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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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eMedinewS Presents Audio News of the Day

Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Workshop on Stress Management and How to be Happy and Healthy

  Editorial …

24th May 2012, Thursday

Azithromycin may up risk of cardiac death

Compared with no antibiotic treatment, the hazard ratio for cardiovascular death during a 5–day course of azithromycin, a macrolide antibiotic, was 2.88, according to Wayne A. Ray, PhD, of Vanderbilt University in Nashville, and colleagues. And compared with amoxicillin the hazard ratio for cardiovascular death was 2.49 for azithromycin, the researchers reported in the May 17 issue of the New England Journal of Medicine.

One should be aware of the potential for QT interval prolongation and heart arrhythmias when prescribing or administering antibacterial drugs. Erythromycin and clarithromycin are known to increase risk of heart–related events such as ventricular arrhythmias and sudden cardiac death, but azithromycin had not been associated with cardiovascular risk. However, there have been increasing reports of events such as torsades de pointes with the drug.

Three-quarters of the azithromycin recipients were women, with an average age of 49. The rates per 1 million antibiotic courses were 85.2 and 64.6 for all cardiovascular deaths and sudden cardiac death, respectively. The rates per million for a 5–day control period among those not given antibiotics were 29.8 and 24, respectively.

Compared with no antibiotic treatment, azithromycin use also had an increased risk for death from any cause. A comparison of a 5-day course of azithromycin with the first 5 days of a course of amoxicillin again found increased risks for cardiovascular death and all–cause mortality.

Thus, patients who took azithromycin had an estimated 47 additional cardiovascular deaths per 1 million 5–day courses of therapy. (MedPgae Today)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Bisphophonate update

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Seminar on contrast echocardiography held

The Board of Medical Education, Moolchand Medicity, organised a Medical Education Programme for the doctors on ‘Contrast Echocardiography’.

Dr K K Aggarwal
    National News

Defence Research and Development Organisation develops affordable cochlea implant

BANGALORE: Here’s an indigenous cochlear implant to enable severely hearing–impaired people to hear. Scientists at Bangalore’s Defence Research and Development Organisation (DRDO) lab –– Defence Bio–engineering and Electro–Medical Laboratory (Debel) –– under the leadership of Naval Science and Technological Laboratory (NSTL), Vishakapatnam, developed this surgically implanted electronic device. It will convey sound to people severely hard of hearing due to loss of sensory hair cells in the cochlea. "The implant, also known as the bionic ear, will be available for clinical trials within four months. After trials at five centres in the country, the implant will be used for commercial production," said chief designer V Bhujanga Rao of NSTL and DRDO scientist VK Atre. Atre said: "These are three distinct groups of potential users. They may have lost hearing due to diseases such as meningitis. The implant will serve different needs and have different outcomes." As per DRDO estimates, nearly 1 million people in India need cochlear implants. "Every year, around 10,000 hearing–impaired children are born. Unfortunately, an imported cochlear implant is very expensive –– priced between Rs 7 lakh and Rs 10 lakh. Only the affluent can afford it," DRDO scientists said. As per initial estimates, the DRDO implant will be available for around Rs 1 lakh. Bhujanga Rao collaborated with scientists from Bangalore, Advanced Numerical Research and Analysis Group (Hyderabad), and Andhra University, Vishakhapatnam, to develop the device. (Source: TOI, May 20, 2012)

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

(Contributed by Dr Monica and Brahm Vasudev)

Weight–loss therapies improve blood pressure in obese patients

Two studies presented this week at the American Society of Hypertension 2012 Scientific Sessions have shown that therapies designed to reduce body weight in obese patients also result in significant reductions in blood pressure. (Source: Medscape)

For comments and archives

Final USPSTF guidelines: no to routine PSA testing

It’s final. The US Preventive Services Task Force (USPSTF) now officially recommends against routine prostate–specific antigen (PSA)–based prostate cancer screening for healthy men, regardless of age. The Task Force released its final recommendations for the screening after a period for public comment on a draft of the report. The new document is published online May 22 in Annals of Internal Medicine. "The USPSTF concludes that there is moderate certainty that the benefits of PSA–based screening for prostate cancer do not outweigh the harms," reads the final assessment. The USPSTF last published recommendations on prostate cancer screening in 2008. At that time, researchers concluded that there was no evidence to support PSA testing for men older than age 75. Now this recommendation extends to all men. The Task Force has given the screening a "D" rating, which means "there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits." (Source: Medscape)

For comments and archives

Women may need lower ambulatory BP cutoffs

The ambulatory blood pressure monitoring (ABPM) cutoff for the diagnosis of hypertension should be lower in women than in men, a researcher suggested at the American Society of Hypertension meeting. (Source: Medpage Today)

For comments and archives

Physical activity may reduce psoriasis risk

Vigorous physical activity appeared to reduce the risk for psoriasis among a group of female nurses in the United States, according to the findings of a cohort study. Hillary C. Frankel, from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues published their findings online May 21 issue of the Archives of Dermatology. (Source: Medscape)

For comments and archives

Resting QRS duration predicts sudden death in men

Results of a new study published online May 21, 2012 in Circulation show that even a moderately prolonged QRS duration may suggest heightened risk for sudden cardiac death. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Moderate coffee intake protects against stroke

@DeepakChopra: To ameliorate pain, feel it. What you resist you will persist.

    Spiritual Update

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

How to be happy and healthy

Once somebody asked Lord Buddha, "after meditating for years, I have not been able to gain anything." Then Lord Buddha asked, "Did you lose anything?" and the disciple said, "Yes, I lost my anger, desires, expectations and ego." Buddha smiled and said, "That is what your gain is by meditating."

To be happy, one must learn to let go the following:

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What do you understand by biochemical pregnancy and clinical pregnancy?

A biochemical pregnancy is a pregnancy confirmed by blood or urine tests but not visible on ultrasound, because the pregnancy stops developing before it is far enough along to be seen on ultrasound.

A clinical pregnancy is one in which the pregnancy is seen with ultrasound, but stops developing sometime afterwards.

For comments and archives

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

(Dr Sanjay Chaudhary, Medical Director, Chaudhary Eye Centre, Dr Pallavi Sugandhi, Consultant Ophthalmologist, Cornea & Refractive surgeon, Chaudhary Eye Centre, Daryaganj, New Delhi)

Q. Does eye donation disfigure the donor’s face?

A. No. The removal of cornea does not cause disfigurement.

Q. Is there any delay in funeral arrangements?

A. No. Tissue procurement is performed within 20 to 30 minutes. Therefore family members of the deceased may proceed as planned with funeral arrangements.

For comments and archives

    An Inspirational Story

(Dr Prabha Sanghi)

A Tale of Two Seas

Sitting in the Geography class in school, I remember how fascinated I was when we were being taught all about the Dead Sea. As you probably recall, the Dead Sea is really a Lake, not a sea (and as my Geography teacher pointed out, if you understood that, it would guarantee 4 marks in the term paper!)

It is so high in salt content that the human body can float easily. You can almost lie down and read a book!

The salt in the Dead Sea is as high as 35% – almost 10 times the normal ocean water. And all that saltiness has meant that there is no life at all in the Dead Sea. No fish. No vegetation. No sea animals. Nothing lives in the Dead sea. And hence the name: Dead Sea.

While the Dead Sea has remained etched in my memory, I don’t seem to recall learning about the Sea of Galilee in my school Geography lesson. So when I heard about the Sea of Galilee and the Dead Sea and the tale of the two seas – I was intrigued. Turns out that the Sea of Galilee is just north of the Dead Sea. Both the Sea of Galilee and the Dead Sea receive their water from river Jordan. And yet, they are very, very different.

Unlike the Dead Sea, the Sea of Galilee is pretty, resplendent with rich, colorful marine life. There are lots of plants. And lots of fish too. In fact, the Sea of Galilee is home to over twenty different types of fishes.

Same region, same source of water, and yet while one sea is full of life, the other is dead. How come?

Here apparently is why. The River Jordan flows into the Sea of Galilee and then flows out. The water simply passes through the Sea of Galilee in and then out – and that keeps the Sea healthy and vibrant, teeming with marine life.

But the Dead Sea is so far below the mean sea level, that it has no outlet. The water flows in from the river Jordan, but does not flow out. There are no outlet streams. It is estimated that over a million tons of water evaporate from the Dead Sea every day. Leaving it salty. Too full of minerals. And unfit for any marine life.

The Dead Sea takes water from the River Jordan, and holds it. It does not give. Result? No life at all.

Think about it.

Life is not just about getting. It’s about giving. We all need to be a bit like the Sea of Galilee.

We are fortunate to get wealth, knowledge, love and respect. But if we don’t learn to give, we could all end up like the Dead Sea. The love and the respect, the wealth and the knowledge could all evaporate. Like the water in the Dead Sea.

If we get the Dead Sea mentality of merely taking in more water, more money, more everything the results can be disastrous. Good idea to make sure that in the sea of your own life, you have outlets. Many outlets. For love and wealth – and everything else that you get in your life. Make sure you don’t just get, you give too. Open the taps.

And you’ll open the floodgates to happiness.

For comments and archives

    Cardiology eMedinewS

Patients Prefer Colonoscopy Over CT Colonography for Cancer Read More

Many Teenagers Have at Least 1 CVD Risk Factor Read More

Devices Dominate Guidelines For Heart Failure Read More

    Pediatric eMedinewS

Folic Acid Tied To Drop In Some Childhood Tumors Read More

Teens Today At More Risk For Heart Disease Read More

Weight–Control Diet For Mom Builds A Better Baby Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with acute pulmonary edema had a blood pressure of 240/140.
Dr. Bad: It is due to heart damage.
Dr. Good: It is due to diastolic heart failure.
Lesson: Patients with significant elevation of blood pressure have mostly preserved left ventricular systolic function.

For comments and archives

Make Sure

Situation: A patient with chest pain with normal ECG died half an hour later.
Reaction: Oh my God! Why was an acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

For comments and archives

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    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. Do you think in the current scenario, the cost of the treatment/procedure should be discussed with the patient during the process of informed consent?

Ans. I am surprised at this question. I don’t know why this query should arise at all. There is no question of what I think or you think about it. There is no question of past or current or future scenario. Law does not go by thinking. Law goes by what is written in black and white and how it is interpreted by the courts in their judgments in black and white. The black and white law is that:

  • Consent is essential for any procedure.
  • Consent means informed consent, not empty or merely formal consent.
  • Informed consent means consent obtained from a patient after providing him all the necessary information. When services are provided for consideration, the cost to be paid by the patient for treatment is necessary information.

However, doctors must be careful that when a patient comes in an emergency, treatment should not be denied to him if he cannot pay the cost of emergency treatment.

  Quote of the Day

(Dr GM Singh)

In shallow holes moles make fools of dragons. Proverb

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Hematology Tips

When to suspect a bleeding disorder

  • Bleeding disorders should be suspected when a patient complains of abnormal bleeding from multiple sites, e.g. bleeds in gums, nosebleeds, skin bleeds, prolonged menstrual bleeds (in women) and prolonged bleed after dental extraction or tooth fall.
  • Basic tests to be done in these cases are platelet count and blood smear examination, prothrombin time (PT) and activated partial thromboplastin time (APTT).
  • It is also better to do these tests in all patients prior to elective surgery.
  • Patients with abnormal readings require more elaborate tests to identify specific problems and proper management.
    Mind Teaser

Read this…………………

Marie with acute lymphocytic leukemia suffers from nausea and headache. These clinical manifestations may indicate all of the following except:

a. Effects of radiation
b. Chemotherapy side effects
c. Meningeal irritation
d. Gastric distension

Yesterday’s Mind Teaser: Karen has been diagnosed with aplastic anemia. The nurse monitors for changes in which of the following physiologic functions?

a. Bowel function
b. Peripheral sensation
c. Bleeding tendencies
d. Intake and output

Answer for Yesterday’s Mind Teaser: c. Bleeding tendencies

Correct answers received from: Dr Niraj kumar Gupta, Dr Sushma Chawla, Dr LC Dhoka, Dr BB Aggarwal, dr prabha sanghi, Dr Sarita Badlani, Raju Kuppusamy, Dr Thakor Hitendrsinh G, Dr Chandresh Jardosh, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Anil Bairaria.

Answer for 22nd May Mind Teaser: a. 4 to 12 years

Correct answers received from:
Dr Niraj kumar Gupta

Send your answer to ijcp12@gmail.com

    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Storing and handling vaccines

To ensure efficacy of vaccines proper storage and handling of vaccines is essential. Important considerations are given below:

  • Store vaccines in refrigerator and freezer units, as required, which can maintain the appropriate temperature range as recommended by the manufacturer.
  • Store vaccine in storage units designated specifically for biologics. If biologic specimens must be stored in the same unit, these should be stored on a lower shelf to prevent contamination. Food and drinks should never be stored in the same unit with vaccines.
  • Keep a calibrated thermometer with a Certificate of Traceability and Calibration in the refrigerator and freezer to monitor the temperature;
  • Maintain a consistent power source.
  • Ensure good air circulation around the vaccine in the storage unit. Proper air circulation is essential to maintaining the correct storage temperatures.
  • Store vaccines on the shelves away from the walls, and vents in the part of the unit best able to maintain the required temperature. Vaccines should never be stored in the door of the freezer or refrigerator. The temperature here is not stable.
  • Place frozen vaccine packs in the door of the freezer.
  • Store unopened and opened vaccines in their original box with the lid in place until administration. Several vaccines must be protected from light.
  • Prepare vaccines at the time the vaccine is administered. This includes reconstituting or “mixing” vaccine, if indicated. Use only the diluent supplied by the vaccine manufacturer. Store the diluent according to the manufacturer’s instructions.

(Ref: CDC Guide on vaccine Storage and Handling 2011)

    Laugh a While

(Dr GM Singh)

Law of Random Comfort Seeking – A cat will always seek, and usually take over, the most comfortable spot in any given room.

    Medicolegal Update

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

Antemortem vs postmortem bruises

In some cases, which are brought dead or are dead on arrival, the attending doctor often is not able to differentiate between antemortem bruise and postmortem artefact and the postmortem bruise is often entered in MLC as injuries. I have seen several such cases in AIIMS during conduction of autopsies. However, with closer examination, it is possible to differentiate between the two.

In antemortem bruises, there is swelling and damage to epithelium, coagulation and infiltration of the tissues with extravasated blood and color changes. These signs are always absent in postmortem bruises.

Contusions and abrasions produced immediately after death show a very low degree of changes. Appreciable bruising does not occur after 2–3 minutes of death due to arrest of heart and blood circulation; but, small bruises can be produced up to 3 hours after death by using great force where the tissue can be forcibly compressed against the bone or if the body is dropped on the ground from a height or from transport trolleys or running vehicle. Some of the evidences of bleeding are seen without history of trauma due to tearing of small veins in the skin when the body is lifted from the scene of death and during transportation; the same is called postmortem artifact.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Do not mix salt with milk

A high–salt diet may increase the risk of developing gastric and duodenal ulcers. High concentrations of salt in the stomach can induce gene activity in the ulcer–causing bacterium, Helicobacter pylori, causing it to become more virulent. Bacterial cells exposed to increased salt exhibited striking morphological changes. Cells become elongated and form long chains. This was stated by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India.

Salt restriction also reduces the diastolic blood pressure by 2–8 mmHg. A WHO report, issued international guidelines, which said that reducing salt intake would be a cost–effective way to reduce the risk of developing high blood pressure directly and reducing the risk of heart attack and stroke indirectly. The report recommends people to reduce consumption of sodium to less than 2 gm per day for each person. Common salt is chemically called Sodium Chloride (NaCl).

About 2.5 gm of table salt contains one gm of sodium. This would mean that about 5 gm of table salt is the current recommended level of consumption per day.

According to a report published from the All India Institute of Medical Sciences in the year 2000, the average intake of salt in India was 10 gm per day for each person. This would amount to about 4 gm of sodium. The current recommendations suggest reducing this consumption by half.

A research study conducted by researchers at Harvard Medical School and published in the recent edition of the British Medical Journal, found that reducing salt intake by 25% reduced the risk of developing heart disease by 25% and reduced the chance of death from heart disease by 20%.

In 2002, the WHO estimated that globally about 62% of strokes and about 50% of heart attacks were attributable to high blood pressure.

Adding a pinch of salt to milk to keep it fresh for longer time, is a common Internet tip for the population but traditional Ayurveda teaching goes against it. According to the Charak Samhita, too much of pipalli, alkali and salt are bad for health. Ayurveda totally prohibits taking salt with milk.

    Readers Responses
  1. Centre To Double Medical Seats By 2021: Sir, the central Govt has a good idea but implementation is tough. Dr Jagadheeswar.
    Forthcoming Events
Dr K K Aggarwal


All are cordially invited for the 2nd National Conference of IYCF Chapter of IAP. This conference is organized by: IYCF Chapter, MOH&FW GOI, MOWCD GOI, WHO, UNICEF, IMLEA, SDHE Trust.
The theme of the conference is: "Proper Nutrition: Defeat Malnutrition – Investing in the Future"
Venue: India Habitat Centre, Lodhi Road, New Delhi – 110 003.
Date: 5th Aug 2012
For further details contact:
Conference Secretariat: Dr. Balraj Yadav, E–Mail: drbalraj@ymail.com, drvisheshkumar@gmail.com,
Ph: +91.124.2223836, Mobile: +91.9811108230

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

    eMedinewS Special

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

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  Dil Ki Batein

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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