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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

  Editorial ...

14th October 2010, Thursday

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

Non–HDL–cholesterol, a new marker

Non–HDL–C is defined as the difference between the total cholesterol and HDL–C. Non–HDL–C includes all cholesterol present in lipoprotein particles that is considered atherogenic, including LDL, lipoprotein (a), intermediate–density lipoprotein, and very–low–density lipoprotein. Non–HDL–C fraction may be a better tool for risk assessment than LDL–C. Lipid Research Clinics Program included a total of 2406 men and 2056 women ages 40 to 64 years at study entry who were followed for an average of 19 years. The LDL–C fraction was a slightly weaker predictor of cardiovascular death than the non–HDL–C fraction. Differences of 30 mg/dL in non–HDL–C and LDL–C corresponded to increases in cardiovascular disease mortality of 19 and 15 %, respectively in men, and 11 and 8 %, respectively in women. ATP III identifies non–HDL–C concentration as a secondary target of therapy in people who have high triglycerides (=200 mg/dL). The goal for non–HDL–C is a concentration that is 30 mg/dL higher than that for LDL–C

  1. Triglycerides require 12 hours fasting.
  2. Non HDLC requires no fasting.
  3. Non HDL C is better than LDLC as a marker.

(Reference: Cui Y, Blumenthal RS, Flaws JA, et al. Non–high–density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med 2001;161:1413–9).

Dr KK Aggarwal
Editor in Chief
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  Dengue Update

What are the side effects of platelets transfusions?

  • Transfusion reactions: More frequent with platelet transfusions than with red cell transfusions. The reported incidence of adverse reactions to platelet transfusion ranges from 5–31%.
  • Fever and Chills: Platelet transfusion can cause 1–2 % of patients to develop fever or chills.
  • Immune–Mediated Platelet Destruction: In some cases, the body may be resistant to the platelet transfusion, a condition called refractoriness to platelet transfusion. When this occurs, the immune system of the body attacks the platelets given through transfusion. This causes the destruction of the platelets and renders the transfusion treatment ineffective.
  • Allergic reactions: Some patients may experience an allergic reaction during or immediately following the platelet transfusion. Symptoms may include itchy skin (urticaria), wheezing or severe swelling beneath the skin (angioedematous).
  • Anaphylactic reactions may occur in IgA–deficient patients. Severe allergic reaction or anaphylaxis may cause significant breathing difficulties.
  Photo Feature (from the HCFI Photo Gallery)

BSNL Dil ka Darbar 2009

Kathak Exponents Nalini Kamalini performed at Maulana Azad Medical College Auditorium, during the BSNL Dil ka Darbar on September 6, 2009. This was a unique public forum which enabled general public to interact directly with top doctors of Delhi.
In the photo: Kathak exponent duo Nalini Kamalini, Chief Secretary Govt of Delhi, Shri R S Mehta and Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President HCFI

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Treatment of co–occurring depression and alcohol dependence

A randomized trial of outpatients with alcohol dependence and major depression found that combined treatment with naltrexone and sertraline reduced relapse and increased time to heavy drinking compared to either drug individually and to placebo.

(Reference: Pettinati HM, et al. A double–blind, placebo–controlled trial combining sertraline and naltrexone for treating co–occurring depression and alcohol dependence. Am J Psychiatry 2010;167:668)).

  National News

IMA Election (for a CHANGE)

Emedinews requests all its readers to support our editor Dr. K.K. Aggarwal, Padma Shri and Dr. B C Roy National Awardee who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well–known for his work in the field of academics.

Integrate alternative medicine for better healthcare: Patil

President Pratibha Patil on Monday made a strong case for integrating the alternative forms of medicine to provide better and affordable healthcare in the country. "While every branch of medicine – be it allopathy, homeopathy, unani, ayurved and siddha – has its own relevance– the integration of these therapies will eventually benefit the common man,"she said while speaking at the golden jubilee function of the Maharashtra Arogya Mandal. The government has set up the department of AYUSH (Ayurved, Unani, Siddha and Homeopathy) towards the integration of the alternative forms of medicine to supplement allopathic treatment, Patil said. (Source: Indian Express)

Taiwan man didn’t get superbug from India, says health ministry

The Union Health Ministry has refuted the claims of Centre for Disease Control (CDC) in Taipei that one of the two Taiwan nationals injured in the Jama Masjid shootout was infected with the NDM–1 superbug bacteria in India. Unidentified men had shot at Ko Chiang, 38, and another tourist on September 19 in old Delhi. Chiang was operated on for hepatic and bowel injuries at Lok Nayak Hospital. He was discharged on September 27. On returning to Taiwan, he was scanned for the controversial NDM–1 enterobacteriaceae at the CDC in Taipei. The NDM–1 Klebseilla pneumoniae bacteria was detected in his stool. The Health Ministry has refuted all claims by the CDC, saying the patient had not received any carbapenem antibiotic during his stay in India. (Source: The Hindustan Times)

1. Dear readers emedinews@gmail.com account was hacked for few hours today morning. Now it is working all right. If any one receive any unconcerned  mail from this account, ignore it.

2. Certificate courses in 2D and 3D Echocardiography/ Fellowship Diploma in non invasive cardiology, contact Dr KK Aggarwal Moolchand Hospital emedinews@gmail.com

  International News

(Dr Monica and Brahm Vasudev)

American Heart Association Meeting Report

An early study in rats provides the first direct indication that a major component of smog might trigger cell death in the heart, researchers reported at the American Heart Association’s Basic Cardiovascular Sciences 2010 Scientific Sessions – Technological and Conceptual Advances in Cardiovascular Disease. The study found that exposure to ground–level ozone over several weeks increased the activity of a substance that triggers cell death in the heart.

Risks, benefits of emerging heart valve replacement technique not fully understood

A newer, less invasive method of heart valve replacement shows promise and may be appropriate for patients who cannot tolerate traditional open heart surgery, but research is needed to understand its potential risks and benefits, according to a new study funded by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ). The report finds that percutaneous heart valve replacement, a procedure in which a replacement valve is implanted through a catheter rather than by open heart surgery, is a realistic option for some patients with heart valve disease, especially older or sicker patients. According to the report, percutaneous heart valve replacement may be a safe and effective alternative to open heart surgery, especially in the short term, for those patients. However, information is lacking on the potential long–term benefits and risks of this procedure, particularly compared with open heart valve replacement surgery. The report did not conclude that any of the seven valves studied is safer or more effective than another. The report was produced by the Duke Evidence–based Practice Center for AHRQ, a leading Federal agency conducting comparative effectiveness research. Results of the report were published online today in Annals of Internal Medicine. Heart valve disease—a narrowing of the heart valve—is blamed for approximately 20,000 deaths a year.

Exercise and caloric restriction rejuvenate synapses in lab mice

Harvard University researchers have uncovered a mechanism through which caloric restriction and exercise delay some of the debilitating effects of aging by rejuvenating connections between nerves and the muscles that they control. The research, conducted in the labs of Joshua Sanes and Jeff Lichtman and described this week in the journal Proceedings of the National Academy of Sciences, begins to explain prior findings that exercise and restricted–calorie diets help to stave off the mental and physical degeneration of aging.

Just drop it: one–size–fits–all approach to blood sugar control, That is

Aggressive blood sugar control does not improve survival in diabetic patients with kidney failure, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results suggest that physicians should individualize blood sugar targets for these patients and not rely on recommendations based on studies in the general population.

  Hepatology Update

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

What are the complications of hepatitis A?
  • Fulminant hepatic failure: 10% of cases of fulminant hepatic failure in children are caused by hepatitis A virus infection. Disease is severe if it occurs over an underlying chronic liver disease. 
  • Prolonged cholestasis: Characterized by a protracted period of jaundice (>3 months) and resolves without intervention. Corticosteroids and ursodeoxycholic acid may shorten the period of cholestasis. The usual features of cholestatic viral hepatitis A are pruritus, fever, diarrhea, and weight loss, with serum bilirubin levels > 10 mg/dL.
  • Relapsing hepatitis A: An uncommon sequela of acute infection; more common in elderly. This occurs in 3-20% of patients. Relapse occurs after a short period (usually <3 wk) and mimics the initial presentation, although it usually is clinically milder. The clinical course is toward resolution, with lengthening periods between flares. The total duration is 3-9 months.
  • Autoimmune hepatitis: Steroid therapy for this condition is associated with good clinical response and improvement in biochemical and clinical parameters.
  • Other complications: Rare: acute renal failure, interstitial nephritis, pancreatitis, Henoch Schonlein Purpura, red blood cell aplasia, agranulocytosis, bone marrow aplasia, transient heart block, Guillain-Barré syndrome, acute arthritis, Still disease, lupus like syndrome, and Sjögren syndrome have been reported in association with hepatitis A virus infection.
  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What advice do you have for young women to prevent possible future fertility problems?

Sexually transmitted diseases (STDs) can be a major cause of future infertility, so young women should ALWAYS have protected sex. Also, women should consult with their Ob/Gyn if they have irregular menstrual cycles or have painful periods or ovulation. If your doctor is dismissive and does not offer to find a cause and solution to your problems, find a physician who will. Unfortunately, many couples'  biggest barrier to conception is an Ob/Gyn who is unfamiliar with the latest technology to treat the causes' of infertility even though the woman may not presently be trying to conceive.

  Gastro Update: Question of the Day

What is the role of immunomodulator therapy in ulcerative colitis? (Dr SP Kalantri)

Some patients with ulcerative colitis remain refractory despite intensive therapy. In these cases, immunomodulator therapy with either azathioprine or its metabolite, 6–mercaptopurine (6–MP), can be considered prior to referral for surgery. Testing for thiopurine methyltransferase (TPMT) activity should be considered before initiating therapy. As surgery in ulcerative colitis is curative and, in many patients, does not require a stoma, most doctors are hesitant about using these potentially toxic medications. However, patients who do not desire surgery or those with more limited disease but with persistent or debilitating symptoms are candidates for long-term therapy with these drugs.

  Medicolegal Update

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

How can insect, spider and scorpion stings and bites be prevented?

The world’s most venomous and poisonous insects are fire ants and the harvester ants

Insect venoms comprise amino acid peptides and proteins. They also may contain allergenic proteins, which can trigger a potentially lethal immune response in sensitive individuals. Biting and stinging are separate actions in ants. Some ants bite and do not sting. Some bite and spray venom on the bitten area. Some bite and inject formic acid with a stinger. Harvester and fire ants bite and sting in a two–part process. The ants grab hold with their mandibles, and then pivot around, repeatedly stinging and injecting venom.

  • Find out about the poisonous insects, caterpillars, spiders, and scorpions in your area. Learn what they look like and where they live.
  • Wear long trousers, long–sleeved shirts and gloves, and cover your head and face as much as possible as protection from bee stings when working among flowers or fruits. Avoid wearing things that attract bees, such as bright flowery clothing, bright shiny jewelry, buttons or buckles, or using scented perfume, soap or shampoo.
  • Do not walk outdoors in bare feet or open shoes.
  • Do not touch insects, caterpillars, spiders, scorpions, or centipedes.
  • Do not put your hands in leaf litter, rotten tree trunks or holes where insects, caterpillars, spiders, scorpions or centipedes might live.

(Ref: IPCS, the United Nations Environment Programme, ILO and the World Health Organization)

  Medi Finance Update

Investing a significant portion of your portfolio in one industry can be risky, especially if that industry falls on hard times. However, the upside can be equally as good if the industry performs well. (We have seen this in the technology sector.)
However, if you have a diversified portfolio you may be able to reap some incremental returns by investing in an industry–specific fund.

  Drug Update

List of drugs prohibited for manufacture and sale through gazette notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Drugs prohibited from the date of notification

Fixed dose combinations of crude Ergot preparations except those containing Ergotamine, Caffeine, analgesics, antihistamines for the treatment of migraine, headaches

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Levels of total cholesterol, LDL and apolipoprotein B, increase significantly in women at the time of menopause thus increasing the risk factors for coronary heart disease.

  IJCP Special

Dr Good Dr Bad

Situation: An asymptomatic patient with no obvious underlying cardiac disease shows ventricular premature contractions (VPCs).
Dr Bad: Anti–arrhythmics should be given.
Dr Good: No treatment is needed.
Lesson: In the absence of cardiac disease, isolated asymptomatic VPCs regardless of configuration and frequency need no treatment.

Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

Quote of the Day (Dr.G M Singh)
"A good deed is never lost: he who sows courtesy reaps friendship; and he who plants kindness gathers love." Basil

  Mind Teaser

Read this…………………

big big
ignore ignore

Answer for yesterday’s Mind Teaser: "Don’t tread on me"

Correct answers received from: Dr Anurag Jain, Dr.K.P.Rajalakshmi, Dr. Prashant Bharadwaj, Dr.K.V.Sarma, Dr Virender Prakash Gautam

Answer for 12th October Mind Teaser is: "A bird in the hand is worth two in the bush"
Correct answers received from: Dr.Rohini Dhillon , Dr.G.Padmanabhan, Dr Rashmi Chhibber, Dr.Satish

Send your answer to ijcp12@gmail.com

Humor Section

Joke (Dr G M Singh)
An efficiency expert concluded his lecture with a note of caution. "You need to be careful about trying these techniques at home." "Why?" asked somebody from the audience. "I watched my wife’s routine at dinner for years," the expert explained. "She made lots of trips between the refrigerator, stove, table and cabinets, often carrying a single item at a time.

One day I told her, ‘Honey, why don’t you try carrying several things at once?’ "Did it save time?" the guy in the audience asked. "Actually, yes," replied the expert. "It used to take her 30 minutes to make dinner. Now I do it in 10…"

You are an Indian if (Anuj Goel)
You have a vinyl table cloth on your kitchen table.

  An Inspirational Story

The Power of Encouragement

God’s Coffee
A group of alumni, highly established in their careers, got together to visit their old university professor. Conversation soon turned into complaints about stress in work and life. Offering his guests coffee, the professor went to the kitchen and returned with a large pot of coffee and an assortment of cups – porcelain, plastic, glass, crystal, some plain looking, some expensive, some exquisite – telling them to help themselves to the coffee.

When all the students had a cup of coffee in hand, the professor said: "If you noticed, all the nice looking expensive cups were taken up, leaving behind the plain and cheap ones. While it is normal for you to want only the best for yourselves, that is the source of your problems and stress. Be assured that the cup itself adds no quality to the coffee. In most cases it is just more expensive and in some cases even hides what we drink. What all of you really wanted was coffee, not the cup, but you consciously went for the best cups… And then you began eyeing each other’s cups.

Now consider this: Life is the coffee; the jobs, money and position in society are the cups. They are just tools to hold and contain Life, and the type of cup we have does not define, nor change the quality of Life we live. Sometimes, by concentrating only on the cup, we fail to enjoy the coffee God has provided us."

God brews the coffee, not the cups………… Enjoy your coffee!

  Readers Responses
  1. Respected Dr KK Aggarwal I have been a regular visitor to the Perfect Health Mela. All the events are very informative. I specially enjoy Medico Masti – A very lively and full of masti. Looking forward to the Mela this year. Regards Dr Anupam
Public Forum

(Press Release for use by the newspapers)

Prevention strategy relies on lifestyle

Stenting may not always be the answer to treating heart disease said Padma Shri and Dr BC Roy National awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela. The forthcoming 17th Perfect Health Mela, country’s most popular health Mela to be held from 23 – 31st October 2010 at NDMC Ground, Laxmi Bai Nagar, New Delhi will have special check ups for the stable heart patients.

The Mela will provide free education, exhibition, general and specialty checkups, ECG, Colour Doppler Echocardiography, competition opportunities, etc. Highly subsidized executive blood tests will be available to the general public at a nominal registration fee of Rs. 110/– (market cost 1500/–)

Exercise is ostensibly an important part of any type of prevention, and that it should be instituted for "anyone with coronary heart disease."  The clear message for patients is to get 30 to 60 minutes of moderate-intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.

  Forthcoming Events

CPLD 2010: Dept. of Gastroenterology & Human Nutrition, AIIMS and Dept. of Gastroenterology, PGIMER, Chandigarh are jointly organizing a conference on Current Perspective in Liver Diseases (CPLD) on 15th and 16th October at AIIMS, New Delhi.

eMedinewS Events: Register at emedinews@gmail.com

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

Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

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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