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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 …

2nd August 2011, Tuesday

Carotid artery blockages

Should I screen each patient for presence of carotid neck artery blockages?

The guideline says no. The potential harms include risks associated with the screening procedure itself like false positive findings leading to anxiety and the potential for unnecessary surgical procedures. Carotid angiography is associated with risk of neurological complications including stroke, with rates ranging from 0.1 to 1%.

What are the screening methods available?

  1. Carotid ultrasound followed by catheter angiography
  2. Carotid ultrasound followed by MRA
  3. Ultrasound alone

How reliable is Doppler carotid study for detecting blockages?

The reliability is variable and operator–dependent.

How risky is carotid stenting or surgery?

Both endarterectomy and carotid stenting are associated with an increased 30–day risk of stroke and death. These are in the range of 2.3 to 3.7 percent for endarterectomy.

How common is carotid artery blockage in general population?

The prevalence of carotid stenosis in general population is less than 1%. Screening with resultant surgical procedures causes more strokes than it can prevent. For severe (≥70%) carotid stenosis, the prevalence increases with age from approximately 0 to 3%.

At what prevalence is screening beneficial?

Only at prevalence rates of over 20% significant benefits are seen with at best about 100 strokes prevented for every 10,000 screened at 20 percent prevalence. Clinical features cannot identify asymptomatic individuals likely to have carotid stenosis. The annual risk of stroke in patients with asymptomatic carotid artery stenosis is relatively low.

When to screen for carotid blockages?

Carotid duplex ultrasonography is not recommended for routine screening of asymptomatic patients who have no clinical manifestations of or risk factors for atherosclerosis. However one should screen asymptomatic individuals who have:

  • Carotid bruit
  • Peripheral arterial disease
  • Coronary disease
  • Aortic aneurysm
  • Two or more risk factors for atherosclerotic disease.

What is symptomatic carotid artery blockage?

Patients who have had a stroke or transient ischemic attack (mini paralysis) due to carotid stenosis are considered symptomatic and often benefit from carotid revascularization. Symptoms means transient or permanent focal neurologic symptoms related to the affected artery (same side loss of vision, opposite side weakness or numbness of an extremity or the face, difficulty in speech or loss of speech). Patients with nonspecific neurologic symptoms (dizziness or syncope/near syncope) are not considered in the definition of symptomatic carotid stenosis.

What are the medical interventions for carotid blockages?

The interventions are management of hypertension, smoking cessation, use of statin drugs and low–dose aspirin.

When should one decide for carotid endarterectomy or removal of blockages with catheter?

It is indicated for selected medically stable patients with asymptomatic carotid stenosis of 60 to 99% who have a life expectancy of at least five years, provided the perioperative risk of stroke and death is less than 3 percent. However, long–term outcomes for patients with carotid blockages managed by intensive medical therapy may be similar to surgical management.

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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

Carotid artery blockages

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

National Conference on
Insight on Medico Legal Issues

Ms Maninder Acharya was felicitated in the National Conference on Insight on Medicoleagl Issues held on 10th July, 2011.

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


Tripura witnesses sharp decline in malaria cases

AGARTALA– Tripura, one of the high endemic malaria zones in the country, has witnessed a sharp decline in the incidence of the ‘fatal’ disease. Incidence of malaria in the State has been reduced by 23 per cent when compared to 2009 while the dead toll stood at only four during 2011, according to figures available with Family Welfare and Preventive Medicine department. Altogether, 1.43 lakh blood samples were tested during 2010, out of which 10,377 tested positive, said Dr RK Dhar, Director, Family Welfare and Preventive Medicine here on Sunday. This year, as many as 1.26 lakh blood samples were collected while only 7,948 cases tested positive. In Tripura, 90 per cent of the cases are Plasmodium Falsiparum which is more fatal than Plasmodium vivax (10 per cent). (Source: The Assam Tribune, August 01, 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)

Sex hormone protects men from allergies

Men can better fight inflammatory diseases as compared to women, thanks to their sex hormones that are known as testosterones, claims a German research. Inflammation is the initial response of our body to harmful stimuli, which could include pathogens, bacteria and other microorganisms. "It is mostly women who are affected by diseases like rheumatoid arthritis, psoriasis or asthma," explains Oliver Werz, professor of pharmacy and medical chemistry at Friedrich Schiller Jena University, Germany. "Although this is a fact known for some time, the reasons for these differences are largely unknown," adds Werz. "In a series of analyses we have shown that cells from men and women react in a different manner to inflammatory stimuli," says Carlo Pergola from the Institute of Pharmacy, Jena University.
(Source: TOI, Jul 27, 2011)

For comments and archives

How COPD disease persists even after smoking cessation

Australian researchers have found why chronic obstructive pulmonary disease (COPD) continues long after patients have quit smoking, the primary cause of the disease. They said cigarette smoke exposure fundamentally alters airway tissue from people with chronic obstructive pulmonary disease (COPD) at the cellular level, laying the groundwork for airway thickening and even precipitating precancerous changes in cell proliferation that may be self—perpetuating long after cigarette smoke exposure ends.

"We have demonstrated for the first time that the extracellular matrix (ECM) produced by fibroblasts following stimulation with cigarette smoke extract is functionally different than non—exposed ECM, and that the cigarette smoke itself may prime the airways in such a way to create an environment whereby airway remodelling is encouraged," wrote lead researcher David Krimmer of the University of Sydney in Australia. The researchers examined the response of human lung tissue from donors with and without COPD to cigarette smoke extract (CSE). They found that CSE exposure induced a significant increase in fibronectin deposition from the tissue of donors with COPD over the tissue of individuals without COPD. Similarly, they found that CSE upregulated the expression of perlecan—an ECM protein that is associated with tumour growth and angiogenesis—in COPD lung tissue.
(Source: http://www.thehindu.com/health/medicine–and–research/article2302451.ece, July 28, 2011)

For comments and archives

Head injury bumps up stroke risk

People experiencing traumatic brain injuries were at substantially increased risk of ischemic and hemorrhagic strokes up to five years later, according to a retrospective study in Taiwan. (Source: Medpage Today)

For comments and archives

New risk for sudden death in dialysis patients

A low concentration of homoarginine in the blood appears to be a risk factor for sudden cardiac death and heart failure death among diabetic patients who require hemodialysis, researchers found. (Source: Medpage Today)

For comments and archives

    Fitness Update

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

Good vibrations

There’s a new trend in fitness: whole body vibration. Increasingly, whole body vibration machines are being used as a platform on which to perform resistance training exercises. Although this new method of exercising is quite popular, its effectiveness is still not well understood by the scientific community.
Researchers in Japan conducted a study aimed at examining the effects of whole body vibration combined with resistance training on muscle strength, power and endurance. Their study included 33 men and women between the ages of 22 and 49, who were divided into two groups. One group performed a resistance training routine on a whole body vibration platform and the other performed an identical strength training routine on a flat, steady surface. The 60 minute sessions were performed twice per week for seven weeks, and different measures of muscle strength were taken after each session. The study found that whole body vibration sessions caused significant increases in muscle strength, power and endurance.

Therefore, if you haven’t jumped on the whole body vibration bandwagon yet, now may be a good time to give it a try and see if it’s right for you!

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #eMedinewS Score predicts blurry coronary CT scans A simple tool can help identify patients with a greater… http://fb.me/Ulez3ZAp

@DeepakChopra: Insight enables you to know your own heart and clarity enables you to accept without illusions.

    Dr KK Answers

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

Can a person donate blood after being vaccinated?

A person is not accepted as a donor for four weeks after Rubella or Varicella Zoster vaccine. A person cannot donate blood for two weeks after vaccination for measles, oral polio, oral typhoid, yellow fever.

For comments and archives

    Spiritual Update

The Deeper Meaning of "Lord Shiva"

Lord Shiva is worshipped along with his entire family in the month of Shravan every Monday. Shiva is given a bath with milk, water, curd, ghee, honey or sugar, ganga jal etc. Belpatra, Samipatra, Kusha and Doob are offered to please him. Most of us worship Lord Shiva without understanding the d

For comments and archives

    An Inspirational Story

(Dr Maj Prachi Garg)

What goes around comes around

Good for the soul…

The man’s name was Fleming and he was a poor Scottish farmer. One day, while trying to make a living for his family, he heard a cry for help coming from a nearby bog. He dropped his tools and ran to the bog. There, mired to his waist in black muck, was a terrified boy, screaming and struggling to free himself. Farmer Fleming saved the lad from what could have been a slow and terrifying death. The next day, a fancy carriage pulled up to the Scotsman’s sparse surroundings.

An elegantly dressed nobleman stepped out and introduced himself as the father of the boy Farmer Fleming had saved. "I want to repay you," said the nobleman. "You saved my son’s life." "No, I can’t accept payment for what I did," the Scottish farmer replied, waving off the offer. At that moment, the farmer’s own son came to the door of the family hovel. "Is that your son?" the nobleman asked. "Yes," the farmer replied proudly. "I’ll make you a deal. Let me take your son and give him a good education. If the lad is anything like his father, he’ll grow up to be a man you can be proud of." And that he did. In time, Farmer Fleming’s son graduated from St. Mary’s Hospital Medical School in London and went on to become known throughout the world as the noted Sir Alexander Fleming; the discoverer of Penicillin. Years afterward, the nobleman’s son was stricken with pneumonia.

What saved him? Penicillin.

The nobleman’s name? Randolph Churchill.

His son’s name? Sir Winston Churchill.

Moral? "What goes around comes around."

Note: According to the investigative web site, TruthorFiction.com, this story is not about Sir Winston Churchill. Churchill’s official biographer, Sir Martin Gilbert, says there is no record of Churchill nearly drowning or of his father paying for Fleming’s education, but Churchill was once treated for pneumonia. However, as an old friend once told me, "never let the truth interfere with a good story." And I believe this is an inspiring story, true or not

For comments and archives


(By Ritu Sinha)

All Greek to me: Meaningless and incomprehensible like someone who cannot read, speak, or understand any of the Greek language would be.

    Pediatric Update

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

How does one assess the severity of croup?

Severity can be assessed by monitoring of the following parameters: Stridor, retractions, cyanosis, heart rate (HR), respiratory rate (RR), mental status and air movement.

Mild croup (the commonest presentation)

  • The child is happy, playful and is feeding well.
  • A barking cough, change in voice and stridor on coughing and crying and absent at rest.
  • There may be mild chest–wall retractions and tachycardia.

Moderate croup

  • Audible stridor at rest, which worsens with agitation,
  • Barky cough, and increased work of breathing (retractions, increased RR and HR),
  • Child may be fussy but is alert, interactive.

Severe croup

  • The child appears increasingly tired and exhausted due to laboured breathing and stridor.
  • Marked tachycardia and tachypnea persists.
  • Restlessness, agitation, irrational behavior, decreased level of consciousness, hypotonia, cyanosis and marked pallor are late signs of life-threatening airway obstruction.

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  Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist, Max Hospital)

What is the importance of influenza vaccine?

Influenza vaccination is recommended for women who may be in the second or third trimester of pregnancy during influenza season. The optimal interval for immunization spans the months of October and November because the flu season occurs during January through March. Injectable influenza vaccines contain inactivated virus and therefore may be administered at any time during pregnancy. In contrast, intranasal influenza vaccines contain live attenuated virus and should not be administered during pregnancy. Influenza infection may increase risk for medical complications, because heart rate, stroke volume, and oxygen consumption are increased and lung capacity is decreased during pregnancy.

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)


Red blood cells (RBC) contain a protein called hemoglobin. Methemoglobin is a type of hemoglobin that is unable to transport oxygen to tissues in blood. Increased production of methemoglobin leads to condition called methemoglobinemia.

This test is used to evaluate and manage a condition called methemoglobinemia. The following are possible reasons why this test may be done:

  • Acquired methemoglobinemia
  • Congenital methemoglobinemia

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with BMI 36 kg/m2.
Dr Bad: Measure waist circumference first.
Dr Good: You need to reduce weight.
Lesson: In patients with a BMI ≥35 kg/m2, measurement of waist circumference is less helpful since it adds little to the predictive power of the disease risk classification of BMI; almost all individuals with this BMI also have an abnormal waist circumference.

For comments and archives

Make Sure

Situation: A diabetic patient was gaining weight.
Reaction: Oh my God!! Why was insulin not considered as the cause of weight gain?
Lesson: Make sure that one considers drugs in the possible list of causes of unexplained weight gain. Medications are a common cause of weight gain and obesity, in particular insulin, sulfonylureas, and antipsychotics.

For comments and archives

  Quote of the Day

(Dr GM Singh)

The whole world steps aside for the man who knows where he is going.

    Medicolegal Update

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

Firearm injuries

When bullets produce tracks in dense tissues, such as muscle, liver, spleen and blood, the tissues are compressed ahead of the track by a compression wave, in the form of a shock wave of spherical form.

  • Tissue damage can also be produced at a considerable distance away from the original bullet track. Thus, the urinary bladder, stomach and colon may be ruptured in high velocity wounds situated at a remote distance from the abdominal cavity itself.
  • After a high velocity missile wound has been inflicted on the tissues, several zones of tissue damage can be identified. The site of the permanent local track is marked by tissues which have been totally destroyed, and this is similar to low–velocity bullets. Surrounding this is a layer of necrotic debris caused by the temporary cavitations effect and secondary missiles, highly contaminated by micro–organisms.
  • A variable thickness layer of live tissue surrounds the zone of necrosis, consisting of an inner portion which will prove to be non–viable as a result of the injuries sustained, and an outer portion that will remain viable provided that optimum conditions are provided for healing. Around this zone is normal tissue.

For comments and archives

    Mind Teaser

Read this…………………

Lumbar sympathectomy is of value in the management of:

1. Intermittent claudication
2. Distal ischemia affecting the skin of the toes
3. Arteriovenous fistula
4. Back pain

Yesterday’s Mind Teaser: Which of the following statement is true regarding Acanthamoeba keratitis?

1. For the isolation of the causative agent, corneal scraping should be cultured on a nutrient agar plate.
2. The causative agent, Acanthamoeba is a helminth whose normal habitat is soil.
3. Keratitis due to Acanthamoeba is not seen in the immunocompromised host.
4. Acanthamoeba does not depend upon a human host for the completion of its life cycle.

Answer for Yesterday’s Mind Teaser: 4. Acanthamoeba does not depend upon a human host for the completion of its life cycle.

Correct answers received from: Dr Surendra Bahadur Mathur, Dr Chandresh Jardosh,
Dr Muthumperumal Thirumalpillai, Dr Shirish Singhal, Dr Jainendra Upadhyay, Dr Neelam Nath,
Dr SK Verma.

Answer for 31st July Mind Teaser: 4. There is a reduction in glucose utilization by corneal epithelium.
Correct answers received from: Dr SK Verma, Dr Anurag Julka.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

At a history examination

Examiner: "Mention an important event in 1564."
Examinee (after thinking for a long time): "Shakespeare was born."
Examner: "Very well, and in 1574?"
Examinee: "Let me think…Ah yes. I know. Shakespeare’s tenth birthday!"

For comments and archives

    Drug Update

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

Drug Name
DCI Approval Date
Ketoprofen Plaster ( Size – 7cm × 10 cm)
For the relief of musculoskeletal pain and inflammation.
    Public Forum

(Press Release for use by the newspapers)

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

Older people should exercise to build muscle even into their 80s

Older people should exercise to build their muscles even into their eighties, according to a new review which suggests that doing so would help them with everyday tasks, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Climbing stairs, housework, walking and even washing was made easier if elderly people worked out two or three times a week, said Chiung–ju Liu of the Department of Occupational Therapy at Indiana University.

People lose muscle as they age, which can make daily chores more difficult. Working out by using small weights or elastic bands can help to rebuild these muscles.

By "walking well", however, you power yourself around all day using muscles in your bottom, midriff and the backs of your thighs. This brings dramatic, sustainable results. For comments and archives

    Readers Responses
  1. Dear Sir, Paracetamol update is really very educative. Regards: Dr Prasha
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.



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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