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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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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

 
    Dr KK Aggarwal on Social Media …

DR KK Aggarwal on Doctor Bhagwan Hai ya Shaitan
ASAR–Aamir Khan And Dr KK Aggarwal on Satyamev Jayate

 
  Editorial …

10th June 2012, Sunday

4th Asia Pacific Vascular Intervention Course

Excerpts from a Panel discussion moderated by Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal at the ongoing 4th Asia Pacific Vascular Intervention Course at The Oberoi, New Delhi

The Panelists included Dr Tyrone J Collins (Director, Cardiac Cath Lab, John Ochsner Heart and Vascular Institute, New Orleans USA), Dr Clifford J Buckley (Director, Div of Vascular Surgery, Texas A&M Health Sciences Center College of Medicine, Texas, USA), Dr Rajiv Lochan (Consultant Interventinol Cardiologist, Saudi German Hospitals Group, Dubai, UAE), Dr Saroj Das, Consultant Surgeon, The Hillingdon Hospital, UK) and Dr NN Khanna (Sr. Consultant Vascular Interventions, Indraprastha Apollo Hospitals and Course Chairman)

  1. The instant reaction and anybody who is not aware or who is not a physician obviously will get biased with the opinion which was given in the episode of Satyamev Jayate that dealt with the issue of corruption in healthcare.
  2. If one person has done something wrong, it cannot be generalized with everybody as bad profession. Secondly, it is also reflecting badly on all practitioners who are working faithfully, lawfully, taking care of the patients without any bias, keeping their income package separate from the interests of the patients, and most of the physicians do take care of their patients.
  3. Doctors are not bad. There are some bad doctors just as there are bad engineers, bad attorneys. The consequences of being a bad doctor is more emotional than some of the other professions, that is why it receives so much press or so much notoriety when one doctor or single person does something that is wrong.
  4. The percentage of bad doctors across the globe is very very small, less than 1%.
  5. A major perception that gets medicine into trouble is that there is a difference between being a bad doctor and having a complication to a procedure that you do. But unfortunately the public wants a perfect result every time. But unfortunately we have complications with every procedure that we do and in a small number of cases, the patients sustain complications which are not really the fault of the surgeon, or the cardiologist or physicians taking care of them.
  6. Most of the time, doctors do not have control over what the patients do to themselves before the doctors get to take care of them. Most of them smoke, many of them abuse their bodies in other ways they use drugs, use alcohol. This tends to increase the risk of any procedure
  7. To err is human. Medical accident, medical adverse event is not medical negligence.
  8. In vascular surgery, if 100 vascular interventions are done, the risk involved would be around 4-5%. In the hands of an experienced operator, you are looking at less than 1% mortality, if you are getting an open operation, probably you are looking at around 3 to 4% depends on what is wrong with the patient.
  9. The United Kingdom has an audit program called PROM i.e. Patient Reported Outcome Measures. It evaluates what the patient feels when a particular intervention has been done for that. Has that improved the QOL of that patient? Is it justified that he should be spending so much of money or would the procedure be doing any good to them?. That is one part of the story.
  10. The role of vascular surgery in patients with erectile dysfunction (ED) is still under investigation. There is a clear link between having a CAD or atherosclerotic disease and having ED. The problem is that is not well established that correcting or revascularizing is the only thing that needs to be done for this patient. Pudendal artery revascularization works, but it only works for some patients.
  11. It is difficult to estimate the durability of some of the vascular interventions because people die of other existing comorbidity so you don’t really get a long term follow up on the effectiveness of that therapy.
  12. Bone marrow transplant in chronic limb ischemia is a very labor intensive procedure and the outcome is still uncertain.
  13. Leech therapy has been usedin India for more than 5000 years. It has been approved in the US as a medical device, as tools for healing skin grafts or restoring circulation. Leeches are used to remove blood pooled under skin grafts for burn patients, or to restore circulation in blocked veins by removing pooled blood.

Some important views from the Panelists about endovascular interventions

Dr Tyrone J Collins

  1. Endovascular surgery therapy may be an alternative to surgical therapy.
  2. Endovascular surgery is complementary to surgical therapy.
  3. Stop smoking.
  4. In patients with coronary artery disease, there is a high likelihood of having a vascular disease – about 30%.
  5. Keep your BP under control.

Dr Clifford J Buckley

  1. Risk factor modification is very important for all patients with vascular disease.
  2. Aspirin and statins should be given to all patients.
  3. Endovascular repair for abdominal aortic aneurysm has been one of the major improvements in endovascular care. It has changed it from a bigger operation to an overnight stay or 2–day stay in the hospital. The number of people who have complications with the device are very small. The benefit for the patient has been huge in terms of their ability to get back to their good quality of life.
  4. Vaso-occlusive disease needs a good trial of intensive medical management if asymptomatic rather than any intervention.
  5. HT should be treated, because HT poorly treated is responsible not only for CAD, but probably one of the largest causes of renal failure and the need for renal dialysis. The guidelines used to be 140/80, they are now down to 120/80 and I would say somewhere between 120/80 to 140/80 should be optimal.

Dr Rajiv Lochan

  1. EV interventional area has vastly developed, it has expanded; surgery is now available from head to toe. Physicians should explore this option before saying no.
  2. Diabetes is a common factor in these patients, so there has to be a strict control of sugar. A1c of 7 is ideal but 6.5 is reasonable because there can be complications with very tight control.
  3. We need to maintain reasonable good control of LDL; atorvastatin 40 mg generally is used, but the dose depends on the level of LDL
  4. Uterine artery embolization can be done in some patients after postpartum hemorrhage, the artery can be blocked without surgery. Earlier ligation of iliac artery was done.
  5. Age is not a bar to endovascular intervention generally, it has to be dependent.

Dr Saroj Das

  1. The oldest patient operated for a complex vascular procedure is Dr Michael DeBakey.
  2. EV intervention has got no boundaries.
  3. Lifestyle management remains the cornerstone of any thing that we do before and after any intervention.
  4. This year, the prediction of diabetes for India is that half a billion people in India would have diabetes. This is going to contribute to the vascular load of patients. 20% of diabetic patients would have vascular disease.

Dr KK Aggarwal

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

 
  eMedinewS Audio PostCard

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

4th Asia Pacific Vascular Intervention Course

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

4th Asia Pacific Vascular Intervention Course

Padma Shri & Dr BC Roy National Awardee Dr KK Aggarwal at the ongoing 4th Asia Pacific Vascular Intervention Course at The Oberoi, New Delhi.

In the Photo: Dr NN Khanna, Course Chairman; Dr Michel Henry, Course Chairman

 
Dr K K Aggarwal
 
    National News

Don’t throw away party leftovers

NEW DELHI: If you organized a big party and were left wondering what to do with the leftovers, there is now an option to avoid such wastage. All you have to do is send an SMS to 58888. In a first, Delhi will now have a food bank that will store excess food left after weddings, parties, etc., donated by people. This food will then be sent to those who are in need of it. "In a system like ours where we often see food going waste instead of reaching the right people, this kind of an initiative is needed. Our similar projects, where we had tied up with city hotels for food packs failed only because of lack of coordination and manpower," said Delhi chief minister Sheila Dikshit at the inauguration of the Food Bank website. An initiative of Indian Food Banking Network (IFBN), the food banks will work with support of Delhi government. The government has committed to sign a Memorandum of Understanding (MoU) with the IFBN for the project. (Source: TOI, Jun 9, 2012)

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

(Contributed by Dr Monica and Brahm Vasudev)

Culturally adapted CBT reaches depressed HIV–positive Hispanics

A cognitive behavioral therapy program designed to treat depression and nonadherence in people with HIV infection has been adapted to the Latino culture, and shows promise in the treatment of Hispanic people living on the American–Mexican border. (Source: Medscape)

For comments and archives

Certolizumab pegol shows efficacy in psoriatic arthritis

Certolizumab pegol (Cimzia, UCB Pharma), a tumor necrosis factor (TNF) inhibitor approved by the US Food and Drug Administration for the treatment of rheumatoid arthritis (RA) and Crohn’s disease, has been shown to be effective in both skin and joint symptoms of psoriatic arthritis, compared with placebo. This finding comes from the interim results of the RAPID–PsA phase 3 trial presented here at the European League Against Rheumatism Congress 2012. (Source: Medscape)

For comments and archives

NAFLD: No clear role for heritability

Nonalcoholic fatty liver disease (NAFLD), as defined by sonographic criteria, does not appear to be inherited. It does however, appear to coexist with vascular parameters linked to increased cardiovascular risk. Dam D. Tarnoki, MD, from Semmelweiss University in Budapest, Hungary, and colleagues published the results of a twin study online May 31 in Liver International. Although scientists have examined families to address the question of heritability in NAFLD, this is the first twin study to investigate the relative contribution of genetic and environmental factors in the disease. (Source: Medscape)

For comments and archives

Zoster vaccine shows no benefit after a shingles episode

Administration of the varicella vaccine in older people with a recent history of shingles does not confer additional immunity, a population–based study suggests. The findings, published online June 4 in the Journal of Infectious Diseases, indicate that immediate vaccination may be unwarranted. (Source: Medscape)

For comments and archives

(Dr SK Verma, New Delhi)

The humble tomato can provide you the best defence against skin damage because it helps protect the skin from sunburn and ageing caused by sunlight exposure according to a team of researchers at Newcastle University in the UK Lycopene, a natural pigment found in tomato making it glowing red, helps protect against sunburn and skin ageing caused the ultra–violet ray in sunlight. (Courtesy: TOI )

 
    Prayer Meeting

Dr. Vidya Prakash Sood (13/04/1936 – 03/03/2012)

A prayer meeting will be held to pay homage to the departed soul of Dr VP Sood
(Issue Editor – Asian Journal of Ear, Nose and Throat) who passed away peacefully on March 3, 2012 in USA.

Date: Sunday 10th June 2012
Venue: Chinmaya Mission (Auditorium), 89, Lodhi Road, New Delhi.
Time: 11 A.M – 12 Noon

(IJCP and eMedinews)

 
    Twitter of the Day

@DrKKAggarwal: To err is human Bad people in a good system or good people in a bad system In US alone, over 98,000 people die…http://fb.me/1x0mcst4p

@DeepakChopra: No regrets and no anticipation, just this moment fresh and as is.

 
    Spiritual Update

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

Why are coconut and the kalash used in all poojas?

If nature wanted you to drink coconut water in non–coastal areas she would not have grown coconuts in the coastal areas is a common naturopathic saying.

For comments and archives

 
    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the side–effects of using methotrexate?

There are no known long–term side effects from use of methotrexate. The short–term side effects are few. The drug can cause temporary ulcers in the mouth and other gastrointestinal sites, and can cause temporary changes in liver function. Rare complications include pneumonia. Decreased platelet production, another rare complication, can cause bleeding within two weeks after the injection. Women should limit sun exposure during treatment, as methotrexate can cause sensitivity to sunlight and sunburn may occur. When being treated with methotrexate, women should not drink alcohol or take vitamins containing folic acid (folate).

For comments and archives

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

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

Component Preparation

Some components require special preparation steps before they can be released for transfusion. Because these steps are time–consuming and can significantly shorten the shelf life of the component, preparation should be carefully coordinated with the anticipated time of transfusion. The transfusion service will make every effort to ensure that the component is ready when needed, but not so early that the shelf life expires before administration. Medical and nursing staff needs to be aware of special requirements for preparation and to understand that these times cannot be significantly shortened, even in urgent situations.

Table. Component Preparation Times

Component

Approximate time*

Shelf life

RBC

30 minutes

24 hours

RBC: thawed–deglycerolized

60 minutes

24 hours

FFP: thawed

30 minutes

24 hours

PLT: pooled

15 minutes

4 hours

CRYO: thawed

10 minutes

6 hours

CRYO: pooled

15 minutes

4 hours

*Will vary with institutional procedures.

RBC=Red blood cells: FFP=Fresh frozen plasma; PLT=Platelets; CRYO=Cryoprecipitated AHF.

For comments and archives

 
    An Inspirational Story

(Ms Ritu Sinha)

Sand and Stone

It’s a story of two friends who were walking through the desert. In a specific point of the journey, they had an argument, and one friend slapped the other one in the face.

The one, who got slapped, was hurt, but without anything to say, he wrote in the sand: "Today, my best friend slapped me in the face".

They kept on walking, until they found an oasis, where they decided to take a bath. The one who got slapped and hurt started drowning, and the other friend saved him. When he recovered from the fright, he wrote on a stone: "Today my best friend saved my life".

The friend who saved and slapped his best friend, asked him, "Why, after I hurt you, you wrote in the sand, and now you write on a stone?"

The other friend, smiling, replied: "When a friend hurts us, we should write it down in the sand, where the winds of forgiveness get in charge of erasing it away, and when something great happens, we should engrave it in the stone of the memory of the heart, where no wind can erase it".

For comments and archives

 
    Cardiology eMedinewS

Sex makes no difference in coronary CT Read More

Hypertension greater among insomniacs Read More

 
    Pediatric eMedinewS

Staph common in household contacts of infected kids Read More

Genetic propensity to obesity shows up early Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A non fasting patient came for cholesterol test.
Dr. Bad: Get complete lipid profile done.
Dr. Good: Get total cholesterol and HDL cholesterol done.
Lesson: For total and HDL cholesterol fasting is not a prerequisite.

Make Sure

Situation: A patient with human bite developed infection in the wound.
Reaction: Oh my God, why were antibiotics not started in time?
Lesson: Make sure all patients with human bite are started early on amoxicillin-clavulanate antibiotic.

For comments and archives

 
    Legal Question of the day

(Prof. M C Gupta Advocate & Medico–legal Consultant)

Q. My PNDT centre was inspected by the Appropriate Authority in June 2008. Some deficiencies were intimated to me. I replied/rectified the same. I have received a notice from the court on 2–2–2012. My questions are:

a. Is there a time limit within which the AA should file a case in the court?

b. What should I do?

Ans.

  1. If you have received summon from the court that means a complaint under section 28 of the PNDT Act has been filed against you in the court. The prosecution in the court can result in imprisonment up to 3 years and fine up to Rs. 10,000/– in accordance with section 23 of the Act.
  2. It would be unusual for the AA to file a criminal complaint against you in the court without giving you a notice under section 20 of the Act. It seems you have not provided complete/relevant facts.
  3. In general, there is no time limit for filing criminal complaints.
  4. You should engage a lawyer and attend the court.

For comments and archives

 
    Quote of the Day

(Dr GM Singh)

History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again. Maya Angelou.

 
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    Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Anemia of chronic disease – Transferrin saturation or index

A low Serum Iron is less specific. It also occurs in the anemia of chronic disease or anemia of chronic inflammation (ACD/ACI). In this setting, however, there is usually a parallel reduction in the TIBC, resulting in a near normal percent saturation. However, about 20% of patients with ACD/ACI have transferrin saturations in the iron deficiency range because of an inability to access their normal or even increased marrow iron stores.

 
    Mind Teaser

Read this…………………

In which of the following stage is the carcinogen irreversible?

a. Progression stage
b. Initiation stage
c. Regression stage
d. Promotion stage

Yesterday’s Mind Teaser: A client is experiencing spinal shock. Nurse Myrna should expect the function of the bladder to be which of the following?

a. Normal
b. Atonic
c. Spastic
d. Uncontrolled

Answer for Yesterday’s Mind Teaser: b. Atonic

Correct answers received from: Shirish Singhal, Dr KV Sarma, Raju Kuppusamy, Dr Kanta jian,
Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh , Dr U Gaur.

Answer for 8th June Mind Teaser: d. Restlessness
Correct answers received from: Dr Avtar Krishan

Send your answer to ijcp12@gmail.com

 
   Laugh a While

(Dr GM Singh)

The trouble with being punctual is that no one is there to appreciate it

 
    Medicolegal Update

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

Right to refuse medical interventions – Theresa Marie "Terri" Schiavo case of United States

In 1990, 27–year–old Theresa Marie "Terri" Schiavo suffered cardiopulmonary arrest in her home leading to a persistent vegetative state requiring artificial nutrition and hydration by feeding tube. After eight years without neurologic recovery, her husband and guardian requested that her feeding tube be removed, but her parents objected and the case went to court. The judge determined that there was "clear and convincing evidence" that she would not have wanted to be kept alive in this state. Despite several attempts on the part of Schiavo’s parents’ to prevent removal of her feeding tube, including claims that she could recover, the Florida state Supreme Court affirmed that her husband could exercise his rights and discontinue treatments. The US Supreme Court stood by the lower court’s decision and refused to hear the case.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

The 4th Asia Pacific Vascular Interventional Course begins

The 4th Asia Pacific Vascular Interventional Course was inaugurated at The Oberoi, New Delhi. The conference is organized by The Society for Cardiovascular Angiography and Interventions and The International Society for Endovascular Specialists. The Theme of the course is Vascular Interventions – From Basic to Advanced.

Addressing a press conference in a joint statement, Dr. Jacques Busquet from France, President of International Society of Endovascular Specialists, Dr. NN Khanna, Course Chairman, Sr. Cardiologist Apollo Hospital, New Delhi, Dr. E Diethrich, Chairman, International Society of Endovascular Specialists, Founder President, Dr. C. Buckley, Senior Cardiologist Texas Heart Institute, Chairman, Dr. Jacques Busquet, President, ISES, Dr. TJ Collins, Society of Cardiac Angiography and Intervention and Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that:

  1. Advanced cardiovascular surgery in India today is at par with any other centre in the world.
  2. Vascular intervention without surgery can be done in any vessel from head to toe.
  3. In patients with erectile dysfunction, after failure of Viagra, pudendal artery stenting can be done.
  4. In patients with chronic lack of blood supply to the limbs, in 30% of cases, amputation can be prevented by autologous bone marrow stem cell transplant.
  5. In acute paralysis, it is possible to suck out the clot by putting a stent in the brain artery and even dissolving the clot by drugs.
  6. For varicose veins, a walk–in procedure is now available using radiofrequency or laser procedures.
  7. Patients with resistant high blood pressure can now be treated with renal artery denervation.
  8. It is possible to occlude the left arterial appendix chamber in patients with irregular heart rhythm to prevent paralysis.
  9. It is possible by catheters to remove clot from lung vessels.
  10. Aortic aneurysm can be cured by new cover stent graft with or without surgery.
  11. There are only 4,000 endovascular procedures done in India as against the need of 4 lakhs.
  12. Multilayered flow diverters are a new advancement in endovascular interventions where surgery can be avoided.
 
    Readers Responses
  1. Dear Dr KK Aggarwal, Vanakkam, Your detailed editorial about the eclipses and our belief and their correlation with our science was nice––The rest of the eMedinewS as usual is excellent The answer for the queries regarding registering a MLC in domestic violence by Dr MCG was informative. With regards Sincerely: Dr. LVK Moorthy.
 
    Forthcoming Events
Dr K K Aggarwal

4th Asia Pacific Vascular Intervention Course (APVIC-IV)

Date: June 8-10-2012

THE OBEROI, Dr. Zakir Hussain Marg, New Delhi
In association with 'International Society of Endovascular Specialists' 'Vascular Society of India' 'Society of Cardiovascular Angiography & Interventions'

IYCNCON 2012

All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
http://www.heartcarefoundation.org

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

 
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