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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


eMedinewS Presents Audio News of the Day

Photos and Videos of 2nd eMedinewS – Revisiting 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

  Editorial …

26th November 2011, Saturday

Combined ACE inhibitor and AR blocker associated with increased risk of cardiovascular death in hemodialysis patients

Over 6 years, 22,800 patients were newly initiated on an ACEI and 5828 on an ARB after at least 60 days of chronic hemodialysis. After adjustment for baseline cardiovascular risk factors, there was no significant difference in the risk of cardiovascular, all–cause, or cerebrovascular mortality in patients initiated on an ARB compared with an ACEI (HR of 0.96).

A third of 28,628 patients, newly started on an ACEI or ARB, went on to another antihypertensive medication in succession. After adjustment for risk factors, 701 patients initiated on combined ACEI and ARB therapy (HR of 1.45) or 6866 patients on ACEI and non–ARB antihypertensive agent (HR of 1.27) were at increased risk of cardiovascular death compared with 1758 patients initiated on an ARB and non–ACEI antihypertensive therapy.

Thus, an ARB, in combination with another antihypertensive medication (but not an ACEI), may have a beneficial effect on cardiovascular mortality. (Medscape Cardiology)

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 on

Combined ACE inhibitor and AR blocker associated with increased risk of CAD in hemodialysis patients

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011–Eco Fest–An Inter School Eco Club’s Health Festival

Keeping the environment clean can prevent a large number of communicable diseases. Childrens from various school took part in the poster making competition and gives the above message.

Dr K K Aggarwal
    National News

National Pharmacy Week at SHIATS

ALLAHABAD: The National Pharmacy Week was organised at Sam Higginbottom Institute of Agriculture Technology & Sciences (SHIATS) on Thursday. The programme, titled ‘Saturnalia’ was organised at the faculty of health, medical sciences, indigenous and alternative systems of medicine of SHIATS. The theme of National Pharmacy Week, which is celebrated every year in the third week of November month by the Indian Pharmaceutical Association, was ‘Pharmacist: A health care professional’. This year is the Golden Jubilee of National Pharmacy Week. (Source: TOI, Nov 25, 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

4 drugs cause most adverse–event hospital stays for seniors

Adverse drug events (ADEs) cause an estimated 100,000 emergency hospitalizations for seniors each year, yet two thirds involve just a handful of anticoagulants and diabetes medications, according to a study published in the November 24 issue of the New England Journal of Medicine. The study, by researchers from the US Centers for Disease Control and Prevention (CDC), singles out 4 drugs and drug classes — warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents. Alone or together, they account for 67% of emergency ADE hospitalizations of adults 65 years and older. Warfarin was implicated in 33%, lead author Daniel Budnitz, MD, MPH, director of the CDC's Medication Safety Program, and coauthors write. (Source: Medscape Medical News)

For comments and archives

Low–dose Zolpidem gets FDA okay for wee–hours awakening

A new formulation of the insomnia drug zolpidem tartrate (Ambien) has been approved with a lower dosage, and with a different brand name, to treat middle–of–the–night awakenings followed by difficulty returning to sleep, the FDA said. Called Intermezzo, the sublingual tablet product has a maximum recommended dose of 1.75 mg for women and 3.5 mg for men, to be taken once per night. The gender difference stems from slower clearance rates in women, according to the FDA. In contrast, the standard Ambien dose is 10 mg. (Source: Medpage Today)

For Comments and archives

MRI of little benefit to most women with breast cancer

For the majority of women with breast cancer, there is no evidence that magnetic resonance imaging (MRI) improves outcome, according to a study published in the November 19 issue of the Lancet. (Source: Medscape Medical News)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Watch Padma Shri Awardee Dr KK Aggarwal on Smoking and obesity do not go toget… http://www.youtube.com/watch?v=NjLBKmFfRVY&feature=share via @youtube

@DeepakChopra: You must find the place inside yourself where nothing is impossible.

    Spiritual Update

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

I want to live after my death

In my workshops, whenever I ask delegates as to how long they want to live, the answer I get from most of them is 60, 70 or 80 years. While answering they forget that they are only talking about the death of the physical body but what about the mental, social, intellectual and spiritual bodies.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Start For Yourself

Start for yourself, Face your greatest fears, and take the new step of faith, because only who can see the invisible, Can do the impossible.

God opens a door before your eyes, it’s up to you to find out. Help yourself and explore the things outside. If only you could see the genuine smile through the eyes of an innocent child that gives you different insight

Sometimes it’s better to be like a child They take the challenge of life No matter what comes out You will see them playing around.

If you want to cope–up with your grief, you must help and start for yourself. Minimize your self–centeredness, Maximize your faith and strength for living. Because, you are still alive!

There are more things to explore outside. Even the air you breathed, the voice you’ve heard, the things you've seen, are enough to analyze, you are still fortunate to be alive! You are blessed to take another day to feel the sun’s ray!

Hey, didn’t you know that you are nature’s greatest miracle?

For comments and archives

  Cardiology eMedinewS

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

CSI News

Sildenafil Improves 6 Minutes Walk Test In Pulmonary Hypertension

For comments and archives

Clinical, Echocardiographic And Angiographic Profile Of Patients Presenting With Acute Massive Pulmonary Embolism

For comments and archives

Nesiritide In Acute Heart Failure

For comments and archives

Both Low, High Salt Intake Linked To Cardiovascular Events.

For comments and archives

  Fitness Update

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

Vigorous exercise burns calories long after training

When you do the math, exercise does not appear to be an effective way to control weight. Most people expend about 10 calories per minute when the exercise at a moderate intensity, such as fast walking or slow jogging. That means you burn about 200 calories one running for 20 minutes–not much for all that effort. On the other hand, almost all people who successfully maintain lost weight for many years exercise almost every day. Exercise, particularly when performing vigorously, triggers increased caloric expenditure above rest after exercise. David Nieman and colleagues from Appalachian State University found that people expended an additional 190 calories after 45 minutes of vigorous cycling. Vigorous exercise burns calories during and after exercise and is an important component of a weight–loss program.

For comments and archives

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Should Old Patients Drive?

Two of the most common violations, failure to yield the right of way and failure to obey a traffic sign, often lead to accidents at intersections where situations require a quick response, full peripheral vision and interaction with other drivers.

    Rabies Update

(Dr AK Gupta, Author of Rabies the Worst Death)

If PET is required for a bite by a vaccinated dog then why vaccinated the dog at all?

Vaccination of the dog is to protect it against rabies following bite by a (stray) rabid dog. If potent TCV (veterinary) vaccine is given correctly as per schedule (preexposure). it will mostly prevent rabies in the vaccinated dog. But in enzootic (rabies prevalence in animals) India, where protection status of vaccinated dog by antibody estimation (RFFIT/MNT Test) is not possible due to scarce facilities and such time rabies is eliminated from the stray dog population in our country, the need for PET in exposed persons continues.

For comments and archives

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emedinews revisiting 2011
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    Medicine Update

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

What is the general management plan for croup?

The management of croup, usually a self–limited disease, is dependent on the severity of respiratory symptoms. The most important task is airway maintenance. General management principles include:

  • Traditionally, patients with croup have received humidified air to sooth the inflamed mucosa, thereby decreasing the amount of coughing due to mucosal irritation. Nevertheless, Neto and colleagues described that mist therapy was not effective in improving clinical symptoms in children presenting to the emergency department with moderate croup. Because these treatments are harmless, many practitioners still use mist therapy, particularly in patients who have received racemic epinephrine and are being observed.
  • The use of glucocorticoids for moderate–to–severe croup has long been recognized as a treatment modality. In comparison with placebo, oral or intramuscular dexamethasone was found to decrease hospitalization rates Although the standard dose of dexamethasone has been accepted to be 0.6 mg/kg, Geelhoed and colleagues showed similar efficacy in patients with moderate croup using lower doses of 0.15 mg/kg and 0.3 mg/kg. Because the half–life of dexamethasone is 36 to 52 hours, it is the preferred agent for croup therapy, and it is not necessary to discharge the patient with additional doses of steroids.
  • Nebulized racemic epinephrine containing levo (L) and dextro (D) epinephrine isomers is the mainstay of treatment for moderate–to–severe croup. Although racemic epinephrine does not alter the natural course of croup, it may reduce the need for emergent airway management. The preferred dose is 0.25 to 0.5 mL with 3 mL of saline.
  • In patients who have severe croup that is unresponsive to nebulized epinephrine, corticosteroids, and heliox, endotracheal intubation and ventilation may be necessary. If intubation is necessary, an endotracheal tube with a diameter smaller than recommended for the patient’s age and size should be used.
  • Antibiotics are not routinely recommended in croup but may be used in children suspected of concomitant bacterial pneumonia

For comments and archives

    Legal Question of the Day

(Dr. M C Gupta)

Should the patient be given the discharge summary if he leaves the hospital against medical advice (DAMA) or is discharged on release bond (DORB)?

  1. The terminology DORB is objectionable. It almost sounds like being discharged from jail on a release bond. Why should any patient be bound by a bond in respect of treatment or stay in the hospital? He should be able to enter or leave the hospital at his sweet will for the purpose of treatment.
  2. There is no logic in denying the discharge summary containing all necessary diagnostic, investigation and treatment details to the patient. He would need the same if he needs further treatment in the hands of another doctor. He may suffer avoidable consequences in the event of such details not being available at the time of treatment later. If he sues the hospital for compensation for such suffering, the court is likely to award compensation.
  3. Not giving medical summary at the time of discharge is illegal. That is why the MCI Regulations, applicable to physicians (but not to hospitals) provide that summary of treatment must be given to an indoor patient by the consultant concerned within 72 hours of demand for the same. There is no reason to believe that this principle should not be extendable to hospitals. There is no rule that some patients are eligible and some are not for the purpose of getting the discharge summary.
  4. Doctors need to remember that giving a discharge summary is not a favour shown to the patient. It is his right.

For Comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient had fever with 3% malarial parasites.
Dr. Bad: This is complicated malaria.
Dr. Good: This is uncomplicated malaria.
Lesson: Uncomplicated malaria consists of symptomatic malaria with parasitemia of less than 5% without evidence of vital organ failure and ability to take oral therapy.

For comments and archives

Make Sure

Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God! Why was he not screened for the cancer of lung?
Lesson: Make sure all chronic smokers are given an option for lung cancer screening with low dose spiral CT.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Patience and silence are powerful energies. Patience makes you mentally strong and silence makes you emotionally strong.

    Mind Teaser

Read this…………………

The most common cause of death in early acute pancreatitis is

a) Renal failure
b) Cardiac failure
c) Respiratory failure
d) Uncontrolled coagulopathy

Yesterday’s Mind Teaser: Which of the following is false for brown pigment stones?

a) They are earthy
b) Stones seen in Asian population
c) Easily breakable
d) All the above

Answer for Yesterday’s Mind Teaser: d) All the above

Correct answers received from: Dr Prabha Sanghi, Anil Bairaria, Yogindra Vasavada, Shikha Jain,
Dr Thakor Hitendrasinh G, Dr Rakesh Bhasin, Dr Ravi, Raju Kuppusamy, Gopal Shinde, Dr Chandresh Jardosh, Dr PC Das, Dr Sukla Das, Dr Jainendra Upadhyay, Dr Neelam Nath, Dr KV Sarma, Dr Ajay Gandhi, Dr Avtar Krishan.

Answer for 24th November Mind Teaser: c) Most of the injuries are due to errors of judgement and skill
Correct answers received from: Dr Chandresh Jardosh, Dr PC Das, Dr Sukla Das, Dr Jainendra Upadhyay, Dr KV Sarma, Dr Ajay Gandhi, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

A cow was kept for viva.

School student: It’s a cow.
College student: Perhaps this is a cow.
University student: This may be a cow or a hypo pigmented buffalo.
PhD student: This may be a hypertrophied goat or an atrophied elephant with congenital anomalies.

Moral: The more you study the more your common sense decreases.

    Medicolegal Update

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

Infliction of an injury on human body may precipitate a myocardial infarct

  • The emotional upset produced due to injury, or even the threat of fear of an injury can cause death due to transient hypertension or tachycardia that may precipitate arrhythmia, cerebral or sub–arachnoids bleeding resulting into death
  • It has been also seen during postmortem examination that physical effort that damaged a diseased heart when the deceased was performing unaccustomed work led to accidents or other trauma and to the extra physical demands while working with defective equipment.
  • A heart attack may occur while a scuffle and fight. The person may sustain simple injury and injury not sufficient to cause death in ordinary course of nature, and the person died due to heart failure.
  • This happen due to unusual physical or mental strain precipitating coronary insufficiency.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Heart patients should avoid stress in winter

All heart patients should have their cardiac and mental stress levels check up done in winter. A heart attack can come with irregular meals, late nights, missing of regular dose of medicines and indulgence in smoking and drinking, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

Acute stress–related events are common during winter, especially near full moon in the early morning hours. The circadian variation in event frequency suggests that cardiac events may be triggered by external activities, particularly those activating the sympathetic nervous system.

Data from the Multicenter Investigation of the Limitation of Infarct Size (MILIS) indicated that among 849 patients with acute heart attack 48 percent described one or more possible triggers, the most common of which was emotional upset (14 percent).

There are several mechanisms by which emotional stress might trigger an acute heart attack.

The physiologic changes that have been described in the morning period of enhanced cardiovascular risk — increase in blood pressure, heart rate, vascular tone, and platelet agreeability — also may result from mental stress.

These factors may all be related to abnormalities in autonomic tone and activation of sympathetic nervous system activity, which may enhance platelet aggregation and increase the susceptibility to serious ventricular arrhythmias.

Guide to heart patients

  1. To have their BP < 120/80 mmHg.
  2. To have blood sugar levels < 90 mg%.
  3. Not to miss their regular dose of cardiac drugs, if on the same. The morning pulse and BP should be normal.
  4. To ask their doctor for a beta blocker, if not contraindicated, to keep the stress under control
  5. Say no to smoking.
  6. Say no to alcohol.
  7. To get flu vaccination done.
  8. To avoid heavy eating.
  9. Not to ignore any suicidal thoughts.
  10. To have a complete medical check up done including a treadmill.

For comments and archives

    Readers Response
  1. Dear Sir, I like reading emedinews daily. Regards:Dr Priya
    Forthcoming Events

CSI 2011

63rd Annual Conference of the Cardiological Society of India

Date: December 8–11, 2011.
Venue: NCPA Complex, Nariman Point, Mumbai 400021

Organizing Committee

B. K. Goyal – Patron
Samuel Mathew – President CSI
Ashok Seth – President Elect & Chairman Scientific Committee
Lekha Adik Pathak – Chairperson
Satish Vaidya & C. V. Vanjani – Vice Chairman
N. O. Bansal – Organizing Secretary
B. R. Bansode – Treasurer
Ajit Desai , Ajay Mahajan , G. P. Ratnaparkhi – Jt. Org. Secretaries
Shantanu Deshpande , Sushil Kumbhat , Haresh Mehta – Asst. Org. Secretaries
D. B. Pahlajani, A. B. Mehta , M. J. Gandhi , G. S. Sainani, Sushil Munsi, GB Parulkar, KR Shetty – Advisory Committee

Contact: Dr. Lekha Adik Pathak, Chairperson, CSI 2011; Dr. Narender O. Bansal, Org. Secretary, CSI 2011 Tel: 91 – 22 – 2649 0261/2649 4946, Fax: 91 – 22 – 2640 5920/2649 4946.
Email: csi2011@ymail.com, csimumbai2011@gmail.com Website: www.csi2011mumbai.com

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in.

Over 400 registrations already done…

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews "Doctor of the Year Award" function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

    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)

Activities eBooks


  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