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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; Member 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

Dear Colleague

24th February 2010, Wednesday

Facts about sex and heart

The question concerning the sexual activity and heart disease is very much popular, specially with the heart diseases becoming very common in young. It’s a common man’s perception that having a heart disease is the end of a satisfied sex life. But, it is possible to enjoy a happy and healthy sex life even if you have a heart disease. Herein we answer some common queries on Sexual activity and Heart.

What are the cardiovascular responses to sexual activity?

a) Peak heart rates at sex are 140 to 180 beats per minute

b) The mean increase in blood pressure during sexual act is 80/50 mmHg

c) The mean heart rate at the time of orgasm is 117 beats per minute.

d) Mean estimated blood pressure during orgasm is 162/89 mmHg.

e) Sexual activity is equated with 2 to 3 METs during the preorgasmic phase and 3 to 4 METs during orgasm; this is equivalent to walking at two to four miles per hour on a level surface.

f) BP and heart rates changes is comparable to a brisk 20–minute walk, with an orgasm putting a strain on the heart similar to an ensuing walk up a flight of stairs.

Which are the high risk individuals at increased risk of mortality during sexual intercourse?

About 75 per cent of deaths that do occur during sexual intercourse are in people having extra marital affairs and in men who are much older than their sexual partners.

What is the risk of getting a heart attack or other disease during sexual activity?

a) The chances of sex causing a heart attack is 2 in a million, even in subjects who had already had one attack. This is double the risk for healthy people in the hours after sexual intercourse. (Harvard study, 800 heart attack survivors; 1996 JAMA)

b) The risk of suffering a heart attack brought on by sex drops as the participants’ amount of regular exercise is increased. People who exercise the most have virtually no risk.

c) Risk is small but highest among patients who are sedentary.

d) Couples in long-term relationships are far less likely to have heart attacks while having sex than those having affairs or one-night stands. (Graham Jackson, St Thomas's Hospital, London)

e) Clustering of psychosocial and physiologic demands, such as illicit affairs, outbursts of anger, alcohol and hearty meals, precipitate reinfarction or death.

f) The danger of having heart failure during extra-marital sex is exacerbated even further when there was a significant difference in age between the partners.

What about counseling for resumption of sexual activity in the cardiac patient?

A sexual activities program is successful only if each partner is committed to give and receive pleasure. (Nurs Clin North Am 1976;11(2):349–59)

Dr K K Aggarwal
Chief Editor

News and Views

Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is an easy, self–administered questionnaire which measures daytime sleepiness as it occurs in ordinary life situations. It can be used as a screening test for excessive sleepiness or to follow an individual’s subjective response to an intervention. The test can be performed in the examination room or waiting room.

The questionnaire describes eight situations:

1. Sitting and reading
2. Watching television
3. Sitting inactively in a public place
4. Riding as a passenger in a car for one hour without a break
5. Lying down to rest in the afternoon when circumstances permit
6. Sitting and talking with someone
7. Sitting quietly after lunch without alcohol
8. Sitting in a car as the driver, while stopped for a few minutes in traffic

Each situation receives a score of 0 to 3, which is related to the likelihood that sleep will be induced:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Thus, the total ESS score can range from zero to 24, with higher scores correlating with increasing degrees of sleepiness.

Total ESS scores differentiate normal subjects from patients in various diagnostic groups including idiopathic hypersomnia, obstructive sleep apnea syndrome and narcolepsy.

A score greater than 10 is consistent with excessive sleepiness. The mean score is approximately six in healthy adults, 16 or greater among patients with narcolepsy, idiopathic hypersomnia, or moderate to severe sleep apnea.

FDA unveils risk management plan for anti anemia drugs (Monica and Brahm Vasudeva)

Doctors who want to prescribe darbepoetin alfa and epoetin alfa, anti–anemia drugs for cancer patients, will have to register and undergo special training under a risk–management plan unveiled by the FDA. The drugmaker also will require physicians to collect signed statements from patients attesting that they have been informed about the dangers of the drugs. Studies have linked erythropoiesis–stimulating agents or ESAs to faster tumor growth or earlier death in cancer patients.

Statins may increase diabetes risk

According to a study published online Feb. 17 in The Lancet, statins may increase the risk of developing diabetes. After analyzing 13 studies of statins encompassing more than 90,000 patients, researchers found that the risk for developing diabetes is tied to the entire class of medications, and the danger increases with age.

Tysabri linked to four new cases of PML

The multiple sclerosis drug Tysabri (natalizumab) has been linked to four new cases of a life-threatening brain illness, progressive multifocal leukoencephalopathy, or PML.

FDA grants EntreMed leukemia treatment orphan drug status

The FDA granted orphan drug designation to a developing cancer treatment. The drug, ENMD–2076, was granted the special designation… for acute myeloid leukemia. Orphan drug status allows the company seven years of market exclusivity following FDA approval, assistance in clinical trial design, a reduction in user fees, and tax credits.

Aspirin boosts survival, cuts risk of breast cancer recurrence

A new study says breast cancer survivors who take aspirin regularly may be less likely to die or have their cancer return. The study found that women who had been diagnosed with early breast cancer and who just happen to be taking aspirin, somewhere between two and five days, had a 50% reduction in dying of the breast cancer. In women who took aspirin just once a week, there was no benefit, but, those who took aspirin two to five times a week experienced a 71 percent reduction in dying from a return of the cancer. The study of 4,164 breast cancer patients has been published in the Journal of Clinical Oncology. Aspirin may help control cancer by fighting inflammation, as breast cancers produce more inflammatory chemicals than normal breast cells.

Conference Calendar

ISPR 2010 (International Symposium on Psychological Research)
Date: February 25–27, 2010
Venue: Banaras Hindu University, Varanasi, Uttar Pradesh

Quote of the Day

Certain thoughts are prayers. There are moments when, whatever be the attitude of the body, the soul is on its knees. (Victor Hugo)

Diabetes Fact

Potential diabetes: clinically no diabetes but family history present

Public Forum (Press Release)

Safe Holi: Balloons may be Harmful

Balloons used by children during Holi can be dangerous and can cause blunt eye injury or even head injury. There can be bleeding in the eyes, lens subluxation, macular edema or retinal detachment. These can lead to loss of vision or even loss of the eye, said Dr. KK Aggarwal President, Heart Care Foundation of India and Editor eMedinewS.

Most synthetic colours are harmful to the eyes or skin. Home–made floral colours are always better. Chemical colours may contain heavy metals like lead which is harmful to the eyes and skin. Other health hazards due to the exposure to heavy metals include skin allergies, dermatitis, drying and chapping of the skin, skin cancer, rhinitis, asthma and pneumonia.

Make your own floral colours
1. Mix Haldi (turmeric) with flour to get yellow colour
2. Use petals of tesu or Palash flowers to get saffron colour.
3. Beetroot pieces soaked in water give magenta colour.

What to do: Chemicals that enter the eye may cause mild allergy or even severe chemical burn in the eye. A patient may present with allergic conjunctivitis, chemical burn, corneal abrasion or blunt eye injury. Most colours used during Holi usually cause mild redness and irritation lasting for upto 48 hours. If clarity of vision is affected, it’s an emergency. The particles in colour powders (shining mica particles in ‘gulal’) can damage the cornea. Corneal abrasion is an emergency and one should immediately consult the eye doctor or ophthalmologist.

First aid: Splash a lot of tap water if any colors enters the eye. If there is vision loss, corneal abrasions, rush to the eye doctor.

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.1 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.2

Suggested readings
1. Velayos FS, Terdiman JP, Walsh JM. 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, Lashner BA. Will a 5-ASA a day keep the cancer (and dysplasia) away? Am J Gastroenterol 2005;100:1354–6.

eMedinewS Try this it Works

Green cannula (Dr Maj Prachi Garg)

Whenever you want to give fast IV. fluids remember G: G for GREEN and G for GO. Green cannula is a high bore cannula and provides avenue for fast fluid drip.

Dr Good Dr Bad

A patient came with acute heart attack
Dr Bad: Chew 300 mg aspirin
Dr Good: Chew 300 mg aspirin and 600 mg clopidogrel
Lesson: For all patients with ST–elevation MI, initiate dual antiplatelet therapy with chewable aspirin (300 mg) and clopidogrel (600 mg) or prasugrel (60mg) as soon as possible after presentation.

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 to check BP before starting intergrilin. 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

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

Formulae in Critical Care

Calculation of arterial O2 content (CaO2)

Formula: CaO2 = (1.36 × SaO2 × Hb) + (0.0031 × PaO2)
SaO2 – percentage saturation of oxygen in arterial blood; Hb – Hemoglobin; PaO2 – Partial pressure arterial oxygen

Milestones in Neurology

Joseph Jules François Félix Babinski (1857–1932) was a Polish neurologist. He is best known for his 1896 description of the Babinski sign, a pathological plantar reflex indicative of corticospinal tract damage.

Mistakes in Clinical Practice

Possible confusion with dose designations that include decimal points – A trailing zero after a decimal point can make a 1.0 mg dose look like a 10 mg dose if the decimal point isn’t seen. Similarly, .5 mg can look like 5 mg. So do not use trailing zeros for doses expressed in whole numbers. Be sure to use a leading zero when the dose is less than a whole unit.

1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)

Stromal hyperplasia (Glandular and fibromuscular) and stimulation of alpha receptors in prostate gland, capsule and bladder neck causes obstruction of bladder neck with overflow of urine.

11th March World Kidney Day (Dr N P Singh)

Reducing risks of developing kidney diseases

Eat healthy and keep the weight in check: This can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease. Reduce salt intake. The recommended sodium intake is 5–6 grams of salt per day (around a teaspoon). In order to reduce intake of salt, try and limit the amount of processed and restaurant foods and do not add salt to food. It will be easier to control the intake if one prepares food with fresh ingredients.

Kidney terms (Dr G M Singh)

Re-infection: An infection with a different strain or serological type after eradication of previous infection

Lab test (Dr Navin Dang)

Guess what is the test which is reported wrong maximum world wide?? Blood group!! Why? Transcription errors!!!

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name Indication Approval Date
Doxofylline 400 mg + Terbutaline 5mg tablets
For the treatment of asthma and chronic obstructive pulmonary disease in adult patients only

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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.


A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17-18, 2010.
Co-organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: On Saturday 17th April (2pm onwards) and Sunday 18th April (7am-4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. Voluntary contributions welcome.
For booking e-mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Stroke Update Workshop for GPs (March 13-14)

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 (Dec 6-7)

An International Symposium on ‘Yogism for Healthy & Happy Living and Aging’ on December 6–7, 2010. BC Harinath, Director, JBTDRC & Coordinator, BIC & Arogyadham Mahatma Gandhi Institute of Medical Sciences, Sevagram – 442102, Wardha, Maharashtra, India, E-mail: bch@jbtdrc.org, bc_harinath@yahoo.com

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Readers Responses

  1. Your richly deserved honour brings elation and pride. May you get still greater honors in the years to come: Veena Upadhyaya

  2. Give me your padadhuli sir, you have given my mom a second birth, congrats for your achievement, you have recovered me from dengue: Bhattacharya family

  3. Heartiest congratulations. What a great news. Well done. Calls for big celebrations.Chowbeys

  4. Dear Dr Agarwal: At the outset Kindly accept my heartfelt congratulations for the Padmashree and good wishes for many more to come. I am a regular reader of RECENT Medical Jpurnals for the last 40 years but I have not found more useful than your medinews published every day: Dr O.P. Agarwal, M.D