Electric cars safe for pacemaker patients

Morning MEDtalks with Dr K K Aggarwal 15^th July 2018

The current study by Lennerz and colleagues published online April 24 in the Annals of Internal Medicine suggest that electric cars do not promote clinically significant EMI among patients with CIEDs (cardiac implantable electronic devices)

The study of 108 patients with CIEDs and one of Europes 4 most popular electric cars showed no evidence of EMI with the CIEDs under a variety of different conditions. In the study participants had their CIED optimized to detect EMI. They were then exposed to one of 4 fully electric cars, which were selected because they are the most popular electric cars in Europe.

Testing was completed in 3 parts. First, participants sat in the front seat of the vehicle as it ran on a roller test bench. Next, study participants charged the car in which they sat. Finally, they drove the cars on open roads.

Levels of exposure were well within those set by the International Commission on Non-Ionizing Radiation Protection (ICNIRP), which are limited to public exposure of 200 µT and professional exposure of 1000 µT, for a varying 50-Hz sinusoidal current.

In the current study, the maximum electromagnetic force generated even in the worst-case scenario was 116.5 µT along the charging cable, which is still well within the standards laid down by ICNIRP.

Essay-competition-for-medical-students

ICMR has invited entries from Under Graduate and Post Graduate medical students for ICMR Essay Competition 2018. Topics are (i) Innovation in Medicine: New Ideas for Translation (ii) Gandhi & Health: Celebrating 150 Years. Three cash prizes each with a First Prize of Rs.1 Lakh, Second prize of Rs 50,000/- and Third prize of Rs 25,000/- Enteries by 15^th August.

Dental Council proposes to MCI to conduct three-year MBBS bridge course for BDS graduates

 Dental Council of India has made a proposal to the Medical Council of India to undertake a three-year MBBS bridge course for the BDS graduates.

The Council has also made one proposal for starting a one year fellowship program for MDS doctors in any specialty. DCI plans to give a period of three years to those who do PhD in their own MDS specialty by which after one year as lecturer they can be promoted as a reader.

As per the new law regarding courses in dental sciences, all the institutions need to be affiliated to a medical college. From the academic year 2019, with a view to curb mushrooming growth of dental colleges, the recently introduced rule that no new dental colleges will be sanctioned if they are not affiliated to medical colleges will be strictly implement.

Dental council has also suggested that all the state governments should appoint a dental surgeon in every public health centre as bad oral hygiene is the root cause of many ailments and the rural people have very poor oral health practices.  There is also a need to set up independent dental directorates in states. (pharmabiz)

Vegan and vegetarian diets help lower HbA1c and cholesterol levels

It also improves other cardiometabolic risk factors in middle-aged, overweight people controlling their type 2 diabetes with medications, say authors in the journal Clinical Nutrition.

False elevation of creatinine

Drugs or diagnostic agents that adversely affect renal function is a frequent cause of worsening renal function. Among patients with CKD, common offenders include aminoglycoside antibiotics (particularly with unadjusted doses), NSAIDs, and radiographic contrast material.

Certain drugs also interfere with either creatinine secretion or the assay used to measure the serum creatinine. These include cimetidine, trimethoprim, cefoxitin, and flucytosine. In these settings, there will be no change in the true GFR; the clinical clue that this may have occurred is the absence of a concurrent elevation in the blood urea nitrogen. ( urea = BUN x 2.14)

High- moderate vs low intensity statin therapy

High Intensity statins lowers bad cholesterol by > 50%. Examples are Atorvastatin 40-80 mg or Rosuvastatin 20-40 mg

Moderate intensity statins will lower bad cholesterol by 30-50%. Examples are Atorvastatin 10-20 mg, Rosuvastatin 5-10 mg, Simvastatin 20-40 mg, Pravastatin 40-80 mg, Lovastatin 40 mg, Fluvastatin 40 mg BD, Pitavastatin 2-4 mg

Low intensity statins will lower bad cholesterol by < 30% and examples are  Simvastatin 10 mg, Pravastatin 10-20 mg, Lovastatin 20 mg, Fluvastatin 20-40 mg BD, Pitavastatin 1 mg

Protocol in diabetes

1. In diabetics with atherosclerotic cardiovascular disease: High-intensity statin therapy
2. Diabetics (< 40 years) with atherosclerotic cardiovascular disease risk factors: moderate-intensity statin in addition to lifestyle therapy.
3. Diabetics 40–75 years and >75 years without atherosclerotic cardiovascular disease: Moderate-intensity statin in addition to lifestyle therapy.
4. Adjust intensity of statin therapy based on individual patient response to medication (side effects, tolerability, LDL cholesterol levels, or percent LDL reduction on statin therapy).
5. In patients who do not tolerate the intended intensity of statin, the maximally tolerated statin dose should be used.
6. Diabetics and atherosclerotic cardiovascular disease, if LDL cholesterol is ≥70 mg/dL on maximally tolerated statin dose: add ezetimibe or PCSK9 inhibitor
7. Statins are contraindicated in pregnancy.

Medscape ten recommendations for preventing cancer

The guidelines focus on 10 core elements that, taken together, should markedly reduce the risk for cancer among individuals.

1. Recommendations to prevent cancer start with maintaining a healthy weight. Many cancers have been linked to overweight and obesity, and even high-normal body mass index values may be associated with an increased risk for cancer.
2. The next recommendation focuses on physical activity. The authors endorse recommendations from the World Health Organization for at least 150 minutes of moderate-intensity, or 75 minutes of high-intensity, physical activity per week among adults. These are minimum requirements, and more exercise is probably more effective in the prevention of cancer.
3. The recommendations encourage a diet with high consumption of whole grains, vegetables, fruits, and beans. Phytochemicals found in fruits and vegetables have been demonstrated to have anticancer effects in cell and animal studies.
4. The goal for total fiber intake should be at least 30 g/day, with at least 5 servings of nonstarchy fruits and vegetables per day.
5. Conversely, the consumption of red meat and processed meat is strongly discouraged. Heterocyclic amines and polycyclic aromatic hydrocarbons formed when meat is cooked at high temperatures have mutagenic potential, and foods that contain high amounts of salt, such as processed meat, can harm the lining of the stomach and lead to colonization with Helicobacter pylori.
6. Consumption of red meat should be limited to 3 times per week (350-500 g/week), at most.
7. Alcohol consumption is discouraged, and even modest levels of drinking alcohol may increase the risk for cancer. Acetaldehyde, a metabolite of alcohol oxidation, can be carcinogenic. Alcohol can also raise levels of circulating estradiol.
8. Individuals should limit their consumption of foods with high levels of fat, starch, or sugar, including fast food, most processed foods, snacks, bakery goods, and candy.
9. Sugar-sweetened beverages are to be avoided because of their association with obesity.
10. The use of supplements to prevent cancer is discouraged. A healthy diet as described here is the best means to reduce the risk for cancer.
11. The recommendations also advise all new mothers to breastfeed their baby, if possible. Breastfeeding is protective against breast cancer, and it reduces the risk for childhood obesity.

Participate in survey on inflammatory bowel disease:

https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI