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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 (07–08c); 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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  Editorial …

14th December 2011, Wednesday

Revisting 2011: American College of Nephrology Update

1. Kidney patients using harmful dietary supplements

About 10–15% patients with chronic kidney disease reported using potentially nephrotoxic dietary supplements, an analysis of a large government database showed. Overall, 52.4% of 21,169 survey respondents reported using dietary supplements. The likelihood of self–reported supplement use was increased among individuals with chronic kidney disease. Total supplement use included substances identified as potentially nephrotoxic by the National Kidney Foundation in 15.3% of cases.

2. Which blood pressure is tied to declining renal function?

A rise in systolic blood pressure (SBP) is associated with greater odds of a rapid decline in kidney function in the general older population. Among men and women 65 and older, those with the highest SBP –– 160 mm Hg or greater –– had about double the chances of their renal function worsening at a fast clip (OR 2.10, 95% CI 1.64 to 2.67), according to Dr Dena Rifkin, of the University of California San Diego in the American Society of Nephrology meeting. The relationship is independent of either diastolic blood pressure or pulse pressure.

The placebo arm of the SHEP (Systolic Hypertension in the Elderly Program) trial earlier also had shown similar results.

The study examined 4,365 older adults (mean age 72) enrolled in the Cardiovascular Health Study. The mean estimated glomerular filtration rate at baseline was 80 mL/min/1.73 m2. A rapid decline in kidney function was defined as a drop of at least 3 mL/min/1.73 m2 per year. Baseline SBP readings ranged from less than 120 mm Hg up to 160 mm Hg and higher. Moving from the lowest to the highest pressure groups, there was an increase in the odds of having a rapid kidney function decline for systolic, diastolic, and pulse pressure. The use of antihypertensives did not affect the association.

3. HCV positive patients on dialysis not receiving treatment

In a large, international cohort study of patients on hemodialysis, only one in every 100 of those who were HCV–positive received antiviral treatment, according to David Goodkin, MD, of the Arbor Research Collaborative for Health in Ann Arbor, Mich.

4. Women diabetics more at risk for CKD

Among patients with type 2 diabetes, women are more likely to have risk factors for chronic kidney disease than men, which may also put them at risk for poorer outcomes. At baseline, diabetic women were more likely to be obese, to have high LDL cholesterol, and to have an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 (ORs 1.31 to 2.20), according to Margaret Yu, MD, of the University of Washington in Seattle.

5. In CKD keep A1c between 6-8%

In one study of patients on hemodialysis, reported by Kamyar Kalantar–Zadeh, MD, PhD, of the Harbor–UCLA Medical Center in Torrance, Calif., glycated hemoglobin (HbA1c) levels outside of 6–8% were associated with worse survival during six years of follow–up.

6. Safe limits of cola drinks is no more than 1 drink a day

Consuming beverages flavored with either sugar or artificial sweeteners is associated with a higher risk of developing hypertension. In three large, prospective studies of healthcare professionals, drinking at least one sweetened beverage a day was associated with a 6–20% greater relative risk of receiving a hypertension diagnosis from a doctor, John Forman, MD, of Harvard Medical School.

7. Hypertension in pregnancy has lingering effects

Development of a hypertensive pregnancy disorder is associated with greater risks of adverse cardiovascular and renal outcomes for the mother later in life. Among women followed after a successful delivery, those with gestational hypertension or preeclampsia during pregnancy had higher rates of hypertension, renal disease, and stroke in their 40s and beyond (P<0.01 for all), according to Dr Vesna Garovic, of the Mayo Clinic in Rochester, Minn. The association could be explained by risk factors common to both preeclampsia and cardiovascular and renal disease –– including endothelial dysfunction –– or by metabolic and vascular changes induced by preeclampsia.

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Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Revisting 2011: American College of
Nephrology Update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011
Eco–Fest An Inter School Health Festival

Purpose of this competition is not only to have a competition but to learn preventive strategies so that the children in future can become healthy adults.

Dr K K Aggarwal
    National News

BHU celebrates Terra Madre day

VARANASI: The Institute of Agricultural Science, Banaras Hindu University (BHU), celebrated Terra Madre Day that is eating locally to popularise the concept of Slow Food on Monday. The BHU is one of the 2,000 Terra Madre Community Food Centers. Slow Food celebrates Terra Madre Day around the world on December 10 every year. It was founded in 1989 to promote the concept of ‘Good Clean and Fair Food’ available locally in Italy. To counter the fast growth of fast food, the foundation has got the people together under umbrella of Slow Food on December 10, under the banner of the Terra Madre Day. (Source: TOI, Dec 13, 2011)

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

Contractile reserve predicts death in HIV cardiomyopathy

The absence of inotropic contractile reserve (ICR) predicts the risk of cardiac death in patients with HIV–associated cardiomyopathy, researchers reported. (Source: Medpage Today)

For comments and archives

ASH: Nine genes drive CLL

Using massively parallel genetic analysis, researchers have found nine genes that appear to be the drivers of chronic lymphocytic leukemia (CLL). (Source: Medpage Today)

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Vitamin, diet link to stroke risk assessed

There’s little that individual vitamins and nutrients can do to prevent stroke, but overall healthier diets may lower the risk, an Australian researcher found. In a review, neither antioxidant vitamins nor B–vitamins were associated with stroke prevention, but a healthy diet, such as the Mediterranean diet, did appear to diminish risk, Graeme Hankey, MD, of Royal Perth Hospital in Australia, reported in The Lancet. (Source: Medpage Today)

For comments and archives

EUROECHO: Heart drugs may block chemo damage

He combination of statin plus ACE inhibitor could be cardioprotective for cancer patients who need anthracycline chemotherapy, a small prospective study suggested. (Source: Medpage Today)

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    Cardiology eMedinewS

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

Coronary Artery Disease

Surgical Treatment of Mechanical Complications

Read More

How to Prevent Late Complications of AMI

Read More

AMI Management in India (Economics) Dr H M Mardikar

Read More

Arrhythmias Recognition and Treatment

Read More

Epicardial fat thickness and extent of CAD

Read More

Newer Risk Factors for CAD

Read More

Key Note

Key Note Address: Future of Echo: Where are we Headed?

Read More

Key Note Address: Women and Heart Disease

Read More

Key Note Addresses: Dr Jagat Narula

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    Twitter of the Day

@DrKKAggarwal: Even Small Blockage Can Cause Heart Attack Smaller plaques in the coronary arteries are more dangerous than…http://fb.me/1oeh9Svlb

@DeepakChopra: Just as a wave is a movement of the whole ocean, you are the energy of the cosmos. Don’t underestimate your power.

    Spiritual Update

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

The Road to Spirituality

‘Love’ is what one is born with and ‘fear’ is what one learns. Spiritual journey is nothing but unlearning of fears and prejudices along with return of love back into one’s heart.

The first principle, therefore, of living a spiritual life is to be full of love. Love is not escaping from sufferings or from your thoughts but is the unity with your own divine self, which is the true consciousness.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

The Legacy of Health

Most of the time, in the pursuit to do what is best, we forget to fulfill the mandatory needs of our children. All they need is our unconditional love and support at every step in their lives, but, we spend our time by accumulating as much wealth as we can, at the cost of our own health.

All of our problems erupt from a bad lifestyle, long working hours, unhealthy food habits and bottling up of unwanted stress. Surprisingly we are all well aware of these facts, but keep on ignoring them, till things go out of hand and make us just too weak to work. That’s the time when we rush to doctors. Doctors cannot cure completely; they can only treat the problem.

Health is wealth, it needs all the attention all the time; it must be our topmost priority. The worst part is that wealth may or may not be hereditary, but health is. So, if we are not healthy, how do we pass on the wealth of our health to our children for them to enjoy? Yesterday life was difficult and living was easy but today life is easy and living is difficult.
We, as Indians, have a rich cultural lineage that enables us to lead a healthy and subsequently a wealthy life under all conditions, lest we believe in exporting our culture to western countries, to be approved by them, and only then we put it into use.

Let's preserve it for our future generations or else it will be destroyed. This can be only done if we inculcate them, in our own daily lives, and pass them on to our children by leading a self disciplined routine life, with a positive outlook, strong moral ethics and values.

Controlling and channeling the negative into positive, works wonders for our mind, body and soul. Like food, exercise of any kind, be it yoga, aerobics or even simple walking is compulsory. Taking care of one’s own self is not being selfish or self–centered. Pamper yourself by taking good care of your body. It’s said a healthy body inhabits a healthy mind.

When one is in good health, only then can one take care of his loved ones and enjoy the pleasures of life in all ways possible. The legacy of health has no substitute for our future generations to come.

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Exercise increases bone mass in adolescents

It’s commonly accepted that adults should perform resistance training and other forms of exercise to increase bone density and prevent osteoporosis. A new research from the University of Zaragoza in Spain set out to investigate whether adolescents who exercise are increasing their bone mass. A total of 373 Spanish teenagers under the age of 18 participated in the study. They were divided into two groups based on their exercise habits: non–active (less than 60 minutes of moderate activity per day) or active (more than 60 minutes). Their bone mineral content was measured by DXA machines and physical activity was assessed with accelerometers. Then, each participant’s fitness level was measured through a series of speed, agility, strength and cardiorespiratory tests. After all the data was collected, researchers performed statistical tests to find their results. Adolescents with lower fitness and lower activity levels were much more likely to have lower bone mineral content when compared to their more active, more fit counterparts.

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    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Loss of vision in one eye does not prevent driving, provided that the person has adjusted to it.

    Medicine Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta)

How is a patient of chronic hepatitis B treated?

  • Consensus guidelines for the treatment of chronic HBV in children have not been established, and indications for antiviral therapy in adults with chronic HBV infection may not be applicable to children.
  • Factors that are predictive of a positive response to interferon (IFN) or nucleoside analogues include high pretreatment levels of aminotransferase (>2 × ULN), low pretreatment HBV DNA levels (<105 copies/mL or 20,000 IU/mL), late acquisition of HBV infection and higher hepatocellular inflammation.
  • Treatment should be considered if patients have persistently elevated ALT levels >2 × ULN and evidence of active viral replication (HBeAg seropositive, and/or HBV DNA levels >105 copies/mL or 20,000 IU/mL in their serum) for more than 3 months.
  • Treatment aims to achieve long–term remission so that the chance of hepatocellular carcinoma and chronic liver disease is decreased.
  • Symptomatic children with ongoing viral replication and active liver disease need treatment. Therapy aims to prevent HBV replication and decrease inflammation and normalize transaminases.
  • According to the American guidelines, pediatric patients should be referred to pediatric liver specialist for development of strategy for monitoring, treatment, and/or cancer evaluation.

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emedinews revisiting 2011
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    IJCP Special

Dr Good Dr Bad

Situation: A patient with fever was found to have raised SGOT, SGPT levels with SGOT>SGPT.
Dr. Bad: It is classical viral hepatitis.
Dr. Good: This can be dengue fever.
Lesson: Mild elevations in SGOT/SGPT are common in both dengue fevers and DHF. However levels are significantly higher in patients with dengue hemorrhagic fever. Elevated SGOT levels are noted earlier in illness and normal SGOT levels is a strong negative predictor of dengue hemorrhagic fever in the first three days of illness (J Infect Dis 1997;176:313)

For comments and archives

Make Sure

Situation: A rape victim developed HIV infection.
Reaction: Oh my God! Why was she not given post exposure ART prophylaxis?
Lesson: Make sure all rape victims are counseled for HIV post exposure ART prophylaxis.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Anything is valuable only in two situations: First before getting it and secondly, after getting it. In between, you do not realize its value.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

5–hydroxyindoleacetic acid

Also known as: HIAA; Serotonin metabolite

This test measures the amount of 5–hydroxyindoleacetic acid (5–HIAA) in the urine. 5–HIAA is the primary metabolite of serotonin, a hormone derived from the amino acid tryptophan.

    Mind Teaser

Read this…………………

(ice) 3

Yesterday’s Mind Teaser: ch poorri

Answer for yesterday’s Mind Teaser: Take from the rich, give to the poor.

Correct answers received from: Dr Prabha Sanghi, YJ Vasavada, Dr Thakor Hitendrasinh G, Dr K Raju, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr PC Das, Dr Sukla Das, Anil Bairaria.

Answer for 12th December Mind Teaser: Crossbow.
Correct answers received from: Dr Sukla Das, Dr PC Das, Dr Thakor Hitendrasinh G.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Blind man in a store

A blind man walks into a store with his seeing eye dog. All of a sudden, he picks up the leash and begins swinging the dog over his head. The manager runs up to the man and asks, "What are you doing?!!" The blind man replies, "Just looking around."

    Medicolegal Update

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

The doctor must preserve broken fragment of weapon if found in wounds to identify the weapon or connect the accused person with the crime.

  • Death due to sharp force violence is most common cause of homicide in India, in many parts of Europe, as well as in Africa and Asia. It also accounts for 30% of fatal and non–fatal family assaults in the USA
  • The doctor conducting the postmortem examination must keep in mind that the shape and size of the wound suggests the width and type of weapon, whether it is single–edged or otherwise. The depth of the wound will indicate the length of weapon, the directions and dimensions of the wound indicate the relative position of the assailant and the victim, and the position, direction and number of wound may indicate manner of production, i.e., suicide, accident or homicide.
  • I have conducted medicolegal postmortem of 29 cases of deaths due to stab wound from South Delhi in the year 2010.
  • A stab wound is produced by long narrow instruments with blunt or pointed ends such as knife, dagger, nail, needle, spear, arrow, screw driver etc. into the depths of the body; the wound is deeper than its length and width on the skin.
  • The wound is caused by driving the object into the body or from the body’s pressing or falling against the object and object penetrate due to the momentum of the body.
  • The wound is called punctured wound when it enters a body cavity only one way; when the weapon enters the body on one side and comes out from the other side, it is called perforating wound.
  • The entry wound is larger and the exit wound is smaller due to tapering of the blade in stab wounds which is contrary to fire arm missile entry and exit wounds.
  • The doctor must preserve for police, broken fragment of weapon if found; it will identify the weapon or connect the accused person with the crime.

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    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Bad teeth are related to bad heart arteries

Winters mean more heart disease, more blood pressure, more heart attacks, more paralysis. Its time to go to not only your cardiologist but also to your dentist because in middle–aged adults, gum disease goes hand in hand with the metabolic syndrome and heart disease, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Metabolic syndrome is a group of risk factors for heart disease, paralysis and diabetes –– including high blood pressure, abdominal obesity, high blood sugar, low levels of "good" HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is usually diagnosed when a person has three or more of these traits. There is a link between periodontitis, an infection of the tissue supporting the teeth seen in up to 40 percent of adults, and system–wide problems such as low grade inflammation and a reduced ability to metabolize glucose. Quoting a study published in the Journal of Clinical Endocrinology and Metabolism, Dr Aggarwal said that people with periodontitis are also at about 20 percent greater risk of heart disease.

Both periodontitis and the metabolic syndrome are linked to inflammation and resistance to insulin. In the study 34% percent of people with moderate periodontitis and 37% with severe periodontitis had the metabolic syndrome, compared to just 18 percent of people with no gum disease or only mild periodontitis.

The likelihood of being diagnosed with metabolic syndrome rose with the severity of bleeding in the gums, as well as the proportion of periodontal pockets, or abnormally deep spaces between teeth and gums.

The relationship was especially strong among people 40 and older. Adults older than age 45 suffering from severe periodontitis were 2.3–times more likely to have metabolic syndrome than unaffected individuals.

In the study treating severe periodontitis resulted in better blood vessel function six months later.

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    Readers Responses
  1. Dear Sir, eMedinewS is really very informative. Regards: Suruchi
    Forthcoming Events

Lecture on Buddism and Astronomy

By Prof. Trinh X. Thuan

UNESCO Kalinga Awardee, 2009; Prof. of Astronomy, University of Virginia, USA; UNESCO Kalinga Awardee for Popularisation of Science by UNESCO, Kalinga Chair awardee by Department of Science & Technology, Government of India.

Organised by Heart Care Foundation of India in association with Nehru Planetarium on behalf of RVPSP, Dept. of Science & Technology Govt.of India

At Nehru Planetarium Chankyapuri New Delhi on 27th Dec 2011 at 10.30 am

No fee, to register email to drkakroo@gmail.com, 9810301261

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews "Doctor of the Year Award" function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

3rd eMedinewS Revisiting 2011

Dr Ajay Kriplani (Surgical management of diabetes); Dr N K Bhatia ( What’s new in transfusion medicine); Dr Kaberi Banerjee (Fertility update); Dr Amit Bahrgava (Cancer update 2011), Onco Radiation update (Rajiv Gandhi Cancer Institute); Dr Ambrish Mithal (Vitamin D update), Dr Praveen Chandra (Interventional Cardiology update); Revisting 2011 (Dr K K Aggarwal), Portfolio management (Central Bank of India); Insurance update (LIC India); General Insurance (Doogar Associates)

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta