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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

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  Editorial …

4th March 2013, Monday

Routine ECG Does Not Help

In populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle-aged adults. It has been shown that electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction. However, performing routine ECG among asymptomatic adults is not supported by current evidence and is not recommended by the US Preventive Services Task Force and the American College of Cardiology Foundation/American Heart Association.

The aim of this study by Auer and colleagues was to determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

How can constipation be described?

Constipation is characterized either by unsatisfactory defecation, infrequent stools, or difficulty with stool passage. In older adults, constipation may be associated with fecal impaction and fecal incontinence. Fecal impaction can cause stercoral ulceration, bleeding, and anemia.

For comments and archives

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

Weight loss may improve sexual health of obese diabetics

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Multi-specialty camp in East Delhi

A multispecialty camp was organized by Heart Care Foundation of India in association with East Delhi Walkers’ Association on 17th February 2013.

Dr K K Aggarwal
    National News

HIV/AIDS patients will soon have health cover

New Delhi: People suffering from HIV/AIDS will soon have health insurance cover. The Delhi government and the Centre, while responding to a public interest litigation on the absence of insurance cover for such patients, informed the Delhi High Court that the health ministry had on September 26, 2012, set up a 15-member working group to give technical support and draft guidelines to provide health insurance to those afflicted with HIV/AIDS. The court asked the ministry to complete the process in six months. The Centre said the "Insurance Regulatory and Development Authority (IRDA) has also made a draft to provide insurance cover to persons living with HIV and people vulnerable to HIV/AIDS under health insurance policies of life and non-life insurance companies". A bench headed by Chief Justice D Murugesan, disposing of the litigation filed by a doctor Rajeev Sharma, asked the Centre to take a decision in six months. "The working group set up by the health ministry is expected to perform the job assigned to it as expeditiously as possible but in any case within six months from today (sic)," the court said. Several NGOs working for such patients, including the AIDS Healthcare Foundation, have been urging the Union health ministry to provide insurance cover to people affected by HIV/AIDS. Currently, HIV is not covered under any insurance policy in India, violating the national mandate of providing stigma-free care and support services. (Source: Hindustan Times, March 02, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Victims who present within 72 hours of the incident need urgent evaluation as they may have suicidal ideation.

    Valvular Heart Disease Update

Should angiograms be done in all patients with valvular heart disease in the elderly?

Coronary artery disease is common in the elderly patients with valvular heart disease. When valve surgery is indicated in them, coronary angiography is indicated to assess the need for concomitant coronary artery bypass surgery.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

FDA panel to address two menopause drugs

Two drugs under review by the FDA to treat symptoms associated with menopause reduced the frequency and severity of hot flashes, the agency said in advance of an advisory committee review of the products. (Source: Medpage Today)

Extreme weather hampers EMT response

Falling temperatures appear to have a significantly adverse effect on the response time of emergency medical services -- in some instances almost doubling response time. (Source: Medpage Today)

Immunotherapy guidelines often ignored

Allergists' attitudes toward allergen immunotherapy in patients with certain medical conditions are often at odds with published recommendations, according to a survey reported at the American Academy of Allergy, Asthma, and Immunology (AAAAI) annual meeting. (Source: Medpage Today)

Sitting less trims diabetes risk

Just getting out of the chair and moving a little may help ward off type 2 diabetes among individuals at risk even more than engaging in strenuous physical activity, British researchers found. (Source: Medpage Today)

5 psych disorders have common genetics

Autism, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, and schizophrenia share common genetic underpinnings -- despite differences in symptoms and course of disease, researchers discovered. (Source: Medpage Today)

  Twitter of the Day

@DrKKAggarwal: IMA national meeting pic.twitter.com/jpQIOaGLjX

@DrKKAggarwal: Be comfortable with and embrace paradox, contradiction, and ambiguity. It is the womb of creativity.

    Spiritual Update

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

Curses in Mythology

Dr K K Aggarwal

There were no judges in mythological era. The role of judges was performed either by Rishi Munies or by the kings.

We have seen lot of examples of curses (shraps) being given by Rishi Munies. In all probabilities, there were the sentences given by them to the guilty or the culprit person. Following are a few examples:

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What precautions should be carried while carrying a multiple pregnancy?

Monitoring a multiple pregnancy: Prenatal diagnosis by chorionic villus sampling can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities. Amniocentesis is performed between 16 to 20 weeks. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation. Tocolytic agents are medications that may slow or stop premature labor. These medications are given in hospital “emergency” settings in an attempt to stop premature labor.

Cesarean section: Vaginal delivery of twins may be safe in some circumstances. Many twins can be delivered vaginally if the presenting infant is in the head first position. Most triplets will be delivered by Cesarean section. Appropriate anesthesia and neonatal support are essential, whether delivery is performed vaginally or requires Cesarean section.

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

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Whole blood

Definition: Whole blood contains 350 ml. of donor blood plus anticoagulants.

Volume: 350 ml.

Storage: Between 2° C to 6° C in approved Blood Bank refrigerator

Shelf Life: 35 days

For comments and archives

    An Inspirational Story

Nothing is too big for God

Two men went fishing. One man was an experienced fisherman, the other wasn’t. Every time the experienced fisherman caught a big fish, he put it in his ice chest to keep it fresh. Whenever the inexperienced fisherman caught a big fish, he threw it back.

The experienced fisherman watched this go on all day and finally got tired of seeing this man waste good fish. "Why do you keep throwing back all the big fish you catch?" he asked. The inexperienced fisherman replied, "I only have a small frying pan."

Sometimes, like that fisherman, we throw back the big plans, the big dreams, the big jobs and the big opportunities that God gives us. Our faith is too small. We laugh at that fisherman who didn’t figure out that all he needed was a bigger frying pan; yet how ready are we to increase the size of our faith?

Whether it’s a problem or a possibility, God will never give you anything bigger than you can handle. That means we can confidently walk into anything God brings our way.

For comments and archives

  Cardiology eMedinewS

Fatal MI more likely after sibling dies Read More

Six factors best predict Afib risk in women Read More

  Pediatric eMedinewS

Natalizumab may be useful for pediatric MS Read More

Deworming programs in schools have limited efficacy Read More

    Rabies Update

(Dr. A. K. Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Do rat bite cases require rabies vaccination?

In India most rodents, rats, squirrel, rabbits, birds and bats have been found to be free of rabies. However, following exposure to mongoose, PEP is recommended. Rat bite cases do not require rabies vaccination but this is a right opportunity to start pre-exposure vaccination.

    IJCP Special

Dr Good Dr Bad

Situation: A patient wanted to know if he could buy Vigor–25 from the net.
Dr Bad: Go ahead.
Dr Good: It can be harmful.
Lesson: The US FDA has warned that Vigor–25, a product marketed as a natural dietary supplement to enhance male sexual performance, should not be purchased or used because it contains sildenafil which may interact with nitrates and can dangerously lower blood pressure. Vigor–25, distributed by Piston Corp., is sold on Internet sites.

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high?
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

  Quote of the Day (Dr GM Singh)

The greatest revolution of our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives. William James

    Mind Teaser

Read this…………………

The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to:

1. Clarify the patient's report by reviewing the patient's nonverbal behavior.
2. Confronting the patient's denial of pain.
3. Obtaining an order for pain medication.
4. Supporting the patient's stoic behavior.

Yesterday’s Mind Teaser: Which is the most effective method for teaching strengthening exercises to patients with chronic pain?

1. Distributing a local listing of strengthening exercise classes
2. Providing demonstration and return demonstration
3. Providing handouts with pictures
4. Viewing a self-instruction video

Answer for Yesterday’s  Mind Teaser: Providing demonstration and return demonstration

Correct answers received from: Dr.Suresh Arora, Dr. Thakor Hitendrsinh G, Dr Chandresh  Jardosh, Dr Avtar Krishan, Dr shashi saini, Muthumperumal Thirumalpillai, dr deepali chatterjee, Dr.K.Raju, Dr. Sushma Chawla, Dr.Jayashree Sen & Dr.Bitaan Sen

Answer for 1st March Mind Teaser: d. Trigeminal neuralgia.

Correct answers received from: Dr Pankaj Agarwal,

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

High Blood Pressure

When a physician remarked on a new patient’s extraordinarily ruddy complexion, he said, "High blood pressure, Doc. It comes from my family."

"Your mother’s side or your father’s?" I asked.

"Neither," he replied. "It’s from my wife’s family."

"Oh, come now," I said. "How could your wife’s family give you high blood pressure?"

He sighed. "You oughta meet ‘em sometime, Doc!"

    Medicolegal Update

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

How should biological samples and medical evidences be collected in a medicolegal case?

The analyst/doctor has a legal responsibility to retain untested biological specimen in legal cases so that another person can test it and come to an independent conclusion as to its origin.

The observation of scenes of crime, collection of human body fluids, weapons of the offence and medical examination of victim, accused, or both is required in any investigation of crime against human body such as injury, rape, murder.

The medical examination is carried out in emergency ward of hospitals and treatment of injured and dying patient remains the major focus of the treating doctor. But, in cases of crime against the human body, the medical examination and collection of biological sample/s, its documentation, packaging, and analysis have an important role and should be done by the doctor very meticulously with the high standards of science and the law in mind. These biological materials include: Blood, seminal stains, vaginal smears/slides gastric lavage, chemical substances, poison, hair, fiber, broken glasses, knives, blunt instruments/objects, fire arms, bullet, live and empty cartridge cases, wads, clothing etc. This scientific biological evidence becomes legal evidence in prosecution/acquittal of case if collected correctly.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Aspirin Paracetamol combination can be dangerous

Taking a combination of aspirin with paracetamol can be risky to the kidney, said Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

If the combination is taken with caffeine or codeine, the risk is further increased. A single analgesic is risky to the kidneys, only if it is given over a period of years.

One should not take over-the-counter painkillers for more than 10 days for pain or for more than 3 days for fever without medical advice said Dr S Arulrhaj Past National president IMA.

People who are taking them should increase the amount of fluid intake i.e. they should take 6 to 8 glasses of water a day. If they are already suffering from kidney disease they should contact the doctor before taking painkiller, added Dr Ramesh Hotchandani Kidney Specialist at Moolchand Medcity and President IMA New Delhi Branch.

According to Dr Vinayak Aggarwal senior cardiologist from Medanta Medicity people who are heart patients, have high blood pressure or kidney disease or are on diuretic medications or are over the age of 65 should also consult their doctor before taking any painkiller.

Over the counter painkillers are non prescription drugs but this does not mean that they can be taken without medical advice, said Dr Aggarwal.

    Readers Response
  1. Budget allocation for Health has increased. A welcome mindset… But the allocation increase on GPD is only marginal; concentrating on Medical education to overcome the Health workforce short fall. Primary Health care is the need of the hour. Public Health & NCD are the next priority areas. These segments are ignored. In India today, Private Healthcare offers 80% of services. Health is the only priority next to defence. Dr. Arul
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