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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 …

19th September 2011, Monday

Anti–nausea drug ondansetron linked to arrhythmias

Ondansetron can trigger dangerous and possibly lethal changes in heart rhythms as per FDA warning. It can cause prolongation of the QT interval in ECG which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes," the FDA said.

Patients at greatest risk include those with "underlying heart conditions, such as congenital long QT syndrome, (and) those who are predisposed to low levels of potassium and magnesium in the blood" as well as patients who are taking other medications also associated with QT prolongation.

Ondansetron is a 5–HT3 serotonin receptor antagonist, commonly prescribed to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery.

The FDA label recommend ECG monitoring in certain patients including those with hypokalemia or hypomagnesemia, congestive heart failure, bradyarrhythmias, and in patients who are taking other medications that increase the risk of QT.

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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

Anti–nausea drug ondansetron
linked to arrhythmias

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

Harmony – An Inter School Health Festival at Perfect Health Mela Students took active participation in Competitions like Poster making in the.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Non–communicable diseases claimed 53% lives in India in 2008

NEW DELHI: Over 52 lakh people died in India of non–communicable diseases (NCDs) like cardiovascular diseases, stroke, diabetes and cancer in 2008. NCDs accounted for 53% of all deaths. Among men, 38% of the deaths were under 60 years, while among women it was 32%. Cardiovascular diseases accounted for 24% of all deaths, cancers (6%), respiratory disease (11%), diabetes (2%) and other NCDs (10%), says the World Health Organization’s latest country profile on NCD trends in 193 countries. Looking at the metabolic risk factors, WHO’s estimates can be worrying for Indians. Around 33% people have high blood pressure, 10% have high blood glucose, 11% are overweight and 27% have high cholesterol. When it comes to behavioral risk factors, 14% smoke tobacco daily and another 14% don’t exercise at all. WHO’s latest report was released on the eve of the global leaders meeting at the United Nations on NCDs that starts in New York on September 19. Union health minister Ghulam Nabi Azad is heading the Indian delegation. (Source: TOI, Sep 17, 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

(Dr Monica and Brahm Vasudev)

Biomarkers may predict CAD, death in diabetics

Two biomarkers may be associated with cardiovascular events and death in type 2 diabetes patients. The antioxidant peroxiredoxin–4 (Prx4) and the inflammatory protein resistin were significantly associated with both outcomes in two separate trials reported here at the European Association for the Study of Diabetes meeting.

For comments and archives

Probiotics give sniffles the heave–ho

Probiotics modestly help stave off colds and the need for antibiotics to treat them, according to a Cochrane review. Taking prophylactic doses of healthy bacteria in yogurt and supplements was associated with 12% fewer acute upper respiratory tract infections (rate ratio 0.88 versus placebo, 95% confidence interval 0.81 to 0.96), Bi Rong Dong, MD, of Sichuan University in Sichuan, China, and colleagues found. Antibiotic use to treat these infections was also lower compared with individuals not taking probiotics in the pooled randomized trials (odds ratio 0.67, 95% CI 0.45 to 0.98), the group reported in The Cochrane Library. (Source: Medpage Today)

For comments and archives

ESGO: Robotic hysterectomy costs more but no better outcome

Robotics increased the cost of hysterectomy without improving outcomes compared with conventional laparoscopic procedures for endometrial cancer, a review of a large database showed. Each robotic hysterectomy cost about $1,600 more than a laparoscopic procedure did, and perioperative morbidity was similar between the two techniques. (Source: Medpage Today)

For comments and archives

    Fitness Update

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

Vigorous exercise burns calories for 14 hours after exercise

When it comes to lasting calorie burn, vigorous–intensity exercise could be the gift that keeps on giving. New research published today by the American College of Sports Medicine reports that a 45–minute bout of vigorous exercise can boost a person’s energy expenditure for up to 14 hours. Researchers with Appalachian State University and the University of North Carolina at Chapel Hill examined energy expenditure among ten healthy, male participants during two nonconsecutive sessions of 24 hours in the metabolic chamber.

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    Twitter of the Day

@DrKKAggarwal: #DNB India: Aspirin and NSAIDs are excellent oral agents but cause unwanted side effects on platelets and the… fb.me/Z3sQeubB

@DeepakChopra: #CosmicConsciousness A cynic knows the price of everything but the value of nothing––Oscar Wilde

    Dr KK Answers

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

Can heart patients take Viagra or Sildenafil?

Sildenafil improves erectile function in patients with stable heart blockages. It is also effective in patients with hypertension, diabetes, and nonvascular organic or psychogenic causes for erectile dysfunction. However it can lower blood pressure and interact with nitrates. It lowers the systolic upper blood pressure by about 8 mmHg. The BP lowering is not more when given with amlodipine. Sildenafil also improves endothelial dysfunction and inhibits platelet activation.

For comments and archives

    Spiritual Update

One must stop smoking 15 years before death to get moksha

Quit Smoking to Get Moksha: Smoking or health, you can not have both. One minute of smoking a cigarette take away one minute of one’s life. Smoking is the biggest menace of the mankind. It has over 4000 chemicals most of them are cancer producing. It is responsible for practically all life style disorders including cancer and heart attacks.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

A doctor diagnoses anemia and advises blood transfusion. The patient comes to a hospital asking for blood transfusion. My queries are:

  • Can the hospital transfuse blood on the recommendation of somebody else.?
  • Can the hospital charge consultation charges, bed charges and transfusion charges?
  • What will be the responsibility of the hospital?
  • Who will be responsible for the transfusion related problems?


  1. A hospital is not supposed to act mechanically like a technician at the bidding of somebody else. Nothing prevents the person advising blood transfusion from doing it under his own supervision and responsibility. If he refers the patient to a higher facility, neither the patient nor the referring physician should think that the higher facility/hospital will act with close eyes and mind at the bidding of the referring physician.
  2. The hospital has no business giving blood transfusion merely because someone else advised it. Blood transfusion is a serious thing and can lead to litigation demanding huge amounts of money in compensation for any mishaps. The hospital should give blood transfusion after assessing independently the patient’s health/disease condition; cause and type and severity of anemia; need for blood transfusion if at all there is a need (after considering other modes of treatment. If blood transfusion is given, it should be after explaining the pros and cons and after obtaining a written informed consent.
  3. The hospital can certainly charge money for the above assessment and can certainly raise a bill for consultation charges, bed charges and transfusion charges.
  4. The responsibility for some mishap will be of the hospital. If it can be proved that the blood bank was also at fault, some liability may fall on the blood bank also.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Harmful addictions

This morning I received a call from a young lady named Jenny. She was the daughter of an old friend, Morgan, whom I had cut off ties with a few years ago because of her addictions relating to alcohol and prescription drugs. The moment I saw the name appear on the caller ID I knew it was not good news –nor was it a "Care–Call" to just check in on me as I had had no contact with any of Morgan’s family members for a number of years as well.

My first instinct, when I read the name announcing itself on my phone line, was that Jenny was calling me to inform me of her grandmother’s passing as Barbara is now in her mid 70s and has had numerous medical complications. However, by the time Jenny was finishing the final words of her very first sentence, I knew the call was relating to her mother Morgan instead! Jenny informed me that her mother had been found dead in her home just two days earlier and that the family would be flying in to hold the services in the city Morgan passed on in.

I live just a few miles away and I was touched that I even got a call! I am a rather private person where my emotions are concerned and I am using this unfortunate and tragic opportunity to simply let my mind wrap around the fact that the final chapter in the book of such an amazing and absolutely brilliant woman’s life has come to a bitter end. Morgan was soft spoken, charismatic and most of all she was a warm and gentle soul. Whenever I met with her outside of her inebriated or drug-influenced state, she spoke of such delightful topics as the value of learning, how to connect to someone else’s situation free of judgment, and to simply observe and remove oneself from discrimination and disdain. She carried a type of wisdom with her that was always a contradiction to the flip-switch we encountered when she would partake in her drinking and substance abuse. She reminded me of those old black and white comedies where in which a gentleman would dress in perfect uniform on one side –allowing viewers to see the very essence of who he was as a proper gentleman while the other half of his appearance mocked its self by transforming him into a woman.

Then the actor would begin to turn from side to side in order to properly assign each character –the feminine and the masculine… allowing them to express and explain their own take on whatever imaginary text or content they were negotiating themselves around. That was Morgan.

She was so profoundly profound on one side of her spirit and yet so frighteningly frightened on the other. I cannot even begin to imagine living within the confines of such a bitter dispute. I see how such an existence could and would drive any human being to the literal brink of insanity. In that place of acceptance, I can begin to unveil the fine line between her battle to defeat her demons and the one those very same monsters waged back in their own determination to prevail as well.

As unfair and unnecessary as all of the tragedy was – it hopefully has instilled in those of us left remaining in this disarranged and obscure moment to recognize the importance each and every one of us must embrace regarding our own value and worth. If I had to say anything about her death it would be that at least now –for Morgan the battle is over. The war has come to an end and she is no longer suffering. The lesson I will carry away with me from all of this is:

Addiction holds its vessels hostage because of the shame and guilt they do not let go of. If an addict could hold his or her head up high and see their true importance –they could then never betray themselves again by contaminating their bodies and minds with its influence. Someone plagued by addiction is really only running from themselves and I, for one, am glad the marathon of madness that Morgan ran for far too long is now over.

I would like to imagine that when she crossed the finish line God himself was there –arms open wide, smiling and embracing her as she deserved nothing less. Her kind of struggle should teach us all about the frailty of being a human being and about the courage it took for her to be here so long while in the strong–hold of a never ending complexity –wrenched in pain and fear.

There are many of us left who have had to remove ourselves –for one reason or another from the demands another’s addictions often placed on us. To the people who are feeling weighed down and burdened by their own decision to walk away I say only this, "We were never showing a lack of love in doing so against that person – we were showing love for ourselves, our children or other loved ones instead." I, for one, forgive myself for discontinuing contact with Morgan on the physical plane because on the spiritual one I never gave up on her and I continued to pray for her –to wish her well – to give room to remembering her qualities instead of her deficits. After all in the end all the love, support and understanding can never save someone from themselves.

Today, however, is a new day and from this moment on we can carry peace and compassion with us…or we can welcome the same conflict as an addict and then we all lose. I, for one, cannot make that choice. Life, in the end, is really ours to command. Pain can only take over our lives if we so allow it. Morgan –and the millions of others who have died because of their addictions are proof of that unfortunate truth. As I draw this to a close –I am left with one thought –a song so faint playing in the background once lost in the archives of my mind –Sara McLachlan’s Song…In the Arms of the Angels.

Morgan "May you find some comfort there!"

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    Medicine Update

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

How can tooth decay be prevented in children?

  • Never put your child to bed with a bottle or food. Not only does this expose your child’s teeth to sugars, it can also put your child at risk for ear infections and choking.
  • Give your child a bottle only during meals. Do not use a bottle or sippy cup as a pacifier or let your child walk around with or drink from them for long periods.
  • Teach your child to drink from a cup as soon as possible. Drinking from a cup is less likely to cause the liquid to collect around the teeth. Also, the cup cannot be taken to bed.
  • If your child must have a bottle or sippy cup for long periods, fill it only with water.

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson – Dr Kaberi Banerjee

Day – 1 Interesting Highlights

Workshop – Only limited seats, first come first basis

Sperm preparation techniques in IUI, Sperm Preparation Techniques for various sperm samples in IVF and ICSI, Sperm Cryopreservation and Banking, ICSI and the Micromanipulator, Ultrasound – The Stethoscope of the Fertility Expert, Slow Freezing and Vitrification, Embryo Culture Media and Preparation

Faculty: Alok Teotia, Srikanth Yatnale, Shubhangi, Deene Vishnukanth, and many more

Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan – e– Hindustan – Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Pls Contact: Address: E –23 Ayurvigyan Nagar New Delhi – 110049

For details contact +91 9871250235

For comments and archives

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Serum potassium

  • Increase in serum potassium (K+) is seen in states characterized by excess destruction of cells, with redistribution of K+ from the intra– to the extra cellular compartment, as in massive hemolytic, crush injuries, hyperkinetic activity, and malignant hyperpyrexia.
  • Hyperkalemia due to pure excess of K+ intake is usually iatrogenic
  • Decreased renal K+ excretion is seen in acute renal failure, some cases of chronic renal failure, Addison’s disease, and other sodium–depleted states.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A smoker wanted to know his risk of lung cancer.
Dr Bad: It’s not that high.
Dr Good: You are at a very high risk.
Lesson: The primary risk factor for lung cancer is cigarette smoking and accounts for 90% of all lung cancers. The risk of lung cancer for a current smoker of one pack per day for 40 years is 20 times that of someone who has never smoked. Factors include the extent of smoking and exposure to asbestos.

For comments and archives

Make Sure

Situation: A patient’s blood pressure was not responding on Armament.
Reaction: Oh my God! Why was the patient given Artamin?
Lesson: Make sure that prescription is clearly written.

For comments and archives

    Quote of the Day

(Dr. GM Singh)

"Finally, all of you, live in harmony with one another; be sympathetic, love as brothers, be compassionate and humble. Do not repay evil with evil or insult with insult, but with blessing, because to this you were called so that you may inherit a blessing.


(Ms Ritu Sinha)

It takes two to Tango: A two–person conflict where both people are at fault.

    Medicolegal Update

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

Smothering death- Forensic autopsy

Deviation of the nose, bruising of the upper lip, and suspected intra–oral and facial bruising are diagnostic autopsy findings in death due to smothering

  • Smothering is defined as an obstruction of the air passages above the level of the epiglottis, including the nose, mouth, and pharynx.
  • This is in contrast to choking, which is considered to be due to an obstruction of the air passages below the epiglottis.
  • The manner of death in smothering can be homicidal, suicidal, or an accident.
  • Accidental smothering is considered to be a rare event among middle–aged adults, yet many cases still occur.
  • Homicidal smothering is the deliberate occlusion of the external airways, usually using the hands, pillows, or bedding.
  • Victims are often those who are unable to resist, such as the young or the old or highly intoxicated. The limited resistance offered by these individuals may result in a comparative lack of injury.
  • Murder is comparatively rare however in some cases the assailant has tried to cover his or her tracks by setting fire to the location at which the deceased is finally found. This could be a house, an office, a workshop, anywhere.
  • The autopsy surgeon must look for the telltale signs: the bloodshot eyes, the high levels of carbon dioxide in the blood and bruising around the nose and mouth and may even collect trace evidence such as hairs and fibers from around the nose and mouth of the deceased.
  • Histological sampling of suspected injuries can be rewarding, even in the presence of severe post–mortem deterioration due to decomposition.
  • The upper lip and lower lip should be excised and processed for histology, sections may show remarkably good tissue preservation and extensive recent bruising,

For comments and archives

    Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: Which of the following is not true regarding ERCP in benign injuries of biliary tract?

a) ERCP should be the initial investigation in all cases of injuries to the bile duct to define the extent of injury.
b) ERCP is of value if there is a incomplete stricture.
c) ERCP is helpful if it is a Type A or Type D injury.
d) ERCP is of no use if clinically or radiologically the bile leak has stopped.

Answer for Yesterday’s Mind Teaser: a) ERCP should be the initial investigation in all cases of injuries to the ble duct to define the extent of injury.

Correct answers received from: Dr K Raju, Dr Binit Sureka, Dr YJ Vasavada, Dr Chandresh Jardosh,
Dr Jainendra Upadhyay, Anil Bairaria.

Answer for 17th September Mind Teaser: c. Lymphoma
Correct answers received from: Dr Ragavan Moudgalya, Dr YJ Vasavada.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr. GM Singh)

The Study

A husband was trying to prove to his wife that women talk more than men. He showed her a study which indicated that men use about 10,000 words per day, where as women use 20,000 words per day.

His wife thought about this for a while. She then told her husband that women use twice as many words as men because they have to repeat everything they say.

Her husband looked stunned. He said "What?"

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
DCI Approval Date
Meropenem IP 1000mg + Sulbactam sodium USP 500mg injection
For the treatment of lower respiratory tract infection caused by gram negative bacteria in adults only
    Public Forum

(Press Release for use by the newspapers)

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5% high risk patients get heart attacks during perioperative period

Patients with underlying heart blockages or those with risk factors are at increased risk for perioperative heart attacks. Perioperative period is the period of time extending from when the patient goes into the hospital for surgery until the time the patient is discharged home, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

The largest data on the subject comes from over 8000 patients in the randomized POISE trial of perioperative beta–blocker therapy, which has shown that at 30 days after the surgery the incidence of heart attack is 5 percent and 71% of these occur within 48 hours of surgery. Approximately 65 percent of patients with heart attack are without symptoms.

Therefore perioperative heart attack is not uncommon and occurs with increasing frequency as the number of identified risk factors increases. Both short– and long–term survival are decreased in patients who have sustained a perioperative heart attack.

Treatment for perioperative heart attack is same as for any heart attack in the general population. However anti clotting drugs should be started carefully.

Perioperative heart attack is detected by presence of an elevated heart muscle injury blood test (troponin) and one or more of the following: ischemic (heart pain) symptoms, ECG changes in two contiguous leads, coronary artery intervention (balloon dilatation or stenting), or evidence of heart attack on cardiac echocardiography or autopsy.

To detect them, one must screen all high–risk patients with cardiac troponin, both before and after non cardiac surgery. One should measure cardiac troponin for the following patients

  • Patients with symptoms or ECG changes suggestive of ischemia or heart attack (two or three serial biomarkers).
  • Patients at high cardiac risk (at 6 to 12 hours, and days 1, 2, and 3 after surgery).

High risk is defined as high–risk surgery with one or more additional risk factors of the revised cardiac risk score.

One should also do a 12–lead ECG in the perioperative period for the following patients

  • All patients with symptoms of myocardial ischemia.
  • All patients with risk factors for perioperative heart attack (baseline and daily for two, and possibly, three days).

For comments and archives

    Readers Responses
  1. Everyone is born a genius, but the process of living de–geniuses them. Dr GM Singh
   Situation Vacant

Urgent Requirement

An MBBS Doctor is required (as a visiting consultant) on a payable basis, for 2 to 3 times a week for an hour each at an office in Noida for their employees Contact: The Mind n Wellness Clinic: 9810021945

    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta