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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 (07–08c); 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 …

11th April 2012, Wednesday

Five things Physicians and Patients should Question (Part 1)

Nine United States specialty societies representing 374,000 physicians have developed lists of "Five Things Physicians and Patients Should Question" in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

American Academy of Allergy, Asthma & Immunology

  1. Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy: Appropriate diagnosis and treatment of allergies requires specific IgE testing (either skin or blood tests) based on the patient’s clinical history. The use of other tests or methods to diagnose allergies is unproven and can lead to inappropriate diagnosis and treatment. Appropriate diagnosis and treatment is both cost effective and essential for optimal patient care.
  2. Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis: Viral infections cause the majority of acute rhinosinusitis and only 0.5–2% progress to bacterial infections. Most acute rhinosinusitis resolves without treatment in two weeks. Uncomplicated acute rhinosinusitis is generally diagnosed clinically and does not require a sinus CT scan or other imaging. Antibiotics are not recommended for patients with uncomplicated acute rhinosinusitis who have mild illness and assurance of follow–up. If a decision is made to treat, amoxicillin should be first–line antibiotic treatment for most acute rhinosinusitis.
  3. Don’t routinely do diagnostic testing in patients with chronic urticaria: In the overwhelming majority of patients with chronic urticaria, a definite etiology is not identified. Limited laboratory testing may be warranted to exclude underlying causes. Targeted laboratory testing based on clinical suspicion is appropriate. Routine extensive testing is neither cost effective nor associated with improved clinical outcomes. Skin or serum–specific IgE testing for inhalants or foods is not indicated, unless there is a clear history implicating an allergen as a provoking or perpetuating factor for urticaria.
  4. Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated: Immunoglobulin (gamma–globulin) replacement is expensive and does not improve outcomes unless there is impairment of antigen–specific IgG antibody responses to vaccine immunizations or natural infections. Low levels of immunoglobulins (isotypes or subclasses), without impaired antigen–specific IgG antibody responses, do not indicate a need for immunoglobulin replacement therapy. Exceptions include IgG levels <150mg/dl and genetically defined/suspected disorders. Measurement of IgG subclasses is not routinely useful in determining the need for immunoglobulin therapy. Selective IgA deficiency is not an indication for administration of immunoglobulin.
  5. Don’t diagnose or manage asthma without Spirometry: Clinicians often rely solely upon symptoms when diagnosing and managing asthma, but these symptoms may be misleading and be from alternate causes. Therefore spirometry is essential to confirm the diagnosis in those patients who can perform this procedure. Recent guidelines highlight spirometry’s value in stratifying disease severity and monitoring control. History and physical exam alone may over– or under–estimate asthma control. Beyond the increased costs of care, repercussions of misdiagnosing asthma include delaying a correct diagnosis and treatment.

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Dr KK Aggarwal
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    eMedinewS Audio PostCard

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

School Health Education

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

First Mega Ajmer Health Camp – blood donations

72 blood donations were collected on the site.

Dr K K Aggarwal
    National News

Delhi hospitals say prepared to fight flu

NEW DELHI: All government hospitals have been put on alert after six cases of swine flu were confirmed in the capital. "The first case was reported from Gokulpuri in northeast Delhi in January. Other cases have been reported from Vasant Vihar, Dwarka and Ram Nagar near Loni. All patients have been discharged after treatment," Singh said. Dr Sarman Singh, professor of microbiology at AIIMS, said the H1N1 virus did not pose a serious threat anymore. "In year 2009, when H1N1 cases were reported for the first time, we had no medicine or practical experience to deal with it. But now we have medicines and even vaccines needed to treat and prevent the disease," he said. The surveillance officer said most of the patients had travelled recently. "An advisory, prepared by the ministry of health in view of the increasing number of cases, has been issued to all government hospitals," he added. (Source: TOI, Apr 10, 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

Biomarkers refine risk in nonvalvular Afib

Two common cardiac biomarkers –– troponin I and N–terminal pro–B–type natriuretic peptide (NT–proBNP) –– may help improve risk prediction among patients with nonvalvular atrial fibrillation, a RE–LY substudy showed. (Source: Medpage Today)

For comments and archives

Vitamin D found most lacking in big city and rural dwellers

When it comes to risks for vitamin D deficiency, and the medical care and costs associated with that deficiency, where you live appears to play an important role. That is the principal finding from a study of more than 9000 veterans carried out in Tennessee. The study was published online April 4 in the Journal of Rural Health. (Source: Medscape)

For comments and archives

Clearer meaning of frailty needed in CVD

It is time to adopt a consistent definition of frailty and simple metrics to evaluate older adults with cardiovascular disease, according to a review. Evidence, although sparse, suggests that simple, well–established performance measures can be highly predictive of clinical outcomes in these patients, reported Rebecca Gary, PhD, RN, from the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta. (Source: Medpage Today)

For comments and archives

Coronary stents provide solid long–term results in younger adults

Young adults who received coronary artery stents through age 40 had excellent short– and longer–term results, and the Italian researchers who reported this finding say the devices should be the treatment of choice in this age group. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Know the Signs Of Strokehttp://blog.kkaggarwal.com/2012/04/07/know–the–signs–of–stroke/

@DeepakChopra: Trusting in yourself, not what you accomplish, is the key to success

    Spiritual Update

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

The lips of truth shall be established forever; but a lying tongue is but for a moment

This sutra from Bible has a very deep significance in day to day life. The truth is everlasting and always ends up in internal happiness and self realization and in the long run always gives you happiness and all win situation. On the contrary, a lying tongue will only give you a momentary pleasure but will end up in some difficulty later in life.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is the duration of multiple pregnancies?

The duration of a normal singleton pregnancy ranges from 37 weeks to 42 weeks from the time of the last menstrual period. Twin pregnancies occasionally progress to 40 weeks but almost always deliver early. As the number of fetuses increases, the expected duration of the pregnancy decreases. The average duration is 35 weeks for twins, 33 weeks for triplets and 29 weeks for quadruplets.

For comments and archives

    Tat Tam Asi………and the Life Continues……

(Dr Sanjay Chaudhury, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre)

Q. What is an Eye Bank?

A. It is the link between donor and recipient/eye surgeon. An Eye Bank is an organization recognized by the government to collect and distribute human eyes to those requiring corneal transplantation.

Q. Who can be an eye donor?

A. Anyone can be a donor irrespective of age, sex or blood group.

For comments and archives

    Medi Finance Update

(Tarun Kumar, Chartered Accountant)

Consequences of an impermissible avoidance arrangement

Once the arrangement is held to be an impermissible avoidance agreement, then the tax authorities may:

  • Disregard or ignore the arrangement or part thereof,
  • Recharacterise any step,
  • Disregarding any corporate structure,
  • Denial of benefits under tax treaty, etc.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Smoke signal

The only survivor of a shipwreck was washed up on a small uninhabited island. He prayed feverishly for God to rescue him. Every day he scanned the horizon for help, but none seemed forthcoming.

Exhausted, he eventually managed to build a little hut out of driftwood to protect himself from the elements, and to store his few possessions. One day, after scavenging for food, he arrived home to find his little hut in flames, with smoke rolling up to the sky. He felt the worst had happened, and everything was lost. He was stunned with disbelief, grief, and anger. He cried out, ‘God! How could you do this to me?’

Early the next day, he was awakened by the sound of a ship approaching the island! It had come to rescue him!

‘How did you know I was here?’ asked the weary man of his rescuers. ‘We saw your smoke signal,’ they replied.

Moral of the story: It’s easy to get discouraged when things are going bad, but we shouldn’t lose heart, because God is at work in our lives, even in the midst of our pain and suffering.

Remember this the next time your little hut seems to be burning to the ground… it just may be a smoke signal that summons the Grace of God.

For comments and archives

    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity)

Normal Microbial Flora: The Beneficial And Harmful Effects

Let us summarize the good and the bad the normal microbial flora that colonizes various surfaces and systems of our body from birth onwards do for us.

First the benefits:

  • The normal flora synthesize and secrete vitamins like vitamin K and B12 (Enteric bacteria) and certain B vitamins (Lactic acid bacteria) for their own use but in large amounts and the excess amount is absorbed and used by us.
  • Normal flora prevents colonization by pathogenic/undesirable microbes by occupying the attachment sites and competing for nutrients as seen in oral cavity, intestinal and vaginal surfaces.
  • Normal flora synthesizes nonspecific substances like fatty acids, peroxides and specific bacteriocins which kill other bacteria.
  • Normal flora stimulates the development of certain tissues e. g. lymphatic tissues– Peyer’s patches in GIT.
  • The normal flora stimulates the formation of natural antibodies. Low levels of these antibodies are produced against the antigens of normal flora and these can cross react with the pathogens; prevent infection and invasion by pathogenic organisms.

For comments and archives

    Cardiology eMedinewS

Walkathon to mark World Health Day Read More

Structural Remodelling Of The Rheumatic Valve Contributes To Increased Level Of Serum C Terminal Propeptide Of Type I Collagen Read More

Molecular Mechanisms In Endothelial Regulation Of Cardiac Function Read More

    Pediatric eMedinewS

Intermittent Better Than Continuous For Nasal Ventilation In Preemies Read More

Prenatal Antipsychotic Exposure May Affect Kids’ Motor Skills Read More

Sotalol Effective First–Line Therapy For Fetal Supraventricular Tachyarrhythmia Read More

    IJCP Special

Dr Good Dr Bad

Situation: A middle–aged patient was found to have central obesity.
Dr Bad: It is normal.
Dr Good: Rule out diabetes.
Lesson: As per results of a prospective cohort study (1989–2007) of 4,193 men and women aged 65 years and older in the Cardiovascular Health Study, among older adults, overall and central adiposity and weight gain during middle age and after the age of 65 years were associated with risk of diabetes.

For comments and archives

Make Sure

Situation: An 18–year–old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin (macrolide) 500 mg twice–daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

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  Quote of the Day

(Dr GM Singh)

For success, attitude is equally as important as ability. Harry F. Banks

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

When should acute leukemia be suspected?

Acute leukemia, especially in children, can be missed if you are not careful. The most common symptom is fever which lasts beyond 2 weeks and which does not respond to normal treatment modalities. Many children present with unexplained limping, joint swellings or just crying spells due to severe bone and soft tissue infiltrates. Suspect leukemia if ESR is beyond 100, even if WBC counts appear normal.
Make sure a bone marrow study is done on all suspected cases, since it is the only way to pick up acute leukemia with certainty. A trephine biopsy may also be needed if the aspirate reveals a ‘dry tap’. Childhood leukemia is curable most of the time (about 60% in India and about 85% in western countries)

    Mind Teaser

Read this…………………

All are precancerous for carcinoma colon except:

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

Yesterday’s Mind Teaser: notic

Answer for yesterday’s Mind Teaser: Short notice

Correct answers received from: Ritu Sinha, Dr PC Das, Dr Thakor Hitendrsinh G, Raju Kuppusamy, yj vasavada, Dr Chandresh Jardosh, Dr Valluri Ramarao.

Answer for 9th April Mind Teaser: c. Cerebral irrigation

Correct answers received from: Dr Shipra, Dr Tapan, Shantanu.

Send your answer to ijcp12@gmail.com

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    Laugh a While

(Dr GM Singh)

Feline Physics

Law of Cat Stretching

A cat will stretch to a distance proportional to the length of the nap just taken.

    Medicolegal Update

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

What is the patient autonomy?

The process of understanding the risks and benefits of treatment is known as informed consent however patient/legal heir must have the capacity to make the decision and understand the benefits and risks of medical care and voluntarily grant consent, without coercion or duress based on the moral and legal premise of patient autonomy.

  • The patient has the right to make decisions about his/her own health and medical conditions and must give voluntary informed consent for treatment, medical tests and procedures.
  • The doctor should give information about a particular treatment or test to the patient in order to decide whether or not he wishes to undergo such treatment or test. This is based on the moral and legal premise of patient autonomy.
  • The legal term for failing to obtain informed consent before performing a test or procedure on a patient is a form of assault a criminal offence in India.
  • For many interactions like a physical exam with the doctor, implied consent is assumed. For more invasive tests or for those tests or treatments with significant risks or alternatives, you will be asked to give explicit written consent.
  • Under certain circumstances there are exceptions to the informed consent rule. The most common exceptions are an emergency in which medical care is needed immediately to prevent serious or irreversible harm and incompetence in which someone is unable to give or refuse permission for testing or treatment.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Diesel bad for the Heart

Diesel exhaust particles contain a chemical component called phenanthraquinone (PQ) that can harm the ability of arteries to regulate blood flow to bone marrow. This can have a number of long–term health effects, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Men, postmenopausal women and elderly people are most likely to be affected.

Doctors at West Virginia University School of Medicine conducted tests with rats. They found that exposure to PQ reduced by about 65 percent the ability of arteries to regulate blood flow to bone marrow in six–month–old male rats. PQ had a similar effect in older male and female rats and in young female rats whose ovaries had been removed.

Because young female rats with intact ovaries were not affected, it appears that estrogen may have protective effects against PQ.

Previous research has found that PQ impaired the ability of larger blood vessels to relax and that exposure to particle pollution may worsen cardiovascular diseases in certain people.

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  1. Dear sir, it was a pleasant surprise to me when a friend of mine forwarded to me your emedinews. It is very informative, useful, thought provoking, educational and entertaining as well. Dr MC Pandey
    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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