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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 …

20th October 2011, Thursday

What every patient with high blood pressure should know about drugs?

It could take you as long as two years to get a date for a simple MRI scan in AIIMS while a CAT scan has a waiting period of more than four months, reports TOI. A waiting list – ranging from 2 months to a year or more – is the case with almost every department.

  • For every 20 mm Hg fall of systolic (upper) and 10 fall of diastolic (lower) blood pressure one needs one intervention, either life style life style intervention or one drug.
  • Lifestyle management alone practiced for six months can reduce blood pressure by up to 20/10 mmHg.
  • If blood pressure is more than 20/10 mmHg above goal blood pressure, consideration should be given to initiating therapy with two drugs and one of which usually should be a diuretic.
  • Addition of a second drug from a different class should be initiated when use of a single drug in adequate doses fails to achieve the BP goal.
  • Most patients with high blood pressure require two or more antihypertensive drugs to achieve goal blood pressure.
  • Combinations of two or more drugs is also needed to achieve the target goal of <130/80 mmHg in diabetics with high blood pressure.
  • Two drugs in the small doses are better than a single drug in high dose.
  • With a triple drug therapy, one of which is a diuretic, it is practically possible to control blood pressure in over 99% of cases.
  • The most effective therapy prescribed will control high blood pressure only if patients are motivated.
  • Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (ACE inhibitors, AR blockers, beta-blockers, calcium channel blockers).
  • Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated high blood pressure, either alone or combined with drugs from other classes.
  • A limited rise in serum creatinine of as much as 35 percent above baseline with ACE inhibitors and AR blockers is acceptable and is not a reason to withhold treatment unless serum potassium rises.
  • With advanced renal disease (estimated GFR <30 ml/min 1.73 m2, corresponding to a serum creatinine of 2.5–3 mg/dL), increasing doses of loop diuretics are usually needed in combination with other drug classes. .

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Dr KK Aggarwal
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What every patient with high blood pressure should know about drugs?

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    Photo Feature (from the HCFI Photo Gallery)

Inaguration of 18th MTNL Perfect Health Mela 2011

Prof. Kiran Walia, Social Welfare Minister, Government of Delhi, Smt. Rajni Abbi, Mayor of Delhi, Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Perfect Health Mela in the inaguration ceremony held at Siri Fort on 18th October 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


India set to be largest collector of cord blood

India will become the largest collector of umbilical cord blood in the world thanks to its vast genetic diversity and high number of births every year. Scientists say that blood from the cord is the natural source of stem cells for treatment of genetic and rare diseases. Since India records about 3 crore births every year, preserving the blood from the cord is easier. India has about 12 cord blood banks, including three in the public sector that can provide cord blood to even unrelated people and non-donors. According to S. Jayesh of the Foundation for Research in Genetics and Endocrinology, “India's booming birth rate and genetic diversity will help it emerge as the largest collector of umbilical cord blood in the world.” There are already about 50,000 samples in the country. He said about 70 per cent of patients of Indian origin, who require bone marrow transplants, do not find a match within their own family. (Source: Deccan Chronicle, Oct 19, 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)

Google helps track Nepal typhoid

Scientists announced on Monday they had combined cutting-edge gene sequencing technology with Google Earth to accurately map the spread of typhoid in Kathmandu for the first time. The Nepalese capital was described in a 2008 study as “a typhoid fever capital of the world”, with thousands of cases a year reported, but outbreaks have been hard to chart in a city where streets are rarely given names. Researchers say they have used GPS signalling and the latest DNA sequencing techniques to plot the course of the disease -- and have discovered the source of outbreaks is usually communal water spouts. The research, published in the journal Open Biology on Sunday, was carried out by scientists at the Vietnam-based Wellcome Trust Major Overseas Programme and the Oxford University Clinical Research units in Kathmandu and Ho Chi Minh City. (Source: Hindustan Times, Oct 17, 2011)

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What causes heart disease in women?

After a heart attack, women's hearts are more likely to maintain their systolic function-their ability to contract and pump blood from the chambers into the arteries, according to new research. According to C. Noel Bairey Merz, MD, Director of the Women's Heart Center at Cedars-Sinai Heart Institute in Los Angeles, this suggests that heart disease manifests differently in women, affecting the microvasculature (small blood vessels) instead of the macrovasculature (major blood vessels) as it does in men. In their study, Dr. Bairey Merz and her colleagues found that women's hearts were less likely than men's to lose their ability to pump blood after a heart attack, and that female heart patients were less likely to present with obstructive coronary artery disease. Instead, the oxygen deprivation and subsequent damage to the heart is more likely to occur when small blood vessels, not major arteries, become dysfunctional. "That is the reason women are often misdiagnosed and suffer adverse events," said Dr. Bairey Merz. "Physicians have been looking for male pattern disease, when we need to start looking at female patterns." (Source: TOI, Oct 16, 2011)

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FDA Panel vetoes new indication for Parkinson's Drug

An FDA advisory committee has voted 17 to 0 that Azilect (rasagiline), a drug that is already approved to treat symptoms of Parkinson's disease, does not work to slow progression of the neurodegenerative disorder. Rasagiline was approved in 2006 to treat signs and symptoms of Parkinson's disease -- such as tremors, difficulty walking, slowness of movement, and decreased facial expressions -- either when used by itself or with levodopa. (Source: Medpage Today)

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    Twitter of the Day

@DrKKAggarwal:#AJD Blood sugar tests alongside eye tests may help detect diabetes Opticians should offer blood sugar checks...fb.me/1krUqp2nT

@DeepakChopra: #CosmicConsciousness We are luminous stardust beings--@cosmicsociety

    Spiritual Update

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

Science behind Ahoi Ashtami

Ahoi Ashtami is observed 4 days after Karva Chauth, 8 days after Sharad Purnima and 12 days after Dusshera. This festival is specifically meant for mothers who have sons. Pure water is offered to stars during the evening time by the mothers and they pray for the long life of their sons.........more

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    An Inspirational Story

(Ms Ritu Sinha)

The Glasses

Mother's father worked as a carpenter. On this particular day, he was building some crates for the clothes his church was sending to some orphanage in China. On his way home, he reached into his shirt pocket to find his glasses, but they were gone. When he mentally replayed his earlier actions, he realized what happened; the glasses had slipped out of his pocket unnoticed and fallen into one of the crates, which he had nailed shut. His brand new glasses were heading for China! The Great Depression was at its height and Grandpa had six children. He had spent $20 for those glasses that very morning. He was upset by the thought of having to buy another pair. "It's not fair," he told God as he drove home in frustration. "I've been very faithful in giving of my time and money to your work, and now this."

Several months later, the director of the orphanage was on furlough in the United States. He wanted to visit all the churches that supported him in China, so he came to speak one Sunday at my grandfather's small church in Chicago. The missionary began by thanking the people for their faithfulness in supporting the orphanage. "But most of all," he said, "I must thank you for the glasses you sent last year. You see, the Communists had just swept through the orphanage, destroying everything, including my glasses. I was desperate. Even if I had the money, there was simply no way of replacing those glasses. Along with not being able to see well, I experienced headaches every day, so my coworkers and I were much in prayer about this. Then your crates arrived. When my staff removed the covers, they found a pair of glasses lying on top.

The missionary paused long enough to let his words sink in. Then, still gripped with the wonder of it all, he continued: "Folks, when I tried on the glasses, it was as though they had been custom-made just for me! I want to thank you for being a part of that." The people listened, happy for the miraculous glasses. But the missionary surely must have confused their church with another, they thought. There were no glasses on their list of items to be sent overseas. But sitting quietly in the back, with tears streaming down his face, an ordinary carpenter realized the Master Carpenter had used him in an extraordinary way.

For comments and archives

    Fitness Update

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

Walking off the pounds leads to decreased risk of metabolic syndrome

Metabolic syndrome is a condition that is characterized by several risk factors that increase one's chance of developing heart disease, stroke, and/or diabetes. These risk factors are insulin resistance, high blood pressure, high cholesterol and obesity. According to a national health survey, more than one out of five Americans has metabolic syndrome, and rates continue to increase. However, there is hope. New research published in the Journal of Exercise Physiology shows that weight loss in the abdominal area is directly related to decreased risk of metabolic syndrome.

Researchers studied a group of healthy, middle aged men (average age of 54) who were either sedentary or performed low levels of physical activity. These men were assigned to a 24-week long activity program that involved moderate intensity walking. Over the course of the program, researchers measured the physiological markers of the various risk factors for metabolic syndrome. They found that the walking intervention, not surprisingly, caused weight loss. Interestingly, the researchers also found a direct relationship between waist circumference and risk for metabolic syndrome. The researchers concluded that weight loss, specifically in the abdominal area, affects metabolism and insulin sensitivity, thereby decreasing the risk for metabolic syndrome and type II diabetes.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

What is the legal status of foreign surgeons who come for camps and conferences and do surgery here? What will be their responsibility regarding complications/ misconduct? Should they take prior permission from MCI or local authority.


1. Nobody can treat a patient in India unless he is registered with the medical council here. The foreign surgeons need to take a special short time/temporary registration with the MCI. Operating without such permission would be illegal.

2. Foreigners should not venture illegally in their own interest. If they operate and a police complaint/FIR is registered against them for criminal negligence, they may have problem leaving the country and may even be arrested.

3. Hospitals sponsoring such surgery will be fully liable in law for compensation and also for criminal negligence for allowing an unlicenced person to operate and causing harm.

4. It is also possible, depending upon legal provisions, that a complaint alleging negligence may be made or referred to the foreign medical council where the surgeon is registered and the council may decide upon the complaint and take action against him.

5. If a hospital thinks that getting a patient operated by the foreign surgeon but not showing his name as the person conducting the surgery in the medical records will save the hospital or the surgeon from the requirements or consequences mentioned above, this is a fallacy. It would be deemed as fraudulent on the part of the hospital.

For comments and archives

    Malaria Update

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

What the National Drug Policy of India says

What advice is given to the patient and/or the caretaker?

Once a suspected case is diagnosed positive by RDT or microscopy, treatment is started. The first dose is always taken in the presence of the health volunteer/worker. If the patient is a child under 5 years or a pregnant woman, ask her or him to wait for 15 minutes after taking the first dose. If it is vomited within this period, let the patient rest for 15 minutes, then give a first dose again (i.e. open a new blister-pack and discard what remains of the old. If the patient vomits again (recurrent vomiting), it is considered a case of severe malaria. The remaining part of the treatment is given to the patient/caretaker to take home with clear instructions.

You should explain to the patient/caretaker about the following:

  • That if the treatment is not completed as prescribed, the disease may recur, possibly being more serious and more difficult to treat
  • To come back immediately, if there is no improvement after 24 hours, if the situation gets worse or the fever comes back.
  • That regular use of a mosquito net is the best way to prevent malaria.

For comments and archives

    Medicine Update

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

What is nalidixic acid resistant-S. typhi (NARST)?

Although advances in public health and hygiene have led to the virtual disappearance of enteric fever from much of the developed world, the disease remains endemic in many developing countries. Since the 1990s, Salmonella typhi has developed resistance simultaneously to all the drugs used in first line treatment (chloramphenicol, cotrimoxazole and ampicillin) and are known as Multi Drug Resistant typhoid fever (MDRTF). Fluoroquinolones are widely regarded as the most effective drug for the treatment of typhoid fever. But unfortunately, some strains of S. typhi have shown reduced susceptibility to fluoroquinolones.

On routine disc testing with the recommended break points, organisms showing susceptibility to fluoroquinolones show poor clinical response to actual treatment. These organisms when tested by disc testing with nalidixic acid show resistance. So in other words resistance to nalidixic acid is a surrogate marker, which predicts fluoroquinolone failure and can be used to guide antibiotic therapy. Unregulated access and indiscriminate use of fluoroquinolones have obviously promoted this debacle. Isolates with reduced susceptibility to ciprofloxacin are fast becoming a major problem in South and South-East Asia. In India, currently, as high as 70 to 80% of isolates in hospital-based studies are NARST and 20 to 50% of isolates are MDR-ST.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Inorganic phosphorus

Hyperphosphatemia may occur in conditions like myeloma, Paget's disease of bone, osseous metastases, Addison’s disease, leukemia, sarcoidosis, milk–alkali syndrome, vitamin D excess, healing fractures, renal failure, diabetic ketoacidosis, hypoparathyroidism, acromegaly and malignant hyperpyrexia.

Drugs that increase serum phosphorous level include androgens, furosemide, growth hormone, hydrochlorothiazide, oral contraceptives, parathormone and phosphates.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with low bone marrow density (BMD) wanted to know if he could take potassium citrate.
Dr. Bad:
There is no role.
Dr. Good:
Take it.
Daily supplementation with potassium citrate significantly increases BMD in the elderly. BMD increases significantly with daily supplementation of 60 mmol potassium citrate.

For comments and archives

Make Sure

Situation: A patient of gross ascites presents with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to only moderately tap ascitic fluid as overenthusiastic tapping can be life–threatening.

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  Quote of the Day

(Dr GM Singh)

Ants are creatures of little strength, yet they store up their food in the summer.


Start from Scratch: To do it all over again from the beginning

    Medicolegal Update

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

If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent.

Medical progress is based on research which ultimately must rest in part on experimentation involving human subjects. The purpose of biomedical research involving human subjects must be to improve diagnostic, therapeutic and prophylactic procedures and the understanding of the etiology and pathogenesis of disease.

  • Mr Bolam was a voluntary patient at a mental health institution run by the Friern Hospital Management Committee in United Kingdom. He agreed to undergo electroconvulsive therapy. He was not given any relaxant drugs, and his body was not restrained during the procedure.
  • He flailed about violently before the procedure was stopped, and he suffered some nasty injuries, including fractures of the hip bone. He sued the Committee for compensation. He argued they were negligent for not issuing relaxants/not restraining him/ not warning him about the risks involved.
  • The Judge noted that medical opinion was opposed to the use of relaxant drugs, and that manual restraints could sometimes increase the risk of fracture and it was the common practice of the profession to not warn patients of the risk of treatment when it is small unless they are asked.
  • In this case, the jury delivered a verdict in favor of the defendant hospital. Given the general medical opinions about what was acceptable electro-shock practice, they had not been negligent in the way they carried out the treatment.
  • That passage is quoted very frequently, and has served as the basic rule for professional negligence over the last fifty years.

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    Mind Teaser

Read this…………………

A 43-year-old man is evaluated in the emergency department because of dyspnea. He was one of several people exposed to an unknown gas released in a subway station. Immediately following exposure to the gas, the victims complained of headache, nausea and vomiting, diaphoresis and shortness of breath. The patient is drenched in sweat, drooling and tearing, and sitting upright, gasping for air. Vital signs are: BP 90/60 mmHg, pulse 45/min, and respiratory rate 24/minute. Pupils are 2 mm and non-reactive. Lung examination reveals diffuse wheezing; the heart sounds are slow but regular. He suddenly becomes too weak to remain sitting, falls back in bed, and appears ashen. Which of the following interventions should be instituted first?

A. Intravenous atropine and 2-pralidoxime chloride (2-PAM)
B. Albuterol and ipratropium via nebulizer
C. Intravenous cyanide antidote kit
D. Subcutaneous scopolamine

Yesterday’s Mind Teaser: Which of the following is the most common cause of death in Crohn's disease of small intestine?
a) Malignancy
b) Sepsis
c) Electrolyte disorders
d) Thromboembolic phenomenon

Answer for Yesterday’s Mind Teaser: a) Malignancy

Correct answers received from: Dr Prabha Sanghi, Dr. Sukla Das, Dr. P. C. Das, Dr Jainendra Upadhyay, Dr Kalpana Verma, Raghavendra Singh, Dr.K.Raju, Muthumperumal Thirumalpillai, Neelam Nath, Anil Bairaria, Dr Surendra Bahadur Mathur, Dr.K.V.Sarma, Nneelima Singh, Dr Kalpana Verma.

Answer for 18th October Mind Teaser
: b) Roux en Y gastrojejunostomy
Correct answers received from: Muthumperumal Thirumalpillai, Jayant Navarange, Dr.Anil Kumar Jain,
Dr Rawat Purushottam Singh.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

A wife's husband had a drinking problem, so she told her best friend that she was going to buy a large bottle of vinegar and pour it in his liquor bottle, which she did. The following week she calls her best friend and says, "I have good news and bad news, the good news is I got him to quit drinking." Her friend asks what the bad news was. "The bad news is, I killed him."

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Harmony-Inter School Competitions Held

The ongoing Perfect Health Mela has now shifted to NDMC grounds Laxmi Bai Nagar, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Perfect Health Mela. Exhibitions, checkups, competitions and non-stop entertainment are being provided at the Mela ground. The Mela will end on 23rd Sunday.

More than 2000 children took part in Harmony- Inter school competitions. The competitions included painting and slogan (Theme: Science behind maintaining good health); Healthy Model Display (Theme: Energy Conservation); Quiz (Theme: Nutrition for schoolgoing children) and Folk dance (Maintaining Good health).

Health check ups showed a 60% incidence of obesity in the Mela visitors.

First aid classes for the teachers

In the ongoing Perfect Health special classes are being held on general first aid, Diwali first aid.

Dr. Aggarwal said that any burn during Diwali days should be washed with running tap water till the burning disappears. One should not puncture the wound.

If a burn particle goes into eyes, the eyes should be washed with running tap water continuously till the irritation disappears. Do not rub the eyes.

People who wear earplugs if they are near a noise pollution of more than 80 decibel over a period of time as it can be harmful to ears. Many crackers may have noise of more than 110 decibel and can harm the hearing if one is exposed to them at a short distance.

Safe driving campaign at MTNL Perfect Health Mela

A safe drive camp was also launched. Dr. Aggarwal, said that there are certain people who should not drive and also should not be given license to drive by the doctors.

A person is prohibited to drive if he has uncontrolled blood pressure, over or under controlled diabetes, history of fits in the last three years, in the first six months after acute heart attack, up to six months after a life threatening heart irregular rhythm, colour blindness, night blindness, significant visual impairment, physical disability of reaction time of less than 15 seconds in walking and returning 15 feet space, reach out test of less than 6 feet of standing, low IQ, more than permissible dose of alcohol in one hour. Patients with uncontrolled blood pressure and those suffering from diabetes on insulin are not allowed to drive commercial vehicles. People who snore in the night and have more than 15 episodes of stopped breathing per hour of sleep are seven times more likely to have accidents.

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    Readers Responses
  1. Respected sir, as a participant, I congratulate and appreciate that all topics under discussion were concluded appropriately during the workshop. Exactly same has been put in your editorial with absolute precision. Topics discussed are immensely relevant to impending and rapidly spreading pandemic like metabolic syndrome. I wish to further say that curd is integral part of community dinner/ feast/ bhoj in North Bihar particularly amongst Maithil Brahmins where it is enjoyed in large quantity. I have not observed any immediate complaints or any long term significant medical condition associated with it. I personally encourage consumption of fresh curd with any meal. Fresh curd may be considered as a fermented probiotic food, friendly to human gut and health. Dr. Dilip Kumar Jha.

    eMedinews Comment: We agree. Curd, being fermented, should not be eaten with non fermented food in the dinner. This is a traditional Ayurveda concept.
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals ..

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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