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Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



 emedinews is now available online on www.emedinews.in

24th December Thursday

Dear Colleague,

       American Heart Association Top Ten Researches in 2009
1. Comparison of weight loss diets with different compositions of fat, protein and carbohydrates: This study found that it was not so much what types of food dieters ate that helped them lose weight as it was the number of calories they consumed. Over a two year period, 811 overweight adults were assigned to one of four diets that differed from high to low fat, average to high protein and highest to lowest carbohydrates. Participants in all comparison groups successfully lost weight on the reduced calorie diets, with no one diet type resulting in any marked superiority. [N Engl J Med 2009;360:859 73]

2. Declines in acute myocardial infarction after smoke free laws and individual risk attributable to secondhand smoke: This study found that enacting strong smoke free legislation is associated with rapid and substantial reductions in heart attacks. One year after passing smoking bans, communities in North America and Europe had 17 percent fewer heart attacks compared to communities without smoking restrictions, and the number of heart attacks kept decreasing with time. [Circulation 2009;120;1373 1379]

3. Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure: Researchers found that a commitment to quality healthcare can result in lower mortality rates for heart attack and heart failure patients. Hospitals receiving performance awards from the American Heart Associationís Get With The Guidelines (GWTG) quality improvement initiative showed lower death rates for heart attack and heart failure patients than other hospitals. According to study authors, while hospital characteristics explained some of this reduction in mortality, improved process of care was also an important factor. The study provides evidence that quality improvement programs that improve processes of care for heart disease may also improve patient outcomes. [Am Heart J 2009;158:546 53]

4. Ticagrelor versus clopidogrel in patients with acute coronary syndromes (From the Study of Platelet Inhibition and Patient Outcomes - PLATO - investigators): The new anti clotting drug appeared to work better than the current standard in reducing deaths from heart attacks and stroke. In this multicenter, double blind, randomized trial 18,624 patients admitted to the hospital with an acute coronary syndrome were given either the new drug, ticagrelor, or clopidogrel to gauge the drugs' effectiveness in preventing cardiovascular events. After one year, deaths from vascular causes, heart attack or stroke had occurred in 9.8 percent of patients receiving ticagrelor as compared with 11.7 percent of those receiving clopidogrel. [N Engl J Med 2009;361:1045 57]

5. Circulating transforming growth factor Ŗ in Marfan syndrome
This study presented evidence that circulating transforming growth factor beta (TGF) may be a biomarker useful for monitoring treatment in patients with Marfan syndrome, an inherited connective tissue disorder that affects nearly one in 5000 people. Marfan syndrome affects many parts of the body, including the aorta which may be weak and need surgical treatment. Researchers in this study tested treatments of losartan and beta blockers in mice and humans and found that blood levels of TGF, which are elevated in Marfan syndrome, decreased after patients received either or both therapies. [Circulation 2009;120;526 532]

6. Dabigatran versus warfarin in patients with atrial fibrillation (from the Randomized Evaluation of Long Term Anticoagulation Therapy - RE LY - study group): A new class of oral blood thinners proved beneficial for preventing stroke in patients with atrial fibrillation. Researchers randomized 18,113 patients who had atrial fibrillation and a risk of stroke to receive dabigatran, 110 mg or 150 mg twice daily, Or adjusted dose warfarin. Over a two year follow up, the patients receiving 110 mg of dabigatran had rates of stroke and systemic embolism similar to those on warfarin, as well as lower rates of major hemorrhage. Rates of stroke and system embolism were lower in those patients receiving 150 mg of dabigatran, compared with warfarin patients, but the rate of major hemorrhage was similar. [N Engl J Med 2009;361:1139 51]

7. Generation of functional ventricular heart muscle from mouse ventricular progenitor cells: In this study, scientists grew a piece of spontaneously beating heart muscle using stem cells from a mouse embryo. This is a major advancement toward one day repairing damage caused to the heart muscle by a heart attack. [science, October 16, 2009; Science 2009;326;426 29]

8. Genome wide association study identifies eight loci associated with blood pressure: These studies identified specific genes associated with hypertension, a major risk factor for heart disease and stroke. The findings could significantly improve the understanding of high blood pressure and could lead to potential targeted drug therapies for preventing and treating this disease. [Nature Genetics, June 2009; Nat Genet 2009; 41; 666 77; 677 87]

9. Prevalence and progression of subclinical atherosclerosis in younger adults with low short term but high lifetime estimated risk for cardiovascular disease: The Coronary Artery Risk Development in Young Adults Study (CARDIA) and Multi Ethnic Study of Atherosclerosis (MESA): In this study, researchers found that even younger people who did not have a high short term risk of heart disease (over the next 10 years or less) may have a significant lifetime risk of developing heart disease if they have several risk factors that contribute to the disease. These patients often experienced more severe disease over the course of their lifetime and also experienced atherosclerosis (plaque deposits causing hardening of the arteries) at a younger age than those people who had fewer or no risk factors. This study is an important look at how the presence of risk factors early in life can be crucial to the lifetime risk of cardiovascular disease. [Circulation 2009;119;382 389]

10. Functional cardiomyocytes derived from human induced pluripotent stem cells: This paper shows that functional heart muscle cells can be produced from induced pluripotent stem (iPS) cells in humans. These findings support the concept that cardiac regeneration can be approached using iPS cells from the individual as a source of new tissue.  [circulation, Feb. 12, 2009; Cir Res 2009;104;e30 e41]

Dr KK Aggarwal 





Take home messages from the Medicine Update 2009, MAMC: Part1

H1 N1 Flu (Dr Koushik Dutta & Dr N P Singh)

1. The disease presently fits in the post pandemic position of population epidemiology curve. So, seeking history of contact with cases has lost relevance.
2. Closing schools and institutions after finding cases, is not recommended.
3. Simple hygienic measures like keeping physical distance from a case (6 feet), covering the nose and mouth while sneezing/ coughing, hand washing, etc. are valuable in prevention.
4. Surgical face mask is nearly as effective as the N95 respirator (which should be reserved for people directly handling cases only).

Follow the MOHFW guidelines:
Category A:
mild symptoms like sore throat, bodyache, diarrhoea, no oseltamavir, no testing. Home confinement and monitoring recommended.
Categories B1 & B2: Symptoms as Cat. A + High fever, include high risk groups (e.g. Child less than 5 yrs, pregnant women, persons above 65 years, patients with co-morbid chronic disease), home confinement plus Oseltamavir.
Category C: breathlessness, chest pain, drowsiness, blood in sputum, fall in BP; in addition to symptoms of cat. A and B, hospitalize and treat with oseltamavir.

Dr Monica and Dr Brahm Vasudeva

Milk thistle (Silybum Marianum) may curb chemotherapy induced liver damage.
An extract from milk thistle, a herb, may help reduce the liver inflammation associated with chemotherapy (Columbia University researchers).

Reducing TV time may spur calorie burn.
Researchers have found a correlation between turning off the TV and lifestyle habits, according to the paper in the Archives of Internal Medicine. Indeed, the fact that  less time watching TV means more calories burned  is  hardly surprising,  but investigators say it  may provide clinicians with a new tool to stem the tide of overweight and obesity.

Most women do not think benefits of tamoxifen outweigh risks.
A study in Breast Cancer Research and Treatment included 632 women whose five year risk for breast cancer made them candidates for tamoxifen. Researchers found that virtually every woman in the study said she would be unlikely to take the drug, while  just six percent said they would consider it after talking to their doctors, and only one percent reported actually filling a prescription for it.  80 percent cited worries about side effects. The study concluded that participants did not think the benefits of tamoxifen outweighed the risks. 

ECMO devices seen as viable options to ventilators
ECMO device is a bridge between respiratory failure and lung transplants and a possible alternative to ventilators.  Extracorporeal membrane oxygenation devices have role in treating swine flu, COPD, pneumonia, and pulmonary fibrosis. Matthew Bacchetta, of the New York Presbyterian Hospital Columbia, explains a ventilator pushes air into the lungs instead  of having the air  naturally  drawn in, and that  often causing lung damage from the pressure differences.  The ECMO machines, bypass the lungs and directly oxygenate the blood.  ECMO, patients can  have most liquids and foods, which helped [them] gain weight and strength. 

Experts tout benefits of heart pump
Left ventricular assist device benefits patient with heart failure. A recent study published in the New England Journal of Medicine found that after two years, participants using the device had a 58% survival rate.

Antiretroviral treatment reduces suicide rate among Swiss AIDS patients.
Suicide among AIDS patients in Switzerland dropped by more than 50 percent after they started getting antiretroviral drugs in 1996, according to a Swiss paper in the American Journal of Psychiatry.

FDA scales back dietary, health restrictions on Azilect label
US health regulators scaled back dietary and health restrictions on its Parkinson    s Disease drug rasagiline. The new labeling eases concerns about drug interactions with other medications, including over the counter cold medicines. The updated label also states that patients no longer have to follow general dietary restrictions on levels of tyramine, an amino acid found in certain foods, including air dried and fermented meats.

FDA says Tarceva slows progression of lung cancer following chemotherapy.
FDA posted documents that erlotinib slows the progression of lung cancer and extends patients lives when used as a follow up to chemotherapy.

Funny clinical notes (Dr. Minakshi)
Patient was alert and unresponsive.

Situation: a patient came  with 105 fever
Dr Bad: Give 2 tab of paracetamol
Dr Good: First do tepid water sponging
Lesson: Paracetamol may not work when the fever is > 104.


1. Reduces phone tag?
2. Help convey information & get responses to questions more quickly and effectively.
3. Keep many people informed with the same information at the same time?
4. Is a way to share information without having to set up meetings?
5. Helps maintain a written record of discussions, decisions, and agreements?
1. Unplanned, poorly written messages may not convey information clearly.
2.  Sloppy messages riddled with errors in grammar, spelling, and even punctuation can contribute to loss of credibility.
3. Potential loss of confidentiality exists when emails contain private or proprietary information.
4. Body language, tone of voice, or facial expressions that help one interpret communication are absent in email, which can lead to misunderstandings.
5. Time can easily be wasted looking for emails and constantly checking for new email.
Some messages, particularly negative feedback, are be best conveyed face to face.(Sources: Dr. Shonu Das, How to Write and Manage email in the Workplace by Janis Fisher Chan) 

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Letter to the editor

1. It is another step of progress to have Olanzapine in depot form, however there has been some side effects reported in clinical trial, which might impact compliance. Post injection syndrome is one of them and it carries risk after every injection though. Post injection syndrome includes a range of signs and symptoms like sedation which ranges from mild sedation to deep sleep and coma, and/or delirium including confusion, anxiety and agitation consistent with olanzapine overdose. Other symptoms include dizziness, weakness, altered speech/dysarthria, hypertension and seizures. Higher doses, increased age and low body mass index may confer a higher risk for post-injection syndrome. There are no controlled data directly comparing olanzapine depot injection with any other depot antipsychotics. Ref: http://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4338b1-03-Lilly.pdf. Regards. Dr.Neeraj Gupta. Consultant Psychiatrist

2. Thanks for your updates: Dr Varsha


emedinews: revisiting 2009
IJCP Group, Heart care Foundation of India and World Fellowships of Religions are  is organizing emedinews: revisiting 2009, day long conference on the top health happenings in the year 2009 on 10th Jan 2010 at Maulana Azad Auditorium. There is no registration fee however advanced information is required.  Top experts (Dr KK Aggarwal (revisiting 2009), Dr Naresh Trehan (whats new in cardiac surgery), Dr Ajay Kriplani (Current Trends in the Management of Morbid Obesity), Dr Praveen Chandra (The Indications of Interventional Treatment in Cardiology), Dr Kaberi Banerjee (IVF Where We Stand Today?) Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephroprotection), Dr. Ambrish Mithal (Diabetes), Dr Vanita Arora (ECG arrhythmias), Dr N Subramanium (Current concept in Male infertility ), Dr Neelam Mohan (Coeliac Disease), Dr. Sanjay Chaudhary (Eye Update), Dr Harish Parashar (aluminum toxicity), Dr Praveen Khillani (Whats new in field of critical care in past decade?), will deliver lectures.

CME will be followed by lively cultural evening guest performances by Shabani Kashyap, Vipin Aneja and perfomances by medical professional singers Dr Praveen Khillani, Dr Lalita and Dr N Subramanium, Dr Lata Tandon, Dr Arti Pathak, Dr Sudipto Pakrasi, Dr Harjeet Kaur, Dr Ramni Narsimhan, Dr Sanjay Chugh (on the drum), Dr Yash Gulati (Anchor) Dr Reshma Aggarwal (Anchor), doctors of the year award, dance and dinner. For registration mail emedinews@gmail.com. We have crossed 1200 registrations.



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