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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

9th August, 2010, Monday

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

Treat Commonwealth Games as our own festival

Citizen of Delhi should create festival out of the Commonwealth Games. The 10 days of the Games should be celebrated like Navratras and Diwali as never before. Each and every citizen of Delhi should illuminate his or her house and workplace with light and diyas.

Everybody in the evening hours should be seen on the road with a festive mood. Nukkad Nataks and folk dances should be held at every corner of the city.

The preparation for the same should start immediately. Every citizen should take the responsibility of 50 meters around his house so that due work is completed and cleanliness is maintained.

One should not feel that this festival is for foreigners and visitors who would be coming to Delhi; instead it should be celebrated as festival of India for Indians and by Indians.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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Photo Feature( From HCFI File)


Dr K K Aggarwal was honored by Ex President of India during World Congress on Clinical, Preventive & Geriatric Cardiology in 2008. 

In the photo: Dr. A P J Abdul Kalam, Former President of India Dr. H K Chopra. Also in the photo Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI

Dr k k Aggarwal


News and Views ( Dr Brahm and Monica Vasudev)

Vascular health and risk management

Raynaud's phenomenon is a common condition characterized by vasospasm of the digital arteries and resulting cyanosis and redness. It often does not require pharmacologic management, but in some cases symptoms are severe and pharmacologic management is necessary. Calcium channel blockers are often used first–line, but in some patients are ineffective. Patients with severe symptoms or intolerance to available therapies have prompted exploration of alternative therapies, including endothelin antagonists, phosphodiesterase–5 inhibitors, antioxidants, newer vasodilators, statins, and botulinum toxin. These newer therapies provide the focus for this review. (Dr G M Singh)

Mayo Clinic researchers green light turning off LVAD in very sick patients

According to Mayo Clinic researchers, in cases where patients who are very sick and are being kept alive by the left ventricular assist device (LVAD), it is ethically and legally permissible to turn off the device in the US. In a study published online in Mayo Clinic Proceedings, researchers cited more than a dozen cases where patients or their representatives wanted the device to be turned off. The study authors said turning off LVAD cannot be equated to euthanasia as there is no new pathology introduced to cause death.

Surveyed voters confident about the safety of drugs made in America.

More than three out of four voters are confident that prescription drugs made in the USA are free from contamination, while fewer than one in 10 feel confident about medications made in India or China, according to a poll released today by the Pew Charitable Trust's Prescription Project.

New Drug Studied for Hard–to–Treat Vascular Condition

Icatibant (bradykinin B2 receptor antagonist) is effective in treating acute attacks of hereditary angioedema (HAE). These people suffer recurrent episodes of swelling caused by fluid leaking from blood vessels. It can occur in a number of areas, including the face, extremities, gastrointestinal tract or the throat and larynx, where it can cause dangerous blockage of the airway.

The condition is caused by low levels or poor function of a protein called C1 esterase inhibitor. The new drug, icatibant, blocks the receptor for a protein called bradykinin, which is thought to play a role in many HAE symptoms.

By interfering with bradykinin's normal actions, which include dilating blood vessels and producing symptoms of inflammation, icatibant prevents HAE's abnormal swelling. Icatibant has already been approved in the European Union. As part of its application to have the drug approved by the US FDA German drug maker Jerini Inc., conducted the two randomized, double–blind clinical trials, which included a total of 130 patients. The study showed that icatibant is safe and effective in treating acute attacks of HAE according to the findings published in the Aug. 5 issue of the New England Journal of Medicine.



Legal Column

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

What is lust murder? Dead body do tell tales

Personnel point health clinic triple murder case which rocked the Delhi city in the year 1996 where two young female and a doctor/owner of the clinic were killed. I conducted the examination of main accused and was prosecutor witness in the court. The culprit was convicted in this case on scientific evidences since the dead body do tell tales 'how he/she has been killed/died'.

Lust Murders are predicated on the obsessive fantasies of the criminal offender and it is not enough for these types of killers just to kill; they have a compulsive and obsessive need to act out their fantasies with their victims and the victim's bodies. This is the strongest "Signature" component of the crime discovered by the doctor conducting the autopsy. The offender enjoy to follow news reports of incidence and will often take a "souvenir" from his victim as a reminder, which is sometimes used by offender to relive/relish the event or continue with the fantasy.


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

Clinical picture

Acute pancreatitis presents with wide variety of symptoms; the clinical course is presently unpredictable.

Abdominal pain, as in adults, is the outstanding symptom, but on rare occasions pain may be absent especially in younger patients. Pain is sudden in onset, located in epigastrium and periumblical area and increases gradually in severity. Pain may radiate to back, middle/lower part of abdomen, right upper quadrant and the anterior aspect of chest wall. Eating usually triggers a worsening of pain and vomiting. The diagnosis is difficult to establish unless a high index of suspicion is maintained. A combination of clinical signs and symptoms, in concert with supportive biochemical abnormalities and imaging techniques, is usually necessary to provide a certain diagnosis.

Question of the day

What should be the approach to a pregnant woman with dilated cardiomyopathy? (Dr. Sandhya Kamat, Mumbai)

Pregnancy is poorly tolerated in women with dilated cardiomyopathy. The risk of maternal death is approximately 7% if the patient is in New York Heart Association (NYHA) functional class III or IV. Other adverse risks factors include ejection fraction <20%, mitral regurgitation, right ventricular failure, Atrial fibrillation (AF) and systemic hypotension.

Such patients should be counseled against pregnancy as apart from the risk of maternal death, there is a high risk of overt heart failure occurring during pregnancy, irreversible deterioration in ventricular function and fetal loss. Distinguishing the symptoms and signs of a normal pregnancy from those of heart failure requires careful clinical assessment. Heart failure should be managed as in the non–pregnant patient, but ACE inhibitors are associated with renal agenesis and should be avoided until after delivery.

Asymptomatic patients with hypertrophic cardiomyopathy (HCM) usually tolerate pregnancy well and few develop symptoms for the first time during pregnancy. Maternal death is uncommon and there is no evidence to suggest that the risk of sudden death is increased by pregnancy. There is little evidence that echocardiographic findings correlate with maternal morbidity, although massive hypertrophy may be an adverse risk factor.

In addition, patients with heart failure and severe symptomatic restrictive physiology are unlikely to tolerate the hemodynamic changes of pregnancy and they should be advised against pregnancy.

Dyspnea and angina may be relieved by beta-blockade to improve coronary perfusion and allow ventricular filling time. AF is poorly tolerated because of the effects of tachycardia and loss of atrial transport; rate control and prompt reversion to sinus rhythm are needed. Vaginal delivery is usually well tolerated. Careful fluid management is needed to maintain ventricular filling but avoid pulmonary venous congestion.

Note: In an uncomplicated pregnancy, the main risk to the fetus is the 50% recurrence risk. Hypertrophic cardiomyopathy is rarely diagnosed in early life, and offspring should be screened until they are 20–25 years old.

Suggested reading

  1. Polish Knapp M, Lachota–Korecka G, Knapp P, Korecki J and Musial WJ. Peripartum cardiomyopathy–a case report. Kardiol. Pol. 2005;62(1): 49–51.

Public Forum (Press Release for use by the newspapers)

Diabetics should take pneumonia vaccine

Diabetes is associated with a 25–75% increase in the relative risk of hospitalization due to pneumonia , 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.

Quoting a study published in the journal Diabetes Care (August edition), Dr Aggarwal said that it is important to give flu and pneumococcal vaccine to diabetics, especially those patients with longer diabetes duration. It is equally important to control diabetes adequately to prevent pneumonia-related hospitalization among diabetic patients.

In the study Dr. Jette B. Kornum from Aarhus University Hospital, Aalborg and colleagues identified 34,239 individuals with a pneumonia–related hospital admission and 342,390 individuals from the general population who served as a control group. The study showed that individuals with diabetes had a 26% higher risk of pneumonia–related hospitalization compared with those without diabetes.

  • The risk of pneumonia–related hospitalization was increased by 4.4–fold in subjects with type 1 diabetes and by 1.2–fold in those with type 2 diabetes.
  • The maximum risk was related to longer duration of diabetes (more than 9 years) with poor glycemic control (A1C > 9%) .
  • The risk was 37 % higher in diabetics of over 9 yrs duration and 60% higher when the A1C was over 9% as compared to 22% when the A1C was lower than 7%. A1C is the measure of average blood sugar of the last three months and should be kept lower than 7%.

Conference Calendar

Telederm 2010 – 2nd National Conference of Indian Society of Teledermatology (INSTED)

Date: August 13–14, 2010
Venue: The Accord Metropolitan, T. Nagar, Chennai, Tamil Nadu.


An Inspirational Story

The Window

A young couple moves into a new neighborhood. The next morning, while they are eating breakfast, the young wife sees her neighbor hang the wash outside.

"That laundry is not very clean," she said to her husband. "The neighbor doesn't know how to wash correctly. Perhaps she needs better laundry soap."

Her husband looked on, but remained silent.

Every time her neighbor hung her wash to dry, the young woman would make the same comments.

About one month later, the young woman was surprised to see a nice clean wash on her neighbor's line and said to her husband, "Look! She has learned how to wash correctly. I wonder who taught her this?"

The husband said, "I got up early this morning and cleaned our windows!"

Can you see how it might be a good idea to check first, to see if your windows are clean? What we see when watching others depends on the purity of the windows through which we look.

Before we give any criticism, it might be a good idea to check our state of mind and ask ourselves if we are ready to see the good rather than just look for something wrong in the people we encounter.


IJCP Special

Dr Good Dr Bad

Situation: A patient's blood pressure was found to be 220/120 mm Hg without symptoms.
Dr Bad: You need ICU admission
Dr. Good: You need oral drug treatment.
Lesson: There is no need to aggressively lower the blood pressure in absence of symptoms.

Make Sure

Situation: An asthmatic patient worsened after receiving a painkiller.
Reaction: Oh my God! Why was he not put on zafirlukast?
Lasson: Make sure that a patient with asthma is put on zafirlukast or montelukast and not given aspirin.

Good Slogans (Dr Chandresh Jardosh)

Sign at a barber's saloon:

We need your heads to run our business.

Quote of the Day (Sunil Parashar)

A person asks a fallen rose, "Do not you get hurt when you are being plugged." The Rose replied, "
"No", I forgot my pain because I become reason for someone's smile.

Are you fit to fly?

Deep vein thrombosis

  1. There is an increased risk of venous clots among patients who fly > 8 hours a further than 5000 kilometers. The risk increases by 26 % for every 2-hour increment of air travel time.

  2. The absolute risk of a first episode of venous clot is 1 in 4600 air flights.
  3. This risk is higher for those with risk factors. Risk is increased in individuals with recent major surgery, including hip or knee arthroplasty within six weeks, increased age, obesity, prior venous clots, use of oral contraceptives, heart failure, hereditary thrombophilia)

International Medical Science Academy Update (IMSA)

Rotavirus vaccine

Vaccine–acquired rotavirus disease within one month of the first or second dose of pentavalent human–bovine reassortant rotavirus vaccine (RV5) has been reported in three infants who subsequently were diagnosed with severe combined immunodeficiency (SCID).


Patel NC, Hertel PM, Estes MK, et al. Vaccine–acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med 2010; 362:314.


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Rivaroxaban film coated Tablets 10mg

For the prevention of venous thromboembolism in patients (VTE) in adult patients undergoing hip or knee replacement surgery.



Medi Finance

Q. If some jewelry is gifted to a minor child and the jewelry is sold at a profit, in whose account will it be taxable?

Ans. If some jewelry is gifted to minor child and the jewelry is sold at a profit, then such income shall be clubbed in the accounts of parents, whose income is higher.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)


To screen for, detect, and monitor treatment for congenital adrenal hyperplasia (CAH); sometimes to help rule out other conditions.


Lateral thinking

Read this………………


The answer for yesterday's puzzle: long time no "c"

Correct answers received from: Dr. Ashok Wasan, Dr. Satish Gunawant, Dr Ashok Kumar 

Correct answers received for 7th August Puzzle from: Nilesh Aggarwal, Dr. Preetish Banerji


Humor Section



Between 18 and 22, a woman is like Africa. Half discovered half wild, fertile and naturally Beautiful!
Between 23 and 30, a woman is like Europe. Well developed and open to trade, especially for someone of real value.
Between 31 and 35, a woman is like Spain, very hot, relaxed and convinced of her own beauty.
Between 36 and 40, a woman is like Greece, gently aging but still a warm and desirable place to visit.
Between 41 and 50, a woman is like Great Britain, with a glorious and all conquering past.
Between 51 and 60, a woman is like Israel, has been through war, doesn't make the same mistakes twice, takes care of business.
Between 61 and 70, a woman is like Canada, self-preserving, but open to meeting new people.
After 70, she becomes Tibet ... Wildly beautiful, with a mysterious past and the wisdom of the ages. An adventurous spirit and a thirst for spiritual knowledge.


Between 1 and 80, a man is like Iran, ruled by nuts.
(Contributed by Dr Chandresh Jardosh)

Fumy One Liners

Boss: We are very keen on cleanliness. Did you wipe your feet on the mat as you came in?
New employee: Yes, sir.
Boss: We are also keen on truthfulness. There is no mat.


Readers Responses

  1. Thanks, Dr K K Aggrawal ji, for managing this multi speciality e medinews in medicos interest in large. Please continue uninterrupted.thanks with regards and love. Dr K P Singh cardiologist Fortis -Escorts  new delhi 25.
  3.  Dear Dr. Aggarwal: You are giving very good material for reading. Please keep it up. Your help is appreciated. Dr.Rohit Bhatt, Obst.Gyb, Baroda
  4. The article “Eating lowers blood-pressure” is very very useful. I read it three times. The article seems to suggest that taking curd with sugar, meetha raita, custard or any sweet dish with food is not a good habit, especially for old people.  Though I find many people (me included) believe that in order to get calories easily without much burden on failing digestive system in old age, carbohydrate rich diet is more appropriate.  vinod varshney: [A: its refined carbs like white sugar which are harmful and not complex carbs)

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

12th 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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