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Editor-in-Chief eMediNexus – Dr KK Aggarwal
25th August 2018
Think before you prescribe

Dr KK Aggarwal, Recipient of Padma Shri

Combination of ACEI/ARBs + diuretic + NSAID may be nephrotoxic

Triple therapy with NSAIDs, diuretics and an ACEI/ARB is associated with increased risk of acute kidney injury. In the retrospective cohort study of almost 5000 000 patients published in BMJ. 2013 Jan 8;346:e8525, the overall risk increased by 31% with the simultaneous use of these three drugs. The use of a double therapy combination containing either a diuretic or ACEI or ARB with NSAIDs was not associated with an increased rate of acute kidney injury.

Since the observed risk was greatest at the start of treatment "first 30 days of use", caution is warranted, especially during the initial few months of therapy. Monitor BP and serum creatinine when more than two anti-hypertensive drugs are used in combination with NSAIDs. more

Top News

UN General Assembly High-Level Meeting in September on Ending TB 2018

Heads of State will gather in New York on 26 September this year at the United Nations General Assembly first-ever high-level meeting on tuberculosis (TB) to accelerate efforts in ending TB and reach all affected people with prevention and care. The theme of the meeting is "United to end tuberculosis: an urgent global response to a global epidemic". This high-level meeting on TB follows on from a very successful Ministerial Conference on Ending TB in Moscow ... read more

PIB shares inspiring video on Twitter of PM wearing a seat belt

The Press Information Bureau has shared an inspiring video on Twitter on August 21, 2018 to promote road safety awareness, which shows Prime Minister Narendra Modi putting on his seat belt as soon as he enters his car. The PIB has put a question to its readers: "First thing the Prime Minister does when getting in his car is put his seat belt on...What’s your excuse?" and says ... read more

Morning Medtalks

Morning MEDTalks with Dr KK Aggarwal 25th August 2018

Medical device margins set to be capped at 65% in India.
Prime Minister Narendra Modi is likely to accept government think tank NITI Aayog’s recommendation to cap trade margin at 65% for medical devices. According to NITI Aayog’s formula, the MRP of a device will be decided by adding the trade margin to the price at the first point of sale (stockist). The trade margin is the difference between the price at which the manufacturers/importers sell to stockists and the price charged to consumers.... read more

Practice Updates

Non-invasive brain stimulation may help treat symptoms of rare movement disorders

Electrical stimulation of the brain and spinal cord may help treat the symptoms of neurodegenerative ataxias, rare movement disorders, according to a study published in the August 22, 2018, online issue of Neurology. There are several types of these disorders, which can be hereditary or occur randomly, ... read more

Some asthmatic women prone to develop COPD

Over 40% of women with asthma go on to develop chronic obstructive pulmonary disease (COPD), suggests a study published online July 17, 2018 in the journal Annals of the American Thoracic Society. Individual risk factors such as smoking, obesity and low socioeconomic status may contribute more to the development of asthma and COPD overlap syndrome... read more

Study shows efficacy of nivolumab + ipilimumab in melanoma patients with brain metastases

Nivolumab combined with ipilimumab had clinically meaningful intracranial efficacy, concordant with extracranial activity, in patients with melanoma who had untreated brain metastases in a study published in the New England Journal of Medicine online August 23, 2018. At follow-up of 14.0 months, the rate of intracranial clinical benefit was 57%, while the rate of extracranial clinical .... read more

Oral glutamine supplementation may help relieve symptoms of post-infection IBS-D

In patients with diarrhea-predominant irritable bowel syndrome (IBS-D) with intestinal hyperpermeability following an enteric infection, oral dietary glutamine supplements dramatically and safely reduced all major IBS-related endpoints of =50 points reduction on the IBS Severity Scoring (IBS-SS) System,... read more

Higher neutrophil count associated with more severe symptoms in patients with first-episode psychosis

As per a study reported online August 10, 2018 in Schizophrenia Bulletin, high neutrophil count is associated with reduced gray matter and enlarged ventricles in patients with first-episode psychosis. Higher neutrophil count was also associated with more severe symptoms.... read more

eMedi Humor
Medicolegal Corner
eMedi Quiz
1. pKa of a drug is the pH at which the drug is 50% ionized.
2. Small changes of pH near the pKa of a weak acidic drug will not affect its degree of ionisation.
3. Knowledge of pKa of a drug is useful in predicting its behaviour in various body fluids.
4. Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionised in plasma
Lifestyle Updates
Inspirational Story 1: A True friend
Inspirational Story 2: The 12 Gifts of Birth
Indoor air pollution can cause as much harm as pollution outdoors
A campaign against indoor pollution has been launched as part of the 25th MTNL Perfect Health Mela 2018
New Delhi, 24th August 2018: According to statistics, indoor air pollution is the second largest killer causing about 1.3 million deaths in India each year. Indoor pollution is a serious health hazard, and in a country like India, it becomes increasingly important to address challenges associated with indoor cooking especially in rural areas. Indoor air quality can also deteriorate due to harmful chemicals and other materials and can be up to 10 times worse than outdoor air pollution.

Poor ventilation and structural designs can trap volatile organic compounds, bioaerosols, and particulate matter leading to many health ailments including impairment of lung function. What exacerbates the situation further is that in the absence of a policy on indoor air policy in India, it is difficult to measure the actual impact.

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