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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR


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    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–7 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

19th September 2012, Wednesday

Ten bypass grafts at a go

In a pathbreaking surgery conducted by Dr Ramakant Panda, a patient from Ludhiana was saved from a fatal heart attack after 10 separate bypass grafts were created for blood to flow smoothly from and into the heart, reports Kounteya Sinha in TOI. The eight–hour–long procedure, conducted at Mumbai's Asian Heart Institute last week, could be the first such surgery where so many grafts were created to bypass clogged arteries.

Panda and his team took 18 cm of healthy artery from the chest (left and right mammary arteries) of 55–year–old Pawan Agarwal and divided them into 10 different grafts, which were then connected to the blocked coronary artery. Dr Panda said, "I have done a maximum of eight grafts on a single patient in my entire career. This was the first time that 10 grafts were created. Most patients require just three grafts. But this patient was in seriously bad condition."

Panda added, "We noticed multiple blockages in not just the three major arteries of the heart but also in its smaller branches. While we used 10 grafts to bypass blocked arteries, one artery was so badly blocked that we couldn’t create a bypass. We, therefore, additionally conducted an arterial cleansing procedure (endarterectomy) to clean up the blockage."

Number of bypasses

The terms used are single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass to the number of coronary arteries bypassed in the procedure.

  1. Double bypass means two coronary arteries are bypassed
  2. Triple bypass means three vessels are bypassed
  3. Quadruple bypass means four vessels are bypassed
  4. Quintuple means five.
  5. Bypass of more than four coronary arteries is uncommon.

A greater number of bypasses does not imply a person is "more sick", nor does a lesser number imply a person is "healthier."

A person with a large amount of coronary artery disease (CAD) may receive fewer bypass grafts owing to the lack of suitable "target" vessels. A coronary artery may be unsuitable for bypass grafting if it is small (< 1 mm or < 1.5 mm), heavily calcified or intramyocardial.

A person with a single stenosis of the left main coronary artery requires only two bypasses to the LAD and the LCX.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What are the causes of primary constipation?

Primary causes of constipation can be grouped into three:

  • Normal transit or functional constipation, which occurs most commonly. The stool passes in the colon at a normal rate.
  • Slow transit constipation, colonic inertia, is a colonic motor disorder characterized by progressive delay in the passage of stool through the colon.
  • Pelvic floor dysfunction is inefficient coordination of the pelvic muscles in the emptying of stool from the rectum. The causes for pelvic floor dysfunction are not clear; a multifactorial etiology has been proposed.

For Comments and archives…

Dr K K Aggarwal
    eMedinewS Audio PostCard

Stay Tuned

Ms. Vartika on Crime against women

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

A non–stop Interaction between Patients and Cardiologists

The Heart Care Foundation of India announced details of the forthcoming 4th Dil Ka Darbar at a press conference. The Darbar will be held on Sunday, 23rd September, 2012 at Talkatora Stadium. The event is being organized by Heart Care Foundation of India in association with World

Dr K K Aggarwal
    National News

4th Dil Ka Darbar

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

A non stop question answer–session between all top cardiologists of the NCR region and the public.

AIIMS–Jodhpur begins session with 50 students

JOHDPUR: The second prestigious medical institution in the country, AIIMS Jodhpur, commenced its maiden session on Monday. This is the first among the six AIIMS, announced by the NDA government in 2004, besides the one in New Delhi. It started its session with induction of 50 students, of which 30 are from Rajasthan. Addressing the inaugural session, its founder–director and noted onco surgeon Sanjeev Mishra termed the institute as a temple of knowledge and committed to highest standards of teaching, research and treatment. He called upon the students to commit themselves to the course with all seriousness and set standards for future batches. He advised the students to put in themselves wholeheartedly not only to become a good doctor but a good human being also. "There is no short–cut to success and there is no alternative to hard work," he said. Referring to the academic atmosphere of the institute, Mishra also said there will be a zero tolerance to any sort of indiscipline in the institute and said that after induction of the students, there will not be any discrimination along caste, creed, religion and financial or social status.

Joint secretary, Union health ministry, Rakesh Kumar said the construction of the building started in 2006 and now the academic block has been completed, which enabled commencement of the session. "From next September, we will start the hospital, which will have 950 beds including trauma unit," he said. The institute will have 24 faculties, which will be increased to 91 by October. "We are making sure that we bring the best possible faculties here in order to make it a top–rated institute," Kumar said. There was tremendous pressure in the OPD of AIIMS (New Delhi) with most of the patients coming from states like Bihar, Orissa, MP and UP.

Six new AIIMS had been proposed at Jodhpur (Rajasthan), Bhubaneshwar (Orissa), Raipur (Chhattisgarh), Bhopal (MP), Rishikesh (Uttarakhand) and Patna (Bihar) with a view to relieve New Delhi AIIMS from pressure. The inaugural session was attended by the former director of AIIMS (New Delhi) and Padma Shri recipient S K Kakkar, principal of S N Medical College (Jodhpur) Arvind Mathur and joint secretary (ministry of health and family welfare) Rakesh Kumar. After the inaugural session, all the students were distributed books for MBBS first year followed by plantation in the institute campus by the guests. (Source: TOI, Sept 18, 2012)

For comments and archives

My Profession My Concern

Suicide will no longer be an offense

New health bill says "any person who has attempted to commit suicide shall be examined by a psychiatrist before any criminal investigation takes place" reports Kounteya Sinha in TOI. The Union health ministry is pushing to decriminalize the act of attempting suicide, which currently is an offence under Section 309 of the IPC with a punishment of up to one year in jail and a fine.

The new Mental Health Care Bill 2012, that is expected to be tabled in the winter session, aims to introduce a provision saying "no complaint, investigation or prosecution shall be entertained against the person who attempted to commit suicide, notwithstanding anything contained in the IPC". The Bill says "any person who has attempted to commit suicide shall be examined by a psychiatrist before any criminal investigation takes place. If the psychiatrist… certifies that the person has a mental illness and there are reasonable clinical grounds to believe the suicide attempt was a result of the illness, no complaint shall be entertained against the person."

Last year, the Supreme Court had also observed that time had come to decriminalize attempt to suicide, dubbing the law "anachronistic" and called for its removal.

Suicide will no longer be an offense

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Valvular Heart Disease Update

What is severe aortic stenosis?

Severe AS is generally defined as an aortic valve area <1.0 cm2. The aortic jet velocity is generally over 4.0 m/sec and the mean transvalvular gradient usually exceeds 40 mmHg. Many patients do not develop symptoms until even more severe valve obstruction is present, while some patients become symptomatic when the stenosis is less severe, particularly if there is coexisting aortic regurgitation.

(Experts: Dr Bhabha Nanda Das and Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr K S Dagar, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

    International News

(Dr S K Verma, Consultant Ophthalmologist, New Delhi)

Popular painkillers can cause hearing loss in women

Regular use of household painkillers like ibuprofen and paracetamol can lead to increased risk of hearing loss in women, according to a study in USA. The study of more than 62,000 women found that taking the drug twice a week increases the risk of hearing loss by 13 percent, taking ibuprofen six times a week increases the risk by 24 percent and taking paracetamol five times a week increases the risk by 21 percent. The data was taken from the Nurse’ health study, a national health survey of 116,430 female registered nurses conducted over 14 years from 1995 to 2009. The study identified 10,000 reported cases of hearing loss. (Courtesy: TOI, 17 Sept. 2012)

For comments and archives

(Contributed by Dr Monica and Brahm Vasudev)

Resuming warfarin after GI bleed cuts thrombosis, death

Resuming warfarin therapy after suffering a gastrointestinal bleed (GIB) is associated with a reduced risk for thrombotic events, including stroke, with only a moderate risk for recurrent bleeding. (Source: Medscape)

For comments and archives

Abiraterone Tx boosts survival in prostate cancer

Final results of a phase III trial confirm that treatment with abiraterone prolongs overall survival in metastatic castration–resistant prostate cancer that has progressed after docetaxel therapy. (Source: Medpage Today)

For comments and archives

Antioxidants tied to older men’s sperm quality

Middle–aged and older men who get enough antioxidants in their diets may have better–quality sperm than men who are lacking in the nutrients, a new study suggests. Researchers found that among men age 45 or older, those who got the most vitamins C and E, folate and zinc tended to have fewer DNA–strand breaks in their sperm. The findings, reported August 28th in Fertility and Sterility, do not prove that antioxidants directly improve sperm quality or boost the chances of a healthy pregnancy. (Source: Medscape)

For comments and archives

Better lasers make tattoo removal easier

Laser treatment is increasingly successful at removing tattoos, with cosmetically acceptable outcomes and refinements in the technology used, studies have found. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: DD India’s Take Care Holistically–Organ Transplant: http://youtu.be/jmhMXCSQiGk

@DeepakChopra: Be kind to yourself and others. Come from love every moment you can.

    Spiritual Update

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

Do your duty with discipline and devotion: The triad represents Rama, Lakshmana and Hanumana

"Vasudaiva kutumbakam" (the whole world is one family) and "Ekam Sat Viprah Bahudavanti" (truth is one but the wise call it by various names) are two basic statements which comes from the ancient Rig Veda and form the fundamentals of Vedic philosophy.

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Is counseling necessary for the surrogate and the intended parents?

Counseling of surrogates is intended to provide the surrogate with a clear understanding of the psychological issues related to pregnancy. With the assistance of a mental health professional (MHP), the gestational surrogate, and her partner should explore issues such as managing a relationship with the intended parents, coping with attachment issues to the fetus, and the impact of a gestational surrogacy arrangement on her children and her relationships with her partner, friends and employers. The intended parents should be counseled regarding their ability to maintain a respectful relationship with the surrogate. The surrogate, the intended parents, and the MHP should also meet to discuss the type of relationship they would like to have.

For comments and archives

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

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

Q: What are the various types of blood donations?

A: There are three types of blood donors:

  • Professional donors: who sell their blood for money. Under no circumstances, should professional donors be allowed to give blood. They sell their blood, which is of very poor quality and can transmit very dangerous diseases to the recipient. It is illegal to take blood from any professional donor.
  • Replacement donation: the healthy relatives and friends of the patient give their blood of any groups in the blood bank. However, from the stocks available in the blood bank, the required number of units of the same blood group as that of the patient is given. This is called replacement donation.
  • Voluntary donation: Here, a donor donates his blood voluntarily. His blood can be used for any patient even without revealing his identity. This is the BEST TYPE of blood donation where motivated human being give their blood in an act of high human selfless service or Nishkama Seva.

For comments and archives

    An Inspirational Story (Dr GM Singh)

Seven Wonders of the World

A group of Geography students were asked to list what they considered to be the Seven Wonders of the World.

Though there was some disagreement, the following got the most votes:

1. Egypt’s Great Pyramids
2. Taj Mahal
3. Grand Canyon
4. Panama Canal
5. Empire State Building
6. St. Peter’s Basilica
7. China’s Great Wall

While gathering the votes, the teacher noticed one student, a quiet girl, hadn’t turned in her paper. So she asked the girl if she was having trouble with her list.

The quiet girl replied, "Yes, a little. I couldn’t quite make up my mind because there were so many."

The teacher said, "Well, tell us what you have, and maybe we can help."

The girl hesitated, then read, "I think the Seven Wonders of the World are:

1. to touch
2. to taste
3. to see
4. to hear
5. to run
6. to laugh
7. and to love

Sometimes we forget what really matters. May you be reminded today of those things which are truly wondrous.

(Source: http://www.fropki.com/seven–wonders–the-world–

For comments and archives

    Cardiology eMedinewS

WARCEF: Warfarin protects against death/stroke in younger HF patients
Read More

Heart disease is lead cause of death in pregnancy Read More

    Pediatric eMedinewS

Tight glycemic control no help to kids after cardiac surgery Read More

Pertussis vaccine protection wanes 42% every year Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with fever and joint pain came with rash.
Dr Bad: It’s a drug allergy.
Dr Good: It looks like Chikungunya.
Lesson: Rash is present in 30% of cases with Chikungunya.

For comments and archives

Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.

For comments and archives

    Legal Question of the Day (Dr MC Gupta)

Q. My friends say that their PG degree is recognized by the state medical council but not by the MCI. How is this possible when a State Medical Council is a part of the MCI?


  • What your friends say is wrong. It is not within the power of a State Medical Council to recognize or not recognize a medical degree. Recognition is granted by the MCI.
  • There was an anomaly that a few Diplomas, such as those in Orthopedics and Radiology, granted by the College of Physicians and Surgeons, Mumbai, were recognized by the Maharashtra Medical Council but not by the MCI. I understand that this anomaly has been removed now.
  • State Medical Councils are not a part of the MCI. Each medical council is established under a separate law.
  • I think it would be a good idea to scrap the State Medical Council laws and to modify the MCI Act, 1956, to provide for a unified set up of central and state councils.

For comments and archives

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

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  Quote of the Day (Dr GM Singh)

If you have controlled your mind you are the conqueror of the whole world. Swami Sivananda

  Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

T3 uptake

This test measures the amount of thyroxine–binding globulin (TBG) in the patient’s serum. When TBG is increased, T3 uptake is decreased, and vice versa. T3 uptake does not measure the level of T3 or T4 in serum.

  • Increased T3 uptake (decreased TBG) in euthyroid patients is seen in chronic liver disease, protein–losing states, and with use of the following drugs: androgens, barbiturates, bishydroxycoumarin, chlorpropamide, corticosteroids, danazol, d–thyroxine, penicillin, phenylbutazone, valproic acid and androgens. It is also seen in hyperthyroidism.
  • Decreased T3 uptake (increased TBG) may occur due to the effects of exogenous estrogens (including oral contraceptives), pregnancy, acute hepatitis, and in genetically–determined elevations of TBG. Drugs that increase TBG include clofibrate, lithium, methimazole, phenothiazines and propylthiouracil. It may also occur in hypothyroidism.
    Mind Teaser

Read this…………………

Which of the following biliary injuries do not present immediately after surgery?

a. Type A
b. Type B
c. Type C
d. Type D

Yesterday’s Mind Teaser: A thoracentesis is performed on a chest–injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client’s vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H2O. The most likely cause of these findings is which of the following?

A. Spontaneous pneumothorax
B. Ruptured diaphragm
C. Hemothorax
D. Pericardial tamponade

Answer for yesterday’s Mind Teaser: D. Pericardial tamponade

Correct answers received from: Dr KP Chandra, Dr Prabha Sanghi, Dr Thakor Hitendrsinh G,
Dr KV Sarma, Dr Sushma Chawla, YJ Vasavada, Raghavendra H Gobbur, Dr BB Aggarwal, Muthumperumal Thirumalpillai, Dr Pankaj Agarwal, Dr K Raju, Dr K Raju, Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr LC Dhoka, N Prabakar, Sudipto Samaddar.

Answer for 17th September Mind Teaser: Bridge over troubled water

Correct answers received from: YJ Vasavada, Dr A P Bhatia, Dr Ashok Barat.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Letter writing

I am well here and hope you are also in the same well.

    Medicolegal Update

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

What is the vegetative state?

Complete absence of behavioral evidence for self or environmental awareness

  • There is preserved capacity for spontaneous or stimulus–induced arousal, evidenced by sleep–wake cycles i.e. patients are awake, but have no awareness. This means that the patients appear awake.
  • They have normal heart beat and breathing, and do not require advanced life support to preserve life and cannot produce a purposeful, co–coordinated, voluntary response in a sustained manner, although they may have primitive reflexive responses to light, sound, touch or pain.
  • They cannot understand, communicate, speak, or have emotions and are unaware of self and environment and have no interaction with voluntary passage of urine or stools. They sleep and awaken. As the centers in the brain controlling the heart and breathing are intact, there is no threat to life, and patients can survive for many years with expert nursing care.
  • The following behaviors may be seen in the vegetative state:
    • Sleep–wake cycles with eyes closed, then opened. Patient breathes on her own; spontaneous blinking and roving eye movements; produce sounds but no words; visual pursuit following an object with her eyes; grimacing to pain; changing facial expression; yawning; chewing jaw movements swallowing of her own spit no purposeful limb movements; arching of back; reflex withdrawal from painful stimuli; brief movements of head or eyes toward sound or movement without apparent localization or fixation; startles with a loud sound.

Almost all of these features consistent with the diagnosis of permanent vegetative state were present during the medical examination of Aruna Shaunbag. Behavior suggestive of a minimally conscious not vegetative state observed during the examination.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Air Quality a Temporary Trigger for MI

Heavy air pollution can trigger acute heart attack in the hours after exposure, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India, Dil Ka Darbar to be held on 23rd September at Talkatora Stadium and MTNL Perfect Health Mela.

Every 10 µg/m3 increase in small particulate matter and nitrogen dioxide temporarily boosts heart attack risk by 1.2% and 1.1%, respectively, as per a report in the BMJ. The chances of suffering an attack increase by 1.3% in the six hours after coming in contact with high levels of vehicle–related pollutants.

The increased risk is seen up to six hours after exposure to typical traffic–related pollutants. The take home message is that breathing in large amounts of traffic fumes can trigger a heart attack within six hours following exposure.

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