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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; 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

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

29th September 2012, Saturday

Endocrine Society issues Hypertriglyceridemia Guidelines

  • The Endocrine Society Guideline for the assessment of patients with hypertriglyceridemia recommends that the diagnosis be based on fasting triglyceride levels.
  • At least every 5 years, adults should be screened for hypertriglyceridemia as part of a lipid panel.
  • To facilitate assessment of cardiovascular risk, mild and moderate hypertriglyceridemia, defined as triglyceride levels of 150 to 999 mg/dL, should be diagnosed, as this condition may be a risk factor for cardiovascular disease.
  • Patients with severe and very severe hypertriglyceridemia, defined as triglyceride levels of more than 1000 mg/dL, should be considered to be at risk for pancreatitis.
  • Patients with hypertriglyceridemia should undergo evaluation for secondary causes of hyperlipidemia, such as endocrine conditions and medications, and treatment should be focused on such secondary causes.
  • Patients with primary hypertriglyceridemia should be assessed for a family history of dyslipidemia and cardiovascular disease, as well as for other cardiovascular risk factors including central obesity, hypertension, abnormalities of glucose metabolism, and liver dysfunction.
  • For patients with moderate hypertriglyceridemia, the treatment goal should be a non–high–density lipoprotein cholesterol level in agreement with NCEP–ATP guidelines.
  • For patients with mild to moderate hypertriglyceridemia, first–line therapy should be lifestyle interventions including physical activity. A combination of diet modification and pharmacotherapy may also be considered.
  • For patients with moderate to severe hypertriglyceridemia, treatment with fibrates, niacin, and/or omega-3 fatty acids alone or in combination with statins should be considered.
  • A fibrate should be used as a first–line agent in patients with severe or very severe hypertriglyceridemia, in addition to reduction of dietary fat and simple carbohydrate intake.
  • Statins should not be used as monotherapy for severe or very severe hypertriglyceridemia, but they may be useful for the treatment of moderate hypertriglyceridemia when indicated to modify cardiovascular risk.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

How does chronic constipation affect quality of life for a patient?

Chronic constipation has been associated with considerable impairment in quality of life as it can be physically and mentally troublesome for many patients, and can significantly interfere with their daily living and well-being. Individuals with constipation have higher medical care (outpatient and emergency) use, which leads to large individual healthcare costs, and represents a burden to healthcare delivery systems.

For Comments and archives…

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

AHA – ACS update new–2

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th Dil Ka Darbar

The Darbar was organized by Heart Care Foundation of India in association with Indian Oil, Central Bank of India Department of AYUSH and various Departments under Health Ministry, Government of Delhi on Sunday 23rd September 2012 at Talkatora Stadium.

Dr K K Aggarwal
    National News

Pause for a cause as Parikrama lends its voice to World Heart Fest 2012

Cardiological Society Of India is organizing "World Heart Fest 2012" a daylong extravaganza event dedicated to the prevention of heart diseases at the NSIC Grounds, Kalkaji in New Delhi on 30th September, 2012 after the World Heart Day.

The event would witness country’s one of the most celebrated rock bands – ‘Parikrama’, who are known for their passionate love for music. The event will witness history by a major Guinness World RecordsTM achievement with attempt for hoisting 25000 heart–shaped balloons and create the biggest human heart logo ever.

There will be various activities aimed to drive awareness about prevention of heart diseases such as free cholesterol, cardiac checkups, healthy heart tips, expert talks etc. It would be graced by the presence of political figures, celebrities and corporate leaders. The corporate and medical fraternity has extended its support by partnering with the event. The event will also be inaugurated by Hon’ble Chief Minister of Delhi Smt. Shiela Dikshit along with Shri. Sandeep Dikshit, MP.

Dr. Ashok Seth, Chairman Cardiac Sciences – Fortis Escorts Heart Institute, New Delhi is elated to witness so many people extensively joining this initiative. We feel that with the increase of heart attacks, India will be the highest capital in Cardiac diseases among all countries in the world by 2020. In reverse to this we are happy to organise this event preventing heart diseases among Indians, he said.

For comments and archives

My Profession My Concern

Include this in your practice

Repeat screening for bone mineral density

In women 65 years of age and older with normal or slightly low bone mass (T–score – 1.01 to – 1.49) at baseline measurement and no risk factors for accelerated bone loss do follow–up dual–energy x–ray absorptiometry (DXA) in 10 to 15 years.

(Ref: Leslie WD, et al; Manitoba Bone Density Program. Rate of bone density change does not enhance fracture prediction in routine clinical practice. J Clin Endocrinol Metab 2012;97:1211)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

When should the first echo be done after valve replacement?

For all patients receiving a prosthetic heart valve, a baseline echocardiogram is suggested at the time of hospital discharge or at their first postoperative follow–up visit 2 to 4 weeks after discharge.

(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)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Docs can prevent car crashes among elderly

Physicians’ warnings to patients that they are potentially unfit to drive can prevent car crashes, researchers reported. The annual rate of car accidents among patients who were so warned fell about 45% in the year after the doctor’s intervention, compared with the 3 years before, according to Donald Redelmeier, MD, of Sunnybrook Health Sciences Centre in Toronto, and colleagues in the Sept. 27 issue of the New England Journal of Medicine. (Source: Medpage Today)

For comments and archives

No bleeding risk from steroid in tonsillectomy

Dexamethasone to control nausea and vomiting after tonsillectomy is not associated with higher rates of serious postoperative bleeding, researchers reported. (Source: Medpage Today)

For comments and archives

WHO issues alert for new SARS–like virus

Healthcare workers around the world should be alert for possible new cases of the novel coronavirus that has left one man critically ill and another dead, the World Health Organization said. The agency issued an interim case definition for the novel virus, urging healthcare workers to be on the lookout for patients with unexplained respiratory illness combined with fever and cough, especially if they have recently visited Saudi Arabia or Qatar. The WHO said no new cases have been confirmed, although a Danish hospital is reporting that it is treating five people with fever, coughing, and influenza–like symptoms. (Source: Medpage Today)

For comments and archives

Monitoring reduces cytomegalovirus transplant infections

An automated monitoring system for cytomegalovirus can slash the rate of serious cytomegalovirus infections, researchers reported here at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy. A monitoring program at Copenhagen University Hospital in Denmark cut hospital readmissions due to cytomegalovirus infection in solid organ transplant patients from 52% to 13%, reported Caspar da Cunha–Bang, MD, an infectious disease specialist at the hospital. (Source: Medscape)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Dealing with Insomnia http://blog.kkaggarwal.com/2012/09/dealing–with–insomnia/

@DeepakChopra: Eminent physicist and author Menas Kafatos concludes his brilliant discussion of "The Riddle of Consciousness" http://tinyurl.com/9qkuneb

    Spiritual Update

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

Symposium on Diet, Health & Religion – Dr KK Aggarwal

A symposium on Diet, Health & Religion, second in a series was held at Bharatiya Vidya Bhavan on 5th September, 2012. The Chief Guest was Shri J Veeraraghavan, Chairman, Bhavan’s KM Munshi Institute of Educational Leadership and Management.

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Do fertility medications increase risk of ovarian cancer?

Despite some older reports suggesting a link with ovarian cancer, recent studies fail to provide any convincing evidence that supports any association between fertility drugs and ovarian cancer.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Blood and blood components are vital to the health care system of a country

Patients with thalassemia, hemophilia, anemia and leukemia require regular blood transfusions. Blood is also required in cases of accidents and surgical operations. Obviously the question arises as to wherefrom all the blood comes and also how are we going to cope up with the load of growing demands and requirements. The only way is to request and motivate more and more of volunteers to come forward and they pour out their small Ahuties in this Maha Yagna of Voluntary Blood Donation Movement.

For comments and archives

    Liver Abscess Update

(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

When should staphylococcal liver abscess be suspected?

Left lobe

  • H/o or presence of skin infection e.g. furuncle
  • Associated necrotic pneumonia
  • Disseminated abscess

For comments and archives

    An Inspirational Story (Ms Ritu Sinha)

What goes around comes around

One day a man saw an old lady, stranded on the side of the road, but even in the dim light of day, he could see she needed help. So he pulled up in front of her Mercedes and got out. His Pontiac was still sputtering when he approached her.

Even with the smile on his face, she was worried. No one had stopped to help for the last hour or so. Was he going to hurt her? He didn’t look safe; he looked poor and hungry. He could see that she was frightened, standing out there in the cold. He knew how she felt. It was those chills which only fear can put in you. He said, "I’m here to help you, ma’am. Why don’t you wait in the car where it’s warm? By the way, my name is Bryan Anderson."

Well, all she had was a flat tire, but for an old lady, that was bad enough. Bryan crawled under the car looking for a place to put the jack, skinning his knuckles a time or two. Soon he was able to change the tire. But he had to get dirty and his hands hurt. As he was tightening up the lug nuts, she rolled down the window and began to talk to him. She told him that she was from St. Louis and was only just passing through. She couldn’t thank him enough for coming to her aid.

Bryan just smiled as he closed her trunk. The lady asked how much she owed him. Any amount would have been all right with her. She already imagined all the awful things that could have happened had he not stopped. Bryan never thought twice about being paid. This was not a job to him. This was helping someone in need, and God knows there were plenty, who had given him a hand in the past. He had lived his whole life that way, and it never occurred to him to act any other way. He told her that if she really wanted to pay him back, the next time she saw someone who needed help, she could give that person the assistance they needed, and Bryan added, "And think of me."

He waited until she started her car and drove off. It had been a cold and depressing day, but he felt good as he headed for home, disappearing into the twilight. A few miles down the road the lady saw a small cafe. She went in to grab a bite to eat, and take the chill off before she made the last leg of her trip home. It was a dingy looking restaurant. Outside were two old gas pumps. The whole scene was unfamiliar to her. The waitress came over and brought a clean towel to wipe her wet hair. She had a sweet smile, one that even being on her feet for the whole day couldn’t erase. The lady noticed the waitress was nearly eight months pregnant, but she never let the strain and aches change her attitude. The old lady wondered how someone who had so little could be so giving to a stranger. Then she remembered Bryan.

After the lady finished her meal, she paid with a hundred dollar bill. The waitress quickly went to get change for her hundred dollar bill, but the old lady had slipped right out the door. She was gone by the time the waitress came back. The waitress wondered where the lady could be. Then she noticed something written on the napkin.

There were tears in her eyes when she read what the lady wrote: "You don’t owe me anything. I have been there too. Somebody once helped me out, the way I’m helping you. If you really want to pay me back, here is what you do: Do not let this chain of love end with you." Under the napkin were four more $100 bills.

Well, there were tables to clear, sugar bowls to fill, and people to serve, but the waitress made it through another day. That night when she got home from work and climbed into bed, she was thinking about the money and what the lady had written. How could the lady have known how much she and her husband needed it? With the baby due next month, it was going to be hard… She knew how worried her husband was, and as he lay sleeping next to her, she gave him a soft kiss and whispered soft and low, "Everything’s going to be all right. I love you, Bryan Anderson."

There is an old saying "What goes around comes around."

For comments and archives

  Cardiology eMedinewS

NSAID CV risk persists for 5 years post heart attack Read More

Kolkata tops metros in heart disease risk Read More

  Pediatric eMedinewS

Mobile phones behind hearing loss in young? Read More

Respiratory viruses differ in inner–city, suburban infants Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient developed acute appendicitis within seven days of taking a Mediclaim policy.
Dr. Bad: Mediclaim will cover.
Dr. Good: It may not cover.
Lesson: Any diseases other than specified in clause 4.3 contracted by the insured person during the first 30 days from the commencement date of policy are not covered under Mediclaim.

For comments and archives

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced?
Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with ten grams of carbohydrates.

For comments and archives

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

eMedinewS Apps
  Quote of the Day (Dr GM Singh)

Love is the only way to grasp another human being in the innermost core of his personality. Viktor E. Frankl

    Legal Question of the Day (Dr M C Gupta)

Q. The government of Uttar Pradesh has not granted permission for doing autopsies in government medical colleges while the autopsies are routinely being carried out by MBBS doctors employed in the Provincial Medical Service in UP. What should be done?


  • This is unusual. There must be some reason. It is for the medical college faculty to find the reason.
  • Performing an autopsy for the police is work done for the police. Redressal of a wrong can be asked only when a wrong has been done or a right has been denied. Medical college faculty cannot demand work from the police department.
  • The government medical college faculty has a right to demand autopsy work if as per the terms and conditions of service, the job of the faculty involves performing, supervising and teaching how to do autopsies. It is a right of the faculty to demand autopsy work for which it was employed. To secure this right, the faculty should send a proper legally drafted representation to the government, on the basis of which a writ petition may be filed if the government does not act.
  • The above representation/writ petition should be so drafted as to include the MCI as a party because it is the MCI which inspects medical colleges and grants them recognition.
    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Cervical cancer is the only cancer suggested by WHO for routine screening.

    Rabies Update (Dr. A. K. Gupta, Author of "RABIES – the worst death")

A pet dog died a sudden unexplained death. What should be done?

If facilities are available, then postmortem of the dog to confirm rabies is required. If not possible, (or if the postmortem proves rabies) all those who came in contact with the saliva of the animal (directly or through its fomites) should be given PEP.

    Fitness Update (Rajat Bhatnagar, MonaVie, www.mymonavie.com/sonraj)

Aerobic exercise reduces risk of diabetes in kids

Currently, about one–third of elementary school aged children are overweight or obese, which increases their risk for chronic diseases, especially diabetes. A study published in the Journal of the American Medical Association, found that just 20 minutes of exercise per day could reduce kids’ risk of developing risk factors for type 2 diabetes. The study looked at the effect of regular aerobic exercise on insulin resistance (the body’s inability to use insulin, the hormone that helps the body use sugar), abdominal obesity, and overall body fat, all known risk factors for diabetes, in 200 overweight or obese American kids. Results showed that both 20 and 40 minute bouts of exercise 5 times per week resulted in reduced insulin resistance and decreases in overall fat and abdominal fat. These findings were consistent across all races in both boys and girls. Ideally, children should exercise at least 60 minutes per day most days of the week.

    Mind Teaser

Read this…………………

somewhere rainbow

Yesterday’s Mind Teaser: The nurse is performing an eye examination on an elderly client. The client states ‘My vision is blurred, and I don’t easily see clearly when I get into a dark room." The nurse’s best response is:

A. "You should be grateful you are not blind."
B. "As one ages, visual changes are noted as part of degenerative changes. This is normal."
C. "You should rest your eyes frequently."
D. "You maybe able to improve you vision if you move slowly."

Answer for Yesterday’s Mind Teaser: B. "As one ages, visual changes are noted as part of degenerative changes. This is normal."

Correct answers received from: Dr PC Das, Dr Kanta Jain, Dr (Maj. Gen.) Anil Bairaria, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardossh, Dr K Raju, Dr Ajay Gandhi.

Answer for 27th September Mind Teaser: D. Sexual intercourse
Correct answers received from: Dr Chandresh Jardossh, Dr K Raju, Dr Ajay Gandhi.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Chocolate reward

A man called his children together, held up a chocolate bar and asked them who should get it.

"Me… me… me," they chorused.

"I’ll tell you who will get it," continued the father. "Who never talks back to mother and does everything she says?"

Three small voices answered in unison: "OK, Dad, you can have it."

    Medicolegal Update

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

What is embalming?

Embalming is the process of chemically treating a dead body developed by the ancient Egyptians of preserving a person’s body after death to delay the decomposition of the body, restore it to an acceptable physical appearance and reduce the presence and growth of bacteria to prevent foul smell as well as perfume or add fragrance to corpse. Embalming certificate is required by law in certain circumstances like air/rail transportation.

  • The process of embalming has a very long history, dating back to the Egyptian process of mummification. Though their techniques were quite different from those used today, the effect was the same — to preserve an individual’s body after death. The ancient Egyptians believed that the spirit would return to the body after death, so it must remain in good condition. To preserve the corpses, they covered bodies in a drying chemical called natron, and then wrapped them in linen sheets.
  • Today, embalming is done by injecting chemicals directly into the bloodstream to preserve the corpse’s appearance. The most commonly used chemicals for embalming are formaldehyde and ethanol. A combination of these two chemicals is sufficient to preserve the body for a short time i.e. up to a week.
  • To keep the corpse in a good condition for a longer period i.e. up to a month, a solution made up almost entirely of formaldehyde is used.
  • There are several steps involved in modern embalming. First, the embalming fluid is injected directly into the deceased’s blood vessels, and pushed through the body with a mechanical pump. Next, the internal organs are hollowed of their contents and filled with embalming fluid. The chemicals are then injected beneath the skin wherever necessary, followed by a final surface embalming on injured areas of the body.
  • One of the most famous embalmed corpses today is that of Russian communist leader Vladimir Lenin, whose embalmed corpse is on display at the Red Square mausoleum in Moscow. The corpse is very well-preserved, and should last for at least another hundred years.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Prevention strategy relies on lifestyle

Stenting may not always be the answer to treating heart disease with stable angina said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

A German study has shown that patients with stable coronary artery disease who were put on an exercise regimen had significantly higher rates of event–free survival than those who had undergone percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event–free survival –– no stroke, heart attack, or death –– compared with 50% of stented patients after four years.

Exercise is an important part of any type of prevention, and it should be instituted for "anyone with stable coronary heart disease."

The study on stenting versus exercise come was a continuation of a pilot study first reported in 2004 in the journal Circulation. That study of 101 male patients found that after one year, 88% of patients who exercised had event-free survival compared with 70% of stented patients.

The updated data reflect an additional 100 patients, who performed moderate intensity exercise for two weeks under hospital supervision, and then were given an exercise bike to continue their regimen at home.

Patients with stable angina exercised at 80% of their threshold, and that after four weeks of exercising, their angina threshold increased.

The clear message for patients is to get 30 to 60 minutes of moderate–intensity aerobic activity every day, noting that 30% of heart disease could be prevented by 2.5 hours of walking per week.

    Readers Response
  1. Dear Sir, I really learn a lot in you CME. Regards: Dr Karan
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