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



You can download previous issues at www.emedinews.in

23rd December Wednesday

Dear Colleague,

All doctors should share their professional arrangements with other doctors in the hospital setting before admitting a patient from their clinic?

DMC while examining a Complaint of Shri Vijay Kumar vs doctors of Holy Angles Hospital, Vasant Vihar (in the treatment administered to his wife late Bindu, resulting in her death on 08.07.2009 at Fortis Hospital, Vasant Kunj) observed the following.

"This case highlights the practice amongst the consultants of having a patient admitted in the hospital under them, but taking undue time in making the first contact with the patient. The explanation put forward in defence by the consultants that they work in a team and hence, since another doctor in the team is available to meet the medical requirements of the patient, the delayed interaction of the primary consultant with the patient should be accepted as a standard professional practice.

We do not find this explanation to be acceptable, since the patient admits in a hospital (in cases of planned admission) reposing the faith in primary consultant as the patient had interacted or has been under the primary doctors care prior to admission but suddenly finds herself or himself dealing with doctors who have never been introduced to them  before and have to explain their medical condition all over again, besides feeling let down by the primary doctor for not being there in the first instance, and especially anguished by his absence in times of emergency/crisis.

It is this anguish that develops into resentment which manifests in the form of grievance (complaint) and result a negative outcome.

We, therefore, recommend that all doctors especially consultants working in team should be conscious of their professional and moral duty toward their patients and should share with the patient/relatives any working arrangement that they may have with other doctors or the hospital before advising admission in a hospital/nursing home, so that the patient/relatives are better prepared to accept the reality of todayís medicine practice that a consultant cannot be available all the time during admission but at the same time she/he has established or is part of a system which will ensure that patientís medical needs will be adequately taken care of and in times when his/her expertise as a consultant is required, he/she will be there to provide his services and emotional support".

Dr KK Aggarwal




Corrigendum: The name of Dr K Srinath Reddy was misprinted as Dr Srikant Reddy. The mistake is regretted.  

Revisiting rheumatology 2009

Nonspecific low back pain: A systematic review has shown that spinal fusion surgery is more effective than unstructured nonsurgical care, but equally effective compared to intense multidisciplinary rehabilitation for patients with persistent nonspecific low back pain.[Spine (Phila Pa 1976) 2009;34:1094].

Carpal tunnel syndrome: A randomized controlled trial with 116 patients has demonstrated that surgical decompression for carpal tunnel syndrome is more effective than nonsurgical treatment consisting of multimodal interventions. [Lancet 2009;374:1074]

Fibromyalgia: Compared with control pain free subjects, fibromyalgia patients have both significantly greater neurologic symptoms and abnormal neurologic findings on detailed neurologic examination. [Arthritis Rheum 2009;60:2839]

Osteoporosis: Vertebroplasty: In two short-term, blinded trials comparing vertebroplasty with a sham procedure in patients with osteoporotic vertebral compression fractures, there was no immediate or delayed benefit of vertebroplasty for the reduction of pain. [N Engl J Med 2009;361:557]

Denosumab:  In the FREEDOM trial (7868 postmenopausal women with bone mineral density T scores between -2.5 and -4.0 at the lumbar spine or total hip), denosumab, a humanized monoclonal antibody against RANK-ligand that reduces osteoclastogenesis, compared with placebo significantly reduced the incidence of new vertebral (2.3 versus 7.2 percent), hip (0.7 versus 1.2 percent), and non-vertebral fractures (6.0 versus 8.5 percent). [N Engl J Med 2009;361:756]

Rheumatoid Arthritis: Switching to a second TNF inhibitor is effective in patients with rheumatoid arthritis who do not respond adequately to initial TNF inhibitor treatment. In a trial of golimumab as the second agent8 461 patients with active RA despite prior use of at least one TNF inhibitor were randomly assigned to golimumab (50 or 100 mg every four weeks) or placebo, while continuing stable doses of baseline DMRD (MTX, SSZ, and/or HCQ), glucocorticoids, and NSAIDs. Patients receiving golimumab were significantly more likely to achieve an ACR20 response at week 14. [Lancet 2009;374:210]

 Letters to the editor

1. Dear Dr. Aggarwal, Here is a synopsis of the Foundation Course in Palliative Care: CanSupport and Institute Rotary Cancer Hospital, AIIMS invite you to attend the 9th Annual Foundation Course in Palliative Care at New Delhi. Basic Foundation Course in Palliative Care 23 & 24 January 2010; Advanced Course in Palliative Care for Nurses 30 January 2010; Workshop on Psychosocial Issues in Palliative Care 31 January 2010. ambikarajvanshi@cansupport.org

2. The new pandemic H1N1 flu may cause blood clots and other unusual damage in the lungs and physicians need to be on the lookout. Two studies published in the American Journal of Roentgenology show the need to check X-rays and CT scans for unusual features, and also point out swine flu can be tricky to diagnose in some of the sickest patients. H1N1 flu is causing a pandemic, and while it is not particularly deadly, it is sickening many younger adults and older children who usually escape the worst effects of seasonal flu.

It is therefore essential that clinicians be able to recognize possible cases of pandemic H1N1 influenza in high-risk groups so that they order the appropriate diagnostic tests, begin specific antiviral therapy, and prepare to provide intensive supportive measures as needed (Dr. Daniel Mollura of the National Institutes of Health Clinical Center in Maryland)
One middle aged man who died was not diagnosed until after death, but unusual findings on his X rays may be able to help physicians save other, similar patients. A CT scan showed irregularities called ground-glass opacities in the patient's lungs. Although the patient was severely ill and had a fever, he tested negative for flu and doctors did not treat him for it.

The man died five days after he went into the hospital and the autopsy confirmed he had swine flu. The lung lesions seen on his CT scan matched lung damage done by the virus.

In another study in the same journal, CT scans of patients with severe cases of swine flu showed many had pulmonary emboli, a team at the University of Michigan found.  Dr. Prachi Agarwal and colleagues examined 66 patients diagnosed with H1N1, 14 of them who were in the intensive care unit. All 66 got standard X-rays. They performed CT scans on 15 of the patients, 10 of them who were in the ICU on ventilators. Five of the ICU patients had blood clots in the lungs.

The study reported that patients who are severely ill with H1N1 are also at risk for developing pulmonary emboli, which should be carefully sought for on contrast-enhanced CT scans. Anticoagulant drugs can break up these clots. The majority of patients undergoing chest X-rays with H1N1 have normal radiographs. Pulmonary emboli are also not normally seen in flu. CT scans proved valuable in identifying those patients at risk of developing more serious complications as a possible result of the H1N1 virus, and for identifying a greater extent of disease than is appreciated on chest radiographs.   Dr. Vivek Chhabra.


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emedinews: revisiting 2009
IJCP Group's emedinews: revisiting 2009, on 10th Jan,  at Maulana Azad Auditorium. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts (Dr KK Aggarwal (revisiting 2009), Dr Naresh Trehan (whats new in cardiac surgery), Dr Ajay Kriplani (surgical cure for obesity and diabetes), Dr Praveen Chandra (left main stenting), Dr Anupam Sibal (a decade of successful liver transplants in India), Dr Kaberi Banerjee (all about infertility), Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephrology update), Dr. Ambrish Mithal  on Diabetes, Dr Vanita Arora (ECG arrhythmias), Dr Subramanium (Co Q 10 a new modality), Dr Neelam Mohan and Dr. Sanjay Chaudhary etc. will deliver lectures.
CME will be followed by lively cultural evening (guest performances by noted singers Shabani Kashyap, Vipin Aneja and top singers of our medical profession Dr Praveen Khillani, Dr and Dr Mrs Subramanium, Dr Lata Tandon, Dr Arti Pathak, Dr Sanjay Chugh (on the drum), Dr Sudipto Pakrasi, Dr Harjeet Kaur, Dr Ramni Narsimhan, Dr Yash Gulati (Anchor) Dr Reshma Aggarwal (Anchor), doctors of the year award, dance and dinner. For registration mail 
emedinews@gmail.com. We have crossed 1200 registrations.

Funny clinical notes (Dr. Minakshi)
The skin was moist and dry

Warning Signs of Scoliosis (Dr Prachi Garg)
1. Hemline, pant legs or shirt sleeves that appear to be uneven.
2. Uneven arm length.
3. Uneven shoulder heights.
4. A slight limp.
5. Complaints of sore back, numbness or tingling.
6. One breast that is more prominent than the other.

Dr Good Dr Bad
Situation: A patient with SLE came with high CRP
r Bad: Itís a part of SLE disease process
Dr Good: I need to rule out TB
Lesson: CRP is never positive in SLE.

Mistake of the day: Unless proved otherwise any first onset attack of acidity after the age of 40 is angina.

Humor: NAD means
1. Not actually done
2. Not able to diagnose
3. Not able to detect
4. No abnormality detected

"You are what your deep rooted desires are"




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