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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 & 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

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    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 7 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity – Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

27th September 2012, Thursday

Vaginal delivery safe for head first births before 32 weeks

Infants born to mothers attempting to deliver vaginally before the 32nd week of pregnancy are as likely to survive as those delivered by a planned cesarean, provided the fetus is in the head–first position, according to researchers at the National Institutes of Health.

Pregnancy typically lasts about 40 weeks. Infants born before the 37th week of pregnancy are classified as preterm, and those born before the 32nd week of pregnancy are classified as early preterm. Preterm infants are at risk for a number of health problems, including increased risk of infant death, cerebral palsy, developmental delays, infection and vision and hearing problems. According to the Centers for Disease Control and Prevention, 54 percent of all infant deaths in the United States occur among the 2 percent of infants born before the 32nd week of pregnancy.

Some studies have suggested that infants delivered vaginally before 32 weeks are less likely to survive through infancy than those delivered by a planned cesarean delivery and more likely to suffer injury and health effects after passing through the birth canal. Cesarean delivery, especially in the early preterm period, poses risks for the mother, such as hemorrhage, bladder injury, and other complications. Women who undergo cesarean delivery are at risk for rupture of the uterus during labor and other complications in subsequent pregnancies.

Their findings appear online in the American Journal of Obstetrics and Gynecology.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

When should enemas be used in a patient with constipation?

Enemas (tap water, sodium phosphate, soapsuds) should be used only as needed for constipation in the older adult, i.e., after several days of constipation in order to prevent fecal impaction. Adverse effects can include fluid and electrolyte abnormalities with phosphate enemas and rectal mucosal damage with soapsuds enemas.

In elderly patients, sodium phosphate enemas should not be used for the treatment of constipation as they may lead to severe metabolic disorders associated with a high mortality and morbidity (Ori Y, et al. Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center’s experience. Arch Intern Med 2012 Feb 13;172(3):263–5).

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

ACE inhibitors better ARBs in new meta–analysis in hypertensives

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th Dil Ka Darbar

The Darbar was organized by Heart Care Foundation of India in association with Indian Oil, Central Bank of India Department of AYUSH and various Departments under Health Ministry, Government of Delhi on Sunday 23rd September 2012 at Talkatora Stadium.

Dr K K Aggarwal
    National News

22cr school children to be screened for 3 Ds in 15 states

NEW DELHI: In the largest ever exercise to detect the three Ds — deficiency, disease and disability — among school children, the Union health ministry will soon start a massive screening and treatment programme that will cover 22 crore children (6–18 years) in 11 lakh government-run institutions across 15 states. Union health minister Ghulam Nabi Azad has recently sanctioned Rs 383 crore for 2012–13, and also set up 2,414 dedicated teams at block levels to conduct the school health programme (SHP) under the aegis of the flagship National Rural Health Mission (NRHM). SHP will undertake biannual health service provision through screening, healthcare and referral to look for anemia and assess the nutritional status of children, besides testing their visual acuity and hearing skills. Dental check-up, common skin diseases, heart defects, physical disabilities, learning disorders and behavioural problems will also be the programme’s priority. Basic medicine kit to take care of common ailments prevalent among young school–going children and referral for service connectivity from primary till super–specialist health facilities will be undertaken. Supplementation like fixed day immunization, micronutrient (Vitamin A and IFA) management, weekly supervised indigestion of iron folate tablets, administration of vitamin A and–de worming will also be conducted. Azad says, "SHP will protect and promote the health of human capital from the beginning. It is universally known that healthy students are more receptive to education, which naturally, influences their scholastic attainment. Around 15 states have positioned dedicated teams for SHP."

Once the dedicated teams are optimally operational, the ministry plans to include pre–school children through anganwadi centres under "SHP Plus". "We are tying up with medical colleges so that children found deficient – physically or mentally — during screening can be given referral support there for free. The teams will be headed by AYUSH doctors along with three other paramedics. Every block will have to have at least one team. UP alone has created 820 such teams," a ministry official said. The official added, "We want to conduct universal screening of population. Early detection is of prime importance in case of disability or disease." The ministry expects the programme to take off from January across all the 15 states. The programme implementation plan says Chhattisgarh has set up 294 teams, Himachal Pradesh (140), Jharkhand (194), Uttarakhand (38), Assam (149), Meghalaya (39), Goa (11) and Arunachal Pradesh (32). In Arunachal Pradesh, 14,523 children will be screened, Chhattisgarh (30 lakh), Himachal Pradesh (10.9 lakh), J&K (2.12 lakh), Odisha (64 lakh), UP (6 crore), Assam (42 lakh), Meghalaya (1.79 lakh) and Manipur (2.63 lakh). Health clubs and health cabinets will also be introduced in government and government–aided schools. First aid room/corners/clinics with support from education department attended by trained staffs and connectivity with public health infrastructure will be established and physical education and activities will be popularized. (Source: TOI, Sep 25, 2012)

For comments and archives

My Profession My Concern

Include this in your practice

Screening for cervical cancer

  • Screen all women aged 21 to 65 years for cervical cancer.
  • Do Pap smear at intervals of every three years for average–risk women aged 21 through 29 years.
  • For average–risk women aged 30 to 65 years do either Pap smear screening every three years, or a combination of Pap smear and HPV testing every five years, if both initial tests are negative.
  • Cervical cancer screening is not indicated for women who have had a hysterectomy, in the absence of a history of cervical cancer or high grade cervical cancer precursor.

(Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 19 June 2012;156(12):880–891)

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

    Valvular Heart Disease Update

What are the five main issues for managing and advising a patient with a prosthetic heart valve?

  • Antithrombotic therapy to prevent valve thrombosis and thromboembolism
  • Evaluation of valve function
  • Endocarditis prophylaxis
  • Safety of exercise
  • Pregnancy

(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)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Linaclotide first IBS–specific medicine approved in Europe

The European Medicines Agency (EMA) has recommended authorization of linaclotide (Constella, Almirall), which would make it the first medicine in the European Union specifically intended for symptoms related to irritable bowel syndrome (IBS), according to an announcement made September 21 by the agency. (Source: Medscape)

For comments and archives

Oxytocin halt not tied to cesarean boost

Once oxytocin has induced active labor, the drug can be stopped if regular contractions continue to generate cervical change, a new report says. Discontinuing the oxytocin under those circumstances doesn’t increase the cesarean delivery rate, according to Pennsylvania–based researchers. But overall, women randomized to oxytocin discontinuation had longer labor, as Dr. Joanne N. Quiñones, senior author of the report, noted in email to Reuters Health. They also had a higher risk for chorioamnionitis related to intrauterine pressure catheter (IUPC) use and duration of membrane rupture. (Source: Medscape)

For comments and archives

Progestogens curb preterm singleton births

Pooled data indicate that progestogens may help prevent preterm birth among women who’ve delivered early in the past, according to researchers based in Tennessee. But the evidence wasn’t very strong, and any benefit appears limited to singleton pregnancies. As Dr. Frances E. Likis told Reuters Health by email, "Progestogens prevent preterm birth in women who have had a previous preterm birth but not in women who are pregnant with twins or triplets." In a September 5th online paper in Obstetrics and Gynecology, Dr. Likis of Vanderbilt University, Nashville and colleagues note that progestogen use "has become common practice over the past decade, although the mechanism for pharmaceutical effects is not well understood." (Source: Medscape)

For comments and archives

Screening directive upped ultrasounds for AAA without improving outcomes

Medicare coverage of screening for abdominal aortic aneurysms (AAA) serves only to increase the number of abdominal ultrasounds performed and has no discernible effect on clinical outcomes, according to a new analysis. Since the implementation of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act in 2007, the use abdominal ultrasonography increased from 7.6% among SAAAVE–eligible men in 2004 to 9.6% in 2009 without any changes in the rates of AAA repair, AAA rupture, or all–cause mortality as reported by Dr Jacqueline Baras Shreibati (Stanford University School of Medicine, CA) in the Archives of Internal Medicine. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: NIH Pilot Study Shows Feasibility of MRI to Guide Heart Catheter Procedures

@DeepakChopra: Do we have to obey God in order to be loved by God? My#askdeepak video reply http://tinyurl.com/8m9gpj2

    Spiritual Update

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

Symposium on Diet, Health & Religion – Samani Charitra Prajna

A symposium on Diet, Health & Religion, second in a series was held at Bharatiya Vidya Bhavan on 5th September, 2012. The Chief Guest was Shri J Veeraraghavan, Chairman, Bhavan’s KM Munshi Institute of Educational Leadership and Management.

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How are the risks of multiple pregnancies related with the IVF procedure?

The more embryos that are transferred into the uterus, the higher the risk. Multiple pregnancies carry significant risks, including:

  • Premature labor with possible risks to the infant
  • Premature delivery
  • Maternal hemorrhage
  • Cesarean delivery
  • Pregnancy–induced high blood pressure
  • Gestational diabetes

Your doctor should transfer the minimum number of embryos necessary to provide a high likelihood of pregnancy with the lowest risk of multiple pregnancy.

For comments and archives

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

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

Q. Are there some other benefits of blood donation?

Yes see what a noble selfless service it is. It gives the donor a feeling of joy and contentment. Also this Liquid Love creates the feeling of Fatherhood of God and Brotherhood of Mankind, as blood knows no caste, color, creed, religion or race, country continent or sex

For comments and archives

    Liver Abscess Update

(Dr Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

What are the common symptoms of liver abscess?

  • Fever
  • Abdominal pain
  • Tender hepatomegaly
  • Pain in right shoulder or cough
  • Pleural effusion/empyema
  • Fulminant sepsis
  • Acute abdomen
  • Nausea and vomiting, anorexia
  • Unexplained anemia

For comments and archives

    An Inspirational Story (Dr GM Singh)

For the always busy

An elderly man in Mumbai calls his son in New York and says, "I hate to ruin your day son, but I have to tell you that your mother and I are getting a divorce; 35 years of marriage… and that much misery is enough!"

"Dad, what are you talking about?" the son screams. "We can’t stand the sight of each other any longer," the old man says.

"We’re sick of each other, and I’m sick of talking about this, so you call your sister in Hong Kong and tell her!"

Frantic, the son calls his sister, who explodes on the phone. "Like heck they're getting divorced," she shouts, "I’ll take care of this."

She calls Mumbai immediately, and screams at the old man, "You are not getting divorced. Don’t do a single thing until I get there. I’m calling my brother back, and we’ll both be there tomorrow. Until then, don’t do a thing, DO YOU HEAR??" and she hangs up.

The old man hangs up his phone and turns to his wife. "Okay", he says, "It’s all set. They’re both coming for our anniversary and paying their own airfare!!"

Moral: No man/woman is busy in this world all 365 days.
The sky is not going to fall down if you take few days LEAVE and meet your dear ones.

Office work is not everything in life and money making is not everything in life.

For comments and archives

    Cardiology eMedinewS

Extreme heat, cold can trigger fatal heart attacks Read More

72% of Indian urbanites heart–unhealthy Read More

    Pediatric eMedinewS

AAP issues guidance on adopted kids Read More

Race a factor in children’s BP levels Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with high grade fever with low platelet count came for evaluation.
Dr Bad: Treat him for dengue.
Dr. Good: Also, do a Tourniquet test and check his PCV.
Lesson: Low platelet count is not the only diagnostic criteria for severe dengue. The classical triad is low platelets, positive tourniquet test and 20% increase in hematocrit.

For comments and archives

Make Sure

Situation: A patient with severe obstructive sleep apnea (OSA) developed acute coronary syndrome (ACS).
Reaction: Oh my God! Why was CAD not ruled out in this case?
Lesson: Make sure that all patients with OSA are investigated for underlying CAD.

For comments and archives

  Quote of the Day (Dr GM Singh)

The only way to get the best of an argument is to avoid it. Dale Carnegie.

    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Serum prolactin

Prolactin estimation should only be done with a mid morning pooled sample i.e. 3 samples taken at 20 minutes interval. A single sample can give an erroneous reading.

    Rabies Update (Dr. A. K. Gupta, Author of "RABIES – the worst death")

If the pet is immunized, do family members need pre–exposure vaccination?

A dog effectively vaccinated against rabies ordinarily will not suffer and transmit rabies. But it is very difficult to say with certainty that a particular dog immunized with specific vaccine is immune against rabies, more so in a rabies–endemic area. Animal lovers and pet owners are always at high risk of rabies, and therefore, pre-exposure vaccination is recommended for all the family members.

    Fitness Update

(Rajat Bhatnagar, MonaVie, www.mymonavie.com/sonraj)

Morning workouts may curb appetite throughout the day

It has long been thought that exercise increases a person’s appetite. But a new study from Brigham Young University suggests that a morning workout may reduce food cravings. The study, published in Medicine & Science in Sports & Exercise, looked at brain responses of 35 women to images of food on exercise and rest days. The women either worked out on a treadmill for 45 minutes in the morning, or performed no activity, prior to viewing 240 images of food.

Results showed that on morning exercise days, the brain responded less to images of food than on rest days. In addition, on the exercise day, physical activity for the rest of that day was higher, but food intake was about the same as on rest days. These findings were true for both obese and normal weight participants, and suggest that regular exercise may play a larger role in controlling weight and obesity than previously thought.

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central bank

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

Photos of Doctor’s Day Celebration

eMedinewS Apps
    Mind Teaser

Read this…………………

Which of the following activities is not encouraged in a patient after an eye surgery?

A. Sneezing, coughing and blowing the nose
B. Straining to have a bowel movement
C. Wearing tight shirt collars
D. Sexual intercourse

Yesterday’s Mind Teaser: An emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to:

A. Increase BP
B. Decrease mucosal swelling
C. Relax the bronchial smooth muscle
D. Decrease bronchial secretions

Answer for Yesterday’s Mind Teaser: C. Relax the bronchial smooth muscle

Correct answers received from: Rajiv Kohli, Dr KP Chandra, Prabha Sanghi, Dr Kanta Jain, Dr (Maj. Gen.) Anil Bairaria, Dr PC Das, YJ Vasavada, Dr K Raju, Dr KV Sarma, Dr Parimal Shah, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Dr Chandresh Jardosh, Dr Shamsher Singh, Dr Avtar Krishan, Dr Thakor Hitendrsinh G, Drjella.

Answer for 24th September Mind Teaser: B. Speak to both parents together and encourage them to support each other and express their emotions freely

Correct answers received from:
Dr KP Chandra, Dr PC Das, Dr P Narayanasamy.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Eye laugh

Cassie was taking two of her grandsons on their very first train ride, from Dayton, Ohio, to Washington, DC.

A vendor came down the corridor selling Pop Rocks, something neither had ever seen before. Cassie bought each grandson a bag.

The first one eagerly tore open the bag and popped one into his mouth just as the train went into a tunnel. When the train emerged from the tunnel, he looked across to his brother and said: "I wouldn’t eat that if I were you."

"Why not?" replied the curious brother "I took one bite and went blind for half a minute."

    Medicolegal Update

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

Medical Testimony of Doctor in the Court of Law

Do not misrepresent documents/medical literature in the Court of Law

When evidence is read into the record of a trial, only that portion of the document, which validates the information being discussed needs to be read aloud. One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point you are making. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time–consuming. When a document is cut in a manner, which lends the quoted passage a meaning other than what would be derived from a more complete reading, you are misrepresenting the document. This does not mean, however, that you are responsible for drawing the same conclusions from information as the author of the document.

Drawing a contrary conclusion from passages accurately interpreted does not constitute misrepresentation. The fact that the author of the document reached a different conclusion from the information argues perhaps persuasively against your conclusion. However, you have not misused the evidence.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

New Form of Heart Failure on the Rise

Heart failure is routinely described as the progressive loss of ability of the heart to pump blood. But, there is another form of heart failure where the blood–pumping ability of the heart remains near normal, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela. This second form of heart failure is too often overlooked and is just as lethal.

In this condition the heart muscle becomes thickened. The chamber inside gets smaller and the heart is unable to relax to accommodate the blood it needs to pump out. As there is no room for the heart to relax, the blood backs up into the lungs. This kind of anomaly is not picked up by standard measurements of "ejection fraction" –– the percentage of blood in the heart that goes out with every beat.

Quoting two studies published in the New England Journal of Medicine, Dr Aggarwal said that this form of the disease is called "diastolic heart failure" because the problem occurs during the diastole portion of heart activity, as the heart relaxes after a beat. Nearly one–third of these patients have an ejection fraction greater than 50 percent, which is very near normal. However, the death rate for this kind of heart failure matches that of patients with the more common form of heart failure, with more than 20% of all the patients dying within a year. There is a steady increase over 15 years of heart failure with normal or near–normal ejection fraction.

For patients, the symptoms of both types of heart failure are the same: Shortness of breath, difficulty exercising and fluid retention in the body. Physicians cannot make a diagnosis on the basis of symptoms or routine examinations. One has to have an echocardiogram and see the heart pumping and see if the ejection fraction is normal or reduced. Until now, relatively little attention has been paid to diastolic heart failure. Advances have been made against systolic heart failure, in which the ejection fraction falls below normal but not much has been done about diastolic heart failure.

Pacing for heart failure

For patients with advanced heart failure waiting for cardiac transplant, biventricular pacing not only improves the quality of life but also prolongs life. If the ejection fraction is low the combo device also gives an electric shock when the heart stops. It is said that all patients with low ejection fraction should ask their doctors for possible implantation of these devices.

Signals of heart failure

One of the commonest presentations is breathlessness on exertion, which is often confused as a part of aging or being obese. Not being able to climb stairs may be the earliest sign of hypertensive diastolic heart failure. Other signals are:

  1. Feeling extra tired even after a good night’s sleep. People with heart failure may limit activities they like to do or take naps to avoid feeling tired.
  2. Weight gain: Call your doctor if you gain weight for more than 2 days in a row or if you gain 2 or more pounds.
  3. Shortness of breath: Heart failure makes breathing harder, especially during exercise. Lying position may make it worse.
  4. Swollen ankles, legs, belly, and/or lower back, the swelling is often worse at the end of the day.
  5. Going to the bathroom more at night.
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  1. This is very good information of all subjects of medicine that I get daily. At present, I am in the USA since last 3 months, though I remain up dated due to this. I am thankful to the whole team of eMedinewS, especially Dr Aggarwal. Pravin Patel.
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