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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 1st Mega Ajmer Health Camp 2012

  Editorial …

15th March 2012, Thursday

First TAVI case in India

Fortis Escorts Delhi created history by doing the first three successful cases of TAVI by a team led by Dr Ashok Seth, also President CSI.

TAVI Transcutaneous Aortic valve Implantation is done in high risk cases aortic stenosis unsuitable for surgery.

TAVI Surgery is now available in India and the permission for the same is given by the DCGI on merit on case to case basis.

One case was 72–years–old post bypass with porcelain aorta; 2nd aged 82 and 3rd aged 79 years, both frail patients. All had calcified severe aortic stenosis. TAVI was done using the core valve.

Total procedure time was 45 minutes with in and out time of 120 minutes. None of them developed a stroke. One patient on 4th day of asymptomatic AV dissociation needed a pacemaker.

In 2004, two cases on pump were attempted by Dr Ashok Seth and Dr P Lal. But truly percutaneous cases have only been done now.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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First TAVI case in India

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

First TAVI case in India

Fortis Escorts Delhi created history by doing the first three successful cases of TAVI by a team led by Dr Ashok Seth, also President CSI.

TAVI Transcutaneous Aortic valve Implantation is done in high risk cases aortic stenosis unsuitable for surgery.

Dr K K Aggarwal
    National News

Parent Awareness Camp for Kidney Diseases in Children organised by Sir Ganga Ram Hospital

The Division of Pediatric Nephrology, Institute of Child Health, Sir Ganga Ram Hospital organized a Parent Awareness Camp on March 11, 2012 at Sir Ganga Ram Hospital on the occasion of World Kidney Day, in an effort to spread awareness about kidney diseases in children. Dr. PK Pruthi, Senior Pediatric Nephrologist, Institute of Child Health, Sir Ganga Ram Hospital said that the main aim of the camp was to educate the general public about early detection of kidney diseases in children so that a prompt treatment is initiated in order to prevent dreaded complications like permanent kidney failure.

One of the parents shared his bad experience regarding late detection of his son’s kidney disease resulting in permanent kidney failure. His 14–year–old son Tejas (name changed), had been having frequent episodes of fever with chills, for which he used to take medicines on OPD basis. Once his fever settled down in 2 to 3 days, he used to stop his treatment. Such episodes went on for 2–3 years before his parents noticed that Tejas was not growing well, his bones of arms and legs started bending, he was getting pale and lethargic day by day with episodes of recurrent vomitings. For these complaints he was admitted at Ganga Ram Hospital and was diagnosed to have kidney failure. This failure occurred because of the recurrent urinary tract infections, presenting as fever with chills. These recurrent infections resulted in permanent kidney damage, causing bony abnormalities, growth retardation and anemia. This child’s course shows us, how a simple urine infection, which if not picked up in time and adequately managed can result in permanent kidney failure.

In order to make the general population more aware about urinary tract infections, Dr. DS Rana, Chairman Board of Management, Sir Ganga Ram Hospital released a ‘Parents sourcebook for Urinary Tract Infection in Children’.

Dr. Kanav Anand, Pediatric Nephrologist, Institute of Child Health, Sir Ganga Ram Hospital stressed that a proper counselling of the parents or caregivers of children with kidney diseases is a must in order to increase their acceptance for the disease, so that they ensure a stringent follow up of their kids, in order to prevent progression of a simple kidney disease to kidney failure. He also emphasized the need for a regular annual blood pressure check for all children in order to pick up hypertension as early as possible, so as to prevent its complications.

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

Cool hands help heavy women exercise more

Staying cool –– and remaining more comfortable –– may be the key to encouraging obese, sedentary women to stick with an exercise program, a small randomized study showed. (Source: Medpage Today)

For comments and archives

Treating HIV helps prevent new infection

More HIV treatment in a community results in fewer new HIV infections, a South African study has revealed. (Source: Medpage Today)

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Menorrhagia before menopause sometimes stops naturally

Menorrhagia before the onset of menopause occasionally stops without drugs or surgery, a new UK study shows. (Source: Medscape)

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Focus on vulnerable plaques too narrow for predicting events

Most ruptures of coronary plaques do not cause coronary events, so efforts to predict and prevent acute coronary events need to integrate a variety of contributing factors beyond the identification of vulnerable plaques, researchers argue in a new "contemporary review" in the March 6, 2012 issue of Circulation. (Source: Medscape)

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    Twitter of the Day

@DrKKAggarwal: #AJOG How will my doctor diagnose hydrosalpinx? There are three ways that your doctor can check if you have… http://fb.me/1xGssUhvu

@DeepakChopra: Reaching your purpose means that you act from your highest values. Don’t sink to the level of those who criticize and oppose you.

    Spiritual Update

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

A Quantum Mechanical Billiard Ball Concept of the Universe

Excerpts from Sages and Scientists 2012 (San Diego 3–5th March 2012)

  1. In classical (Newtonian) physics each part of the universe interacts with other parts according to deterministic, inviolable laws and the same can be equated to the game of billiards where the balls follow paths prescribed by simple mechanical laws.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What causes ectopic pregnancies?

Women with pre–existing tubal damage are more likely to develop an ectopic pregnancy. Fallopian tube damage commonly results from prior pelvic infection, such as gonorrhea, chlamydia, or other sexually transmitted diseases. Tubal disease may also occur as a result of endometriosis, appendicitis, previous pelvic surgery, or exposure to diethylstilbestrol (DES). Women who conceive after having a tubal ligation for sterilization, reversal of a tubal ligation, or any other type of tubal surgery also have a higher risk of having an ectopic pregnancy.

For comments and archives

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

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

Organ transplantation: History

In the late 1940s Peter Medawar, working for the National Institute for Medical Research, improved the understanding of rejection. Identifying the immune reactions in 1951, Medawar suggested that immunosuppressive drugs could be used. Cortisone had been recently discovered and the more effective azathioprine was identified in 1959, but it was not until the discovery of cyclosporine in 1970 that transplant surgery found a sufficiently powerful immunosuppressive.

Dr. Murray’s success with the kidney led to attempts with other organs. There was a successful deceased–donor lung transplant into a lung cancer sufferer in June 1963 by James Hardy in Jackson, Mississippi. The patient survived for 18 days before dying of kidney failure. Thomas Starzl of Denver attempted a liver transplant in the same year but was not successful until 1967.

The heart was a major prize for transplant surgeons. But over and above rejection issues, the heart deteriorates within minutes of death, so any operation would have to be performed at great speed. The development of the heart–lung machine was also needed. Lung pioneer James Hardy attempted a human heart transplant in 1964, but when a premature failure of the recipient’s heart caught Hardy with no human donor, he used a chimpanzee heart, which failed very quickly. The first success was achieved on December 3, 1967, by Christian Barnard in Cape Town, South Africa. Louis Washkansky, the recipient, survived for 18 days amid what many saw as a distasteful publicity circus. The media interest prompted a spate of heart transplants. Over a hundred were performed in 1968–69, but almost all the patients died within sixty days. Barnard’s second patient, Philip Blaiberg, lived for 19 months.

It was the advent of cyclosporine that altered transplants from research surgery to life–saving treatment. In 1968 surgical pioneer Denton Cooley performed seventeen transplants, including the first heart–lung transplant. Fourteen of his patients were dead within six months. By 1984 two–thirds of all heart transplant patients survived for five years or more. With organ transplants becoming commonplace, limited only by donors, surgeons moved onto more risky fields, multiple–organ transplants on humans and whole–body transplant research on animals. On March 9, 1981, the first successful heart–lung transplant took place at Stanford University Hospital. The head surgeon, Bruce Reitz, credited the patient’s recovery to cyclosporine–A.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Teamwork Lesson

When you see geese flying along in "V" formation, you might consider what science has discovered as to why they fly that way. As each bird flaps its wings, it creates an uplift for the bird immediately following. By flying in "V" formation, the whole flock adds at least 71 percent greater flying range than if each bird flew on its own. People who share a common direction and sense of community can get where they are going more quickly and easily because they are traveling on the thrust of one another.

When a goose falls out of formation, it suddenly feels the drag and resistance of trying to go it alone – and quickly gets back into formation to take advantage of the lifting power of the bird in front. If we have as much sense as a goose, we will stay in formation with those people who are headed the same way we are.

When the head goose gets tired, it rotates back in the wing and another goose flies point. It is sensible to take turns doing demanding jobs, whether with people or with geese flying south. Geese honk from behind to encourage those up front to keep up their speed.

What messages do we give when we honk from behind? Finally – and this is important – when a goose gets sick or is wounded by gunshot, and falls out of formation, two other geese fall out with that goose and follow it down to lend help and protection. They stay with the fallen goose until it is able to fly or until it dies, and only then do they launch out on their own, or with another formation to catch up with their group.

If we have the sense of a goose, we will stand by each other like that.

Source: http://academictips.org/blogs/the–goose–story–teamwork–lesson/

For comments and archives

    Cardiology eMedinewS

One in 50 new hypertensive end up with resistant BP within 18 months Read More

Glass of wine eases stroke risk in women Read More

Adding second drug no help in Alzheimer’s Read More

    Pediatric eMedinewS

Near–term infants at risk for poor health in childhood Read More

Sublingual battles oral immunotherapy in peanut allergy Read More

SCAD in younger women may not be as rare as previously thought
Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with community–acquired pneumonia (CAP) required hospitalization.
Dr Bad: Start a macrolide.
Dr. Good: Start combination of macrolide and third–generation cephalosporin.
Lesson: Combination therapy with a macrolide + third-generation cephalosporin is the treatment of choice for CAP patients requiring hospitalization.

For comments and archives

Make Sure

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that in all dengue patients, pulse pressure (upper minus lower blood pressure) is maintained above 40.

  Microbial World: The Good and the Bad they do

(Dr Sunil Sharma, Senior Consultant Microbiology, Medanta The Medicity)

Anton van Leeuwenhoek was the first to observe bacteria under a crude microscope in 17th century. But it was only in the 19th century that the discoveries of Koch and Pasteur established bacteria as cause of many diseases. In the mid–1800s, studies by Ignaz Semmelweis in Vienna, Austria, and Oliver Wendell Holmes in Boston, USA, established that hospital-acquired diseases were transmitted via the hands of health care workers. In 1867, Lister used carbolic acid as an antiseptic, and it became the first widely used antiseptic in surgery.

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  Quote of the Day

(Dr GM Singh)

Learn the art of patience. Apply discipline to your thoughts when they become anxious over the outcome of a goal. Impatience breeds anxiety, fear, discouragement and failure. Patience creates confidence, decisiveness and a rational outlook, which eventually leads to success. Brian Adams

    12 Most Common Technology Hazards (Part 5)

(Dr Arpan Gandhi and Dr Navin Dang)

Failing to pay sufficient attention to new device connectivity

Hazards can arise from software problems, interoperability between systems, and poor network performance. Problems could create a domino effect, in which changes to one component of the system affect the operation of another. Potential problems also include issues about wireless networks, cybersecurity and software upgrades.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

LDL Cholesterol = Total cholesterol (–) HDL cholesterol (–) VLDL cholesterol

    Mind Teaser

Read this…………………

Which of the following is false regarding GIST (Gastrointestinal stromal tumor) of stomach?

a) It is the same as leiomyoma and leiomyosarcoma as described previously.
b) The origin is from mucosa from the interstitial cells of Cajal.
c) Associated with C–Kit mutation.
d) Imatinab is a new effective drug for adjuvant therapy.

Yesterday’s Mind Teaser: Which of the following is not true about gastric lymphoma?

a) Stomach is the most common organ in the GI system, which is involved in lymphoma.
b) Peak incidence of lymphomas is seen in 6th–7th decades.
c) Endoscopy usually reveals gastritis–like picture or gastric ulcer.
d) MALT lymphoma is the commonest variety.

Answer for Yesterday’s Mind Teaser: d) MALT lymphoma is the commonest variety.

Correct answers received from: Neelima Singh, Raju Kuppusamy, Anil Bairaria, Dr Thakor Hitendrasinh G, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Dr Krishna Kavita.

Answer for 13th March Mind Teaser
: c) Low nitrate consumption
Correct answers received from: Dr RK Sahoo, Suresh Kumar Verma, Dr Rakesh Bhasin, Prof Chetana Vaishnavi.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Love and Marriage

The child was a typical four–year–old girl, cute, inquisitive, bright as a new penny. When she expressed difficulty in grasping the concept of marriage, her father decided to pull out his wedding photo album, thinking visual images would help.

One page after another, he pointed out the bride arriving at the church, the entrance, the wedding ceremony, the recessional, the reception, etc. "Now do you understand?" he asked.

"I think so," she said, "is that when mommy came to work for us?"

    Medicolegal Update

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

WMA declaration of Malta on hunger strikers – Guidelines for medical management

Physicians need to satisfy themselves that food or treatment refusal is the individual’s voluntary choice. Hunger strikers should be protected from coercion. Physicians can often help to achieve this and should be aware that coercion may come from the peer group, authorities or others, such as family members. Physicians or other health care personnel may not apply undue pressure of any sort on the hunger striker to suspend the strike. Treatment or care of the hunger striker must not be conditional upon suspension of the hunger strike. If a physician is unable for reasons of conscience to abide by a hunger striker’s refusal of treatment or artificial feeding, the physician should make this clear at the outset and refer the hunger striker to another physician who is willing to abide by the hunger striker’s refusal.

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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)

Do not ignore daytime sleepiness

Obstructive sleep apnea (OSA) with snoring is related to several cardiovascular diseases. It is a cause of systemic hypertension said Dr. KK Aggarwal, Padma Shri and Dr. B.C. Roy National Awardee and President, Heart Care Foundation of India.

Mild lung hypertension is also associated with OSA. Heart blockages are associated with severe OSA but not mild OSA. Night cardiac arrhythmias with OSA are known and therefore all patients with nocturnal cardiac arrhythmias should be evaluated for possible OSA. Treatment of OSA may reduce systemic blood pressure, lung pressure, cardiovascular events and eliminate nocturnal ventricular bradycardia and asystole in many patients with OSA.

Explaining how sleep apnea occurs, Dr Aggarwal said that the throat is surrounded by muscles that control the airway for speaking, swallowing and breathing. During sleep, these muscles are less active, and this causes the throat to narrow. In most people, this narrowing does not affect breathing. In others, it can cause snoring, sometimes with reduced or completely blocked airflow.

A completely blocked airway without airflow is called an obstructive apnea. Partial obstruction with diminished airflow is called a hypopnea. A person may have apnea and hypopnea during sleep.

Insufficient breathing due to apnea or hypopnea causes oxygen levels to fall and carbon dioxide to rise. Because the airway is blocked, breathing faster or harder does not help to improve oxygen levels until the airway is reopened. Typically, this requires the person to awaken to activate the upper airway muscles. Once the airway is opened, the person then takes several deep breaths to catch up on breathing. As the person awakens, he or she may move briefly, snort or snore, and take a deep breath. Less frequently, a person may awaken completely with a sensation of gasping, smothering, or choking.

Many people with sleep apnea are unaware of their abnormal breathing in sleep, and all patients underestimate how often their sleep is interrupted. Awakening from sleep causes sleep to be unrefreshing and causes fatigue and daytime sleepiness.

Symptoms of OSA

The main symptoms include loud snoring, fatigue, and daytime sleepiness. However, some people have no symptoms. Fatigue and sleepiness have many causes and are often attributed to overwork and increasing age.

Other symptoms may include one or more of the following:

  • Restless sleep
  • Awakening with choking, gasping, or smothering
  • Morning headaches, dry mouth or sore throat
  • Waking frequently to urinate
  • Awakening unrested, groggy
  • Memory impairment, difficulty concentrating, low energy

Certain factors increase the risk of sleep apnea.

  • Increasing age: Sleep apnea occurs at all ages, but it is more common in middle and older age adults.
  • Male sex: Sleep apnea is two times more common in men, especially in middle age.
  • Obesity: The more obese a person is, the more likely they are to have sleep apnea.
  • Sedation from medication or alcohol interferes with the ability to awaken from sleep and can lengthen periods of apnea (no breathing), with potentially dangerous consequences.
  • Abnormality of the airway

Complications of sleep apnea

  • Daytime sleepiness
  • Difficulty concentrating
  • Increased risk of accidents and errors in daily activities
  • More than twice as likely to be involved in a motor vehicle accident
  • Increased risk of cardiovascular problems such as high blood pressure, heart attack, abnormal heart rhythms, or stroke

Diagnosis of sleep apnea

  • A complaint of snoring and ineffective sleep
  • Neck size (greater than 17 inches in men or 16 inches in women) is associated with an increased risk of sleep apnea.
  • A small upper airway: Difficulty seeing the throat because of a tongue that is large for the mouth.
  • High blood pressure, especially if it is resistant to treatment
  • If a bed partner has observed the patient during episodes of stopped breathing (apnea), choking, or gasping during sleep, there is a good possibility of sleep apnea.
    Conference Calendar

CCT 2012 – Current Concepts In Trauma 2012 – 23 Mar to 25 Mar, Patna, Bihar.

    Readers Responses
  1. Dear Sir, You are doing a wonderful job. Regards: Dr Prachi
    Forthcoming Events
Dr K K Aggarwal

National Summit on "Stress Management" and Workshop on "How to be happy and Healthy"

Date: Saturday 2PM–Sunday 4PM, 21–22 April 2012
Venue: Om Shanti Retreat Center, Bhora Kalan, on Pataudi Road, Manesar
Course Directors: Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal and BK sapna
Organisers: Heart Care Foundation of India, Prajapati Brahma Kumari Ishwariya Vidyalaya and eMedinewS
Fee: No fee, donations welcome in favour of Om Shanti Retreat Center
Facilities: Lodging and boarding provided ( One room per family or one room for two persons). Limited rooms for first three registrants.
Course: Meditation, Lectures, Practical workshops,
Atmosphere: Silence of Nature, Pyramid Meditation, Night Walk,
Registration: Rekha 9899974439 rekhapapola@gmail.com, BK Sapna 9350170370 bksapna@hotmail.com

Study Camp on ‘Mind–Body Medicine and Beyond’

16–23 June 2012, Nainital Centre (Van Nivas)

Sri Aurobindo Ashram – Delhi Branch will organize the 5th Study Camp on ‘Mind–Body Medicine and Beyond’ for doctors, medical students and other health professionals at its Nainital Centre (Van Nivas) from 16–23 June 2012. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind–body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of a mind–body medicine clinic at AIIMS, and the author of Back to Health through Yoga and Essays on Yoga. For more details, send an e–mail to the Ashram (aurobindo@vsnl.com) or to Dr. Bijlani (rambij@gmail.com).

BSNL Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

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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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