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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

  Editorial …

14th February, 2011, Monday                       eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Now MRI–safe pacemaker

A cardiac pacemaker, Revo MRI SureScan pacemaker, made by Medtronic that is MRI safe has won FDA approval.

MRI produces powerful magnetic forces that react with ferric metals and induce electrical currents in electronic components. MRI machines also emit radiofrequency energy that may interact with pacemakers. As a result, MRI scans can disrupt pacemaker settings or cause wires to overheat, resulting in unintended heart stimulation, device electrical failure, or tissue damage. Until now, most MRI scans have been contraindicated for patients with pacemakers. About half of such patients have conditions that would ordinarily call for MRI scans. Among the features included in the Revo MRI product is a function to be switched on prior to undergoing an MRI to eliminate problems associated with induced currents and radiofrequency emissions.

The FDA’s approval is conditional meaning that it is safe with MRI scans under certain conditions. The major clinical trial published last month only tested the device with MRI machines of no more than 1.5 Tesla and the scanning isocenters were located above the cervical spine or below the thoracic spine. In the trial, 464 patients received the Revo device and were randomized 1:1 to receive an MRI or not. No scan–related complications were seen in patients who had the scans. The Revo MRI SureScan pacemaker must be used with special leads designed for the system.

Dr KK Aggarwal
Editor in Chief
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  eMedinewS Audio PostCard

  2nd eMedinewS revisiting 2010

Revisiting the Year 2010 with Dr KK Aggarwal
Abbott withdraws sibutramine

Audio PostCard
  Quote of the Day

(Dr GM Singh)

Children find everything in nothing; men find nothing in everything.

Giacomo Leopardi

    Photo Feature (from the HCFI Photo Gallery)


2nd eMedinewS revisiting 2010

Dr N Subramanium and Dr Lalitha Subramanium presenting a duet at the musical nite in 2nd eMedinewS revisiting 2010 at Maulana Azad Medical College on 9th January 2011. 


Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

India among 52 nations facing health crisis

India is among 52 countries across the world which is facing a health crisis with rising rates of heart disease, diabetes, obesity and other non–communicable diseases. This disproportionately affects poor families, with possible side–effects of disability and premature death, and worsening poverty as people pay for their own medical treatment, a new World Bank report said on Wednesday. The report titled, ‘Capitalising on the Demographic Transition: Tackling Non–communicable Diseases in South Asia’ warns that heart disease in the region is the leading cause of death in adults aged 15–69, with their first heart attacks six years earlier than other groups worldwide. The study conducted in nations including Bangladesh, India, Nepal, Pakistan and Sri Lanka, also notes, "South Asians were six years younger (53 vs 59 years) with heart problems and had high levels of risk factors, such as diabetes, high lipids and low levels of physical activity and healthy dietary habits." "This unfair burden is especially harsh on poor, who face life–long complications, and have to pay for most of their care out of their savings or by selling their possessions", says co–author Michael Engelgau, a World Bank Senior Public Health Specialist, in a statement. (Source: The Pioneer, February 10, 2011)

    International News

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

Help kids be more active, eat better and grow up healthy

Today marks the first anniversary of First Lady Michelle Obama’s Let’s Move! campaign, an initiative to end the epidemic of childhood obesity. One third of all children born in 2000 or later will face chronic obesity–related health problems like heart disease, high blood pressure, cancer, and asthma. Having a home with lead or other health hazards can impair children’s development and trigger asthma. For that reason, HUD recently awarded nearly $127 million in grants intended to protect children and families from potentially dangerous lead–based paint and other home health and safety hazards.These grants aren’t just about making our homes safer – they’re about breaking the linkages between unhealthy housing and health. While the First Lady leads the charge on childhood obesity by helping kids become more physically active and ensuing that every family has healthy, affordable food choices, HUD wants to make sure health hazards in your home don’t go unchecked. Putting children on the path to a healthy future starts with living in a healthy home. Help kids be more active, eat better and grow up healthy!

(Dr Monica and Brahm Vasudev)

Novel agent cuts stroke in hard–to–treat afibrillation

In patients with atrial fibrillation who can't take vitamin K antagonist therapy, the experimental anticoagulant apixaban is superior to aspirin for preventing stroke or systemic embolism, final results of the AVERROES trial confirmed.

Low–trauma fractures may predispose nursing–home residents to future hip fracture

One in five elderly nursing home residents with a low–trauma non–hip fracture will ultimately fracture their hip in the following 2.5 years, according to a study in the Journal Bone and Mineral Research.

Risk for fifth dose DTaP vaccine reaction higher when injected in arm

Risk for a local reaction to the fifth dose of the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) is higher when it is injected in the arm, according to a retrospective cohort study reported in Pediatrics.

Sending removed tonsils for pathological analysis may not be cost–effective

Analyzing removed tonsils for evidence of more serious medical problems, such as cancer may not be cost–effective, according to a study in the journal Otolaryngology –– Head and Neck Surgery.

Abstract of the day

RESPeRATE: Nonpharmacological treatment of hypertension

Systemic hypertension has been well documented as a major risk factor for premature cardiovascular morbidity and mortality. Reduction of high blood pressure (BP) by nonpharmacological means is widely recommended, either as a primary prevention therapy or as an adjunctive treatment with antihypertensive drugs. RESPeRATE is a commercially available electronic device that presents a novel nonpharmacological approach to the treatment of hypertension. RESPeRATE–guided slow–paced breathing aimed at achieving a respiratory frequency of<10 breaths per minute has been shown, in multiple studies, to reduce BP in hypertensive individuals by improving the autonomic balance through respiratory control. (Sharma M, Frishman WH, Gandhi K. Cardiology in Review 2011 Mar–Apr;19(2):47–51).

Note: This is what is Pranayama.

    IMT Update

Echolucent carotid plaques strongly associated with ACS (acute coronary syndrome), surrogate marker of high-risk patients. (Circ J 2006;70(12):1629-34)

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What are the complementary and alternative treatments of infertility?


In a German study published in 2002, acupuncture performed 25 minutes before and after IVF embryo transfer increased IVF pregnancy rates. In a similar study conducted by The University of South Australia in 2006, the acupuncture group’s odds (although not statistically significant) were 1.5 higher than the control group. Although definitive results of the effects of acupuncture on embryo transfer remain a topic of discussion, study authors state that it appears to be a safe adjunct to IVF.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

What is the role of spirometry in diagnosis of asthma?

While spirometry offers objective and sensitive criteria, by no means are these specific to a diagnosis of asthma. Spirometric findings are thus, to be interpreted in concert with the clinical setting. In children below 7–8 years, spirometry is difficult to perform. It is technician dependent and reproducibility of test results is poor. Spirometric results only reflect the lung function on the day of testing and may thus be normal since asthma is a dynamic condition. The procedure is expensive and the equipment is not widely available.
For all these reasons, the consensus group of Indian Academy of Pediatrics feels that spirometry has a very restricted role in the diagnosis of asthma in the Indian setting. However in a typical case, an obstructive defect is present in the form of normal forced vital capacity (FVC), reduced FEV1, and reduced forced expiratory flow more than 25–75% of the FVC (FEF 25–75). The flow–volume loop can be concave. Documentation of reversibility of airway obstruction after bronchodilator therapy is central to the definition of asthma. FEF 25–75% is a sensitive indicator of obstruction and may be the only abnormality in a child with mild disease.

For queries contact: drneelam@yahoo.com

    Medicolegal Update

Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

What is the time limit of exhumation?

  • In India, there is no time limit for ordering of the exhumation, but many western countries have well-defined time limit up to which exhumation can be done.
  • In France the time limit is 10 years, Thus in France, if in the 11th year (say) of death, some relevant facts is found which reveal foul play and even then the body cannot be exhumed. In Germany the time limit is 30 years.
  • The term exhumation is applied only when a proper inhumation, which means ritual burial of the body in a legal and legitimate fashion, was done in the first place. This difference is not merely academic; it has important legal repercussions.
  • In India, while a proper exhumation can only be ordered by a magistrate under section 176 of Criminal Procedure Code (Cr.P.C.)
  • The magistrate or the coroner ordering the exhumation and the doctor should be present at the site.
  • It is customary to open the lid of the coffin once it is brought out of the grave. It not only allows foul gases to escape in open air (rather than be released in the mortuary later), but also enables the pathologist to make a quick examination of the remains. When the coffin is opened, the medical officer in–charge should first of all examine the body in situ, and preferably take photographs. Bones may be friable, and may break during subsequent handling, so in situ examination is often quite helpful.
  • Post–mortem –After an in situ examination is done, the body is transferred to the mortuary for a post–mortem. Here the post–mortem is done as in any other case. If there are worms or other insects over the body, it might be tempting to sprinkle insecticides over the body, but it should never be done, as it might interfere later with the determination of poison in the body. If the smell is too offensive, it is advisable to wear a gauze mask dipped in a solution of potassium permanganate.
  • Samples of viscera should be taken for detection of poisons. Many poisons, such as metallic poisons remain in the body for several years.
  • Hair, nails and bones such as femur may also reveal metallic poisons like arsenic.
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Tests for Adrenal Insufficiency & Addison’s Disease

Aldosterone. Blood or urine aldosterone levels are measured to help diagnose Addison’s disease – to determine whether the adrenal gland is producing aldosterone. If the levels are low, it is another indication that the patient may have a primary adrenal insufficiency.

    Medi Finance Update

Personal Accident Insurance

  • Medical or surgical treatment (except where such treatment is rendered necessary within the scope the policy).
  • Aviation other than as a passenger (fare–paying or otherwise) in any duly licensed standard type of aircraft any where in the world.
  • Nuclear radiation of nuclear weapons materials.
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name
DCI Approval Date
Amlodipine 5mg + Ramipril 10mg/5mg Tablets (additional strength)
For the treatment of hypertension only
    IMSA Update

International Medical Science Academy (IMSA) Update

Oocyte triggering in antagonist assisted reproductive technology cycles

A Cochrane review recommends against routine use of GnRH agonists as a final oocyte maturation trigger in fresh autologous cycles because of lowered live birth rates and ongoing pregnancy rates. An exception could be made for women with high risk of OHSS, after appropriate counseling.

(Ref: Youssef MA, et al. Gonadotropin–releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles. Cochrane Database Syst Rev 2010 Nov 10;11:CD008046).

    IJCP Special

Dr Good Dr Bad

Situation: An elderly type 2 diabetic patient with cancer lung came with A1c of 7.5%.
Dr Bad: This is high. You need insulin therapy.
Dr Good: This result is ok.
Lesson: As per the 2007 American College of Physicians (ACP) guidelines, A1C goal is > 7% for type 2 diabetic patients who are elderly or frail or have a limited lifespan due to comorbid condition.

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1c is very high!
Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Arpan Gandhi
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

Run, Patti, Run

At a young and tender age, Patti Wilson was told by her doctor that she was an epileptic. Her father, Jim Wilson, is a morning jogger. One day she smiled through her teenage braces and said, "Daddy what I’d really love to do is run with you every day, but I’m afraid I’ll have a seizure." Her father told her, "If you do, I know how to handle it so let’s start running!" That’s just what they did every day. It was a wonderful experience for them to share and there were no seizures at all while she was running. After a few weeks, she told her father, "Daddy, what I’d really love to do is break the world’s long– distance running record for women."

Her father checked the Guinness Book of World Records and found that the farthest any woman had run was 80 miles. As a freshman in high school, Patti announced, "I’m going to run from Orange County up to San Francisco." (A distance of 400 miles.) "As a sophomore," she went on, "I’m going to run to Portland, Oregon." (Over 1,500 miles.) "As a junior I’ll run to St. Louis. (About 2,000 miles.) "As a senior I’ll run to the White House." (More than 3,000 miles away.) In view of her handicap, Patti was as ambitious as she was enthusiastic, but she said she looked at the handicap of being an epileptic as simply "an inconvenience." She focused not on what she had lost, but on what she had left.

That year she completed her run to San Francisco wearing a T–shirt that read, "I love Epileptics." Her dad ran every mile at her side, and her mom, a nurse, followed in a motor home behind them in case anything went wrong. In her sophomore year Patti’s classmates got behind her. They built a giant poster that read, "Run, Patti, Run!" (This has since become her motto and the title of a book she has written.)

On her second marathon, en route to Portland, she fractured a bone in her foot. A doctor told her she had to stop her run. He said, "I’ve got to put a cast on your ankle so that you don’t sustain permanent damage." "Doc, you don’t understand," she said. "This isn’t just a whim of mine, it’s a magnificent obsession! I’m not just doing it for me, I’m doing it to break the chains on the brains that limit so many others. Isn’t there a way I can keep running?" He gave her one option. He could wrap it in adhesive instead of putting it in a cast. He warned her that it would be incredibly painful, and told her, "It will blister." She told the doctor to wrap it up. She finished the run to Portland, completing her last mile with the governor of Oregon. You may have seen the headlines: "Super Runner, Patti Wilson Ends Marathon For Epilepsy On Her 17th Birthday."

After four months of almost continuous running from West Coast to the East Coast, Patti arrived in Washington and shook the hand of the President of the United States. She told him, "I wanted people to know that epileptics are normal human beings with normal lives."


Mind Teaser

Read this…………………

$0 all all all all

Yesterday’s Mind Teaser: siinformationde
Answer for yesterday’s Mind Teaser: Inside information

Correct answers received from: Dr Sudipto Samaddar, Dr Neelam Nath, Dr Rakesh Bhasin, Dr.K.V.Sarma, Dr Rawat Purushottam Singh, Dr karani Vishanji, Dr S.Upadhyaya, Dr MK Bhandari, Dr.K.Raju, Dr. B.V.Sai Chandran, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr Maneesh Gupta, Dr  Meera Rekhari, Dr.(Maj. Gen.) Anil Bairaria, Dr.Parvesh Sablok

Answer for 12th February Mind Teaser: Makes no difference
Correct answers received from: Dr.K.Raju, Dr Neelam Nath

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr Chandresh Jardosh)

A man who surrenders when he’s WRONG, is HONEST.
A man who surrenders when he’s NOT SURE, is WISE.
A man who surrenders when he’'s RIGHT, is a HUSBAND


Knowledge is amusing

TYPEWRITER is the longest word that can be made using the letters only on one row of the keyboard

5–Minute Management Course

Lesson 1

A man is getting into the shower just as his wife is finishing up her shower, when the doorbell rings. The wife quickly wraps herself in a towel and runs downstairs. When she opens the door, there stands Bob, the next–door neighbor… Before she says a word, Bob says, "I’ll give you $800 to drop that towel." After thinking for a moment, the woman drops her towel and stands naked in front of Bob, after a few seconds, Bob hands her $800 and leaves. The woman wraps back up in the towel and goes back upstairs. When she gets to the bathroom, her husband asks, ‘Who was that?’ ‘It was Bob the next door neighbor,’ she replies…"Great," the husband says, "Did he say anything about the $800 he owes me?"

Moral of the story: If you share critical information pertaining to credit and risk with your shareholders in time, you may be in a position to prevent avoidable exposure.

    Readers Responses
  1. Dear Dr.K.K Aggarwal, through your "eMedinewS" you are updating the latest news both in profession and in IMA activities. Really it is a great service to our profession keep it up . Congratulations. Regards: Dr.Alex Franklin.
    Public Forum

(Press Release for use by the newspapers)

1 in 100 Children born with congenital heart disease

Over one per cent of all children born in India are born with congenital heart diseases. Most cases of fetal cardiac anomalies occur in low risk population. Congenital anomalies cause 20 percent of deaths between 20 weeks of gestation and one year after the birth and congenital heart diseases account for one–third of these deaths.

Population screening studies have shown that congenital heart diseases occur in 8–10 out of 1000 newborn with about 50 percent causing major heart diseases and other 50 percent causing minor heart diseases. While there are no formal definitions of major and minor, major can be considered to be those congenital heart diseases that are clearly evident at or shortly after the birth, such as blue baby, severe valvular narrowing or large hole in the heart. Minor diseases include small holes and mild narrowing of the valves.

These views were expressed at IMSA workshop conducted at Moolchand Medcity by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, Dr. Vandana Chadha, Fetal Echo Specialist and Dr. Savitri Srivastava, Director, Pediatric Cardiology Escorts Heart Institute.

Following were the conclusions:

  1. The appropiate time for visualization of the fetal heart is 18 to 22 weeks of gestation.
  2. A full fetal Echo should be performed in all pregnancies with risk factors for congenital heart anomalies.
  3. The risk factors are:
    • Previous child with congenital heart disease
    • One of the parents having congenital heart disease
    • Syndromes known to have congenital heart disease in the family
    • Exposure to certain drugs during pregnancies
    • Diabetes in the mother
    • History of rubella in the first trimester in the mother
    • In vitro fertilization
    • Suspected cardiac anomaly during ultrasound
    • Presence of any other congenital anomaly in ultrasound
    • Abnormal heart rate in the fetus
    • Any chromosomal abnormalities in the fetus
    • Increased nuchal translucency at 11–14 weeks of gestation in ultrasound
  4. Most congenital heart diseases can be detected before 20 weeks of gestation and pregnancy can be terminated if the congenital heart disease is incompatible with life. As per MTP law, termination of pregnancy is only allowed before 20 weeks with the consent of two gynecologists.
  5. Once a congenital heart disease is detected, such delivery should only take place in an institute with proper neonatal cardiac care. Such cases should also be referred to maternal fetal specialists, obstretic cardiologists, genesists and neonatalist to discuss prognosis and neonatal management options.

    Talking about congenital heart disease in children, Dr. Savitri Srivastava said that most congenital heart diseases today can be treated surgically with good success.

    Talking about heart blockages, Dr. KK Aggarwal said that the start of blockages is usually in adolescents and young children due to faulty lifestyle. The only way to know chances of heart attack 20 years later is to screen children for high risk lifestyle (not exercising, faulty diet), and by doing neck artery  wall thickness ultrasound. If the neck artery wall is thick, then children have more chances of heart attacks after one or two decades.
    Forthcoming Events

Delhi Medical Council Inaugural CME on Managing Common Emergencies
Date: Sunday, 20 Feb., 2011
Programme – 1.00PM – 4.00PM
1.00 PM 1.30PM Lunch
1.30 PM 1.45PM Inauguration
1.45 PM 4.00PM Scientific Programme

Topics Time Speakers Chairpersons
RTA, Emerging Epidemic
1:45 PM – 2.05 PM
Dr MC Misra
Dr BK Dhaon, Dr Praveen Bhatia, Dr Chander Prakash
Acute Febrile Illness
2.05 PM – 2.25 PM
Dr N.P Singh
Dr OP Kalra, Dr SP Byotra,
Dr B Gupta
Haematuria – Red Alarm
2.25 PM – 2.45 PM
Dr Anil Goyal
Dr P.N Dogra, Dr. Rajeev Sood
Managing PPH – Saving Lives
2.45 PM – 3.05 PM
Dr Reva Tripathi
Dr Sharda Jain
Panel Discussion of Update of Lt. Side chest pain 3.05 PM – 3.50 PM Dr Purshottam Lal,
Dr Naresh Gupta
Dr PS Gupta, Dr K.K Aggarwal, Dr Ashok Seth

Vote of Thanks: 3.50 PM – 4.00 PM

Followed by Tea

Please Note: Prior Registration Is Mandatory (No Registration Charges)

For Registration e–mail to delhimedbalcouncil@gmail.com, SMS to Secretary – 9868116494 & Organizing Chairman – 9811101454

Organization: President: Dr Arun Aggarwal, Vice President: Dr Vinay Aggarwal, Secretary: Dr Girish Tyagi, Organizing Chairman: Dr Anil Goyal, CME Committee Members: Dr Anil Bansal, Dr Manoj Singh, Dr NP Singh, Dr Praveen Bhatia.

eMedinewS Events: Register at emedinews@gmail.com

World Fellowships of Religions and Perfect Health Parade

First ever conference which will talk about science behind all Religions, Dharmas and Pathies under one roof

Subject: Global Warming, Ethnic Crises, How to be Healthy
Date: Sunday 3rd April, 2011
Venue: Maulana Azad Medical College, New Delhi
Time: 8AM - 4PM
Register: rekhapapola@gmail.com

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