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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 …

1st November 2011, Tuesday

Cut Daily Salt Intake to 1,500 mg

  • Daily intake of salt should be limited to 1,500 mg according to an advisory statement from the American Heart Association (AHA).
  • The 2020 goal of the American Heart Association is to improve the cardiovascular health of all by 20% while continuing to reduce deaths from (cardiovascular disease) and stroke by 20%. (Dr Lawrence J. Appel, of Johns Hopkins, and colleagues wrote online in Circulation.)
  • Two key components of improving cardiovascular health are population-wide lowering of blood pressure below 120/80 and reducing sodium chloride intake below 1,500 mg per day.
  • The evidence includes more than 50 trials assessing the blood pressure effects of salt, as well as a meta-analysis showing that cutting salt intake by about 1,800 mg per day lowered blood pressure by 5 mm Hg systolic and 2.7 mm Hg diastolic.
  • Reducing salt consumption also can help prevent the blood pressure increases that come with age, ultimately affecting 90% of adults.
  • Salt also has pernicious effects aside from blood pressure increases, including left ventricular hypertrophy and renal damage, including interference with the renin-angiotensin-aldosterone system.
  • Excess sodium also can result in abnormalities in mineral metabolism, fibrosis in several organs including the heart, and endothelial and arterial dysfunction.
  • Benefits of lowering sodium intake by 1,200 mg per day could lead to:
    a. Up to 120,000 fewer coronary heart disease events
    b. As many as 66,000 fewer strokes
    c. Almost 100,000 fewer heart attacks
    d. Up to 92,000 fewer deaths.
  • The previous recommendation was that salt intake should be below 2,300 mg per day but advised that people at risk -- those with hypertension, blacks, and older individuals -- lower their intake to 1,500 mg. 10. Processed foods are a main contributor, as these foods contain three-quarters of the sodium consumed
  • Naproxen increase the risk of death or recurrent heat attack by 76% after a week but for treatments lasting 30 to 90 days the risk increased risk was 15%
  • Ibuprofen had the lowest initial risk, just a 4% increase for treatments lasting seven days or less.

    Source: MedpageToday

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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

 Revise Psychiatry

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Heart Checkup Camp “ask dr kk”

The camp was organised by Maheshwari club in association with Heart Care Foundation of India and World Fellowship of Religions. In the Photo Padmashri and Dr B C Roy national Awardee Dr KK Aggarwal President Heart Care Foundation of India in the camp.

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


Pink ribbon campaign sets world record

Cancer survivors, patients, care givers, nurses, corporates, students – in total, over 6,583 participants – formed the largest human awareness pink ribbon in the world to create awareness on breast cancer, in Bangalore on Sunday. Wearing pink ‘T’ shirts and head bands, they stood for over 10 minutes to form the ribbon measuring 280X220 feet at the event that would enter the Guinness Book of World Records. The host, HealthCare Global Enterprises (HCG), provided the participants with mammography coupons, cancer screening and consultation with cancer specialist free of cost. HCG Chairman Dr B S Ajaikumar said India lacked awareness on health and neglected preventive health checkup. He said distributing mammography coupons is one of the measures to eradicate the social stigma associated with cancer. According to Population-Based Cancer Registry - 2006/2008, compared to any other City in India, Bangalore has the highest incidence of breast cancer at 36.1 per every 1,00,000 persons, followed by Thiruvananthapuram at 33, Mumbai at 32.3, Delhi at 32.3, Chennai at 31.5 and Kolkata at 25.5. (Source: Deccan Herald, 31 October 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

(Dr Monica and Brahm Vasudev)

Lupron label updated with added puberty data

The FDA has approved an updated label -- including 18 years of data -- for a drug that delays the onset of early puberty. The Abbott drug, leuprolide acetate for depot suspension (Lupron Depot-PED), is already approved to treat central precocious puberty (CPP), a condition which causes children to enter puberty too soon (in girls, before the age of eight and in boys, before the age of 9). CPP results in early breast development in females and early genital development in both females and males, and can lead to diminished adult height. (Source: Medpage Today)

For comments and archives

AAP urges universal drug screening for teens

All adolescents should be screened for alcohol, tobacco, and other drug use at every office visit, the American Academy of Pediatrics (AAP) recommended. Rather than just asking teens, pediatricians should use a formal, validated screening tool at routine visits as well as appropriate acute care visits, according to the AAP statement in the November issue of Pediatrics. (Source: Medpage Today)

For comments and archives

An egg a day raises risk of diabetes

People who eat eggs every day may substantially increase their risk of type 2 diabetes, researchers here said. Men with the highest level of egg consumption -- at seven or more per week -- were 58% more likely to develop type 2 diabetes than those who did not eat eggs, and women were 77% more likely to become diabetic if they ate at least an egg a day, Luc Djoussé, M.D., D.Sc., of Brigham and Women's Hospital and Harvard, and colleagues reported online in Diabetes Care. Levels of egg intake above one a week also incrementally increased diabetes risk in both men and women (both P<0.0001 for trend), the researchers said. (Source: Medpage Today)

For comments and archives

Poor countries bear higher stroke burden

Low-income countries and those that spend little on healthcare have higher rates of stroke than wealthier nations and countries with higher healthcare expenditures, a systematic review showed. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: : #AJPP Presence of severe oligohydramnios and early onset IUGR is an alarm for fetal malformations. Pandher... fb.me/RiL97aKB

@DeepakChopra: #CosmicConsciousness The manifest world unfolds from the un-manifest through being, feeling, thinking & doing.

    Spiritual Update

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

Science behind Chhath pooja

1. Chhath puja is mainly observed in Bihar and Nepal. Bihar has a number of Sun temples, flanked by a surajkund or sacred pool of the Sun.

2. It is a ritual bathing festival that follows a period of abstinence and ritual segregation of the worshipper (parvaitin) from the main household for four days. The parvaitin observes ritual purity, and sleeps on the floor on a single blanket.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Nothing Is More Important

I sat next to the bed of old man, a friend for over twenty years, and held his hand. Hal was dying. We both knew these next few days would be his last.

We spent time reminiscing about his long and fruitful career as a church pastor. We talked about old friends. We chatted about his family. And I listened as he offered sage wisdom and advice to a member of a "younger generation."

At a lull in the conversation, Hal seemed to carefully consider what he was about to say next. Then he squeezed my hand, gazed intently into my eyes and whispered, just loud enough for me to hear, "Nothing is more important than relationships."

I knew that this was somehow near the pinnacle of his life's learning’s. As he considered all of his experiences -- personal, professional, spiritual and family, this one ultimate observation surfaced above the rest: "Nothing is more important than relationships."

"Don't get overly caught up in your career," he seemed to be saying to me.

"Likewise, don't use people in order to achieve your goals, and then throw them away. No project, no program, no task should be pursued at the expense of friends and family. Remember," I heard him saying, as clearly as if he were speaking the words, "that in the end, only your relationships will truly matter. Tend them well."

Writer Og Mandino puts it this way: "Beginning today," he said, "treat everyone you meet as if he or she were going to be dead by midnight. Extend to them all the care, kindness, and understanding you can muster, and do so with no thought of any reward. Your life will never be the same again." At the end of a long life, my friend Hal would have agreed.

For comments and archives

    Fitness Update

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

12 Indian foods that cut fat


This is a thermogenic herb that increases metabolism and helps burn body fat. Cardamom is considered one of the best digestive aids and is believed to soothe the digestive system and help the body process other foods more efficiently.

For comments and archives

    Healthy Driving

Healthy Driving – Safe Driving

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

Who is not fit to drive?

Patients with uncontrolled BP should not drive commercial vehicles.

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    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What the National Drug Policy of India says

What are the symptoms for immediate referral of a malaria case to a higher level healthcare facility?

The management of severe malaria requires immediate administration of life–saving drugs. Therefore essential requirements for management of severe malaria are as follows:

  • Persistence of fever after 48 hours of initial treatment
  • Continuous vomiting and inability to retain oral drugs
  • Headache continues to increase
  • Severe dehydration – dry, parched skin, sunken face
  • Too weak to walk in the absence of any other obvious reason
  • Change in sensorium e.g. confusion, drowsiness, blurring of vision, photophobia, disorientation
  • Convulsions or muscle twitching
  • Bleeding and clotting disorders
  • Suspicion of severe anemia
  • Jaundice
  • Hypothermia

For comments and archives

    Medicine Update

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

What is the role of liver transplantation in glycogen liver disease?

Liver transplantation is indicated in glycogen storage disease:

• When cirrhosis develops and is decompensated.

• Tumors in liver

• Medical therapy is unable to control symptoms and in uncontrolled hypoglycemia.

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Vitamin B1, Plasma

Thiamine, or thiamin, sometimes called aneurin, is a water–soluble vitamin of the B complex (vitamin B1), whose phosphate derivatives are involved in many cellular processes. Thiamine deficiency can lead to myriad problems including neurodegeneration, wasting and death.

• A lack of thiamine can be caused by malnutrition, a diet high in thiaminase–rich foods (raw freshwater fish, raw shellfish, ferns) and/or foods high in anti–thiamine factors (tea, coffee, betel nuts) and by grossly impaired nutritional status associated with chronic diseases, such as alcoholism, gastrointestinal diseases, HIV–AIDS, and persistent vomiting.

• It is thought that many people with diabetes have a deficiency of thiamine and that this may be linked to some of the complications that can occur.

• Well–known syndromes caused by thiamine deficiency include beriberi and Wernicke–Korsakoff syndrome, diseases also common with chronic alcoholism.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A female smoker wanted to know her risk of diabetes.
Dr Bad: There is no risk.
Dr Good: You are at high risk.
Lesson: A study published in February 25 issue of the journal ‘Diabetes Care’ has shown that females who smoke more than 20 cigarettes daily have high chances of developing type 2 diabetes.

For comments and archives

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy. Gingival hyperplasia is a known side effect of amlodipine.

For comments and archives

  Quote of the Day

(Dr Jitendra Ingole)

The reason most people fail instead of succeed is that they trade what they want most for what they want at the moment. Anon.


Till the cows come home: A long time.

    Mind Teaser

Read this…………………

What is not true about the immune mechanism in the small intestine?

a) Intestine contains more than 70% of IgA producing cells in the body.
b) Ig A acts by activating the complement pathway.
c) Ig A is produced by plasma cells in the lamina propria.
d) Approximately 60% of the lymphoid cells are T cells.

Yesterday’s Mind Teaser: Which of the following hormones are not released in the duodenum?

a) Gastrin
b) Motilin
c) Somatostatin
d) Pancreatic YY

Answer for Yesterday’s Mind Teaser: d) Pancreatic YY

Correct answers received from: Dr.Anil Kumar Jain, Dr. Sukla Das, Dr. P. C. Das, Dr. Rajshree Aggarwal, Dr.Sathiyamoorthy Veerasamy, Y. J. Vasavada, Muthumperumal Thirumalpillai, Dr.K.Raju, Dr Chandresh Jardosh, Jayaraman TP, Dr Jainendra Upadhyay, Neelam Nath, Dr.Krishna Kavita, Dr Ajay Gandhi.

Answer for 30th October Mind Teaser: a) Diverticulectomy
Correct answers received from: Dr Chandresh Jardosh, Jayaraman TP, Dr Jainendra Upadhyay, Neelam Nath, Dr.Krishna Kavita, Dr Ajay Gandhi.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

The Mathematician and the Physicist

A mathematician and a physicist agree to a psychological experiment.

The (hungry) mathematician is put in a chair in a large empty room and his favorite meal, perfectly prepared, is placed at the other end of the room. The psychologist explains, "You are to remain in your chair. Every minute, I will move your chair to a position halfway between its current location and the meal."

The mathematician looks at the psychologist in disgust. "What? I'm not going to go through this. You know I'll never reach the food!" And he gets up and storms out.

The psychologist ushers the physicist in. He explains the situation, and the physicist's eyes light up and he starts drooling.

The psychologist is a bit confused. "Don't you realize that you'll never reach the food?"

The physicist smiles and replies: "Of course! But I'll get close enough for all practical purposes!"

  Medicolegal Update

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

Sudden and unexpected death presents a challenge in legal autopsy

  • In cases of sudden death after pneumothorax, intravenous infusions, childbirth, operations, or sharp instrument injuries to the neck and thorax, it is important to check for air embolism to the heart.
  • A postmortem chest radiograph should be taken and inspected for larger quantities of air in the heart and great vessels.
  • Accuracy of observation, completeness of detail, and sound conclusions can be obtained only when the postmortem examination is done according to some definite and systematic plan so that regions and organs are successively examined without disturbing the relations and appearances yet to be investigated.
  • Chest radiographs provide the most reliable method for determining the extent of pneumothoraces and whether or not a pneumothorax has resulted in mediastinal shift.
  • Detection of a pneumothorax is easily done by holding the dissected skin and subcutaneous tissues of the chest to form a pocket adjacent to the ribcage in postmortem examination.
  • The pocket is filled with water, and a scalpel is used to incise the thoracic cavity. The presence of air bubbles indicates a pneumothorax.
  • In the cases of neonates and small infants during the autopsy, the thorax may be submerged in a bucket of water.
  • The apparatuses described previously for detection of air emboli work equally well for detecting pneumothoraces
  • The patients for whom death can be considered an expected outcome of a known illness and those for whom death is unexpected: This distinction is important because unexpected death due to unnatural causes, unintentional and intentional, usually falls within the purview of forensic pathology.

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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)

Dengue Patients Don’t Die of Platelet Deficiency but of intra vascular leakage

As per international guidelines, unless the platelet count is less than 2% of base line levels AND there is spontaneous active bleeding, no platelet transfusion is required, said Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal, President, Heart Care Foundation of India. Minor episodes of bleeding need not concern one.

The cause of death in dengue is capillary leakage causing blood deficiency in vascular department, leading to multi organ failure. At the first instance of plasma leakage from intra vascular compartment to extra vascular compartment, one need to give 20 ml per kg body weight per hour of fluid replacement to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Leakage normally occur after the fever is over.

Giving unnecessary platelet transfusion to the patient can harm the individual.

Dr. Aggarwal has created a formula of 20 for the family doctors to decide about admission of a case of dengue.
a. There is a rise in pulse by 20
b. Three is a fall in upper Blood Pressure by 20 mmHg
c. The pulse pressure (difference between upper and lower blood pressure) is lower than 20
d. The Hematocrit (thickness of blood) increased by 20%
e. Platelet count is less than 20,000
f. There are more than 20 petechiae (bleeding spots) in the tourniquet test in one square inch area.

For comments and archives

    Readers Response
  1. Dear Dr.K.K.Aggarwal, Excessive tea/coffee consumption is common in subjects who suffer from excessive daytime sleepiness (EDS).The common causes of EDS are sleep deprivation and Obstructive sleep apnea. Both are common conditions and both can cause cardiac arrhythmias. Tea/coffee consumption only accelerates the cardiac effects. In any given case of cardiac arrhythmias suspected to be due to tea/coffee it is also necessary to find out the cause for this excessive consumption and treat them. Dr.S.Ramnathan Iyer, Consultant Physician and Consultant Sleep Medicine.
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IMA East Delhi Branch in association with ART OF LIVING (founded by Sri Sri Ravi Shankar Ji) is organising a 4-day Basic Course EXCLUSIVELY for DOCTORS from 17th Nov. to 20th Nov., 6am to 9am every day, at Arya Samaj Mandir, "D" Block, Anand Vihar, East Delhi. Contact 9899666633: Dr. Rakesh Sachdeva, 9899666633.

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