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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

  Editorial ...

26th November 2010, Friday

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

Anacetrapib lower LDL cholesterol while raising HDL cholesterol

According to a study published Nov. 17 in the New England Journal of Medicine and presented at the American Heart Association meeting, Merck’s experimental drug anacetrapib increases HDL or ‘good cholesterol even as it lowers LDL, the bad cholesterol. The drug, works by inhibiting an enzyme called CETP, which is involved in transforming particles of good cholesterol into bad cholesterol. The drug was tested in 1,623 patients who were already taking statins to control their cholesterol. Researchers at Boston’s Brigham and Women’s Hospital found that patients taking the drug saw a 39.8% reduction in LDL beyond what was seen in patients who got a placebo.

CETP inhibition

Drugs that inhibit CETP raise HDL–cholesterol levels. Investigation of torcetrapib has stopped; anacetrapib and dalcetrapib are under investigation. In the randomized ILLUMINATE trial of over 15,000 patients treated with atorvastatin, a significant increase in HDL–cholesterol (72 %) and an additional decline in LDL–cholesterol (25 %) below baseline were seen after 12 months of torcetrapib therapy. However, the trial was stopped early because, at a mean follow–up of 550 days, torcetrapib therapy was associated with a significant increase in the risk of cardiovascular events and death from any cause.
Anacetrapib: Significant findings include an increase in HDL cholesterol of 129 %, a decrease in LDL–cholesterol of 38 %, and no effect on blood pressure (in contrast to the increase in blood pressure with torcetrapib in the ILLUMINATE trial).
Dalcetrapib: Dalcetrapib use is accompanied by a dose–dependent decrease in CETP activity and an increase (nearly 40 %) in HDL cholesterol.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
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  Quote of the Day

(By Dr GM Singh)

"People who can hold their tongue, rarely have trouble holding onto their friends." - Mother Teresa

    Photo Feature (from the HCFI Photo Gallery)

 Divya Jyoti – 17th Perfect Health Mela 2010

Nurses from Delhi and NCR participated in large numbers in competitions like Health Model display in Divya Jyoti, a Festival of Nurses.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Sickle cell disorder drive starts in Chhattisgarh

A Sickle Cell Disorder Management project was launched by the Chhattisgarh Government on Monday, under which a campaign will be started for blood tests to identify afflicted individuals and give genetic counselling for its management. During the inaugural ceremony the Fourth International Congress of Sickle Cell Disease which began at the Jawaharlal Nehru Medical College, Chief Minister Raman Singh said a massive campaign would be launched to collect blood samples of children up to high schools, expecting mothers and others to identify the patients and carriers of sickle cell disorder. Inaugurating the event, former president APJ Abdul Kalam said there must be a focus on how to treat sickle cell by drugs and vaccines and there was need for adequate research. (Source: The Pioneer, November 23, 2010)

    International News

(Dr Monica and Brahm Vasudev)

Kidney function in diabetics

A phase II trial, involving more than 200 patients, found those treated with bardoxolone methyl had a mean improvement in eGFR of 10.1 mL/min/1.73 m2 after six months compared with 0.1 mL/min/1.732 m2 in the placebo group (P<0.0001). (Dr Pablo E. Pergola, of the University of Texas Health Science Center at San Antonio)

Percutaneous closure of PFO may not shut down the risk of recurrent stroke

According to a study presented at the American Heart Association (AHA) meeting, percutaneous closure of patent foramen ovale (PFO) does not shut down the risk of recurrent stroke of unknown origin.

Presumed consent associated with lower live kidney donation rates

Nations with presumed consent have higher rates of deceased donor kidney transplantation than nations with explicit consent, but lower rates of live donation, according to a study published in the Nov. 16 issue of the Annals of Internal Medicine.

Pioglitazone suppress growth of renal and hepatic cysts in rat model of polycystic kidney disease

According to a study published online in PPAR Research, pioglitazone shows potential to suppress renal and hepatic cyst growth and fibrosis in an animal model of polycystic kidney disease.

Xanthelasmata associated with increased risk for heart attack, arterial disease

According to research presented at the American Heart Association meeting, cholesterol deposits on or around people’s eyelids, called xanthelasmata, may indicate an increased risk for heart attack, arterial disease, and early death.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

When should infertility treatment be stopped?

Many couples undergo years of treatment with no success. It is useful to decide when to call off further treatment. Before the couples even think of doing that they should be certain that they are going to the right infertility specialist and centre. Unfortunately in today’s world there are many doctor and quacks who continue to ‘treat’ infertile couples with inadequate knowledge and facilities. However once they have found the right place for treatment, it is important to know when to stop. It has already been mentioned that IUI should be stopped after 6 unsuccessful trials. When it comes to IVF, once we are certain that good embryos have been formed and the endometrium is good, most couples should conceive within 3 attempts. There is no upper limit to the number of trials a couple should give for IVF, but we would not recommend more than 5 trials. If the embryo quality is poor, egg donation, sperm donation or embryo donation should be discussed. For poor endometrium due to endometritis or Ascherman syndrome, surrogacy is the best option. The choice of adoption should also be discussed after reasonable attempts fails to give success.

For queries contact: banerjee.kaberi@gmail.com

    Hepatology Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

5 ways to fight depression

If you feel depressed, it's best to do something about it - depression doesn't just go away on its own. In addition to getting help from a doctor or therapist, here are 5 things you can do to feel better.

  • Exercise. Take a 15- to 30-minute brisk walk every day — or dance, jog, or bike if you prefer. In addition, some yoga poses can help relieve feelings of depression. Try downward-facing dog or legs-up-the-wall pose. Two other aspects of yoga — breathing exercises and meditation — can also help.
  • Nurture yourself with good nutrition. Depression can affect appetite. So eat plenty of fruits and vegetables and get regular meals (even if you don't feel hungry, try to eat something light, like a piece of fruit, to keep you going).
  • Identify troubles, but don't dwell on them. Try to identify any situations that have contributed to your depression. When you know what's got you feeling blue and why, talk about it with a caring friend. Once you air out these thoughts and feelings, turn your attention to something positive. Take action to solve problems. Ask for help if you need it. Feeling connected to friends and family can help relieve depression. (It may also help them feel there's something they can do instead of just watching you hurt.)
  • Express yourself. With depression, a person's creativity and sense of fun may seem blocked. Exercise your imagination (painting, drawing, doodling, sewing, writing, dancing, composing music, etc.) and you not only get those creative juices flowing, you also loosen up some positive emotions. Take time to play with a friend or a pet, or do something fun for yourself. Find something to laugh about — a funny movie, perhaps. Laughter helps lighten your mood.
  • Look on the bright side. Depression affects a person's thoughts, making everything seem dismal, negative, and hopeless. If depression has you noticing only the negative, make an effort to notice the good things in life. Try to notice one thing, then try to think of one more. Consider your strengths, gifts, or blessings. Most of all, don't forget to be patient with yourself. Depression takes time to heal.
    Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

What is a Laceration?

Lacerations are tears, avulsion or splits of skin, mucous membranes, muscle or internal organs produced by application of blunt force to a broad area of the body which crushed or stretched tissues beyond the limits of their elasticity.

  • Crush injury from a direct blow may produce an irregular or stellate laceration with a variable degree of devitalized tissue, abrasion and visible contamination.
  • Do not close a laceration if there is visible contamination, debris, non–viable tissue or signs of infection.
  • Wounds may involve vascular areas of the face and scalp where the risk of infection is low or extremities where infection becomes a greater risk, along with the possibility of tendon and nerve damage.
  • The elderly and patients on chronic steroid therapy may present with "wet tissue paper" skin tears following relatively minor trauma.
  • When produced by a blunt weapon, such as club, crowbar, stone, brick etc., a lacerated wound is usually accompanied by a considerable amount of bruising of the surrounding and underlying tissues, and has inverted and irregular edges.
  • The direction of the shelving of margins of a lacerated wound indicates the direction of the blow applied to cause the wound in MLC cases.
  • When a heavy weight like wheel/s of a heavy cart or a truck passes over an extremity, it tears the skin from the underlying tissue by its shearing and grinding force and crushes the muscles and soft part lying beneath it realizing considerable blood and fat in them. Crush injury syndrome or fat emboli may follow a lacerated wound.
    Rabies Update

Dr. AK Gupta, APCRI, Author of "RABIES – the worst death"

Can rabies be transmitted from man to man?

Man–to–man transmission of rabies is possible. Rabies can be transmitted following bite by a rabies patient.
In 2004, three cases of human rabies were reported in U.S. following liver and kidney transplantation from rabies patients.
Transplantation of rabies infected cornea can cause rabies in recipient. Therefore a careful neurological history of donor must be taken before cornea transplantation.

    Legal Case

(Contributed by Dr. Surender N. Gupta)

Docs to pay Rs 3 lakh for negligence

Shariq Majeed/TNS: Sangrur, November 22

The District Consumer Disputes Redressal Forum has ordered Dr Sunny Kumar Mehta and Dr Shweta Mehta, owners of Mehta Hospital, Khanauri Mandi, to pay Rs 1 lakh while Dr Vijay Kumar and Dr Kiran V Kumar, owners of Arya Spiral CT Scan Centre and Maternity Home, Kaithal, have been ordered to pay Rs 2 lakh to the complainant. The forum, including its President MD Sharma and members, Harvinder Lal Sharma and Nisha Shard, passed the order responding to the complaint of Usha Rani and her husband, Balraj Kumar, of Khanauri Mandi for negligence in the delivery case of Usha. The complainants alleged that Usha during her pregnancy was under treatment at Mehta Hospital. Early in morning on May 6, 2010, she got labor pain and was admitted to this hospital where the couple was assured that the delivery would be normal and that the child was safe in the womb.
Later, observing deterioration in her condition, she was referred to the CT scan centre at Kaithal where an ultrasound and X–ray revealed that the child was dead in the womb. Usha was operated on immediately. It was alleged that the doctors at the centre were also negligent in conducting the operation, following severe pain in the womb. On May 24, 2010, the couple approached PGI, Chandigarh, after two or three days of Usha’s discharge from the CT scan centre, when her condition deteriorated. She was admitted to the PGI the next day in a serious condition. She learnt of a serious infection in her womb at the PGI after the stitches broke. On May 26, her operation was conducted successfully but she was shocked when the doctors told her that she would not be able to conceive in future. The complainants further alleged that they filed an application before the Sangrur Deputy Commissioner but no action was initiated against the doctors due to their alleged political influence.

    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

Serum Albumin

  • To screen for liver or kidney disease
  • To evaluate nutritional status, especially in hospitalized patients
    Medi Finance Update

Personal Accident Individual


  • Any pre–existing diseases. However, cover is available after certain waiting period depending upon the insurance company’s product.
  • Any disease of critical in nature, contracted by the Insured person during the first 30 days from the commencement date of this policy.
    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

List of drugs prohibited for import


    IMSA Update

International Medical Science Academy (IMSA) Update

Children with mild–moderate asthma

A meta–analysis of randomized trials found that children with mild to moderate persistent asthma who were treated with inhaled glucocorticoids had better pulmonary function and asthma control than those treated with montelukast.

(Ref: Castro–Rodriguez JA, et al. The role of inhaled corticosteroids and montelukast in children with mild–moderate asthma: results of a systematic review with meta–analysis. Arch Dis Child 2010;95:365).

    IJCP Special

Dr Good Dr Bad

Situation: A re–sterilized defibrillator was re–implanted in a patient.
Dr Bad: This is unethical.
Dr Good: With consent its ok.
Lesson: Defibrillators that still have significant battery life can be successfully removed from patients who no longer need them and re–implanted in other patients. A total of 21 implantable cardioverter defibrillators (ICDs) and 19 cardiac resynchronization therapy defibrillators (CRT–Ds) were removed from U.S. patients and re–implanted in Indian patients, resulting in a 35% successful shock rate and no instances of infectious complication (Pavru BB, et al. Preliminary experience regarding re–use of explanted, resterilized defibrilators Abstract 18350 presented at the American Heart Association Meeting 2010)

Make Sure

Situation: A patient with ejection fraction of 20% dies a sudden cardiac death.
Reaction: Oh my God! Why was ICD not put?
Lesson: Make sure all patients with ejection fraction less than 35% are put on ICD unless contraindicated.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Major V V Narayanan)

Whom to give?

Many times we avoid giving by finding fault with the person who is seeking. However, being judge mental and rejecting a person on the presumption that he may not be the most deserving is not justified. "Give without being judgmental!"

Next we have to answer:

How to give?

Coming to the manner of giving, one has to ensure that the receiver does not feel humiliated, nor the giver feels proud by giving. In giving follow the advice, "Let not your left hand know what your right hand gives? Charity without publicity and fanfare is the highest form of charity." Give quietly! While giving let not the recipient feel small or humiliated. After all what we give never really belonged to us. We come to this world with nothing and will go with nothing. The thing gifted was only with us for a temporary period. Why then take pride in giving away something which really did not belong to us? Give with grace and with a feeling of gratitude.

— — — — — — — — — —

Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: |……| ome  
Answer for yesterday’s Mind Teaser: A long letter from home

Correct answers received from: Dr.K.Raju, Dr Chandresh Jardosh,  Dr.K.V.Sarma, Dr Joshi Sachin, Dr Rashmi Chhibber     

Answer for 24th November Mind Teaser: "One way or another"
Correct answers received from: Dr.K.Raju,  Dr Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr G M Singh)

I have stolen a fat goose from a poultry yard…

Confessor: I have stolen a fat goose from a poultry yard! Priest: That is very wrong.

Confessor: Would you like to accept it, Father? Priest: Certainly not, return it to the man whom you stole it from.

Confessor: But I have offered it to him and he won’t have it. Priest: In that case you may keep it yourself. Confessor: Thank you, Father.

The Priest arrived home to find one of his geese had been stolen…

    Readers Responses
  1. Dear Sir, I am very much pleased to see your articles. Regards Sastry Durga
    Public Forum

(Press Release for use by the newspapers)

Beware of winter drinking

Winter is the month of high alcohol intake. Moderation is the key provided we understand what moderation is, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

He was interacting with the public at the Heart Care Foundation of India stall being put up at the ongoing India International Trade Fair, Pragati Maidan in the Ministry of Health & Family Welfare pavilion.

  • Healthy middle–aged women can have up to one and men up to two drinks a day without increasing the risk of the abnormal heartbeat called atrial fibrillation. More than three drinks increase the risk.
  • Atrial fibrillation is a common disease of today. It occurs in about 1 percent of people up to the age of 80 and it can cause significant symptoms in those who have it. In atrial fibrillation, the two upper chambers of the heart (atria) beat irregularly and faster than they should. Blood can pool in the atria, leading to formation of clots that can block a major artery to the brain, causing a stroke.
  • Higher intakes of alcohol can cause elevation in the risk for atrial fibrillation.
  • In a Harvard study of 35,000 women, all above 45 years, none had atrial fibrillation or any other heart condition at the start of the study. Over an average follow–up period of 12.4 years, 1.9 percent of the women who had one drink or less a day developed atrial fibrillation, compared to 1.8 percent of those having one to two drinks a day and 2.9 percent of those having two or more drinks a day.
  • There is a 40 to 50 percent increase in the incidence of atrial fibrillation at about three drinks a day.
  • Drinking more than six drinks in a day can precipitate sudden death
  • Drinking more than 5 drinks in one hour can precipitate sudden death or a heart attack.
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Workshop on Kidney Transplant

International Medical Science Academy, eMedinewS, Moolchand Medcity Board of Medical Education, IMA New Delhi Branch and IMA Janak Puri Branch

Date: Sunday 28th November 2010
Venue: Moolchand Medcity Auditorium, 9 – 12 noon

Chairperson: Dr (Prof) S C Tiwari, Director Fortis Institute of Renal Sciences & Kidney Transplant Moderators: Dr KK Aggarwal, Dr Kamlesh Chopra, Dr Sanjay Sood, Dr A K Kansal, Dr Archna Virmani
9.00 – 9.30 AM: Kidney Transplant: What every one should know: Dr Ramesh Hotchandani, Senior Nephrologist, Moolchand Medicity
9.30 – 10.00 AM: Kidney transplant scenario in India: Dr Sandeep Guleria, Transplant Surgeon, AIIMS
10.00 – 10.30 AM: Transplant immunobiology and immunosuppression. Dr Monica Vasudev, Assistant Professor Division of Allergy and Clinical Immunology, Medical College of Wisconsin, Milwaukee
10.30 – 11.00 AM: Kidney Transplant: managing difficult cases. Dr Brahm Vasudev, Assistant Professor of Medicine, Division of Nephrology, Director, Nephrology Fellowship Program, Medical College of Wisconsin
11.00 – 12.00 AM: Panel discussion

1. Dr. (Prof.) S C Tiwari
2. Dr. K K Aggarwal
3. Dr. S V Kotwal
4 .Dr. Ambar Khaira
5. Dr. Saurabh Misra
6 All Speakers

12.00 Noon: Lunch

(Registration free: email to emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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