HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



10t December Thursday

Dear Colleague,

 emedinews is now available online on www.emedinews.in

Drunk and Drugged Driving Prevention Month
Celebrate December as  Drunk and Drugged Driving Prevention Month (3D Month).

Tips for safe drinking

1. About three in every ten persons is involved in an alcohol related crash at some point in their lives.

2. Nearly one third of all traffic related deaths is related to alcohol.

3. During the holiday season, and year round, take steps to make sure that you and everyone you celebrate with avoids driving under the influence of alcohol.

4. Always designate a non drinking driver before any holiday party or celebration begins.

5. Do not let a friend drive if they are impaired.  Take the keys.

6. If you're hosting a party this holiday season, remind your guests to plan ahead and designate their sober driver, always offer alcohol-free beverages, and make sure all of your guests leave with a sober driver.

7. One is not safe for up to one hour after 19 gram of alcohol intake. 2 hours after 20 grams of alcohol intake and so on.

8. Several studies confirm that consuming one or two drinks leads to an increased risk of injury. No safe level of alcohol use exists for the use of potentially dangerous equipment.

9. Exposure to alcohol is measured in blood alcohol concentration (BAC) rather than drinks per day or week. The legal BAC limit for driving is 0.03 percent. This corresponds to approximately four drinks for a 200 pound man, but only 2.5 drinks for a 150 pound woman.

10. BACs of 0.02 to 0.05 percent impair the ability to operate motor vehicles; this level of blood alcohol can occur with even a single drink.

11. The risk of involvement in a collision while driving doubles at a BAC of only 0.05 percent

12. Simulated driving ability is impaired with BACs as low as 0.02 percent.

13. The risk of driving accidents is greatest in the first two years of exposure to alcohol.

14. For pilots the BAC offense level is 0.04 percent.

15. Alcohol is involved in one-half to two-thirds of all homicides, at least one half of serious assaults, and more than one-quarter of all rapes.

16. There is consensus that non drinkers should not start and the ones who drink should do so in moderation provided they do so in moderation and in absence of contraindications.

17. Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified.

18. The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic paralysis, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.

19. For young to middle aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).

20. Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer.

21. Men under the age of 45 also may experience more harm than benefit from alcohol consumption. In these younger age groups, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even that level of alcohol use is dangerous.

22. Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 grams per day. Medically safe limits are 10 grams in one hour, 20 grams in a day and 70 grams in a week. (50% for the women). 10 gram is present in 30 ml wisky.

 Dr KK Aggarwal




 Snippets by Dr G M Singh

1. In naive patients with HIV, the first   line protease inhibitor recommended is now darunavir to address multiresistant virus, followed by atazanavir for better tolerance.

2. Lipid assessment in vascular disease can be simplified by measurement of either total and HDL cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride.

3. Women with gestational diabetes have at least a four fold risk of developing postpartum diabetes if they have two or more risk factors. The risk of postpartum diabetes is higher in obese women, women diagnosed with diabetes at less than 24 weeks gestation, women with a 1   h antenatal value greater than 200 mg/dL, and women receiving insulin.

4. Revascularization through angioplasty and stenting does not significantly improve renal function in patients with atherosclerotic renovascular disease compared to medical therapy alone. The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) investigators randomized 806 patients who had atherosclerotic renovascular disease to receive either medical therapy only (statins, anti platelet agents and blood pressure control) or medical therapy plus angioplasty (and stenting, as appropriate). The researchers found that the rate of renal impairment progression was slightly less in the revascularization group by 0.06x10-3 liters per micromole per year (the slope of the reciprocal of the serum creatinine level), a reduction not considered clinically significant. Results were similar in both groups for mortality and rates of renal and major cardiac events. Meanwhile, 23 patients suffered complications associated with revascularization, which included two deaths and three amputations. In summary, revascularization carried substantial risk but was not associated with any benefit with respect to renal function, blood pressure, renal or cardiovascular events, or mortality.

5. Exposure to five common infections potentially linked to atherosclerosis may increase the risk for first stroke (Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus (HSV) 1 and 2). The researchers found that each individual positive test for infection was positively associated with stroke risk after adjustment for other risk factors: hazard ratio for cytomegalovirus, 2.19; for HSV 2, 1.59; for HSV 1, 1.35; for C. pneumoniae, 1.30; and for H. pylori, 1.13.

6. The DPP was a large trial comparing the relative effects of metformin, lifestyle intervention, and placebo in the prevention of type 2 diabetes among high   risk adults. The study demonstrates that both lifestyle interventions and metformin can help prevent incident type 2 diabetes in the long term, although lifestyle changes had the biggest impact in reducing the risk for diabetes.

7. Migraine with aura in women and in smokers is associated with an increased risk for ischemic, but not hemorrhagic stroke. The researchers found no overall association between any migraine and myocardial infarction or death from cardiovascular disease.

8. If you are a female athlete or someone who likes challenging workouts who also wants to get pregnant? It may make sense to ease off a bit as you try to get pregnant. New research from the Norwegian University of Science and Technology shows that the body may not have enough energy to support both hard workouts and getting pregnant.


Snippets from Dr Maj Prachi Garg

Less Hypoglycemia with Newer Analogs
Ass per Dr Eugene E. Wright Jr., MD, Medical Director Primary Care and Specialty Practices Cape Fear Valley Health System Fayetteville, North Carolina the most likely reason for the lower risk for hypoglycemia with newer insulin analogs is that their pharmacokinetic/pharmacodynamic profiles more closely match those for normal physiologic insulin secretion. Long-acting insulin analogs do not have a distinct peak in their time-action profiles; therefore, patients do not have abnormally high insulin levels between meals or at night that can lead to hypoglycemia.

Will Copper Keep Us Safe from the Superbugs?
The copper surfaces have 90-100% fewer live bacteria than the non copper surfaces and the copper based disinfectant clean the microfibre as well as the environment. [Journal of Hospital Infection]

Brush Your Teeth to Reduce the Risk of Heart Disease
Many people with cardiovascular disease have none of the common risk factors such as smoking, obesity and high cholesterol. Now, researchers have discovered a new link between gum disease and heart disease. There are now over 50 studies linking gum disease with heart disease and stroke.
A number of theories have been put forward to explain the link between oral infection and heart disease, said Professor Greg Seymour from the University of Otago Dunedin, New Zealand. One of these is that certain Heat shock proteins from bacteria initiate atherosclerosis and help it progress.

Bacterial Infection May Contribute To Cardiovascular Disease
A new dissertation shows that Chlamydia pneumoniae can contribute to cardiovascular disease. Half of the population of Swedish twenty year olds are carriers of the bacterium Chlamydia pneumoniae, an ubiquitous pathogen previously known to cause acute respiratory disease. It now appears that this bacterium also contributes to cardiovascular disease, the single greatest killer disease in the western world. The C. pneumoniae bacteria stimulates the formation of reactive oxygen species, radicals which are responsible for oxidative damage to low density lipoprotein, the bad cholesterol. It is this oxidation that is thought to trigger arteriosclerosis. 

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Letters to the editor

1. Dear KK  In India we practice US CENTRIC medicine and feel safe in following all those guidelines to fall back upon in case of any litigation, or more importantly in convincing the patient or their relatives in case of anything going wrong with the outcome of treatment, being "Evidence Based." The evidences are US Population based and changing every now and then, my only issue is that we should be practicing Indian Population based evidences but unfortunately do not have much of those and not all will be willing to follow unless we formulate  National consensus guidelines. We are genetically, environmentally financially different. Dr. H.L. Kapoor ( Cancer Consultation and Counseling Services)

2.  Dear Dr. Aggarwal, The information given by you about the HINI Pandemic Mania in US is absolutely true.  This mania may be a trick by those authorities to sell their products.  I feel this information should be spread in the daily newspapers as well for the information of general public. Ashok Ahooja Sqn. Ldr(Retd).

3.  DR KK: Your editorial write up of 8th of December is a bold one. This should come up on the front page of national dailies. You have decreed swine flu as a flake. I believed it from the   start; I endorse your opinion; it is a kind of forcing most of the countries of the world to purchase Tami flu worth billions of dollars. The drug has a short shelf life. Most of the money will go down the drain benefitting a few who are already rich. But truth will surface and the looser will be medical profession. Please be courageous enough to call for a press conference at Delhi and call spade a spade; your voice matters. Dr Satish Chugh

4.  Strangely we are witnessing a mushrooming of 5 star hospitals, all for this rich 1% only. Even the earlier charitably run hospitals for the middle and poor people have been taken over by the businessmen in collusion with the authorities. It is time somebody thought about the middle and poor class which comprise 99%. Our following the western model without modification as per our needs will never be able to fulfill the dream of health for all. Vinay Bhasin

5.  Dear Dr Aggarwal, Thank you for starting emedinews which has become a very useful medium for expatriate Indians like me to keep in touch with the medical scene back home.  Why not introduce brief newsletters from Indian doctors working in various parts of the world?  In this context, I wonder if it will it be possible to include a brief notification about a major Indo-Australasian Psychiatry Association (IAPA) conference we are organizing in Invercargill, New Zealand in May 2010?  On hearing from you, I will send the relevant details. D S Goel, Consultant Psychiatrist, Southland Hospital Mental Health Services, Invercargill 9812, New Zealand




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