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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

  Editorial …

26th February, 2011, Saturday                                eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

NIH–funded study finds new possible risk factor of heart disease

Abnormal heart rate turbulence is associated with an increased risk of heart disease death in otherwise low–risk older individuals, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. This study appears in the Feb. 15 edition of the Journal of Cardiovascular Electrophysiology.

Among the nearly 1,300 study participants, heart rate turbulence, which reflects how well the heart reacts to occasional premature contractions, was an even stronger heart disease risk factor than elevated levels of C–reactive protein. CRP is a potential heart disease biomarker that has emerged in recent years.

Study participants considered at low risk of heart disease based on traditional risk factors were on average 8 to 9 times more likely to die of heart disease during the roughly 14–year follow–up period if they had abnormal heart rate turbulence values. Traditional risk factors include age, gender, high blood cholesterol, high blood pressure, obesity, diabetes, and smoking. Low–risk individuals with elevated CRP in their blood were about 2.5 times more likely to die than those with normal or low CRP.

This study followed 1,272 adults aged 65 and older as part of the NHLBI’s Cardiovascular Health Study. Participants were categorized as healthy (no sign of heart disease risk except possibly diabetes), subclinical (some signs of heart disease) or clinical (had a cardiovascular event, such as a heart attack). At the onset, participants underwent 24–hour monitoring of their hearts’ electrical activity through a Holter monitor.

Abnormal heart rate turbulence and CRP levels both appeared to independently correlate with an increased likelihood of dying of heart disease in the group that was categorized as healthy, even after controlling for other risk factors. Abnormal heart rate turbulence — present in about 7 percent of the study participants — also predicted an increased likelihood of heart disease death in the subclinical and clinical groups, though these results were not as pronounced.

Heart rate turbulence refers to how smoothly the heart rate returns to normal after a premature ventricular contraction, a fairly common event in which the second portion of a heart beat is triggered too soon. Due to the improper timing between the atrial and ventricular contractions, the ventricles haven’t fully filled with blood and therefore do not push out enough blood to the body. The brain detects this sub–optimal release of blood and instantly increases the heart rate to pump more blood. However, this overcompensation raises blood pressure, causing the brain to react again and lower the heart rate until blood pressure returns to normal.

By analyzing the heart’s electrical signals, physicians can measure the magnitude of the initial heart rate jump (turbulence onset) and the speed at which heart rate returns to normal (turbulence slope), and then determine if the heart rate turbulence response is normal or abnormal.

A heart rate turbulence measurement is insightful because it offers a sign of how well the autonomic, or subconscious, nervous system is functioning," said study author Phyllis K. Stein, Ph.D., a research associate professor of medicine and director of the Heart Rate Variability Laboratory at Washington University School of Medicine in St. Louis.

  1. After a VPC, heart rate increases for 1 or 2 beats, then decreases.
  2. This phenomenon was discovered by Georg Schmidt’s research group in Munich, when they averaged the RR interval sequences flanking VPCs
  3. RR interval start to increase at beat 3 after the paced VPC, and reaches a peak bradycardia over the baseline RR at beat 8.
  4. HRT quantifies these heart rate changes by 2 parameters, turbulence onset (TO) and turbulence slope (TS).
  5. TO is the amount of sinus acceleration following a VPC, TS is the rate of sinus deceleration that follows the sinus acceleration.
  6. HRT is measured. RR intervals are plotted vs beat number, with 2 beats preceding and 20 beats succeeding the VPC beat and compensatory pause.
  7. TO (%)= 100 × ((RR (1) + RR (2)) – (RR (–3) + RR (–2))/(RR (–3) + RR (–2)), where the numbers in brackets denote beat number, with the compensatory pause being beat 0.
  8. To obtain TS (ms/beat), the slopes of RR change are calculated by fitting each 5 beat RR sequence following the compensatory pause (RR (1)~RR (5), RR (2)~RR (6), …, RR (16)~RR (20)) with a straight line. The maximum of the 16 slopes is taken to be TS. TO<0 and TS>2.5 are considered normal, TO > 0 and TS < 2.5 are considered abnormal.
  9. In other words, strong sinus acceleration followed by rapid deceleration marks a healthy response.
  10. TO is the difference in the average of the 2 RR intervals preceding and succeeding the VPC/compensatory pause sequence expressed as a percentage.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

 Treating Diabetes Post 2010

Dr Ambrish Mithal speaks on
Adverse effects of current treatments of type 2 diabetes: Metformin

Audio PostCard
  Quote of the Day

(By Dr GM Singh)

Morality is simply the attitude we adopt toward people whom we personally dislike. Oscar Wilde

    Photo Feature (from the HCFI Photo Gallery)

Press Conferene Dr Sadhna International Women Empowerment Award

Padma Shri & Dr B C Roy National Awardee Dr. KK Aggarwal, President Heart Care Foundation of India, Acharya Dr. Sadhvi Sadhna ji Maharaj, Chairperson World Fellowship of Religions, Dr. Vandana Chadha, Fetal Gynecologist, Moolchand Medcity, in a Press Conference organized to earmark Dr. Sadhna International Women Empowerment Day being observed on Sunday, 27th February, 2011.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Commonwealth Health Professions Alliance (CHPA)

Dear Colleagues, Prof. Dr. S. Arulrhaj, MD., FRCP (Glasg) Imm. Past President, Commonwealth Medical Association, UK have been unanimously elected as the Chairperson, Commonwealth Health Professions Alliance (CHPA), London, UK. CHPA is a body above all the Health organizations of  Commonwealth  like, Commonwealth Medical Association, Commonwealth Association  for  Health and  Disability,  Commonwealth Association for Paediatric Gastroenterology and Nutrition, Commonwealth Dental Association, Commonwealth HIV and AIDS Action Group, Commonwealth Nurses Federation, Commonwealth Pharmacists Association etc.

Cashless facility for patients

Moolchand is proud to have been selected by India’s leading insurance companies (National Insurance Company Ltd., United India Insurance Company Ltd., The New India Assurance Company Ltd. and The Oriental Insurance Company Ltd.) to extend cashless facility for patients

    International News

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

February is Heart Health Month

Spinach. Popeye knew firsthand the value of eating spinach. Hands down, spinach is the powerhouse of the vegetable kingdom. Its rich, dark color comes from the multiple phytochemicals, vitamins, and minerals (especially folate and iron) that also fight disease, protect against heart disease, and preserve your eyesight.

(Dr Monica and Brahm Vasudev)

Psoriasis patients at increased risk of osteoporosis

According to a study published in International Journal of Dermatology, psoriasis patients are at increased risk of osteoporosis.

Western diet and low eGFR

A new study published in American Journal of Kidney Diseases shows that western diet is associated with increased risk of kidney function decline.

CAD screening may reduce cardiovascular mortality, morbidity in type 2 diabetes

According to a study published online in the journal Internal Emergency Medicine, screening for asymptomatic coronary artery disease (CAD) helps reduce cardiovascular (CV) mortality and morbidity in patients with type 2 diabetes.

Insulin therapy to control blood glucose in hospitalized patients not necessary

There’s no need to use insulin therapy to control blood glucose in hospitalized patients –– with or without known diabetes –– according to new clinical practice guidelines from the American College of Physicians. In fact, a review of the literature, published in the Annals of Internal Medicine, found intensive insulin therapy did not offer short– or long–term mortality benefits, leading the ACP to recommend against its use to manage hyperglycemia in ICU patients. What’s more, data from 10 trials showed that intensive glucose management was associated with a greatly increased risk of severe hypoglycemia.

    Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What advice do you have for young women to prevent possible future fertility problems?

Sexually transmitted diseases (STDs) can be a major cause of future infertility; therefore young women should ALWAYS have protected sex. Also, women should consult with their Ob/Gyns if they have irregular menstrual cycles or have painful periods or ovulation. If your doctor is dismissive and does not offer to find a cause and solution to your problems, find a physician who will. Unfortunately, the biggest barrier to conception for many couples is an Ob/gyn who is unfamiliar with the latest technology to treat the causes of infertility even though the woman may not presently be trying to conceive.

For queries contact: banerjee.kaberi@gmail.com

    Hepatology Update

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

What is the common site of liver abscess in children ?

Approx 2/3rd of liver abscesses occur in the right lobe of liver and majority i.e. approx 2/3rd are solitary. Left lobe abscesses should be treated with caution as they are frequently associated with complications like rupture into peritoneum and pericardium and cause pericardial effusions each of which may be life threatening. Left sided liver abscesses require drainage far more often (85% cases) when compared to right sided lesions, even when aetiology is amoebic. 20-25% of all cases have multiple abscess which are in majority of cases pyogenic in nature and are confined to right side of the liver. With multiple liver abscesses mortality may be almost twice that in solitary cases.

For queries contact: drneelam@yahoo.com

    Medicolegal Update

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

What should be Post mortem test in case of medical negligence?

In India for the Autopsy surgeons the strict test to be applied should be: ‘would death could have occurred, if the operation had not taken place?’

  • Information is needed before beginning the medico–legal autopsy. The patient’s notes are essential along with some other relevant information. Equally important is the attendance of clinicians at the autopsy, more indeed, in deaths associated with anesthesia.
  • Discussion among autopsy surgeon and the anesthetist may arrive at an amicable conclusion of opinion to offer the investigating authority.
  • The hospital lab may be requested to retain any ante–mortem blood or fluid samples sent to them so that they remain available for analytical checks, such as blood grouping in transfusion mishaps, or creatine phosphokinase activity in malignant hyperthermia
  • Were death is due to a disease or disability, other than that for which the operation was performed, a distinction has to be drawn between those conditions that were known before the operation was performed;
  • A distinction has to be drawn between those conditions that were known before the operations and those which were unexpected. Naturally, operative and anesthetic techniques may have to be modified to take account of the known adverse conditions
  • Death may occur due to failure of a surgical technique. This may be inadvertent, from a true ‘accident’ sometimes caused by unusually difficult operative circumstances, to anatomical abnormalities or even failure of equipment.
  • When it is one result of error of incompetence, then a legal action for negligence may ensue and the autopsy surgeon must be even more meticulous than usual in producing a detailed and impartial report.
  • When a failure of equipment may be responsible, then expert examination and advice is required. Anesthetic machines, gas supply, compatibility of connections and all the sophisticated hardware of Operation Theater must be subjected to the most rigorous inspection if a malfunction is suspected. This becomes important part of the autopsy surgeon concern, because he is responsible for the eventual decision about the cause of death.
  • The risk of death from all causes cardiac arrest was the most common single mode of death, being seen on average once or twice a year in most busy operating suites even under the most careful surgical and anesthetic regimens. Most cardiac arrest occurs at either the start or finish of the surgical procedure.
    Legal Question of the Day

(Dr MC Gupta)

Q. I want certain information from IMA. If the IMA does not provide it, what can I do further? Can I get it under RTI?


  • If you are a member of IMA and want information that members are bound to get as per the IMA constitution/rules and regulations etc. but the IMA refuses to provide the same, you can get it legally. It would be helpful to consult a lawyer for this.
  • In my opinion, you cannot use the RTI for this purpose.
    Useful Websites

(Dr Surendernikhil Gupta)


Three On Neglected Tropical Diseases


    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Total Iron binding capacity (TIBC)

Increased: Acute and chronic blood loss, iron deficiency anemia, hepatitis, oral contraceptives.
Decreased: Anemia of infection and chronic diseases, cirrhosis, nephrosis, hemochromatosis

    Medi Finance Update

Money Market Funds

Bond funds typically invest in bonds issued by governments and large companies. Bond fund returns are based on a combination of interest payments and price changes of the bonds in the fund.

The market value of bonds is affected by prevailing interest rates. When interest rates fall, existing bonds will generally rise in value; when interest rates rise, bonds will generally fall in value. Overall, bond funds are affected in the same way.

    Drug Update

List of Approved Drug From 01.01.2010 TO 31.8.2010

Drug Name


DCI Approval Date

Atorvastatin 20mg + Ramipril 2.5mg/5mg Capsules

Additional higher strength


Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    IMSA Update

International Medical Science Academy (IMSA) Update

Goal blood pressure in diabetes and CVD

The new target blood pressure goal is 140/90 mmHg in patients with diabetes mellitus and/or cardiovascular disease.

    IJCP Special

Dr Good Dr Bad

Situation: An asymptomatic patient came with erectile dysfunction.
Dr Bad: You can start taking the drug Viagra.
Dr Good: Rule out CAD first.
Lesson: Patients with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of coronary or other vascular disease, should be screened for cardiovascular disease prior to initiating therapy for their sexual dysfunction, as there are potential cardiac risks associated with sexual activity in patients with heart disease.

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminium toxicity.
Reaction: You should have put him on magaldrate preparations.
Lesson: Magaldrate preparations do not cause aluminium toxicity in patients undergoing dialysis.

Five common eye myths dispelled

Myth: Eating carrots is good for the eyes
Fact: There is some truth in this one. Carrots, which contain vitamin A, are one of several vegetables that are good for the eyes. But fresh fruits and dark green leafy vegetables, which contain more antioxidant vitamins such as C and E, are even better. Antioxidant vitamins may help protect the eyes against cataract and age–related macular degeneration. But eating any vegetables or supplements containing these vitamins or substances will not prevent or correct basic vision problems such as nearsightedness or farsightedness.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Anupam Sethi Malhotra)

Do not be jealous

We all have experienced how jealousy can disturb our peace of mind. You know that you work harder than your colleagues in the office, but sometimes they get promotions; you do not. You started a business several years ago, but you are not as successful as your neighbor whose business is only one year old. There are several examples like these in everyday life.

Should you be jealous? No. Remember everybody’s life is shaped by his or her previous Karma, which has now become his destiny. If you are destined to be rich, nothing in the world can stop you. If you are not so destined, no one can help you either. Nothing will be gained by blaming others for your misfortune. Jealousy will not get you anywhere; it will only take away your peace of mind.

— — — — — — — — — —

Mind Teaser

Read this…………………

gone let gone
gone be gone

Yesterday’s Mind Teaser: VAD ERS
Answer for Yesterday’s Mind Teaser: Space Invaders

Correct answers received from: Dr K P Rajalakshmi, Dr Susheela Gupta, Dr Sudipto Samaddar, Dr U C Vasavada Mehsana, Dr Anil Kumar, Dr.Satyoban Ghosh

Answer for 24th February Mind Teaser: I’ll be there in a minute
Correct answers received from: Dr Manjesha., Dr Satyoban Ghosh, Dr Renu Garg, Dr Anil Kumar, Dr Rakesh Bhasin, Dr Shirish Singhal, Dr U Gaur, Dr R S Bajaj, Dr Vijay Kansal, Dr Jayashree sen, Dr Bina Sawhney, Dr Parvesh K Sablok, Dr R S Bajaj

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr G M Singh)

A Horoscope for the Workplace

SALES: Laziest of all signs, often referred to as "marketing without a degree," you are also self–centered and paranoid. Unless someone calls you and begs you to take their money, you like to avoid contact with "customers" so you can "concentrate on the big picture." You seek admiration for your golf game throughout your life.

— — — — — — — — — —

Knowledge is amusing

ELEPHANTS are the only animals that can’t jump.

    Readers Responses
  1. Good to hear via eMedinewS that Dr Naresh Chawla is keen to activate the GP forum via elearning techniques. I will be pleased to connect this medium and any other, if raised, with Indian GPs in the UK, to share knowledge and skills further. Regards, Vivek Chhabra
    Public Forum

(Press Release for use by the newspapers)

Exams and the anticipation of results can be a stress

Stress is the reaction of the mind and the body to the interpretation of a situation LIKE AN EXAM RESULT, said by Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee and President, Heart Care Foundation of India. One may find it difficult to cope with the results or might get anxious anticipating the results. Not only does it mess with the mind, it could also affect the physical health.

Even Sachin Tendulkar does not make century every time he plays. He even gets out at zero. Our perfomance in exam is like a cricket match and is dependent on our luck, on the umpire the examiner and the state of mind we are giving the exam. We shouold not get disturbed with the results and act and react.

Talking about the symptoms Dr Aggarwal said that there can be difficulty getting to sleep or difficulty waking up in the morning, constant fatigue, forgetfulness, aches and pains for no apparent reason, poor appetite, social withdrawal, loss of interest in activities, increased anxiety and irritability, increased heart rate, migraines/headaches, blurred vision and dizziness.

In the case of exam results time it may be, pressure from parents and relatives to do well, the need to get high grades to get on track for the career you really want or uncertainty on what to do next.

If you are suffering from stress try some of the following ways to calm down and chill out:

  • Change your perceptions
  • Divert your mind and make time for yourself away from work to wind down.
  • Take time for your mind and body to relax.
  • Methods can include reading, meditation, pranayam and yoga.
  • Do extra exercise or go for a long walk.
  • Eat well.
  • Skipping meals will deplete your energy and leave you drained.
  • Communicate, talking to your family and friends help.
   eMedinewS Special
  1. eMedinewS audio lectures
  2. eMedinewS ebooks
    Forthcoming Events

ICC Cricket World Cup 2011

World Cup Schedule… very very creative


6th Annual Conference of Indian Academy of Nephrology (IANCON–2011)

Date: March 12–13, 2011
Venue: Taj Deccan, Banjara Hills, Hyderabad–34
Faculty: Dr MS Amarsen, Dr KV Jhony, Dr SC Dash, Dr Kashivishweswaran, Dr V Sakhuja, Dr RK Sharma, Dr Girishnarayan, Dr Anuradha, Dr SK Agarwal, Dr P Sundarajan, Dr P Keshivya, Dr Ravi Raju, Dr Dilip Pahari, Dr LC Sharma, Dr Sanjeev Saxena, Dr Sanjay Gupta, Dr Abhijit Tarapdhar, Dr PP Verma, Dr Harun Rashid, Dr Sampath Kumar, Dr Sanjib Sharma, Dr S Padmanabhan.
Topics: CKD Symposium (From India, Nepal, Bangladesh), Newer concepts in the pathogenesis of hypertension, Fluid and Electrolyte & AKI, RAAS in treatment of Diabetic Nephropathy, Primary Prevention of CKD: Trials & tribulation in Indian condition, Vitamin–D andchronic kidney disease, Mycophenolate Vs Cyclyophosphamide in Lupus nephritis, Individual zinganemia therapy, How to monitor Immunosuppression minimization, Obesity Diabetes epidemic, Life Style changes & therapeutics, BKV and CMV Nephropathy, Leptospira and Acute Kidney Injury, HIV Nephropathy, Hypophosphatemia and Renal Disease, Immunosuppressant and risk of Malignancy, Pregnancy ARF, Expanding Dialysis services in Andhra Pradesh,Making kidney transplant easier for less privileged, Cardiovascular risk reduction in CKD

Organizing Secretary: Dr Sree Bhushan Raju, Associate Professor, Dept of Nephrology, NIMS, Hyderabad
Contact: Mob: 09848492951, sreebhushan@hotmail.com
Website: www.ian2011.in
Note: "Prof SC Dash oration in Nephrology" from this year onwards. Three awards each in oral, poster and imaging in Nephrology sessions

Registration for Delegates Amount
Up to 15th February 2011
Rs. 1500/–
Up to 5th March 2011
Rs. 2000/–
Spot registration
Rs. 2500/–
Rs. 500/–

DD/Cheque in favor of "IANCON– 2011" payable at Hyderabad. Add Rs 100/– for outstation cheque.

eMedinewS Events: Register at emedinews@gmail.com

Medifinance Conference On Portfolio Management for Doctors and update on Budget 2011

Date: 13th March 2011
Time: 10 Am – 5 Pm

Speakers: Top of line from finance sector. The speakers to be chosen from the industry will be experts in each field to be covered in this conference

Separate sessions for portfolio management, insurance, mediclaim, banking sector, investments primary market, secondary market, taxation, loans for setting up hospitals, nursing homes, labs, etc. all under one roof.

No entry fee, the number of participants will be limited to 100 on first cum first serve basis. advance registration by mail to hcfi.1986@gmail.com /drkk@ijcp.com or by phone on 9899974439/9873716235 .

World Fellowships of Religions and Perfect Health Parade

First ever Conference which will talk about science behind all Religions, Dharmas and Pathies under one roof
Subject: Global Warming, Ethnic Crises, How to be Healthy
Date: Sunday 3rd April, 2011
Venue: Maulana Azad Medical College Auditorium, New Delhi
Time: 8 AM – 4 PM Parade through tableaus to be flagged off at 10 am from outside MAMC to move till 5 pm on different predefined routes in Delhi to create awareness about health matters.

Parade Route: Vikas Marg – Shahdara – Seemapuri – Guru Tegh Bhadur Hospital – Seelampur Pusta – Gandhinagar, to ISBT Kashmiri Gate – Civil Lines – Delhi University North Campus – Azadpur – Punjabi Bagh – Mayapuri – Raja Garden – Janakpuri – Tilak Nagar – Tihar Jail Road – Delhi Cantt. – R.K Puram – Munirka – IIT Gate – Panchsheel Park – Chirag Delhi Flyover – Nehru Place – Modi Mill Flyover – Ashram – Nizamuddin – Sunder Nagar – Pragati Maidan – ITO – finally culminate at Maulana Azad Medical College at 4pm.

Full day conference on ethnic crisis and global warming. Pre lunch session to be addressed by religious representatives who would talk on what each religion has to say. Post lunch to be addressed by doctors from all streams of medicinal practice (allopathy, ISM)
Register: rekhapapola@gmail.com

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