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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

10th July, 2010, Saturday

Gender–specific formula for women’s
peak heart rate ‘more accurate’

We should start using a new genderspecific formula for a woman’s peak heart rate as it better predicts the risk of heartrelated death. A simple formula, 220 minus age, has long been used to calculate peak heart rates for women and men during exercise. But this formula was based on studies of men. The new formula developed for women is 206 minus 88% of age.

At age 50, the peak heart rate for a man will be 170 beats per minute and for woman will be 162 beats per minute. Most use the peak heart rate multiplied by 65% to 85% to calculate maximum heart rate when exercising.

The new formula is based on an analysis of 5,437 healthy women aged 35 and older (average age 52) from the greater Chicago metropolitan area, who volunteered to take part in the St. James Women Take Heart Project, launched in 1992.

Using the old formula, one is more 'likely' to tell women they have a worse prognosis than they do men. The new formula predicts risk more accurately said Dr. Martha Gulati, an assistant professor of medicine and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago. There is a physiologic response in women that is different from men. The study appears in the June 28 online issue of Circulation. (Story idea: Dr Vijay Grover)

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)


Playing Cards with Health Messages

Playing Cards with Health Messages were demonstrated during a pre-mela press conference on October 25, 2007 to announce the dates of Perfect Health Mela 2007. Such Playing Cards, devised by Heart Care Foundation of India developed into and eye & catching and effective module for health education.

Dr k k Aggarwal

Dr. AK Walia, Former Health Minister Delhi and Former Cricketer, Atul Vasan displaying Playing Cards with health messages. Also in the Photo: Padma Shri and Dr. BC Roy National Awardee Dr. KK Aggarwal, President HCFI


News and Views

Top CSIR Scientist Dies after Drinking Lauki-Karela Juice
1. Karela (bitter gourd) juice proved lethal for a 59-year-old diabetic Sushil Kumar Saxena, Deputy Secretary in Council for Scientific and Industrial Research, who died in Rockland Hospital after vomiting blood, reports Mail Today.  Saxena’s wife 56-year-old Neeraj, also a diabetic, was also hospitalized for a week after drinking the lethal juice.
1. It is a case of poisoning
2. It can be external poisoning or food poisoning
3. Food poisoning can be due to bitter abnormal lauki. Bottle gourd, cucumber, squash, pumpkin and melon can turn toxic if they taste bitter as they have Tetracyclic Triterpenoid Cucurbitacins compound which is toxic. The compound is responsible for bitterness in vegetables. But can they cause GI bleed?
4. Vegetables like bottle gourd (lauki), cucumber, squash, pumpkin and melon belong to the cucurbitaceae family. Cucurbitacins are complex compounds found in plants belonging to the cucumber family.
5. As per Botanists higher levels of chemicals cucurbitacins are triggered by wide temperature swings, high temperature, too little water and low soil fertility. Improper storage of vegetables is also one of the reasons of forming such compounds. These toxins, cause swelling in the liver, pancreas, gall bladder and kidney when absorbed into the blood.  This in turn can lead to multiorgan dysfunction.
6. As per the sources he had GI bleed with malena. Malena can not come in hours. Was it a case of poisoning, with poison given by someone the night before and it was lauki ka juice which just precipitated already occurring GI bleed inside the stomach?
7.    If lauki is to be blamed we should have got more cases of poisoning in the city.
8.    Another message: Fruits and vegetables which are more colorful, different taste, more bitterly more pulpy should be avoided ad they have undergone some degradation.

Ways to control bedroom noise (Dr. G M Singh)

A quiet bedroom can help contribute to a good night’s sleep, especially among older adults. The elderly spend less time in deep sleep and, therefore, are more easily awakened by noises. Here are some ways to reduce noises that can interfere with sleep:

  • Use earplugs.

  • Decorate with heavy curtains and rugs, which absorb sounds.

  • Install doublepaned windows.

  • Use a fan or other appliance that produces a steady "white noise." White noise devices, designed specifically to provide this kind of steady hum, are available in stores, as are tapes and CDs that provide soothing sounds.
FDA approves implantable telescope to help patients with agerelated macular degeneration (Dr. Monica and Brahma Vasudeva)

A firstofitskind technology, a tiny telescope implanted inside the eye, to counter a leading cause of blindness in older adults has been given the FDA nod. The Implantable Miniature Telescope aims to help in the end stages of incurable age-related macular degeneration.

Atorvastatin beats rosuvastatin in protecting kidneys in diabetic and nondiabetic patients (Dr. Varesh Nagrath)

Results of the two PLANET trials investigating the effects of statins on urinary protein excretion and kidney function found atorvastatin protective and rosuvastatin unprotective, and possibly harmful, in diabetic and nondiabetic patients. Highdose atorvastatin significantly reduced proteinuria and did not affect renal function, whereas rosuvastatin was associated with a significant decrease in function and had no effect on proteinuria. The study findings were reported by Dick de Zeeuw, MD, PhD, a clinical pharmacologist and clinical trialist at the University Medical Center in Groningen, the Netherlandsat the XLVII European Renal AssociationEuropean Dialysis and Transplant Association Congress.

Proteinuria is a risk factor for further deterioration of kidney function and progression to endstage renal diseaseIn diabetic and nondiabetic patients, even when angiotensinconvertingenzyme (ACE) inhibitors or angiotensinreceptor blockers (ARBs) are used to lower blood pressure. Statins reduce proteinuria as suggested in experimental studies, however, but clinical studies did not suggest so and instead produced mixed results.

Tranexamic acid reduces trauma deaths

Tranexamic acid finds another application. In a new study, tranexamic acid significantly reduced risk of fatal bleeding in trauma patients by 15% vs placebo;4.9% vs 5.7% (RR 0.85, 95% CI, 0.76 to 0.96, P=0.0077). Tranexamic acid is an inexpensive drug approved for treatment of abnormally heavy menstrual flow.

Govt to spend Rs 1,231 cr to promote healthy lifestyle (Economic times)

The government will spend around Rs 1,231 crore in the next two years for an ambitious healthcare programme to prevent, detect and control the spread of cancer, diabetes, heart ailments and stroke. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is expected to screen more than seven crore adults across 100 districts in 15 states and union territories for diabetes, hypertension, early diagnosis of non-communicable diseases and treatment at early stages. The programme, approved by the Cabinet Committee on Economic Affairs (CCEA) on Thursday, will train about 32,000 people to provide opportunistic and targeted screening, diagnosis and management of non-communicable diseases. Of the total outlay, Rs 499.38 crore will be spent for interventions on diabetes, cardiovascular diseases and stroke, while Rs 731.52 crore will be spent for cancer control. The Centre will provide 80% of the cost of the scheme, while the states would have to cough up the balance. The objective of the programme is to promote healthy lifestyle. Non-communicable diseases are emerging as the leading cause of death in India accounting for over 42% of all deaths. They cause considerable loss of potentially productive years (35-64 years) of life.


Legal Column

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

Issuance of death Certificate by Doctor

It is essential that the cause of death must be documented/ determined before lawful disposal of the deceased body by the doctor. The death certificate also provides the exact cause of death for statistical purposes.

The certificate of death is always issued by doctor as an honor/respect to the deceased person without any fee. In accordance with the Registration of births and deaths Act 1969, the Registration of deaths is now compulsory throughout India. For this purpose it is compulsory by law for the medical practitioner who has attended the deceased person, to issue a death certificate after inspecting the body and satisfying himself of the person’s death, stating the underlying cause of death-that is the morbid condition or disease process, or abnormality leading directly or indirectly to death. The cause of death is recorded according to international conventions; the sequence being that adopted by the World Health Organization.

The International Medical Certificate for the cause of death consists of 2 parts.

  • Part I: Records (a) the immediate cause, and (b) the morbid conditions, if any, giving rise to the immediate cause. Thus (a) must be due to (b). When (b) is due to other causes, it should be mentioned in(c). The basic pathological condition is mentioned on the lower-most line and this is the one that is used for statistical purposes.

  • Part II: Records any other significant condition contributing to death, but not related to the immediate cause of death. The underlying cause of death is defined as the disease, which initiated the train of morbid events leading directly to death

For example, a patient may die primarily from myocardial infarction due to coronary artery disease. These should be placed in parts (a) and (b) of  Part I as the myocardial infraction due to coronary artery disease (or coronary insufficiency). Similarly, it can be certified that the patient died of cerebral hemorrhage due to hypertension. However, if the patient also had diabetes, it should be entered in part II as it does not have a direct contributing role to the immediate cause of death.

It is incorrect to write ‘heart failure’ or ‘cardiac failure or cardiopulmonary arrest’ without mentioning the underlying pathological cause, which might be ‘coronary artery disease or rheumatic valve lesions or senile myocardial degeneration.’ It should be kept in mind that everyone dies of cardiopulmonary arrest or heart failure or cardiac failure which simply means cessation of circulation and respiration leading to somatic death.

The modes of death, e.g., cardiacrespiratory failure, or asphyxia should not be recorded as the cause of death, unless they qualify; for instance, ‘coma’ is a clinical symptom and not a cause of death. It should be used with proper cause such as crush injury of head or meningitis etc. Terms like angina, cancer, tumor apoplexy congestion’,’ debility’, ‘asthenia,’ organic disease toxemia, sepsis and hemorrhage are signs/symptoms of a disease and not a pathological condition. It is pertinent for medical professional to note that a death certificate requires the underlying pathological cause and not clinical manifestations or modes of death.The doctor must write his registration number in Death Certificate. A register for such should be maintained at his clinic/hospital and a copy/information must be sent immediately to the Birth and Death Registration Office.


Experts’ Views

Interesting tips in Hepatology & Gastroenterology
(Dr Neelam Mohan, Consultant Pediatric, Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician Sir Ganga Ram Hospital, Delhi)

Aerated cold drinks: Facts

  • Each 300-ml bottle of it contains atleast 7-8 spoons of sugar, 35-45 mg of caffeine, acids, volatile oils, Benzene and other chemicals & additives. It has no calcium, organic salts/ sugars/ minerals or any other nutrients
  • Cold drinks are highly acidic and tend to make the blood acidic, which then draws out calcium from the bones to maintain its alkalinity.
  • Caffeine, which is not listed as caffeine, but included under ‘natural ingredients’ besides being habit-forming, is a natural diuretic.
  • Both, the caffeine & high sugar content are definitely habit-forming for a child.

Question of the Day (Dr. I. P. S. Kalra)

Is there a role of clopidogrel 300 mg stat in acute coronary syndrome?

Antiplatelet drugs constitute an important aspect of the management of acute coronary syndrome (ACS). Whereas the administration of acetylsalicylic acid (ASA) is wellestablished, the guidelines recommend the additive use of clopidogrel in patients with ACS without persisting STelevation.

  • Clopidogrel should be added to ASA as soon as possible in patients with a noninvasive treatment strategy and continued for more than one month (class 1A) and up to 9 months (class 1B).

  • In patients for whom a PCI is planned, an additional loadingdose of 300 mg clopidogrel should be given on top of ASA (100 mg).

These recommendations are based on data recently published in the CURE and CREDO trials. The recent multinational, randomised, prospective studies Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE), PCI substudy of CURE (PCICURE) and Clopidogrel for the Reduction of Events During Observation (CREDO) have demonstrated the clinical efficacy and safety of clopidogrel for the treatment of patients with nonSTsegment elevation acute coronary syndromes (ACS), including those undergoing PCI. In these settings, clopidogrel significantly reduces the risk of athero-thrombotic events, with relative risk reductions of 2030% (absolute risk reduction 1.93.0%). Treatment with clopidogrel plus standard therapy reduces the cost of initial hospitalization as well as the total cost associated with hospitalizations.


View Point (MCI Medical Education)

In this column, eminent Padma Awardees express their thoughts on Medical education. Today, we present the views of Padma Shri Awardee Dr. Raman Kapur, Head, Dept of Acupunture, Sir Ganga Ram Hospital, Kapur Acupuncture Clinic, New Delhi

The present system of multiple examinations for admission to undergraduate and postgraduate courses is very cumbersome and difficult for the students. In this scenario, the best way would be to have a common undergraduate medical entrance exam for all medical colleges, which includes both government and private medical colleges. A common merit list should be prepared and depending on that, a student can take the course. At the postgraduation level also, a similar exam can be held for all the medical colleges of the country. Presently, there is no need for having short courses of three years which were being mooted by the ministry to create rural doctors. This will only bring down the quality of medical care to the people.


Public Forum (Press Release for use by the newspapers)

Exercise Guidelines

All adults should engage in moderately intense exercises for atleast 30 minutes for five days a week or vigorous exercises for atleast 20 minutes three days a week, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Quoting new guidelines from American Heart Association and American College of Sports Medicine, Dr. Aggarwal said that physical inactivity is biggest public health problem today. It accounts for more morbidity and mortality than any other factor except cigarette smoking. The earlier 1995 recommendations had advocated 30 minutes of moderate intense activity to be done all seven days a week.

Giving an example, Dr. Aggarwal said that moderate intensity exercises include brisk walk, light jogging or exercises that noticeably increase heart rate. On the other hand, vigorous intensity exercises include jogging with rapid breathing and spontaneous increase in heart rate.

The new guidelines also call for weight lifting exercise to build muscular strength and endurance with eight to ten different exercises on two nonconsecutive days a week. Even people above the age of 65 should consider lifting weights and balance training.

High resting heart rate and respiratory rate dangerous

There is a traditional yogic saying that "one who eats once is a yogi, one who eats twice is a bhogi and one who eats thrice is a rogi". ‘Eating less prolongs life’ is a well-known phenomenon. The same is true for the resting heart rate and respiratory rate, said Dr. Aggarwal.

High resting heart rate and respiratory rate is associated with diminished life span. It is a traditional yogic teaching that one is born with a fixed number of heart rate and respiratory rate and the earlier you use them, the sooner you will have to go for a refill but with a different body.

Efforts should be made to reduce both respiratory and pulse rate. Both can be reduced by pranayama, yoga and meditation.


An Inspirational Story

Helping hands

A mother, wishing to encourage her son’s progress at the piano, bought tickets to a performance by the great Polish pianist Ignace Paderewski. When the evening arrived, they found their seats near the front of the concert hall and eyed the majestic Steinway waiting on the stage. Soon the mother found a friend to talk to, and the boy slipped away.

At eight o’clock, the lights in the auditorium began to dim, the spotlights came on, and only then did they notice the boy up on the piano bench, innocently picking out "Twinkle, Twinkle Little Star." His mother gasped in shock and embarrassment but, before she could retrieve her son, the master himself appeared on the stage and quickly moved to the keyboard.

He whispered gently to the boy, "Don’t quit. Keep playing." Leaning over, Paderewski reached down with his left hand and began filling in the bass part. Soon his right arm reached around the other side and improvised a delightful obligato. Together, the old master and the young novice held the crowd mesmerized with their blended and beautiful music.

In all our lives, we receive helping hands some we notice, some we don’t. Likewise, we ourselves have countless opportunities to provide helping hands sometimes we would like our assistance to be noticed, sometimes we don’t. Little of what we all achieve is without learning from others and without support from others and what we receive we should hand out.


IJCP Special

Dr Good Dr Bad

Situation: A patient came with erectile dysfunction.
Dr Bad: Start treatment.
Dr Good: First get cardiovascular tests done.
Lesson: Erectile dysfunction and cardiovascular disease share many risk factors and their pathophysiology is mediated through endothelial dysfunction. Underlying vascular disease is the cause of erectile dysfunction in many men.

Make Sure

Situation: A patient of pulmonary Koch’s taking ATT complained of numbness in fingers and toes.
Reaction: Oh my God! I forgot to prescribe vitamin B complex.
Lasson: Make sure that in patients talking ATT (including INH) Bcomplex vitamins (especially vitamin B6) are prescribed to prevent neuropathy. Addition of antioxidants and multivitamins also boost the immune system.

Quote of the Day (Dr. Santosh Sahi)

"He who is not courageous enough to take risks will accomplish nothing in life." Mohammad Ali

Milestones in Cardiology

Oscar Langendorff (1853-1908) was a German physiologist known primarily for his experiments on the ‘isolated perfused heart, the so–called Langendroff Heart apparatus. He was ‘Habilitated* for physiology in 1879 and became professor extraordinary–associate professor in 1884.

* Habilitation is the highest academic qualification a person can achieve after obtaining a research doctrate in European and Asian countries like France, Germany, Austria, Russia and Ukraine etc.

Mnemonic of the Day (Dr Varesh Nagrath)

Causes of cold extremities


Drugs (Propranolol)
Oxygen inhalation
Peripheral vascular disease
Acute arterial occlusion
Coronary insufficiency (Angina/MI)
Anxiety neurosis (Hands > Feet) & Panic attacks
Raynaud’s phenomenon (initial phase)


IMSA Update

International Medical Science Academy Update (IMSA)

The diagnosis of diabetes mellitus can be established by a hemoglobin A1C level ≥6.5 % as recommended by an International Expert Committee consensus report and confirmed by the American Diabetes Association.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Methyl Phenidate ER Tablet 10/20/30mg

For the treatment of Attention Deficit Hyperactivity Disorder (ADHD)



Medi Finance

Q. Can losses from the business or profession be set off?

A. Yes, loss from one’s business can be set off against other income from business under the same head. Interhead loss adjustment can also be made subject to some restrictions i.e. speculation loss can be set off only from speculation income.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Protein Electrophoresis

Immunofixation Electrophoresis

To help diagnose and monitor multiple myeloma and a variety of other conditions that affect protein absorption, production, and loss as seen in severe organ disease and altered nutritional states.


Humor Section


Dr Jhatka: I am proud, coz my son is in Medical College.

Friend: Really, what is he studying?

Dr Jhatka: No, he is not studying, they are studying him.

Funny Definitions

Seizure……………Roman emperor

Medical bloopers on medical charts!

Patient was released to outpatient department without dressing.


Forthcoming Events

Sunday workshop with Dr KK Aggarwal Moolchand Medcity, 12th July 8-10am. Cardiac emergencies

15th July: workshop with Dr KK Aggarwal IMA Bhawan Janakpuri 2-3pm

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 daylong 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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