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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

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    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–4 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

17th September 2012, Monday

Hot Cocoa for Improving Brain Cognition

In a double–blind study, elderly patients with mild cognitive impairment who consumed high or moderate levels of cocoa flavanols for 2 months had significant improvements on certain cognitive assessment tests compared with those who took in only small amounts, Giovambattista Desideri, PhD, of the University of L’Aquila in Italy, and colleagues reported online in Hypertension.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

How is fetal impaction diagnosed?

The diagnosis of fecal impaction is confirmed by performing a digital rectal examination. The impacted stool is not necessarily hard, but the key to the diagnosis of fecal impaction is in finding a copious amount of stool in the rectum. It is important to note that fecal impactions can occur in the proximal rectum or sigmoid colon, and a digital rectal examination will be nondiagnostic. If the clinical suspicion for a fecal impaction is high, an abdominal radiograph should be obtained to detect fecal loading in the absence of a rectal impaction.

For comments and archives

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

obesity reduces life expectancy

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

A non–stop Interaction between Patients and Cardiologists

The Heart Care Foundation of India announced details of the forthcoming 4th Dil Ka Darbar at a press conference. The Darbar will be held on Sunday, 23rd September, 2012 at Talkatora Stadium. The event is being organized by Heart Care Foundation of India in association with World

Dr K K Aggarwal
    National News

Over 3 under–five kids died every minute in India in 2011: UNICEF report

NEW DELHI: Despite having improved infant and mother mortality rates, more than three children of under five years of age died every minute in India during 2011, a latest Unicef report has said. With the highest number of 16.55 lakh deaths of under–five children reported in 2011, India topped the list of nations across the world. The ‘Child Mortality Estimates Report 2012’ released by Unicef in New York has said that there have been a total of 69 lakh under–five deaths across the world in 2011, which has decreased from nearly 12 million in 1990. "About 14,000 fewer children die each day than did two decades ago. Still, almost 19,000 children under five die every day," the report stated, adding that almost 40 per cent of these children died in the first month of life, mostly from preventable diseases. According to figures in the Unicef report, as many as 4,534 under-five children died every day and 189 every hour in India, accounting for almost 24 per cent of the world figures. The global under-five mortality rate has fallen from 87 per 1,000 live births in 1990 to 51 per 1,000 live births in 2011, the report said. Reacting on the high number of under-5 children deaths, WHO’s India Representative Nata Menabde said, "India always had in absolute term high numbers… We still have a challenge…it is a problem." Going by the progress made by India in reducing the child and mother mortality rates, she said, "India is moving steadily towards achieving the MDS targets. India will probably reach or come closer to them provided the current rate is sustained." (Source: TOI, Sept 13, 2012)

For comments and archives

4th Dil Ka Darbar

September 23, 2012, 9:00 AM–6:00 PM , Tal Katora Indoor Stadium, Connaught Place, New Delhi

A non stop question answer–session between all top cardiologists of the NCR region and the public.

My Profession My Concern

(Dr Anil K. Raina, Sr Consultant Internal Medicine, Apollo Hospitals, Noida.)

Update on rising new type of Swine flu

Introduction: In the August update, the CDC says additional cases of the illness have been reported beginning in July 2012, and that as of August 9, a total of 153 cases of H3N2v have shown up in 4 states: Indiana (120), Ohio (31), Illinois (1), and Hawaii (1).All the affected people have reported either direct or indirect contact with swine, mostly at agricultural fairs crowded with pigs.

The new virus is novel in that it contains mix of bird flu, swine flu, human influenza genes. New influenza A H3N2 virus being called "variant H3N2," or "H3N2v," for short, have been found in the past in swine but only very rarely infected people. However, this virus, first detected in August, 2011 was a little bit different. It contained another genetic change. It had acquired the matrix (M) gene from the 2009 H1N1 pandemic virus. Although we know that the M gene plays a role in viral assembly and replication, we aren't certain what the addition of this M gene means in terms of illness severity or transmissibility in humans. Similar H3N2 viruses have circulated in US swine since the 1990s, and the H3N2 variant with the 2009 H1N1 pandemic M gene was detected in US swine as early at 2010. August 2011, however, was the first time this virus was found in a person.

Diagnostics: Negative results from rapid influenza diagnostic tests (RIDTs) for influenza A (H3N2v) should not be considered reliable evidence of lack of infection, according to an update published in the August 10 issue of the Morbidity and Mortality Weekly Report. To validate the accuracy of RIDTs routinely used in clinical settings.CDC researchers checked the accuracy of 7 commercially available tests using 7 different H3N2v viral strains,BinaxNOW (Alere),Directigen (Becton–Dickinson), FluAlert (SA Scientific), QuickVue (Quidel),Sofia (Quidel), Veritor (Becton–Dickinson), and Xpect (Remel).
The CDC reports that only 4 of the 7 RIDTs tested (Directigen, Sofia, Veritor, and Xpect) detected all 7 of the H3N2v strains. The BinaxNOW test spotted 5 of the 7 strains, and the QuickVue test found 3 of the 7. The FluAlert test detected only 1 of the viral samples in this test. "In this evaluation of seven RIDTs, the ability to detect H3N2v virus varied substantially among the tests," the authors write, adding, "This evaluation emphasizes the fact that a negative RIDT result should not be considered as conclusive evidence of lack of infection with influenza A (H3N2)v (virus)."

Treatment: Treatment of influenza consists of the use of either M2 inhibitors (amantadine and rimantadine, which are active against susceptible influenza A) or neuraminidase inhibitors (oseltamivir and zanamivir, which are active against susceptible influenza A and B). Recently, treatment of influenza has been primarily with neuraminidase inhibitors because of the widespread resistance to M2 inhibitors. Treatment should be initiated promptly, ideally within 48 h of disease onset, for better efficacy. There is limited data on the use of zanamivir and it is recommended that rescue inhalers are available during its use. The two classes of anti-influenza drugs (adamantanes or M2 inhibitors [amantadine and rimantadine) and neuraminidase inhibitors (oseltamivir and zanamivir)) were shown, in immunocompetentindividuals, to reduce severity of influenza, shorten duration of viral shedding and reduce the frequency of complications. However, the widespread resistance to M2 inhibitors led to the adoption of neuraminidase inhibitors as the preferred prophylactic drugs.

Prologue: There is paucity of data on other anti-virals like Rituximab, Virus specific immunoglobulins, Famciclovir, Ribavirin etc. in this infection.

1. CDC, USA.
2. Medscape

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Valvular Heart Disease Update

When should aortic valve replacement be done?

Aortic valve replacement should be performed in essentially all patients with symptomatic aortic stenosis. Surgery in such patients is associated with marked reductions in symptoms and subsequent mortality.

(Experts: Dr Bhabha Nanda Das and Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr K S Dagar, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Hypothyroidism evaluation and treatment guidelines released

Fifty–two evidence–based recommendations for the optimal evaluation, treatment, and follow–up of patients with hypothyroidism have been released in an effort to help clinicians provide patients with optimal care. Jointly developed by the American Association of Clinical Endocrinologists and the American Thyroid Association, the recommendations were published online simultaneously in Endocrine Practice and Thyroid . Of particular note for primary care clinicians: (Source: Medscape)

  • Clinicians are advised to consult with an endocrinologist when treating hypothyroidism in infants and pediatric patients, women who are or plan to become pregnant, patients with heart disease, and those with other endocrine diseases such as adrenal or pituitary disorders, as well as patients for whom it is "difficult to render and maintain a euthyroid state"; those with a goiter, nodule or structural changes to the thyroid; or those who have an "unusual constellation of thyroid function test results."
  • Although a serum thyrotrophin hormone (TSH) test is the single best screening test for hypothyroidism, clinicians should be aware that it is insufficient for assessing hospitalized patients or when central hypothyroidism is either present or suspected.
  • The standard treatment for hypothyroidism is individually tailored replacement levothyroxine; there are no data to support the clinical efficacy of over–the–counter products marketed for "thyroid support" or "to promote thyroid health."
  • Levothyroxine and levotriiodothyronine combinations, including desiccated thyroid, should not be used in women who are pregnant or trying to conceive.
  • Mild TSH elevations in the elderly may be a normal manifestation of aging and do not necessarily indicate hypothyroidism.

For comments and archives

Hyperventilation reduction may reduce use of asthma medication

Breathing techniques designed to reduce hyperventilation may improve asthma symptoms and reduce medication use in adults with poorly controlled asthma, although the evidence regarding breathing techniques overall appears to be limited, according to a report by Elizabeth O’Connor, PhD, from the Kaiser Permanente Center for Health Research in Portland, Oregon. The comparative effectiveness review published online September 10 by the Agency for Healthcare Research and Quality found that the evidence in support of therapeutic breathing techniques is only somewhat supportive and may not be applicable to the United States. (Source: Medscape)

For comments and archives

Multimorbidity: A clinical challenge with few answers

Improved case management and multidisciplinary teamwork were 2 of the strategies that appeared to be most effective in improving outcomes for patients suffering from 2 or more chronic conditions, also known as multimorbidity, according to a review published online September 3 in BMJ. (Source: Medscape)

For comments and archives

Readmissions common with VADs

Unplanned hospitalization rates were high after heart failure patients go on a ventricular assist device (VAD), although institutional changes appear to be helping, researchers found. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Post Monsoon Health Problemshttp://blog.kkaggarwal.com/2012/09/post–monsoon-health-problems/

@DrKKAggarwal: Every object perceived is a reflection of the observer

    Spiritual Update

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

The scientific aspects of prayer

It is natural for us to promise or offer to pray for someone who suffers from sickness. So many people believe in the power of prayer that it has now caught the attention of scientists and doctors.

Today most hospitals and nursing homes are building prayer rooms for their patients, based on the principle that a relaxed mind is a creative mind. During prayer, a person is in touch with the consciousness, and is able to take correct decisions. Most doctors even write on their prescriptions "I treat He cures".

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is the procedure of selecting a gestational surrogate?

Gestational surrogates may be known to the intended parents or may be anonymous. Known surrogates are typically relatives or friends who volunteer to carry the pregnancy. Anonymous surrogates are identified thorough agencies that specialize in recruiting women to become surrogates. The surrogate should be a minimum of 21 years of age and have delivered a live born child at term. Certainly evaluation of a woman’s overall health and appropriate screening for underlying medical conditions that might complicate a pregnancy, as well as counseling regarding the obstetric risk should be preformed if considering an older surrogate.

For comments and archives

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

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

Q: What is a unit of blood?

A: The blood is collected in plastic bags. They contain a watery fluid, which prevents the blood from getting coagulated. On an average, we draw about 350 or 450 ml. of blood from a person depending on his body weight. This blood plus the amount of anticoagulant present in the bag is known as one unit of blood.

For comments and archives

    An Inspirational Story

Socrates’ Triple Filter Test

In ancient Greece, (469 – 399 BC), Socrates was reputed to hold knowledge in high esteem. One day an acquaintance met the great philosopher and said, "Do you know what I just heard about your friend?" "Hold on a minute," Socrates replied. "Before telling me anything, I’d like you to pass a little test. It’s called the Triple Filter Test."

"Triple filter?"

"That’s right," Socrates continued. "Before you talk to me about my friend, it might be a good idea to take a moment and filter what you’re going to say. That’s why I call it the triple filter test."

"The first filter is TRUTH. Have you made absolutely sure that what you are about to tell me is true?"
"No," the man said, "actually I just heard about it and…"
"All right," said Socrates. "So you don’t really know if it’s true or not. Now let’s try the second filter, the filter of GOODNESS. Is what you are about to tell me about my friend something good?"
"No, on the contrary…"
"So," Socrates continued, "you want to tell me something bad about him, but you’re not certain it’s true. You may still pass the test though, because there’s one filter left: the filter of USEFULNESS. Is what you want to tell me about my friend going to be useful to me?"

"No, not really."
"Well," concluded Socrates, "if what you want to tell me is neither true nor good nor even useful, why tell it to me at all?"
This is why Socrates was a great philosopher & held in such high esteem. We should all use this triple filter each time we hear loose talk about any of our friends, family and other associates.
(Source: http://www.inspire21.com/

For comments and archives

  Cardiology eMedinewS

Efforts Continue To Reduce "Door To Balloon" Time. Read More

Unrecognized Heart Attacks Common In Elderly Diabetes Patients.
Read More

  Pediatric eMedinewS

Perinatal Risk Factors For ADHD Confirmed Read More

Overweight Adolescents Eat Less Than Healthy-Weight Peers Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with sleep anpea wanted to know his cardiac risk.
Dr. Bad: There is no risk.
Dr. Good: There is a risk.
Lesson: Obstructive sleep apnea is associated with development of coronary artery diseases and heart failure.

For comments and archives

Make Sure

Situation: An HIV patient died after sulfa prophylaxis.
Reaction: Oh my God! You should have known that he was sulfa sensitive.
Lesson: Make sure that patients with a history consistent with Stevens Johnson syndrome and toxic epidermal necrolysis or an exfoliative dermatitis due to a sulfonamide medication should strictly avoid the culprit drug and other agents in the same sulfonamide group. Re–exposure to the same agent may be fatal.

For comments and archives

  Quote of the Day (Dr GM Singh)

When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us. Helen Keller

    Legal Question of the Day (Dr MC Gupta)

Q. Who all can legally prescribe allopathic drugs?

Ans. The answer depends upon what is meant by prescription.

  1. If it includes self-prescription, anybody can legally buy any OTC drug without a prescription from a doctor.

    (NOTE––Over–the–counter (OTC) drugs are those drugs that can be legally purchased without a prescription from a registered medical practitioner. In practical terms, this means those drugs that are not included in Schedules H and X of the Drugs and Cosmetics Rules, 1945 Schedule H is a list of drugs which are "Prescription drugs". The list runs over 5–6 pages. Schedule X is a list of about 15 drugs like phenobarbital, dexoamphetamine etc. Most of these can be poisonous.)
  2. If it includes advice/prescription by one layman to another layman to buy an OTC drug for relief of an ailment in good faith, anybody can legally so prescribe any OTC drug without a prescription from a doctor.
  3. If it includes prescription by a health practitioner, other than a modern medicine RMP, (such as a nurse practitioner; dentist; lady health visitor; ANM; AWW etc.) then it would be logical to assume that he or she can prescribe OTC drugs.
  4. If it includes prescription by an AYUSH practitioner, it is clear that he can prescribe OTC drugs even if they be of an allopathic nature. The SC held in Dr. Mukhtiar Chand & Ors. Vs. State Of Punjab & Ors., decided by the Supreme Court on 08/10/1998, as follows:

    "But after Sub–section (2) of Section 15 was inserted in the 1956 Act, with effect from 15.09.1964, which inter alia, provides that no person other than a medical practitioner enrolled on a ‘State Medical Register’ shall practise modern scientific medicine in any State, the right of non–allopathic doctors to prescribe drugs by virtue of the declaration issued under the said drugs Rules, by implication, got obliterated. However, this does not debar them from prescribing or administering allopathic drugs sold across the counter for common ailments.
  5. It is clear that anybody, including AYUSH practitioners, can prescribe allopathic drugs labelled as OTC drugs.
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

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    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Tests for Celiac disease

The best initial laboratory test for diagnosis of celiac disease is anti–tissue transglutaminase antibody (anti–tTG), IgA. If this test is positive, it is likely that the patient has celiac disease.

The doctor may request an

  1. Intestinal biopsy to determine whether there is damage to the intestinal villi.
  2. CBC (complete blood count) to look for anemia.
  3. ESR (erythrocyte sedimentation rate) and CRP (C–Reactive protein) to evaluate inflammation.
  4. CMP (complete metabolic panel) to determine electrolyte, protein, and calcium levels and to verify the status of the kidney and liver.
  5. Vitamin D, E, and B12 to measure vitamin deficiencies
  6. Stool fat, to help evaluate malabsorption.
    Mind Teaser

Read this…………………

w t r
a e

Yesterday’s Mind Teaser: A major goal for the client during the first 48 hours after a severe bum is to prevent hypovolemic shock. The best indicator of adequate fluid balance during this period is

A. Elevated hematocrit levels.
B. Urine output of 30 to 50 ml/hr.
C. Change in level of consciousness.
D. Estimate of fluid loss through the burn eschar.

Answer for Yesterday’s  Mind Teaser: B. Urine output of 30 to 50 ml/hr.

Correct answers received from: ...................

Answer for 15th September Mind Teaser: D. Assessing her VS especially her RR
Correct answers received from: .........

Send your answer to ijcp12@gmail.com

    Fitness Update (Rajat Bhatnagar, MonaVie, www.mymonavie.com/sonraj)

Exercise improves depression in people with heart failure

Heart failure is a gradual condition in which the heart becomes weakened and is no longer able to pump enough blood throughout the body. Many people with heart failure experience symptoms of depression, and some even develop clinical depression. Exercise has been shown to alleviate depressive symptoms associated with several chronic diseases, but little was known about the effect of exercise on depression in people with heart failure.

Recently, researchers studied over 2,300 patients in the US, France, and Canada who had heart failure to assess the effects of aerobic exercise on depression. Results were published in the Journal of the American Medical Association. During the study, half of the participants received the standard treatment for heart failure, and the other half received standard treatment plus 3 months of supervised aerobic exercise with a goal of 90 minutes per week and 9 months of at home exercise with a goal of greater than 120 minutes per week. Results showed that people who exercised experienced fewer symptoms of depression than their counterparts who did not exercise.

    Laugh a While (Dr GM Singh)

A horoscope for the workplace

Senior Management: Catty, cut–throat, yet completely spineless, you are destined to remain at your current job for the rest of your life. Unable to make a single decision you tend to measure your worth by the number of meetings you can schedule for yourself. Best suited to marry other "Senior Managers," as everyone in your social circle is a "Senior Manager."

    Medicolegal Update

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


Supreme Court of Georgia echoed the Illinois decision, albeit with somewhat different wording

  • Every person who enters into a learned profession undertakes to bring to the exercise of his profession a reasonable degree of care and skill. He does not undertake to use the highest possible degree of skill, for there may be persons who, for having enjoyed a better education and greater advantages, are possessed of greater skill in their profession; but he undertakes that he will bring a fair, reasonable, and competent degree of skill…He is not responsible for an error in judgment…if such error arises from the peculiar circumstance of the case, and not from the want of proper care or competent skill on his part.
  • Nearly a half–century later, a state of New York appeals court issued an opinion as to what constitutes the standard of care of a medical physician. Although the lawsuit did not involve radiology, the court decision could have well applied to radiologic interpretation
  • The law requires a physician to possess the skill and learning which is possessed by the average member of the medical profession…and to apply that skill and learning with ordinary reasonable care. He is not liable for a mere error in judgment, provided he does what he thinks is best after a careful examination. He does not guarantee a good result.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Be cautious in giving painkiller to patients with high cholesterol

Long–term non–steroidal anti–inflammatory painkiller drugs (NSAIDs) such as naproxen should not be prescribed to patients with high cholesterol said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and Dil Ka Darbar to be held on 23rd September at Talkatora Stadium and MTNL Perfect Health Mela.

In a swine model study published in Surgery Dr Frank Sellke, chief of cardiothoracic surgery and research at Rhode Island Hospital found that a high–cholesterol diet reduced blood flow to the heart muscle in animal models with chronic heart disease when given daily naproxen. They also found reduced levels of prostacyclin, a compound that dilates blood vessels and prevents blood clots.

These findings suggest that there may be a stronger risk of negative effects on the heart in patients who have high cholesterol levels and are taking NSAIDs as a form of pain or inflammation relief.

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