medinews january 2010
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Medinews January 2010TRANSCRIPT
Dr KK AggArwAlGr. Editor-in-Chief, IJCP Group
MemberThe Indian Newspaper Society
Official Voice ofDoctors of India
Pages 16
Dr KK AggarwalPadma Shri and Dr BC Roy National Awardee
Sr Physician and Cardiologist, Moolchand MedcityPresident, Heart Care Foundation of India
Group Editor-in-Chief, IJCP GroupEditor-in-Chief, eMedinewS
Chairman Ethical Committee, Delhi Medical CouncilDirector, IMA AKN Sinha Institute (08-09)
Hony. Finance Secretary, IMA (07-08)Chairman, IMA AMS (06-07)
President, Delhi Medical Association (05-06)[email protected]
http//twitter.com/DrKKAggarwalKrishan Kumar Aggarwal (Facebook)
E d i t o r i a l
MAKe Sureduring MEdical PracticE
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A 11-year-old child with diarrhea had little response with the prescribed antibiotics.
Make sure that lactobacilli are prescribed along with antibiotics because they restore the normal flora of the gastrointestinal tract and decrease the duration of diarrhea.
Dr KK Aggarwal
I n s I d e
Smoking: An Enemy of LongevitySmoking contributes to heart disease, osteoporosis, emphysema and other chronic lung problems and stroke.It makes breathing during exercise much harder and thus can make activity less enticing.It appears to compromise memory, too.
Quitter WinsPeople who quit smoking can repair some, if not all, of the damage done.
After a smoker quits, the risk of heart disease begins to drop within a few months, and in five years, it matches that of someone who never smoked.Stroke risk drops to equal that of a nonsmoker within 2 to 4 years after a smoker quits.The death rate from colorectal cancer also decreases each year after quitting.At any age, quitting progressively cuts your risk of dying from cancer related to smoking, although this drop is most marked in those who quit before age 50.
(Source HealthBeat)
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Clinical Tips 3
Top 22 Stories of the Year 2010 6
Photo Quiz 9
OH My God! you should have added lactobacilli to the antibiotic Regimen
It is not in the stars to hold our destiny but in ourselves. —William Shakespeare
Anger and intolerance are the twin enemies of correct understanding.
—Mahatma Gandhi
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Vol. 11, No. 1, January 2011 ISSN 0971-880X Single Copy rs. 100/-
Cystatin C Beats Creatinine at Predicting Complications of
Kidney DiseaseTesting for cystatin C, a protease inhibitor made by most cells and a biomarker of renal function, more accurately identifies chronic kidney disease (CKD) patients who are at high risk for complications than creatinine testing does, according to a new study in the Journal of the American Society of Nephrology on Dec. 16.
ACR Hybrid Score More Sensitive than the ACR20
Response CriteriaResults of a post-hoc analysis show that ACR hybrid is more sensitive than the ACR20 response criteria in detecting response to therapy in rheumatoid arthritis. The hybrid score - which combines the ACR20/50/70 scores with percent change from baseline in multiple disease domains. The study is reported in the January issue of Arthritis Care & Research.
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Dr KMK Masthan
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D.O. No.: 5982RM/2009Dated: 23-12-09
Clinical TipsBackground: Peptic ulcer bleeding is usually treated endoscopically, then followed by proton pump inhibitor therapy, and the discontinuation of aspirin or other antiplatelet agents until the ulcer heals. The resulting risk of cardiovascular or cerebrovascular events and death is believed to be offset by reducing the risk of recurrent bleeding, but the true risk-benefit ratio is unknown. Sung and colleagues conducted a randomized, placebo-controlled trial to examine the effect of continuing aspirin therapy in patients being treated for peptic ulcer bleeding. The Study: The authors recruited 156 patients with acute peptic ulcer bleeding who were already on low-dose aspirin (325 mg per day or less) for prophylaxis or treatment of cardiovascular disease. Within 24 hours of bleeding onset, all patients received endoscopic treatment with epinephrine and thermal coagulation, followed by pantoprazole (Protonix; 80-mg bolus intravenously, then 8 mg per hour intravenously for 72 hours, then 40 mg per day orally for the remainder of the study). After endoscopic hemostasis was achieved, patients were randomized to receive 80 mg per day of aspirin or placebo for eight weeks and were monitored for episodes of recurrent peptic ulcer bleeding and cardiovascular or cerebrovascular events. Patients were excluded if they were using aspirin for primary prophylaxis; had gastric outlet obstruction or ulcer perforation; were taking corticosteroids, nonsteroidal anti-inflammatory drugs, or other anticoagulants; or if hemostasis could not be achieved.
Aspirin after Peptic Ulcer Bleeding: Is It Worth the Risk?Results: Although the 30-day incidence of recurrent ulcer bleeding was 10.3 percent in the aspirin group and 5.4 percent in the placebo group, the risk comparison was not statistically significant (hazard ratio [HR] = 1.9; confidence interval, 0.6 to 6.0). Total number of units of blood transfused and duration of hospital stay were similar between the two groups. However, the aspirin group had a significantly lower 30-day mortality rate than the placebo group (1.3 versus 9.0 percent; HR = 0.2), with similar estimates of eight-week mortality (HR = 0.2). Mortality caused by cardiovascular, cerebrovascular, or gastrointestinal complications was also lower in the aspirin group (HR = 0.2). Conclusion: The authors conclude that continuing lowdose aspirin therapy after peptic ulcer bleeding may increase the risk of rebleeding, but it is also associated with a 12 percent reduction in all-cause mortality in comparison with placebo. The protective effect of aspirin (in combination with pantoprazole) seems to outweigh its potential gastrointestinal toxicity in these patients. The authors of this study tentatively suggest that aspirin be stopped for three to five days after the index bleed and resumed after stabilization, because most observed deaths from gastrointestinal bleeding occurred within the first few days after index bleeding. However, confirmatory studies examining the optimal time to restart antiplatelet therapy are needed.
Source: Adapted from Am Fam Physician. 2010;82(11):1395-1396.
What is the Best Vasopressor for the Treatment of Shock?Background: Consensus guidelines recommend that dopamine or norepinephrine be the first-choice vasopressor for patients in shock. Dopamine may increase splanchnic and renal perfusion more than norepinephrine, but observational studies have reported that it is also associated with a greater risk of death.
The true benefits of these agents compared with each other are unknown. De Backer and colleagues conducted a multicenter, randomized, double-blind trial to determine if using norepinephrine instead of dopamine could reduce the death rate among patients in shock.
The Study: The authors enrolled 1,679 adult patients in shock (i.e., signs of tissue hypoperfusion despite hydration, with a mean arterial pressure less than 70 mm Hg or systolic blood pressure remaining below 100 mm Hg) who received dopamine or norepinephrine.
If hypotension persisted with the maximal drug dosage (20 mcg per kg per minute for dopamine or 0.19 mcg per kg per minute for norepinephrine), open-label norepinephrine was added. Patients were excluded for serious arrhythmias (e.g., rapid atrial fibrillation [more than 160 beats per minute]) or if they had already received a vasopressor for more than four hours during the current episode of shock.
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DoCtor of the yeAr AwArDS
Dr AN MalviyaeMedinewS Distinguished Speaker of the Year 2010 Award
Dr Naresh trehaneMedinewS Life Time Achievement Award
Dr Praveen ChandraeMedinewS Medical Statesman of the Year the 2010 Award
Dr Neelam MohaneMedinewS Most Popular Doctor of the Year 2010 Award
Dr AK AggarwaleMedinewS Medical Doctor of the Year 2010 Award
Dr hK ChopraeMedinewS Medical Doctor of the Year 2010 Award
Dr Kaberi BanerjeeeMedinewS Medical Doctor of the Year 2010 Award
Dr NK BhatiaeMedinewS Distinguished Speaker of the Year 2010 Award
Dr Neelam KlereMedinewS Medical Doctor of the Year 2010 Award
Dr Subhash AryaeMedinewS Life Time Achievement Award
Dr Vinay Sanghi eMedinewS Medical Doctor of the Year 2010 Award
Dr SC tiwari eMedinewS Distinguished Speaker of the Year 2010 Award
Dr Mahesh VermaeMedinewS Medical Statesman of the Year the 2010 Award
Dr Anupam SibaleMedinewS Distinguished Speaker of the Year 2010 Award
Dr Swati BhaveeMedinewS Medical Doctor of the Year 2010 Award
Dr AS SoineMedinewS Medical Statesman of the Year the 2010 Award
Dr Ashok SetheMedinewS Medical Statesman of the Year the 2010 Award
Dr ranjit roy ChaudhuryeMedinewS Medical Statesman of the Year the 2010 Award
Dr Ambrish MithaleMedinewS Medical Statesman of the Year the 2010 Award
Dr rohini honda eMedinewS Distinguished Speaker of the Year 2010 Award
Dr reshma AggarwaleMedinewS Medical Doctor of the Year 2010 Award
Dr Sudhir guptaeMedinewS Medical Doctor of the Year 2010 Award
Dr Sudhir Kumar guptaeMedinewS Medical Doctor of the Year 2010 Award
Dr rajiv ParakheMedinewS Medical Doctor of the Year 2010 Award
Dr Praveen Bhatia eMedinewS Distinguished Speaker of the Year 2010 Award
Dr Anoop SaryaeMedinewS Distinguished Speaker of the Year 2010 Award
Dr Sanjay Choudhary eMedinewS Distinguished Speaker of the Year 2010 Award
Dr Sheh rawat eMedinewS Distinguished Speaker of the Year 2010 Award
Dr girish tyagieMedinewS Medical Doctor of the Year 2010 Award
Dr yash gulatieMedinewS Medical Singer of the Year Award
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eMedinewS life time Achievement Award Dr Subhash Arya
Dr Naresh trehan
eMedinewS Medical Statesman of the year the 2010 Award Dr Praveen Chandra
Dr Ambrish Mithal
Dr AS Soin
Dr Ashok Seth
Dr ranjit roy Chaudhury
Dr Mahesh Verma
eMedinewS Medical Singer of the year Award Dr N Subramanium
Dr lalitha Subramanium
Dr ramani Narasimhan
Dr Arti Pathak
Dr Praveen Khilanani
Dr harjit Kaur
Dr yash gulati
eMedinewS Medical Doctor of the year 2010 Award Dr MK Pal
Dr AK Aggarwal
Dr S Bhattacharjee
Dr AC Dhariwal
Dr Kaberi Banerjee
Dr Ajay Kriplani
Dr Vijay trehan
Dr yatin Mehta
eXCelleNCe AwArDS
Dr Ashok rajgopal
Dr Sudhir gupta
Dr rajvardhan Azad
Dr Sudhir Kumar gupta
Dr Neelam Kler
Dr Veena Chowdhry
Dr hK Chopra
Dr reshma Aggarwal
Dr girish tyagi
Dr Anoop Sarya
Dr Vinay Sanghi
Dr rajiv Parakh
Dr Swati Bhave
eMedinewS Distinguished Speaker of the year 2010 Award Dr Anil goyal
Dr SC tiwari
Dr DM Mahajan
Dr Awdesh Pandey
Dr NK Bhatia
Dr Anoop gupta
Dr Anupam Sibal
Dr Jamal A Khan
Dr AN Malviya
Dr Sanjay Choudhary
Dr rajiv Khosla
Dr rohini handa
Dr Praveen Bhatia
Dr Sheh rawat
eMedinewS Most Popular Doctor of the year 2010 Award Dr Neelam Mohan
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Top 22 Stories of the Year 20101. DelhiBug A huge controversy arose when the Lancet Infectious
Diseases broke a story where researchers reported a new gene called NDM-1, which stands for New Delhi metallo-beta-lactamase-1. The new bug is a gram negative bacteria showing resistance to all present antibiotics. The enzyme NDM–1 confers resistance to a broad range of beta-lactam antibiotics including the carbapenems, the mainstay of treatment of antibiotic–resistant bacterial infections. The gene for NDM–1 is one member of a large gene family that encodes beta–lactamase enzymes called carbapenemases. Bacteria that produce carbapenemases are often referred to in the news media as “superbugs” because infections caused by them are difficult to treat. Such bacteria are usually only susceptible to polymyxins and tigecycline. NDM–1 was first detected in a Klebsiella pneumoniae isolate from a Swedish patient of Indian origin in 2008. It was later detected in bacteria in India, Pakistan, the United Kingdom, the United States, Canada, Japan and Brazil.
2 H1N1Havoc The H1N1 virus created great havoc, but in the end,
proved to be just a ‘much hyped’ virus with mortality even lower than the regular human flu virus. The WHO declared the swine flu pandemic officially with the virus moving into the ‘post–pandemic’ phase. The upside of this was an increased awareness of flu prevention practices.
3 TheChikungunyaEpidemic Chikungunya re-emerged and was the latest epidemic
in North India with patients presenting with fever, rash and joint pains. The joint pains persisted after the fever was gone. It complicated pre-existing dengue epidemic in the society.
4 DenguewithaDifference Dengue once again made its presence felt, especially
in the national capital. However, this year dengue was different than other years. It presented with more GI symptoms, pancreas involvement, dengue hepatopathy and lot of skin reactions. The platelet count dropped to less than 10000 but most required no platelet transfusion.
5 DiabetesDiagnosis The year saw a new advancement when the American
Diabetes Association (ADA) released its new clinical practice guidelines, which recommended use of A1C was recommended for the diagnosis of diabetes and pre diabetes and not fasting sugar. A1c measures
average blood glucose levels for a period of up to 3 months. An A1C >6.5% means diabetes.
6 NewpillforHIVPrevention A new pill is now available for HIV prevention along
with condoms. It is to be used before the act and continues for seven days. In a trial of more than 2000 HIV-negative, but high risk, gay men in six countries, the combination antiretroviral pill (tenofovir and emtricitabine) reduced the risk of HIV infection by 44%, compared with placebo. Also, it was observed that the risk of contracting HIV was even lower, 73% lower than the placebo group. However, according to public health experts, safe sex and consistent use of condoms still remain as the best method of prophylaxis because the pre–exposure prophylaxis acts by loading up the high–risk individuals with the HIV–disabling antiretroviral drugs prior to exposure to the virus. This allows the drug to attack the virus as early as possible. But the drugs do not work as a vaccine would, by priming the immune system to actually prevent infection.
7 NationalProgrammeforPrevention&ControlofCancer,Diabetes,CardiovascularDiseasesandStroke(NPCDCS)StartedintheCountry
The Ministry of Health and Family Welfare, Government of India has started the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The Non-Communicable Diseases (NCDs) are increasing in India and are a major cause of morbidity and mortality.
8 NewDrugforPrematureEjaculation
A new drug for treatment for premature ejaculation is now available. Dapoxetine is a selective serotonin reuptake inhibitor that blocks the re-absorption of the neurotransmitter serotonin.
Premature ejaculation is the most common sexual problem aside from erectile dysfunction. While the currently existing drugs, which are not specific to treat premature ejaculation, need to be taken regularly, this new drug is an SOS drug and can be taken an hour or two before intercourse.
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Top 22 Stories of the Year 2010and Emergency Cardiovascular Care Science in October. The highlight of these new guidelines was the Change from “A-B-C” to “C-A-B.” i.e. change from the traditional approach of airway-breathing-chest compressions (“A-B-C”) to first establishing good chest compressions (“C-A-B”). Significant studies now report that chest compression only, or ‘Hands Only CPR’ for adults by bystander lay rescuers improves survival outcome. It is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest
13 ResearchSupportsHealthyLifestyleBehavior
New research has supported the benefits of altering one’s diet and physical activity in conditions like obesity and hypertension. Results from the HEALTHY study showed that the earlier one starts to adopt healthy behaviors the better the effect on health outcomes. The HEALTHY study was a school-based intervention program and involved 42 middle schools in seven regions of the US. Another study showed that diet together with physical activity resulted in clinically significant weight loss and favorable changes in cardiac risk factors in individuals who were severely obese.
14 “TimeisBrain”:TreatmentofAcuteIschemicStroke
A combined analysis of eight trials of clot-dissolving treatment for acute ischemic stroke again emphasized that every effort should be taken to shorten delay in initiation of clot-dissolving treatment in order to get maximum benefit. The trial reported in the Lancet also showed for the first time that treatment given beyond the first 4.5 hours after onset carried the risk of increased mortality due to delay in treatment.
15 CRESTTrialDirectlyComparedCarotidEndarterectomyandCarotidArteryStenting
The large CREST trial compared carotid endarterectomy (open surgical repair) and carotid stenting (endovascular placement of a stent), the two major methods to reopen narrowed carotid arteries carrying blood flow to the brain. On the whole, both techniques had similar rates of success and complication, but among younger patients, under
9 FDALimitsAccesstoRosiglitazone
In September, the US FDA put new restrictions on rosiglitazone, a drug prescribed for type 2 diabetes due to concerns about increased risk of heart attacks and other cardiovascular problems.
It now requires patients to have a consent form to get the drug and has created new rules for doctors writing prescriptions for it. Now, doctors in the US will now have to attest and document each patient’s eligibility to receive rosiglitazone. In November this year, the Drug Controller General of India banned the much controversial drug “Rosiglitazone”
10 RevolutionaryTuberculosisTest
The World Health Organization endorsed a new rapid molecular diagnostic test for TB that is accurate nearly 99% of the time and reduces the diagnosis time by giving results in ≤2 hours. The test, called Xpert MTB/RIF, was developed by Cepheid and the Foundation for Innovative and New Diagnostics (FIND), a non-profit group funded by the Bill & Melinda Gates Foundation. Use of this test could lead to an increase in the diagnosis of patients with drug-resistant TB including the number of HIV-associated TB cases diagnosed in areas with high rates of both diseases.
11 TailoringTreatmentforPeoplewithDiabetestoReduceTheirRiskofHeartDisease
Patients with diabetes have 2 to 4 times higher mortality rates due to heart disease than those without diabetes. New research from the ACCORD Study Group shed light on tailoring treatment to diabetic patients to reduce their risk of developing heart disease. In the first study, it was found that aggressive control of blood pressure with systolic blood pressure reading of less than 120 mm Hg versus less than 140 mm Hg did not cut down on the chances of heart disease in people with type 2 diabetes. Combining anti lipid treatment (stain plus fibrate) was beneficial in reducing chances of heart disease in those type 2 diabetes patients who had low HDL cholesterol and low triglycerides, reported another study.
12 ImprovingtheWayWeReverseSuddenCardiacArrest
The American Heart Association issued updated Guidelines for Cardiopulmonary Resuscitation
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Top 22 Stories of the Year 201070 years of age, stenting appeared advantageous while among older patients endarterectomy appeared advantageous.
16 TheINTERSTROKEStudyIdentifiestheTenMajorRiskFactorsforStroke
The worldwide INTERSTROKE study identified the top 10 risk factors for stroke namely High blood pressure, smoking, waist-to-hip ratio (abdominal obesity), diet, physical activity, blood lipids, diabetes mellitus (type 2), alcohol intake, stress and depression and heart disorders. Put together, these risk factors were found to be associated with 90 percent of the risk of stroke. This study analyzed risk factors for stroke in 22 countries and showed that 10 risk factors are associated with 90% of the risk of stroke. Hypertension was the most important of these modifiable risk factors for all strokes including brain hemorrhage. The most important message from the study was that controlling the blood pressure can reduce the chances of stroke.
17 NewGuidelinesforProstateCancerScreening
The American Cancer Society (ACS) updated its prostate cancer screening guidelines, which called upon physicians to spend more time counseling patients about their informed about the benefits and risks of PSA testing. PSA testing should be individualized rather than be taken as an annual test for any man aged 50 and over. The group’s newly revised guidelines make it clear that prostate specific antigen (PSA) blood testing should not occur unless this discussion happens. Screening can in some cases save lives with early treatment; but, it also picks up benign disease in addition to cancer, and it can’t distinguish between aggressive and mild forms of the disease.
18 CalciumBoostsHeartAttackRisk
A meta–analysis of 15 randomized trials study reported in BMJ noted that calcium supplements taken without vitamin D may increase the risk for heart attack as much as 30%. Most osteoporosis guidelines currently recommend calcium supplements, despite relatively small benefits in bone health. Senior author Dr. Ian R. Reid, from the University of Auckland, New Zealand stated that in most cases, stopping
calcium would seem appropriate. The study raised many questions, such as why calcium could have this effect during a relatively short period of time. Some experts recommend eating a calcium-rich diet rather than taking supplements.
19 PhysicalActivity,EvenModerateinDegree,ReducesStrokerisk
A study reported in the journal Stroke concluded that leisure-time physical activity, even in modest degree, is associated with lower stroke risk in women. Walking, in particular, was generally associated with lower risks of total, ischemic, and hemorrhagic stroke.
20 FDAWarnsAgainstQuinineforCramps
The FDA re-issued guidelines on the use of quinine taking note of the fact that most of the quinine being prescribed in the United States is not for the approved indication i.e. uncomplicated malaria but, for leg cramps. Taking quinine may result in serious and life–threatening hematologic adverse effects.
21 TaskForceRevisesMammographyGuidelines
The American College of Radiology and the Society of Breast Imaging directly contradicted the US Preventive Services Task Force and recommended routine mammography for women at age 40 years and older. In 2009, the Task Force had asked for an end to routine mammography for women younger than 50 years, citing a lack of evidence for benefits in women of this age group, which sparked off a great controversy
22 The1stSyntheticCell J. Craig Venter, co-mapper of the human genome,
this year took another step toward creating life in the laboratory when scientists created a synthetic cell that can survive and reproduce itself according to an artificial DNA sequence. Generated from a process of carefully stitching together the chemicals that compose DNA, the entire genome of a bacterium was synthesized, which was inserted into a cell and was able to replicate. This represents a major step towards applications in biofuels and chemical synthesis through synthetic biology.
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A 22-year-old woman presented to the emergency department five days after eating lettuce that she said had scratched her throat. She had seen two physicians in the outpatient setting and was given pain medication. However, she was now unable to tolerate oral fluids. She had an intact airway with moderate trismus and mild anterior cervical lymphadenopathy. She was afebrile. Computed tomography (Figure 1) and radiography (Figure 2) were performed.
QuestionBased on the patient’s history and physical examination, which one of the following is the most likely diagnosis?
A. Angioedema.
B. Epiglottitis.
C. Laryngotracheobronchitis (croup).
D. Peritonsillar abscess.
E. Retropharyngeal abscess.
DiscussionThe correct answer is E: retropharyngeal abscess.
Although the condition is commonly described as a childhood disease, it can occur in adults.1,2 Even with the use of antibiotics, mortality in patients with retropharyngeal abscess
Photo Quiz
Figure 1. Figure 2.
Unusual Case of Pharyngitis
can be as high as 50 percent.2 The retropharyngeal space is a potential area of infection, but normally regresses by six years of age.3 In adults, retropharyngeal abscess commonly causes sore throat, fever, dysphagia, odynophagia, neck pain, and dyspnea. However, most patients also have a history of trauma, such as from endotracheal intubation, endoscopy, or a foreign body in the hypopharyngeal area.
The patient’s computed tomography scan demonstrates fluid collection and abscess formation in the retropharyngeal space (Figure 3). There is also significant soft tissue swelling anterior to the abscess (Figure 4).
Summary tableCondition Characteristics
Angioedema Painless nonpitting edema most pronounced in the head and neck
Epiglottitis Fever, difficulty swallowing, drooling, stridor; infection usually confined to the epiglottis
Laryngotracheobronchitis (croup) “Barking” cough, stridor, possibly dyspnea; usually occurs in children three months to three years of age
Peritonsillar abscess Unilateral sore throat, tender lymphadenopathy on the affected side, fever
Retropharyngeal abscess Sore throat, fever, dysphagia, odynophagia, neck pain, dyspnea; patients usually have a history of trauma; posterior pharyngeal edema and lymphadenopathy; abnormal lateral neck radiography
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Potential complications of retropharyngeal abscess are airway obstruction, mediastinitis, aspiration pneumonia, epidural abscess, jugular venous thrombosis, necrotizing fasciitis, sepsis, and erosion into the carotid artery. In the outpatient setting, protection of the airway is crucial, with emergent surgical consultation for drainage of the abscess.4
With angioedema, painless and nonpitting soft tissue edema would be evident on clinical examination and imaging. The edema is most pronounced in the head and neck.
Epiglottitis causes fever, difficulty swallowing, drooling,
and stridor. The infection is usually confined to the epiglottis. Occurrence of this disease has decreased dramatically since the introduction of Haemophilus influenzae type b vaccine.
Laryngotracheobronchitis (croup) usually occurs in children three months to three years of age. Symptoms include a “barking” cough, stridor, hoarseness, and potentially dyspnea. Anteroposterior radiography may show subglottic narrowing (steeple sign).
A peritonsillar abscess may lead to similar symptoms as retropharyngeal abscess. Typically, patients with peritonsillar abscess have unilateral sore throat and tender lymphadenopathy on the affected side.
References1. Abdel-Haq NM, Harahsheh A, Asmar BL. Retropharyngeal abscess in
children: the emerging role of group A beta hemolytic streptococcus. South Med J. 2006;99(9):927-931.
2. Tannebaum RD. Adult retropharyngeal abscess: A case report and review of the literature. J Emerg Med. 1996;14(2):147-158.
3. J Echevarria. Deep neck infections. In: Schlossberg D, ed. Infections of the Head and Neck. New York, NY: Springer; 1987:172-174.
4. Nwaorgu OG, Onakoya PA, Fasunla JA, Ibekwe TS. Retropharyngeal abscess: a clinical experience at the University College Hospital Ibadan. Niger J Med. 2005;14(4):415-418.
Source: Adapted from Am Fam Physician. 2010;82(12):1523-1525.
Figure 3. Figure 4.
...Cont’d from Page 3
The primary end point was the rate of death at 28 days. Secondary end points included the rates of death in the intensive care unit and in the hospital, and the duration of stay in the intensive care unit.
Results: Septic shock (62.2 percent) was the most common etiology, followed by cardiogenic shock (16.7 percent) and hypovolemic shock (15.7 percent). Baseline characteristics were similar between groups, as were initial mean arterial pressure and the mean time to achieve a mean arterial pressure of 65 mm Hg.
Overall mortality rates were similar; however, subgroup analysis found that dopamine was associated with a higher risk of death in patients with cardiogenic
shock. Arrhythmias were nearly twice as common in the dopamine group compared with the norepinephrine group (24.1 versus 12.4 percent), with atrial fibrillation being the most common arrhythmia with either agent. There was nearly a fourfold greater discontinuation rate with dopamine because of severe arrhythmias, compared with norepinephrine (6.1 versus 1.6 percent).
Conclusion: The authors conclude that although there is no overall difference in the rate of death between patients treated with dopamine or norepinephrine, dopamine is associated with more arrhythmias and increased mortality among patients with cardiogenic shock.
Source: Adapted from Am Fam Physician. 2010 Dec 1;82(11):1395.
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Dr. Good and Dr. Bad
Dr KK Aggarwal
© IJ
CP
AC
AD
eMy
SituatiON: A diabetic patient was found to have higher baPWV.
LeSSON: Brachial-ankle pulse wave velocity (baPWV) is a marker for arterial stiffness and may be a risk stratification index for short-term prognosis in clinical practice, suggesting the need for further aggressive treatment and strict follow-up in coronary artery disease (CAd) patients with diabetes and higher baPWV. In a multivariate analysis, a higher baPWV was independently associated with poorer short-term prognosis (hazard ratio, 1.97;95% CI, 1.01-3.84) in diabetic CAd patients.
Hypertens Res 2010;33(10):1018-24.
It Is nORMalYOu need fuRtHeR
evaluatIOn
Say aloud the ink color of each word. how quickly can you do it? Illusion
Did you slow down?
Pioneer in Medical JournalismIJCP grouP of PuBlICAtIoNSDr Sanjiv ChopraProf. of Medicine & Faculty DeanHarvard Medical SchoolGroup Consultant Editor
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