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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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  Editorial …

2nd April 2013, Tuesday

Air Pollution may Raise Risk of Stroke, Cognitive Decline

Car exhaust and other air pollution, even at levels considered safe by federal regulations, may substantially increase the risk of a stroke, a research team from Beth Israel Deaconess Medical Center has found.

After reviewing the medical records of more than 1,700 stroke patients in the Boston area over 10 years, the researchers found a 34 percent increase in the risk of ischemic strokes on days with moderate air quality compared with days when the air was rated good by the US Environmental Protection Agency.

A lifetime’s exposure to air pollution may contribute to mental decline in older women,” according to the study published online Feb. 13 in the journal Archives of Internal Medicine.

Exposure to fine particulate matter air pollution — less than 2.5 micrometers in diameter, or about 1/30th of the diameter of a human hair — as well as coarse particulate matter — between 2.5 and 10 micrometers in diameter — were associated with mental declines in women.

A second study published in the same journal “found that more people were admitted to a Boston hospital for ischemic stroke on days when levels of fine particulate air pollution were high.

The second study “found that short-term exposure to fine particulate matter — even at levels allowed by the EPA – can increase the risk of ischemic stroke.

The relationship between higher particulate levels and increased risk of stroke was linear, strongest within 12 hours of exposure, and was seen among patients with strokes caused by large-artery atherosclerosis or small-vessel occlusion but not cardioembolism. (AMA News)

For Comments and archives…

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

Monitoring LFT in a patient on statins

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Awardees meet

Padma Awardee doctors had a relaxing evening at Dr Yash Gulati’s Residence on 29th March 2013

Dr K K Aggarwal
    National News

Delhi's HIV death rate higher than official figures

New Delhi: Over 2,300 HIV-infected people registered with various Delhi hospitals have died in the past eight years but authorities suspect the numbers could be much higher as another 3,000 who signed up with them are now untraceable and their status not known. According to statistics compiled by Delhi State AIDS Control Society (DSACS), 2,319 HIV-infected people registered with Anti-Retroviral Therapy (ART) centres in Delhi hospitals have died during these years while 2,936 patients have failed to turn up for treatment. Since there is no trace of 2,936 patients, health authorities are uncertain as to how many of them are still alive. "A total of 41,065 HIV-patients in Delhi have been registered with ART centres in the past eight years and 2,319 such patients have died due to the infection so far.”Similarly, there are around 2,936 patients, whose treatment was initiated but they failed to continue with the treatment and are now untraceable," Dr A K Gupta, assistant project director of DSACS, said. The patients died while they were undergoing treatment for HIV infection in ART centres in the capital, he said, adding these facilities provide free of cost monthly drug dose to patients to improve their quality of life. Whether to put patient on ART or not is decided in accordance with the severity of infection. As per the parameters laid down by Delhi health authorities, nearly half of the total HIV positive patients are currently undergoing treatment at the ART centres. However, more than one-third of the total patients put on treatment are not getting medical care today. "Compared to 21,254 patients, who have been put on treatment for HIV/AIDS, number of patients getting anti- retro-viral treatment is 12,479. Besides those who have either died or failed to turn up, there are 2,700 such patients who have been shifted to other states," said Gupta. He said there were another 607 patients, who have missed their last monthly visit to the ART centre and these patients are also treated as those who are not getting treatment. ART regimen mandates for each patient undergoing treatment to monthly visit the centre to undergo routine check up and gets monthly drugs' stock. Besides providing drugs free of cost, rationale behind the mandatory visit is to keep patients in rapport with the centre, which assures patient's psychological care as well. Patients, who miss three monthly visits to their respective ART centres in a row, are kept under "Lost to Follow-Up" category. (Source: Indian Express, Mar 31 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Fifty percent of school children do not reveal sexual assault to anyone.

    Valvular Heart Disease Update

Bicuspid aortic valve can be associated with ventricular or atrial septal defect, hypoplastic left heart syndrome, patent ductus arteriosus, bicuspid pulmonic valve and Ebstein’s anomaly.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Diastolic dysfunction common in RA

Patients with rheumatoid arthritis (RA) have an increased incidence of diastolic dysfunction, which may further raise their already high risk for congestive heart failure, a meta-analysis suggested. (Source: Medpage Today)

Light therapy reduces depressive symptoms in epilepsy

The use of bright light therapy may reduce symptoms of anxiety and depression in patients with epilepsy, new research suggests. (Source: Medscape)

Proteinuria linked to life expectancy

Individuals with proteinuria may have a shorter estimated life expectancy compared with their healthier counterparts, a Canadian study showed. (Source: Medpage Today)

Ob/Gyns report high levels of burnout

More than 40% of ob/gyns report some degree of burnout, according to the 2013 Medscape Physician Lifestyle Report. The report, a survey of physicians in 24 specialties, examines the links between work burnout and physicians' lives outside of practice. Symptoms of burnout include feeling cynical, loss of enthusiasm for work, and a dwindling sense of personal accomplishment. (Source: Medscape)

New kidney function tied to vitamin D status

Low vitamin D after a kidney transplant is associated with worse kidney function and increased fibrosis, researchers reported. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: Restricting salt in the diet can lower the risk of developing heart disease by 25 percent and the risk of dying... http://fb.me/FnEqzEvk

@DrKKAggarwal: The idea that electrochemical activity in the brain produces consciousness is like saying that rubbing Aladdin's lamp produces a genie

    Spiritual Update

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

Why do We Worship the Tulsi Plant?

Yanmule sarvatirhaani

Yannagre sarvadevataa

Yanmadhye sarvavedaascha

Tulasi taam namaamyaham

“I bow to the Tulsi, At whose base are all the holy places, At whose top reside all the deities and In whose middle are all the Vedas.”

The Tulsi or Sacred Basil is one of the most sacred plants. There is a Sanskrit shloka: “Tulanaa naasti athaiva tulsi” - which is incomparable in its qualities, is the tulsi. It is the only pooja samagri which can be washed and reused.

For Comments and archives…

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Smoking cessation as a treatment issue in couples undergoing fertility therapy

Cessation of smoking for at least two months before attempting IVF signi?cantly improves chances for conception. Although long-term cigarette smoking can have an irreversible effect on ovarian function, the harmful effect on treatment outcome may, in part, be reversed if smoking is discontinued prior to entering into fertility therapy.

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

How is blood formed?

Blood consists of RBCs, WBCs and platelets suspended in plasma. In early embryonic life, blood cells are formed in liver and spleen. But by the 5th month, hemopoiesis (i.e., formation of blood) occurs in bone marrow and lymphatic tissues. At birth, the entire bone marrow is red and active. Gradually as the child grows, only the marrow in the flat bones and vertebrae remains red. The RBCs, granulocytes of WBCs and platelets are mainly produced by bone marrow. The lymphocytes, monocytes, plasma cells are formed in the lymphoid and reticuloendothelial tissues. The orderly proliferation of the cells in the bone marrow and their release into circulation is carefully regulated according to the needs of body. Everyday new blood cells are being produced in the bone marrow and every day old cells are dying and are being removed from the body.

Red blood cells have life of 120 days i.e. any red cell formed in the body will live for the next 120 days and when it becomes old and senile it is thrown out. White cells live for a couple of weeks and platelets for a few days.

For Comments and archives…

    An Inspirational Story

Just Listen

I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it's given from the heart. When people are talking, there's no need to do anything but receive them. Just take them in. Listen to what they're saying. Care about it. Most times caring about it is even more important than understanding it. Most of us don't value ourselves or our love enough to know this. It has taken me along time to believe in the power of simple saying, "I'm so sorry," when someone is in pain. And meaning it.

One of my patients told me that when she tried to tell her story, people often interrupted to tell her that they once had something just like that happen to them. Subtly her pain became a story about themselves. Eventually she stopped talking to most people. It was just too lonely. We connect through listening. When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care. Many people with cancer can talk about the relief of having someone just listen.

I have even learned to respond to someone crying by just listening. In the old days I used to reach for the tissues, until I realized that passing a person a tissue may be just another way to shut them down, to take them out of their experience of sadness and grief. Now I just listen. When they have cried all they need to cry, they find me there with them.

This simple thing has not been that easy to learn. It certainly went against everything I had been taught since I was very young. I thought people listened only because they were too timid to speak or did not know the answer. A loving silence often has far more power to heal and to connect than the most well intentioned words.

For comments and archives

   Cardiology eMedinewS

Dietary fiber nibbles down stroke risk Read More

   Pedia News

ESA dose predicts death in kids on peritoneal dialysis Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Is there a one-shot ARV? Is there any ARV that offers lifelong protection?

There is no single dose vaccine or a vaccine that gives lifelong immunity.

    IJCP Special

Dr Good Dr Bad

Situation: A patient had a strong family history of cancer.
Dr Bad: Just get regular check ups.
Dr Good: Take low-dose aspirin.
Lesson: An observational analysis published online in The Lancet reported that long–term daily aspirin may prevent cancer deaths. (Ref: Rothwell PM, et al. Effect of daily aspirin on long–term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 2011 Jan 1;377(9759):31-41)

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide?
Lesson: Make Sure to prescribe nimesulide as it is safe in acid peptic disease.

  Quote of the Day (Dr GM Singh)

Inventing is the mixing of brains and materials. The more brain you use, the less material you need. Charles F. Kettering

    Mind Teaser

Read this…………………

An infant, 6 weeks old, is brought to the clinic for a well-baby visit. To assess the fontanels, how should Nurse Oliver position the infant?

a. Supine
b. Prone
c. In the left lateral position
d. Seated upright

Yesterday’s Mind Teaser: A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should nurse Bea include in a bladder retraining program?

a. Establishing a predetermined fluid intake pattern for the client
b. Encouraging the client to increase the time between voidings
c. Restricting fluid intake to reduce the need to void
d. Assessing present elimination patterns of erythropoietin.

Answer for Yesterday’s Mind Teaser: d. Assessing present elimination patterns of erythropoietin.

Correct answers received from: Dr Shashi Saini, Dr KV Sarma, Dr Suresh Arora, Dr Jella, Dr Thakor Hitendrsinh G, Dr Bharat Bhushan Aggarwal, Kanta Jain, Dr Bharat Bhushan Aggarwal, Dr PC Das, Dr Avtar Krishan, Anil Bairaria,
Dr BB Gupta, Dr Arpan Gandhi, Dr Pankaj Agarwal, Dr Jainendra Upadhyay,
Dr Chandresh Jardosh, Dr PC Das.

Answer for 31st March Mind Teaser: b. 7 to 10 days.

Correct answers received from: Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr PC Das.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.

  Medicolegal Update

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

What is a medicolegal case?

A medicolegal case is a case of injury, ailment, hurt or illness or death due to evident criminal cause or where the attending doctor, on examining the patient, concludes that criminal force/weapon has been used against human body and an inquiry/investigation by law agencies is required in accordance with the prevailing law of the land. It is a legal duty of the treating doctor to inform a medicolegal case to the nearest police station immediately after completing primary lifesaving medical care. In accordance with Section 39 of Criminal Procedure Code of India, the treating doctor is duty bound to inform the nearest police station as soon as he/she completes his primary medical care. Phones/mobile phones can be used for informing the police in this era of modern advancement in telecommunication. An acknowledgement of receipt of such a message should be taken for future reference. If the intimation is given orally or on phone, the diary number (DD or the Daily Docket number/name and designation of police officer) should be taken down as proof of intimation and should be properly documented in the patient’s records. The idea is to initiate legal proceeding at the earliest so that the maximum evidence can be collected by the police officer with minimum destruction of evidences, site of occurrence, knowingly or unknowingly by any party. There is a quote in Bernard Knight Text Book of Forensic Medicine, which says that ‘the doctor dealing with medico–legal cases should not act /behave like a detective; equally the doctor should never act like curtain between police and patient involved in crime.'

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Tips on family history of high cholesterol

Premature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85% said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk.

First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL "bad cholesterol") levels and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 31689 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

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  1. Dear Sir, emedinews is very inspirative. Regards: Dr SP Kamant
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