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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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  Editorial …

10th August 2011, Wednesday

Early and Mild Rheumatoid arthritis

What is early and mild rheumatoid arthritis?

Patients with disease of less than six months duration who meet the ACR criteria for RA and typically have less than six inflamed joints, no extraarticular disease, and no evidence of erosions or cartilage loss on plain radiographs.

Can mild rheumatoid arthritis be seropositive?

A patient need not be "seronegative" to be categorized as having mild disease.

In mild rheumatoid arthritis can anti CCP antibodies be negative?

Absence of rheumatoid factor or antibodies to cyclic citrullinated peptides is a favorable prognostic factor.

What is the initial treatment of a patient with early and mild rheumatoid arthritis?

Initial therapy of patients with mild disease includes an NSAID at full therapeutic dose, unless contraindicated.

When to start DMRD in early and mild rheumatoid arthritis?

Disease modifying antirheumatic drugs should be started in all patients whose disease does not remit after six weeks to three months of treatment with NSAIDs alone.

Which is the first–line DMRD in early and mild rheumatoid arthritis?

Hydroxychloroquine or sulfasalazine because of their relative safety.

When should more drugs be added in early and mild rheumatoid arthritis?

Patients with persistent or increasing disease despite treatment for 3–6 months of full dose NSAIDs and either hydroxychloroquine or sulfasalazine require additional treatment.

What else can be tried in the treatment?

Additional therapies may include simple analgesics (paracetamol), bisphosphonates, nutritional supplements and cardiovascular risk reduction strategies.

When to give intra–articular steroid injections?

They can be given for one or a few joints if infection has been excluded. Oral glucocorticoids should be avoided or used in low dose.

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Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

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

Early and Mild Rheumatoid arthritis

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

National Conference on
Insight on Medico Legal Issues

Dr MC Gupta, was felicitated at the National Conference on Insight on Medico legal issues.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


3G offers major hope in rural healthcare: expert

BANGALORE: It’s 3G that could be triggering a radical change in healthcare. Doctors are hoping that 3G technology will make telemedicine consultation much smoother, giving patients a clear picture of who they consult. The clarity in voice and video can make a huge difference, feels Dr Prathap C Reddy, chairman, Apollo Hospitals. Reddy was speaking at the conference on inclusive healthcare management for sustainable development organized by All India Management Association on Saturday. Gubbi village is one of the latest in Karnataka to be connected with telemedicine network. (Source: TOI, Aug 7, 2011)

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

(Dr Monica and Brahm Vasudev)

Local practice patterns drive diagnostic angios

There is wide variation among U.S. institutions in the rate of positive findings of obstructive coronary artery disease (CAD) when patients undergo diagnostic angiography, a retrospective study found. Among hospitals, the rate of positive findings (≥50% obstruction) varied from 23% to 100%, reported Pamela S. Douglas, MD, from Duke University Medical Center in Durham, N.C., and colleagues. Hospitals with lower rates of obstructive CAD findings performed coronary angiography more often in younger patients, women, blacks, and outpatients (all P<0.001), researchers reported in the August 16 Journal of the American College of Cardiology. (Source: Medpage Today)

For comments and archives

Antidepressant scripts often lack diagnosis

Almost three–quarters of the antidepressant prescriptions written by nonpsychiatrists had no documentation of psychiatric diagnoses, an analysis of recent prescribing trends showed. Prescriptions without psychiatric diagnoses accounted for a majority of nonpsychiatrists’ antidepressant prescriptions from 1996 to 2007, according to an article published online in Health Affairs. (Source: Medpage Today)

For comments and archives

This gadget helps stop overeating

LONDON: Mindless snacking is a problem for many weight–watchers. Now, scientists have developed a new device which they say could help stop people from overeating by monitoring how many mouthfuls they eat. Developed by researchers at Clemson University in South Carolina, the Bite Counter is worn like a watch and tracks a pattern of wrist–roll motion to identify when the wearer has taken a bite of food. Then this data can be used to monitor how many calories people are eating long–term. People can also set a bite limit so if they snack too much an alarm will go off. The researchers have described the innovative device as a pedometer for eating, the Daily Mail reported. Lead scientist Eric Muth said: "At the societal level, current weight–loss and maintenance programs are failing to make a significant impact. Studies have shown that people tend to underestimate what they eat by large margins, mostly because traditional methods rely upon self–observation and reporting. Our preliminary data suggest that bite count can be used as a proxy for caloric count." (Source: TOI, Aug 8, 2011)

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    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Eating fat when sad really does lift mood

There may be more to the term comfort eating than we realize. However, consuming fat appears to be the mood–lifter, rather than any other food ingredient. Researchers from University of Leuven, Belgium, reported on a study in the Journal of Clinical Investigation. The authors explained that humans have an intimate relationship between their emotional state and what they eat. When we feel tired, stressed, anxious or overworked we tend to grab the chocolate bar, rather than an apple – in other words, comfort foods. Lukas Van Oudenhove, MD., PhD. and team charted areas of the brain with functional magnetic resonance imaging (MRI) scans – specific areas of the brain are seen to light up when a person is sad. They recruited 12 healthy individuals, none of them was obese. They were then given an infusion of fatty acid or saline via a feeding tube. Fatty acid was used because most comfort foods have high fatty acid content.

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    Twitter of the Day

@DrKKAggarwal: #IJMD As the tracheostomy needs transtracheal dissection and carries significant morbidity, submental intubation… http://fb.me/1dTJfgock

@DeepakChopra: #CosmicConsciousness The more universal or cosmic your sense of self, the bigger will be your world.

    Dr KK Answers

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

How safe is angiography radiation?

The mean duration of fluoroscopy in electro physiologic cardiac interventional procedures ranges from 15 to 67 minutes. The radiation dose from one hour of fluoroscopy during electro physiologic ablation procedures can result in 0.7 to 1.4 excess fatal malignancies per 1000 women and 1.0 to 2.6 per 1000 men as per two studies published in American Journal of Cardiology (1998) and Circulation (2004)

For comments and archives

    Spiritual Update

How to meditate

Meditation is not concentration. Concentration is holding the mind to something within or outside the body. On the other hand, meditation is an unbrok.

For comments and archives

    An Inspirational Story

(Dr. Anupam Sethi Malhotra)

A little boy came up to his mother in the kitchen one evening while she was fixing supper,

and handed her a piece of paper that he had been writing on.

After his Mom dried her hands on an apron, she read it, and this is what it said:

For cutting the grass: 35/–
For cleaning up my room this week: 25/–
For going to the store for you: 10/–
Baby–sitting my kid brother while you went shopping: 10/–
Taking out the garbage: 35/–
For getting a good report card: 25/–
For cleaning up and raking the yard: 10/–
Total owed: 150/–

Well, his mother looked at him standing there, and the boy could see the memories flashing through her mind.

She picked up the pen, turned over the paper he’d written on, and this is what she wrote:

For the nine months I carried you while you were growing inside me:
No Charge

For all the nights that I’ve sat up with you, doctored and prayed for you:
No Charge

For all the trying times, and all the tears that you’ve caused through the years:
No Charge

For all the nights that were filled with dread, and for the worries I knew were ahead:
No Charge

For the toys, food, clothes, and even wiping your nose:
No Charge

Son, when you add it up, the cost of my love is:
No Charge.

When the boy finished reading what his mother had written, there were big tears in his eyes, and he looked straight at his mother and said, Mom, I sure do love you. And then he took the pen and in great big letters he wrote: PAID IN FULL

For comments and archives

    Pediatric Update

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

What is the cause of UGI bleed in newborns ?

The common causes of UGI bleed in newborn period are:

  • Swallowed maternal blood
  • Hemorrhagic disease of newborn
  • Stress gastritis
  • Acid–peptic disease
  • Vascular anomaly
  • Coagulopathy

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

What are the ethical issues associated with infertility and its treatment?

  • High–cost treatments are financially out of reach for some couples.
  • Debate over whether health insurance companies should be forced to cover infertility treatment.
  • Allocation of medical resources that could be used elsewhere
  • The legal status of embryos fertilized in vitro and not transferred in vivo.
  • Pro–life opposition to the destruction of embryos not transferred in vivo.
  • IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems.
  • Religious leaders’ opinions on fertility treatments.
  • Infertility caused by DNA defects on the Y chromosome is passed on from father to son. If natural selection is the primary error correction mechanism that prevents random mutations on the Y chromosome, then fertility treatments for men with abnormal sperm (in particular ICSI) only defer the underlying problem to the next male generation.

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  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Iron deficiency anemia

In iron deficiency anemia, the serum iron concentration is reduced, and the level of transferring also measured as total iron binding capacity (TIBC) is elevated; the latter finding reflects the reciprocal relationship between serum iron and transferrin gene expression in most nonerythroid cells.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure came for cardiac evaluation.
Dr. Bad: Go for Echo test.
Dr. Good: Go for Tissue Doppler Echo test.
Lesson: A patient with heart failure must go for Tissue Doppler Echo Test for evaluation of diastolic function.

For comments and archives

Make Sure

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

For comments and archives

  Quote of the Day

(Dr GM Singh)

Success is century, make it. Problem is yorker, face it. Failure is bouncer, leave it. Luck is fulltoss, use it. But opportunity is free hit, never miss it.

    Medicolegal Update

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

Mercury is not toxic when taken orally as it is not absorbed.

  • Mercury or quicksilver is a liquid metal with a bright silvery luster, which is volatile even at room temperature, and boils at 356.9 degrees.
  • It is 13.5 times denser then water, and 1.2 times heavier than lead. The fumes are odorless and invisible. Mercury is used to making thermometers, lamps, and as an amalgam with other metals for dental fillings.
  • Fatal Dose: An intravenous injection of 0.06g of metallic mercury as a 40% oil emulsion has proved fatal. The usual fatal period is 3 to 5 days, but death may take place much sooner or later than this; death has been recorded in half an hour.
  • Metallic mercury when perfectly pure is hardly poisonous. Cases have been recorded where individuals have swallowed a pound or two of the liquid metal as a treatment of chronic constipation without any harmful effects. Mercury is not toxic when taken orally as it is not absorbed. The hazard is from swallowing parts of a broken thermometer are that of the glass and not the mercury.

For comments and archives

    Mind Teaser

Read this…………………

Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with:

1. Medullary carcinoma of thyroid
2. Papillary carcinoma of thyroid
3. Anaplastic carcinoma of thyroid
4. Follicular carcinoma of thyroid

Yesterday’s Mind Teaser: In which of the following locations is carcinoid tumor most common?

1. Esophagus
2. Stomach
3. Small bowel
4. Appendix

Answer for yesterday’s Mind Teaser: 4. Appendix

Correct answers received from: Dr Rajshree Aggarwal, Dr Nowneet Bhat, Dr Joshi Sachin, Dr Prabodh Kumar Gupta, Dr TS Daral, Dr Priyanka Sharma, Dr Sukanta Sen, Dr Chandresh Jardosh, Dr K Raju,
Dr Muthumperumal Thirumalpillai, Dr Madhu Sinha, Dr Neelam Nath.

Answer for 8th August Mind Teaser: Cycloplegia
Correct answers received from: Dr Dilip Kumar Jha, Dr Ragavan Moudgalya, Dr S Upadhyaya,
Dr BB Aggarwal, Dr Shashi Saini.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

I was teaching my son how to fly a kite in the park when a guy walks by and says: "Flying a kite?" I said: "No, fishing for birds."

For Comments and Archives

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name


DCI Approval Date

Cefpodoxime IP 100mg/200mg + Ofloxacin IP 100mg/200mg Tablets

For the treatment of lower and upper respiratory tract infection and Typhoid fever in adults only


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Night urination linked to snoring

Sleep apnea, a common but serious sleep snoring disorder, is the root cause of nocturia, or getting up frequently during the night to urinate said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela.

The results of a study conducted by researchers at the University of Alabama at Birmingham, which reported these findings are particularly important for older adults who are at greater risk of falling and being hurt if they must get up frequently during the night to urinate.

People with nocturia often report the problem to their gynecologist or urologist but not a sleep clinician. Doctors most often attribute nocturia to aging in women or to prostate problems in men.

One event per night is within normal limits but two or more events per night may be associated with sleep deprivation.

In sleep apnea, the soft structures in the throat relax and close off the airway. Oxygen decreases, carbon dioxide increases, the heart rate drops and blood vessels in the lung constrict. The heart starts racing and experiences a false signal of fluid overload. Body tries to get rid of sodium and water, resulting in nocturia.

In sleep apnea airway obstruction lasts for 10 seconds or more, and occurs five or more times per hour of sleep. People with the most severe cases of sleep apnea can have more than 100 such events per hour of sleep. Symptoms include snoring, restless sleep with frequent awakenings, excessive daytime sleepiness, and morning headaches.

For comments and archives

    Readers Responses
  1. Nice review of drug fever. I would also add JH reaction, although rarely seen. Dr Monica Vasudev, MD.
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.



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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