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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal
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  Editorial …

29th May 2013, Wednesday

Jaslok hospital advises doctors against prescribing Ranbaxy drugs

Jaslok Mumbai hospital has put up a notice advising its doctors to avoid prescribing drugs manufactured by Ranbaxy Laboratories. This comes a fortnight after Ranbaxy Laboratories agreed to pay a $500-million penalty to US authorities for "selling adulterated drugs" in the American market. It is not known whether the two are linked, reports TOI.

In 2008-09, the US Food and Drug Administration found the company had not followed adequate rules in manufacturing drugs meant for the American market. This resulted in a ban of around 30 Ranbaxy drugs.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Monitoring LFT in a patient on statins

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

CPR 10 camp was organized by Heart Care Foundation of India at Police Training College, Najafgarh on 27th May 2013

Dr K K Aggarwal
    National News

Rise in neurological diseases concern docs

MUMBAI: On the occasion of World Multiple Sclerosis Day observed on Monday, specialists have expressed concern about the rise in cases of neurological disease, reports TOI. Many think the numbers could be rising because of better diagnosis but several others feel other factors need to be investigated as well. Estimates suggest that there are between 1-2 lakh patients of multiple sclerosis in the country but the numbers are at best an assumption. Women are twice more likely to fall prey to multiple sclerosis than men. Genetic and environmental factors are thought to contribute to MS, but a specific cause for the disease hasn't been yet identified. Also, there is no permanent cure, although certain disease modifying medications help reduce recurrent attacks and prevent disability. "There has been a steady increase in the number of neurological diseases such as multiple sclerosis in recent times. The numbers are rising apparently due to increased awareness or increased availability of imaging facilities such as MRI scans. This chronic neurological condition causes long-term disability if left untreated. Also, such patients suffer severe pain and go through mental as well as physical trauma. It becomes crucial to give support to such patients with high priority," said Dr Arun Shah, consultant neurologist, Breach Candy Hospital. (Source: TOI, May 27, 2013)

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, every Thursday 4:30 PM in DD India

    Valvular Heart Disease Update

The 2006 American College of Cardiology/American Heart Association valvular disease guidelines recommend echocardiography to assess pulmonary artery pressure every 3 to 5 years in those with mild MS, every 1 to 2 years in those with moderate MS, and every year in asymptomatic severe MS, and sooner if symptoms develop.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand

Childhood sexual abuse (CSA) is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.

Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30.

After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen’s d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%.

(Source: Fergusson DM, McLeod GF, Horwood LJ. Child Abuse Negl. 2013 Apr 24)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Transcranial laser therapy unhelpful after ischemic stroke

Despite apparently encouraging initial results, transcranial laser therapy (TLT) appears to be of no benefit in patients with acute ischemic stroke. (Source: Medscape)

'Flow' test aids chest pain Dx

For patients with chest pain, incorporating an assessment of fractional flow reserve (FFR) at the time of diagnostic angiography guided management decisions, although it remains unclear whether that influenced outcomes, researchers found. (Source: Medpage Today)

Bronchial thermoplasty benefits asthma sufferers long term

The heat is on for patients with asthma, and the news is good. Bronchial thermoplasty gives long-lasting relief after just a few treatments. Results from the AIR2 pivotal trial show efficacy lasting up to 5 years, and new research suggests that an increasing number of patients will likely benefit from therapy. Investigators presenting here at the American Thoracic Society 2013 International Conference say that one third of patients at the Severe and Brittle Asthma Unit at Birmingham Heartlands Hospital in the United Kingdom were good candidates for therapy. (Source: Medscape)

CV safety of vildagliptin in HF unclear

The diabetes medication vildagliptin may be beneficial in patients with type 2 diabetes and heart failure, but its cardiovascular safety is uncertain, a placebo-controlled trial showed. (Source: Medpage Today)

Alternative ankle-brachial index better at finding risk for death

An alternative ankle-brachial index (ABI) method identifies individuals at increased risk for mortality who would be missed by the traditional ABI methods, researchers from Stanford University School of Medicine report. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Heat index should be communicated to the public http://bit.ly/15743f2 #Health

@DrKKAggarwal: I AM is all bodies, all minds all universes #CosmicConsciousness

    Spiritual Update

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

Why you remove shoes before entering temple?

There are etiquettes that when you enter a worship area in all religions, you are required to take off your shoes before you enter any spiritual place. It is better to remove them in your car or a vehicle or give to an authorized shoe keeper otherwise all the time; the shoes will remain in your mind when you are visiting the temple.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Why do varicoceles cause fertility problems?

Varicoceles raise the temperature in the testicles, which may affect the production of sperm, as well as sperm movement and/or shape. It may also affect other aspects of sperm function.

    An Inspirational Story

Cracked Pots

A water bearer in China had two large pots, each hung on the ends of a pole which he carried across his neck. One pot had a crack in it, while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full.

For a full two years this went on daily, with the bearer delivering only one and a half pots full of water to his house.

Of course, the perfect pot was proud of its accomplishments, perfect for which it was made. But the poor cracked pot was ashamed of its own imperfection, and miserable that it was able to accomplish only half of what it had been made to do.

After 2 years of what it perceived to be a bitter failure, it spoke to the water bearer one day by the stream... "I am ashamed of myself, because this crack in my side causes water to leak out all the way back to your house."

The bearer said to the pot, "Did you notice that there were flowers only on your side of the path, but not on the other pot's side? That's because I have always known about your flaw, and I planted flower seeds on your side of the path. Every day while we walk back, you've watered them. For two years I have been able to pick these beautiful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house."

Moral: Each of us has our own unique flaws. We're all cracked pots. But it's the cracks and flaws we each have that make our lives together so very interesting and rewarding. You've just got to take each person for what they are, and look for the good in them.

Blessings to all my crackpot friends and relatives

For comments and archives

    Cardiology eMedinewS

CV Safety of Vildagliptin in HF Unclear Read More

    Pediatric eMedinewS

Schools need to get kids moving, IOM says Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Can RIG and rabies vaccine be administered in the same syringe?

RIG should never be administered in the same syringe or at the same anatomical site as vaccine administration.

    IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have sarcopenia.
Dr Bad: It is of no consequence.
Dr Good: You are at risk of heart disease as well as diabetes.
Lesson: A cross-sectional study of Japanese women concluded that the coexistence of sarcopenia and metabolic syndrome further increases the risks of cardiovascular diseases, such as type 2 diabetes mellitus, hypertension, arterial stiffness and hyperlipidemia even after adjustment of age and body composition (Eur J Clin Nutr 2012 Oct;66(10):1093-8).

Make Sure

Situation: A 40–year–old male developed acute heart attack after playing squash.
Reaction: Oh my God! Why was a cardiac test not done?
Lesson: Make sure that anybody going for anaerobic games after the age of 40 should first get a cardiac clearance.

  Quote of the Day (Dr GM Singh)

Little deeds of kindness, little words of love, help to make earth happy, like heaven above. Julia Fletcher Carney

    Mind Teaser

Read this…………………

Jane, a 20- year old college student is admitted to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:

A. Brief exaggeration of symptoms
B. Prolonged symptomatic improvement
C. Rapid but brief symptomatic improvement
D. Symptomatic improvement of just the ptosis

Yesterday’s Mind Teaser: An 8-month-old is admitted to the pediatric unit following a fall from his high chair. The child is awake, alert, and crying. Nurse Fatima should know that a brain injury is more severe in children because of:

a. Increased myelination
b. Intracranial hypotension
c. Cerebral hyperemia
d. A slightly thicker cranium

Answer for yesterday’s Mind Teaser: c. Cerebral hyperemia

Correct answers received from: Arpan Gandhi, Dr Bharat Bhushan Aggarwal, Dr Gajveer singh, Dr Bharat Bhushan Aggarwal, Dr Bharat Bhushan Aggarwal,
Dr BB Gupta, Anil Bairaria, Raju Kuppusamy, Dr KV Sarma, Dr Pankaj Agarwal, Rajeev Ardey, Dr Jainendra Upadhyay, Dr Jayashree Sen & Dr Bitaan Sen,
Dr Pawan Mehta, Dr U Gaur, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Daivadheenam, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr KP Chandra.

Answer for 27th May Mind Teaser: a. 1 minute

Correct answers received from: Dr Bharat Bhushan Aggarwal, Raju Kuppusamy.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Are we over the border yet?

A guy was driving when a policeman pulled him over. He rolled down his window and said to the officer, "Is there a problem, Officer?"

"No problem at all. I just observed your safe driving and am pleased to award you a $5,000 Safe Driver Award. Congratulations. What do you think you're going to do with the money?"

He thought for a minute and said, "Well, I guess I'll go get that drivers' license."

The lady sitting in the passenger seat said to the policeman, "Oh, don't pay attention to him - he's just over smart when he's drunk and stoned."

The guy from the back seat said, "I TOLD you guys we wouldn't get far in a stolen car!"

At that moment, there was a knock from the trunk and a muffled voice said, "Are we over the border yet?"

    Medicolegal Update

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

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

The doctor must assess the mental capacity of the individual. This involves verifying that an individual intending to fast does not have a mental impairment that would seriously undermine the person’s ability to make health care decisions. Individuals with seriously impaired mental capacity cannot be considered to be hunger strikers. They need to be given treatment for their mental health problems rather than allowed to fast in a manner that risks their health.

As early as possible, physicians should acquire a detailed and accurate medical history of the person who is intending to fast. The medical implications of any existing condition should be explained to the individual. Physicians should verify that hunger strikers understand the potential health consequences of fasting and forewarn them in plain language of the disadvantages. Physicians should also explain how damage to health can be minimized or delayed by, for example, increasing fluid intake. Since the person’s decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Smoking makes you 5 years older

Men have a greater chance of dying then women, and smoking increases any adult's risk of death just as if five years were suddenly added to their age, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 54166 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Responses
  1. Sir, I appreciate your concern for society. Thanks & regards, Dr. (Vet) S. C. Gupta, General Manager (Technical)
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta