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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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eMedinewS Presents Audio News of the Day

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

Photos of 1st Mega Ajmer Health Camp 2012

  Editorial …

14th April 2012, Saturday

Five Things Physicians and Patients should question (Part 4)

American College of Physicians

  1. Don’t obtain screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. In asymptomatic individuals at low risk for coronary heart disease (10–year risk <10%) screening for coronary heart disease with exercise electrocardiography does not improve patient outcomes.
  2. Don’t obtain imaging studies in patients with non–specific low back pain. In patients with back pain that cannot be attributed to a specific disease or spinal abnormality following a history and physical examination (e.g., non–specific low back pain), imaging with plain radiography, computed tomography (CT) scan, or magnetic resonance imaging (MRI) does not improve patient outcomes.
  3. In the evaluation of simple syncope and a normal neurological examination, don’t obtain brain imaging studies (CT or MRI). In patients with witnessed syncope but with no suggestion of seizure and no report of other neurologic symptoms or signs, the likelihood of a central nervous system (CNS) cause of the event is extremely low and patient outcomes are not improved with brain imaging studies.
  4. In patients with low pretest probability of venous thromboembolism (VTE), obtain a high–sensitive D–dimer measurement as the initial diagnostic test; don’t obtain imaging studies as the initial diagnostic test. In patients with low pretest probability of VTE as defined by the Wells prediction rules, a negative high–sensitivity D–dimer measurement effectively excludes VTE and the need for further imaging studies.
  5. Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology. In the absence of cardiopulmonary symptoms, preoperative chest radiography rarely provides any meaningful changes in management or improved patient outcomes.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Donating blood reduces chances of heart attack

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Vaisakhi celebrated with the message of to "give"

Vaisakhi (Baisakhi) and World Health day function was celebrated on 7th April at Radha Krishan Vidya Niketan Push Vihar. The Punjabi theme based event was organized jointly by Friends of Tribal Society, Heart Care Foundation of India and Rotary Club of Delhi South Central. Addressing a gathering of over 200 people Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Dr K K Aggarwal
    National News

Technology to reduce infection

Risky Hospitals: Software will help keep germs at bay

The All India Institute of Medical Sciences trauma centre has launched an indigenously developed electronic system to monitor the spread of infections patients catch in hospitals. The authorities claim it will go a long way to reduce overuse of antibiotics and hence decrease drug resistance. The software, Automated Surveillance of Hospital Acquired Infections (ASHAIN), funded by the Indian Council of Medical Research (ICMR) identifies and monitors each indoor patient from the time of admission for development of infections. It will guide preventive activities and monitor the rate of Hospital Acquired Infections (HAI), based on Centre for Disease Control (CDC)-defined criteria. The creation of the software cost Rs 95,000. "So far, we have been collecting the data manually. The software will primarily help in analysing the data," said Dr Purva Mathur, associate professor, laboratory science at the AIIMS trauma centre who designed the software. (Source: Deccan Herald, 12 April 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

ACR updates RA advice on DMARDS, biologics, switching drugs

An American College of Rheumatology (ACR) working group led by Jasvinder A. Singh, MBBS, MPH, has reported 2012 updates to the ACR's 2008 recommendations on the use of disease–modifying antirheumatic drugs (DMARDs) and biologic agents in patients with rheumatoid arthritis (RA). (Source: Medscape)

For comments and archives

Gene variants linked to IBD

Low frequency of genetic variants associated with recognition and processing of bacteria may offer protection against inflammatory bowel disease (IBD), a study of indigenous people of Canada suggested. (Source: Medpage Today)

For comments and archives

Should statins be used in primary prevention? JAMA gets in on the debate

Differing opinions on the use of statins in primary prevention make the pages of one of the leading medical journals this week, with the Journal of the American Medical Association (JAMA) the latest in a line of professional and mainstream media outlets getting in on the contentious topic. Introduced by the JAMA editors to encourage discussion and debate, the inaugural "dueling viewpoints" kicks off its new series by considering the clinical question of whether or not a healthy 55–year–old male with elevated cholesterol levels should begin taking the lipid–lowering medication. (Source: Medscape)

For comments and archives

Anti–VEGF shot sharpens sight in diabetic eyes

Advantages in improved visual acuity seen with bevacizumab injections are maintained long term for diabetic macular edema patients compared with improvements from laser surgery, researchers found. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Children and adolescents with congenital heart disease should avoid body piercing.

@DeepakChopra: The world is a self interaction in an infinite, unbounded consciousness that its experiencing itself.

    Spiritual Update

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

Fate and Effort (Prarabdha and Purushartha)

By Purushartha (effort) we may be in a position to change our Prarabdha (Fate).

‘You pay your past debt’ is an old saying. The law of Karma is often misunderstood as the law of destiny. Most people say that if the destiny is decided, why work and might as well leave everything to the fate. To understand the law of karma, one needs to understand the types of Karmas.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What precautions should be carried while carrying a multiple pregnancy?

  • Metabolic and nutritional considerations: There is an increased need for maternal nutrition in multiple pregnancies. An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. With multiples, weight gain of approximately 45 pounds is optimal for normal weight women. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.
  • Activity precautions: Women with multiple pregnancies are usually advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may increase birth weight up to 20%. Intercourse is generally discouraged when bed rest is recommended.
  • Monitoring a multiple pregnancy: Prenatal diagnosis by chorionic villus sampling can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities Amniocentesis is performed between 16 to 20 weeks. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation. Tocolytic agents are medications that may slow or stop premature labor. These medications are given in hospital "emergency" settings in an attempt to stop premature labor.
  • Cesarean section: Vaginal delivery of twins may be safe in some circumstances. Many twins can be delivered vaginally if the presenting infant is in the head first position. Most triplets will be delivered by Cesarean section. Appropriate anesthesia and neonatal support are essential, whether delivery is performed vaginally or requires Cesarean section.

For comments and archives

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

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

Does donor need any rest after donating blood?

Yes. The donor should rest for about 20–30 minutes before resuming his routine work; it takes only 3–8 minutes to take blood from a donor.

For comments and archives

    Medi Finance Update

(Tarun Kumar, Chartered Accountant)


  • The Assessing Officer would be required to make a reference to the Commissioner for invoking the anti–avoidance provisions who may refer the case to an Approving Panel, consisting of 3 members.
  • The Approving Panel would be required to either declare an arrangement to be impermissible or otherwise within a period of six months.
  • Taxpayer to file appeal before the Income Tax Appellate Tribunal.

For comments and archives

    An Inspirational Story

(Dr. GM Singh)

The Wise Man and The Young Man

There was once an old wise man who lived on top of a mountain. (I don’t know why the wise men always like to stay on top of mountains.) Whenever the villagers had a problem, they would climb up the mountain and ask the old man for advice. One day a young man decided to climb up and ask the old man a question.

"Wise man," he asked, "What makes a man truly great?" The old man looked at him and said, "Do you sincerely want to know?" "Yes!" the young man replied.

"Well," the wise old man said to him, "Let me tell you in the form of a story."

There was once a Greek man who suffered from a deadly disease. Knowing that he would die soon, he was the first to join the army when his country was in a battle with the enemy. Hoping to die in battle, he would fight in the front line, exposing himself without any worry for his life, eventually they won the battle and he was still alive. His general was very impressed with his bravery, which contributed much to the victory.

The general decided to promote him and award him with medals of bravery and honor, on the day of presentation, he was looking very down and sad.

Curiously, the general asked him the reason why and was told of his deadly disease. "How could I let such a brave soldier die?", the general thought.

So the general hired the best physician and finally cured the soldier, but from that day onwards, the once valiant soldier was no longer seen at the front.

He would always avoid danger and tries his best to avoid danger and protect his life.

"Young man", he wise man said, "if you want to be truly great, you must not be scared of dying, you must be daring.

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)

Modes of transmission of microbes

  • Contact transmission: There are two types of contact transmission: direct and indirect. Direct transmission involves direct body–to–body contact with the transfer of microorganisms during the care of patients’ e.g. needle sticks or cuts from other sharp instruments. Mucocutaneous exposure of the eyes, nose, or mouth or contact of the skin with blood and body fluids of infected patients is another example. Indirect–contact transmission is the transmission of pathogens from contact with blood/body fluid contaminated objects such as dressings, needles, surfaces and instruments.
  • Droplet transmission: Droplets are generated during coughing, sneezing, and talking and during the performance of certain procedures such as suctioning and bronchoscopy. Here, the pathogen (bacteria, viruses, fungi and parasites) in the droplet travel directly from mucosal surface of patient to the mucosal surface of HCW. Severe acute respiratory syndrome (SARS) is one of the illnesses transmitted by droplets. The area of defined risk for such transmission is approximately ≤3 feet around the patient. However, experimental studies with SARS revealed spread up to a distance of 6 feet from the source. It is prudent to don a mask when 6–8 feet from the infectious patient.
  • Airborne transmission: Aerosols and droplets are formed when blood or another body fluid are mechanically disturbed. Size is small (<5 μm), these particles can remain suspended or dispersed widely by air currents. Mycobacterium tuberculosis is an example of a typical microorganism transmitted by this airborne route. Many viral infections like SARS, avian influenza, HINI influenza are also transmitted through this route in addition to the direct contact route.

For comments and archives

  Cardiology eMedinewS

PCI or no PCI on Top Of Medical Therapy in Patients With Stable Coronary Artery Disease? Read More

Incomplete Revascularization Makes For Worse Outcomes Out To One Year Read More

Acute MI Due To Thrombus in Angiographically Normal Coronary Artery
Read More

BMI Not Reliable Read More

  Pediatric eMedinewS

Tenfold Medication Errors Pose Threat To Pediatric Patients Read More

Breast Diseases May Manifest In Young Drinkers Read More

Whooping Cough Vaccine Fades In Pre–Teens: Study Read More

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with laryngopharyngeal reflux wanted to know if he could have soft drinks.
Dr Bad: Yes, you can take.
Dr Good: You must avoid carbonated beverages.
Lesson: Carbonated beverages should be avoided. Many contain caffeine and loosen the sphincters, causing stomach contents to come up with each burp. Carbonated drinks with alcohol have similar effects.

For comments and archives

Make Sure

Situation: A patient with acute rheumatic fever was directly put on penicillin prophylaxis.
Reaction: Oh my God! Why was the full initial course of penicillin not given?
Lesson: Make sure that patients with acute rheumatic fever are started on antibiotic therapy as delineated for eradication of streptococcal pharyngitis, whether or not pharyngitis is present at the time of diagnosis.

For comments and archives

    Legal Question of the day

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

Q. What are the possible future trends about hospital services?


A. Trends in USA:

  • In 2011, there were 5,754 registered hospitals in the USA according to the American Hospital Association.
  • It is estimated that by 2020, one–third of these will either close down or convert themselves into a different type of health care service provider.
  • The reason for a third of American hospitals ceasing to exist as hospitals are the following:
    • The cost of health care in hospitals is too much and increasing. The average American worker costs the employer $12,000 annually for health care benefits and this figure is increasing more than 10 percent every year. Hospitals are the most expensive part of the health delivery system in America.
    • Hospitalisation adds to risk of death. According to a paper published in the Journal of the American Medical Association, nearly 100,000 people (1 out of every 370 admissions) die annually in American hospitals from medical errors. 80% of the times they die of hospital acquired infections, many of which can be prevented.
    • The management efficiency of hospitals is low. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours.
    • Increase in online data and connectivity will enhance transparency and enable clients to compare the indices like infection rates, surgical success rates, medical error rates, malpractice rates, health care cost rates etc. across hospitals. They will thus be able to choose the best hospitals, even in an emergency, and the hospitals that rate low will have no option but to close.

      [Note—The above information can be seen in detail in a write up by David Houle and Jonathan Fleece at—

      http://www.linkedin.com/news?actionBar=&articleID=5585832137677873199&ids= dz0Sc3sRdj8VdPkUcjsRczARdiMVejoUejcPd38OdPcScPsPejkRb34Re3sOc38Sczs Mcz4NdPgVdjkIcjcQcjoVd3cUd3oUdj0SczwRdiMVej4PdPwTdPoTcP4OcPwRe3kR& aag=true&freq=weekly&trk=eml-tod2–b–ttl–0&ut=05vN2T0cZbilc1

B. Trends in India: I think the following will happen:

  • Many small hospitals, say up to 20 beds, often managed by individual doctors and their immediate family members (doctor couples and their doctor children) will close because of the following reasons:
    • Cost of medical care, including the cost of land, equipment and staff etc., will increase so much that small hospitals will cease to be a viable option for doctors.
    • The proportion of rural population will decrease and more and more people will live in urban areas, with wider mobility and choices, with the result that there will be less and less captive population forced to depend on small hospitals in rural areas and small towns.
    • Medical insurance/Mediclaim will become more common with increase in hospitalisation costs. Insurance companies will prefer to deal with big hospitals and not the small ones. People with deep pockets will have different companies in the health field supporting each other—such as hospitals; mediclaim insurance; drug trials; drug manufacture etc. the deep pockets will absorb the small pockets, just as the large fish eats up the small fish.
    • The big–small fish phenomenon will get accelerated by the Clinical Establishments Act, 2010, which has already been notified. Only the owners of small nursing homes will be affected by this Act. It is noteworthy that no large hospital has opposed this Act till today.
    • Small nursing homes will possibly be unable to find enough doctors to work in the hospital at salaries that the small hospitals can afford. This may happen because of the following reasons:
      • There is a general tendency among senior school students today not to have medical studies as the first choice. The high cost of medical education in terms of money, labour and the duration of medical studies, and the low returns on the cost, all these factors, along with the scourge of reservation policy, dissuade them from becoming doctors.
      • Those who become doctors would prefer to go abroad or work in India on high salaries that the small hospitals cannot afford.
  • Health is an industry the demand for which will never decrease. Big pocket industrialists and big corporate houses out to make money will see to it that the small hospitals are acquired and closed thereby.
  Quote of the Day

(Dr GM Singh)

Luck is what happens when preparation meets opportunity. Seneca

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Hemoglobin A1c; HbA1c

To monitor a person’s diabetes and to aid in treatment decisions; to screen for and/or diagnose diabetes and prediabetes.

    Mind Teaser

Read this…………………

Which of the following is not fermented by colonic bacteria?

a. Lignin
b. Pectin
c. Cellulose
d. None of above

Yesterday’s Mind Teaser: 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

Answer for Yesterday’s Mind Teaser: a) Complete proctocolectomy and Brook’s ileostomy

Correct answers received from: Dr PC Das, Raju Kuppusamy, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Anil Bairaria.

Answer for 12th April Mind Teaser: Heart disease
Correct answers received from: Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Anil Bairaria.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Vivek Chhabra)

Sunday Musing

Husband: Wow, Tum itni gulabi kyon lag rahi ho?

Wife: When your lovely words touch the bundle branches of the circulation system of my heart, it starts beating faster & the increased output is transmitted to adrenals which start secreting glucagon to increase blood glucose level and to combat this emergency, the pituitary output also increases, which raises blood estrogen level, causing vasodilation and consequently, I look pink.

Moral of the story: Aur laao padhi likhi biwi……!!

    Medicolegal Update

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

Gratuitous medical services should also be rendered with reasonable skill & care

The legal and ethical duties imposed on the doctor to exercise due skill and care in catering medical services only arise where a doctor/patient relationship comes in contractual existence as per Indian Evidence Act. If a doctor is passing/crossing the scene of an road traffic accident/any medical emergency in which some person has been injured/sick and is in need of urgent medical/surgical attention/intervention to save the life or limb of the injured, he/she would not be held to have been negligent, if he does not render/provide medical assistance to the patient in the eye of law for violation of code of ethics/civil/criminal or consumer law, as in such cases no doctor/patient relationship has been established for medical care delivery.

If the doctor goes to the medical assistance of a person who is injured in an accident site revealing/pronouncing himself as doctor and offer to assist the injured, then a doctor/patient relationship is at once established in implied manner and the doctor is ethically bound and has a duty to exercise reasonable/required standard skill and care in providing medical care possible at that time regardless of whether or not his medical services are being given gratuitously.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Vote for Delhi: Heart Care Foundation of India

eMedinewS, a daily enewspaper has appealed to all the doctors in Delhi to come out and vote in the forthcoming MCD elections. HCFI president, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal said that voting is one’s fundamental right and should be exercised. He further added that all doctors should come forward and declare Sunday as a free consultation day for those who have voted. About 40000 doctors in Delhi have been appealed through eMedinewS to vote.

Heart Care Foundation of India has also appealed to the public in general and heart patients in particular to come out and vote. Standing in a queue even for sometime is not a contraindication for voting.

The Foundation with the Election Commission of Delhi and Deshbandhu newspaper has also launched an advertisement and sticker campaign motivating people to come out and vote. The campaign was inaugurated by Mrs. Krishna Tirath and Mr. Vijay Kumar Malhotra.

Dr Aggarwal also appealed to the contestants to take it easy as win or loss is a part of the game. Contestants who are also heart patients are advised not to miss their aspirin dose as any cardiac event getting precipitated due to excitement can be taken care of by aspirin.

    Readers Response
  1. Dear Sir, We are enjoying reading emedinews. Regards: Dr PS Satija
    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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