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Dr KK Aggarwal

From the Desk of Editor in Chief
Padmashri 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; Elecetd Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director, IMA AKN Sinha Institute; Past Chairman IMA Academy of Medical Specialities; Past Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

19th February 2010, Friday

Low gradient aortic stenosis

Patients with aortic (AS) stenosis and left ventricular dysfunction (low EF) have a low transvalvular pressure gradient despite significant valve narrowing.

Low gradient AS is defined as a transaortic pressure gradient of less than 30 mmHg and a calculated aortic valve area < 1.0 cm2 in association with low flow.

Some patients with low gradient AS have true severe AS, whereas others have ‘pseudostenosis,’ with a low transvalvular pressure gradient because of the combination of moderate AS and low cardiac output.

The distinction between true stenosis and pseudostenosis is made by evaluation of characteristic changes in hemodynamic and structural measurements in response to pharmacologic interventions, dobutamine stress echocardiograpgy, that augment cardiac output.

DSE response

1. Patients with pseudostenosis will manifest an increase in the calculated aortic valve area and a decrease in valve resistance in response to an elevation in cardiac output induced by dobutamine infusion.

2. The response is different in patients with severe true aortic stenosis in whom a dobutamine-induced increase in transvalvular flow will produce an increase in the mean transvalvular gradient but no change in aortic valve area.

(Dobutamine is started at 5 microg/kg per min and gradually increased to a maximal dose of 20 microg/kg per min)

3. In addition to its role in distinguishing between true stenosis and pseudostenosis, low–dose dobutamine echocardiography is helpful in risk stratifying patients with severe true aortic stenosis and in determining the appropriate therapy. Patients with contractile reserve have a much better outcome after surgery. Contractile reserve is defined as an increase in stroke volume of ≥20 percent above baseline or 10 mmHg increase in the mean transvalvular pressure gradient. (Excerpts from a symposium at Medanta: the Medicity)

Dr KK Aggarwal
Chief Editor

News and Views

Psychosocial problems are common in children with dental fear Children and adolescents with severe dental fear often come from families with a turbulent background. It is also more common that they have had counseling contact with a psychologist. These are the conclusions of research carried out at the Sahlgrenska Academy at the University of Gothenburg, Sweden.

Short–term radiation therapy successful for breast cancer

An intense three–week course of radiation therapy is just as effective as the standard five–week regimen for women with early–stage breast cancer. (Feb. 11 issue, New England Journal of Medicine)

Hot Pepper: A painkiller

Scientist at Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center have discovered a new category of painkillers, called TRPV1 antagonists. These drugs block the transient receptor potential vannilloid–1 (TRPV1) channel, which is the same receptor responsible for the sensation of hotness from hot peppers. However, clinical trials have revealed that TRPV1 antagonists cause hyperthermia–– a dangerous, fever–like rise in body temperature.

Women with gout at greater risk of heart attack than men

Women with gout are at greater risk of a heart attack than men with the disease, indicates a in the Annals of the Rheumatic Diseases.

Intense sweets taste

New research from the Monell Center reports that children’s response to intense sweet taste is related to both a family history of alcoholism and the child's own self–reports of depression.

High intake of vitamin D linked to lower MS risk

Women whose mothers consumed high levels of vitamin D during pregnancy have a lower risk of developing multiple sclerosis, a large, observational study confirmed. Mothers who reported the highest intake during pregnancy were 45% less likely to have a daughter who subsequently developed the disease than those who consumed the least vitamin D according to Fariba Mirzaei, MD, MPH, a doctoral student at the Harvard School of Public Health.

Foods causing migranes (Dr GM Singh)

Migraine headaches frequently are characterized by symptoms such as nausea, dull or severe head pain and sensitivity to light.
In some sufferers, certain foods may help trigger migraines. Processed, marinated, fermented or pickled foods.
Baked goods.
Chocolate or dairy foods.
Foods that contain MSG (monosodium glutamate).
Foods that contain tyramine, including red wine, aged cheese, smoked fish, chicken liver, figs or certain beans.
Citrus fruits, bananas or avocados.
Processed meats containing nitrates, such as hot dogs, salami or bacon.
Nuts or peanut butte

Conference Update

Faith under the scalpel
Medical Humanities Group, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi is organizing second lecture of Confluence on 25th February 2010 between 1–2 pm at Conference Hall, Library Block, G.T.B Hospital, Delhi. The guest speaker is a Sanal Edamaruku is a renowned rationalist and atheist who will be speaking on the topic–"Faith under the scalpel." Sanal Edamaruku is the founder president of Rationalist International and president of the Indian Rationalist Association (IRA): Dr Satendra Singh, Assistant Professor of Physiology, UCMS

Diabetes Fact

Diabetes can be diagnosed if random sugar is > 200, only if the person is symptomatic. If asymptomatic, one cannot label as diabetes with simply random sugar.

Public Forum (Press Release)

Kidney stone of less than 5 mm size needs no treatment

A stone in the kidney passage of less than 5mm should not be treated as it will invariably pass in the next four weeks, as per the new kidney stone international guidelines, said Dr. K K Aggarwal, President, Heart Care Foundation of India, and Editor eMedinewS.

A stone between 5 to 10 mm has only 20% chances of passing spontaneously. A stone of more than 10mm invariably require a non–medical intervention.

Dr. Aggarwal said that new avenues in stone management include a trial by drugs, which help in expulsion of the stone by relaxing the smooth muscle. The drugs used are Nifedipine (calcium channel blocker), alpha–blockers and steroids.

Uptil now it was thought that the best investigation for renal stone is intravenous pyelography. But now it has been prove beyond doubt that when a patient presents with kidney pain and a renal stone is suspected the undisputed investigation of choice is unenhanced CT scan of the abdomen. As per the guidelines, open removal of stones is no more recommended. Lithotripsy, PCNL and ureteroscopy have practically taken over from the open surgical procedures.

North India is considered a stone belt, with maximum cases of kidney stones in India.

Punjab & Sind Bank
Central Bank of India

Question of the day

Can colon cancers be prevented in patients with ulcerative colitis?

Studies evaluating cancer and dysplasia risk in patients with ulcerative colitis have suggested a possible protective effect of 5–aminosalicylic acid (5–ASA) drugs.
Evidences: A meta–analysis of nine observational studies, at the Division of Gastroenterology and UCSF Center for Colitis and Crohn’s Disease, University of California, San Francisco, California, estimated that the risk of colorectal cancer was reduced by approximately 50% (0.51, 95% CI 0.37–0.69) with 5–aminosalicylic. The specific dose and potential differences among agents needed to confer this benefit remains unclear. The available literature provides evidence for recommending adherence to a 5–ASA regimen for preventing colorectal cancer in patients with ulcerative colitis.

Suggested readings
1. Velayos FS, et al. Effect of 5–aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and meta–analysis of observational studies. Am J Gastroenterol 2005;100:1345–53.
2. Rubin DT, et al. Will a 5–ASA a day keep the cancer (and dysplasia) away? Am J Gastroenterol 2005;100:1354–6.

eMedinewS Try this it Works : Easing the rectal exam

Often, the most uncomfortable portion of a rectal examination is the actual insertion of the finger. Place the examining finger at the anal orifice and instruct the patient to cough forcefully. The contraction and subsequent relaxation of the anal sphincter draws the finger into the rectum with minimal discomfort. In addition, the cough maneuver removes the patient's focus from the insertion procedure.

Dr Good Dr Bad

Situation: A 80–year–old male patient with acute heart attack was posted for reperfusion therapy.
Dr Bad: Chew 300 mg aspirin.
Dr Good: Chew 300 mg aspirin and 75 mg clopidogrel.
Lesson: Start clopidogrel 75 mg as opposed to prasugrel in patients older than 75 years of age who are treated with fibrinolytic therapy.

Thought for the day

People are tired of words. However we still need to use words, so how could words become a means of giving an experience? For this we need to pay attention to the alignment of thoughts, words, and actions. Words are such they could either ‘make’ or ‘break’. Words have broken relationships into so many pieces. Now I am staying in a peace palace and my job is to put back together all the broken pieces. Ask yourself, who is inside the temple of my heart? Who is the one who has made my heart into a temple? Make the temple of your heart such that others can take rest and comfort with your pure feelings. God is looking for instruments who can do such service to others. Now, look at the time, the fortune of being an instrument for world service, and transform yourself. Do not get stuck in the thought that others should transform, but transform yourself and be free from bondages. This time of transformation will not come again. Keep the determination that it is now or never. ………… Dadi Jankiji

Make Sure

Situation: A patient with hypertension developed bleeding at the puncture site while on intergrilin therapy.
Reaction: Oh my God! Why was the anti–platelet agent started?
Make Sure before starting intergrilin the BP is checked. Severe hypertension (Systolic blood pressure>/ 200 mmHg or diastolic blood pressure >110 mmHg not adequately controlled on antihypertensive therapy is a contraindication for intergrilin therapy.

Laughter the best medicine

Shortly after the 911 emergency number became available, an elderly and quite ill lady appeared in a hospital emergency room, having driven herself to the hospital and barely managing to stagger in from the parking lot.
The horrified nurse said, "Why didn't you call the 911 number and get an ambulance?"
The lady said, "My phone doesn't have an eleven."

Quote of the Day

Prayer does not change God, but it changes him who prays. (Søren Kierkegaard)

Formulae in Critical Care

Calculation of lean body mass in women: Formula: Lean body weight (women) = (1.07 × weight [kg]) – 148 [Weight2/(100 × height in m2)]

SMS Anemia

Anemia during pregnancy is associated with adverse outcomes (like premature delivery, low birth weight and fetal death.

Milestones in Neurology

Franz Joseph Gall (1758–1828) was a neuroanatomist and physiologist; he was a pioneer in the study of the localization of mental functions in the brain. Around 1800, he developed ‘cranioscopy’, a method to define the personality, development of mental and moral faculties on the basis of the external shape of the skull.

LIST OF APPROVED DRUG FROM 1.01.2009 to 31.10.2009

Drug Name Indication Approval Date
Levodopa 100/100/250 + Carbidopa 10/25/25mg mouth dissolving tablet
For the symptomatic treatment of idiopathic Parkinson’s Disease

(Advertorial section)

Silicic Acid and Herbs: A New Approach.

Various clinical studies have proved that silicic acid as sodium metasilicate, has a synergistic effect with concomitant use of relevant herbal extracts when both are used in conjunction. Silicic acid and herbs compliment each other and in fact, the Herbs potentiate the absorption, assimilation and response to sodium metasilicate. Herbal extracts are known to enhance the Bio-availability of Sodium Metasilicate at the cellular Level and thus play a significant role to be a part of silicic acid supplementation. Interestingly, The most popular brands of silicic acid health Supplements, Available in the USA Market contain Herbal Extracts along with the Silicic acid as a major Ingredient. Sodium Metasilicate is NOW available in India as ZENIMMUNE Range of Products.

Advertising in emedinews

emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com 

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors′ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

eMedinewS–revisiting 2010

The second 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 hangama and live webcast. Suggestions are invited.

Stress Management Workshop

A stress management workshop with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized on April 17–18, 2010.
Organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, In association with IMA New Delhi Branch and IMA Janak Puri Branch
Venue: Om Shanti Retreat Center, National Highway 8, Bilaspur Chowk Pataudi Road, Near Manesar.
Timings: On Saturday (2pm onwards) and Sunday (7am–4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. For booking e mail to emedinews@gmail.com or sms to Dr KK Aggarwal 9811090206/ BK Sapna 9811796962

Stroke Update Workshop for GPs

Indian stroke association and International Stroke Conference is organizing a Stroke Update Workshop on March 13–14, 2010 at AIIMS Auditorium. eMedinewS has tied up with the conference for free registration for first 200 GPs of NCR. Organizer: Dr Padma, Prof of Neurology, AIIMS, New Delhi SMS for free registration to 9717298178 or email to isacon2010@gmail.com

International Symposium on ‘Yogism for Healthy & Happy Living and Aging’

The 7th convocation of SVYASA Yoga University was organized on January 12, 2010. The concept Yogism was well received and we now plan to have an International Symposium on ‘Yogism for Healthy & Happy Living and Aging’ on December 6–7, 2010. There is considerable interest abroad to integrate alternate medicine with modern medicine in Medical schools. We feel Yoga, Meditation and Naturopathy should be integrated with modern medicine in promotion of positive health and healing: BC Harinath, Director, JBTDRC & Coordinator, BIC & Arogyadham Mahatma Gandhi Institute of Medical Sciences, Sevagram – 442102, Wardha, Maharashtra, India, TeleFax: +91 7152 284038, Home: +91 7152 260219, E-mail: bch@jbtdrc.org, bc_harinath@yahoo.com

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Readers Responses

  1. Dr. K.K. Aggarwal: Chief Editor, Dear Sir, I take this opportunity to greet and congratulate you once again for being conferred with one of the most highest award of Indian Government the PADMASHREE. Not many Doctors have ever been decorated with such a prestigious award and you are one among them –ns a well deserving award for your excellent services in the fieled of medicine and also for your kind attachment to the society and to the people of India. It makes all our medical fraternity throughout our incredible India to feel happy and proud of you. Congratulations! your eMedinewS keeps us updated with day–to–day happenings, even at a long distance of tens of thousands miles away from home thanks to your incredible idea of stating eMedinewS. Regards, Dr. Anil Khari, M.D. Kingston, Jamaica, W.I.

  2. Congratulations to you for getting such a prestigious award: Umesh Kansal

  3. Respected Sir, Kindly accept my heartfelt congratulations for the Padmashree and good wishes for many more to come: Dr. Prashant

  4. Great. Heartiest congratulations for bringing laurels to cardiology fraternity: Dr. Praveen Jain, Jhansi

  5. Our heartiet congratulations for the award Sir. May you always prosper and your name shine bright: Dr. Vivek Arora, IIHP DSB

  6. Congratulations Sir for another well deserved feather in your illustrious cap. Regards Sandeep