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Dr KK Aggarwal

From the Desk of Editor in Chief
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

14th July, 2010, Wednesday

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

Nitrate–rich foods

Nitrates present in foods can lower blood pressure. Nitrates are essential plant nutrients found in soil that are taken up by plants and used as their primary nitrogen source. They are a natural part of all vegetables, fruits and cereals. On the other hand, nitrite, is a chemical within the body produced by the digestion of nitrate–containig foods.

Nitrates may have a role in controlling blood pressure by maintaining the health of blood vessels. A short–term study involving 17, non–smoking and healthy young adults, observed the effects of nitrate supplement on the participants. Each person was given a daily dose of nitrate supplement that equalled the amount found in 150–250 grams of vegetables rich in nitrate (lettuce, spinach, beetroot). The study subjects were asked to take the supplement for three days, and then take a daily placebo during three different days. The results of the study concluded that although the nitrate supplement did not reduce the systolic BP, it lowered diastolic blood pressure by an average of 3.7 mm Hg.

Foods high in nitrates include Lettuce, Spinach, Cabbage, Beets, Radishes and Carrots. Nitrate can also be found in the air, water; it is also a preservative found in foods including cheese, processed meats, and fish, as well as in spirits and liqueurs.

In an earlier study, led by Professors Amrita Ahluwalia and Ben Benjamin and published in the February 2008 issue of Hypertension, two groups of healthy volunteers were given beetroot juice 500 ml (high in nitrates) to drink. The first group swallowed their saliva with the juice whereas the second group refrained from swallowing their saliva whilst drinking and for 3 hours afterwards. On measuring blood pressure, it was found that the group who had taken juice plus saliva showed a significant drop in blood pressure. The non–saliva group showed no such reduction. The study found a relationship between blood nitrite levels and lowered blood pressure in the juice plus saliva group and no rise in nitrite levels in the other group. In the first group the bacteria on the tongue converted the nitrate in the juice to nitrite which was then washed into the stomach by the saliva. In the second group, very little nitrite would have entered the stomach.

Nitric oxide is a chemical messenger produced by the walls of blood vessels and has the effect of relaxing the vessels and therefore lowering blood pressure. The body makes nitric oxide from nitrite which is derived from nitrates in food, particularly vegetables.

Dr KK Aggarwal
Editor in Chief

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Photo Feature (From HCFI file)


Campaign against Heart Disease among Women


Heart Care Foundation of India inaugurated ‘Glow Red’ a campaign against rising incidences of heart diseases in women on September 5, 2006 in New Delhi. The color red was the dress code of the participants; it was also used symbolically as an alert sign to protect women’s heart.

Dr k k Aggarwal
Mr Mangat Ram Singhal, Delhi Industries and Labour Minister, Mr Ashish Vidyarthi, Film Actor at the inauguration. Also in the photo: Padma Shri and Dr B C Roy Awardee Dr K K Aggarwal, President HCFI and Mrs. Abheeta Khanna, Director PR, HCFI


News and Views ( Dr Brahm and Monica Vasudeva)

Simple diagnostic tool predicts type 2 diabetes in Southeast Asians

Researchers from Australia and Vietnam have developed a simple tool to identify people at high–risk for developing type 2 diabetes. The chances of developing diabetes increased more than 6–folds in men and 4–folds in women, when the levels of central obesity and hypertension were high. The study results were published in the journal Diabetologia by Professors Tuan Nguyen and Lesley Campbell from Sydney’s Garvan Institute of Medical Research, in collaboration with Dr Mai Ta from Nhan dan Gia Dinh hospital in Ho Chi Minh City.

Music therapy may benefit recovery from stroke

According to the results of two small clinical trials, involving 98 patients with stroke, rhythmic auditory stimulation, a type of music therapy improved gait in patients who had suffered a recent stroke. According to Joke Bradt, PhD, a board–certified music therapist at Temple University in Philadelphia, and coauthors, gait velocity, cadence, and symmetry, as well as stride length, were all improved with the therapy.

New way to detect viral infections gives homeopathy a boost ( Dr Anupam Malhotra)

Professor Luc Montagnier, a French virologist, presented a new method for detecting viral infections which bears close similarlity to the basic tenets of homeopathy. Solutions containing DNA of pathogenic bacteria and viruses, including HIV, could emit low frequency radio waves that induced surrounding water molecules to become arranged into nanostructures. These water molecules could also emit radio waves. According to him, water could retain such properties even after the original solutions were massively diluted, to the point where the original DNA had effectively disappeared. Water thus could retain the memory of substances with which it had been in contact. The emissions can be used by doctors to detect disease. (Sunday Times London, Times of India – 5th July 2010)

Patients admitted to ICUs over the weekend may be more likely to die (Dr G M Singh)

A new research states that patients admitted to an intensive care unit over the weekend may be more likely to die than those admitted at other times, perhaps because of reduced staffing. The study is published in the journal Chest.


Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Inevitable Medical Accident in Health Care Delivery?

An inevitable medical accident or "unavoidable medical occurrence" in health care delivery is that which could not be possibly prevented by the exercise of ordinary medical/surgical/paramedics and nursing care, caution and skill.

In medical profession, it means any medical/surgical accident that results in damage/injury/disability or death that was not avoidable by any such precautions as a reasonable qualified medical professional/hospital doing such an act then there, "could be expected to take." A general/ reasonable medical professional is not credited by the law with exact perfection of judgment. As observed by Greene M.R., an accident is “one out of the ordinary course of things, something so unusual as not to be looked for by a person of ordinary prudence.

During the course of treatment, an accident occurs which could not be avoided by any ordinary skill or care on the part of the doctor administering the treatment, the accident is said to be inevitable accident. The term ‘inevitable accident ‘has been defined as an accident not avoidable by any such precautions as a reasonable man can be expected to take’. In the case of (Gerber V.pines 21) the plaintiff claimed damages against the defendant alleging that during the administration of a hypodermic injection the defendant left part of a broken needle in her buttock. The defendant denied liability and said that the breakage of the needle was due to a sudden muscular spasm and that no skill or care on his part could have prevented the fracture of the needle or the retention of the broken part in the plaintiff‘s body. The judge found that there had been no negligence on the part of the defendant in so far as the fracture of the needle was concerned, he found however, that had been a breach of duty on the part of defendant in not informing the plaintiff or her husband that the needle had fractured and that a piece of it was still in her body. For this the judge awarded the plaintiff a small sum by way of damages.

In cases of inevitable medical accident, a very positive/sympathetic/grief sharing approach should be made by the doctor towards his/her patient and all logistic medical/surgical services must be extended/provided to the patient without cost by the doctor/hospital to restore/enhance faith and trust of this profession since the service which medical professionals render to the people/society and nation is the noblest one. The patient must also be told that inevitable medical accident was due to the elementary forces of nature unconnected with the hospital/doctor and they are there to share with the patient's suffering.


Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

eMedinews Guest Editor: Dr. Neelam Mohan – Consultant Pediatric Gastroenterologist, Hepatologist, therapeutic Endoscopist and Liver Transplant Physician has now moved to Medanta Medicity – Gurgaon as Director Pediatric Gastroenterology, Hepatology and Liver Transplantation.)

Who can be a living liver donor ?

  1. Willing, family donor with matching blood group

  2. HLA matching is not required for liver donation, unlike kidney transplantation

  3. 18–55 year old, weighing 55 – 85 kg but not fat

  4. Healthy, normal liver function.

  5. No major health issues related to heart, kidney, brain, malignancies etc.

  6. HBsAg, HCV, HIV–negative

  7. Informed consent, psychological evaluation

How much liver can one donate ?

One can donate 6070% of his/her liver volume. For example a normal adult with, for example, 1500 gms of liver could donate 900 1000 gms of his / her liver. This is provided, the liver is not fatty. If the liver is fatty then an extra 1020% of liver is left behind with the donor.

Question of the Day

What is the role of digoxin in heart failure? (Dr. Tilak Suvarna Mumbai)

Unlike beta–blockers, ACE inhibitors and aldosterone antagonists, digoxin has not shown any benefit in reducing mortality when used in patients with heart failure. It has only shown decrease in hospitalizations for heart failure and relief of symptoms. Accordingly, the indications for digoxin in heart failure are restricted to:

  1. Stage C heart failure: Structural heart disease with current or prior symptoms of heart failure. (Class II A indication)

  2. For control of ventricular rate in patients with AF.

    Thus, digoxin is reserved for only symptomatic patients of heart failure with systolic dysfunction and for those patients of AF who require control of their ventricular rate.

View Point (MCI Medical Education)

In this column, eminent Padma Awardees express their thoughts on Medical education. Today, we present the views of Padma Shri Awardee Dr AK Bhalla.

There should be a common entrance exam at an AllIndia level for admission to MBBS course on the basis of marks obtained in the 12th Standard. About 1015% marks in the interview should be for aptitude test. The National Board exam should be on the basis of merit in the entrance test. Criteria should be defined to recognize a center for national board training. Rural posting for one year should be optional with full pay. Medical degrees for rural areas may be considered.


Public Forum (Press Release for use by the newspapers)

NIH classification of Alcoholism Subtypes

As per National Institutes of Health (NIH) there are five distinct subtypes of alcoholism.
Quoting NIH, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela said that nearly 20 percent of alcoholics are highly functional and well–educated with good incomes. More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes. Some alcoholics improve with specific medications and psychotherapies while others do not.

  1. Young Adult subtype: (31.5%) Young adult drinkers, with relatively low rates of co–occurring substance abuse and other mental disorders, a low rate of family alcoholism, and who rarely seek any kind of help for their drinking.

  2. Young Antisocial subtype: (21%) Tend to be in their mid-twenties, had early onset of regular drinking, and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder, and anxiety problems. More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one–third of these alcoholics seek help for their drinking.

  3. Functional subtype: (19.5%) Typically middle–aged, well–educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one–quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.

  4. Intermediate Familial subtype: (19%) Middle–aged, with about 50 percent from families with multigenerational alcoholism. Almost half have had clinical depression, and 20 percent have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent ever sought treatment for their problem drinking.

  5. Chronic Severe subtype: (9%) Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine, and opiate dependence. Two–thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.

An Inspirational Story : Life In London

A stranger in a foreign land, Gandhi had difficulty adjusting to the seasonal weather in London and would often be teased for his inappropriate seasonal attire and his poor command of the English language. To make up for all those, he worked very hard, trying to excel in both his studies and other curricular activities such as French, dancing, violin and elocution. He also tried to improve on his dressing by buying more suits. Those proved to be short lived as he found himself running out of money gradually. To cut costs, he gave up his hotel for a small room and walked instead of traveling on buses. He also changed his diet, switching English meals for simple vegetarian fmeals. Interestingly, those newly adopted lifestyle habits formed the basis of his lessons on health and simple living subsequently.


IJCP Special

Dr Good Dr Bad

Situation: An adolescent came with pre pubertal gynecomastia of more than six months duration.
Dr Bad: It’s normal.
Dr Good: Its persistent pre pubertal gynecomastia.
Lesson: If the patient is an adolescent and has a normal general physical and genital examination, then it is quite likely that he has pubertal gynecomastia (seen in 25% cases). Reevaluation at
6 monthly intervals will show whether the condition is persistent or not; improvement supports the initial impression of a pubertal cause.

Make Sure

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure, that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.

Quote of the Day (Dr. Santosh Sahi)

"There are two mistakes one can make along the road to truth, not going all the way, and not starting." Budda

Common Myths about Aging

Myth: Dementia is an inevitable part of aging

Milestones in Gastroenterology

Paul Langerhans (18471888) was a famous German pathologist and biologist. In 1869, he presented a thesis entitled "Contributions to the microscopic anatomy of the pancreas", which refers to islands of clear cells throughout the gland, staining differently than the surrounding tissue.


IMSA Update (International Medical Science Academy)

The diagnosis of diabetes mellitus can be established by a hemoglobin A1C level ≥6.5 percent, as recommended by an International Expert Committee consensus report and confirmed by the American Diabetes Association.


Drug Update

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Chlorthalidone Tablet 6.25mg

For the treatment of mild to moderate hypetension.



Medi Finance

Can a doctor invest income where tax liability is free?

Yes, there are various investment centers where tax–exemption is available, subject to various conditions and procedures.


Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Semen Aanlysis

A semen analysis is recommended following a vasectomy and when a physician thinks that the patient might have a fertility problem


Humor Section


Dr Jhatka complained to the police: ‘Sir, all the items are missing, except the TV in my house.’

Police: ‘Howz that the thief did not take the TV?’

Dr Jhatka: I was watching TV news…’

Medical bloopers on medical charts!

Secretion…………………Hiding something


Readers Responses

1. Dear Dr. KK, In the readers response coloumn DR. K.K. Arora has asked for clarification about use of Army Rank by Lt. Col. Dr. A R N Setlvad. In this connection I would like to clarify as under: Under the Army Act, all retired officers are permitted to use their last rank held by them. In other cases all officers released on completion of their short term service can also write their rank by prefixing with Ex. Col etc. Certain other categories of officers who take pre–mature retirement are also officially permitted to use their rank and in all other cases the officers are specifically ordered not to use their service rank i.e officers whose services have been terminated/dismissed etc. I hope this will clarify the doubt of Dr. K.K. Arora.

However if the doubt has been raised against this particular doctor, then the matter can be taken u–p with Army HQ, DGAFMS to clarify but I am sure since he is using the rank of Lt. Col. He must have served for the required number of years otherwise he cant be holding the rank of Lt. Col for which one has to serve for a longer period. Regards: Ashok Ahooja, Sqn. Ldr(Retd), Advisor

2. Poem (Dr Shridhar Dwivedi)

Choice is Simply Yours–A Physician’s Submission

A body with flabs, folds and central bulge,
Or a slim, hour glass figure,
Suffering diabetes, heart or pressure,
Alternatively best health, full of fun and sparkle,
Choosing junk, tobacco or smoke,
Glued to TV, internet, twitter most time,
Or practising yoga, jogging and mix of moderate life,
Eating fruits, nuts, cereals and veggies,
Choice is simply yours!

Picking appropriate food and exercise,
Performing duty with joy and conscience,
Following dictum of ‘early to bed & early to rise’,
‘Makes one healthy, wealthy and wise’,
Thus living long happy life,
Or perishing early with lot of sufferings,
A heart attack, raised sugar or pressure,
Failing kidneys, diminishing vision or stroke!

Why not a blessed and useful long life,
Look at ‘walking God of Siddhgangaswami’ ,
Down to earth our own APJ Kalam,
Hundred three not out practising Patna advocate,
Still digging Nrega worker lady ninety three,
All born in humble families,
Distant interiors of rural motherland,
Chose simplicity, austerity over junk or smoke,
Followed basics, human values and nature,
Legends of their time, living with excellence,
They all chose their life,
Choice is simply yours
Emulate or deviate!


Forthcoming Events

eMedinews Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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