emedinews
Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

21st February 2013, Thursday

Use accessible, affordable and safe quality medicines in India

I was invited to be a part of inaugural session on the subject ‘pen House Consultation on Accessibility to Quality Medicines in the Supply Chain’ organized at India Habitat Centre on Friday, 15th February, 2013 by the Partnership for Safe Medicines India (PSM).

The symposium was inaugurated by Mr. Keshav Desiraju, IAS, Health Secretary, Government of India.

Apart from me, those who participated in the inauguration function were Mr. Praful D. Sheth, Vice President International Pharmaceutical Federation; Dr. Dilip G. Shah, Secretary General, Indian Pharmaceutical Alliance, Mumbai; Dr. G.N. Singh, Drug Controller General India (DGCI), Government of India; Padma Shri awardee Dr. Ranjit Roy Chaudhary, Founder Delhi Society for Promotion of Rational Use of Drugs; Mr. C.P. Singh, IAS, Chairman, National Pharmaceutical Pricing Authority; Ms Mridula Jain, Joint Secretary, Ministry of Commerce, Government of India and Ms Reena George, Lawyer, Supreme Court of India.

The meeting was organized by Mr. Bejon Misra Founder, Partnership for Safe Medicines India.

Introducing the seminar, Mr. Sheth said that as on date, substandard drugs only constitute 5% and spurious drugs constitute 0.5% of drugs.

Dr. Ranjit Roy Chaudhary focused on the importance of rational use of drugs. He said that misuse of drugs and side effects of drugs are enormous but can be prevented; if not they can cause death. He said people go to hospital to get well and not to get sick.

Mr. Shah said that if in two words I have to define the role of pharma, it would be ensuring a supply chain of quality drugs.

Dr. GN Singh, Drug Controller General India said that any drug which is approved by DGCI, whether popular brand, unknown brand or drugs sold under a chemical name, is same as far as quality and standard of drug is concerned. He said that substandard drugs used to be 8-10% about 10 years back but because of good manufacture practices, now they have been brought down to 4-5% and we aim at reducing it to 1% in another five years.

Mr C P Singh said that every process in making a drug costs money. But affordability is an issue in India.

Ms Mridula Jain, Joint Secretary, Ministry of Commerce, said that more and more of exports of medicines in other countries are by default controlling the quality and safety. Today, Indian pharmaceuticals are present in trade over 220 countries.

Inaugurating the conference, Mr. Desiraju said that all stake holders need to work in symphony with each other with an objective to provide safe quality drug. He said that everybody knows that making a spurious medicine is a criminal act. What is important is to improve the quality and make sure that substandard drugs are not sold. He said that word ‘generic’ does not mean that the drug is substandard. He also showed concern on the rising problem of drug resistance. He also expressed concern that medical colleges today are producing doctors who are not as trained as they used to be in the past. The art and science of diagnosis is missing in them.

I participated in the symposium as the National Vice President (Elect), IMA and elaborated on the role of medical practitioner in accessible and affordable medical care to the community.

As per WHO, one in 10 hospital admissions leads to an adverse effect and one in 300 admissions in death. As per American Medical Association, 2000 death occur every year from unnecessary surgery, 7000 from medication errors in hospitals, 20000 from other errors in hospitals, 80000 from hospital acquired infections, 1.06 lakh deaths from adverse effects of drugs. In total, 2.25 lakh deaths occur every year in US due to unintentional medical errors. The incidence is between 10-17% in all cases.

As per CDC, 7 lakh people visit hospital emergency department every year because of wrong use of medication. Till 1994, one lakh people used to die every year in US alone because of preventable medical errors. When compared to Alzheimer’s, less than 50% people die in a year and only 17,000 people die of illicit drug used in the same year.

US has been able to prevent one lakh deaths every year under 1,00,000 campaign.

A point was raised that it is the duty of DGCI to inform every doctor on regular basis about new introductions on drugs, banning of drugs. It was also said that doctors should write cheapest drugs maintaining the quality and safety.

Ending the seminar, Mr. Bejon Misra said that most important is focus on consumer education.

*About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA (blog.kkaggarwal.com)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What are the alarm symptoms in constipation?

Alarm symptoms include rectal bleeding, hemoccult positive stools, obstructive symptoms, recent onset of constipation, weight loss, a change in stool caliber. The presence of these symptoms calls for more extensive evaluation.

For comments and archives

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

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

PPIs may be associated with a higher risk for clostridium difficile–associated diarrhea

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

CPR Sensitization meeting with DG DAVP

Mr A P Frank Noronha DG DAVP said that CPR 10 should be learnt by every one

 
Dr K K Aggarwal
    National News

Rajasthan tops in swine flu deaths this year

JAIPUR: Rajasthan has become India's swine flu 'capital' this year. The state emerged among top three states with highest number of deaths due to swine flu this year, with more than 70 deaths so far in 2013.
Maharashtra reported 1,084 deaths, Gujarat 538 and Rajasthan 442 so far (February 10) since 2009, the ministry of health figures show. In 2012, Rajasthan reported second highest number of swine flu deaths in the country. Maharashtra reported 135 deaths in 1,551 swine flu cases while 60 persons died of swine flu in Rajasthan. Even though swine flu cases reported in South India - Tamil Nadu, Kerala, and Karnataka- were higher than Rajasthan, the number of deaths in Rajasthan in higher. In Karnataka, 878 persons tested positive for swine flu with 48 deaths. Tamil Nadu reported 750 cases and 40 deaths. In Kerala 623 persons tested positive with 14 deaths. Rajasthan (343) and Andhra Pradesh (326) reported more or less the same number of cases but the difference in number of deaths was 26. Rajasthan reported 60 while AP saw 34 dying of the flu. In terms of swine flu cases Rajasthan was at 5th place but stood second in deaths due to it in 2012, the ministry of health figures show. Rajasthan is at number one position so far with 70 deaths in 2013 till February 10th. Haryana is at second position with 24 deaths and Maharashtra reported 7 deaths. From February 10 to February 15, nine more deaths were reported due to swine flu in the state.
The state officials said that they have already informed the Centre about the rising number of swine flu cases and deaths. They have also written to the National Institute of Virology to find out if the H1N1 virus can mutate. (Source: TOI, Feb 19, 2013)

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Sexual abuse is when a child engages in sexual activity for which he/she cannot give consent, is unprepared for developmentally, cannot comprehend, and/or an activity that violates the law or social taboos of society.

For comments and archives

 
    Valvular Heart Disease Update

When should one intervene in patients with chronic MR with symptoms?

Patients with chronic MR who become symptomatic are candidates for corrective mitral surgery, even if symptoms improve with medical therapy or the left ventricle appears to be compensated. If there is uncertainty about the presence or absence of symptoms, exercise testing may provide objective information that may not be available from the medical history alone.

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

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Gestational HTN, other high-BP states in pregnancy raise later CV, renal risks

A range of different high blood-pressure conditions of pregnancy predicted onset of cardiovascular events, chronic kidney disease (CKD), and diabetes over the subsequent decades, to varying degrees, over an average of about 40 years in the Northern Finland Birth Cohort 1966. (Source: Medscape)

Barrett's esophagus: Endoluminal therapy safe, effective

Endoluminal therapy combining endoscopic mucosal resection and ablation is successful long-term in patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal carcinoma, according to a retrospective cohort study of 166 patients with dysplastic BE. (Source: Medscape)

Pine bark extract improves several perimenopausal symptoms

Low-dose treatment with French maritime pine bark extract (Pycnogenol, Horphag Research Ltd) appears to alleviate several of the symptoms associated with perimenopause in women but has no effect on many other symptoms, according to the findings of a randomized, double-blind, placebo-controlled trial. (Source: Medscape)

Definition of IUGR needs overhaul

The standard definition for intrauterine growth restriction (IUGR) may be too broad by including many infants who won't have a bad outcome, a study showed. (Source: Medpage Today)

Multidrug-resistant gonorrhea: New treatment guidelines

Multidrug-resistant gonorrhea is increasing in the United States, and the Centers for Disease Control and Prevention (CDC) has updated its treatment recommendations, according to a report published in the February 15 issue of the Morbidity and Mortality Weekly Report. (Source: Medscape)

 
    Twitter of the Day

@DrKKAggarwal:Stress during exam by Dr K K aggarwal http://bit.ly/WVKWDb #Health

@Dr Deepak Chopra: Those seen dancing were thought mad by those who could not hear the music

 
    Spiritual Update

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

Euphoria, reaction, adjustment and liking: The four phases in life

Dr. Anil Goyal was recently elected as the President (Elect) of Delhi Medical Association. In one of his felicitation function, I said that he is going to be in a euphoric period for some time.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Will endometrial ablation makes periods lighter?

About 9 of 10 women have lighter periods or no period after endometrial ablation. These improvements may not last forever, though. Your periods may get heavier and longer after several years. If this happens, you may need to have your uterus taken out. This procedure is called a hysterectomy.

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

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

Blood products

  • Safe blood products, used correctly, can be life saving. However, even where quality standards are very high, transfusion carries some risks. If standards are poor or inconsistent, transfusion may be extremely risky.
  • No blood or blood product should be administered unless all nationally required tests have been carried out.
  • Each unit should be tested and labeled as regards the ABO and RhD group.
  • Whole blood can be transfused to replace red cells in acute bleeding when there is also a need to correct hypovolemia.
 
    An Inspirational Story

If and Were Planted

How is "if and when" planted? The short stories below are examples of planting "if and when":

Karen, one of my coworkers was stressed about where she was living. She hated the apartment she was in and complained every day about it. One day over coffee, I asked her why she didn't look for another apartment - it seemed like an easy solution to me. Karen's reply to this was, "I will look for another apartment when I come back from vacation."

Sam hated his job. He dreaded getting up in the morning. He hated the work he was doing and it started to take a toll on him. He had a love for photography and was currently taking a two-year course to obtain his certificate. Every night he complained about his work. After listening to his complaints for a month, I asked him why he didn't finish his course and start a small business doing photography on the weekends. His reply, "if only I had more time to finish my course. When I finish my course I will start a business."

Sarah had saved all her life and now was retired and living comfortably. The house she bought had a dishwasher in it; however, the dishwasher was old and didn't work. She hated doing dishes, and every time we visited with her she complained about doing the dishes. One night, I asked her, "Why don't you buy a new dishwasher Sarah." Her reply, "I have been thinking about it, if they would only come on sale I would."

Larry worked for a company that allowed early retirement. Larry had both the years of service and his age, which allowed him to retire, but at a reduced pension. He was having difficulty coping with all the changes that were being made in his work. He had a couple of mild attacks, not a heart attack but similar to one. He called me and we talked for hours. I was worried about the stress of his job and the effects it was having on his health. "Why don't you retire Harry? Do something that you have always wanted to do," I asked. Harry's reply to my question was, "If only I was older then I would get my full pension." I got bolder in my conversation with him, "But Harry, you have your house paid off, you have no bills, the kids are grown up. You could sell your house and downsize, it really is not worth your health is it? Harry then said, "When the summer comes maybe I will."

All of these stories have the same theme running through them. There is a proverb that says it all: "If and when were planted, and nothing grew."

Now a year later,

Karen is still living in the apartment she hates!

Sam is still complaining about his job and still has not finished his course!

Sarah is still washing dishes!

Larry is still working and his health is not what it used to be!

The sad part of all of these stories is that all of these people had a lot of stress in their lives that they could have taken action to reduce. But, all of them defeated themselves by thinking "if" or "when". Life is too short for "if's and when's".

The next time you are in a stressful situation and you find yourself saying or thinking - "if or when" - remember the saying, "If and when were planted and nothing grew!" Change your thinking and take action, so that you can reduce your stress right now.

For comments and archives

 
    Cardiology eMedinewS

Troponin I levels may help predict event risk in patients with stable CAD
Read More

 
    Pediatric eMedinewS

Zinc marker spots kids' iron deficiency Read More

No benefit of planned cesarean for twins Read More

 
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Can rabies infection be transmitted through environment?

Rabies infection can be transmitted through aerial (by aerosol) route. Airborne infections, such as inhaling an aerosol of infected animal brain tissue in virus laboratories, or of contaminated air in bat-inhabited caves, have been reported.

Bats that are the easiest to approach and capture (unable to fly, etc.) are the most likely to have rabies. Bat rabies is not present in India.

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient with knee osteoarthritis was put on statins.
Dr. Bad: They have no role.
Dr. Good: One can try that.
Lesson: Statin use was found to be associated with more than a 50% reduction in overall progression of osteoarthritis of the knee in the Rotterdam study, but not of the hip (Ann Rheum Dis 2012 May;71(5):642–7).

Make Sure

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are observed for gum hypertrophy. Gingival hyperplasia is a known side effect of amlodipine.

 
Our Social
Network sites
… Stay Connected

        FaceBook
  > Dr K K Aggarwal
  > eMedinewS
  > Hcfi NGO
  > IJCP Group

        Twitter
  > Dr K K Aggarwal
  > eMedinewS
  > HCFIindia
  > IJCP Group

        Blog
  > Dr K K Aggarwal
  > eMedinewS
  > HCFI-NGO
  > IJCP Group

        You Tube
  > Dr K K Aggarwal
  > eMedinewS

ioc
central bank
lic bank
 

Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

 
eMedinewS Apps
Archives
Archive
Archive
Archive
Archive
Archive
Alert
 
  Quote of the Day (Dr GM Singh)

Every test in our life makes us bitter or better,
Every problem comes to make us or break us,
Choice is ours, whether we become victim or victorious !!!!

 
    Legal Question of the Day ((Ex)Prof. M C Gupta, Advocate & Medico-legal Consultant)

Q. A girl in Gujarat was raped by her boy friend and conceived and went to Dr. BA for abortion. Dr. BA asked her to continue with pregnancy and told her that he would manage to give the baby to a childless couple in Maharashtra. She delivered a male child in Oct 2011. She filed a police case against the boy friend and Dr. BA. Later she patched up with the boy friend and wants to marry him. This baby and another, both born in October 2011, were given to an infertile couple (Dr. DV and his wife) who claimed that they were twins born to a surrogate mother. No surrogacy agreement exists. Both babies are believed to have been born to two different mothers in Oct 2011. The other mother is yet to be traced. Documents, believed to be false, seized by the police from Dr. BA’s clinic show that Dr. DV’s wife delivered twins. The police have registered a case against Dr. BA for human trafficking.
My questions are:
i) What is human trafficking?
ii) What is the law regarding surrogate mothers?
iii) Is it a must to have a written surrogacy agreement? Can an oral agreement suffice?
iv) Who will have the custody of the kids?

Ans.

  1. Article 3, paragraph (a) of the Protocol to Prevent, Suppress and Punish Trafficking in Persons defines Trafficking in Persons as the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs. http://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html
  2. There is no clear surrogacy law in India. Assisted Reproductive Technology (Regulation) Bill, 2010, is pending before the parliament. Chapter 7 of the Bill concerns surrogacy. It can be viewed at— http://icmr.nic.in/guide/ART%20REGULATION%20Draft%20Bill1.pdf
  3. Section 34(1) of the Bill reads—“Both the couple or individual seeking surrogacy through the use of assisted reproductive technology, and the surrogate mother, shall enter into a surrogacy agreement which shall be legally enforceable.”
  4. Section 34(4) of the Bill reads—“A surrogate mother shall relinquish all parental rights over the child.”
 
    Mind Teaser

Read this…………………

The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by:

1. Adding bulk fiber to the diet
2. Giving the patient enemas as needed
3. Increasing fluids and exercise
4. Using a bowel stimulant and stool softener

Yesterday’s Mind Teaser: Which of the following may cause your hair to fall out by the fistful?

A. A medical condition like lupus, a thyroid disorder, or a recent high fever or case of the flu.
B. A fungal infection on the scalp.
C. Tight hairstyles (braids, extensions, cornrows, ponytails).
D. Hormonal shifts caused by pregnancy, changes in birth-control–pill use, or menopause.
E. All of the above and more.

Answer for Yesterday’s Mind Teaser: All of the above and more.

Correct answers received from: Dr PK Sahu, Rajiv Kohli, Dr Tabassum Vali, Dr Arpan Gandhi,
Dr KV Sarma, Dr Sushma Chawla, Dr Kanta Jain, Dr Puneet Wadhwa, Dr Alok Rai, Dr PC Das, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Dr Jella, Muthumperumal Thirumalpillai, Dr. Thakor Hitendrsinh G,
Dr Valluri Ramarao, Dr Shashi Saini, Dr PK Sahu, Dr AK Kela, Dr Jayashree Sen & Dr Bitaan Sen,
Dr Bharat Bhushan Aggarwal.

Answer for 19th February Mind Teaser: C. You should get your first mammogram at age 40.

Correct answers received from: Dr. Sushma Chawla.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A lady was taking 2 dogs for a walk around the lake. A man approaches her.
HE: Ma'am, those are the two cutest dogs in the tri-state area.
SHE: Yes, I am aware of that and I love them very, very much.
HE: What would be their names, ma'am?
SHE: Timex and Rolex.
HE: Why would you name them after a couple of watch companies, ma'am?
SHE: Well.....they are WATCHDOGS...

 
    Medicolegal Update

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

What is cannabis poisoning?

Cannabis, also known as marijuana, Indian hemp, hashish, ganja, pot, dope and grass, is made from the Indian hemp plant, Cannabis sativa. Cannabis is often abused and, in some countries it is used almost as much as alcohol or tobacco.

Cannabis harms the brain; however, it does not cause much harm to adults, unless it is injected. The signs and symptoms start within 10 minutes of smoking the drug and last for about 2–3 hours. When taken orally, the effects start to appear within 30-60 minutes and last for 2–5 hours. The major effects are a feeling of well–being, happiness and sleepiness; high doses may cause fear, panic and confusion, impaired balance, hallucinations, drowsiness, slurred speech, coughing if the drug is breathed in, as when smoking cigarettes. If the drug is injected it may cause more serious problems such as severe headache, dizziness, irregular breathing, fever, low blood pressure, unconsciousness.

  • If the patient is unconscious or drowsy, lay him or her on one side in the recovery position. Check breathing every 10 min. A patient who is anxious or confused should be kept in a quiet, warm room. If the cannabis was swallowed: there is no need to make the patient vomit.
  • If the patient is fully awake, breathing normally, and not vomiting: Give activated charcoal and water to drink.
  • If the patient is hallucinating or violent: Give chlorpromazine, 50–100 mg (adult dose), intramuscularly.
  • If cannabis has been injected: Monitor breathing, pulse, blood pressure, temperature. Supportive care, including oxygen and mechanical ventilation, should be given as needed. If low BP, keep the patient lying with the feet higher than the head; intravenous fluids can be given.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Scorpion bites can even be fatal

Scorpion bites are common in India. Usually, these bites are harmless but sometime have serious clinical sequelae, including death. Tarachand Saini and Colleagues at Dept. of Medicine Jawaharlal Nehru Medical College, Ajmer have reported a case of scorpion bite that presented with acute severe myocarditis in the January Issue of Asian Journal of Critical Care.

There are about 1,500 species of scorpions worldwide; out of these, 50 are dangerous to humans. Among 86 species in India, Mesobuthus tamulus and Palamnaeus swammerdami are of medical importance. Almost all lethal scorpions except Hemiscorpius species belong to the scorpion family called Buthidae.

Scorpions live in warm dry regions throughout India. They commonly inhabit the crevices of dwellings, underground burrows, under logs or debris, paddy husk, sugarcane fields, coconut and banana plantations. Their distribution is more in regions with abundant red soil.

They hunt during night and hide in crevices and burrow during the day to avoid light. Scorpion stings increase dramatically in summer months and lower in winter.

Scorpion stings cause a wide range of manifestations from local skin reaction to neurological, respiratory and cardiovascular collapse. Cardiovascular effects are particularly prominent after stings by Indian red scorpion (M. tamulus).

Scorpion bites usually have a good prognosis. However, occasionally potentially fatal complications involving heart can occur leading to heart failure said Dr K K Aggarwal Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA.

 
    Readers Responses
  1. Reference criteria of severe aortic stenosis: The mean gradient of more than 40 mmHg is as per American Society of Echo criteria while the value suggested is more than 50 mmHg by the European Society criteria. Many of us, including few top American echocardiographers still follow the European criteria, especially if due to technical reasons one can not determine aortic valve area. One should not forget the dimensionless index ratio of < 0.25 for severe aortic stenosis. Dr.Parashar
 
    eMedinewS Special

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

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

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

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

HCFI
Activities eBooks

  DIET BOOK

  HCFI

  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

 
    Our Contributors

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