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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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Photos of 1st Mega Ajmer Health Camp 2012

  Editorial …

13th April 2012, Friday

Five Things Physicians and Patients should question (Part 3)

American College of Cardiology

  1. Don’t perform stress cardiac imaging or advanced non–invasive imaging in the initial evaluation of patients without cardiac symptoms unless high–risk markers are present. Asymptomatic, low–risk patients account for up to 45% of unnecessary "screening." Testing should be performed only when the following findings are present: diabetes in patients older than 40–years–old; peripheral arterial disease; or > 2% yearly risk for coronary heart disease events.
  2. Don’t perform annual stress cardiac imaging or advanced non–invasive imaging as part of routine follow–up in asymptomatic patients. Performing stress cardiac imaging or advanced non–invasive imaging in patients without symptoms on a serial or scheduled pattern (e.g., every one to two years or at a heart procedure anniversary) rarely results in any meaningful change in patient management. This practice may, in fact, lead to unnecessary invasive procedures and excess radiation exposure without any proven impact on patients’ outcomes. An exception to this rule would be for patients more than five years after a bypass operation.
  3. Don’t perform stress cardiac imaging or advanced non–invasive imaging as a pre–operative assessment in patients scheduled to undergo low–risk non–cardiac surgery. Non–invasive testing is not useful for patients undergoing low–risk non–cardiac surgery (e.g., cataract removal). These types of tests do not change the patient’s clinical management or outcomes and will result in increased costs.
  4. Don’t perform echocardiography as routine follow–up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms. Patients with native valve disease usually have years without symptoms before the onset of deterioration. An echocardiogram is not recommended yearly unless there is a change in clinical status.
  5. Don’t perform stenting of non–culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST–segment elevation myocardial infarction (STEMI). Stent placement in a non–infarct artery during primary PCI for STEMI in a hemodynamically stable patient may lead to increased mortality and complications. While potentially beneficial in patients with hemodynamic compromise, intervention beyond the culprit lesion during primary PCI has not demonstrated benefit in clinical trials to date.

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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

Five Things Physicians and Patients should question (Part 3)

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

Inauguration of Vote for Delhi Campaign

 eMedinewS appeals that every one should vote

Dr K K Aggarwal
    National News

1 in 8 Indians hit by chronic sinusitis: Study

MUMBAI: An estimated 134 million Indians suffer from chronic sinusitis, the symptoms of which include but are not limited to debilitating headaches, fever and nasal congestion and obstruction. That’s more than population of Japan. The National Institute of Allergy and Infectious Diseases’ (NIAID) estimate does not even take into account those of us who suffer from acute sinusitis. Among Indians this disease is more widespread than diabetes, asthma or coronary heart disease. One in eight Indians suffer from chronic sinusitis caused by the inflammation of the nasal and throat lining, which results in the accumulation of mucus in the sinus cavity, and pressure build–up in the face, eyes and brain. What’s worrying, say Mumbai doctors, is that the disease is likely to be higher in Mumbai given the pollution levels and unhealthy lifestyle of its citizens. Most people suffer silently until the varied symptoms begin to affect their productivity. More often than not, patients who start off with a mild sinus infection do not realize that symptoms, which last beyond 12 weeks, could be an indication that they suffer from sinusitis. (Source: TOI, Apr 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

Dental X–rays may raise risk of brain cancer

Frequent exposure to dental x–rays correlated with a twofold increase in the risk of meningioma, investigators reported. (Source: Medpage Today)

For comments and archives

Patients want choice of colon cancer screen

Patients were less compliant with screening for colorectal cancer when colonoscopy was the only testing option they were given, according to a community–based study. (Source: Medpage Today)

For comments and archives

HHS announces ICD–10 delay

The Department of Health and Human Services (HHS) has proposed a 1–year delay in its deadline for implementing the new ICD–10 diagnosis coding system. (Source: Medpage Today)

For comments and archives

FDA OKs agent to differentiate Alzheimer’s

The FDA has approved the radioactive diagnostic agent florbetapir (Amyvid) for evaluation of the causes of cognitive decline, including Alzheimer’s disease, according to Eli Lilly, developer of the compound. Florbetapir is used in conjunction with positron emission tomography to evaluate the burden of amyloid plaques in the brain, according to Daniel Skovronsky, MD, PhD, the company’s brand development leader for the product. (Source: Medpage Today)

For comments and archives

   Twitter of the Day

@DrKKAggarwal: Diesel bad for the Heart Diesel exhaust particles contain a chemical component called phenanthraquinone (PQ).

@DeepakChopra: Awareness of our mortality makes every moment precious so the purpose of life can become the expansion.

    Spiritual Update

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

Ecstasy or Permanent Bliss

Dharma, Artha, Kama and Moksha are the four purposes of life with which all of us are born with. Most of us think that one attains moksha only at the time of death. It is said that a person who achieves Moksha goes to heaven and the others take a re–birth and come back.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

How can multiple pregnancies be prevented?

When a triplet or higher order multiple pregnancy occurs, multifetal pregnancy reduction may be considered for the health of the mother and to improve survival of the pregnancy. While multifetal pregnancy reduction carries some risk of a complete miscarriage, it also reduces the chances of extreme premature birth.

For comments and archives

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

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

Does the donor suffer from any harmful effects after giving blood donations?

Absolutely not. Rather a donor after having given blood voluntarily gets a feeling of great pleasure, peace and bliss. Soon within a period of 24–48 hours, the same amount of new blood gets formed in his body, which helps the donor in many ways. His own body resistance improves, the circulation improves, and he himself feels healthier than before.

For comments and archives

    Medi Finance Update

(Tarun Kumar, Chartered Accountant)


The onus to prove that the main purpose of the arrangement is not to obtain tax benefits would be on the taxpayer.

For comments and archives

   An Inspirational Story

(Dr. GM Singh)

Everybody Needs Someone

People need people and friends need friends, And we all need love for a full life depends Not on vast riches or great acclaim, Not on success or on worldly fame, But just in knowing that someone cares, And holds us close in their thoughts and prayers For only the knowledge that we’re understood, Makes everyday living feel wonderfully good, And we rob ourselves of life’s greatest need, When we "lock up our hearts" and fail to heed The outstretched hand reaching to find, A kindred spirit whose heart and mind Are lonely and longing to somehow share, Our joys and sorrows and to make us aware That life’s completeness and richness depends, On the things we share with our loved ones and friends.

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)

Safety of Healthcare Professionals

Let us now take up the issues most important to our health and safety. Wherever we work, in hospitals or in our clinics, we are exposed to many biosafety hazards, more so in hospitals. The hazards are of various types and are detailed in OSHA Standards, US Department of Labor Occupational Safety & Health Administration (OSHA). These include exposure to blood–borne pathogens, gases, chemicals, radioactive materials, etc. It is important that we protect ourselves and our family from particularly the infectious agents.

Transmission of infectious agents in a healthcare setting involves the microbe/infectious agent, the susceptible host and vehicle/route of entry. The infectious agents come from patients, healthy carriers, fomites and contaminated food and water. All of us are susceptible to most of pathogenic microbes we come in contact with. However, we do not always suffer from infections because of innate or acquired immunity developed after immunization/subclinical infections. The portal of entry of infectious agent has to be ideal, only then the infectious agent will be able to enter the host, colonize, establish it and cause infection.

For comments and archives

   Cardiology eMedinewS

Infection May Trigger Venous Clots Read More

Statins Often Ignored After Surgery Read More

AAA Repair Weaker for Women Read More

   Pediatric eMedinewS

Obesity In Kids Not Just About Snacks And Sloth Read More

Pediatric Dentists Want Anesthesiology Help Read More

Mom’s Obesity May Sway Child's Risk For Autism Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with fever and low TSH had ESR > 100.
Dr Bad: This is TB.
Dr Good: This is thyroiditis.
Lesson: Typically thyroiditis has very high ESR and low TSH.

For comments and archives

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

For comments and archives

    Legal Question of the day

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

Q. I have visited the MCI office a few times and observed the following:

  • There were many students, apparently of Nepali origin, who had been making the rounds of the MCI for many months regarding their problem of getting registered but the MCI refused to register them in spite of them having passed MBBS on the grounds that they were ineligible for admission to the MBBS course since they had secured less than 50% marks in the school leaving examination.
  • There is too much spying on visitors’ activities in the MCI building with spy cameras having been installed even at the door of the toilets.
  • There are no lawyers available near MCI to attend to the legal problems of young doctors. I think there should be lawyers’ chambers in or near MCI.

What are your comments?

Ans. My comments are as follows:

  • MCI or anybody else has to act as per rules. If somebody is not eligible for registration, he cannot be registered merely because he says he has been waiting for long.
  • Spy cameras have nothing to do with the issue of registration by MCI.
  • Lawyers’ chambers don’t drop from the skies. I won’t open a chamber there even if it is offered free to me. In any case, it is not for the MCI to offer chambers to advocates. There is no dearth of advocates. Anybody who wants legal services is free to approach any advocate.
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  Quote of the Day

(Dr GM Singh)

Great works are performed not by strength, but by perseverance. Samuel Johnson

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Creatinine Clearance Test

Evaluates the rate and efficiency of kidney filtration. It is used to help detect and diagnose kidney dysfunction and/or the presence of decreased blood flow to the kidneys.

In patients with known chronic kidney disease or congestive heart failure (which decreases the rate of blood flow), the creatinine clearance test may be ordered to help monitor the progress of the disease and evaluate its severity.

    Mind Teaser

Read this…………………

In ulcerative colitis with toxic megacolon, the lowest rate of recurrence is seen in:

a) Complete proctocolectomy and Brook’s ileostomy
b) Ileorectal anastomoses
c) Kock’s pouch
d) Ileoanal pull through procedure

Yesterday’s Mind Teaser: 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

Answer for yesterday’s Mind Teaser: Heart disease

Correct answers received from: Rajiv Kohli, Dr Mrs S Das, Dr PC Das, Selva Pandian, Dr BB Aggarwal, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Raju Kuppusamy, Anil Bairaria, Dr Jainendra Upadhyay, Dr U Gaur.

Answer for 11th April Mind Teaser: Carotone
Correct answers received from: Dr B B Aggarwal, Dr Avtar Krishan, Dr A K Kela.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

There was once a very prim and proper older lady who had a problem with passing gas. Since she came from a generation when people didn’t even talk about this kind of problem it took a long time for her to seek help. Finally, however, she was persuaded to consult her family doctor.

After she filled out all the proper forms and had waited about 20 minutes in the waiting room the doctor called her into his office, leaned back in his chair, folded his hands into a steeple and asked her how he could help.

"Doctor," she said, "I have a very bad gas problem."
"A gas problem?" replied the doctor.

"Yes. Yesterday afternoon, I had lunch with the Secretary of State and his wife and had six, um, er, ahhh…silent gas emissions.

"Last night, I had dinner with the governor and his wife and had (blush) four silent gas emissions.

"Then, while sitting in your waiting room I had five silent gas emissions!
Doctor, you’ve got to help me! What can we do?"

"Well," said the doctor, "I think the first thing we’re going to do is give you a hearing test!"

    Medicolegal Update

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

Medical authentication of Doctor in the Court of law

A doctor should not be dogmatic about his opinion, and lawyers also should not expect him to be so. He should be reasonable in his opinions and should not overstate the likelihood of a relationship between cause and effect. The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds in the court of law. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved. For the purpose of illustrating and clarifying his testimony in the court of law, the medical expert may employ photographs, maps, diagrams, charts, X–rays, skeletons, models, slides, films, tapes, etc., when they are properly verified. The doctor should avoid talking too much, talking too soon, and talking to the wrong persons. Prejudicial and sensational statements should not be made prior to trial. Courts of law are open to the public and the junior doctors should attend the Courts, where they can follow the proceedings, hear the evidence given by their senior medical colleague as a witness, to familiarize themselves with the procedures of the court of law.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Earth Eating – PICA

Consumption of non food items by children, in medical terms is called pica. Such children may eat clay, sand dirt, plaster, chalk, baking soda, cigarette ash, burnt match heads, glue, paper, tooth paste or soap. Pica is often associated with iron deficiency anemia, said Dr KK Aggarwal, Dr BC Roy and Padma Shri National Awardee and President, Heart Care Foundation of India.

Deliberate eating of earth substances such as clay, or dirt is called ‘geophagia’. It can cause iron deficiency and iron deficiency further increases the craving for geophagia.

In some cultures, people eat clay or dirt as they have a belief that it helps relieve nausea, control diarrhea, increase salivation and remove toxins from the body.

Pica is also used in religious rituals, folk medicines and magical believes. Some old traditional cultures believed that eating dirt would help them incorporate magical spirits into their body.

One should look for nutritional deficiency in any patient who is indulging into non food items. Parents of any child above the age of two years who has pica should seek medical attention.

    Readers Response
  1. Dear Dr. KK Aggarwal, Thanks for your information. Continue sending this bulletin. Dr. Omprakash Shukla
    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, Dr Usha K Baveja