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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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

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  Editorial …

4th April 2013, Thursday

Treatment of mild hypertension in low-risk patients

There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease.

A meta-analysis combined four placebo-controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow-up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low-risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk six meters in less than eight seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).


  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012; 8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012; 172:1162.

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Dr KK Aggarwal
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Monitoring LFT in a patient on statins

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    Photo Feature (from the HCFI Photo Gallery)

Dr B M L Kapoor endorses CPR10

Dr K K Aggarwal
    National News

Pushpanjali Medicine Update 2013

PUSHPANJALI CROSSLAY HOSPITAL in association with API Ghaziabad is organizing first round of Zonal CME of API “Pushpanjali Medicine Update 2013” on 21st April 2013 (Sunday). The Conference will cover a wide range of scientific topics of relevance to Physicians and Residents in their day-to-day practice. Participants/Delegates will have an opportunity of interacting with Eminent National and International Faculty at the CPC and Q&A during the sessions learning latest and updated International best practice procedure/methods.

Venue: Hotel Radisson Blu, Kaushambi, Ghaziabad. 12.30pm onwards.

Contact: Dr. Neelesh Goyal (09810003488) at docneelesh@yahoo.co.in

AIIMS launches telemedicine services

RAIPUR: AIIMS, Raipur, in collaboration with the CRPF today formally launched a telemedicine program to treat and advise patients, including civilians, in the Maoist hit areas of Chhattisgarh. The telemedicine service, to commence at 10 places in the state over the popular internet video conferencing platform, Skype, would also be utilised by the CRPF to treat its personnel suffering from psychiatric disorders like depression and stress. Talking to newsmen soon after inaugurating the service, Director AIIMS, Nitin M Nagarker, said the aim of the service was to make expert advice available to people in the far-flung areas of the state. He said a panel of three doctors would be available twice a week over Skype and patients and paramedic staff at various CRPF camps would be connected through high speed internet for consultation. CRPF personnel and doctors requiring medical advice would also utilise the service, Dr Nagarkar said. When queried about medical help for CRPF personnel suffering from depression, as suicides and acts of violence by them in Maoist affected areas is a matter of concern, the AIIMS director said psychiatrists would be made available as and when required. However, CRPF Director General, Pranay Sahay tried to underplay the issue of suicides among CRPF personnel and said that there is no evidence to suggest that its prevalence was higher in the force. "The CRPF has three lakh personnel and we have about 40 to 45 such cases every year, which is not high by any standards", he said. Meanwhile, the service is likely to be a boon for residents of remote villages in the state where access to expert medical advice is still a distant dream. The healthcare facilities in the far flung rural areas of the state are in shambles with very few doctors working in the field. The service would initially be launched from Kondagaon, Jagadalpur and Narayanpur. On the occasion, Ram Niwas, DG, Chhattisgarh police, Pradeep Chandra, DIG, Chhattisgarh CRPF and Z Hasan, IG, Chhattisgarh CRPF were among those present. (Source: TOI, Apr 3, 2013)

For comments and archives

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)


Children with emotional abuse may present with anxiety, depression, agitation, fearfulness, social withdrawal, running away from home, developmental delay, drug or alcohol abuse, anorexia nervosa bulimia.

    Valvular Heart Disease Update

Sudden death can occur in children with aortic stenosis due to a bicuspid aortic valve, especially during and immediately after exertion.

(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)

Mud packs appear to help knee OA

Mud packs may help relieve pain and improve function for patients with knee osteoarthritis (OA), according to a review published online December 11, 2012, and in the April 2013 issue of Rheumatology. (Source: Medscape)

Exercise not a 'shocker' for HF patients with ICD

Exercise doesn't trigger inappropriate implantable cardioverter-defibrillator (ICD) shocks in most heart failure patients, a subanalysis of the HF-ACTION trial showed. (Source: Medpage Today)

Carvedilol superior to metoprolol in MADIT-CRT analysis

Treatment with carvedilol is associated with a significant 30% reduction in the risk of hospitalization for heart failure (HF) or death when compared with patients treated metoprolol, according to a new analysis of the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). (Source: Medscape)

Duloxetine may ease neuropathy from chemo

The depression and anxiety drug duloxetine effectively treated painful chemotherapy-induced peripheral neuropathy, results of a phase III trial showed. (Source: Medpage Today)

Glucocorticoids may increase risk for venous thromboembolism

The use of glucocorticoids may be associated with an increased risk for venous thromboembolism (VTE), according to the findings of a population-based case-control study. Sigrun A. Johannesdottir, BSc, from Aarhus University Hospital in the Netherlands, and colleagues published their findings online April 1 in JAMA Internal Medicine. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Energy Drinks May Put Heart at Risk for Sudden Death Energy drinks may raise blood pressure and prolong QT... http://fb.me/1FCAlQlWj

@Dr Deepak Chopra: How does a skeptic view consciousness? Michael Shermer shares during his presentation in Sages & Scientists http://tinyurl.com/d3oj3m3

    Spiritual Update

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

The Vedic Will – as I understand it

Sometimes back, I used to think Will means after my death how my finances will be controlled by me wife and my children.

As I started acquiring Vedic knowledge, my interpretation changed. Following is the gist for writing a Will, as I understand it the Vedic way.

For comments and archives

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

Why is infertility stressful?

Most couples are used to planning their lives. They may believe that if they work hard at something, they can achieve it. So when it's hard to get pregnant, they feel as if they don't have control of their bodies or of their goal of becoming parents. Infertility tests and treatments can be physically, emotionally and financially stressful. Infertility can cause a couple to grow apart, which increases stress levels.

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

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

ABO system

The fetal immunoglobulin production is low, so the plasma contains very little of anti-A and B agglutinins.

    An Inspirational Story

The Circle of Joy

And old story tells that one day, a countryman knocked hard on a monastery door. When the monk tending the gates opened up, he was given a magnificent bunch of grapes.

Brother, these are the finest my vineyard has produced. I’ve come to bear them as a gift.

Thank you! I will take them to the Abbot immediately; he’ll be delighted with this offering.

No! I brought them for you. For whenever I knock on the door, it is you who opens it. When I needed help because the crop was destroyed by drought, you gave me a piece of bread and a cup of wine every day.

The monk held the grapes and spent the entire morning admiring it and decided to deliver the gift to the Abbot, who had always encouraged him with words of wisdom.

The Abbot was very pleased with the grapes, but he recalled that there was a sick brother in the monastery, and thought:

“I’ll give him the grapes. Who knows, they may bring some joy to his life.”

And that is what he did. But the grapes didn’t stay in the sick monk’s room for long, for he reflected:

“The cook has looked after me for so long, feeding me only the best meals. I’m sure he will enjoy these.”

The cook was amazed at the beauty of the grapes. So perfect that no one would appreciate them more than the sexton; many at the monastery considered him a holy man, he would be best qualified to value this marvel of nature.

The sexton, in turn, gave the grapes as a gift to the youngest novice, that he might understand that the work of God is in the smallest details of Creation. When the novice received them, he remembered the first time he came to the monastery, and of the person who had opened the gates for him; it was that gesture which allowed him to be among this community of people who knew how to value the wonders of life.

And so, just before nightfall, he took the grapes to the monk at the gates.

Eat and enjoy them, he said. For you spend most of your time alone here, and these grapes will make you very happy.

The monk understood that the gift had been truly destined for him, and relished each of the grapes, before falling into a pleasant sleep.

Thus the circle was closed; the circle of happiness and joy, which always shines brightly around generous people.

For comments and archives

    Cardiology eMedinewS

Stress varies in parents of kids with cancer Read More

MI risk drops with post-ED angina care Read More

    Pediatric eMedinewS

“Disease” tag prompts parents to want Tx for healthy babies Read More

GERD label in infants encourages parents to medicate 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)

Can rabies vaccine be given to a child with chicken pox or measles?

As rabies is 100% fatal, there is no contraindication for anti-rabies vaccination. Rabies vaccine can be given to a child with chicken pox or measles and it is effective. If possible, the administration of measles vaccine should be postponed by a fortnight after the completion of antirabies immunization.

    IJCP Special

Dr Good Dr Bad

Situation: A patient came with dengue hemorrhagic shock.
Dr. Bad: Give platelet transfusion.
Dr. Good: Give initial bolus of 5% dextrose in saline or Ringer Lactate 20ml/kg body weight infused over 15 minutes.
Lesson: In hemorrhagic shock, fluid resuscitation is more important. Bolus should be followed by continuous infusion of 10–20 ml/kg body weight fluids until urine output normalizes. (World Health Organization, Geneva 2009, p. 1)

Make Sure

Situation: A patient who had multiple blunt traumas on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt traumas to exclude peritoneal hemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

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  Quote of the Day (Dr GM Singh)

A total commitment is paramount to reaching the ultimate in performance. Tom Flores

    Mind Teaser

Read this…………………

An infant, age 8 months, has a tentative diagnosis of congenital heart disease. During physical assessment, Nurse Jasmine measures a heart rate of 170 beats/minute and a respiratory rate of 70 breaths/minute. How should the nurse position the infant?

a. Lying on the back
b. Lying on the abdomen
c. Sitting in an infant seat
d. Sitting in high Fowler’s position

Yesterday’s Mind Teaser: Nurse Claudine is reviewing a client’s fluid intake and output record. Fluid intake and urine output should relate in which way?

a. Fluid intake should be double the urine output. b. Fluid intake should be approximately equal to the urine output. c. Fluid intake should be half the urine output. d. Fluid intake should be inversely proportional to the urine output.

Answer for Yesterday’s Mind Teaser: b. Fluid intake should be approximately equal to the urine output.

Correct answers: Dr VM Kartha, Dr BK Agarwal, Rajiv Kohli, Dr KV Sarma, Tukaram Pagad, Prabha Sanghi, Dr Jainendra Upadhyay, Bharat Bhushan Aggarwal, Dr BB Gupta, Mukta Govil, Dr Jella, Dr Avtar Krishan, Dr Raghavendra Jayesh, Dr Jayashree Sen & Dr Bitaan Sen, Dr (Maj. Gen.) Anil Bairaria,
Dr Pankaj Agarwal, Dr Arapn Gandhi, Dr PC Das, Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Muthumperumal Thirumalpillai, Dr Kanta Jain.

Answer for 2nd April Mind Teaser: d. Seated upright

Correct answers received from: Dr Deepali Chatterjee, Dr PC Das, Sufiya Humnabad.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

New Teeth

Our local minister had all of his remaining teeth pulled and new dentures made a few weeks ago.

The first Sunday, his sermon lasted 10 minutes. The second Sunday, he preached only 20 minutes. But, on the third Sunday, he preached for an hour and a half.

I asked him about this. He then told me "well, John, that first Sunday, my gums were so sore it hurt to talk. The second Sunday, my dentures were still hurting a lot. Now the third Sunday, I accidentally grabbed my wife's dentures AND I COULDN'T STOP TALKING!"

    Medicolegal Update

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

What is postmortem discoloration?

The bluish color of postmortem discoloration does not have the same connotation as cyanosis produced during life

  • There is a gravitational pooling of blood in the veins and capillary beds of the dependent parts of the body occur since after death the body remains lying in a position and cessation of the circulation. The postmortem coloration helps a doctor to estimate the time since death.
  • The skin of deceased may show dark purple discoloration due to accumulated blood. The process begins immediately after the circulation stops, and in a person dying slowly with circulatory failure, it may be pronounced very shortly after death. Lividity is present in all bodies, although it may be inconspicuous in some and thus escape notice.
  • Postmortem lividity is first apparent about 20–30 minutes after death as dull red patches or blotches, which deepen in intensity and coalesce over the succeeding hours to form extensive areas.
  • Postmortem lividity is usually well marked in the earlobes and in the fingernail beds. In a supine corpse, there may be isolated areas of lividity over the front and sides of the neck resulting from incomplete emptying of superficial veins. If the head is slightly flexed on the neck, then lividity may have a linear distribution corresponding to the skin folds.
  • Fading of the primary pattern of lividity and development of a secondary pattern of lividity will be quicker and more complete if the body is moved.
  • Cyanide poisoning results in lividity, which is described by different authors as pink, bright scarlet, and violet.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Massive CPR 10 exercise to earmark World Health Day

For the first time in India, Heart Care Foundation of India will train over 10000 people on 6th April, 2013, Saturday in a special function "CPR 10 Utsav" being organised at Dr. Sampoornanand Sarvodaya Kanya Vidyalaya, C-1, Yamuna Vihar, Delhi. The function is being organised by Heart Care Foundation of India in association with Directorate of Education, Government of NCT of Delhi.

The practical training will be given by Dr. KK Aggarwal to school students, teachers and other members of the public. There are no charges for the training.

Apart from Sarvodaya Kanya Vidyalaya, the host school at Yamuna Vihar, other schools co-hosting the event are Govt. Boys Sr. Secondary School C-1 & B-1 Yamuna Vihar.

Over 40 schools from various parts of the city will also be participating in the Utsav.

Giving the details, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India said that this will be for the first time in the history that over 10000 people will be trained in hands-only cardiopulmonary resuscitation (CPR 10) at one venue in one single day.

Shri J.P. Aggarwal, Member of Parliament will be launching the camp.

Dr. Aggarwal said that the CPR 10 mantra is "Within 10 minutes of death (earlier the better), at least for at least 10 minutes, longer the better (adults 25 minutes and children 35 minutes), compress the centre of the chest of the deceased person continuously (uninterrupted) and effectively (1½inch) with a speed of 10x10 = 100 per minute.” Over 35000 people have already been trained in CPR 10.

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