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
11th November Wednesday
Following are the excerpts of a seminar organised at Moolchand Medcity. Speakers were Dr. N.P. Singh, Dr. S. Saxena and Dr. Sandeep Guleria.
- In India there are 1 lakh renal failure patients at any time but only 2500 to 3500 undergo transplant.
- After transplant in the first year, the cost is equivalent to that of one year cost of dialysis but in second year onwards the cost is 20% of dialysis cost.
- Donating kidney is not 100% safe. One in 4000 may lose life and one in 40 may require reopening for chest tube insertion.
- In India, 64% donors are females, usually wife or mother.
- The concept of marginal donors is picking up which means people with multiple renal arteries, obesity, hypertension, tuberculosis, ectopic kidney, tubular sclerosis, scoliosis can also donate kidney.
- Fungal hyphae in urine require no treatment unless there is sepsis.
- GFR and serum creatinine levels do not go together.
- Do not give NSAIDs unless they are a must.
- If BP is high before the age of 20 or after the age of 50, look for secondary causes.
- Catch diabetes and hypertension early and treat rigorously to prevent renal failure.
- Always give drugs as per estimated GFR.
- Stents should not be put in every renal artery stenosis.
- Use Ace Inhibitors with caution.
- If GFR is more than 60, protein restriction in diet is not required.
- North Indians eat more tomato and South Indian eat more Imli that may be the reason that stones are less common in South Indians.
- Patients with renal failure must be encourages to produce at least 2 ltrs of urine.
- People who eat less of maithi and saag can have precipitation of oxalate crystal in urine.
- BP spikes with aircraft sound (even during sleep) and with traffic sound and snoring of same intensity (HYENA Study)
- If BP & diabetes are kept under control, 75% dialysis & transplants can be prevented.
- Smoking, high blood pressure, and high cholesterol,together reduces lifespan by 10 years for 50-year-old men.
- If salt intake is less than 2.3 grams a day there would be 1.1crore less patients of high BP
- A 5 mmHg reduction in upper reading and 2 mmHg reading in the lower reading of the community can reduce the incidence of heart attack, paralysis and heart failure by up to 40%.
- If uncontrolled, blood pressure can cause heart attack, paralysis and kidney failure. High blood pressure is responsible for 67% of all heart attacks, 77% of all paralytic attacks; 74% of all heart failure cases and 26% of all kidney diseases
- High blood pressure causes more visits to doctors than any other condition.
- High blood pressure is a risk factor for mental deterioration and dementia.
Dr K K Aggarwal
emedinews sends condolence to untimely death of the son of Dr Z S Meherwal, HOD Cardiothoracic surgery at Escorts Heart Institute. My God give the courage to the family to bear the loss. You can SMS condolence message to Dr Meherwal at 9810149301.
Anabolic Steroid Abuse May Damage Kidneys
Among other hazards, bodybuilders who use anabolic steroids to improve their physique may be putting their kidneys at risk. Ten bodybuilders who admitted to long term use of steroids and other performance enhancing drugs developed focal segmental glomerulosclerosis that was more severe than the condition found in a historical control group of morbidly obese individuals, Leal Herlitz, MD, of Columbia, reported at the American Society of Nephrology meeting. They had higher mean serum creatinine (3.0 versus 1.47 mg/dL) and proteinuria (10.1 versus 4.09 g/day) and more glomerular and tubulointerstitial scarring. This was despite a lower BMI among the bodybuilders (34.6 versus 41.7 kg/m2)
Regular Soda Not to Blame for Hyperuricemia
Drinking regular soda is not associated with the development of hyperuricemia or chronic kidney disease as per a large epidemiological study.
Although drinking more than one soda a day was earlier shown to be associated with an increased risk of prevalent hyperuricemia, the link disappeared in a longitudinal analysis, as per Andrew Bomback, of Columbia University at the American Society of Nephrology meeting.
The longitudinal look allows the investigators to better adjust for confounders and explains why the findings differ from previous epidemiological studies that identified a relationship between drinking regular soda and kidney disease.
Sugared soda consumption, is just a marker for some lifestyle factors like going to McDonald's, sitting on the couch, playing video games, not eating enough fruits and vegetables, smoking, or drinking. The study examined data from 15,745 participants in the Ath erosclerosis Risk in Communities (ARIC) study. Mean uric acid level went up as consumption increased from 6.0 to 6.2 to 6.3 mg/dL. Hyperuricemia was defined as a uric acid level greater than 5.7 mg/dL in women and 7.0 mg/dL in men. Drinking more than one soda a day was associated with prevalent hyperuricemia compared with drinking less than one a day. The association between soda consumption and prevalent chronic kidney disease approached statistical significance. A longitudinal analysis, however, found no significant association between soda consumption and the development of hyperuricemia or chronic kidney disease.
Statin Does Not Enhance Sensitivity to Anemia Treatment
Although statins get credit for many benefits besides lowering lipids, they apparently don't increase sensitivity to anemia treatment in patients on hemodialysis, a post hoc analysis has shown. Two small, uncontrolled studies of 30 and 33 patients published within the last year suggested that treatment with atorvastatin might improve responsiveness to erythropoietin in anemic patients on maintenance hemodialysis, but a post hoc analysis of the larger and placebo-controlled 4D (Deutsche Diabetes Dialyse Studie) trial did not find the same benefit in patients treated with the statin (Source: American Society of Nephrology meeting)
Do night time dialysis
Doubling the time spent on dialysis by doing it while patients are sleeping is associated with increased sensitivity to treatments for anemia. After a group of patients switched from standard in center hemodialysis to nocturnal hemodialysis, the mean required dose of erythropoiesis stimulating agent (ESA) decreased from 19,334 units per patient per week to 17,426 units (P<0.002), according to Linda Francisco, medical director for DaVita. Despite the decrease in the ESA dose, hemoglobin levels remained steady after conversion to nocturnal dialysis at a mean of 12.1 g/dL. Thus, erythropoietin sensitivity a ratio of mean hemoglobin level to the ESA dose per patient per month increased.
Chronic Acid Suppression Linked to Bacterial Overgrowth
Chronic acid suppression therapy may predispose otherwise healthy individuals to clinically significant small intestinal bacterial overgrowth (SIBO). In the study half of patients on chronic acid suppression had positive lactulose breath tests, compared with about 30% of a control group. Chronic acid suppression was associated with a significantly higher proportion of bacteria that produced mixed hydrogen methane gas.
If a patient has small bowel bacterial overgrowth and has no other risk factors for it, physicians might consider stopping treatment with a proton pump inhibitor, if the patient can tolerate it, to prevent recurrence of the bacterial overgrowth, Dr Walter Chan of Brigham and Women's Hospital in Boston, said during a presentation at the American College of Gastroenterology meeting.
Formula to know
Erythropoietin sensitivity: is the ratio of mean hemoglobin level to the ESA dose per patient per month.
Mistake to be avoided
Write fluids to be given IV every hour and not 4 bottles in one day. In that case the nurse on duty may give 1 bottle in 20 hours and the next three in 4 hours.
Tip of use in clinical practice
When ordering IV calcium slow, write 1cc every minute and not 10 ml IV slow.
Humor (Dr N K Kaphatia Aurangabad)
A Woman and her husband approach their pharmacist and begin to ask questions like if the pharmacy checks for medications past their expiration date and the reliability of a certain company that makes birth control pills. Finally the pharmacist asks the couple what's the matter. The wife explains, 'In spite of using birth control pills I continue to get pregnant."
The pharmacist is astounded and asks the woman if she takes them every day.
The woman replies, "My husband takes them every day."
"What ?" the pharmacist croaks.
"Yep. After we read all those potential side-effects, my husband said ' Ah honey.. I don't what you taking that stuff...it's too dangerous,...let ME take them.'
Letter to the ditor
1. Dear.Dr.Aggarwal, Let me at the onset thank you for bestowing the honour on me by introducing me to the audience on 7th Nov during the seminar on replacement of knee joints. The topic of knee replacement was informative and lot of misgivings were cleared by the speaker. Specially that these days instead of cutting the muscle, they are lifting from the side and doing the required repair to the knee and the patient is able to lift his legs within 2 days. Ashok Ahooja (Sqn. Ldr(Retd)}
2. I enjoy reading the emedinews as it is quite informative and is a good mix of current medical and scientific happenings. Only one suggestions in the medico legal stories donot carry the actual names of medical personnel. Dr K K Handa
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