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  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



23rd November Monday 

Dear Colleague,


 The year end is coming and its time to revise what was new in the year 2009. As you are aware that emedinews is organizing a day long CME on 10th Jan on the same subject by the name REVISITING 2009. From now on we from time to time will talk about the advances in the year 2009. Here are some of them.

1. In a randomized trial, patients who had discontinued statin therapy because of myalgias tolerated treatment with red yeast rice at a rate similar to placebo, while achieving significant reductions in LDL-C [Ann Intern Med 2009; 150:830.].

2.  In a longitudinal study, participants who met criteria for four healthy lifestyle factors (never smoking, BMI < 30, physical activity >3.5 hours weekly, and a prudent diet) had approximately one-third the risk of cancer compared to those who met none of these criteria [Arch Intern Med 2009; 169:1355.].

3.  Regular exercise and the Mediterranean diet were independently associated with a decreased risk for Alzheimer disease in a prospective cohort study of 1880 older patients followed for 14 years [JAMA 2009; 302:627.].

4. Early studies of primary first degree atrioventricular block suggested a benign prognosis. This view has been challenged by a large prospective community based cohort study of individuals from the Framingham Heart Study [JAMA 2009; 301:2571.]. Compared with those with a normal PR interval, individuals with first degree AV block were more likely to develop atrial fibrillation, had a greater risk of receiving a permanent pacemaker, and a higher all cause mortality.

5. Two randomized trials in patient with ST elevation MI who were treated with fibrinolytic therapy found that transfer for possible percutaneous coronary intervention was superior to ischemia guided treatment in local hospitals [J Am Coll Cardiol 2009; N Engl J Med 2009; 360:2705]. The results of these two trials have led to a change in recommendations for the management of patients after fibrinolysis.


Dr K K Aggarwal


Dr Maj Prachi Garg


Migraine Raises Risk of Most Common Form of Stroke
Pooling results from 21 studies, involving 622,381 men and women at Johns Hopkins have affirmed that migraine headaches are associated with more than twofold higher chances of the most common kind of stroke: those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot. The risk for those with migraines is 2.3 times more. For those who experience aura, the risk is 2.5 times higher.

Surgery Potentially Best Option for Severe Migraine Headaches
The disability from migraine headaches is an enormous health burden. The new data finds promising outcomes for treating trigger sites surgically for migraine headaches resulting in elimination of pain for those afflicted with the condition.

The new data provides strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate (cure) or reduce the frequency, duration, and/or intensity of migraine headaches with lasting results says Dr. Bahman Guyuron, MD, Chairman of Plastic Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine.

For patients who suffer frontal migraine headaches, Dr. Guyuron removed the corrugator supercilii (frowning) muscle group in the forehead that is suspected to be a trigger point for headaches, compressing nerves and causing nerve inflammation. Temple migraine headaches are treated by removing a small branch of the trigeminal nerve. For those patients who suffer from occipital (back of the head) migraine headaches, a small piece of muscle encasing the nerve is removed and replaced with a soft tissue flap. When the headaches are located behind eyes and are triggered by weather change, he works on the nose septum and surrounding structures.

5 Exercises That Can Reduce Neck and Shoulder Pain
Strength training exercises using dumbbells can reduce pain and improve function in the trapezius muscle, the large muscle which extends from the back of the head, down the neck and into the upper back. The exercises also improve the muscle's ability to respond quickly and forcefully among those suffering trapezius myalgia, a tenderness and tightness in the upper trapezius muscle.

1. Five strength exercises are
2. one arm row
3. shoulder abduction
4. shoulder elevation
5. reverse fly
6. upright row

Dr Good Dr Bad
Situation: A young female on oral contraceptives presented with severe headache and blurring of vision.
Dr Bad: Go for refraction.
Dr Good: You should stop oral contraceptives.
Lesson: Migraine patients have more chances of developing stroke and hence they should avoid talking Oral contraceptives.


Neurotics build castles in the sky.

Psychotics live in them.

Psychiatrics collects the rent.


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History of ophthalmic dispensing (Dr Narendra Kumar)

Armati of Italy in 1285 is supposed to be the inventor of spectacles. Since the first lenses were plus or convex, these were used as reading glasses. Concave lenses (-) were developed in 16th century for the correction of myopia. Toric lenses for the correction of astigmatism were developed in 19th century. In 1784, Benjamin Franklin made the first bifocals by splitting a pair of distance glasses and reading glasses

Around 1800, Accommodation and Refraction of the Eye by Donders improved opticians' knowledge and ability in sight testing. Two classes of opticians then evolved:  (i) prescription opticians, and (ii) refracting opticians.

In 1873, Cuignet developed the procedure of retinoscopy, which hindered the action of ciliary muscle and retarded accommodation through the use of a drug; that also dilated the pupil, enabling the physician to better view the retina and easily diagnose diseases of the eye.

Refracting opticians chose the name of optometry for their profession. By 1930, optometry (without the use of drugs) was legalized in USA. The remaining opticianry group (prescription opticians) were to supply eyeglasses prescribed by physicians, and were eventually called dispensing opticians.

Optometry was introduced in India in 1958 with the dual aim of (i) lessening the burden of refraction on the already busy ophthalmologist and (ii) taking over scientific dispensing of spectacles.

"Doctor, doctor, I've lost my memory.
When did it happen?
When did what happen? "

Multiple consultations (Error of the day)
A lady with accelerated hypertension, cholecystitis and lower abdominal pain was admitted in the medicine ward. She was advised anti hypertensives and paracetamol for her fever by the intern on duty who also requested for surgical and gynecological opinions. The surgeon added an antibiotic and a pain killer for cholecystitis. The gynae also added an antibiotic and a pain killer for the pelvic inflammatory disease. For 2 days the patient was on three antibiotics and three pain killers. She subsequently developed Gl bleed. 

It is a common mistake. In this case none of the doctors checked the prescription of the other doctor. The mistake is at every level, the nurse on duty, the doctor on duty and the consultant incharge of the case. The cause of mistake is multiple brand names and multiple drugs available for the same condition. There are instances where a patient ends up getting three doses of the same pain killer but with different brands.

Letters to the editor

1. Respected Sir, It has been established beyond doubt that the initiative which you have taken is revolutionary in our country. For the first time all who have had some form of education in our country, are having access to a daily update on the current in clinics and legalities in managing a hospital. It was never done before and I pray that this lasts for ever.  Sir, my humble submission is that in addition to the latest on the various studies cited in reputed journals, the E medinews also must educate us regarding the Evidence base for various forms of common problems in disease diagnosis and their management. This humble submission is considering the changing scenario all over the world regarding approach to medicine. As now there is a high degree of importance given all over the world to the Evidence gathered from various meta analysis for optimal management of various cases. Warm  Regards, Yours sincerely: Prashant
Emedinews comments: we will start a column of evidence based practice.

2. With reference to your advice regarding intra cardiac adrenaline, I fail to understand why it should not be tried as a last resort in cardiac arrest. A dead patient is not bothered about any injury caused. Intra cardiac adrenaline injection  is recommended even in life threatening anaphylaxis. American Heart Association ACLS says intra cardiac injection may be given in desperate situations when I.V is not feasible . Intra cardiac injection has been show to be effective in restoring cardiac contractions in asystloe where IV epinephrine was ineffective. Whether the needle stick or the drug itself was effective has not been resolved. The major hazard of intra cardiac injection is the need to interrupt CPR. Although uncommon, complications may follow intra cardiac injection.
JAMA 1980:240:1110-1111 and Harrison's Principles of Internal Medicine 16th Edition -1622 column 11, para 4. Dr. Vinay Bhasin
Emedinews response: You have given the answer already. It is not to be given as the first step and interruption of CPR is more dangerous and more over IV adrenaline is as effective. Keep it as a last resort. I agree that a dead pt is not bothered about the injury but our purpose of CPR is to revive him and once he is revived the cardiac injury may affect the chances of further survival.

Thanks for the prompt reply. In the scenario of the case qouted by you, the doctor administered it after eliciting no response with repeated doses of adrenaline and atropine. Is he safe medico legally. VB
Emedinews response: Yes. IV is as effective as intra cardiac. There is no need for intra cardiac if IV line is available. It is as per standard guidelines.

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emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact drkk@ijcp.com.

emedinews: revisiting 2009

IJCP Group is organizing emedinews: Revisiting 2009, a day long conference on 10th Jan  2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts will deliver lectures. CME will be followed by lively cultural evening, doctors of the year award, dance and dinner. For regiatration mail  emedinews@gmail.com. We have crossed 800 registrations.

You can gift emedinews to some one just write to emedinews@gmail.com 




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