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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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  Editorial …

15th August 2011, Monday

eMedinews Wishes all its Readers Happy Independence Day

Folic acid may decrease homocysteine in type 2 diabetes

Folic acid supplementation decreases homocysteine (Hcy) levels in individuals with type 2 diabetes patients under metformin treatment, according to a study published in the journal Diabetes Research and Clinical Practice.

The researchers found that eight weeks of 5 mg folic acid supplementation led to a significant decrease in levels of insulin, HOMA–IR, and HbA1c (16.2%, 20.5%, and 7.5%, respectively). There was also a substantial 21.2% drop in Hcy levels and a 7.5% reduction in FBG in the FA group when compared to the placebo group.

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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 on

Folic acid may decrease homocysteine
in type 2 diabetes

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight
on Medicolegal Issues

Dr Vinod Khetrapal presented his views on Medical Insurance in the National Conference on Insight on Medicolegal Issues held on 10th July, 2011.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Health Bank in West Bengal likely

The West Bengal government is contemplating setting up a health bank to reach basic medical benefits to remote corners and make treatment easily available to all sections of the people. Health department sources said the proposal to set up the health bank were discussed in a meeting of Chief Minister Mamata Banerjee with the health secretary, director of medical education and other high officials during her visit to ‘Swasthya Bhavan’ (health department headquarter) today. Mr. Banerjee, who holds the health portfolio, discussed plans and programmes with the department officials who presented a ‘Health Vision’ for five years. Under the plans, a superspeciality hospital on the lines of AIIMS in Delhi will be set up at Kalyani in Nadia district and for which land has been located, the sources said. A major hospital is planned in Darjeeling apart from 10 big hospitals in the state in next five years. The health department has also plans to provide special health infrastructural facilities for people of tribal Jangalmahal region, sources said. (Source: http://www.thehindu.com/health/policy–and–issues/article2347458.ece, August 11, 2011)

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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

(Dr Monica and Brahm Vasudev)

Smoking harms women more: Study

NEW DELHI: This should come as a serious wake up call for female smokers. The risk of developing coronary heart disease is 25% higher for women smokers compared with men, according to a study published in the British medical journal ‘The Lancet’ on Thursday. The authors say this could be due to the physiological differences between the sexes with cigarette smoke toxins having a more potent effect on women. In India, more and more women are now taking to smoking. According to the Tobacco Atlas, the country ranks third in the top 20 female smoking populations across the globe. With around a crore female smokers in India, only the US with 2.3 crore female smokers and China with 1.3 crore female smokers, are worse off. (Source: TOI, Aug 12, 2011)

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Alzheimer’s disease may look different in the very old

Alzheimer’s disease (AD) may be more difficult to detect in people older than 80 years, suggest results of a new study, because disease presentation may be different than that seen in the larger population of patients. "The typical pattern of AD–related cognitive and morphometric changes seen in the young old appear to be less salient in the very old," first author Nikki H. Stricker, PhD, from the Veterans Affairs Boston Healthcare System and the Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, and colleagues report. "Thus, mild cases of AD in the very old may go undetected if one expects to see the prototypical pattern and severity of cognitive or brain changes that occur in the young old with AD," they conclude. (Source: Medscape Medical News)

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Depression increases stroke risk in older women

Postmenopausal women with current or past history of depression are at increased risk for stroke, researchers found. Among a cohort of more than 80,000 women followed for a six–year period, those with a history of depression had a 29% greater risk of stroke than those without depression, according to Kathryn M. Rexrode, MD, of Harvard Medical School in Boston, and colleagues. Additionally, those with current depression had a 41% greater risk of stroke, while those with only a history of depression had a 23% greater risk, compared with women who never reported a diagnosis of depression or antidepressant medication use, according to the study published online in Stroke: Journal of the American Heart Association. (Source: Medpage Today)

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    Fitness Update

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

Exercise reduces the risk of peripheral artery disease

Peripheral artery disease (PAD) narrows the leg arteries and reduces blood flow to the limbs, thereby impairing walking. Approximately 8 to 12 million people worldwide have the condition, which can cause pain in the legs and increases the risk of stroke and heart attack.

Researchers at Stanford University and the University of Melbourne in Australia collaborated to investigate the link between physical activity and PAD. The results, published in the Journal of Vascular Surgery, show that physical activity decreases the risk of PAD. They studied a total of 1,381 patients between 2004 and 2008. To determine the incidence of PAD, they measured their ankle–brachial (ABI), which is the ratio of blood pressure in the lower legs to blood pressure in the arms. A lower ABI score is an indication of blocked arteries. Subsequently they administered a questionnaire on lifetime physical activity that assessed the frequency, duration and intensity of physical activity. The study results showed that low physical activity was a predictor of low ABI, and the authors concluded that people who were sedentary or engaged in very low levels of physical activity were more likely to develop PAD later in life.

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    Twitter of the Day

@DrKKAggarwal: #AJENT The pre– and postoperative results of the nasal tip projection were measured manually using a ruler from… http://fb.me/HBq7lcbP

@DeepakChopra: #vmdhealthblog Have you heard the term functional foods yet? I explain what they are in my article. bitly.com/Dpak_Fnctn

    Dr KK Answers

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

Can stress be responsible for heart diseases in young?

Psychological factors such as uncontrolled anger can lead to premature heart diseases.

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    Spiritual Update

Even a spiritual man can suffer from a disease

There is a misconception that once one has mastered spirituality one cannot fall prey to any disease. As per the Vedic philosophy anybody who has taken birth has to die. All the known God incarnations also had to leave the physical body and depart from this world. The difference is that a spiritua

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    An Inspirational Story

(Ms Ritu Sinha)

The Power of Words

A group of frogs were traveling through the woods, and two of them fell into a deep pit. All the other frogs gathered around the pit. When they saw how deep the pit was, they told the two frogs that they were as good as dead.

The two frogs ignored the comments and tried to jump up out of the pit with all of their might. The other frogs kept telling them to stop, that they were as good as dead. Finally, one of the frogs took heed to what the other frogs were saying and gave up. He fell down and died.

The other frog continued to jump as hard as he could. Once again, the crowd of frogs yelled at him to stop the pain and just die. He jumped even harder and finally made it out.

When he got out, the other frogs said, "Did you not hear us?" The frog explained to them that he was practically deaf. He thought they were encouraging him the entire time.

The moral of this story: Be careful of what you say.

  1. Encouraging words to people who are down can motivate them to achieve their goals.
  2. Destructive words to people who are down can have a devastating effect.

Consider this statement as it relates to Words… "The Snow may look smooth and soft, but the rocks underneath are sharp!" Mark Russell

Phrase your words so they inspire and encourage, not hurt or destroy.

For comments and archives

    Pediatric Update

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

What is constipation?

Constipation is defined as a delay (<3 stools/week) or difficulty (due to consistency) in defecation present for two or more weeks and sufficient enough to cause significant distress to the patient. In the West, 3% of children visiting the pediatrician are due to constipation and one in four (25%) Pediatric Gastroenterology consultations are due to constipation. There is no such prevalence data from our country but it is quite common especially among toddlers and preschool children.

For comments and archives

    Infertility Update

(Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation)

Do I need endometriosis surgery if I am already planning to pursue IVF?

The question of endometriosis surgery prior to IVF is a somewhat controversial area of reproductive medicine. Most reproductive endocrinologists do not recommend surgery prior to IVF unless the woman has advanced endometriosis, in particular, an ovarian endometrioma.

IVF is associated with excellent pregnancy rates (even without surgery) in women who have only mild to moderate endometriosis. When advanced endometriosis is present, such as an ovarian endometrioma, its surgical removal prior to IVF may enhance the chances for a successful IVF outcome and may decrease infectious complications related to egg collection. Thus, in such cases, most reproductive endocrinologists often recommend the removal of advanced endometriosis prior to treatment using IVF.

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum amylase

Increased: Acute pancreatitis, pancreatic duct obstruction, alcohol ingestion, mumps, parotitidis, renal disease, cholecystitis, peptic ulcers, intestinal obstruction, mesenteric thrombosis, postop abdominal surgery.
Decreased: Liver damage, pancreatic destruction (pancreatitis, cystic fibrosis)

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with chronotropic insufficiency (i.e. the inability of the sinus rate to accelerate) was to undergo pacing.
Dr Bad: DDD pacemaker can be used.
Dr Good: Either WIR or DDDR pacemaker should be used.
Lesson: Chronotropic insufficiency is a contraindication for DDD pacemaker. In these situations, a rate–adaptive or "physiologic" pacemaker is indicated (WIR or DDDR).

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Make Sure

Situation: An asthmatic patient became worse after receiving a painkiller.
Reaction: Oh my God! Why was he not put on zafirlukast?
Lesson: Make sure that a patient with asthma is not given aspirin or he is put on zafirlukast or montelukast.

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    Quote of the Day

(Dr GM Singh)

Decide what you want, decide what you are willing to exchange for it. Establish your priorities and go to work. HL Hunt


(Ms Ritu Sinha)

Don’t look a gift horse in the mouth: When someone gives you a gift, don’t be ungrateful.

    Medicolegal Update

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

What are ordinary and extraordinary medical care?

The Pope and Catholic teachings advocate a distinction between ordinary and extraordinary care, with ordinary care being mandatory, whereas extraordinary care may be withheld or withdrawn.*

One commentator explicated this distinction in the following way. According to him,

  • Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or inconvenience.
  • Extraordinary means of preserving life mean all medicines, treatments, and operations, which cannot be obtained without excessive expense, pain, or other inconvenience, or which, if used, would not offer reasonable hope of benefit.

Many ethicists and courts have concluded that this distinction is too vague and has "too many conflicting meanings" to be helpful in guiding surrogate decision makers and clinicians As one lawyer noted ordinary and extraordinary are "extremely fact–sensitive, relative terms…what is ordinary for one patient under particular circumstances may be extraordinary for the same patient under different circumstances, or for a different patient under the same circumstances". Thus, the ordinary/extraordinary distinction should not be used to justify decisions about stopping treatment.

*Pope Pius XII. The prolongation of life In: Ethics in medicine. Reiser SJ, Dyck AJ, Curran WJ (Eds), MIT Press, Cambridge 1997.

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    Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: All of the following are true for patients of ulcerative colitis associated with primary sclerosing cholangitis (PSC), except:

1. They may develop biliary cirrhosis.
2. May have raised alkaline phosphatase.
3. Increased risk of hilar cholangiocarcinoma.
4. PSC reverts after a total colectomy.

Answer for Yesterday’s Mind Teaser: 4. PSC reverts after a total colectomy.

Correct answers received from: Dr Neelam Nath, Dr.K.Raju, Dr Anil Kumar Jain, Dr Chandresh Jardosh,  Dr Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr Anil Bairaria,

Answer for 12th August Mind Teaser: 1 Oesophagitis.
Correct answers received from:  Dr. B. B. Aggarwal, Dr Rawat Purushottam Singh, Dr Prabodh Kumar Gupta, Dr.K.Raju, Dr Neelam Nath

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr Chandresh Jardosh)

Once upon a time there was a loving couple. The were both poets and for some strange reason when they had a fight, it was very poetic. Here is a sample of an exchange between the two:

Roses are red; Violets are blue
Monkeys like u should be kept in zoo.
Don’t feel so angry you will find me there too
Not in cage but outside, laughing at you

For comments and archives

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Brinzolamide Ophthalmic Suspension 1%w/v
For the treatment of elevated intraocular pressure in patients with ocular hypertension or open–angle glaucoma.
    Public Forum

(Press Release for use by the newspapers)

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Heart Disease is every woman’s concern

Heart disease kills more women than all cancers combined in women including breast cancer. Normally, women are not supposed to get heart attack before menopause but now a days, ratio is 40:60 indicating a faulty lifestyle amongst women, said Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

Being an Indian woman, is a risk factor for heart attack. A study from UK had shown that Indian women are 17% more prone to get heart attack than a local UK women. Indian women are more prone to get obesity, fatty liver, diabetes and insulin resistance.

Earlier women used to prevent heart attack by indulging into regular walks, skipping, dancing and games like Kikli at ceremonies but now, most women are living a faulty lifestyle indulging into both active and passive smoking, having late nights with faulty diet heavy in white sugar, white maida and white rice.

It has been observed that heart attack in women is more serious, more fatal and less attended to. Chances of women undergoing angioplasty or bypass surgery are less than that of any man.

With simple changes and a better understanding of the condition, many people live full and active lives. The time to take charge of your health is today.

Changing lifestyle, stress and a poor metabolic profile are making young and middle-aged women more susceptible to heart diseases.

Facts about women and heart

Although the traditional risk factors for coronary artery disease such as high cholesterol, high blood pressure and obesity affect women and men, other factors may play a bigger role in the development of heart disease in women. For example:

  1. Metabolic syndrome a combination of fat around the abdomen, high blood pressure, high blood sugar and high triglycerides has a greater impact on women than on men.
  2. Mental stress and depression affect women’s hearts more than men’s.
  3. Smoking is a greater risk factor for heart disease in women than in men.
  4. Low levels of estrogen after menopause pose a significant risk factor for developing cardiovascular disease in the smaller blood vessels (small vessel heart disease).
  5. While heart disease is the leading cause of death for women 65 and older, it’s the third–leading cause of death for women 25 to 44 and the second–leading cause of death for women 45 to 64. Women under the age of 65 who have a family history of heart disease should pay particularly close attention to the heart disease risk factors. Still, all women, of all ages, should take heart disease seriously.
  6. The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But it’s not always severe or even the most prominent symptom, particularly in women. Women are more likely than men to have signs and symptoms unrelated to chest pain, such as: Neck, shoulder, upper back or abdominal discomfort; Shortness of breath; Nausea or vomiting; Sweating; Light–headedness or dizziness; Unusual fatigue. These signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks. This may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart a condition called small vessel heart disease.
  7. In some women, plaques build up as an evenly spread layer along artery walls, which isn't treatable using procedures such as angioplasty and stenting designed to flatten the bulky, irregular plaques in some men’s arteries. For some women, drug treatment rather than angioplasty or stenting may be a better option.
  8. Certain heart medications, such as clot–busting drugs thrombolytics) tend to be more effective in women than in men. Aspirin therapy benefits both men and women, but there’s also a difference between men and women in the effects of aspirin therapy. In women, aspirin therapy seems to reduce the risk of stroke more than in men, while in men it reduces the risk of heart attack more than it reduces stroke.
  9. There are several lifestyle changes women can make to reduce your risk of heart disease: Exercise 30 to 60 minutes a day on most days of the week; Maintain a healthy weight; Quit or don’t start smoking and eat a diet that’s low in saturated fat, cholesterol and salt.
  10. Some women at high risk of heart disease may also benefit from the use of supplements, such as omega–3 fatty acids.
  11. Today 1 in 2 women die of heart disease or stroke, compared with 1 in 25 women who die of breast cancer. 42% of women who have heart attacks die within 1 year compared with 24 percent of men.
  12. Smoking by women causes almost as many deaths from heart disease as from lung cancer.
  13. Women with heart disease are more likely to die (5.6% of the women versus 4.3% of the men).
  14. One of every three deaths for women is from heart disease, only one in every thirty death is from breast cancer. Over 60% of women believe their biggest health threat is breast cancer but heart disease kills 6 times as many women as breast cancer. Most women do not realize heart disease is a health threat.
  15. Women who smoke are two to six times more likely to suffer a heart attack than a non smoking woman and the risk increases with the number of cigarettes you smoke each day. Smoking also boosts the risk of stroke. Women who smoke risk having a heart attack 19 years earlier than non smoking women.
  16. Women with diabetes are two to three times more likely to have heart attacks.

    The survival rate following a heart attack is lower among women than men. Reasons for high mortality in women include differences in diagnosis, treatment, symptoms, reaction to drugs and age at the onset of the disease.

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    Readers Responses
  1. Dear Sir your editorial on "The Indian Health Sector: Where are we after 64 years of independence?" is very much true. Regards Dr Prachi
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.



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