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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


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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of 1st Mega Ajmer Health Camp 2012

  Editorial …

12th April 2012, Thursday

Five Things Physicians and Patients should question (Part 2)

American Academy of Family Physicians

  1. Don’t do imaging for low back pain within the first six weeks, unless red flags are present. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits.
  2. Don’t routinely prescribe antibiotics for acute mild–to–moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement. Symptoms must include discolored nasal secretions and facial or dental tenderness when touched. Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in > 80% of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs.
  3. Don’t use dual–energy x–ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors. DEXA is not cost effective in younger, low–risk patients, but is cost effective in older patients.
  4. Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low–risk patients without symptoms. There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False–positive tests are likely to lead to harm through unnecessary invasive procedures, over–treatment and misdiagnosis. Potential harms of this routine annual screening exceed the potential benefit.
  5. Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non–cancer disease. Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety, additional testing and cost. Pap smears are not helpful in women after hysterectomy (for non–cancer disease) and there is little evidence for improved outcomes.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Strain echo imaging for cancer chemotherapy toxicity_1–2

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

First Mega Ajmer Health Camp – Distribution of devices

11,700 devices were distributed including hearing aids, spectacles, crutches, wheel chairs, tricycles and walking sticks etc.

Dr K K Aggarwal
    National News

Parkinson’s disease now striking below 40

The frequency of Parkinson’s disease in Andhra Pradesh has increased two–fold in the past decade, alarming medical experts and health planners. What is even more worrying is that Parkinson’s, always known as an elderly person’s disease, is now being detected among younger patients. On the eve of World Parkinson’s Day, the Indian Parkinson’s Disease and Movement Disorder Society pointed out that the disease is now being diagnosed among people younger than 60 years. It is no longer simply a disease of the old. "The average age of diagnosis for Parkinson’s disease used to be the early sixties. Now, a growing number of people under the age of 40 are being diagnosed with the condition. This number makes up about 10 per cent of the total amount of Parkinson’s cases in the country," according to data released by the society. (Source: Deccan Chronicle, April 11, 2012)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

Higher BMI tied to ovarian cancer risk

A woman’s height and body mass index (BMI) may significantly influence her ovarian cancer risk, a large meta–analysis found. (Source: Medpage Today)

For comments and archives

Adverse events minor in young women taking HPV4 vaccine

Adverse events from initial human papillomavirus vaccination (HPV4; Gardasil, Merck) are mild, according to a study published online January 9 in the Journal of Women’s Health. Results also indicate that older women understand the role of the virus in elevating cervical cancer risk better than younger women. (Source: Medscape)

For comments and archives

Less intensive Hodgkin’s chemo works better

Fewer cycles of an intensive chemotherapy regimen for advanced Hodgkin's lymphoma improves outcomes and reduces toxicity, researchers found. (Source: Medpage Today)

For comments and archives

Cesarean scar pregnancies emerge in wake of increased Cesareans

As cesarean delivery rats increease in the United States and around the world, clinicians report a significant increase in so–called "cesarean scar pregnancies," involving the implantation of a pregnancy in the site of a cesarean scar, according to research presented here at the American Institute of Ultrasound in Medicine (AIUM) 2012 Annual Convention. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: What are the effects of smoking in the heart?http://blog.kkaggarwal.com/2012/04/09/what–are–the–effects–of–smoking–in–the–heart/

@DeepakChopra: Why the ego exists? As we are all made of love, why do we need this false view of our world?

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Human Behavior – Understanding The Needs

Every one behaves according to his or her needs. Every behavior is justified medically as every action is done according to one’s own psyche, which in turn depends upon the needs. The most primitive needs of a person are that of food, shelter and procreation. Most thefts minor, criminal acts, eve teasing, rapes, etc are done to fulfill these needs. These needs satisfy the "physical body".

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the complications of multiple pregnancies?

Complications increase with each additional fetus in a multiple pregnancy and include severe nausea and vomiting, Cesarean section, or forceps delivery:

  • Premature birth: Premature labor and delivery pose the greatest risk to a multiple pregnancy. Feasibility of a vaginal delivery depends on the size, position, and health of the infants, as well as the size and shape of the pelvic bones. Cesarean section is often needed for twin pregnancies and is expected for delivery of triplets. Pelvic pressure, low back pain, increased vaginal discharge, or a change in the frequency of "false labor" pains should be reported to the physician, who can sometimes delay premature delivery by a few days or more if it is detected early.
  • Placental problems: The placenta is attached to the uterine wall, and the fetus is attached to the placenta by the umbilical cord. The placenta provides blood, oxygen, and nutrition to the fetus through the umbilical cord. Placental function is likely to be abnormal in a multiple pregnancy. The placenta ages prematurely and may slow fetal growth, especially late in the third trimester. If the placenta is unable to provide adequate oxygen or nutrients to the fetus, the fetus cannot grow properly. Twins and multiples that are > 30% "underweight" by ultrasound measurements are at increased risk of complications and have death rates of nearly 25%.
  • Preeclampsia: Preeclampsia, also known as toxemia, occurs 3 to 5 times more often in multiple pregnancies. Preeclampsia is diagnosed when the mother’s blood pressure becomes elevated and protein is detected in the urine. The condition may progress and threaten the health of the mother and the pregnancy.
  • Diabetes: Women with multiple pregnancies are more likely to develop gestational diabetes during pregnancy. Babies of diabetic mothers are more likely to experience respiratory distress and other newborn complications.
  • Fetal and Newborn Complications: Premature delivery places an infant at increased risk for severe complications or early death. A baby’s lungs, brain, circulatory system, intestinal system, and eyes may be too immature. Survivors of premature birth may have lifelong handicaps. Of the premature babies who die, 50% succumb to respiratory distress syndrome, the inability to circulate oxygen from the lungs throughout the body. Brain damage is responsible for almost 10% of premature newborn deaths. Birth defects and stillbirths account for about 30% of the deaths in twins and multiple pregnancies. Low birth weight of <5.5 pounds (2,500 grams) occurs in 50% of twins. The average birth weight is approximately 4 pounds (1,800– 7gm) for triplets and 3 pounds (1,400 gm) for quadruplets. As a result of prematurity, the risk for cerebral palsy is four times more likely to occur in twins.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity Hospital, Gurgaon)

Is it safe to donate a part of our liver ?

Most people think that we have only one liver so how can we donate it? We have nearly 70% extra liver and a healthy liver is the only organ which regenerates. Fortunately there are two lobes of the liver – right and left and each lobe is further divided into segments. Each lobe has separate arterial, venous and ductal (bile duct) supply. Therefore, we can donate one part of our liver – right, left or left lateral.

For comments and archives

    Medi Finance Update

(Tarun Kumar, Chartered Accountant)

Framing of guidelines

GAAR provisions to be applied in accordance with guidelines to be prescribed by Board.

For comments and archives

    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

As I was passing by the elephants, I suddenly stopped, confused by the fact that these huge creatures were being held by only a small rope tied to their front leg……no chains, no cages.

It was obvious that the elephants could, at anytime, break away from the ropes they were tied to but for some reason, they did not. I saw a trainer nearby and asked why these beautiful, magnificent animals just stood there and made no attempt to get away. "Well," he said, "when they are very young and much smaller we use the same size rope to tie them and, at that age, it’s enough to hold them. As they grow up, they are conditioned to believe they cannot break away. They believe the rope can still hold them, so they never try to break free.

"I was amazed". These animals could at any time break free from their bonds but because they believed they couldn't, they were stuck right where they were.

Like the elephants, how many of us go through life hanging onto a belief that we cannot do something, simply because we failed at it once before?

The Wise say," Your attempt may fail, but never fail to make an attempt".

For comments and archives

    Microbial World: The Good and the Bad They Do

(Dr Sunil Sharma, Senior Consultant Microbiology, Medanta The Medicity)

There is evidence that heavy metals and some pollutants may select for antibiotic–resistant bacteria. In one study, drug–resistant bacilli were much greater in sediments containing high concentrations of mercury and other heavy metals than in sediments from areas where heavy–metal concentrations were low. Bacilli strains with combined ampicillin and mercury resistances were almost six times as frequent at the sludge dump site as in control sediments. This observation suggests that genes for mercury resistance and beta–lactamase production are simultaneously selected for in Bacillus. It means that heavy–metal contamination in an ecosystem can result in a selection for antibiotic resistance in bacteria in that system.

For comments and archives

    Cardiology eMedinewS

Be Cautious When Giving Painkillers To Patients With High Cholesterol Read More

Most Fat People Don’t Think They Are Fat: Study Read More

Mitral Regurgitation: Early Hazard, Later Gains Following TAVI Read More

Cardiac Biomarkers In Non Valvular AF Read More

    Pediatric eMedinewS

Adjustable or Tied–Off Sutures In Strabismus Surgery? Read More

Persistent Pus In Ear May Signal Unusual TB Read More

Cardiovascular Manifestations Of HIV Infected Children: A Cross Sectional Study Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have high ESR with normal CRP.
Dr. Bad: The lab report is wrong.
Dr. Good: We need to rule out SLE.
Lesson: Raised ESR together with a normal C–reactive protein (CRP) is often a false–positive value for the ESR; but, these findings can also be observed in acute SLE (systemic lupus erythematosus).

For comments and archives

Make Sure

Situation: A patient with acute heart attack died on the way to the hospital.
Reaction: Oh my God! Why was the patient not accompanied by the doctor?
Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression (CPR) can be given if the heart stops on the way.

For comments and archives

    Legal Question of the day

(Ex) Prof. M C Gupta Advocate & Medico–legal Consultant)

Q. I am a radiologist. A case was filed against me under section 23 of the PC & PNDT Act. I have been given bail by the ACJM court today. The next date is 17th April. The allegation against me is that the Form F was incompletely filled in January 2009 when I was working in the hospital which I later left. Columns at no. 3, 6, 11(a), 14,15 and 16 were left fully or partially blank. Everybody knows nothing illegal is done in our hospital. What should I do?


  1. The fact that nothing illegal is done in your hospital is not correct and, even otherwise, does not help you.
  2. It is illegal to leave any columns blank in the F Form. The foot note in Form F clearly states as follows: "Person conducting ultrasonography on a pregnant woman shall keep complete record thereof in the clinic/centre in Form – F and any deficiency or inaccuracy found therein shall amount to contravention of provisions of section 5 or section 6 of the Act, unless contrary is proved by the person conducting such ultrasonography".
  3. It is nice that you have been released on bail. What you should do is to engage an advocate to defend you.
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(BK Sapna)

The power to pack up

In a second I can pack up all wasteful thinking, so the soul becomes light and free of burdens and worries.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Indirect Antiglobulin test

  • Also known as IAT; Indirect Coomb’s test; Antibody screen; Indirect Anti–human globulin test
  • To detect antibodies directed against red blood cell antigens, in preparation for a blood transfusion, or during pregnancy and at delivery.
    Mind Teaser

Read this…………………

A recent fitness walk left you breathless, and you’ve been having trouble sleeping. You’ve also been dealing with an upset stomach and occasional dizziness. These could be symptoms of:

a. Depression
b. Heart disease
c. Diabetes
d. High blood pressure
e. All of the above

Yesterday’s Mind Teaser: All are precancerous for carcinoma colon except:

a. Crohn’s disease
b. Bile acids
c. Fats
d. Carotene

Answer for Yesterday’s Mind Teaser: d. Carotene

Correct answers received from: Dr PC Das, Ravi Shanmugavel, yj vasavada, Dr KV Sarma, Dr Thakor Hitendrsinh G, Raju Kuppusamy, Dr Jainendra Upadhyay, Dr Valluri Ramarao, Dr Chandresh Jardosh,
Dr Ragavan Sivaramakrishnan Moudgalya.
Answer for 10th April Mind Teaser
: Short notice
Correct answers received from: Sudipto Samaddar.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Too Late, He’s Long Dead

The orthopaedic surgeon I work for was moving to a new office, and his staff was helping transport many of the items.

I sat the display skeleton in the front of my car, and had fastened the seatbelt around it to stop it falling over. I hadn’t considered the drive across town.

At one traffic light, the stares of the people in the car beside me became obvious, and I looked across and explained, "I’m delivering him to my doctor’s office."

The other driver leaned out of his window. "I hate to tell you, man," he said, "but I think it’s too late!"

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Q. Sir, how are samples for virological examination preserved & transported. Are they also kept in saturated saline. Dr. Surendra Bahadur Mathur

Ans: Samples for virology in autopsy cases are generally required in cases of rabies. The brain is preserved in 50% glycol solution sealed and transported as early as possible.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

High risk groups for H1N1flu

Swine flu is usually mild and requires no attention but if the following groups of people develop flu–like symptoms, they should contact their doctor, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

These include:

  • Children younger than 5 years of age (particularly those less than 2 years of age)
  • Individuals 65 years of age or older
  • Individuals younger than 19 years of age who are receiving long–term aspirin therapy and who therefore might be at risk for Reye syndrome after influenza virus infection
  • Pregnant women
  • Individuals with chronic medical conditions requiring ongoing medical care, including:
    • Chronic pulmonary disease, including asthma particularly if systemic glucocorticoids have been required during the past year)
    • Cardiovascular disease, except isolated hypertension
    • Active malignancy
    • Chronic renal insufficiency
    • Chronic liver disease
    • Diabetes mellitus
    • Hemoglobinopathies such as sickle cell disease
    • Immunosuppression, including HIV infection (particularly if CD4 <200 cells/μL), organ or hematopoietic stem cell transplantation, inflammatory disorders treated with immunosuppressants
    • Individuals who have any condition that can compromise handling of respiratory secretions (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, neuromuscular disorders, cerebral palsy, metabolic conditions)
    • Children with an underlying metabolic disorder, such as medium–chain acyl–CoA dehydrogenase deficiency, who are unable to tolerate prolonged fasting
    • Children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea
    • Residents of nursing homes and other chronic care facilities
    • People without spleen
    • Obesity
    Readers Responses
  1. Something should be seriously done to prevent the use of IgG, IgA and IgM in diagnosing tuberculosis. It is rampant in use in this part of the country and is very costly and also not specific: Vivek Kumar, Varanasi.
    Forthcoming Events
Dr K K Aggarwal

Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta