Address: 39 Daryacha, Hauz Khas Village, 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


eMedinewS is now available online on www.emedinews.in and www.emedinews.org

Action replay: watch emedinews-revisiting 09 proceedings at http://webex.wstream.net/emedinews/100110/webcast.asp

or www.docconnect.com

 17th January Sunday

 Dear Colleague,

 Are canned foods safe?

A Study from England stands that people with highest levels of a chemical known as bisphenol A (BPA) in their urine are more likely to be diagnosed with heart disease. Researchers found that high urinary levels of BPA boosted the risk of heart disease by 1.3 to 1.4 times compared to those with low levels. BPA has been linked to sexual dysfunction, heart disease, cancer, diabetes and even hyperactivity in girls. (JAMA 2008; 300:1303)
BPA is a monomer used to make hard, polycarbonate plastics, and some epoxy resins. Polycarbonate plastics are used in many hard sport water bottles, infant bottles, and some medical devices. The BPA containing epoxy resins are used to coat metal products, such as food cans, and are also used in some dental sealants and composites. The primary route of exposure is through the diet, since BPA can migrate into food from food and beverage containers. People who eat out of cans and plastic have higher BPA levels.

Animal studies have shown that BPA acts as a weak estrogen in the body and can impact biological systems at low doses. Animal studies have shown that low levels of exposure to BPA during development could cause changes in behavior, the brain, prostate gland, mammary gland, and the age at which the female animals attain maturity. (National Institute of Environmental Health Sciences)

A draft report from the United States Department of Health and Human Services' National Toxicology Program (NTP) endorsed the conclusions of an expert panel of the Center for the Evaluation of Risks to Human Reproduction (CERHR). This panel concluded that there is "some concern" for neural and behavioral effects in fetuses, infants, and children at current human BPA exposures.

There are some personal choices one can make, to avoid exposure to BPA intake from dietary sources.

1. Not micro waving polycarbonate plastic food containers.
2. Avoiding use of containers that have the #7 on the bottom, since some of these are polycarbonate and might contain BPA.
3. Reducing use of canned food.
4. Using baby bottles that are BPA-free.
5. When possible, opting for glass, porcelain, stainless steel, or safer types of plastics for hot food or liquids.

A study of 77 college students demonstrated that urinary excretion of BPA increased by over two-thirds after the students drank water from a BPA containing polycarbonate bottle for one week following a previous wash out phase. (Environ Health Perspect 2009; 117:1368).
Department of Public Health in Massachusetts issued an advisory to pregnant and breastfeeding women to "avoid products that may contain BPA"

Dr KK Aggarwal
Chief Editor

News: American Heart Association, Orlando, FL November 14-18.
1. Middle-aged men are about three times more likely to suffer sudden cardiac death than women. At age 40, the lifetime risk of sudden cardiac death through age 95 is 12.3% for men and 4.2% for women. The lifetime risk decreased with age and increased with a greater burden of cardiovascular risk factors, like smoking, diabetes, high cholesterol, and hypertension. (Dr Donald Lloyd-Jones, Northwestern University, Chicago)

2. Routine use of the radial artery as an access point resulted in fewer bleeding complications and less pain without substantial increases in procedure time. (Dr Tim Schaufele, MD, of the MediClin Heart Center Lahr/Baden in Germany).

3. The novel fast-on, fast-off intravenous antiplatelet agent cangrelor given at the time of percutaneous coronary intervention or stenting did not reduce the rate of death, MI, or ischemia-driven revascularization at 48 hours compared with clopidogrel. In CHAMPION PCI, in which IV cangrelor was started 30 minutes before stenting and continued for two hours after the procedure, the rate of death, MI, or ischemia-driven revascularization at 48 hours was 7.5% in the cangrelor arm versus 7.1% in patients who received a 600 mg loading dose of clopidogrel (Dr Robert A. Harrington, Duke Clinical Research Center, Durham, N.C). The second trial, CHAMPION PLATFORM, had similarly disappointing results; 7% of patients receiving cangrelor at the time of PCI achieved the primary composite endpoint at 48 hours compared with 8% of patients in the placebo group. In this trial, 60 mg of clopidogrel was given after stenting. (Dr Deepak L. Bhatt, Brigham and Women's Hospital, Boston.)

4. For patients suffering depression after coronary artery bypass grafting (CABG), regular phone calls from a nurse may boost antidepressive therapy as much as psychotherapy and medication. Depression symptom scores improved significantly more for patients who got phone-based management from a nurse than for those who got usual care (Hamilton Rating Scale for Depression score change 7.6 versus 4.5 points). (Dr Bruce L. Rollman, University of Pittsburgh)

5. Bariatric surgery led to sustained improvements in left ventricular mass and diastolic function in morbidly obese teenagers. The gains were seen as early as six months after the operations and they persisted through two years. (Dr Holly Ippisch, Cincinnati Children's Hospital)

6. A subset analysis of data from the JUPITER trial indicates that apparently healthy women treated with rosuvastatin reduced their relative risk of major cardiovascular events by 46%, slightly higher than the 42% reduction seen in men.

Dr Good Dr Bad
Situation: A child with bicuspid aortic valve came for dental extraction.
Dr Bad: You need antibiotic prophylaxis.
Dr Good: You do not need antibiotics.
Lesson: Common valvular lesions for which antimicrobial prophylaxis is no longer recommended in the 2007 AHA guidelines include bicuspid aortic valve, acquired aortic or mitral valve disease (including mitral valve prolapse with regurgitation), and hypertrophic cardiomyopathy with latent or resting obstruction.
Make Sure
Situation: A patient with past seizures on high dose penicillin developed seizures.
Reaction: Oh my God! Why was high dose penicillin given to this patient.
Make sure that high dose penicillin is avoided in such situations as high doses of the beta-lactam antibiotics (particularly penicillin) may cause seizures.

Mistakes in critical care
Pharmacokinetic changes lead to increased plasma drug concentrations and pharmacodynamic changes lead to increased drug sensitivity in the elderly.

Milestones in neurology
Jacques Jean Lhermitte was a French neurologist and neuropsychiatrist. He specialized in neurology and became Chef-de-clinique (resident) for nervous diseases in 1908, Lhermitte-Trelles syndrome: A syndrome characterized by lymphoblastic infiltration of the peripheral nervous system, associated with paralysis and amyotrophy.

Laughter the best medicine
Gynecologist - a man who works and operates in another man's field.

ENT Facts
Acute otitis media (AOM) is an acute illness with middle ear fluid and inflammation of the mucosal lining of the middle ear space.

Question of the Day
What is the role of immunomodulator therapy in ulcerative colitis?
Some patients with ulcerative colitis remain refractory despite intensive therapy. In these cases, immunomodulator therapy with either azathioprine or its metabolite, 6-mercaptopurine (6-MP), can be considered prior to referral for surgery. Testing for thiopurine methyltransferase (TPMT) activity should be considered before initiating therapy.

As surgery in ulcerative colitis is curative and, in many patients, does not require a stoma, most doctors are hesitant about using these potentially toxic medications. However, patients who do not desire surgery or those with more limited disease but with persistent or debilitating symptoms are candidates for long-term therapy with these drugs.

Formula to Practice
Clearance of a drug from body
Formula: CL = CL renal + CL hepatic
CL renal = Q x E

Q = Plasma flow to kidneys in ml/min
E = Extraction ratio
E = Ca - Cv
Ca = Concentration of drug in arterial plasma
Cv = Concentration of drug in venous plasma

Mnemonic to know
HEART - Causes of atrial fibrillation
H= CHF, other Cardiomyopathies
E= Enlargement of the atria
A= Alcohol binge drinking
R= Rheumatic heart disease
T= hyperThyroidism

When we pray to God we must be seeking nothing - nothing...
Saint Francis of Assisi

What are the requirements for medical negligence to be proven?
There are a few requisites for medical negligence to be proven which have been evolved through various case laws. The first and foremost test is the Bolam's test which was evolved in the Bolam's case. This test has been followed time and again in recent judgements of courts, as laid down in the landmark case of  Jacob Mathew vs. State of Punjab decided by the Apex Court in 2005.

This test is the simplest and says that for medical negligence to be proven, three things need to be shown and proven:

1. That there existed a duty of care.
2. That this duty of care was breached.
3. That the injury caused was a direct result of the breach of care.
The important requirement of this test is that all the three points are to be seen from the eyes of what a reasonable man would. This makes it highly subjective.

eMedinewS try this it works
Keeping inhalers straight: Label inhalers as "rescue," "reliever" or “controller.” This can save confusion in an emergency.

Letters to the editor
1. Dear Dr Aggarwal, I think no word is left for me to express gratitude for excellent job done by you together with your team in organizing the conference in totality. I am looking forward to attend many more such conferences helping us gathering maximum information under one roof in short time. I wish you to organize a tour for MEDICITY as well in near future. Thank you for being our wonderful GUIDE. Dr [Mrs] Bharati Banerjee.

2. Dear Dr Aggarwal, VOW........great show,  great man, heartiest congratulations, two things were out standing, no specific lunch hour and direct live telecast on net. I think all organizers of each conference must follow the same. Dr A C Bansal, Gwalior.

3.  Sir, congratulation for organizing such a wonderful CME in MAMC auditorium. This was the best ONE DAY CME I have ever attended in past 7years. Dr Naresh Trehan rightly said that you are mover and shaker for medical professionals. Sir we should never forget our roots and our roots are in rural India. We should device some mechanism by which we can train those doctors who are sitting far away and taking care of are parents and relatives. Sir under your able leadership we can do wonder. Dr Kuldeep Kumar. (Ex President, FORDA Delhi & RDA MAMC New Delhi). Assistt. Professor, Department of Medicine, UCMS and associated GTB Hospital,

4.IMA Kerala State against BRMS: IMA Kerala State Branch conducted an emergency state working committee on 10/01/10 at Ernakulam.The meeting was attended by 168 members. Representatives from the student unions of the medical  colleges participated. The state working committee unanimously decided to fight BRMS unitedly.
IMA Kerala State Branch has floated a Joint Action Council under the chairmanship of  Dr V C Velayudhan Pillai,Past National President  of IMA .This is a national forum.A website of the JAC will start functioning in a few days.A coordination meeting of all the 22 medical colleges in Kerala has been called on 17/01/10.Direct action by students has been planned.

Calling the bluff of Govt  of India

The statistics gleaned from Govt.of India  sources show that doctors are in excess in PHCs in 20 states and only in 4 states there is a need .It also shows there is an acute shortage of lab technicians, nurses and  health  workers in all states. So much  for the  credibility of Government of India. Dr R V Asokan, On behalf of Joint Action Council

Docconnect update: is a website for a doctor to stay connected with his community and enrich his knowledge and enhance relationship with patients.

Emedinews - Revisiting 2009 update
Was organized by Emedinews, a daily national medical newspaper on 10th January 2010. The whole medical conference was live webcast on
www.docconnect.com and www.emedinews.in. The health care IT partner for the webcast was HealthHiway. The agenda of the conference was revisiting new advances in medicine in 2009. Apart from 950 doctors who were registered for the conference at Maulana Azad Medical College Auditorium, 500 new visitors and 150 new sign ups, visited at www.docconnect.com. More than 200 doctors viewed the webcast online live.  This was for the first time in India that a live webcast was done and viewed by a large number of doctors from across the country. 

Punjab & Sind
Punjab & Sind Bank
Coca cola 

(Advertorial section)

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HealthHiway (www.healthhiway.com) is the services infrastructure for the healthcare ecosystem to facilitate better collaboration and seamless information sharing between Providers, Insurance companies, Doctor Practices and other service organizations, for safer and enhanced patient care. 

Advertising in emedinews
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Rationale for consideration of testing Al in the drinking water
The absorption of Al is poorly understood but both soluble and mucosally associated luminal metal-binding ligands may regulate the initial uptake. Several recent studies have demonstrated that co-administration of Al with citrate, lactate or acetate increases Al levels in a variety of organs including the brain. Organic Al-complexes that do not undergo hydrolysis, such as Al-maltolate, are also associated with increased uptake of Al. Diets with suboptimal levels of copper also result in increased deposition of Al in the tissues.The potential relevance of such Al- complexes derives from the observation that under slightly acidic source water conditions organic Al-complexes and Al-F complexes predominate, and these can persist to a significant degree through drinking water treatment. The absorption and toxicity vary by species of Al.