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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

13th February 2010, Saturday

Coronary artery disease: Primary prevention is the key

On Thursday, Former US President Bill Clinton underwent angioplasty. He had complained of chest discomfort and subsequently had two stents placed at New York Presbyterian Hospital. Six years ago, President Clinton had undergone a successful quadruple bypass surgery after angiography revealed significant blockages in four coronary arteries. One of the bypass grafts out of the four was blocked. Hence, the native coronary artery at the site of the graft was opened and two stents were placed. In a similar case, Dr Manmohan Singh had had a bypass surgery as well as angioplasty. Last year, he underwent a Re-do or repeat bypass surgery after he complained of chest.

What are the options available after a bypass surgery?

  1. Stent the obstructed graft
  2. Open the native artery (as done in the case of Former President Bill Clinton)
  3. Perform a re-do bypass

On an average, bypass or angioplasty do not last for more than 6 to 8 years. Patients often require another procedure as the graft may re-obstruct . Also, new blockages tend to develop on account of the progressive nature of the disease. A regular and close watch is crucial.

The answer is primary prevention. Healthy lifestyle choices like eating judiciously, regular exercise, maintaining optimal body weight, not smoking can help prevent coronary artery disease. These drug-free approaches can avoid heart disease by improving risk factors like blood pressure, fats, blood sugar etc. Preventing steps taken at the right time are a much better option than altering lifestyle after a heart attack.

 Dr KK Aggarwal
Chief Editor

News and Views

  1. Screening for short cervix could improve pregnancy outcomes
    Using ultrasound to screen all pregnant women for signs of a shortening cervix improves pregnancy outcomes and is a cost–effective way to reduce preterm birth, Yale School of Medicine researchers report in a new study.
  2. Powerful hallucinogenic plant linked to food poisoning case
    The CDC has determined that Jimsonweed, a plant with fairly well–known hallucinogenic properties, was the cause of an incident that took place in a Maryland emergency room in 2008 in which six family members presented with hallucinations, confusion and rapid heart rates.
  3. FAST
    Focused Assessment by Sonology in Trauma or FAST is another important field in ultrasound which is done by emergency physicians to help them take crucial decisions regarding disposition of patient to operation theatre for laparoscopy, or picking up pericaridial effusion in trauma victims. (Dr Vivek Chhabra)
  4. Supreme Court judgment clarifies the definition of negligence (Dr G M Singh)
    Providing relief to doctors from unhappy patients and their families who harass them with accusations of medical negligence, the Supreme Court has ruled that a "simple lack of care or an error of judgement or an accident" does not amount to negligence. "It would not be conducive to the efficiency of the medical profession if a doctor is to administer medicine with a halter around his neck," said a division bench of Justices Dalveer Bhandari and H S Bedi.
    The doctors inevitably become the first human casualty for patients or their families dejected by an unsuccessful treatment, the bench said that "a surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient".
    The Supreme Court defined, for the first time, the term "medical negligence", making it even more difficult to initiate criminal action against doctors for treatment gone awry, even in cases involving death of patients. The bench said that "Negligence in the context of medical profession necessarily calls for a treatment with a difference. A simple lack of care, an error of judgement or an accident, is not proof of negligence on the part of a medical professional. Treatment skills differ from doctor to doctor".
    A medical professional, the bench clarified, cannot be hauled up on the criminal charge of medical negligence "so long as the doctor followed a practice acceptable to the medical profession of that day".
    "He cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused doctor followed," the bench ruled.
    To prosecute a medical professional for criminal negligence "it must be shown that the accused doctor did something or failed to do something which in the given facts and circumstances no medical professional in his ordinary senses and prudence would have done or failed to do".
    "It is a matter of common knowledge that after the happening of some unfortunate event, there is a marked tendency to look for a human factor to blame for an untoward event, a tendency which is closely linked with the desire to punish. Things have gone wrong and, therefore, somebody must be found to answer for it. A professional deserves total protection," the court said.
    As an afterthought, the bench clarified that "we should not be understood to have held that doctors can never be prosecuted for medical negligence. As long as the doctors have performed their duties and exercised an ordinary degree of professional skill and competence, they cannot be held guilty of medical negligence." The objective of their judgment, the bench wrote in the verdict, is to ensure that it is imperative that "doctors must be able to perform their professional duties with a free mind".
    The judgment was passed while dismissing an appeal filed by Kusum Sharma, a Delhi resident who sought a compensation of Rs 45 lakh from Dr Batra Hospital for alleged negligence which caused the death of her husband in 1990.
    Kusum Sharma’s husband, R K Sharma, Senior Operations Manager with the Indian Oil Corporation, was operated upon for adrenal cancer at the hospital. He later died of other medical complications. Dismissing the appeal of the widow, the court said "medicine is not an exact science involving precision and every surgical operation involves uncalculated risks".
    In the present case, the court observed that "merely because a complication had ensued, it does not mean that the hospital or the doctor was guilty of negligence".
    "A medical practitioner is not expected to achieve success in every case that he treats. The duty of the doctor like that of other professional men is to exercise reasonable skill and care. The test is the standard of the ordinary skilled man," the court ruled.

Conference Calendar
Ahead 2010 Amrita Head & Neck Oncology Teaching Programme 2010
February 12–14, 2010
Venue: AIMS, Kochi, Kerala

Public Forum
Press Release

Valentine Day Special–14th February
Extramarital affairs bad for the heart
About 75 percent of deaths that do occur during sexual intercourse are in people who have extra marital affairs and in men who are much older than their sexual partners, said Dr. KK Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.
Dr Aggarwal said that extramarital sex is more stressful than sex with a spouse.

  1. Often there is an unexpressed need to perform well with a new partner.
  2. Sometimes there has been a high food and alcohol intake, which adds to the overall stress. Sexual activity after food is more strenuous than on the fasting state.
  3. The anxiety to perform better during extramarital sex could precipitate angina, heart attack and sudden death.
  4. Also, extramarital sex usually takes place in unfamiliar surroundings, which increases stress.
  5. Often the sex takes place under the cover of Viagra-like drugs as most elderly patients having sex would take a tablet of Viagra if having sex with the younger newer partner. The combination of Viagra and nitrates (if they are a heart patient) could prove fatal for such patients.

Danger signals of heart attack during the act are a feeling of pressure, pain or discomfort in the jaw, neck, arm, chest or stomach; marked shortness of breath; and excessively rapid or irregular heartbeats. Researchers from St Thomas Hospital, London, have shown that couples in long–term relationship were far less likely to have heart attack while having sex compared to those having affairs or one–night stands.

Stopping Statins may not stop statins induced muscle pains

Patients getting muscle pains and weakness with statins may continue to suffer symptoms long after stopping statins. Almost a third of patients who stopped statin treatment because of neuromuscular symptoms still showed myalgia six months later, and creatine kinase levels above 200 units/L persisted in 17%, according to Dr Andoni Echaniz-Laguna, of Hopitaux Universitaires in Strasbourg.[Feb New England Journal of Medicine]. Creatine kinase measurements at the start of statin therapy could help identify patients with underlying neuromuscular diseases.

Punjab & Sind Bank
Central Bank of India

Question of the day
Is it advisable to give hematinics in malaria?
WHO guidelines recommend that iron and folic acid supplementation should be targeted to those who are anemic and at risk of iron deficiency. They should receive concurrent protection from malaria and other infectious diseases through prevention and effective case management. Children in regions of the world where malaria transmission is intense and infectious disease are highly prevalent, should be given supplements. (Suggested reading: Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. WHO statement. April 2004)

Dr Good Dr Bad
Situation: A diabetic child failed on lifestyle therapy and metformin.
Dr Bad: Add another oral drug.
Dr Good: Add insulin.
Lesson: In children initially treated with both non pharmacologic therapy and metformin who fail to achieve glycemic targets, use insulin glargine, a long–acting insulin analogue, as the next therapeutic agent. Although others have suggested that sulfonylureas can be considered as an alternative to insulin therapy. Sulfonylureas are not currently FDA approved for use in pediatric patients. (Source: Plotnick L. Diabetes Mellitus. In: Principles and Practice of Pediatric Endocrinology, Kappy, SM, Allen, DB, Geffner, ME (Eds), Charles C. Thomsa, Springfield, 2005. p. 635.)

Make Sure
A patient with community acquired pneumonia (CAP) developed diarrhea after 3 weeks of antibiotics.
Reaction: Oh my God! Why was the antibiotic given for 3 weeks?
Make sure that CAP patients are treated for five days (Infectious Diseases Society of America/American Thoracic Society Guidelines)

Laughter the Best Medicine
You don’t want to hear during Gyne surgery: Damn! Page 84 of the manual is missing!

Formulae in Imaging
A common bile duct greater than 11 mm in diameter on USG is strongly suggestive of obstruction by stone or tumor. (Source: Radiology 1979;133:703–7)

ENT Facts
Myringotomy with tympanostomy tubes may be considered for persistent symptomatic effusions at 12 weeks, and earlier for selected patients with need for immediate pressure equalization.

SMS Anemia
In the elderly, target hemoglobin level should be in the range of 10 to 12 g/dL.

Milestones in Neurology
Sir James Crichton–Browne (1840–1938) was a British psychiatrist known for the scientific study of brain tissue in cases of psychiatric disorder, for his concepts of mental illness in relation to evolutionary theory and for the development of medical psychology in public health and education.

Mistakes in Critical Care
Never use ‘&’ for ‘and’ as it can be misread as ‘2’. Instead write ‘and’

(Advertorial section)

Zen Immune - facts

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Advertising in emedinews
emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com 

eMedinewS–PadmaCon 2010 
Will be organized at MAMC on July 4, 2010, Sunday to commemorate Doctors′ Day. The speakers, chairpersons and panelists will be various past and present medical Padma awardees of NCR.

eMedinewS–revisiting 2010
The second 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 hangama and live webcast. Suggestions are invited.

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Dear Dr. KK Aggarwal: We are delighted to see your name in the Padma awardees list. On behalf of everyone at IIC, I extend heartiest felicitations to you and your family. With best wishes, Many More, Yours sincerely: Commodore (Retd.) Ravinder Datta, Secretary, India International Center.
  2. Dear Sir, I wish to extend my heartiest congratulations to you for being conferred with the Padmashri award. Indeed, you do deserve this great honour. May you keep progressing and earn more laurels on your way. I feel proud to be associated with you. With regards and best wishes: Dr Veena Ambekar
  3. Dear Dr KK Aggarwal: Pls accept my heartiest congratulations for being honoured with padmashree award. urs sincerely: Vinay Kumar Gupta
  4. Respected Dr KK Aggarwal, This is a excellent job. I am in Bahrain and getting all latest updates from IJMA.Thanks a lot, keep the good work up!!!! Three cheers for IMA. (suggestion- can use facebook for daily updates). Regards: Dr Meenakshi
  5. Dear Dr. KK Aggarwal, though a gynecologist, I read your newsletter everyday. In one of your e-medinews letters there was a mention that for lipid profile fasting is not required, I need that reference: Dr Maninder Ahuja Emedinews responds: A fasting state is not required to total cholesterol and HDL cholesterol. But for TGs, we require fasting. That is the reason the new trend is not to do TG and rely on non-HDLC.
  6. Ultrasound scan are good as well as safer and affordable in the most cases for screening: Dr VK Agarwal