eMedinewS5th April 2014,Saturday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Why Many Vein Grafts Fail

(NIH) In bypass surgery, a healthy artery or vein from elsewhere in the body is grafted onto arteries that feed the heart to bypass clogged vessels and restore blood flow. The great saphenous vein—the large vein running up the length of the leg—is often used as a bypass due to its size and the ease of removing a small segment. After grafting, implanted veins remodel to become more arterial. However, the remodeling can go awry and the vein can become too thick, resulting in clogged blood flow. About 40% of vein grafts fail within 18 months of the operation.

Dr. Manfred Boehm of NIH’s National Heart, Lung, and Blood Institute examined veins from mouse models of bypass surgery. They suspected that a process known as endothelial–to–mesenchymal transition, or EndoMT, may cause the inside of the vein to over-thicken. During EndoMT, endothelial cells that line the inner surface of the vein proliferate and convert into more fibrous and muscle–like cells. These mesenchymal cells begin to accumulate on the inner wall, narrowing the vessel. The inner walls of the vein become too thick, slowing or blocking the blood flow that the graft was intended to restore. The scientists used mice in which endothelial cells express a protein that can be used to track their fate. The results were published on March 12, 2014, in Science Translational Medicine.

By tracing the fate of endothelial cells, the researchers showed that endothelial-derived cells contribute to vein thickening through EndoMT. They discovered that the process was triggered by transforming growth factor beta (TGF–beta), a secreted protein known to control the proliferation and maturation of several cell types. TGF–beta, the scientists found, becomes highly expressed just a few hours after graft surgery. Inhibition of the TGF–beta signaling pathway reduced overgrowth in the grafted veins.

The team examined human veins taken from failed bypass operations and found corroborating evidence for a role for EndoMT in human graft failure. In short-term grafts (less than 1 year), many of the cells inside the human veins displayed both endothelial and mesenchymal cell characteristics, while in long-term grafts (more than 6 years) the cells on the inner wall were primarily mesenchymal in nature.

"This study shows for the first time that endothelial cells in the vein directly contribute to blood vessel narrowing following a vein graft," Boehm says. "Now that we better understand the mechanism that causes the abnormal thickening, we can look for therapeutic strategies to attenuate it and reduce the number of bypass reoperations we need to perform each year."

Certain drugs that are known to inhibit TGF–beta are a possible treatment strategy. However, more studies will be needed before any clinical studies can begin.

News Around The Globe

Dr Sonia Malik takes over as the President of the Indian Fertility Society

Dr Sonia Malik, DGO,MD, FICOG,FIAMS, Programme Director, Southend Fertility & IVF Centre, Delhi NCR, took over as the 5th President of the Indian Fertility Society from 1st April.

A national society, the Indian Fertility Society was formed in Delhi in 2004 with the intention to create awareness about the subject and has since grown nationally to over a thousand members across its ten chapters. The aim of the society is to promote good ethical evidence based medicine amongst the clinicians practicing infertility management across the country. The society is in the process of making clinical practice guidelines pertinent to India and will be rolling them out by the end of this year.

  • A new consensus paper published online in Stroke has stated that factors besides size and location must be given due consideration while deciding whether to repair an unruptured intracranial aneurysm. The factors that appeared significant for decision–making include the following: patient age and life expectancy; comorbid diseases; risk factors like previous subarachnoid hemorrhage, family history of unruptured intracranial aneurysm, etc.; aneurysm location, size, and morphology (lobulation/irregularity); aneurysm growth; clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events); and risk factors for treatment.
  • A new study presented at the American Academy of Dermatology 72nd Annual Meeting revealed that the current practice of re–excision of atypical nevi with microscopic margins on initial biopsy may not be necessary in mild–moderate cases. A retrospective review of cases was conducted wherein 2936 consecutive biopsies were evaluated; 871 of these revealed atypia. About 167 of these nevi were re–excised. Nearly 85% of re–excisions showed no sign of residual atypical nevus. The subjects who did not undergo re–excision were monitored for a median of 12 months and did not show any signs of melanoma development during the follow–up period.
  • A new research from National Cheng Kung University in Taiwan reports that doubling the dose of proton–pump inhibitor in high–risk patients who have undergone gastroscopy for bleeding peptic ulcers may reduce the rate of recurrent bleeding. The study has been published in Gut. Patients who received high–dose oral esomeprazole for 11 days were less than half as likely to develop new bleeding as compared to those who received a standard dose. The intention–to–treat analysis revealed that 11% of the high–risk patients on double-dose esomeprazole experienced rebleeding between the 4th and the 28th day, versus 29% of the high–risk patients on standard–dose esomeprazole.
  • A new study published in the British Medical Journal has reported that maintaining "prudent" eating patterns (raw and cooked vegetables, fruits, nuts, vegetables oils, water as a beverage, whole grain cereals, poultry and fiber-rich bread) during pregnancy was associated with lesser chances of having preterm births compared to eating a "Western" diet (salty snacks, chocolate and sweets, cakes, French fries, white bread, ketchup, sugar–sweetened drinks, processed meat products and pasta). Researchers identified 66,000 women who participated in the Norwegian Mother and Child Cohort Study and were pregnant between 2002 and 2008. Women who complied with the prudent diet were 11% less likely to have preterm deliveries compared to women who did not follow the diet as closely.
  • A novel study in Diabetes Care has reported that consuming a higher–complex carbohydrate, lower–fat (CHOICE) diet has the ability to achieve glycemic targets as well as reduce lipid levels in women with gestational diabetes (GDM). The CHOICE diet was compared with a carbohydrate–restricted, higher–fat diet in a crossover study of 16 women with diet–controlled GDM. There were no between–diet differences in mean nocturnal and 24–hour glucose; however, daytime mean glucose was higher with CHOICE than with the conventional diet (98 mg/dL vs. 93 mg/dL). The 24–hour total glucose AUC was also 6% higher on the CHOICE diet. Additionally, the free fatty acid AUC was 19% lower on CHOICE diet than on the conventional diet.

Rabies News (Dr A K Gupta)

If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.

Cardiology eMedinewS

  • New AF guideline includes four key changes: A new AF guideline by the American Heart Association, American College of Cardiology and Heart Rhythm Society in collaboration with the Society of Thoracic Surgery, describes a more precise stroke–risk calculator and when to use aspirin, novel oral anticoagulants, and catheter ablation. Simultaneously published online March 28, 2014 in the Journal of the American College of Cardiology, Circulation, and Heart Rhythm, the guideline supersedes the AF guideline published in 2006 and two updates published in 20113,4) and reflects some but not all changes to a 2012 European update. The guideline contains four significant changes.
    1. CHA2DS2–VASc replaces CHADS2: To estimate the risk of stroke in patients with nonvalvular AF, the guideline recommends replacing the CHADS2 score with the more comprehensive CHA2DS2-VASc score, whereby one point is given each for CHF, hypertension, diabetes, vascular disease (prior MI, PAD, aortic plaque), age 65 to 74, and sex category (female), and two points each for aged 75 or older and prior stroke/transient ischemic attack (TIA)/thromboembolism. "Compared with the CHADS2 score, the CHA2DS2–VASc score for nonvalvular AF has a broader score range (0 to 9) and includes a larger number of risk factors (female sex, 65 to 74 years of age, and vascular disease). In this scheme, women cannot achieve a CHA2DS 2–VASc score of zero. CHA2DS2–VASc is better helped to define the risk, particularly in people at low risk.
    2. Aspirin’s role diminished: Aspirin carries with it a small but definable bleeding risk and many trials (showed) either no benefit or weak benefit in terms of stroke reduction, so there’s a diminished role, if any role, for aspirin.
    3. New anticoagulants join treatment options: Whereas the only anticoagulant previously recommended was warfarin, the guideline now includes recommendations for the three new anticoagulants for nonvalvular AF that entered the marketplace in the past two years. For patients with nonvalvular AF with prior stroke, TIA, or a CHA2DS2–VASc score of 2 or greater, oral anticoagulants are recommended. Options include warfarin, dabigatran etexilate, rivaroxaban, or apixaban. Dabigatran and rivaroxaban are contraindicated in patients with end-stage renal disease or on hemodialysis. Apixaban has recently been approved for patients on hemodialysis.
    4. More prominent role for catheter ablation: In patients with recurrent symptomatic paroxysmal AF, catheter ablation is a reasonable initial rhythm–control strategy prior to therapeutic trials of antiarrhythmic drug therapy, after weighing risks and outcomes of drug and ablation therapy.
  • Patients with newly diagnosed type 2 diabetes who improve their diet and become more physically active during the next year have a significantly lower risk of having a cardiovascular disease (CVD) event within 5 years, reports a recent study published online in Diabetes Care. It was noted during the study that those who failed to improve any of the 4 lifestyle changes — increasing physical activity; decreasing alcohol consumption; improving fiber and vitamin C intake; and reducing both calorie and total fat intake — had a 4–fold increased risk of developing a CVD, such as a heart attack or stroke, or die from CVD during 5 years of follow–up, compared with those who made positive changes in at least 3 of the behaviors. Physical activity and drinking less alcohol appeared to have the biggest effects.

Pediatrics eMedinewS

  • There are many children who do not see dentists regularly, and a lack of oral care is commonly seen in children younger than 3 years. A study published online March 31 in Pediatrics addressed this issue and stated that primary care physicians can easily reduce tooth decay in indigent children by extending fluoride treatment, oral health education, exams, and referrals. An oral health care program provided services to children enrolled in Medicaid from the time of the first tooth eruption until age 42 months. Researchers evaluated the program’s success and noted that the decayed, missing, and filled teeth (DMFT) rate increased from 1.53 per child in 1998 to 1.84 in 2004 and then dropped back to 1.59 in 2009.
  • Children with symptoms of atopic dermatitis (AD) are likely to have persistent symptoms into their teens, and often well beyond, according to findings from a long–term longitudinal study of more than 7000 children, published online April 2 in JAMA Dermatology.

Dr K K Spiritual Blog

On 6th Navratri chant AUM

Mata Katyayani is worshipped on the sixth day of Navratri. SHE has three eyes and four hands and rides on a Lion.

The top right hand is positioned in a gesture of providing courage and the other hand is positioned in a gesture of rendering a boon. The top left hand is holding a sword and the other holding a lotus.
In Yoga Shastra she represents the Ajna Chakra and AUM bija mantra. AUM chanting helps attaining success in religion, wealth, passion and salvation and removing fear and sorrows.

Spiritual mantra on the 6th Navratri

AUM chanting is one of the most powerful chakra and should be done concentrating on the Ajna chakra.

Wellness Blog

High fat diet, prostate cancer prone

Diets high in saturated fat increase the risk of prostate cancer. As per a report from University of Texas M. D. Anderson Cancer Center in Houston published in the International Journal of Cancer:

  • Men who consume high saturated animal fat diet are two times more likely to experience disease progression after prostate cancer surgery than men with lower saturated fat intake.
  • There is also shorter "disease–free" survival time among obese men who eat high saturated fat diet compared with non–obese men consuming diets low in saturated fat.
  • Men with a high saturated fat intake had the shortest survival time free of prostate cancer (19 months)
  • Non–obese men with low fat intake survived the longest time free of the disease (46 months).
  • Non–obese men with high intake and obese men with low intake had "disease–free" survival of 29 and 42 months, respectively.

Take home messages

  • High saturated fat diet has been linked to cancer of the prostate
  • Reducing saturated fat in the diet after prostate cancer surgery can help reduce the cancer progression.
  • Cancer prostate has the same risk factors as that of heart blockages and both are linked to high saturated fat intake.
  • With an increase in number of heart patients, a corresponding increase in prostate cancer patients is also seen in the society.

Inspirational Story

The Three Dolls

A sage presented a prince with a set of three small dolls. The prince was not amused. "Am I a girl that you give me dolls?" He asked.

"This is a gift for a future king," Said the sage. "If you look carefully, you’ll see a hole in the ear of each doll." The sage handed him a piece of string. "Pass it through each doll." He said.

Intrigued, the prince picked up the first doll and put the string into the ear. It came out from the other ear. "This is one type of person," said the sage, "whatever you tell him, comes out from the other ear. He doesn’t retain anything."

The prince put the string into the second doll. It came out from the mouth. "This is the second type of person," said the sage, "whatever you tell him, he tells everybody else."

The prince picked up the third doll and repeated the process. The string did not come out. "This is the third type of person," said the sage, "whatever you tell him is locked up within him. It never comes out."

"What is the best type of person?" Asked the prince. The sage handed him a fourth doll, in answer. When the prince put the string into the doll, it came out from the other ear.

"Do it again." Said the sage. The prince repeated the process. This time the string came out from the mouth. When he put the string in a third time, it did not come out at all.

"This is the best type of person," said the sage. "To be trustworthy, a man must know when not to listen, when to remain silent and when to speak out."

ePress Release

Eat less to remember more

"Eat less to remember more" is the prescription of the day for the elderly, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

A study published in Proceedings of the National Academy of Sciences, by Dr. Agnes Floel, assistant professor of Neurology at the University of Munster, has shown that memory and thinking skills improved among healthy, overweight elderly subjects who cut their calorie intake by 30 percent over a three–month period.

Calorie restriction boosts memory and cognition by reducing insulin resistance and inflammation, which may be linked to age–related cognitive decline.

Improvements in memory could be especially important, because memory losses are an early indication of Alzheimer’s disease and its precursor, mild cognitive impairment.

The 49 men and women in the study had a mean age of 60.5 years and a body mass index of 28. Those in the calorie–restriction group were not told what to eat but were advised to cut portions and not to eat less than 1,200 calories daily.

The calorie restrictors lost an average of five pounds, with those who most closely adhered to the dietary recommendations losing an average of eight pounds. This subset with the largest weight loss also showed the biggest improvements in memory performance.

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 88972 people since 1stNovember 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."

Zee News – Health Wealth Shows

Cancer Prevention
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Total CPR since 1st November 2012 – 88972 trained

cpr10 Mantra 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 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

emedipicstoday emedipics

A free heart checkup camp was organised by Heart Care Foundation of India at Mandi House, Doordarshan Kendra where over 500 people were examined.

press release

Day care PCI is the future

video of day video of day


IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :


Make Sure

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

eMedinewS Humor

Cardiovascular: The three kinds of blood vessels are arteries, veins and caterpillars.

Quote of the Day

Coming together is a beginning. Keeping together is progress. Working together is success. Henry Ford


Twitter of the Day

Dr KK Aggarwal: Diabetes is a progressive disease http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: Recurrent anxiety can have a devastating toll on all aspects of our life. How to deal with anxiety? http://tinyurl.com/mboexab


Forthcoming events

Date: Saturday 2PM–Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – reg mno, rawat.vandana89@gmail.com
SMS – BK Sapna reg mno1, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed


Our Contributors

Dr Veena Aggarwal, Dr Chanchal Pal, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Monica Vasudev, Dr Navin Dang, Dr Pawan Gupta, Dr Parveen Bhatia, Dr Prachi Garg, Rajat Bhatnagar, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

eMedi Quiz

Beta–oxidation of odd–chain fatty acids produces:

1.Succinyl CoA.
2.Propionyl CoA.
3.Acetyl CoA.
4.Malonyl CoA.

Yesterday’s Mind Teaser: Injury to radial nerve in lower part of spiral groove:

1. Spares nerve supply to extensor carpi radialis longus.
2. Results in paralysis of anconeus muscle.
3. Leaves extension at elbow joint intact.
4. Weakens pronation movement.

Answer for yesterday’s Mind Teaser: 3. Leaves extension at elbow joint intact.

Correct answers received from: Dr P C Das, Dr Poonam Chablani, Dr K V Sarma, Dr Jainendra Upadhyay, Dr Avtar Krishan, Daivadheenam Jella, Dr B K Agarwal, Dr Bitaan Sen & Dr Jayashree Sen, Dr Prakash Khalap.

Answer for 3rd April Mind Teaser: 1. Transitional

Correct answers received from: Dr Poonam Chablani.

Send your answer to ijcp12@gmail.com

medicolegal update

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medicolegal update

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medicolegal update
  1. Dear Editor, "Babloo goes for an eye test" for students, parents and teachers is equally suitable and must-read book for everyone including doctors…and the added bonus is that the little book is available "free" for collection for libraries of hospitals and medical teaching institutions (from Ophthacare Eye Centre, C2C/236A Janakpuri, New Delhi 110058, 6.00 pm to 8.00 pm) with prior intimation at Phone 25599839. Dr. Narendra Kumar Chairman, Eye Care India
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