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Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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; Member 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

Dear Colleague

26th February 2010, Friday

Coronary Artery Disease in the Young (Part 1)

Well–known fashion designer Rohit Bal suffered a heart attack and was admitted to Medanta Medicity in Gurgaon. Bal, 42, popularly known as ‘Gudda’ in the fashion industry, has been described as master of fabric and fantasy. Apart from designing for many Bollywood celebrities, Bal also has several international clients like Uma Thurman, Cindy Crawford, Pamela Anderson, Naomi Campbell and Anna Kournikova to name a few. He has been a brand ambassador of Omega watches since 2001 and has ventured into the hotel business by launching two restaurants – Veda and Cibo – in the capital. We will discuss trhe subject of CAD in the young.

What is CAD in the young?

Coronary artery disease (CAD) primarily occurs in patients over the age of 40 but younger men and women can be affected. Most use an age cut–off of 40 to 45 years to define ‘young’ patients with CAD.

How common is young CAD?

Advanced coronary atheromata is seen in 2 percent of men (aged 15 to 19). An advanced lesion is seen in 20 and 8 percent of men and women aged 30 to 34, respectively and 19 and 8 percent, respectively, have a ≥40 percent stenosis of the left anterior descending artery.(Autopsy studies)

How common is young MI?

In the Framingham Heart Study, the incidence of an myocardial infarction (MI) over a 10 year follow–up was 12.9/1000 in men 30 to 34 years old and 5.2/1000 in women 35 to 44 years old. In other studies, 4 to 10 percent of patients with MI were ≤40 or 45 years of age.

What is the risk of CAD with age?

  1. Age – relative risk 1.63 per six year increase

  2. Serum cholesterol – relative risk 1.92 per 40 mg/dL [1.04 mmol/L] increase

  3. Systolic blood pressure – relative risk 1.32 per 20 mmHg increase

  4. Cigarette smoking – relative risk 1.36 per 10 cigarette/day increase.

What are the risk factors in the young?

Young patients with MI usually have multiple risk factors for coronary heart disease (CHD).

  1. Cigarette smoking is the most common and most modifiable risk factor in young patients. It has been noted in 65 to 92 percent of young patients with MI, compared to 24 to 56 percent of patients older than 45 years of age.

  2. Younger patients with CHD more often have a family history of premature CHD: 41 compared to 28 and 12 percent in middle aged or elderly patients, respectively.

  3. The offspring of patients with premature CHD are more likely to have coronary risk factors than those without such a family history. These include overweight and high serum cholesterol, glucose, and insulin. These offspring are also more likely to have evidence of vascular disease such as endothelial dysfunction and increased carotid artery intima–media thickness.

  4. Hypercholesterolemia is common in young patients with CHD, but its prevalence is similar to that in older patients.

  5. When compared to older patients, young patients have lower mean serum HDL concentrations (35 versus 43 mg/dL) and higher serum triglycerides (239 versus 186 mg/dL.

  6. Hypertriglyceridemia is the most common lipid abnormality in young patients with MI. It may be associated with glucose intolerance and a predominance of small atherogenic LDL particles.

  7. Two other important coronary risk factors, diabetes mellitus and hypertension, appear to be less common in young patients with CHD than in older patients.

  8. Anger may be important in the development of premature CHD.

Dr KK Aggarwal
Chief Editor

News and Views

Common causes of Nasal congestion (Dr G M Singh)

  1. Having the common cold or flu.
  2. Having a sinus infection.
  3. Having allergies.
  4. Using nasal sprays or drops for longer than three days.
  5. Having nasal polyps.
  6. Being pregnant.
  7. Having a condition called vasomotor rhinitis

Managing hypoglycemia

People who have diabetes should carry at least 15 grams of a fast–acting carbohydrate with them at all times in case of hypoglycemia. The following are examples of quick sources of energy that can relieve the symptoms:
Non-diet soda– 1/2 to 3/4 cup
Fruit juice– 1/2 cup Fruit– 2 tablespoons of raisins
Milk- 1 cup
Candy– 5 Lifesavers
Glucose tablets–3 tablets (5 grams each)
If you don't feel better 15 minutes after having a fast–acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, take another 15 grams of a fast–acting carbohydrate.

Vaginal delivery after LSCS

Women who attempt vaginal childbirth after having several cesarean babies may not have a greater risk of complications than women who have had only one prior C–section, suggests a study published in the journal BJOG. Researchers from Washington University School of Medicine found that women with at least three prior C–sections showed no increased risk of uterine rupture during vaginal delivery. The researchers reviewed the records of 25,000 women who gave birth after having at least one prior C–section. The group included 860 women with at least three prior C–sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C–section. There were no cases of uterine rupture in either group

Aspirin associated with decreased risk for breast cancer recurrence and death

Women with breast cancer who take aspirin after their diagnosis may be less likely to experience recurrence or die of the disease. Doctors used data from the Nurses’ Health Study to perform a prospective observational study of aspirin use in 4,164 women diagnosed with stage I, II, or III breast cancer between 1976 and 2002. Aspirin use was first assessed 12 months after cancer diagnosis because it is contraindicated during chemotherapy. During follow-up, 341 women died of breast cancer. The adjusted relative risks (RRs) for breast cancer death with one, two to five, and six to seven days of aspirin use per week versus no use were 1.07, 0.29 and 0.36 respectively. The adjusted RRs for recurrence were 0.91, 0.40, and 0.57 for the same aspirin use categories compared with no use. (The Journal of Clinical Oncology, Feb. 16, 2010).

Classifying diabetic nephropathy should improve clinical management

Diabetic nephropathy is a major cause of end–stage renal disease, and diabetes rates are rising rapidly. The consensus group published new classifications in the Journal of the American Society of Nephrology. They classified diabetic nephropathy due to type 1 and type 2 diabetes together because of the substantial overlap of histologic lesions and renal complications.

Conference Calendar

IACTA 2010 – (13th National Conference of the Indian Association of Cardiovascular Thoracic Anesthesiologists)
Date: February 26–28, 2010
Venue: Swabhumi Heritage Park, Kolkata, West Bengal.

Quote of the Day

When a man is at his wits’ end it is not a cowardly thing to pray, it is the only way he can get in touch with reality. (Oswald Chambers)

Diabetes Fact

Type 1 diabetes is can now be treated with injections (insulin) or oral drugs (DPP 4 inhibitors, alpha–glucosidase inhibitors).

Public Forum (Press Release)

Burn the Internal Holika First

The story behind Holi starts with Holika, the sister of Hiranakashyap, father of Prahlad.
Narrating the story, Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS said that Hiranakashyap considered himself to be GOD and ordered every one including his own son Prahlad to worship him and not Lord Vishnu. When Prahlad refused to do the same, he was made to sit with Holika in an open fire. Holika had been granted a boon that she could not be burned even if she was on live fire. When she was made to sit with Prahlad on the live fire, the opposite happened. She lost her life and got burned but Prahlad came out alive from the fire.

The above story has a deep spiritual meaning. Every day of our life, Holi is celebrated deep inside our body.

Hiranakashyap represents one’s "EGO", Holika the sum total of all negative thoughts and Prahalad, the realized soul.

Ego, if takes over one’s control, impairs the power of judgment between good and bad. Under its influence one thinks, that he is the supreme power and not the soul consciousness.

Prahlad is the soul or one's true self. In Bhagwad Gita, Krishna and Yama in Kathopanishads talk about the soul’ "fire cannot burn it, water cannot wet it, air cannot dry it and weapons cannot cut it". It is imperishable and everlasting. Self realized persons are in a state of GOD acquaintance and nothing can destroy them.

The obstacles to self–realization are "attachment, anger, desire, greed and ego known as kama, krodha, lobha, moha and ahankar". When they overpower an individual, they take one away from the path of self–realization. Holika represents the sum total of the negative forces in the body, which if not controlled in time will lead to destruction of the human body.

Getting attached to any of the five senses can end in a vicious cycle and one can get burnt in this ‘chakarvyuha’ of attachments. Negative forces expressed or repressed, can burn any one over time. If one is truthful, and has attained a state of one-point contemplation on a known truth, all the negative forces will stay away.

The practice of burning Holi a day before the festival symbolizes burning up of all negative thoughts and neutralizing the poison arising out of them. Once negativity is removed, one can attain spiritual vision full of positive thoughts, which is celebrated as sharing and loving each other, the next day.

Who needs IVF (Dr G M Singh)

Patients suffering from the following disorders are advised to undergo IVF treatment:-

• Bilateral blocked Fallopian tubes
• Severe endometriosis
• Pelvic inflammatory disease with severe adhesion
• Ovulatory Dysfunction
• Six or more failed IUI
• Unexplained infertility
• Premature Menopause
• Failed reversal of Vasectomy/ Tubectomy
• Severe oligo, astheno or teratozoospermia
• Obstructive azoospermia
• Female age over 40 yrs
• Genetic diseases
• Surrogacy (Traditional/Gestational)

Breast Implants (Dr G M Singh) Patient Handout

1. Breast implants aren't guaranteed to last a lifetime.

2. You'll likely need additional surgery at some point to correct leakage or cosmetic issues.

3. If you decide to have your implants removed, you may need a breast lift or other corrective surgery to help your breasts return to their pre-implant appearance.

4. Breast implants may interfere with breast cancer screening.

5. Although it may be easier to see or feel breast lumps if you have breast implants, the implants may complicate routine mammography to screen for breast cancer.

6. You may need additional images offering special views of your breasts, and the images may be harder to interpret because cancers can be obscured by the implants.

7. You may need routine MRI scans. If you have silicone breast implants, you may need routine MRI scans to ensure that the implants aren't leaking.

8. Breast implants may hamper breast-feeding. You may produce only limited breast milk, or you may not produce any milk at all.

9. Insurance may not cover breast implants. You may need to pay out-of-pocket for any fees associated with elective breast implants, including follow-up screening and corrective surgery.


Happily married gets less strokes

Single men appear to have a greater risk of dying from stroke than those who are happily married. Through 34 years of follow-up, men who were not married at baseline were 64% more likely to die from stroke than married men according to Uri Goldbourt, PhD, of Tel Aviv University in Israel.

Punjab & Sind Bank
Central Bank of India

Question of the day

What is the Indian practice for preventing colon cancer in IBD?

  1. In patients with ulcerative colitis extending proximal to the splenic flexure or Crohn’s colitis, surveillance colonoscopy should be done after eight years of disease followed by annual examinations.

  2. In patients with Crohn’s colitis, use a thin caliber colonoscope to adequately sample the colon including strictured areas.

  3. Offer surgical resection to patients with Crohn’s colitis who have an impassable stricture since they cannot be surveyed adequately. Suggest a barium enema in those who decline resection.

  4. In patients with left–sided ulcerative colitis, begin with colonoscopy after eight years of disease. Examinations are then performed every two years upto 15 year of disease and then yearly.

  5. Do not perform surveillance for patients with ulcerative colitis limited to the rectum.

  6. In patients with a pouch, do flexible sigmoidoscopy every other year; however, if they have evidence of severe atrophy increase the surveillance interval to yearly.

  7. Multiple biopsies are required to adequately sample the colon.

  8. Areas of mucosal irregularity should be biopsied.

  9. Go for colectomy for patients who are found to have high–grade dysplasia.

  10. Consider colectomy for those with low–grade dysplasia.

  11. Rather than performing a colectomy, an adenomatous polyp can be removed endoscopically with close follow–up for polyps which appear endoscopically and histologically to be adenomas (i.e. adenoma–like DALM) regardless of whether they occurred in an area of the colon involved with colitis or are not associated with dysplastic changes in flat mucosa elsewhere in the colon.

eMedinewS Try this it Works

Simple maneuver for swallowed air

With a simple maneuver, parents can comfort a baby with colic caused by a stomach distended with swallowed air.

With the baby lying on the parent’s lap, head to the left and looking up, the parent slips the left hand under the baby’s head and neck and the right index and middle fingers over the left side of the baby’s stomach, just under the ribs. While lifting the baby to a sitting position with the left hand, pressure is applied with the fingers of the right hand, which positions the air bubble in the baby’s stomach so it can easily go up the esophagus and out of the mouth. Sometimes big gulps of air come out, other times only small amounts come of out each time. The maneuver is repeated as needed. Doing this maneuver before, during, and after every feeding––as well as any time the baby is fussy––often prevents and relieves colic. And since it is even easier to push air out of a happy baby’s stomach, doing this little maneuver whenever he or she is picked up is especially helpful.

Dr Good Dr Bad

Situation: A diabetic obese came for prescription.
Dr Bad: It’s ok for diabetics to be obese.
Dr Good: Join a weight control program.
Lesson: Overweight adults diagnosed as having type 2 diabetes experience significant improvement in health–related quality of life (HRQOL) by enrolling in a weight management program that led to significant weight loss, improved physical fitness, and reduced physical symptoms. (Source: Arch Intern Med 2009;169(2):163–71.

Make Sure

A patient of COPD with evidence of superadded chest infection was admitted to the hospital
Oh , my God ! septicemia! Why did you not chose doxycycline as an antibiotic?
Make sure to prescribe doxycycline in patients of COPD with superadded chest infection as it is highly effective and a well tolerated antibiotic in lower respiratory tract infections.

Laughter the best medicine

Overheard in a busy clinic as a receptionist spoke to an obviously hard–of–hearing client: "No Mrs Smith, not the HEARSE, I’m sending the NURSE!"

Formulae in Critical Care

Inspiratory capacity (IC)
Formula: IC = IRV + TV (Ins reserve volume or residual volume + tidal volume)

Milestones in Neurology

Morris Bender (1905–1983) was an American neuroscientist and professor of neurology at the Mount Sinai School of Medicine. Bender was among the most widely published neuorologists of his generation, publishing more than two hundred peer–reviewed articles. His textbook, Disorders in Perception (1952), remains highly influential. Bender was a leading researcher on the ocular motor system. His work clarified how the brain sends signals that move the eye and resulted in significant advances in therapy for brain tumors. He also developed the first test for detecting spinal cord lesions. Bender is best known today for pioneering non–surgical treatments for subdural hematomas.

Mistakes in Clinical Practice

Write legibly. Most prescription errors are due to bad handwritings. 

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

The common diseases of prostate glands are Benign Prostate Hyperplasia, Carcinoma Prostate, Chronic Prostatitis and Prostatic Calculi.

11th March World Kidney Day (Dr N P Singh)

Reducing risks of developing kidney diseases

Do not take NSAIDS on a regular basis: Common NSAIDs such as ibuprofen are known to cause kidney damage and disease if taken regularly. Such drugs do not pose significant danger if the kidneys are relatively healthy and one uses them for emergencies only, but if one is dealing with chronic pain, such as arthritis or back pain, one should work with the doctor to find a way to control pain without putting the kidneys at risk.

Kidney terms (Dr G M Singh)

Recurrent UTI: Patients with at least 2 infections within six months or more than 3 during a single year in which initial episode is resolved and is followed by another infection

Lab test (Dr Navin Dang)

Prevent congenital abnormalities. Get your patients screened for thalassemias and abnormal hemoglobinopathies by HPLC.

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name Indication Approval Date
Amphotericin B Emulsion 5mg/ml (Addl. Indication)
Febrile Neutropenia in cancer patients

(Advertorial section)



Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com 

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second 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.

Stress Management Workshop (April 17–18)

A stress management workshop with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized on April 17–18, 2010.

Organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, in association with IMA New Delhi Branch and IMA Janak Puri Branch

Venue: Om Shanti Retreat Center, National Highway 8, Bilaspur Chowk Pataudi Road, Near Manesar.

Timings: On Saturday (2pm onwards) and Sunday (7am–4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. For booking e–mail to emedinews@gmail.com or sms to Dr KK Aggarwal 9811090206/ BK Sapna 9811796962

Stroke Update Workshop for GPs (March13-14)

Indian stroke association and International Stroke Conference is organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi. SMS for free registration to 9717298178 or email to isacon2010@gmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Heartiest congratulations to have won a great national honour. A matter of pride for medical fraternity: Dr. Manish

  2. Proud to be your student and congrats: Dr. Khanna

  3. Congrats on a well deserved award: Suresh Pathak

  4. Congrats from the core of the heart. Dr. J M S Kalra

  5. Congratulations for the award: Dr. H.L. Gulati & Dr. (Mrs.) Sudesh Gulati