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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


1st August, 2010, Sunday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Calcium supplements and heart attack risk 

BMJ report: Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used, these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted. In a linked editorial, John Cleland and colleagues writes that Calcium supplements in people with osteoporosis should not be given without concomitant treatment for osteoporosis.

  1. In the systematic review, Bolland and colleagues found that calcium supplements increased the risk of myocardial infarction (hazard ratio 1.31) but they found no significant difference in the risk of stroke, death, or the composite end point of myocardial infarction, stroke, or sudden death.

  2. The effort on detecting and treating osteoporosis is only worthwhile if it translates into a health benefit. There must be a reduction in bone fractures that are either subtle and progressive.

  3. BMD (Bone mineral density), often used as a measure of treatment success, is a surrogate measure for real clinical benefit. Surrogate measures may be useful in pilot studies but become problematic when they become the goal of treatment.

  4. Bone fractures in older people are an important cause of disability, and more than 20% of patients will die within one year of a low trauma hip fracture.

  5. Calcium supplements, given alone, improve BMD but they are ineffective in reducing the risk of fractures and might even increase risk, they might increase the risk of cardiovascular events, and they do not reduce mortality.

  6. They seem to be unnecessary in adults with an adequate diet. Given the uncertain benefits of calcium supplements, any level of risk is unwarranted.

  7. Why calcium supplements increase cardiovascular risk? They may improve some conventional cardiovascular risk factors including blood pressure and lipids. Accumulation of calcium in the arterial wall leading to reduced compliance would be expected to take years, but the increased risk of myocardial infarction reported by Bolland and colleagues occurred early after calcium supplementation (median follow–up of 3.6 years).

  8. An alternative possibility is that the increased risk of myocardial infarction is not a true effect. If an intervention changes the rate of vascular events but is not associated with a commensurate change in mortality, the intervention may be changing the presentation rather than the incidence. Flecainide reduces the risk of non-fatal myocardial infarction by about 30% because infarctions are more likely to be fatal before patients reach hospital. Similarly, long term treatment with aspirin seems to modify the presentation of vascular events with no effect on mortality and, possibly, with acceleration of the progression of vascular disease.

  9. Although the risk of myocardial infarction seemed to increase substantially (by about 25%) with calcium supplementation this was not accompanied by an increase in mortality.

  10. Calcium supplements could simply be causing gastrointestinal symptoms that could be misdiagnosed as cardiac chest pain. However, even if calcium supplements really are safe, a neutral effect on mortality casts doubt on whether they are effective prophylaxis for fractures.

  11. A combination of calcium and vitamin D is commonly used to treat osteoporosis. Vitamin D supplements might reduce the risk of falls, might have important clinical effects on cardiovascular function, do not increase mortality, and may mitigate the trend to excess mortality seen with calcium supplements alone. However, no conclusive data are available to show that current doses of vitamin D supplements with or without calcium supplements reduce the rates of fracture.

  12. Several agents that are, or might be, used to treat osteoporosis do reduce mortality, including bisphosphonates,raloxifene, and thiazides.

  13. In the meantime, on the basis of the limited evidence available, patients with osteoporosis should generally not be treated with calcium supplements, either alone or combined with vitamin D, unless they are also receiving an effective treatment for osteoporosis for a recognised indication.

Other reports

  1. CBS News: Calcium supplements are a good way to keep your bones strong, but research published online in the BMJ suggests that "they could lead to an increased risk for heart attack."

  2. The Los Angeles Times: "combined results from 11 randomized controlled trials of calcium supplements…involving more than 12,000 patients found a 31% increase in the risk of heart attack and smaller, non–significant increases in the risk of stroke and death."

  3. Bloomberg News: "The researchers said they excluded from their analysis studies that compared coadministered calcium and vitamin D supplements with placebo. The findings may not be applicable to those supplements."

  4. BBC News: "The reason for the increased risk of heart attack is not clear, but it is thought the extra calcium circulating in the blood could lead to a hardening of the arteries."

  5. Health Day: "Earlier studies did not find a similar risk when people get calcium through eating foods rich in the mineral, which suggests that supplements may be an independent risk factor."

  6. CNN /Health.com: "Findings…have some experts questioning whether calcium supplements should be used as widely as they are now, especially by elderly women, who suffer disproportionately from both heart disease and osteoporosis.

     eMedinews Views: Do not give calcium supplements alone give them with vitamin D.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature (From HCFI file)

Press Conference Perfect Health Mela 2009

Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, Cartoonist Mr Sudhir Tailang and Vandana Vadera, singer at a press conference organized for Perfect Health Mela 2009.

Also in the Photo: Mr S K Bhatnagar, GM, MTNL, New Delhi; Mr. Sandeep Marwah Director, Asian Academy of Film and Television

Dr k k Aggarwal

 

News and Views

National News

Punjab Medical Council through its letter no. PMC/2010/4037 dated 22.7.10 has suspended the Punjab Medical Council Registration of Dr. Ajit Pal Singh. He has been asked to deposit his original registration certificate with the Punjab Medical Council at once. For now on Dr. Ajit Pal Singh can not practice medicine. This action of Punjab Medical Council is as a result of years of efforts of Punjab Human Rights Committee Punjab, who took up the case of issue of several bogus medical certificates to kins of convicts in Central Jail Bathinda facilitating their paroles, by Dr. Ajit Pal Singh.

Former MCI president brought to Kolkata for probe 
 
Former MCI president Dr Ketan Desai, was brought to Kolkata Friday for his alleged involvement in another case of Kolkata-based private hospital - KPC Medical College. The CBI Anti-Corruption Department in Kolkata filed a case against him for his alleged involvement in the KPC Medical College case. 
Friday Desai was brought to Kolkata and produced before the CBI court in Bankshal and remanded in seven days police custody. Dr Desai was taken to the central lockup in Lalbazar - city police headquarters. (IANS)

International News

Plagiarism in US residency applications

Plagiarized material showed up in the personal statements of 5.2% of applicants to large U.S. medical–residency programs, according to researchers led by Scott Segal of Brigham and Women’s Hospital in Boston. Computers scanned the assays and searched for matches with web pages, printed materials, and other submitted essays.

(Contributed by Rajat Bhatnagar)

Cardiac manifestations of neuromuscular disorders in children

The most common cardiac findingsin children with neuromuscular disorders include dilated or hypertrophic cardiomyopathy, atrioventricular conduction defects, atrial fibrillation and ventricular arrhythmias. Screening for cardiac involvement should be performed in all these children. The most common neuromuscular disorders that have the potential for cardiac involvement include: muscular dystrophies–Duchenne, Becker, limb-girdle and Emery Dreifuss. Friedreich Ataxia and myotonic dystrophy also have important cardiac involvement. (Dr G M Singh)

Physicians across US differ greatly in their options to open up clogged neck arteries to prevent stroke

A study published in the Archives of Internal Medicine reports that there’s no consensus on the best way to treat blocked carotid arteries. The study found that physicians across the United States differ greatly in how they choose options to open up blocked neck arteries to help prevent stroke. According to the researchers, patients can expect to be offered different treatments depending on where they live in the US.

Children who survive cancer may be at increased risk for long–term heart problems

Children who survive cancer may be at increased risk for long–term heart problems. Researchers examined 601 childhood cancer survivors who were followed for an average of 15.4 years. They found that long–term abnormalities in heart function occurred in 27 % of the patients. The study is published in the Archives of Internal Medicine.

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Medical Testimony of Doctor in the Court of Law

Medical literature/books/journals if produced by medical practioner as medical evidence must be available for visual inspection in the court of Law. Even though the doctor has ready evidence regarding the record of the trial/debate, the opposition has the right to examine the evidence more closely. An opponent may ask to inspect your evidence at the conclusion of your argument/speech, and your critic may ask to inspect select pieces of evidence at the conclusion of the argument/debate. Both requests are quite common. The doctor should give them the evidence that is asked for, and also be able to tell them exactly what he has read from the document. What medical evidence is, and how is it used, will become more clear as one listens to few cross–examination trials and the legal debates in the court of Law.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

(Dr. Neelam Mohan – Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity)

Toxic Toys

  1. The Phthalates are organic chemicals,odourless and colourless liquids,produced from petrochemicals. They are essentially used for making plastics (mainly PVC) soft and flexible.
  2. Studies on mammals have also linked some phthalates with increased skeletal retardation and malformations.
  3. Children under three years are more likely to be exposed to phthalates because they tend to chew and suck on plastic toys – and since their metabolic, endocrine and reproductive systems are immature, they are more vulnerable.
 

Advantages of Breastfeeding

Advantages of Breastfeeding (Dr. Satwika Sinha, MMC, Khammam)

Breastfeeding protects against illnesses

  • General: Infants of middle class and well–educated populations benefit from breastfeeding and its protective effects, more so if they are exclusively breastfed and for a longer period.

  • Immunologic development

  • Wheezing

  • SIDS: Some studies suggest that breastfeeding is protective against SIDS (Sudden Infant Death Syndrome).

  • General morbidity

  • AIDS:The lack of a dose response affect between breastfeeding and perinatal HIV–1 transmission in the presence of the protective effect of breastfeeding against common causes of early childhood morbidity and mortality support the current WHO recommendation that breastfeeding should continue to be promoted in all developing countries, including those with high HIV–1 prevalence rates in women of childbearing age.

  • Infant survival

  • Gastroesophageal reflex

  • Multiple sclerosis

  • Inguinal hernia

  • Cryptorchidism (Undescended testicle): A case controlled study has shown a significant association of cryptorchidism and lack of breastfeeding.
 

Public Forum (Press Release for use by the newspapers)

BSNL Dil Ka Darbar on 26th September

The 2nd BSNL Dil Ka Darbar will be held at Maulana Azad Medical College on Sunday, 26th September on the occasion of World Heart Day. The Darbar will be organized by Heart Care Foundation of India in association with Health Department, Govt. of India, MCD, NDMC, BSNL and World Fellowship of Religions.

Giving the details Padma Shri & Dr. B.C. Roy National Awardee Dr. K. K. Aggarwal and President of Darbar said that this will be a non stop Question Answer session between heart patients and top Cardiologists and Cardiac Surgeons of the city. It will be on the lines of the Mughal Darbar where patients can come with their ‘fariyads’ (problems) and the same wouldl be sorted out there and then.

The Darbar will also provide highly subsidized blood tests, free ECGs, consultations, exhibitions, second opinions and final opinion. Thousands of heart patients are expected to avail these facilities. There will be no entry fee. The Darbar will be followed by a lively cultural evening.

 

Commonwealth Medical Association 

(Dr. S. Arulrhaj, MD., FRCP (Glasg), Presiden)

Commonwealth Foundation

The Theme of CMA for the previous year was "Promoting the Millennium
Developmental Goals" – HIV, AIDS, Malaria, Child Safety, Safe Motherhood & Gender – Themes of WHO. 
Theme for my Term include the persuation of MDG. In addition I will be concentrating on

Theme : Redefining Health Care & Strengthening Family Medicine

Sub Themes
1. Healthy Life Style
2. Safe Patient Care
3. Pre Hospital Trauma & Emergency Care System
4. Alcohol – Beyond Addiction
5. Health Care Human Resource Challenge

ijcp
IJCP
IJCP
ijcpgroup
nuspera
Docconnect
IJCP
 

An Inspirational Story

Dreams Can Come Tue

Back in 1959 Walt Disney said, "If you can dream about it… you can make it happen!!"

A good friend of mine, Gabriel, had a tiny farm near Medellin, Colombia in a little town called San Pedro de Los Milagros. He only had a cow and dreamed about having a large cattle ranch.

He looked at the horizon every sunset and once he told his father, "Jose, I would like to have that land over there… how can I get it?"

His father encouraged him to go and talk to the landowner to see how they could obtain the land.

Gabriel replied, "But we don’t have the money."

His father said, "Do not worry; go and talk to him."

Several years have passed and right now Gabriel not only owns the land but Via Lactea Theme Park that includes several hundred cows, an small zoo, canopy, horse ride cabalgatas, four wheels motos and much more fun for the whole family enjoyment.

A year ago, when the park was already attracting a huge number of ecotourist, Gabriel’s wife Sarah had a dream… "I want to build the biggest cow in the world ", she said.

They called a friend of mine, Manuel Hernandez, for this task. In three days he had plans for the whole project. Then they asked, "How much will it cost?"

Manuel mentioned a big sum of money.

"Nobody will loan us that quantity of money to build a Cow", they thought but the manager of the bank trusted them and their dreams.

Last October, La Manuela, the biggest cow in the world was opened to the public.

It is 9 meters tall and 16 meters long. The cow actually eats you …and you travel inside the cow learning how grass is converted into milk. Afterwards, you descend from the udder of the cow lift completing a 17 minute magical ride inside the cow.

If you can dream about it and you put all your energy and foremost desire to make it happen, it will become a reality despite how difficult or expensive it may sound.

 

IJCP Special

Dr Good Dr Bad

Situation: A child on penicillin for rheumatic fever prophylaxis undergoing an invasive dental procedure required infective endocarditis prophylaxis.
Dr Bad: Give amoxicillin.
Dr Good: You need clindamycin, cephalexin, or azithromycin.
Lesson: If patients are receiving antibiotics for other indications at the time that dental or invasive procedures are being undertaken, an alternate antibiotic of a different class is often chosen.

Make Sure

Situation: A patient with fever and black stools developed enteric perforation.
Reaction: Oh my God! Why was typhoid not suspected early?
Lesson: Make sure that all patients with fever and small intestinal bleeding are treated for typhoid unless diagnosed otherwise.

Quote of the Day

"Throw your heart over the fence, and the rest will follow." Norman Vincent Peale

Are you fit to fly?

Heart patients

  1. Patients with uncomplicated heart attack, or those who have undergone uncomplicated percutaneous coronary interventions(PCI) should not fly until at least two to three weeks have passed and they are tolerating their usual daily activities.

  2. Travel in the week immediately after coronary stent placement should be avoided, due to the high risk of acute stent thrombosis during this time.

  3. Following a heart attack, a stress test is recommended in all low–risk patients.
 

International Medical Science Academy Update (IMSA)

Cumaltive incidence of false-positive test results in lung cancer screening

A randomized trial of lung cancer screening in over 3,000 high–risk individuals found a high probability of a false positive findings. The cumulative probability of a false positive finding was 33 percent for screening by low–dose CT and 15 percent for chest x–ray. (Ann Intern Med 2010;152:505.)

 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Pemetrexed Disodium 500mg/100mg. Powder for Injection (additional indication)

Indicated as a monotherapy for the maintenance treatment of locally advanced or metastatic Non Small Cell Lung Cancer (NSCLC) other than predominantly squamous cell histology in patients whose disease has not progressed immediately following platinum–based chemotherapy. First–line treatment should be a platinum doublet with gemcitabine, paclitaxel or docetaxel

16–Jan–10

 

Medi Finance

Q. If payments are made in cash towards purchase of medicines worth Rs. 50,000, then what would be the tax implication?

Ans. As per section 40 A (3), in case payment is made in excess of Rs. 20,000 other than by cross cheque or bank draft (cross), then exemption of such expense shall be disallowed.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Antidiuretic hormone

  • To help detect, diagnose, and determine the cause of antidiuretic hormone (ADH) deficiency or excess

  • To investigate low blood sodium levels (hypernatremia)

  • To distinguish between the two types of diabetes insipidus
 

Lateral thinking

Read this………………

0

………

M.D

………

Ph.D

………

Send in your answer to emedinews@gmail.com

The answer for yesterday’s puzzle "Tri cycle"

Correct answers were received from:
Dr. RAJIV BHATT, Dr Sunita Kalra, Kala Sarma, Dr Vijay Kansal, Dr R K Goel, Dr Ashok Kumar, Dr.Chandresh Jardosh,

Correct answers receive for 30th July Puzzle:
Dr Sunita Kalra

 

Humor Section

Funny One–liners

The easiest way to make your old car run better, is to check the prices of new car.

Medical bloopers on medical charts!

Whilst in Casualty she was examined, X–rated and sent home.

 

Readers Responses

  1. Sir Your comments and inputs through E Medinews are admirable, keep it up. U do update us on the latest in the field as well as motivate to do something good. Regards: M.Wali MD, FACC (USA)


  2. Dear Dr. K.K.Aggarwal, just want to know that whether any doctor has the right to refuse treatment to any patient if he feels that he is not competent enough by virtue of his technical specialty and training. Does the law require that we are supposed to treat all the cases whether the facilities to treat that particular patient are present at that particular time?  Or not. What wrong Dr. Manocha has done that he referred the case to proper place for needed treatment. Dr A. K.Srivastava
    eMedinews Responds: In emergency no.


  3. Thanks sir providing information regarding madras High Court order the practice of Unani Ayurveda.........and controversy and arises of the question of the implementation of these High Courts orders and future of these orders. Dr KP Singh, Cardiologist Fortis Escorts New Delhi.
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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