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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; Member 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


Dear Colleague

19th April, 2010 Monday

Statin use and risk of gallstone disease followed by cholecystectomy

Gallstone disease is a leading cause of morbidity. Statins decrease hepatic cholesterol biosynthesis and may therefore lower the risk of cholesterol gallstones by reducing the cholesterol concentration in the bile.

To study the association between the use of statins(cholesterol lowering agent) and the risk of incident gallstone disease a case–control analysis using the UK–based General Practice Research Database was done.

Patients between 1994 and 2008 and 4 controls per each patient were identified and matched on age, sex, general practice, calendar time, and years of history in the database. The  mean (SD) age was 53.4 (15.0) years.

A total of 27 035 patients with cholecystectomy and 106 531 matched controls were identified. 2396 patients and 8868 controls had statin use. Compared with non use, current statin use (last prescription recorded within 90 days) was 1.0% for patients and 0.8% for controls; 2.6% vs 2.4% for 5 to 19 prescriptions, and 3.2% vs 3.7% for 20 or more prescriptions.

Conclusion: Long–term use of statins was associated with a decreased risk of gallstones.

(JAMA 2009 Nov 11;302(18):2001-7).

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

Photo feature

Sh Rakesh Mehta Chief Secretary Delhi inaugurating the two days workshop on stress prevention organised at Om Shanti Retreat Center Near Manesar. The retreat was organised by Heart Care Foundation of India and Brahm Kumaris in Association with IMA Janak Puri, New Delhi, South Delhi Branches; IMSA(Delhi) and IIHP (Delhi) and was attended by 490 delegates from across the globe. 

Dr k k Aggarwal

News and views (Dr Monica anbd Brahm Vasudeva)

Medpage Meeting Notes: American College of Cardiology
Atlanta, GA • March 14 – 16, 2010

1. Wrongful shock from ICD could be harbinger of death

Inappropriate shocks from an implantable cardioverter defibrillator (ICD) device may be linked to higher mortality, although causality remains questionable. Each ICD discharge not delivered for ventricular tachycardia or ventricular fibrillation independently raised the risk of dying from any cause by 40%. (Dr Johannes B. van Rees, Leiden University Medical Center).

2. Endovascular mitral valve repair challenges surgery

In patients with significant mitral value regurgitation, transcatheter repair using an investigational valve clip device appears to be safer than surgery and almost as durable. At 30 days, the major adverse clinical event rate (MACE) was 9.6% among patients treated with the catheter device, MitraClip, compared with 57% among the surgery group. (Dr Ted Feldman, NorthShore University Health System, Evanston, Ill.)

3. RF ablation helps in complex atrial fibrillation

Catheter ablation appears better than drug therapy for more complex, symptomatic atrial fibrillation, according to initial results of the CABANA pilot trial. Patients undergoing radiofrequency ablation had a 58% reduced risk of symptomatic recurrence compared with patients taking rate and rhythm control medication (65% versus 41% at 12 months, P=0.033) ( Dr Douglas L. Packer, of the Mayo Clinic in Rochester, Minn).

4. Anticoagulant seems safe and effective

An investigational, selective factor Xa inhibitor called betrixaban demonstrated apparent safety and efficacy in a phase II trial, making it yet another contender in the race to develop an alternative to warfarin.

5. STEMI patients helped by aspirating the clot

Rheolytic thrombectomy before stenting improved outcomes over stenting alone among patients with ST–elevation myocardial infarction (STEMI), a multicenter, randomized trial showed. Removal of the thrombus with the AngioJet system was independently associated with early ST–segment resolution. (Dr David Antoniucci, Careggi Hospital in Florence, Italy)

Mnemonic of the Day (Dr Prachi Garg)

Leg Ulcers – VAIN PAIN



Infection (e.g. syphilis)


Pressure sores

Arthritis (e.g. Rheumatoid arthritis, Polyarteritis nodosa (RA), PAN)

Injury / IDB


What’s New

Initiating atomoxetine therapy for attention deficit hyperactivity disorder

When initiating atomoxetine therapy for attention deficit hyperactivity disorder, an observational study suggests that evening administration of once–daily atomoxetine is associated with fewer adverse effects than morning administration. (Block SL, Kelsey D, Coury D, et al. Once –daily atomoxetine for treating pediatric attention– deficit/hyperactivity disorder: comparison of morning and evening dosing. Clin Pediatr (Phila) 2009;48:723.)

eMedinewS Fact about rheumatoid arthritis

Acute phase reactants, particularly ESR and CRP monitoring can also be used to assess the activity of the disease

Quote of the day

"Great things are not done by impulse, but by a series of small things brought together." Vincent Van Gogh

Diabetes Fact

Rare complication of diabetes is malignant otitis externa: is due to pseudomonas and presents with pain and ear discharge. Can be fatal

Public Forum (Press Release for use by the newspapers)

Guidelines on sudden cardiac death

Sudden cardiac death is death occuring within an hour of the symptoms of heart disease and includes night deaths on the bed. It has been estimated that over 24 lac people die in India every year with sudden cardiac death. About 75% of them die before reaching the hospital.

A large number of such deaths can be prevented if the public is educated about cardiac revival and the high risk affording individuals are put on ICD. 

ICD or automatic internal electric shock giving pacemaker is the treatment of choice, for those who can afford, to prevent sudden cardiac death in high risk individuals. The same is also reimbursable under public sector companies and CGHS.

Not advising the devise to those who need it may amount to medical defeciency said Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Regarding patients without heart attack, Dr Aggarwal said that all symptomatic patients with enlarged low functioning heart (ejection fraction <35%) and normal coronary arteries and who can afford should be put on ICD. And if there is also associated widening of QRS of >120 msec, in the ECG one should implant a combined CRT–D device (biventricular pacing combined with an ICD). Some experts and the 2006 American Heart Association Guidelines also recommend ICD implantation in asymptomatic patients with low heart functioning, ejection fraction between 30–35%.

After a heart attack, all patients who can afford should be implanted with ICD after 40 days of heart attack or three months of post angioplasty or bypass surgery with heart functioning of less than 30%.

ICD is also recommended if the heart functioning is between 30–35% and the patient is symptomatic. In patients with heart functioning of >40%, periodic Holter monitoring should be done and if abnormal ICD should be advised.

Question of the day

How can baldness be treated? Who can undergo hair transplantation?

Both medical and surgical treatments are available. Medical treatments include minoxidil lotion and tablet finasteride. However the effect of these drugs lasts only as long as they are taken. Also these drugs can promote hair growth of existing follicles only and cannot create any new hair. Hence surgical treatment by transplantation is a useful alternative. The transplanted hair is removed from back of the scalp (donor site) and transferred to the balding site (recipient site).

The transferred hair are not "rejected" as they are patient’s own hair and are not foreign tissue. The hair in the back of the scalp is insensitive to the androgen mediated balding process and hence the transplanted hair will last a lifetime – this is the basis for transplantation. Thus, hair transplantation is the only permanent method of treating baldness.

Any person with significant baldness can undergo the procedure. Women can also undergo the procedure in selected cases. However it is important to understand that pattern hairloss is a continuous process and hence frequently combination with drug therapy is also required. Very young people are not suitable candidates as they are not emotionally mature and their pattern of hairloss is yet to be established. Likewise, elderly people with extensive baldness are also not good candidates. As in any surgical procedure, history of serious underlying medical illness is a contraindication for hair restoration.

eMedinewS Try this it Works

Getting to the facts about drinking

When taking an alcohol history, avoid such vague terms as "social drinker" or "occasional drinker." Instead, ask about amounts of alcohol used and any associated problems, such as alcohol–related arrests, concerns expressed by family or friends, history of drug or alcohol treatment, and involvement with Alcoholics Anonymous.

Dr Good Dr Bad

Situation: A patient was found to have low serum creatinine levels.

Dr Bad: It’s good.

Dr Good: Rule out diabetes.

Lesson: Lower serum creatinine increases the risk of type 2 diabetes. Serum creatinine is primarily a metabolite of creatine, almost all of which is located in skeletal muscle. As skeletal muscle is one of the target tissues for insulin, low skeletal muscle mass might be associated with type 2 diabetes. Serum creatinine is a possible surrogate marker of skeletal muscle mass. (Diabetes Care 2009;32:424–6.)

Make Sure

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis (IE).

Reaction: Oh my God! Why was IE prophylaxis not given

Make sure that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.


Laughter the best medicine

After receiving his medication from the pharmacist, the customer asks, "Are these time release pills?" The pharmacist replies, "Yes. They begin to work after your check clears."

Formulae in Critical Care

Blood volume

Formula: Blood volume = 65–69 ml/kg lean body weight.
Or 8.5–9% lean body weight

Milestones in Medicine

1943 – Swiss chemist Albert Hofmann discovered the psychedelic effects of the semisynthetic drug LSD.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Fructosamine: is done to help monitor the blood sugar over time, especially if it is not possible to monitor using the A1C test. It is also done to help determine the effectiveness of changes to the diabetic treatment plan.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Levodopa 100/100/250 + Carbidopa 10/25/25mg mouth dissolving tablet

For the symptomatic treatment of idiopathic Parkinson’s Disease


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Readers Responses

  1. Congratulations for being receiving prestigious Padma award. Dr A K Jain
  2. To Dr K K congratulations for government recognising your services and honouring you with Padma Shri award. I watched it on TV and felt proud. Arvind Kumar
  3. I watched the award ceremony. Heartiest congratulations. Vivek Kumar

  4. Good morning Sir. Many many congrats to you for Padmashri award. It is honour for us that we know you. Divya Aggarwal, News 24