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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 …

22nd July 2011, Friday

Should we measure carotid intima media thickness in
any cardiac risk assessment?

Measuring maximum intima–media wall thickness of the internal carotid (neck) artery may boost the predictive power of Framingham risk scores as per Dr Joseph Polak, of Tufts University, and colleagues who reported their findings in the New England Journal of Medicine.

  1. Thickening in both arteries is used as a surrogate measure of atherosclerosis.
  2. In the common carotid it manifests as diffuse arterial wall thickening.
  3. In the internal carotid artery, it’s a surrogate for focal atherosclerotic plaque.
  4. Both are recognized tools for cardiovascular risk assessment.
  5. To clarify the issue, Polak and colleagues analyzed data from 2,965 patients in the Framingham Offspring Study who were followed for an average of 7.2 years, and 296 of them had a cardiovascular event during that time.
  6. Plaque is defined as an intima–media thickness of more than 1.5 mm in the internal carotid artery. Plaque in ICA is a significant predictor of cardiovascular events.
  7. Recent American College of Cardiology and American Heart Association guidelines give common carotid artery intima–media thickness a level IIa recommendation for risk evaluation –– the same level as ankle–brachial index and coronary artery calcium scoring.
  8. Intima–media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of cardiovascular risk assessment.

For comments

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Dr KK Aggarwal
Group Editor in Chief

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Should we measure carotid intima media thickness in any cardiac risk assessment?

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    Photo Feature (From HCFI Photo Gallery)

National Conference on Insight on
Medico Legal Issues

Dr Kaberi Banerjee delivers a lecture on MTP and PNDT Acts in the recently concluded Conference on Insight on Medico Legal Issues.

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


Energy drinks are a health risk, says CSE study

Energy drinks consumed to increase stamina do more harm to health than good and can lead to addiction to alcohol, a study released by NGO Centre for Science and Environment said. The CSE had tested two samples each of eight popular energy brands sold in India and found 44% of the samples breached the safety limit of 145 particles per million (ppm) of caffeine prescribed under the Prevention of Food Adulteration Act, 1954. Caffeine is a psycho–stimulant and can lead to seizure, strokes and even death. "These drinks are touted to have major health benefits but could be doing irreparable harm instead, mainly to the young ones," the CSE said in a statement on Monday. Other sources of caffeine are tea and coffee. (Source: Hindustan Times, Jul 18, 2011) For comments and archives

Rajasthan youth creates world’s biggest ashtray

JAIPUR: Every day we come across the warning, ‘smoking is injurious to heath’ at many places. However, rarely does it evoke a thought in our mind on the ill–effects of tobacco. But there are a few individuals who do take it seriously. Jaipur boy Akshat Pabuwal (18) is one such person. He has secured a place in the Guinness and Limca book of world records for creating the biggest ‘ashtray’ in the world. This ashtray, made in Jaipur, was unveiled on Monday evening at India Habitat Centre, New Delhi by Rohit Bal. The ashtray is a replica of World Health Organization (WHO) symbol against antismoking. "The statements warning people of health hazards against smoking is not deterring people from smoking. So I thought of re–defining the campaign by crafting this ashtray," said an elated Pabuwal, who was not aware that he was creating history. Made of white metal and gold–plated with traditional Rajasthani meenakari, the ashtray is 48x48 inches in length and breadth. The design is rectangular, having a height of 12 inches. "Though an ashtray symbolizes smoking, once you see this beautifully–crafted piece with rose inscribed on the top, you will hate smoking," claimed Pabuwal. (Source: TOI, Jul 20, 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)

Super tomatoes’ can crush cancer

London: British researchers claim to have developed new "super tomatoes" fortified with minerals which can improve your immune system and help prevent cancer. The new varieties, which have hit shelves across the UK, have been enriched with selenium, a powerful anti–oxidant which the researchers believe could not only boost the immune system but also help prevent cancer. The mineral, found naturally in foods such as Brazil nuts, shellfish and liver, is also important for the thyroid gland, which determines how quickly the body uses energy and also produces proteins, the Daily Mail reported. (Source: TOI, Mumbai edition July 18, 2011) For comments and archives

New therapy to cure bowel incontinence

A new therapy is offering hope to millions of harried people worldwide who suffer from the debilitating condition of chronic bowel incontinence. The treatment called InterStim Therapy, is a minimally invasive procedure, which uses electrical impulses to stimulate the sacral nerve and improve muscle function. It is one of the only effective long–term treatments for bowel incontinence available to patients and Northwestern Memorial Hospital is one of the first medical centers to offer the procedure. (Source: TOI, July 19, 2011) For comments and archives

FDA Panel says no to new antidiabetes agent

The US Food and Drug Administration (FDA)’s Endocrinologic and Metabolic Drugs Advisory Committee (EMDAC) today voted 9 to 6 against recommending the approval of the novel antidiabetic agent dapagliflozin (Bristol–Myers Squibb and AstraZeneca), largely because of fears that the product may cause breast and bladder cancer. (Source: Medscape Medical News) For comments and archives

   Fitness Update

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

Major new exercise guidelines announced

New advice has been launched about how people of all ages can maintain fitness levels. The new guidance was launched as part of the first UK–wide physical activity guidelines by the four nations’ Chief Medical Officers. A key new element is a more flexible approach for adults to get their 150 minutes of activity in week. The guidelines build on previous advice but reflect the growing body of knowledge about physical activity levels and links to reducing the risk of serious diseases like heart disease, stroke, cancer and obesity.

Key new elements are:

  • Weekly exercise targets being more flexible for busy lives. Adults can get their 150 minutes of activity a week in ten minute or more and should aim to be active every day. 30 minutes five times a week is just one way this can be achieved.
  • A weekly target for adults to get 150 minutes of physical activity in bouts of ten minutes or more and to aim to be active every day.
  • More flexibility for busy lives – 30 minutes five times a week is a great way to be active, but there are many more.
  • More emphasis on vigorous activity and muscle strengthening through, for example gardening, group sports such as volleyball and netball or swimming. There is good evidence this stimulates bone formation and maintains muscle mass.
  • Advice tailored to every age group including – for the first time – guidance for parents for under-fives; and
  • Reducing and minimising periods of sedentary behaviour in leisure time.


For comments and archives

   Twitter of the Day

@DrKKAggarwal: DMBindia:In post–hoc analysis of pts with reduced renal fun and/or proteinuria (ONTARGET & TRANSCEND trials)…http://fb.me/OA2kBMs7

@DeepakChopra: #vmdhealthblog Do you know what are the dangers of High–Fructose Corn Syrup? Read my Health Tip to find out!bitly.com/Dpak_Corn

    Dr KK Answers

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

How common is atrial fibrillation after myocardial infarction?

Atrial fibrillation (irregular heart rhythms of the smaller atrial chamber) is common during hospitalization for acute heart attack. Approximately 40 percent of individuals developed atrial fibrillation two years, and many of these episodes are asymptomatic. (Heart Rhythm 2011;8:342) For comments and archives

    Spiritual Update

The art of controlling anger

Cynicism is one of the recognized major risk factor for causation of coronary artery disease (blockages in the channels supplying blood to the heart). And anger, jealousy and irritability form the triad responsible for this. Anger is the enemy of peace, knowledge and devotion. According to Ayurveda

For comments and archives

    An Inspirational Story

(Dr Prachi)

The Mountain Climber

They tell the story of a mountain climber who, desperate to conquer the Aconcagua, initiated his climb after years of preparation. But he wanted the glory to himself, therefore, he went up alone. He started climbing and it was becoming later, and later. He did not prepare for camping, but decided to keep on going.

Soon it got dark. Night fell with heaviness at a very high altitude. Visibility was zero. Everything was black. There was no moon, and the stars were covered by clouds. As he was climbing a ridge at about 100 meters from the top, he slipped and fell. Falling rapidly he could only see blotches of darkness that passed. He felt a terrible sensation of being sucked in by gravity. He kept falling… and in those anguishing moments good and bad memories passed through his mind. He thought certainly he would die.

But then he felt a jolt that almost tore him in half. Yes! Like any good mountain climber he had staked himself with a long rope tied to his waist. In those moments of stillness, suspended in the air he had no other choice but to shout: "Help me God. help me!" All of a sudden he heard a deep voice from heaven… "What do you want me to do?" "Save me." "Do you really think that I can save you?" "Of course, My God." "Then cut the rope that is holding you up." There was another moment of silence and stillness. The man just held tighter to the rope.

The rescue team says that the next day they found a frozen mountain climber hanging strongly to a rope... Two feet off the ground.

How about you? How trusting are you in that rope? Why don’t you let it go? I tell you, God has great and marvelous things planned for you. Cut the rope and simply trust in him.

(Source: http://www.inspire21.com/stories/faithstories/TheMountainClimber)

For comments and archives


(By Ritu Sinha)

A bird in the hand is worth two in the bush: Having something that is certain is much better than taking a risk for more, because chances are you might lose everything.

    Pediatric Update

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

Should hepatitis A vaccine be given?

Hepatitis A vaccine is not routinely recommended. People who should be vaccinated include:

  • All children starting at age 1 year (12–23 months)
  • People aged 12 months or older who are traveling to or working in endemic areas
  • Homosexuals
  • Users of illicit drugs, injectable or noninjectable
  • People with chronic liver disease
  • People who anticipate having close personal contact with an international adoptee from a country of high or intermediate endemicity during the first 60 days
  • People who have blood clotting disorders
  • People who work with HAV–infected primates or with HAV in a research laboratory setting
  • Any person who wishes to be immune to HAV infection

In an endemic country like India, routine vaccination for all children is not recommended, therefore, it is an optional vaccine and especially children of high income group are suggested to take the vaccine as they have lower chances of natural immunity against Hepatitis A. Two doses of vaccine at a gap of 6 months are recommended after the age of 18 months.

For comments and archives

    Did You Know

(Dr Uday Kakroo)

The Earth gets 100 tons heavier every day due to falling space dust.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Hemoglobin electrophoresis

  • To detect each type of hemoglobin in the blood. This can be used to diagnose certain types of anemia (such as thalassemia).
  • To check treatment for diseases that have abnormal types of hemoglobin in the blood.
  • To help couples to find out how likely they are to have a child with certain forms of anemia that can be passed from a parent to a child (inherited).

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with sleep apnea wanted to know his cardiac risk.
Dr. Bad: There is no risk.
Dr. Good: There is a risk.
Lesson: Obstructive sleep apnea is associated with development of coronary artery diseases and heart failure. For comments and archives

Make Sure

Situation: An HIV patient died after sulfa prophylaxis.
Reaction: Oh my God! You should have known that he was sulfa sensitive.
Lesson: Make sure that patients with a history consistent with Stevens Johnson syndrome and toxic epidermal necrolysis or an exfoliative dermatitis due to a sulfonamide medication should strictly avoid the culprit drug and other agents in the same sulfonamide group. Re–exposure to the same agent may be fatal. For comments and archives

  Quote of the Day

(Dr GM Singh)

Books are the bees which carry the quickening pollen from one to another mind. James Russell Lowell

  Rabies Update

(Dr AK Gupta, Author of "RABIES – the worst death")

What are most dangerous sites of bites/exposure in man?

Theoretically, the richly innervated areas like head, neck, face, hands and genitals are the most dangerous sites of bite in man. But in reality, it is often the wounds on legs, which are ignored/neglected, that cause rabies. For comments and archives

    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

At what age should mammography be done ?

Among younger women (40–49 years), breast cancer is uncommon, and screening mammograms are associated with high false–positive rates and unnecessary biopsies; accordingly, the U.S. Preventive Services Task Force (USPSTF) has recommended against routinely screening women before age 50 in Nov 2009 updated guidelines. A study from Sweden has shown that mammography in this age group lowered mortality. From 1986 to 2005, 803 screened women and 1238 unscreened women died from breast cancer that was diagnosed at age 40–49. The relative risk for fatal breast cancer associated with screening was 0.71 (95% confidence interval, 0.62–0.80) in women in their 40s. The authors estimated that during a 10–year period (about 6 mammography screens), one case of fatal breast cancer was prevented for every 1252 women screened.

Summary of USPSTF Recommendations for Mammography

  • The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. (Grade B recommendation).
  • The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. (Grade C recommendation).
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (Grade I Statement).
  • The USPSTF recommends against teaching breast self–examination (BSE). (Grade D recommendation).
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. (Grade I Statement).
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. (Grade I Statement).

So for the time being, the consensus is that in this age group of 40–49, the high–risk women should be screened but not those without high risk. For comments and archives

    Insight on Medicolegal issues

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

False negative chemical analysis report of viscera–autopsy

The doctor who conducts an autopsy in case of death due to poisoning and after ruling out any other cause of death and based on clinical evidence, if he forms a conclusive opinion that the death is due to poisoning, he has all the authority to inform the investigating officer. He must mention, in his postmortem report, his conclusive opinion and that he is preserving viscera for chemical analysis. A false-negative test report may be received due to:

  • Delay in chemical analysis
  • Improper preservation
  • Use of wrong analytical technique
  • Early disintegration of poison
  • Complete metabolism
  • Lack of suitable test for certain poison

In accordance with a judicial pronouncement, the doctor who has conducted the postmortem examination, on the basis of his examination and findings suggestive of poisoning in postmortem can give his opinion regarding the cause of death to be due to poisoning in spite of negative viscera report.

For comments and archives

    Mind Teaser

Read this…………………

One of the following statements regarding pathophysiology of UTI is true.

a. Immunological factors are not involved
b. Increase in urinary progestins and estrogens helps in resisting bacteria
c. Increase in plasma volume decreases urinary oligosaccharides
d. Aminoaciduria does not affect invasion of bacteria

Yesterday’s Mind Teaser: The prevalence of symptomatic bacteriuria in pregnant women is

a. 25%
b. 30%
c. 10%
d. <5%

Answer for yesterday’s Mind Teaser: c. 10%

Correct answers received from: Dr K Raju, Dr Chandresh Jardosh, Dr BB Aggarwal, Dr Suneera,
Dr Rashmi Chhibber, Dr Rakesh Bhasin.

Answer for 20th July June Mind Teaser: Two–timer
Correct answers received from: Dr Rashmi Chhibber, Dr Rakesh Bhasin, Dr KV Sarma, Dr Prabha Sanghi.

Send your answer to ijcp12@gmail.com

    Medi Finance Update

(Dr GM Singh)

Superior returns: FMP’s invest mainly in rated debt instruments where returns may be higher, an attractive option for risk–averse investors.

    Laughter the Best Medicine

(Dr. GM Singh)

Two cops are talking, one cop says that every time he pulls over a drunk, he always says that he only had 2 beers. The next time I pull one over & he tells me the truth, I let him go. Later that day he pulls over a drunk driver. He’s so drunk the cop has to hold him up. He asked the person what had he been drinking? The drunk said: "Beer." The cop asked how many. The drunk puts up one finger & then a second finger. The cop said: "Two!!!" The drunks said: "No, 11." For comments and archives

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Bicalutamide Tablet 150 mg.(Additional Strength and Indication)
Indicated either alone or as adjuvant to radical prostatectomy or radiotherapy in patients with locally advanced prostate cancer at high risk for disease progression.
    Public Forum

(Press Release for use by the newspapers)

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

Food allergy from non food items

Non–food items may contain food ingredients to which people may develop allergy, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela. Giving examples he said that:

  1. Gelatin, egg, and chicken products may be used in the production of certain vaccines.
  2. Gelatin is included in measles, mumps, rubella (MMR), varicella, diphtheria, tetanus, acellular pertussis (DTaP) and Japanese encephalitis vaccines.
  3. Egg protein is present in yellow fever and influenza vaccines.
  4. Some people with egg allergies can be given the influenza vaccine safely.
  5. Chicken proteins may be present in the yellow fever vaccine.
  6. Lactose is a sugar derived from milk. Highly allergic patients should avoid using products that contain lactose (e.g, use metered dose inhalers rather than dry powder inhalers that contain lactose).
  7. Soy lecithin is the fatty derivative of soy and it contains trace amounts of soy proteins. Certain asthma inhalers contain small amounts of soy lecithin, which could potentially cause an allergic reaction in a person who was highly allergic to soybeans or peanuts. You should discuss the risks and benefits of these inhalers with your healthcare provider.
  8. Casein is a cow’s milk protein used as an anti–stick agent on latex gloves.
  9. Cosmetics may contain a variety of food–derived ingredients, including milk, nut oils, wheat, and soy.
  10. Craft items like modeling dough may contain wheat.
  11. Egg white is sometimes used to smooth finger–paints.

For comments

    Readers Responses
  1. Dear Sir, In reference to the query raised in the Reader’s column (16th July 2011) by Dr S K Verma regarding OTC drugs & the subsequent response from eMedinews, I wish to state that I agree with Dr Verma and that no drug in India has been classified as OTC drug under the Drugs & Cosmetic Act, 1940 & Rules, 1945. In fact, no such schedule exists; whatever does not come under Schedule C, D, H, X etc is wrongly categorized as "OTC". It is only a US/FDA nomenclature and has no legal stand in India. Even for sale of Ayurvedic/Homeopathic drugs, a chemist license is required. Its another thing that even drugs under restricted schedules are available freely in India as OTC ! Regards: Dr Kapil Aggarwal.
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.



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