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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 …

13th November 2011, Sunday

CABG, PCI Guidelines stress collaboration

  • A multidisciplinary heart team –– including an interventional cardiologist and a cardiac surgeon –– should work together to develop a care plan for each patient with coronary artery disease, according to updated guidelines from the American College of Cardiology Foundation and the American Heart Association and published in the Dec. 6 issue of the Journal of the American College of Cardiology.
  • The team should review the patient’s medical condition and coronary anatomy and then determine whether percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG) were feasible and reasonable. After discussing options with the patient, a treatment strategy should be selected, according to the guidelines.
  • Support for this approach comes from reports that patients with complex coronary artery disease referred specifically for PCI or CABG in concurrent trial registries have lower mortality rates than those randomly assigned to PCI or CABG in controlled trials.
  • The team concept was included as a class I recommendation for patients with unprotected left main or complex CAD.
  • Another new recommendation in the guideline is the use of the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score when making treatment decisions for patients with multivessel disease. This system uses angiography results to estimate the extent and complexity of arterial disease and gives a more objective way to guide decision making.
  • The guidelines say that PCI is a reasonable alternative to CABG in stable patients with left main artery CAD, low risk of PCI complications, and a high risk for adverse surgical outcomes. They also confirm the superiority of CABG compared to both medical therapy and PCI in patients with three–vessel disease.
  • Specific to CABG, the experts also weighed in on the use of anti-platelet therapy both before and after the operation. The guidelines suggest aspirin should be given to CABG patients preoperatively. In those undergoing elective procedures, clopidogrel and ticagrelor should be stopped five days before elective surgery. In emergent situations, they should be discontinued for at least 24 hours if possible.
  • After the operation, aspirin should be started within the first six hours if not already begun before the procedure. Clopidogrel was termed a "reasonable alternative" in patients allergic to aspirin.
  • The PCI group also addressed anti–platelet therapy. The committee simplified the regimen for aspirin use, suggesting using 81 mg daily following PCI instead of higher maintenance doses. They also provided a class I recommendation for dosing ticagrelor for at least 12 months following insertion of both drug–eluting and bare metal stents. (Source MedPage Today)

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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

CABG, PCI Guidelines stress collaboration

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011– Eco Fest – An Inter School Eco Club’s Health Festival

Purpose of this competition is not only to have a competition but to learn preventive strategies so that the children in future can become healthy adults.

Dr K K Aggarwal
    National News

Major city buildings to go blue on diabetes day

Several buildings in the city will go blue on Sunday as part of a campaign to create awareness around diabetes. The Siddhivinayak Temple, Chhatrapati Shivaji Terminus, the municipal corporation building, KEM Hospital, Nair Hospital, Abbott Office Building, and Sion Hospital will bask in a blue glow on the eve of World Diabetes Day, which will be observed on Monday. The lighting is part of a campaign to prevent Mumbai from becoming the diabetes capital of the world. Around 50 monuments and buildings across the country will be lit blue as part of the "Abbott Diabetes Blue Fortnight–2011" campaign ahead of World Diabetes Day. It is being organised by non–profit organisation HEAL Foundation, Via Media Group, the ministry of health and family welfare, International Diabetes Federation, Archeological Survey of India and the city’s municipal corporation. "Monuments illuminated in blue symbolise unity in the fight against diabetes, something akin to a blue sky uniting the world," said Dr CS Pandav, national president, Indian Public Health Association and head of department of Centre for Community Medicine at AIIMS, New Delhi. Other monuments across the country that will be lit blue include Shaniwarwada Fort in Pune, Red Fort and Qutub Minar in Delhi, Agra Fort in Agra, Konark Temple in Orissa, among others. (Source: Hindustan Times, November 11, 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

US colorectal cancer screening strategy questioned

The use of colonoscopy as the primary screening strategy for colorectal cancer in the United States, which has been famously dubbed "going the distance," might be a case of going too far, suggests an editorial published online November 9 in the Journal of the National Cancer Institute. (Source: Medscape Medical News)

For comments and archives

MRI and CT better than Echo in evaluation for TAVI

Cardiac MR and CT imaging are better and more reproducible assessment of the aortic root than transthoracic echocardiography for patients undergoing transcatheter aortic valve implantation (TAVI) and are better predictors of the severity of aortic regurgitation following TAVI compared with TTE, reports Dr Raad H. Mohiaddin 0f the Royal Brompton Hospital in the U.K., and colleagues in November 15 issue of the Journal of the American College of Cardiology.

For comments and archives

More than two thirds of us adult smokers want to quit

Many adult smokers in the United States are motivated to quit, according to the results of a US Centers for Disease Control and Prevention (CDC) survey published in the November 11 issue of the Morbidity and Mortality Weekly Report. However, the study also shows that proven treatment and services for smoking cessation are being underused. (Source: Medscape Medical News)

For comments and archives

TCT: Radial access for PCI Reaches tipping point

Radial access for percutaneous coronary intervention has taken a place in the spotlight at this year’s Transcatheter Cardiovascular Therapeutics meeting here, with U.S. adoption rates doubling over the last few years. Still, no more than about 11% of U.S. physicians take the radial route. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #AJPP What is the function of endoscopic ultrasonography in diagnosis of chronic pancreatitis? Endoscopic… fb.me/MYgtK3os

@DeepakChopra: Recife–20111111–00505.jpg Good Morning from Recife Brazilhttp://twitpic.com/7d0c0m

    Spiritual Update

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

What is the Purpose of Life?

The Four Purusharthas: Dharma, Artha, Karma and Moksha Purusha means human being and artha means object or objective. Thus Purusharthasmeans objectives of a man.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Our Time in History

The paradox of our time in history is that we have taller buildings, but shorter tempers; wider freeways, but narrower viewpoints.

We spend more, but have less; we buy more, but enjoy it less. We have bigger houses and smaller families; more conveniences, but less time.

We have more degrees, but less sense; more knowledge, but less judgment; more experts, but less solutions; more medicine, but less wellness.

We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.

We’ve learned how to make a living, but not a life. We’ve added years to life, not life to years.

We’ve been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor.

We've conquered outer space, but not inner space.
We've cleaned up the air, but polluted the soul. We’ve split the atom, but not our prejudice.

We have higher incomes, but lower morals. We’ve become long on quantity, but short on quality.

These are the times of tall men, and short character; steep profits, and shallow relationships. These are the times of world peace, but domestic warfare; more leisure, but less fun; more kinds of food, but less nutrition.
These are days of two incomes, but more divorces; of fancier houses, but broken homes. It is a time when there is much in the show window and nothing in the stockroom.

For comments and archives

    Cardiology eMedinewS

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


Heart failure patients should be encouraged to exercise

For comments and archives

CSI Abstracts

Echo should be done when suspecting rheumatic fever

For comments and archives

CSI News

Coronary calcification linked colorectal cancer

For comments and archives

TCT Update: Platelet Testing in PCI no use in day to day practice

For comments and archives

Facts and figures in cardiology

Less than 15% patients with CKD have their blood pressure controlled to <130/80 mm Hg despite of the use on average of 3 different antihypertensive agents (Blood Press. 2005; 14: 170–176)

    Fitness Update

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

Brain damage in newborns: enzyme controlling cell death

Birth asphyxia can cause irreparable brain damage and lifelong handicaps, including cerebral palsy, epilepsy and mental retardation. The brain damage evolves over a time period of hours to days after the injury. This opens up a therapeutic window where we are able to affect outcome. Birth asphyxia is normally treated by cooling the infant, which has been shown to reduce the risk of lasting problems.

Unfortunately this therapy stops only one child in nine from suffering brain damage. Furthermore, premature babies cannot be treated in this way. In her thesis, Ylva Carlsson has therefore attempted to find a new treatment strategy that can be used not only in combination with cooling therapy but also to help children where cooling therapy is not an option. The focus is on an enzyme which controls elements of the apoptosis – cell death – associated with the brain damage… "The results show that a reduction in the amount of this enzyme also reduces the extent of the brain damage. Added protection is given if cooling therapy is used too," says Carlsson. Based on a study of mice, Carlsson is also able to show in her thesis that the mechanisms behind brain damage vary according to the age of the brain: a treatment that can protect adults turned out to exacerbate the damage in newborns.

For comments and archives

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

What is the 2–second Rule?

Following a vehicle too closely is called ‘tail–gating.’ The 2–second rule helps to determine a safe following distance at any speed. Select a fixed object on the road ahead such as a sign, tree or overpass. When the vehicle ahead of you passes the object, count ‘one–thousand one, one–thousand-two.’ You should not reach the object before you count to one–thousand–two. If you do, you are following too closely. Most rear end collisions are caused by the vehicle in back following too closely. It helps to avoid road rage. The two–second rule also applies to the speed when one is on a good road and during good weather conditions. If the road and/or weather conditions are not good, increase your distance to a four– or five–second count. If you are being tail–gated, move to another lane or slowly pull off the road and allow the vehicle to pass.

For comments and archives

    Medicine Update

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

What are the features of appendicitis in neonates?

Clinical features of appendicitis in neonates are:

  • Nonspecific with irritability or lethargy in 22%
  • Abdominal distention and vomiting in 60–90%
  • Other features include a palpable mass in 20–40%
  • Hypotension, hypothermia, and respiratory distress

For comments and archives

    Legal Question of the Day

(Dr. M C Gupta)

How long we are legally required to preserve the Birth Register (Delivery Register)? People are asking for such records even after twenty years. What should we do?

  1. The legal requirement can be as per the law concerned and applicable in the state. Often, there is no clear law on this.
  2. As per the proposed/draft "Clinical Establishments (Registration and Regulation) Rules, 2010, "Copies of all records and statistics shall be kept with the clinical establishment concerned for at least 3 or 5 years or in accordance with any other relevant Act in force at the time".
  3. It is best to follow the guidelines given by the Central Government for its hospitals vide DGHS letter No. 10–3/68–MH dated 31–8–68 as follows:

    For inpatient medical records (case sheets)……………10 years
    For medico–legal registers………………………………………10 years
    For outpatient records……………………………………………………5 years
    The above guidelines can be found in the "Hospital Manual" published in 2002 by the Directorate General of Health Services, MOHFW, GOI, in chapter 12 titled "Medical Record Services".
  4. There are no special requirements for maintaining the delivery/birth register. However, a hospital is free to keep any record for as long as it wants. But it must be clearly understood that nobody has a right to demand to see such a register, say, after a lapse of 20 years. Nobody can take any legal action for not meeting such an illegal demand.

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Prolactin estimation should only be done with a mid morning pooled sample i.e. 3 samples taken at 20 minutes interval. A single sample can give an erroneous reading.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with high grade fever with low platelet count came for evaluation.
Dr Bad: Treat him for dengue.
Dr. Good: Also do a Tourniquet test and check his PCV.
Lesson: Low platelet count is not the only diagnostic criterion for severe dengue. The classical triad is low platelets, positive tourniquet test and 20% increase in hematocrit.

For comments and archives

Make Sure

Situation: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).
Reaction: Oh my God! Why was CAD not ruled out in this case?
Lesson: Make sure that all patients with OSA are investigated for underlying CAD.

For comments and archives

    Quote of the Day

(Dr GM Singh)

Quality is not an act, it is a habit. Aristotle

    Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: All are precancerous for carcinoma colon except:

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

Answer for Yesterday’s Mind Teaser: d. Carotene

Correct answers received from: Dr AK KELA, Dr BB Aggarwal, yogindra vasavada, Rakesh Bhasin, Raju Kuppusamy, Dr Chandresh Jardosh,
Dr Harkanwaljit Singh Saini, Muthumperumal Thirumalpillai, Dr Harkanwaljit Singh Saini, Dr Jainendra Upadhyay, Anil Bairaria, Dr KV Sarma.

Answer for 11th November Mind Teaser: a) Complete proctocolectomy and Brook’s ileostomy
Correct answers received from: Dr Harkanwaljit Singh Saini, Dr Jainendra Upadhyay, Anil Bairaria, Dr KV Sarma.

Send your answer to ijcp12@gmail.com

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   Laugh a While

(Dr GM Singh)

Mutual Attraction
In the middle of an argument a man said to his wife, "I don’t know how you can be so stupid and so beautiful all at the same time!"

The wife responded calmly, "Allow me to explain…the good Lord made me beautiful so you would be attracted to me; and he made me stupid so I would be attracted to you!"

    Medicolegal Update

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

A Criminal Investigative model of FBI for lust murders

On the basis of various literature and experience of two decades, I endorse/feel that the dead bodies do tell tales as to ‘how he/she has been killed/died"; what is required is a meticulous autopsy surgeon to hear/understand its language.

  • Lust murder may be organized or disorganized depending on the psychopathology of the offender and the same is manifested in the crime scene of the killings.
  • It is determined by very close observation/examination of the scene and corpse. In the case of a disorganized offender the victim will be immediately rendered unconscious or dead by a "blitz–style" of attack and there will be evidence of symbolic and postmortem sexual activities.
  • In both instances, however, the cutting, mutilation and overkill type wound structures will be directed towards those parts of the body that the offender finds significant to him as per his fantasy and serve as a sexual stimulus.
  • The disorganized offender usually depersonalizes his victim by facial destruction or overkill type of wounds and it became a signature forensic component for crime detection.
  • Any sexually sadistic acts are performed postmortem. Mutilation to the genitalia in females, neck, throat and buttocks are performed because these parts of the body contain a strong sexual significance to him. Most cases of lust murder usually involve male perpetrators. However, accounts of female lust murderers do exist also.

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    Public Forum

(Press Release for use by the newspapers)

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

Diabetics are more at risk of having depression

Depression is a significant but independent risk factor for both first heart attack and cardiovascular mortality said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Depression has been found to be associated with approximately 3–4 fold increase in the risk of subsequent cardiovascular mortality and morbidity. The prevalence of major depression in individuals with coronary artery disease is estimated to range from 15–23%.

Treating depression can reduce the associated mortality and morbidity. But most patients with recent heart attack or unstable angina and co-morbid depression do not receive anti-depressive treatment.

Diabetes and depression often go hand in hand. Depression may be a major factor in development of type 2 diabetes. Also, depression occurs in 8–22% of diabetics. Presence of diabetes displays the risk of depression.

Depression in diabetics is associated with poor sugar control, poor adherence to dietary recommendations, decreased quality of life and greater prevalence and earlier onset of multiple diabetic complications.

Treatment of depression in diabetics may improve insulin resistance and better glycemic control.

The American Heart Association (AHA) scientific advisory recommends screening for depressive symptoms in such patients.

In the Patients Health Questionnaire (PHQ–2) tool, the provider asks the patient the following two–part question:

Over the past two weeks, how often have you been bothered by any of the following problems:

  • Little interest or pleasure in doing things.
  • Feeling down, depressed, or hopeless.

A "yes" answer to either part should prompt the practitioner to arrange for a more comprehensive evaluation by a qualified professional to rule out depression.

For comments and archives

    Readers Responses
  1. Many Many thanks for your emedinews. It is very useful. God bless all your good works. Regards and best wishes. Dr Satish.
    Forthcoming Events

CSI 2011

63rd Annual Conference of the Cardiological Society of India

Date: December 8–11, 2011.
Venue: NCPA Complex, Nariman Point, Mumbai 400021

Organizing Committee

B. K. Goyal – Patron
Samuel Mathew – President CSI
Ashok Seth – President Elect & Chairman Scientific Committee
Lekha Adik Pathak – Chairperson
Satish Vaidya & C. V. Vanjani – Vice Chairman
N. O. Bansal – Organizing Secretary
B. R. Bansode – Treasurer
Ajit Desai , Ajay Mahajan , G. P. Ratnaparkhi – Jt. Org. Secretaries
Shantanu Deshpande , Sushil Kumbhat , Haresh Mehta – Asst. Org. Secretaries
D. B. Pahlajani, A. B. Mehta , M. J. Gandhi , G. S. Sainani, Sushil Munsi, GB Parulkar, KR Shetty – Advisory Committee

Contact: Dr. Lekha Adik Pathak, Chairperson, CSI 2011; Dr. Narender O. Bansal, Org. Secretary, CSI 2011 Tel: 91 – 22 – 2649 0261/2649 4946, Fax: 91 – 22 – 2640 5920/2649 4946.
Email: csi2011@ymail.com, csimumbai2011@gmail.com Website: www.csi2011mumbai.com

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews "Doctor of the Year Award" function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

    eMedinewS Special

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

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    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