Among patients undergoing major vascular surgery, ONE SHOULD continue statins in patients already being treated with a statin. Should statins be stated untreated patients with vascular disease the evidence comes from the DECREASE III trial. The trial randomly assigned 500 patients to either 80 mg of extended release fluvastatin daily or placebo 30 days before elective non cardiac vascular surgery. Myocardial ischemia and or transient ECG abnormalities within 30 days of surgery, occurred significantly less often in the fluvastatin group (10.8 versus 19.0 percent). [ N Engl J Med 2009; 361:980]
5. A subgroup analysis of 1500 patients in the ACUITY trial who had ACS and underwent CABG found that those who received clopidogrel, compared to those who did not, had significantly fewer death, myocardial infarction, or unplanned revascularization at 30 days with no different bleeding rates. Clopidogrel should not be withheld due to concerns of excess bleeding in this population.[J Am Coll Cardiol 2009; 53:1965]
News and views (Dr G M Singh)
Imperforate hymen is a relatively rare congenital anomaly. However, it is not an uncommon cause of lower abdominal pain presenting in teenage girls. Without careful history taking and thorough examination, the condition can be missed easily.
Transfats: The data obtained in Indian adolescents has shown that a consistent proportion of adolescents do not follow the nutritional recommendations for intake of trans fats, a risk factor for cardiovascular diseases.
Patients with osteoporosis or osteopenia have a 1.7 times higher chance of stress test induced myocardial ischemia than those with normal BMD after controlling the confounding effects of systemic hypertension, diabetes mellitus, body mass index, and age.
Gabapentin enacarbil at 1200 mg significantly improve restless leg syndrome symptoms compared with placebo. Efficacy outcomes for GEn at 600 mg is similar to placebo.
Dr Good Dr Bad
Situation: a child was suspected to have nephrotic syndrome
Dr Bad: Get an urgent KUB X ray done
Dr Good: Get urine dipstick, random urine protein to creatinine ratio, serum creatinine, serum albumin, lipid panel done
Lesson: Imaging studies are generally not needed in the evaluation of nephrotic syndrome.
Tip: The production and use of tissue culture vaccine in rabies should be encouraged with the aim to phase out neural tissue vaccine. Indian J. Pediatr. 2003 Mar.;70(Suppl. 1):S11 S16.
Funny clinical notes (Dr. Minakshi)
She is numb from her toes down.
Health Tips (Dr Prachi Garg), Signs That You Might Be Malnourished
1. Losing consciousness or fainting.
2. Lack of menstrual periods in pre menopausal women.
3. Stunted growth in children.
4. Sudden loss of hair.
Dr Monica Vasudeva (Source: Office of Pediatric Medical Education.)
TO REDUICE STRESS CHANGE YOUR PERCEPTION: In the book who moved my cheese, Dr. Spencer Johnson, MD tells a short story about two mice Hem and Haw who struggled with change. The change was disappearance of their daily nutrition source and the need to search out a new one. Lessons:
1. Change Happens
2. Anticipate Change
3. Monitor Change
4. Adapt to Change Quickly
6. Enjoy Change
7. Be Ready to Quickly Change Again and Again
emedinews: 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 (revisiting 2009), Dr Naresh Trehan (whats new in Cardiac Surgery), Dr Anupakm Sibal (a decade of liver transplant in India), Dr Ajay Kriplani (Surgical cure for Obesity and Diabetes), Dr Praveen Chandra (left main stenting), Dr Kaberi Banerjee (all about infertility), Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephrology update), Dr. Ambrish Mithal (Diabetes), Dr Vanita Arora (ECG arrhythmias), Dr Subramanium (Co Q 10 a new modality), Dr Neelam Mohan (Coeliac Disease) and Dr. Sanjay Chaudhary (Eye Update etc) will deliver lectures.
CME will be followed by lively cultural evening (guest performances by noted singers Shabani Kashyap, Vipin Aneja and by top singers of our medical profession Dr Praveen Khillani, Dr and Dr Mrs Subramanium, Dr Lata Tandon, Dr Arti Pathak, Dr Sanjay Chugh (on the drum), Dr Sudipto Pakrasi, Dr Harjeet Kaur, Dr Ramni Narsimhan, Dr Yash Gulati (Anchor) Dr Reshma Aggarwal (Anchor), doctors of the year award, dance and dinner. For registration mail email@example.com. We have crossed 1200 registrations.
You can gift emedinews to some one just write to firstname.lastname@example.org
Also if you like emedinews you can FORWARD it to your email addresses
Letter to the editor : Dear Dr K K Aggarwal Ji, I have always taken keen interest in your spiritual expositions and symbolic interpretation of life events in a broader (spiritual Dimensions). On the subject of dharma, kama, artha and moksha I would like to add the following.
This knowledge is not religion, time, place or people specific but timeless wisdom as taught to us by our wise Rishis. This knowledge can be imbibed only in the company of enlightened masters and not through books just like medicine has to be learnt in the company of senior and experienced doctors.
These four are not acts but essential factors in any act being performed. Dharma means nature (property, righteousness, duty and religion) Artha means the 'means'. Kama means kamna or desire (until unless there is desire, no action occurs). Last and not the least is moksha or release from desire (once the action has been accomplished) otherwise life cannot continue.
We need the desire to grind the wheat (kama), wheat and the grinder, (artha) It is the property of wheat to be grinded (dharma) and after grinding you have to have release from the desire to grind the wheat (moksha). Dr. J P Jain