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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


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  Editorial …

31st March 2012, Saturday

Non–HDL–C Levels Linked to Risk for Cardiovascular Events

Levels of non–HDLC among users of statins is linked to the risk for a major cardiovascular event, such as a heart attack or stroke, more strongly than are levels of LDLC and apolipoprotein B. The finding, from a meta-analysis of data from 8 trials comprising a total of 62,154 patients, is published in the March 28 issue of JAMA by S. Matthijs Boekholdt, MD, PhD, from the Academic Medical Center, Amsterdam, the Netherlands.

The meta–analysis looked at individual–patient data from randomized, controlled statin trials published between 1994 and 2008. All study participants had conventional lipids and apolipoprotein levels assessed at baseline and at 1–year follow–up.

Among the 38,153 patients who were randomly assigned to statin therapy, 158 (0.4%) had a fatal myocardial infarction and 1678 (4.4%) had a nonfatal myocardial infarction during follow–up. Death due to other types of coronary artery disease occurred in 615 (1.6%) of the study participants, and fatal or nonfatal stroke occurred in 1029 (2.7%) study participants. In addition, 2806 (7.4%) patients were hospitalized for unstable angina, and 6286 major cardiovascular events (MACE) occurred in 5387 participants, for an event rate of 14.1%. The analysis showed that all the studied lipid and apolipoprotein measures were associated with the risk for MACE and that these associations were statistically significant.

Further analysis showed that the difference between LDL–C and non–HDL–C in predicting the risk for MACE for each 1–standard deviation increase was statistically significant (P = .002). The difference between non–HDL–C and apoB was also statistically significant (P = .02), but the difference between LDL-C and ApoB was not (P = .21).

Given the fact that many other arguments for the clinical applicability of non–HDL–C and LDL–C are identical, non–HDL–C may be a more appropriate target for statin therapy than LDL–C. (Source Medsacpe)

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Dr KK Aggarwal
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  eMedinewS Audio PostCard

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

White rice linked to diabetes in Asians

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Communication skills for Health Care Professionals

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal presenting an Lecture on "Communication skills for Health Care Professionals" at Puspanjali Hospital, Ghaziabad

Dr K K Aggarwal
    National News

14 bird species on verge of extinction in India

NEW DELHI: At least 14 species of birds from India are on the verge of extinction due to poaching, over use of pesticides and loss of habitat, government said. However, the "National Bird" peacock is not currently under the threat of extinction, minister of environment and forests Jayanthi Natarajan said. "According to the International Union for Conservation of Nature (IUCN) Red List of Threatened Species, 14 species of birds from India are critically endangered, which do not include peacocks," she said in a written reply to Lok Sabha. "The major threats being faced by these bird species include habitual destruction, poaching, indiscriminate use of pesticides and chemicals harmful to birds etc," she explained. According to the IUCN list, the critically endangered birds include White–rumped Vulture, Indian Vulture, Red–headed Vulture, Pink–headed Duck, White–belled Heron, Sociable Lapwing, Christmas Frigatebird, Jerdon’s Courser, Siberian Crane, Bengal Florican, Himalayan Quail, Forest Owlet, Spoon–billed Sandpiper. (Source: TOI, Mar 26, 2012)

For comments and archives

Cancer death comes early in India

An estimated 71% of all cancer deaths in India occur in people 30 to 69 years of age, according to a study published online March 28 in the Lancet. This is a "landmark study" because it is a "nationally representative sample," according to an accompanying comment. The study provides adequate coverage of often neglected rural areas where three quarters of Indians live, write Rengaswamy Sankaranarayanan, MD, from the International Agency for Research on Cancer in Lyon, France, and Rajaraman Swaminathan, PhD, from the Cancer Institute in Chennai, India, in their comment. (Source: Medscape)

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

    International News

Drugs best suited for treating irritable bowel syndrome identified

New Delhi: Two prevalent drug therapies— rifaximin and lubiprostone — have been identified as having the fewest side–effects for treating irritable bowel syndrome, according to a study. ‘Patients with irritable bowel syndrome often experience abdominal pain or cramps, excess gas or bloating and ‘visible abdominal distension. Many drug therapies cause troubling side–effects of their own, including nausea, insomnia, palpitations and decreased appetite. The findings are based on an analysis of more than two dozen large–scale clinical trials. "For the millions of patients who suffer from IBS, effective treatment options have been very scarce," said Dr Mark Pimentel, a lead; author of the study and director of Cedars–Sinai’s Gastrointestinal Motility Program. (ANI)

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Your presence stirs up 37 mn bugs indoors

An individual’s mere presence in a room stirs up 37 million bugs every hour – actually material left behind on the floor by previous occupants, says a new study. "We live in this microbial soup, and a big ingredient is our own micro–organisms," said Jordan Peccia, associate professor of environmental engineering at Yale University and the principal study investigator. "Mostly people are re–suspending what’s been deposited before. The floor dust turns out to be the major source of the bacteria that we breathe," said Peccia, the journal Indoor Air reports. This is the first study that quantifies how much a lone human presence affects the level of indoor biological aerosols, according to a Yale statement. (Source: TOI, Mar 29, 2012)

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Dietary trans fats linked to aggression

Consumption of dietary trans fatty acids is associated with irritability and aggression, new research shows. The cross–sectional study of 945 adult men and women provides the first evidence linking trans–fat consumption to adverse behaviors that affect others. These range from impatience to overt aggression, said lead author Beatrice A. Golomb, MD, PhD, from the University of California, San Diego. "There were studies showing that omega–3 fatty acids were associated with increased agreeableness and reduced impulsivity, and there’s evidence that trans fats adversely affect ability to create the long–chain omega–3 fatty acids that are favorable for your brain, and that prompted us to study this further," Dr. Golomb said. The study was published online March 5 in PLoS One. (Source: Medscape)

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Bariatric surgery eyed for expansion in diabetes, HF

Bariatric surgery may gain a bigger role in diabetes treatment and possibly heart failure, too, as this exclusive InFocus report explains. Results reported in the New England Journal of Medicine and simultaneously at the American College of Cardiology meeting are likely to move bariatric procedures away from being a last resort for obese diabetes patients, according to Mariell Jessup, MD, of the University of Pennsylvania in Philadelphia and a spokesperson for the American Heart Association. (Source: Medpage Today)

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  Twitter of the Day

@DrKKAggarwal: Only an Indian Should Break My Record: Sachin Tendulkar

@DeepakChopra: Instead of projecting unfold your true self and relate from that level

    Spiritual Update

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

7th Chaitra Navratri: Kalaratri

"Spiritual summary: By the time chanting of Bija mantras LAM, VAM, RAM, YAM, HAM and AUM is over the inner darkness goes over."

Navratri is the detoxification of body, mind and soul. The 9–day purification process is observed twice in a year, at the start of summer and winter. Chaitra Navratri is observed at the start of the summer for preparing the body to tolerate summer.

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    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is genetic screening?

Genetic screening refers to the use of specific tests to determine which members of a population are at increased risk for an inherited condition. Genetic screening may help identify couples who have an increased risk of age–related or familial genetic disorders and birth defect. Screening for genetic diseases that may affect offspring depends upon the racial or ethnic background of the couple, their family and medical history, and associated conditions.

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

(Dr. Bharat Singh, Director SBTC Delhi)

Blood Transfusion Is It Really Required……?

Think & Decide!

Blood Transfusion is beneficial but associated with risk similar to the organ transplant. Risks are due to HLA (Human Leukocyte Antigen), Red cell Antigens and Platelet refractoriness. Risks are also due to transfusion transmitted infections like HIV, Hepatitis B, Hepatitis C, Malaria, Cytomegalovirus etc. There are several other hundreds of viruses, which can be transmitted by the blood.

Presently blood is not screened for these infections due to high cost and being non mandatory by the statutory legal agencies. The risks are more so with the fresh/ warm blood because of inadequate testing and sensitivity of the rapid tests.

Use of blood components is recommended in place of whole blood. Therefore before prescribing blood transfusion thinks about the benefit and risks associated with blood transfusion.

Transfuse only when the benefits outweigh the risks.

For comments and archives

    Celiac Disease Update

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

Can a person be put on gluten–free diet just on the basis of positive serology for disease?

Because of the major implications of a diagnosis of celiac disease, professional guidelines recommend that a positive blood test should still be followed by an endoscopy/gastroscopy and biopsy. A negative serology test may still be followed by a recommendation for endoscopy and duodenal biopsy if clinical suspicion remains high due to the 1 in 100 "false–negative" results. As such, tissue biopsy is still considered the gold standard in the diagnosis of celiac disease.

It’s a diagnosis, which is for life–long therefore one should not leave any scope of error in it.

Guidelines recommend that a total serum IgA level is checked in parallel, as celiac patients with IgA deficiency may be unable to produce the antibodies on which these tests depend (false–negative). In those patients, IgG antibodies against transglutaminase (IgG–tTG) may be diagnostic.

Most patients with celiac disease have a small bowel that appears normal on endoscopy; however, five concurrent endoscopic findings have been associated with a high specificity for celiac disease: scalloping of the small bowel folds, paucity in the folds, a mosaic pattern to the mucosa (described as a "cracked–mud" appearance), prominence of the submucosa blood vessels and a nodular pattern to the mucosa.

For comments and archives

    Medi Finance Update

(Tarun Kumar, Chartered Accountant)

Securities Transaction Tax (STT)

STT on actual delivery or transfer of shares reduced from the existing 0.125% to 0.1%.

Alternate Minimum Tax (AMT)

  • Presently, AMT which is applicable to LLP is now extended to all non-corporates who claim certain deductions in computing their total income.
  • Threshold limit of Rs. 20 lakhs for individuals, HUF, AOP, BOI and artificial juridical persons.
  • AMT Credit allowed to be carried forward up to 10 years.
  • Tax rate proposed is 18.5%.

For comments and archives

    An Inspirational Story

(Dr GM Singh)

Daddy, how much do you make an hour?

With a timid voice and idolizing eyes, the little boy greeted his Father as he returned from work, "Daddy, how much do you make an hour?" Greatly surprised, but giving his boy a glaring look, the Father said: "Look, son, not even your mother knows that. Don’t bother me now, I’m tired."

"But Daddy, just tell me please!? How much do you make an hour," the boy insisted. The Father finally giving up replied: "Twenty dollars per hour." "Okay, Daddy? Could you loan me ten dollars?" the boy asked.

Showing restlessness and positively disturbed, the Father yelled: "So that was the reason you asked how much I earn, right?? Go to sleep and don’t bother me anymore!"

It was already dark and the Father was meditating on what he had said and was feeling guilty. He thought that his son wanted to buy something.

Finally, trying to ease his mind, the Father went to his son’s room. "Are you asleep son?" asked the Father.

"No, Daddy. Why?" replied the boy partially asleep. "Here’s the money you asked for earlier," the Father said.

"Thanks, Daddy!" rejoiced the son, while putting his hand under his pillow and removing some money.

"Now I have enough! I have twenty dollars!" the boy said to his Father.

The Father sat there, gazing at his son, confused at what his son just said. "Now Daddy could you sell me one hour of your time?"

For comments and archives

    Fitness Update

(Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, www.mymonavie.com/sonraj)

For every pound of fat you gain, your body produces seven miles of new blood vessels

These are mostly tiny capillaries, but these new vessels also include mini veins and arteries called venules and arterioles. For every 10 pounds of fat gained, your heart has to pump blood through an additional 70 miles of blood vessels! Consequently, it is not difficult to see why obesity and heart disease go hand in hand. The good news, however, is that the reverse is also true – for every pound of fat lost, your body breaks down and reabsorbs 7 miles of vessels!

This can be really reassuring if you’re trying to lose weight. One pound may not look like a lot of weight lost on the outside, but it has innumerable health benefits. It can even reduce your chances of getting breast cancer, ovarian cancer, or prostate cancer.

For comments and archives

  Cardiology eMedinewS

Transcatheter Valves in Inoperable Patients at Two Years: PARTNER B
Read More

PARTNER A: Even Mild Paravalvular Leaks Linked With Higher Mortality at Two Years Read More

Off–pump and On–pump CABG Give Similar Short–Term Outcomes
Read More

CCTA–first ER Strategy Safely Discharges More Patients Read More

  Pediatric eMedinewS

Non–HDL–C Levels Linked to Risk for Cardiovascular Events Read More

Less Invasive Protocol Helps Preemies Breathe Easier In Limited Resource Settings Read More

Kids Recover More Easily From Intracapsular Vs Total Tonsillectomy
Read More

Start Lowering LDL in Childhood, New Study Suggests Read More

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient presented with first–onset CAD to a GP.
Dr Bad: You need a cardiac consult.
Dr Good: You need a cardiac and a dental consult.
Lesson: Diabetic persons with severe periodontal disease may be particularly susceptible to microvascular and macrovascular complications, which are primarily responsible for the increased morbidity and mortality associated with diabetes. Several epidemiological studies suggest that periodontal infection may be a risk factor for heart disease. Periodontal disease is a strong predictor of death from cardiorenal disease in those with type 2 diabetes (Diabetes Care 2005;28(1):27–32).

For comments and archives

Make Sure

Situation: A foreigner presents with travelers diarrhea.
Reaction: Put him on ciprofloxacin.
Lesson: Make sure that foreigner patients with travelers diarrhea are put on a course of ciprofloxacin and tinidazole

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  Quote of the Day

(Dr GM Singh)

Too many people spend money they haven't earned, to buy things they don't want, to impress people they don't like. Will Rogers

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Typhidot has no FDA approval and has got minimal supportive literature to prove its accuracy.

    Mind Teaser

Read this…………………

The grandson is about as many days old as the son is in weeks. The grandson is approximately as many months old as the father is in years. The ages of the grandson, the son, and the father add up to 120 years. What are their ages in years?

Yesterday’s Mind Teaser: The risk of malignancy in adenomatous polyp is related to all except:

a) Size
b) Number
c) Histological appearance
d) Dysplasia

Answer for Yesterday’s Mind Teaser: b) Number

Correct answers received from: Dr Thakor Hitendrsinh G, Dr Ragavan Sivaramakrishnan Moudgalya, Dr Shashi Saini, Raju Kuppusamy, Dr PC Das, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Anil Bairaria, Dr Valluri Ramarao.

Answer for 29th March Mind Teaser: a) Hypertension
Correct answers received from: Raksha Vaishnav.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Veena Aggarwal)

Couldn’t help but forward………………all the women will really have a good laugh…

The doctor, after an examination, sighed and said, "I’ve got some bad news. You have cancer, and you’d best put your affairs in order."

The woman was shocked, but managed to compose herself and walk into the waiting room where her daughter had been waiting.

"Well, daughter, we women celebrate when things are good, and we celebrate when things don’t go so well. In this case, things aren’t well. I have cancer. So, let’s head to the club and have a martini."

After 3 or 4 martinis, the two were feeling a little less somber. There were some laughs and more martinis.

They were eventually approached by some of the woman’s old friends, who were curious as to what the two were celebrating. The woman told her friends they were drinking to her impending end. "I’ve been diagnosed with AIDS."

The friends were aghast, gave the woman their condolences and beat a hasty retreat.

After the friends left, the woman’s daughter leaned over and whispered, "Momma, I thought you said you were dying of cancer, and you just told your friends you were dying of AIDS! Why did you do that?"

"Because I don’t want any of those bitches sleeping with your father after I'm gone."

And THAT, my friends, is called, "Putting Your Affairs In Order."

    Legal Question of the Day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. Medical teachers in Gujarat are agitating for the following: 1–Pay according to sixth pay commission or UGC; 2–2. Time bound promotion; 3– Recognition of ad hoc service; 4–Removal of ceiling of pay; 5– Allowance as per Central Pay Commission rates; 6– Transparency in transfers; 7– No extra duties like VIP duties, Jail duties etc.; 8– No transfer to semi government colleges. A Notice was given to the government before going on strike. We have organised two rallies and two mass casual leave events. We have submitted 7 memoranda. Our issues have been in local newspapers for about last 6 months. There has been no result so far. What should we do now?


  • Everybody takes doctors for granted. Doctors are often OK with that and hence the practice and suffering continues. A major reason for such continuance is that doctors do not know their legal rights and duties and manage everything themselves without getting legal opinion.
  • I suspect that your notice and memoranda were not drafted by a lawyer and hence the government is sitting pretty over them in the safe knowledge that they can be used against you.
  • It is possible that the HC may issue directions to end the strike either by taking suo moto action or if somebody petitions it. That will leave you nowhere.
  • You should do as follows:
    • Prepare a folder chronicling the developments and documents related to this strike and the previous similar movements over last 4–5 years.
    • Engage a good lawyer, pay him his fee, discuss the case with him, give him a copy of the folder, and ask him to give you legal opinion regarding:
      • Which of your demands are just and how much?
      • What is the next best course?
      • How to avoid a possible HC intervention and order to end the strike.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Cholesterol tips released

Blood lipid levels may exhibit mild seasonal variation with a peak in total cholesterol level in the winter and a drop in the summer. The variation can be up to 5 mg/dL, said Dr. K.K. Aggarwal, Padma Shri and Dr B C Roy National Awardee and President, Heart Care Foundation of India.

Serum total and HDL–cholesterol can be measured in fasting or non–fasting individuals. There are only small clinically insignificant differences in these values when measured in the fasting or non–fasting state.

The total cholesterol can vary by 4 to 11 percent within an individual due to multiple factors including stress, minor illness and posture. Values may also vary between different laboratories, with data suggesting that a single measurement of serum cholesterol can vary as much as 14 percent. Therefore in an individual with "true" serum cholesterol concentration of 200 mg/dL the range of expected values is 172 to 228 mg/dL. More than one measurement of total cholesterol should therefore be obtained when treatment considerations demand a precise determination. Measurement of serum HDL–C and triglycerides may demonstrate even greater variability.

A standard serum lipid profile consists of total cholesterol, triglycerides, and HDL–cholesterol. Lipid profile should be performed after 12 to 14 hours of fasting to minimize the influence of postprandial hyperlipidemia. One can use either a plasma or serum specimen can be used. The serum cholesterol is approximately 3 percent lower than the plasma value.

    Readers Response
  1. Dear Sir, Thanks for providing the updated informations. Regards: Dr Sneha
    Forthcoming Events
Dr K K Aggarwal

BSNL Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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