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Dr KK Aggarwal

From the Desk of Editor in Chief
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

7th August, Saturday, 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Eating can cause low blood pressure

Feeling dizzy or lightheaded after eating a meal may indicate a common condition called postprandial hypotension reports the July issue of the Harvard Heart Letter. Digestion requires coordination between the digestive, nervous, and circulatory systems. To compensate for blood going to the stomach and small intestine during digestion, the heart beats faster while blood vessels narrow. When the heart and blood vessels do not respond as they should, blood pressure drops.
Postprandial hypotension may cause some people to fall, others to faint. It can trigger chest pain, disturb vision, or cause nausea. In most, postprandial hypotension stems from aging–related changes that interfere with the body’s ability to respond to sudden changes in blood pressure. There is no treatment but some lifestyle changes can make a difference:

1. Water before meals: Drink 12 to 18 ounces of water 15 minutes before eating.
2. Smaller meals: Larger meals are more likely to trigger the response than smaller ones. Try six or seven smaller meals a day.
3. Fewer rapidly digested carbs: Foods made with refined flour, white rice, and potatoes, as well as sugary beverages, pass quickly from the stomach to the small intestine, which contributes to postprandial hypotension. Eat slowly digested whole grains, beans, and protein to keep your blood pressure up.
4. Easy does it: Blood pressure usually hits bottom 30 to 60 minutes after a meal. Sitting or lying down for an hour after eating is another way to cope with postprandial hypotension.

Dr KK Aggarwal
Editor in Chief
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Photo Feature (From HCFI file)

 Examination Stress among Students

A press conference was organised in 2009 by Heart Care Foundation of India (HCFI) to spread awareness about the rising problem of Examination Stress among students.

In the Photo: Acharya Dr Sadhna Ji Maharaj, Singer Ms Shibani Kashyap, with Dr Aruna Broota psycologist. Also in the Photo: Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President HCFI .

Dr k k Aggarwal


News and Views ( Dr Brahm and Monica Vasudev)

Bone marrow and kidney transplants most common transplants in living donors

You can become a potential donor of stem cells or bone marrow for leukemia patients. Would-be donors between the ages of 18 and 55 may join a registry. Also, they should not have cancer, HIV, heart disease, hepatitis, or epilepsy. If a donor matches a patient who needs a transplant, the donor can be invited to undergo more extensive testing to assure compatibility with the recipient. Donors are not obligated to go through with a procedure, however. If they do go ahead with a donation, their expenses and travel can be reimbursed. The most common transplants in living donors are bone marrow and kidney transplants.

High cholesterol in youth may increase heart risks later in life

Even the younger individuals should pay heed to their cholesterol levels as it may affect their health later in life. Analysis of data from more than 3000 men and women aged 18 to 30 at the beginning of the study who have been tracked by the CARDIA, or Coronary Artery Risk Development in Young Adults study for the last 20 years, showed that participants with histories of high levels of the 'bad' LDL cholesterol were five and a half times as likely to have a buildup of calcium in their coronary arteries than those who had optimal LDL cholesterol levels.

Sleep duration may be linked to cardiovascular risk

People, who sleep for < 7 hours in a day, including naps, are at a greater risk of cardiovascular disease, but sleeping <5 hours in a day, including naps, more than doubles the risk of chest pain, heart attack, or stroke. These observations were published in the journal Sleep. Participants who slept for = 9 hours were found to be one-and-a half times more likely to develop cardiovascular disease than people who slept 7 hours.

Occupation a key factor in men’s lung cancer risk

Certain occupations increase risk of lung cancer in men. About 5 % of lung cancers in men are job-related. Researchers from IRCCS Ospedale Maggiore Policlinico in Milan found that for men, about 12 % had worked in occupations listed as known lung cancer risks (mining, metalworking, and certain types of construction work) vs 6 % of controls. Men in the risky occupations were 74 per cent more likely to have been diagnosed with lung cancer. Ceramic and pottery jobs and brick manufacturing showed the strongest association, including those working in manufacturing of non-iron metals. The results of the study are published in the American Journal of Epidemiology.


Legal Column

Forensic Column: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Medical Testimony of Doctor in the Court of Law (Contd)

Do not misrepresent documents/medical literature in the Court of Law

When evidence is read into the record of a trial, only that portion of the document which validates the information being discussed needs to be read aloud. One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point you are making. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time-consuming. When a document is cut in a manner which lends the quoted passage a meaning other than what would be derived from a more complete reading, you are misrepresenting the document. This does not mean, however, that you are responsible for drawing the same conclusions from information as the author of the document.

Drawing a contrary conclusion from passages accurately interpreted does not constitute misrepresentation. The fact that the author of the document reached a different conclusion from the information argues perhaps persuasively against your conclusion. However, you have not misused the evidence.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

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

Childhood Pancreatitis : Acute Pancreatitis in Children

Acute pancreatitis represents a diagnostic challenge in the pediatric age group.  Although it occurs less frequently in children than in adults it is probably more common in childhood than has previously been appreciated and may have significant morbidity and mortality

Question of the day

Like ACE inhibitors, do ARBs also cause angioedema?

Many studies have confirmed that there is an elevated risk of angioedema with ACE inhibitors. There is little evidence supporting such a link with use of ARBs. Very few studies have compared ACE inhibitors with ARBs regarding their propensity to induce angioedema.

According to an article published by Dr. Soren P. Johnsen, from Aarhus University Hospital in Denmark in Am J Med (2006;118:1428–1429) the author said that it was believed that ACE inhibitors cause angioedema by raising bradykinin levels. Because ARBs do not affect such levels, it was thought that they might not induce angioedema, yet a number of case reports have surfaced suggesting that they do, in fact, cause this problem. In the study, Dr. Johnsen compared ACE inhibitor and ARB use among 641 patients with a first–time hospitalization for angioedema and among 6,364 matched controls. Current use of ACE inhibitors raised the risk of angioedema by 10 –fold relative to nonuse. New users had the highest increased risk — 31.6-fold — but an effect was also seen in long–term users and in former users. The overall analysis did not show an elevated angioedema risk with ARB use, but the findings could not completely rule out an association with new use of these drugs.


Public Forum (Press Release for use by the newspapers)

Smoking and clopidogrel may not go together

Clopidogrel is an important antiplatelet (anti clotting) drug that is effective in preventing thrombotic (heart attack) events, especially for patients undergoing percutaneous coronary intervention (balloon angioplasty) said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil ka Darbar & MTNL Perfect Health Mela.

A study from the Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan, and published in J Clin Pharm Ther has concluded that smoking is a significant factor affecting the pharmacokinetics of clopidogrel, following administration of a single 75 mg dose in healthy young volunteers. The study supports smoking-cessation recommendations in all patients on clopidogrel.

In the study, 76 healthy adult male volunteers were selected randomly. Each subject received a single 75 mg oral dose of clopidogrel after overnight fast. Clopidogrel carboxylate plasma levels were measured.

One-third of volunteers were smokers (n = 27). Smokers had lower area under the curve [AUC] (smokers: 6.24 ± 2.32 microg/h/mL vs. non-smokers: 8.93 ± 3.80 microg/h/mL, P < 0.001) and shorter half-life (smokers: 5.46 ± 2.99 vs. non-smokers: 8.43 ± 4.26, P = 0.001).

Earlier studies have also shown that BP drugs are not effective in patients who continue to smoke. This study gives one more reason for smoker heart patients to quit.


Conference Calendar

SACRED CME - MSK Imaging - Essentials of Musculoskeletal Imaging Date: August 8, 2010
Venue: SSSIHMS, Whitefield, Bangalore, Karnataka.


Humor Section


Patient: My tongue tingles when I touch it to a cracked walnut wrapped in used toaster oven aluminum foil. What’s wrong with me?

Doctor: You have far too much free time.

Fumy One Liners

Mother: So, you want to become my son–in–law?

Boy: Not really, but I don’t see any other way to marry your daughter.


An Inspirational Story

How Much Do You Make An Hour?

With a timid voice and idolizing eyes, the little boy greeted his father as he returned from work, "Daddy, how much do you make an hour?" Greatly surprised, but giving his boy a glaring look, the father said: "Look, son, not even your mother knows that. Don’t bother me now, I’m tired." "But Daddy, just tell me please!? How much do you make an hour," the boy insisted.

The father finally giving up replied: "Twenty dollars per hour." "Okay, Daddy? Could you loan me ten dollars?" the boy asked. Showing restlessness and positively disturbed, the father yelled: "So that was the reason you asked how much I earn, right?? Go to sleep and don’t bother me anymore!"

It was already dark and the father was meditating on what he had said and was feeling guilty. Maybe he thought, his son wanted to buy something. Finally, trying to ease his mind, the father went to his son’s room.

"Are you asleep son?" asked the father. "No, Daddy. Why?" replied the boy partially asleep. "Here’s the money you asked for earlier," the father said. "Thanks, Daddy!" rejoiced the son, while putting his hand under his pillow and removing some money. "Now I have enough! Now I have twenty dollars!" the boy said to his father, who was gazing at his son, confused at what his son just said. "Daddy could you sell me one hour of your time?"


IJCP Special

Dr Good Dr Bad

Situation: A patient with burns came with severe pain.
Dr Bad: It is bad sign.
Dr Good: It is a good sign.
Lesson: Pain indicates that the nerves are intact.

Make Sure

Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my God! Why was the prophylaxis not started?
Lasson: Make sure that one administers secondary prophylaxis in the setting of suspected post streptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.

Good Slogans

"Sign at a famous beauty parlor in Bombay: Don't whistle at the girl

(Contributed by Dr Chandresh Jardosh)

Are you fit to fly?

Low Hemoglobin

  1. The relative hypoxia in the cabin poses a particular risk to patients with sickle cell anemia. Such patients should use supplemental oxygen and be kept well-hydrated.

  2. Those with sickle cell trait are not considered at risk for flights at normal altitudes under usual conditions.

International Medical Science Academy Update (IMSA)

The USFDA has approved a 13–valent pneumococcal conjugate vaccine (PCV13). It adds serotypes 1, 3, 5, 6A, 7F, and 19A to those contained in the PCV7, the 7–valent vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F) 1,2. The six additional serotypes accounted for 63 percent of invasive pneumococcal disease among children younger than five years of age in the United States during 2006 to 2007.3

  1. Lowry F. FDA panel recommends prevnar 13 vaccine for approval. Available at: www.medscape.com/viewarticle/712717. (Accessed on January 20, 2010).

  2. American Academy of Pediatrics. Red Book Online. Status of licensure and recommendations for new vaccines. Available at: aapredbook.aappublications.org/news/vaccstatus.dtl. (Accessed on January 20, 2010).

  3. Pilishvili T, Lexau C, Farley MM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 2010;201:32.

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Soybean oil 60gm + Triglycerides (medium chain) 50gm + Olive oil purified fish oil 30gm + dl–alpha–tocopherol 163–225mg + Glycerol (anhydrous) 25gm + Egg lecithin 12gm + Sodium hydroxide (to approx pH 8) + Sodium pleate 0.3mg emulsion for infusion in 100ml.

Total parenteral nutrition following major abdominal, major thoracic or major urological surgery



Medi Finance

Q. If arrears of rent of earlier year is received, when will it be taxable?

Ans. If any amount is received by way of arrears of rent, which pertains to last year, it will be considered as taxable income of current year.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Prothrombin time (PT)

PT is indicated in a person with hepatitis or suspected hepatitis. Proteins used in the formation of a blood clot (coagulation factors) are mostly produced by the liver. Prolonged PT may indicate the severity of liver damage.


Lateral thinking

Read this………………


Send in your answer to emedinews@gmail.com

The answer for yesterday’s puzzle "backward glance"

Correct answers received from: Dr.Akshat Bhargava, Dr Ashok Kumar, Dr.Akshat Bhargava


Readers Responses

  1. Good evening Sir/Madam,
    Today is one of the memorable day  – the launch of IRM journal in the 10th International Conference of UPDATING IN SUB FERTILITY, OBSTETRICS & GYNAECOLOGY, in Chennai. The IRM journal was released in the conference and Dr.Thankam Varma expressed that her dreams have come true because of  Chitra Mohan from IJCP Publications. The book was released by Dr. Dr. Peter Sjoblom.  Dr. Abha majumdar, Dr. Ameet Patki, Dr. Nalini Mahajan and Dr.Narendra Malhotra were all sitting on the dias. Dr.Varma called me on the dias and introduced me. I assured that all the delegates will be getting the quarterly journal. We distributed Around 300 copies in the conference. I wish to thank each one of you  for the co-operation and support for this success And  making today as wonderful day. Chitra

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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