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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; 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

21st August, 2010, Saturday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Kidneys from cardiac-death equal to those from brain-death patients

For first-time kidney recipients, kidneys from controlled cardiac-death donors (when people have irreversible brain injury and their heart has stopped after life support is switched off) is  equivalent to those donated from brain-death donors and had similar rates of graft survival and graft function, according to a study published online Aug. 19 in the Lancet.

To compare outcomes of kidneys donated from cardiac-death patients and brain-death patients, Dr Dominic M. Summers, of the University of Cambridge, U.K. evaluated 9,134 kidney transplants performed at 23 U.K. centers. They chose patients who received transplants from cardiac-death donors of Maastricht category III, defined as donors awaiting cardiac arrest after withdrawal of life-support treatment. This excludes donors who have died on arrival at hospital or who have not responded to resuscitation attempts following a heart attack,  for example

They defined delayed graft function as having a need for dialysis after transplantation. The median follow-up for the study was six to 10 years and graft survival was assessed at five years.

Of the 9,134 recipients, 845 (9 percent) received kidneys from controlled cardiac-death donors, while 8,289 (91 percent) received kidneys from heart-beating brain- dead donors.

Patients who received kidneys from cardiac-death patients were older and received kidneys that were less well matched for human leukocyte antigen (HLA).

Delayed graft function occurred in 50 percent of kidneys from cardiac-death donors compared to 25 percent in kidneys from brain-death donors. Acute rejection occurred in 17 percent of patients who received kidneys from cardiac-death donors and 24 percent of recipients who received kidneys from brain-death donors during the first three months after transplantation. For first-time kidney recipients, graft survival up to five years after implantation was similar between both donors.

Graft failure at five years was equivalent for first-time recipients of kidneys from cardiac-death donors (n=739) compared with brain-death donors (n=6,759).

Although brain stem death and cardiac death both damage the donor kidney, the level of damage differs between the two. In the past there had been concerns that kidneys from cardiac-death donors could be inferior to those from brain-dead donors due to the period of “warm ischaemia” that occurs. This is where the blood supply to the kidney is cut off, between the time the heart stops and cold preservation solution is added. Concerns have also been raised about the long-term outcomes of such transplants, and uncertainty about the factors that might affect their success.

Dr KK Aggarwal
Editor in Chief
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Photo Feature (From HCFI File)

Perfect Health Mela is a annual feature of Heart Care Foundation of India since 1991. It is a blend of entertainment and information for all strata of the society.

In the photo: Actor, Jackie Shroff; in one of the Perfect Health Mela.


K K Aggarwal


News and Views

Dr Monica and Dr Brahm Vasudev

Remote monitoring technology may help improve outcomes in heart failure patients

A recent Cochrane review states that keeping an eye on heart failure patients with remote monitoring technology between visits can improve outcomes. Telemonitoring, and structured telephone support to a lesser extent, led to a decline in the all–cause mortality in heart failure patients. Heart failure–related hospitalizations decreased with both telemonitoring and structured telephone support.

High LDL in youth predicts coronary calcification later

Young adults whose lipid levels are less than optimal are likely in midlife to develop coronary calcium, a surrogate measure of coronary artery disease. According to Mark J. Pletcher, MD, of the University of California San Francisco, and colleagues, the adjusted odds ratio for having coronary calcium two decades later was 5.6 (95% CI 2 to 16) for young adults ages 18 to 30 years whose low–density lipoprotein (LDL) cholesterol levels were 4.14 mmol/L or greater vs those whose levels were below 1.81 mmol/L, Moreover, even those whose levels were as low as 2.59 to 3.34 mmol/L had increased risk (adjusted OR 2.4, 95% CI 1.1 to 5.3). The study is reported in the Aug. 3 issue of the Annals of Internal Medicine.

Dr. G M Singh

Some question statins’ benefits for patients who do not have clear signs of heart disease

Contrary to the general perception, a study published in the Archives of Internal Medicine has found that statins do not drive down death rates among those who take them to prevent a first heart attack.

Air pollution may also have an effect on heart, brains, and blood vessels

A new statement on air pollution issued in May by the American Heart Association (AHA) revealed that evidence linking air pollution to heart disease and deaths has ‘substantially strengthened’. A strong link with heart attacks, increasing evidence for links to heart failure, stroke, irregular heart beats, cardiac arrest and vascular diseases, and a ‘small yet consistent’ link between short–term exposure to high pollution levels and death has been found.

ABI Index

The ratio of ankle to brachial systolic blood pressure or the ankle–brachial index (ABI) is useful in gauging arterial insufficiency.

1. Normal ABI is 1.0

2. Claudication occurs at ABI <0.8
3. Rest pain and non healing ulcers occur at ABI <0.4

Toe–brachial index can be used in diabetic or renal failure patients where tibial arteries are calcified and non compressible.

Penile–brachial index (PBI) can be used when vasogenic impotence is suspected; PBI <0.6 suggest significant arterial disease


Legal Column

Forensic Column: Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

WMA declaration of Malta on hunger strikers – Guidelines for medical management

Physicians need to satisfy themselves that food or treatment refusal is the individual’s voluntary choice. Hunger strikers should be protected from coercion. Physicians can often help to achieve this and should be aware that coercion may come from the peer group, authorities or others, such as family members. Physicians or other health care personnel may not apply undue pressure of any sort on the hunger striker to suspend the strike. Treatment or care of the hunger striker must not be conditional upon suspension of the hunger strike. If a physician is unable for reasons of conscience to abide by a hunger striker’s refusal of treatment or artificial feeding, the physician should make this clear at the outset and refer the hunger striker to another physician who is willing to abide by the hunger striker’s refusal.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity

Imaging studies commonly used for the evaluation of pancreatic disease: 

•  USG
•  CT scan 
•  ERP (endoscopic retrograde pancreatography)
•  EUS (endo ultrasound) and
•  MRI 

Question of the day

What are the common misconceptions about diet in diabetes mellitus? (Ms. Sonal V Modi)

A diabetic diet is usually an extremely restricted diet with only a few varieties of food allowed. In fact, today the scenario regarding nutrition management in diabetes is completely different. A diet recommended to a diabetic is the same as that recommended to the general population. It works as a prudent, preventive diet as it is usually low in simple sugars and saturated fats; high in complex carbohydrate, protein and fiber. The qualitative aspect of the diabetic diet in terms of both carbohydrate and dietary fat as well as the cooking methods recommended is extremely beneficial towards preventing chronic, degenerative diseases.


Public Forum (Press Release for use by the newspapers)

Routine HIV Testing Recommended for All Women, Regardless of Individual Risk Factors

Women represent the fastest growing population of persons infected with HIV said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health.

A committee opinion issued by the American College of Obstetricians and Gynecologists (ACOG) and published in the Obstetrics and Gynecology recommends HIV screening for all women aged 19 to 64 years, regardless of their risk factors and targeted screening for women outside this age range who are at high risk. For example, all sexually active teenagers under 19 years should be tested, as well as women older than 64 years who have had multiple partners in recent years.

Currently, testing is done only for pregnant patients, patients at high risk, and/or upon patient request. Present recommendation on HIV screening emphasises "opt–out" testing as the preferred approach.

Reduce salt to reduce blood pressure

Dr Aggarwal also said if left untreated, high blood pressure can increases the risk of coronary heart disease, heart attack and stroke. A large British study of more than 11,000 European men and women, by researchers at the University of Cambridge, reaffirms that salt intake has a significant effect on blood pressure, and it is clearly something that one can control.

The study published in the American Journal of Clinical Nutrition noted that people who took in and excreted more salt had higher blood pressure, regardless of genetic factor or the gene for angiotensinogen, a molecule that can raise blood pressure by tightening arteries.

The study clearly showed that people who had high salt intake were the ones who had high blood pressure. This was independent of the genotype for this specific gene.

As per Ayurveda also, most patients with high blood pressure are salt sensitive. Both pitta and kapha personalities will increase their BP with increase in salt–intake. However the Vata constitution types may not be salt sensitive.

Reducing salt intake to no more than 100 mmol per day which is 2.4 grams of sodium or 6 grams of common salt can reduce blood pressure by 2–8 mm of Hg.


Conference Calendar

Infertilty update: new frontiers

Moolchand Medcity is organizing a CME on
Date: Saturday 21.8.10 at 2.30 to 5pm.
Course organizers:
Dr. Aanchal Agarwal/Dr. Rashmi Sharma
For free registration contact: 9810120619/9810252619


Medi Finance

Q. Can a return be filed again if the doctor filing the return thinks that there was some defect in the return filed?

Ans. Doctor can file a revised return within one year from the assessment year or before the assessment is completed whichever is earlier.


An Inspirational Story

Life itself isn’t hard

A student asked a teacher, "What is love?"

The teacher said, "in order to answer your question, go to the wheat field and choose the biggest wheat and come back. But the rule is: you can go through them only once and cannot turn back to pick."

The student went to the field, got through the first row, he saw one big wheat, but he wondered…may be there would be a bigger one later.

Then he saw another bigger one… but again he thought that may be there was an even bigger one waiting for him.

Later, when he had gone through more than half of the field, he started to realize that the wheat was not as big as the previous one he had seen; he knew that he had missed the biggest one, and he regretted.

So, he went back to the teacher empty-handed.

The teacher told him, "…this is love… you keep looking for a better one, but when later you realize, you have already missed the person…"

*"What is marriage then?" the student asked.

The teacher said, "in order to answer your question, go to the corn field and choose the biggest corn and come back. But the rule is the same: you can go through them only once and cannot turn back to pick."

The student went to the corn field, this time he was careful not to repeat the previous mistake. When he reached the middle of the field, he picked one medium–sized corn that he felt would be satisfactory, and came back to the teacher.

The teacher told him, "this time you brought back a corn… you looked for one that was just nice, and you had faith and belief this was the best one you got… this is marriage."

(Contributed by Dr Chandresh Jardosh)


IJCP Special

Dr Good Dr Bad

Situation: A patient with community–acquired pneumonia (CAP) required hospitalization.
Dr Bad: Start a macrolide.
Dr. Good: Start combination of macrolide and third–generation cephalosporin.
Lesson: Combination therapy with a marcolide + third generation cephalosporin is the treatment of choice for CAP patients requiring hospitalization.

Make Sure

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given?
Lesson: Make sure that in all dengue patients, pulse pressure (upper minus lower blood pressure) is maintained above 40.

Quote of the Day

Shakespeare …"Never play with the feelings of others because you may win the game, but you will surely lose the person for life time".

Asthma Alert

Nebulizer versus MDI (MDI is better)

  1. The relatively large particle size generated by continuous flow nebulizers and the loss of drug from the expiratory port of the nebulizer system make this method of delivery relatively inefficient compared to a metered dose inhaler (MDI).

  2. Comparisons of MDI plus spacer systems to nebulizer delivery, using the same beta agonist (asthma reliever drug) but in much reduced doses, have demonstrated comparable improvements in lung function.

  3. Four to six carefully administered inhalations from an MDI with spacer have generally been found to equal one nebulizer treatment.

Take home message: Inhalers area as good as and even better than nebulizers even in emergent situations. In emergency situation give 6 does of inhalers with spacer every 20 minutes for the next one hour. Over 60% of the admissions thus can be saved.


International Medical Science Academy (IMSA) Update

That the risk of multiple sclerosis increases with latitude from south to north has been challenged by findings from a 2010 systematic review and meta-analysis (Lancet Neurol 2010;9:520).


Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name


DCI Approval Date

Celecoxib Mouth–Dissolving Tablet 50/100/200 mg

For the treatment of Osteoarthritis and Rheumatoid Arthritis



Lab Test

LDL Cholesterol = Total cholesterol (–) HDL Cholesterol (–) VLDL Cholesterol


Lateral thinking

Read this………………


The answer for yesterday’s puzzle "there is life after forty"

Correct answers received from: Dr Ashok Wasan, Dr Muthumperumal Thirumalpillai, Dr.Akshat Bhargava, Dr.R.K.Goel, Dr Meera Rekhari, Dr. Rohini Vaswani, Dr. Dinesh Kumar S, Dr Ashok Kumar

Correct answer received for 17h August Puzzle from: Dr Anurag Jain, Dr Anupam Sethi Malhotra

Send your answer to ijcp12@gmail.com


Humor Section


Four expectant fathers were in a Minneapolis hospital waiting room while their wives were in labor. The nurse arrived and proudly announced to the first man, "Congratulations, sir. You’re the father of twins!"

"What a coincidence! I work for the Minnesota Twins Baseball team!"

Later the nurse returned and congratulated the second father on the birth of his triplets.

"Wow! That’s incredible! I work for the 3M Corporation."

An hour later, the nurse returned to congratulate the third man on the birth of his quadruplets. Stunned, he barely could reply, "I don’t believe it! I work for the Four Seasons Hotel!"

After this, everyone turned to the fourth guy who had just fainted. The nurse rushed to his side.

As he slowly gained consciousness, they could hear him mutter over and over, "I should never have taken that job at 7–Eleven. I should never have taken that job at 7–Eleven. I should never have taken that job…

(Contributed by Dr GM Singh)

Poems written by Wife and Husband

The rain makes all things beautiful, The grass and flowers too,
If rain makes all things beautiful, Why doesn’t it rain on you?

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 a cage, but laughing at you

(Contributed by Dr Chandresh Jardosh)

  Readers Responses (AMCD)
  1. Dear Dr Aggarwal, I totally agree with AMCD and the efforts to raise the concern against the exploitation being done on the consultants esp with this new categorization and various other issues which need solutions. Pl let me know if I can be help to this association. Dr Bharat Gopal
  2. Dear All, The gradation of the hospitals by Insurance and TPA`s is by the infrastructure and add on facilities provided. It has to do little or nothing with the Doctors/ consultants qualifications, experience, expertise and competent.  A good consultant in class C set up  will be treated as  C category while a bad consultant in class A set up  will be treated as A. This is unprofessional and should be opposed. Kindly also note that there is attrition of RMOs and staff from Nursing homes Further my reading and understanding of the NHAB is that ta single   clinic or small diagnostic centers and nursing homes are at par with a 200 bedded hospital paying same fees for inspection and a annual fees of  Rs.2 lakh  to QCI /NHAB  for what. Dr Anil Varshney, National consultant to GOI  for World Bank assisted Project, formerly with UNICEF and WHO, chief coordinator , Health-care Consultancy services.
  3.  Dear Dr. KK Aggarwal: Now AMCD is opposing categorisation. For your kind information this is going to happen after the implementation of Clinical Establishment Bill as per clause 13, there will be classification of clinical establishments as per the norms set by national council. I had requested you that the bill is passed in Rajya Sabha and also sent a article to you. I hope it is a high time to create awareness regarding CLE bill and to make opinion on the adversities of this bill of the medical fratenity. We need brain storming sessions to find way to oppose this bill may be legally. Dr. Yash Sharma, Ex-Member Punjab Medical Council, IMA Punjab State President 2009

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26 th September: Sunday- BSNL Dil ka Darbar A day-long interaction with top cardiologists of the city. 8 AM - 5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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