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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

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


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  Editorial …

1st September 2011, Thursday

Air pollution is linked to heart disease

  • The Women’s Health Initiative Observational study database of more than 65,000 postmenopausal women without prior CVD evaluated the relation between a woman’s long term exposure to air pollutants and the risk for a first cardiovascular event.1 For each 10 µg/m3 increase in pollution concentration, there were significant increases in the risk of any cardiovascular event (hazard ratio 1.24), death from CVD (hazard ratio 1.76), and of cerebrovascular events (hazard ratio 1.35).
  • Mortality data from nearly 450,000 patients in the American Cancer Society Cancer Prevention Study II data base showed that PM2.5 (fine particulate matter ≤2.5 micrometers in diameter)2 but not ozone concentration was significantly associated with the risk of death from cardiovascular causes (relative risk 1.2).
  • Further support for the importance of air pollution comes from a study of death rates in Dublin, Ireland before and after a ban on coal sales that led to a 70 percent reduction in black smoke concentrations.3 Adjusted cardiovascular deaths fell by 10.3 % in the six years after the ban.
  • In addition to long–term risk, short–term exposure to air pollutants (both ozone and fine particulate matter) has been associated with acute coronary ischemic events.4,5
  • In a study of over 12,000 patients living in a defined geographic area, a short–term increase in fine ambient particulate matter positively correlated with an increase in acute ischemic coronary events.4,5
  • Air pollution: Carbon particulates in the air from the burning of fossil fuels, wood, and other materials scatter and absorb UVB rays. Ozone absorbs UVB radiation, so holes in the ozone layer could be a pollution problem that winds up enhancing vitamin D levels.

Possible mechanisms by which fine particulate air pollution may increase the risk of CVD include: An increase in mean resting arterial blood pressure through an increase in sympathetic tone and/or the modulation of basal systemic vascular tone, An increase in the likelihood of intravascular thrombosis through transient increases in plasma viscosity and impaired endothelial dysfunction and Initiation and promotion of atherosclerosis.6–8


  1. Miller KA, Siscovick DS, Sheppard L, et al. Long-term exposure to air pollution and incidence of cardiovascular events in women. N Engl J Med 2007;356:447.
  2. Jerrett M, Burnett RT, Pope CA 3rd, et al. Long–term ozone exposure and mortality. N Engl J Med 2009;360:1085.
  3. Clancy L, Goodman P, Sinclair H, Dockery DW. Effect of air–pollution control on death rates in Dublin, Ireland: an intervention study. Lancet 2002;360:1210.
  4. Pope CA 3rd, Muhlestein JB, May HT, et al. Ischemic heart disease events triggered by short–term exposure to fine particulate air pollution. Circulation 2006;114:2443.
  5. Ruidavets JB, Cournot M, Cassadou S, et al. Ozone air pollution is associated with acute myocardial infarction. Circulation 2005;111:563.
  6. Brook RD, Brook JR, Urch B, et al. Inhalation of fine particulate air pollution and ozone causes acute arterial vasoconstriction in healthy adults. Circulation 2002;105:1534.
  7. Pekkanen J, Peters A, Hoek G, et al. Particulate air pollution and risk of ST–segment depression during repeated submaximal exercise tests among subjects with coronary heart disease: the Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) study. Circulation 2002;106:933.
  8. Sun Q, Hong X, Wold LE. Cardiovascular effects of ambient particulate air pollution exposure. Circulation 2010;121:2755.

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Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Air pollution is linked to heart disease

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issue

Invited Guests among the audience in the recently concluded National Conference on Insight on Medico Legal Issue

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Food vendors must don gloves, maintain hygiene or pay 1L fine

MUMBAI: The next time you visit your favourite chai, pani puri or bhel puri stall, or any other small–time food seller, don’t be surprised to see the vendors sport aprons and hand gloves. For, according to the new Food Safety Act, hawkers, food vendors and temporary stall owners must follow minimum standards of food safety or pay a maximum fine of Rs 1 lakh. The new Central Food Safety and Standard Act, 2006, replaces the existing Prevention of Food Adulteration Act; the State Food Safety Act came into effect in Maharashtra from August 5, 2011. With the implementation of the new rules, even vegetable or fruit sellers who use chemicals to ripen their products will be liable for punishment. "Small–time food stalls, vegetable and fruit vendors and even big–time restaurants – all will have to mandatorily follow basic hygiene rules such as wearing an apron, gloves, using clean utensils and potable water," said Satej Patil, minister of state for Food and Drugs Administration (FDA), in Mantralaya on Monday. (Source: TOI, Aug 30, 2011)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

New Infant UTI guideline includes ultrasound

Updated guidelines from the American Academy of Pediatrics (AAP) recommend urinalysis and culture when a urinary tract infection (UTI) is suspected or when antibiotic treatment will be started empirically in children 2–24 months. Changes from the previous guidelines in 1999 include one specific to the first UTI: the new guidelines recommend renal and bladder ultrasound with no voiding cystourethrogram (VCUG) unless the ultrasound is suggestive of anatomic abnormalities, and follow–up but no antimicrobial prophylaxis. Urine culture should show the presence of at least 50,000 colony–forming units (CFUs) per mL of a single uropathogen to confirm clinical suspicion arising from pyuria, positive nitrates, or bacteriuria.

For comments and archives

Nocturnal ACS linked to belly fat, disordered sleep

Nighttime acute coronary syndrome (ACS) occurred significantly more often in patients with visceral fat accumulation and sleep–disordered breathing, investigators reported. Among 25 patients with nighttime onset of ACS, two–thirds of those with ≥100 cm2 of visceral fat accumulation also had sleep–disordered breathing as compared with a fourth of patients with less visceral fat. In contrast, sleep–disordered breathing occurred in a similar proportion of patients with and without visceral fat and daytime–onset ACS. ACS during sleep occurs infrequently, and predisposing factors remain unclear but could include disordered sleep and obstructive sleep apnea (OSA). Patients with OSA have an increased risk of sudden cardiac death with nighttime onset, the authors noted in their introduction. (Source: Medpage Today)

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Speedy treatment for heart attacks called ‘finest moment’

Over a span of five years, the initiative to improve door–to–balloon time for people experiencing out–of–hospital myocardial infarction has resulted in significantly lower transport and treatment times, a nationwide analysis showed. From 2005 to 2010, door–to–balloon time declined from a median of 96 minutes to 64 minutes, reported Harlan R. Krumholz, MD, from Yale University School of Medicine, and colleagues. Moreover, there were corresponding increases in the percentage of patients who had times under 90 minutes (44.2% to 91.4%), as well as under 75 minutes (27.3% to 70.4%), according to the study published online in Circulation: Journal of the American Heart Association. (Source: Medpage Today)

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    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Exercise can prevent migraines

While doctors suspect that exercise helps alleviate migraines, this is based on anecdotal evidence from patients alone. No research studies have ever been done to show a relationship between the two. Therefore, researchers in Germany set out to design an exercise program suitable for migraine sufferers in order to evaluate how they are affected by exercise in a lab setting. Their results were published in the International Journal of Sports Medicine. Researchers examined the effect of exercise on migraines in 16 chronic migraine sufferers. The participants were divided into two groups: half of the patients completed a 10–week aerobic exercise program consisting of 3 workouts per week (running in a treadmill) and half the patients did not perform any physical activity. Migraine patients in the running group showed both a reduction in the number of days they suffered a migraine each month and a decrease in the intensity of their attacks.

If you or someone you know has recurring migraines, running on a treadmill may be the answer to their problems.

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #IJMD Peripheral ameloblastoma (PA) is a rare soft tissue neoplasm of odontogenic origin that arises in the… fb.me/14ayvtUE7

@DeepakChopra: #CosmicConsciousness I look into your eyes & see the universe not yet born––Rumi

    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

A patient of CAD with bronchial asthma, how do you treat CAD without aspirin?

Being bronchial asthma we cannot give beta blockers. Aspirin also needs to be avoided in asthma. But we can give Clopidogrel, diltiazem, amlodipine and nitrates.

For comments and archives

    Spiritual Update

Relieve Stress by Changing the Interpretation

Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves changing the situation, changing its interpretation or preparing the body and the mind in such a way that stress does not affect them. Changing the situation is always n…

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

(Contributed by Mr Radhakrishna)

"One day a farmer’s donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn’t worth it to retrieve the donkey. He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone’s amazement he quieted down.

A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up.

As the farmer’s neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!

Moral: Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.

Remember the five simple rules to be happy:

1. Free your heart from hatred – Forgive.
2. Free your mind from worries – Most never happens.
3. Live simply and appreciate what you have.
4. Give more –
5. Expect less from people

For comments and archives

    Gastro Update

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

Medical management of neonatal cholestasis

First line drugs

  • Ursodeoxycholic acid 10–20 mg/kg/day
  • Rifampicin 10mg/kg/day,
  • Cholestyramine 4–8gm/kg/day
  • Phenobarbitone 5mg/kg/day

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Angiotensin Converting Enzyme

ACE is primarily ordered to help diagnose and monitor sarcoidosis. It is often ordered as part of an investigation into the cause of a group of troubling chronic symptoms that may or may not be due to sarcoidosis

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient had LDLC of 100 mg/dL and HDLC 61 mg/dL.
Dr Bad: Start statins.
Dr Good: No treatment is required yet.
Lesson: HDL–C ≥60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count.

For comments and archives

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

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  Quote of the Day

(Dr Chandresh Jardosh)

Sharing problems and asking for help doesn’t mean that we are weak or incompetent. It usually indicates an advanced level of Trust.


Doozy: Something outstanding.

  G P Pearls

(Dr Pawan Gupta)

Predicting Pregnancy HT: Uterine artery Doppler at 18–20 week of pregnancy is useful tool and screening test for predicting development or not of pregnancy–induced HT. It has specificity of > 96% and sensitivity of 65%. (BMJ 2011/53/358)

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is the concussion of the brain?

It is a rotational injury caused by sudden acceleration.

  • As seen in autopsy, concussion occurs when the head is free to move with sufficient velocity, but not when it is fixed. It is popularly known as ‘stunning’, and may be produced by direct violence on the vertex, by indirect violence as a result of a violent fall upon the feet from height, or by an unexpected fall on the ground, when pushed forcibly in any traffic accident or an injury received in industry.
  • The impact on the hollow structure of skull is propagated by radiating waves of motion along with the site of impact and coverage as they approach the opposite pole giving rise at the point of collision to a contralateral or countercoup injury.
  • The contusion and laceration of brain occurs due to the traction as the brain is torn away from its covering by the force of its own momentum. Application of a blow to the movable head is followed by a positive pressure in the area of brain underlying the zone of impact and by a negative pressure over the contralateral brain surface where the brain pulls away from the skull.
  • The injuries of the brain heal by forming adhesions and may later cause secondary epilepsy.

For comments and archives

    Mind Teaser

Read this…………………

The laryngeal mask airway used for securing the airway of a patient in all of the following conditions except:

1. In a difficult intubation
2. In cardiopulmonary resuscitation
3. In a child undergoing an elective routine eye surgery
4. In a patient with a large tumor in the oral cavity

Yesterday’s Mind Teaser: Ideal treatment of alkaline reflux gastritis after Billroth I and Billroth II gastrectomy is

a) Conversion of Billroth I to Billroth II
b) Roux en Y gastrojejunostomy
c) Total gastrectomy
d) Conservative management

Answer for Yesterday’s Mind Teaser: b) Roux en Y gastrojejunostomy

Correct answers received from: Dr Chandresh Jardosh, Dr K Raju, Dr Muthumperumal Thirumalpillai,
Dr Neelam Nath, Anil Bairaria, Dr Dilip Kumar Jha, Dr Valluri Ramarao.

Answer for 30th August Mind Teaser
: 2. Neuroblastoma
Correct answers received from: Dr Mukesh Agarwal, Dr Sukanta Sen.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Chandresh Jardosh)

Bhakt: Hey Bhagwan… promotion karwa dena. 51 rupees ka bhog aapke charnon mein rakh raha hoon
God: Pagal marwayega kya? Anna dekh raha hai…

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Bicalutamide Tablet 150 mg. (Additional Strength and Indication)
Indicated either alone or as adjuvant to radical prostatectomy or radiotherapy in patients with locally advanced prostate cancer at high risk for disease progression.


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Sudden Cardiac Death

It is easy to anticipate and identify people at risk of sudden cardiac death, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, and MTNL Perfect Health Mela.

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes occurring in a short time period (generally within 1 hour of symptom onset) in a person with known or unknown cardiac disease. Most cases of SCD are related to cardiac arrhythmias. Approximately half of all cardiac deaths can be classified as SCDs. SCD represents the first expression of cardiac disease in many individuals presenting with out–of–hospital cardiac arrest.

Other forms of sudden death may be noncardiac in origin. Examples of this include respiratory arrest (such as due to airway obstruction, which may be seen in cases of choking or asphyxiation), toxicity or poisoning, anaphylaxis, or trauma.

It is important to make a distinction between this term and the related term cardiac arrest, which refers to cessation of cardiac pump function which may be reversible. The phrase sudden cardiac death is a public health concept incorporating the features of natural, rapid, and unexpected. It does not specifically refer to the mechanism or cause of death. Talking about sudden cardiac death, Dr Aggarwal, said that the following people are at risk:

  • People who have survived a past cardiac arrest.
  • Heart patient with pumping action of the heart less than 30%
  • ECG showing wide QRS conduction of more than 120 msec.
  • Inability to climb two flights of stairs without symptoms.
  • Inability to walk 2 kms on level ground without symptoms.
  • Inability to do exercise in the bed with the partner without symptoms.
  • Patient with uncontrolled blood pressure, diabetes, smoking and people who drink more than 5 pegs of alcohol in one hour or 6 pegs of alcohol in one day.
  • People who have uncontrolled snoring.

For comments and archives

    Readers Responses
  1. A man must be big enough to admit his mistakes, smart enough to profit them & strong enough to correct them…! Regards: Dr. Chandresh Jardosh
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta