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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 and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

  Editorial …

13th May 2012, Sunday

Guidelines out for diagnostic cath use

The explosion of advanced cardiovascular diagnostic technology has prompted the publication of the first–ever appropriate use criteria for diagnostic catheterization.

Out of a possible 166 clinical scenarios for the use of diagnostic cath, a panel of experts identified nearly half as appropriate, 30% as uncertain, and 25% as inappropriate, according to Manesh Patel, MD, from Duke University, and colleagues. The document will be published in the May 29 issue of the Journal of the American College of Cardiology and also will be co–published in Catheterization and Cardiovascular Interventions and the Journal of Thoracic and Cardiovascular Surgery.

A few examples where the technical panel determined that diagnostic cardiac catheterization was appropriate include patients:

  • Without prior stress testing but who report symptoms and have a high pretest probability, or high likelihood of disease in the physician’s judgment
  • With definite or suspected acute coronary syndrome
  • With typical symptoms and intermediate– or high–risk findings on prior diagnostic testing
  • With suspected pulmonary hypertension with equivocal or borderline elevated estimated right ventricular systolic pressure on resting echo

Examples of where the panel determined a diagnostic cath to be inappropriate include:

  • Asymptomatic patients at low or intermediate risk for coronary artery disease without a prior stress test
  • As part of a preoperative work up for noncardiac surgery in patients with good functional or exercise capacity
  • In mild, moderate, or severe mitral stenosis or regurgitation when noninvasive imaging is concordant with the clinical impression of severity
  • In patients with syncope and low risk of heart disease and in patients with new–onset atrial fibrillation or flutter with low or intermediate coronary heart disease risk.

A few examples of tests the panel deemed uncertain include those in:

  • Asymptomatic patients with a high global coronary artery disease risk and no prior stress test
  • Symptomatic patients with an intermediate pretest probability and no prior stress test
  • Asymptomatic patients whose imaging stress test showed intermediate risk (however, the test is appropriate in symptomatic patients whose stress test shows intermediate risk)
  • Suspected arrhythmogenic right ventricular dysplasia

A diagnostic cath is inappropriate in asymptomatic patients no matter what their coronary artery calcium score is. No grades were given for symptomatic patients because coronary artery calcium scans are inappropriate in these patients.

In symptomatic patients who have undergone coronary CT angiography, a diagnostic cath is appropriate when the imaging shows:

  • A non-left main or left main lesion greater than 50% stenosed or lesions of the same severity in more than one coronary branch
  • A lesion of unclear severity, possibly obstructive, left main or non–left main

However, it is of uncertain appropriateness when the non–left main lesion is less than 50% blocked and when a similarly blocked lesion has extensive partly calcified and non–calcified plaque. The use of fractional flow reserve or intravascular ultrasound in conjunction with an appropriate diagnostic cath is generally inappropriate when non–obstructive lesions are less than 50% blocked, or when the lesions are greater than 70% stenosed and prior testing has agreed with ischemic findings.

AUC for diagnostic cath should be used with the AUC for coronary revascularization. They also suggested that decision support and educational tools be developed around the two sets of criteria.

These criteria were developed by American College of Cardiology and the Society for Cardiovascular Angiography and Interventions in collaboration with the American Association for Thoracic Surgery, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Heart Failure Society of America, the Heart Rhythm Society, the Society of Critical Care Medicine, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance and the Society of Thoracic Surgeons.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Aishwarya’s weight gain

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2012

Students of Delhi Public School presents a beautiful group song on the occasion of World Earth Day 2012. The event was jointly organised by Heart Care Foundation of India, Delhi Pulic School–Mathura Road and Ministry of Eart and Sciences

Dr K K Aggarwal
    National News

16.8 lakh children under five in India died of infectious diseases in 2010

More than 16.8 lakh children below five years died of infectious but preventable diseases in India in 2010 and more than half of them could not complete the first month of their life, a new study has claimed. Of the total deaths, 52 per cent or about 0.875 million were among the children who died in the first 28 days of their life, according to the study published in The Lancet on Thursday. Pneumonia remained the leading killer, which accounted for 28.6 per cent of all deaths in children under five, followed by preterm birth complications (18.1 per cent) and diarrhoea (12.6 per cent), the study found. India was also among the five countries that collectively accounted for 49.3 per cent (or 3.754 million) of 7.6 million children who died in the first 5 years of their life in 2010. These countries — India, Nigeria, Democratic Republic of the Congo, Pakistan, and China — also accounted for half (2.4 million) of global deaths from infections and 53.3 per cent (1.636 million) of neonatal deaths. (Source: The Hindu, May 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

(Contributed by Dr Monica and Brahm Vasudev)

Retinopathy screenings can be less frequent

Screening for retinopathy every 2 years instead of the recommended annual screening would be safe and could reduce screening costs by about 25% for people in the United Kingdom who have type 2 diabetes but who have not developed retinopathy, according to an article published online May 7 in Diabetes Care. (Source: Medscape)

For comments and archives

FDA Panel OKs Truvada as first HIV–preventive drug

An FDA advisory panel today recommended approval of the drug Truvada to prevent the spread of HIV infection in high–risk, healthy people. Since 2004, the drug has been been approved to treat people already infected with HIV, the virus that causes AIDS. The FDA’s Antiviral Drugs Advisory Committee recommended approval for three groups:

  • Men who have sex with men
  • Uninfected partners of HIV–positive partners
  • Others at risk of infection through sexual activity

The yes vote was strongest for the first group, with the panel voting 19–3. For the second group, the panel voted 19–2 with 1 abstention. For the third group, the panel voted 12–8 with 2 abstentions. (Source: WebMD)

For comments and archives

Retinal microchip restores vision in retinitis pigmentosa

A subretinal microchip implant has entered new clinical trials in the United Kingdom and Hong Kong, and early results are encouraging, according to researchers from 2 studies. An earlier clinical trial conducted in Germany was reported in the November 2010 issue of the Proceedings of the Royal Society. (Source: Medscape)

For comments and archives

Tired at workplace, piling on pounds? Blame ‘social jetlag’

LONDON: Feeling tired and often spotted snoozing at your desk? Also piling on the pounds? You may have "social jetlag", say German researchers. Social jetlag – a syndrome related to the mismatch between the body’s internal clock and the realities of our daily schedules – does more than make people sleepy and also make them obese, according to a team at University of Munich. (Source: TOI, May 12, 2012)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Padma Shri Awardee Dr KK Aggarwal on Give your mother a health check on…: http://youtu.be/lK0Wqn0YFXg via @youtube

@DeepakChopra: No matter what the situation, remind yourself "I have a choice."

    Spiritual Update

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

Treat every adversity as an opportunity

Sometimes back, one of my patients was arrested by the police and was to be sent to Tihar Jail. It was Friday evening and, obviously, he could not have applied for the bail till Monday morning. It is an unwritten law that most of the times, the police arrests a person on Friday evening so that at least two days are spent in the jail. The person contacted me and wanted to get admitted in the hospital. He was a heart patient and there was justification for his admission. The stress of getting into jail was putting him under pressure.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is the conservative treatment for pelvic pain?

Conservative treatment means treatment without performing surgery. Your doctor may first try to treat your pelvic pain with birth control pills and/or non–narcotic pain medications. If these options do not work, you may be given medications that take away the estrogen in your body. Decreasing the estrogen in your body will decrease the endometriosis implants and pain.

For comments and archives

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

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

Blood components

Red cell concentrates


  • 150–200 ml red cells from which most of the plasma has been removed
  • Hemoglobin approximately20g/100ml (not less than 45 G per unit)
  • Hematocrit 55%–75%

Unit of issue: 1 donation

Infection risk:
Same as whole blood

Same as whole blood


  • Replacement of red cells in anemic patients
  • Use with crystalloid replacement fluids or colloid solution in acute blood loss


  • Same as whole blood
  • To improve transfusion flow, normal saline (50–100 ml) may be added using a Y–pattern infusion set.

For comments and archives

    An Inspirational Story

The little wave

The story is abut a little wave, bobbing along in the ocean, having a grand old time. He’s enjoying the wind and the fresh air – until he notices the other waves in front of him, crashing against the shore. "My God, this terrible", the wave says. "Look what’s going to happen to me!"

Then along comes another wave. It sees the first wave, looking grim, and it says to him: "Why do you look so sad?" The first wave says: "You don’t understand! We’re all going to crash! All of us waves are going to be nothing! Isn't it terrible?"

The second wave says: "No, you don’t understand. You’re not a wave; you’re part of the ocean."

Source: "Tuesdays With Morrie" by Mitch Albom

For comments and archives

    Cardiology eMedinewS

Cath Labs May No Longer Need Surgical Backup Read More

Big Midsection May Up Risk of Dying Suddenly Read More

FDA Warns About Controversial MS Therapy Read More

Exercise Slows Muscle Loss in CHF Patients Read More

    Pediatric eMedinewS

NICU Immunizes Parents against Flu To Protect Infants Read More

Growth Hormone Maintains Cognition In Children With Prader–Willi Syndrome Read More

Norovirus Outbreak Traced To Reusable Grocery Bag Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient of recurrent miscarriage wanted to know her future risk of heart attack.
Dr. Bad: There is no risk.
Dr. Good: There is a future risk of heart attack.
Lesson: Women who suffer recurrent miscarriage have an increased risk of heart attack. Each miscarriage increases heart attack risk by 40% and having > 2 miscarriages increases the risk by more than four–folds. In women who had > 3 miscarriages, the risk is increased 9–folds. One stillbirth increases the risk of heart attack by 3.5 times (Kharazmi E, et al. Pregnancy loss and risk of cardiovascular disease: a prospective population–based cohort study (EPIC–Heidelberg. Heart 2011 Jan;97(1):49–54).

For comments and archives

Make Sure

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected?
Lesson: Make sure that every time a patient is given penicillin injection, anti anaphylaxis measures are available.

For comments and archives

    Legal Question of the day

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

Q. Is informed consent necessary for a radiological or pathology test if the patient is referred by a qualified medical practitioner along with a referral chit?


  1. It is presumed here that the test proposed to be done is of a type that might be potentially sensitive or controversial and liable to lead to legal proceedings. Examples of such tests are: HIV testing; CT scan (which involves high radiation); vaginal smear/cytology, etc.
  2. The responsibility for taking prior consent lies with the person who carries out the procedure and not with the one who refers.

For comments and archives

    Quote of the Day

(Dr GM Singh)

Do not be afraid of showing your affection. Be warm and tender, thoughtful and affectionate. Men are more helped by sympathy, than by service; love is more than money, and a kind word will give more pleasure than a present. John Lubbock

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum phosphorus

Hypophosphatemia or low serum phosphorus levels can be seen in several biochemical derangements, including acute alcohol intoxication, sepsis, hypokalemia, malabsorption syndromes, hyperinsulinism, hyperparathyroidism, and as result of drugs, e.g., acetazolamide, aluminum–containing antacids etc.

    Mind Teaser

Read this…………………

A client has undergone with penile implant. After 24 hours of surgery, the client’s scrotum was edematous and painful. The nurse should:

a. Assist the client with Sietz bath
b. Apply war soaks in the scrotum
c. Elevate the scrotum using a soft support
d. Prepare for a possible incision and drainage.

Yesterday’s Mind Teaser: A client is admitted to the hospital with benign prostatic hyperplasia, the nurse most relevant assessment would be:

a. Flank pain radiating in the groin
b. Distention of the lower abdomen
c. Perineal edema
d. Urethral discharge

Answer for Yesterday’s Mind Teaser: b. Distention of the lower abdomen

Correct answers received from: Dr Thakor Hitendrsinh G, Dr Ragavan Sivaramakrishnan Moudgalya, Yogindra Vasavada, Raju Kuppusamy, Dr Chandresh Jardosh, Dr Surendra Bahadur Mathur, Dr Jainendra Upadhyay, Anil Bairaria, Yogindra Vasavada, Dr KV Sarma.

Answer for 11th May Mind Teaser: a. Flapping hand tremors
Correct answers received from: Muthumperumal Thirumalpillai, Raju Kuppusamy, Dr BB Aggarwal,
Dr Chandresh Jardosh, Dr Hitendrasinh Thakor.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr GM Singh)

Doctor, Doctor my son has swallowed my pen, what should I do?

Use a pencil till I get there.

    Medicolegal Update

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

What is the legal definition of Rape?

Rape is not a medical diagnosis. It is a legal definition. Rape is the commission of unlawful sexual intercourse or unlawful sexual intrusion and it constitutes more than 90% of all the sexual offences in our country. Section 375 of IPC defines that a man is said to have committed "rape" falling under any of the six following descriptions:

  • First – against her will.
  • Second – without her consent
  • Third – with her consent when her consent has been obtained by putting her or any person in whom she is interested in fear of death or of hurt.
  • Fourth – with her consent when the man knows that he is not her husband, and that her consent is given because she believes that he is another man to whom she is or believes herself to be lawfully married.
  • Fifth – with her consent, when at the time of giving such consent by reasons of unsoundness of mind or intoxication or the administration by him personally or through another of any stupefying or unwholesome substance, she is unable to understand the nature and consequences of that to which she gives consent.
  • Sixth – with or without her consent when she is under 16 years of age exception in case of sexual intercourse by a man with his wife, the wife not being under 15 years of age, is not rape

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Osteoporosis is preventable and treatable

Osteoporosis is termed as "The Silent Thief," because it can progress for years without symptoms, robbing the strength from bones until a fracture occurs, said Padma Shri and Dr B C Roy Awardee Dr KK Aggarwal, President Heart Care Foundation of India. Early diagnosis can check bone loss and reduce risk of fractures.

Though osteoporosis can occur in any one, it is more common in older women after menopause. Risk of osteoporosis is so high in women that developing an osteoporosis–related hip fracture is equal to combined risk of developing breast, uterine, and ovarian cancer.

One out of every five persons who has a hip fracture will not survive more than 1 year. Men and younger women are also victims to osteoporosis.

On the occasion of Mother’s Day, Dr Aggarwal said that the standard x–ray cannot diagnose osteoporosis until approximately 30% of bone is already lost. A Bone Mineral Density test is the best way to detect osteoporosis before a fracture occurs.

Four out of 10 women above 50 years of age experience a hip, spine, or wrist fracture during their lifetime.

    Readers Responses
  1. Dear sir, I am regular reader of this medinews. I congratulate your efforts for bringing this updates for the medical fraternity. You discuss on many burning issues of this medical profession I would like to recall – once so many questions and comments were made at the time of Dr Venugopal’ AIIMS vs Dr Anbumani Ramdas (the then health minister) episode. There was Abig fight on T.V Channels regarding reservations in medical coleges. Now in these days of private Medicaleducation, do you expect same standard like Govt Medical colleges.? Can you comment on Medical graduates and post graduates coming out of this Private Mediacal colleges? Dr Ramarao vijayawada
    Forthcoming Events
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

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

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    Our Contributors

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