Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague,

31st January, Sunday 2010

 Practice Changing Updates: Cardiac resynchronization therapy for heart failure

Cardiac resynchronization therapy (CRT) should be given to all at the time of implantable cardioverter-defibrillator (ICD) placement for patients with mild  symptoms of heart failure (NYHA class II HF) despite optimal medical therapy who meet the following criteria: sinus rhythm, left ventricular ejection fraction (LVEF) of less than 35 percent, and QRS >150 msec.


Earlier recommendation was that CRT improves symptoms and mortality only in selected heart failure patients who have moderate to severe symptoms (NYHA class III or IV HF) despite optimal medical therapy.


The evidence for benefit in patients with less severe heart failure comes from the MADIT-CRT trial in which 1820 patients with an LVEF of 30 percent, QRS =130 msec, and NYHA class I or II HF were randomly assigned to CRT plus ICD or ICD alone. CRT-ICD produced a decrease in HF events and induced reverse remodeling. The benefit was observed primarily in patients with a QRS duration >150 msec.


Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009;361:1329.

Dr KK Aggarwal
Chief Editor

1. Many American women are prescribed estrogen to combat the negative effects of menopause, such as bone loss and mood swings. Now, new evidence from a Tel Aviv University study suggests that hormone replacement therapy might also protect them, and younger women, from schizophrenia as well.

2. Combining drugs and radiotherapy improves the survival chances of women receiving treatment for cervical cancer. These are the conclusions of Cochrane Researchers who carried out the most comprehensive study of the effects of combined drug and radiotherapy in cervical cancer treatment to date.

3. Current evidence suggests that using Doppler ultrasound in high-risk pregnancies to monitor a fetus' health may reduce cesarean sections and the number of babies who die, according to a new Cochrane Systematic Review.

4. Even when their tumors are shrinking in response to therapy, some non-small cell lung cancer (NSCLC) patients have a scattering of cancer cells that are undeterred by the drug, causing the tumor to resume its growth, Dana-Farber Cancer Institute and Massachusetts General Hospital (MGH) Cancer Center scientists report in the January issue of Cancer Cell. The findings suggest that identifying such patients and treating them with a combination of drugs from the very start of therapy can produce longer remissions.

5. The widespread use of so-called fertility drugs, not just high-tech laboratory procedures, likely plays a larger role than previously realized in the growing problem of premature births in the United States, because these drugs cause a high percentage of multiple births, the March of Dimes said today. The organization's comments came in response to a study published in the American Journal of Epidemiology by authors from the Centers for Disease Control and Prevention (CDC) and the March of Dimes that found controlled ovarian hyperstimulation (COH) drugs, used to stimulate a woman's ovaries to speed the maturity and multiply the production of eggs, account for four times more live births than assisted reproductive technologies (ARTs) such as in vitro fertilization.

6. Giving vitamin D to people living in nursing facilities can reduce the rate of falls, according to a new Cochrane Review. This finding comes from a study of many different interventions used in different situations. In hospitals, multifactorial interventions and supervised exercise programs also showed benefit.

7. Researchers at the University of Minnesota and Minneapolis VA Medical Center have identified a biological marker in the brains of those exhibiting post-traumatic stress disorder (PTSD). A group of 74 United States veterans were involved in the study, which for the first time objectively diagnoses PTSD using magnetoencephalography (MEG), a non-invasive measurement of magnetic fields in the brain. It's something conventional brain scans such as an X-ray, CT, or MRI have failed to do.

8. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be more effective for relieving period pain than paracetamol, according to the update of a Cochrane Review. However, it remains unclear whether any one NSAID is safer or more effective than others.

9. Elderly people who are heavy drinkers are more likely to suffer memory and cognitive problems than mild-to-moderate drinkers. (Alcoholism: Clinical and Experimental Research, News Release, Jan. 27, 2010)

10. Monitoring high-risk pregnancies with ultrasound tests may help prevent some fetal and newborn deaths, a new research review finds. The review assessed Doppler ultrasound, which measures blood flow through the umbilical cord. Abnormal findings indicate that the fetus may be under stress. (Cochrane Database of Systematic Reviews, January 2010)

11. Very tight blood sugar control may raise the risk of premature death in people with type 2 diabetes, with the risk even higher among patients taking insulin. The study authors, from Cardiff University School of Medicine in Wales, suggest revising diabetes guidelines to include a low threshold for blood sugar levels in addition to the well known upper thresholds. (The Lancet, Jan 2, 2010)

12. Children can develop toilet seat dermatitis after repeated exposure to residue from harsh cleaning chemicals (especially those with varnishes and paints) or after several uses of a wooden seat, said Dr. Bernard Cohen, director of pediatric dermatology at Johns Hopkins Children's Center, and colleagues. They offered tips on how to prevent toilet seat dermatitis: use paper toilet seat covers in public restrooms; replace wooden toilet seats with plastic ones,; clean toilet seats and bowls daily and not to use harsh cleansers, which often contain skin-irritating chemicals. Instead, use rubbing alcohol and hydrogen peroxide, which is effective and gentler on the skin. (Johns Hopkins Children's Center, News Release, Jan. 25, 2010)

13. Obesity increases the risk of developing a common and virulent form of kidney cancer. Researchers examined 1,640 patients, average age 62, with kidney tumors and found that obese patients were 48 percent more likely to develop a clear-cell renal cell cancer than those with a body-mass index (BMI) of less than 30, the cutoff for obesity. The odds of developing renal cell carcinoma increased by 4 percent for every extra BMI point. (BJUI, News Release, Jan. 12, 2010)

The seven goals for achieving ideal cardiovascular health for adults:
1. Never smoked or quit more than a year ago.
2. Body mass index (BMI), a measure based on weight and height, less than 23.
3. Physical exercise -- at least 160 minutes of moderate intensity or 80 minutes of vigorous intensity each week.
4. At least four key components of a healthy diet, such as fewer calories, more fruits and vegetables, and oily fish, such as salmon, four times a week.
5. LDL cholesterol lower than 80 mg%. 
6. Diastolic blood pressure below 80 mmHg.
7. Fasting blood sugar below 80.

Readers Responses

1. Dear Dr KK Agarwal: I was delighted to learn of your getting the prestigious Padmashree award. Please accept my heartiest congratulations on being honored for your achievements and having earned the respect of all for your outstanding talent, perseverance, devotion to the profession and your many contributions to society. Above all we all respect you as a person of unquestioned integrity. I send you my genuine compliments and wishes for your happiness and continued success in your future endeavors. Dr Avdesh Mehta: Dr Avdesh Mehta: Dy. Gen. Manager - Med. Admn: MEDANTA - the Medicity

2. Dear Colleague, It is my proud privilege to highlight that one of our professional colleague, Dr H S Rissam has achieved excellence in literature & arts. He has honoured the field of medicine & cardiology by writing a book of fiction "The Scalpel" the first ever written medical thriller in India. This book is being published & distributed by Rupa publications & is being given the acclaim in World Book Fair on Friday Feb 5th. I would request you to be a part of this memorable & historical event. Warm regards, Dr. Rakesh Gupta

Letter to the Editor

Dear Sir, This is a query regarding something that is mentioned in the emedinews update (dated 28th Jan, 2007).Your newsletter mentions a case as follows: A 70-year-old male with antibiotic-associated diarrhea and TLC of 24000 per cumm died.
Reaction: Oh my God! Why was surgery not considered in this case? Make sure that urgent surgical evaluation is done in patients with acute gastroenteritis who are above 65 years and have a white blood cell count over 20,000 cells/microL and/or a plasma lactate between 2.2 and 4.9 mEq/L.
Query: I am unable to understand as to what was the underlying cause for which an urgent surgical evaluation is recommended in such a case. I would be really obliged if you could further elaborate on it and clear my doubt. (Dr. Deepali Garg)

A: As per guidelines, in a case with antibiotic confirmed associated diarrhea (C difficile), conditions as mentioned herein are the indications for surgical intervention.


Punjab & Sind Bank
Central Bank of India

Question of the Day

How is combination therapy effective in combating multiresistant malaria?
Antimalarial chemotherapy has been the primary option in the fight against malaria. However, the burden of this disease is still very heavy partly due to the development of multi-drug resistant Plasmodium falciparum strains. The malaria community presently considers mono-therapy as an inappropriate approach for malaria treatment. One of these strategies is the use of artemisinin-based combination therapies (ACTs) which have proven to be very effective against malaria in Africa, and some African countries plagued with resistant forms of P. falciparum have started instituting the ACTs as first-line malaria treatment.

Suggested readings

1. World Health Organization: Position of WHO' Roll Back Malaria Department on malaria treatment policy.
Statement: WHO [http://www.who.int/malaria/docs/who_apt_position.htm] 2004.
2. Kremsner PG and Krishna S. Antimalarial combinations. Lancet 2004;364:285-94. 3. World Malaria Report 2005: 5-minute briefing [http://rbm.who.int/wmr2005/ pdf/adv_e.pdf] 2005.

Dr Good Dr Bad

Situation: A 34-year-old-woman with PCOS on metformin got pregnant.
Dr Good: Continue metformin.
Dr Bad: Stop metformin.
Lesson: In women with PCOS, continuous use of metformin during pregnancy significantly reduces the rate of miscarriage, gestational diabetes requiring insulin treatment and fetal growth restriction. No congenital anomaly, intrauterine death or stillbirth is reported. (J Obstet Gynaecol Res 2008;34(5):832-7)

Make Sure

Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?

Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

Formulae in Imaging

British Thoracic Society guidelines define a pneumothorax as small if the distance from chest wall to the visceral pleural line is less than 2 cm or large if the distance from the chest wall to the visceral pleural line is 2 cm or greater. Some clinicians prefer 3 cm as the threshold to distinguish small and large pneumothoraces. (Source: Thorax 2003;58:39)

Mistakes in Critical Care

Written prescriptions must be legible; printing is usually best.

Emedinews Try this It Works

"Magic feather" can aid pediatric venipuncture
Administering injections or taking blood can be difficult in children. Magic feather technique is used in Cambridge UK to improve the success rate of pediatric venipuncture. Try not to be embarrassed. (This requires quite a bit of role-play!)

1. Hand the child an imaginary magic feather and describe it in detail.
2. Show the child that by blowing gently on the invisible feather, it can be suspended in the air above the child's head.
3. Ask the child to continue blowing to keep the imaginary feather in the air, so its magic power doesn't disappear.
4. When the child is deeply engrossed in playing with the magic feather, venipuncture can be carried out.

Milestones in Neurology

Samuel Alexander Kinnier Wilson was a British neurologist who specialized in clinical neurology, and made important contributions in his studies of epilepsy, narcolepsy, apraxia and speech disorders. He described hepatolenticular degeneration, which later came to be known as 'Wilson's disease. In this treatise, he is credited for introducing the term 'extrapyramidal' into neurological medicine.

Laughter the Best Medicine

Gynecologist: Nurse, how is that little boy doing, the one who swallowed ten quarters? Nurse: No change yet.

SMS Anemia

Neutrophil hypersegmentation is defined as the presence of >5 percent of neutrophils with five or more lobes and/or the presence of one or more neutrophils with six or more lobes.               


When you pray, rather let your heart be without words than your words without heart. (John Bunyan)

Congratulatory Messages for Dr KK Aggarwal

1. Manjuli Bhargava, Manjuli Prakashan: Congratulations on receiving Padmashri award. Wishing you luck and success in all that you do.
2. VB Nagpal and family: Respected Doctor Saheb, many many congratulations for Padmashri award.
3. Dr. B M S Bedi: Congratulations. Great honour to you.
4. Dr Alka Gujral: Congrats. We are proud of you.
5. Dr. DR Rai: Heartiest congratulations. May God bless you with more success and achievements.
6. Vipin Kharbanda: Congratulations
7. Tarun Bhalla & family: Dr. Aggarwal, our heartiest congratulations for Padmashri award.
8. Dr Chowbeys: Heartiest congratulations. What a great news. Well done. Will be back in India on 29th. Calls for big celebrations.
9. Nitish IBN7: Congratulations, Sir for getting such a prosperous award.
10. Tewari: Heartiest congratulations on being decorated by Padmashri.
11. Dr. P K Srivastava: Congratulations and good wishes for success in every field of life.
12. Karishma Paul, Congrats. You deserved it long back.
13. Anjali Sethi, Principal, ITI Pub School, Dwarka: Heartiest congratulations for being awarded Padmashri.
14. Dr. Prakash Jain: Heartiest congratulations Sir. You worked so hard to maintain dignity of the profession.
15. Dr. G S Batra: Heartiest congrats.
16. Dr Narottam Puri: Congrats on being conferred Padmashri
17. R. Vij: Our family congrats you for being recognized for your passion and devotion for the welfare of society and even beyond humanity. Very well deserved Sir. Our best wishes for many more recognitions to follow globally.
18. Sanjay Chaudhary: Congrats. I feel proud that I know a Padmashri so close.
19. Many congrats. Well deserved honour: Ajay Gambhir
20. Heartiest congratulation: Manoj Sethi, Director (Fin.) NDMC
21. Congratulations: Nalini Singh
22. Many many congratulations Dr. Aggarwal: Vaid Satya Dev
23. Congratulations for Padmashri: Vijay Kr. Gupta
24. Dr.Asim Sarkar, IMA Calcutta: Congrats. We feel proud of you.
25. Subhash Vatsain: Congratulations. Padmashri is true recognition of your untiring service to lakhs of Delhites. We are sure your health tips reach millions and benefit them forever.
26. Dr. Subramanian: Congrats on your Padmashri.
27. Atal: Many many congratulations, Sir. 

Public Forum
Press Release

P.P. Jhunjhunwala XXI National Excellence Award Conferred on Dr KK Aggarwal

P P Jhunjhunwala Foundation XXI National Excellence Award 2010 was presented to Dr. K.K. Aggarwal, President Heart Care Foundation of India and Chief Editor, Emedinews and Mr. Ravi Singhania, an eminent legal luminary. The Chief Guest was Sh. Sudarshan Aggarwal, Former Governer of Uttarakhand. Dr. Abhishek Manu Singhavi, eminent Parliamentarian and Legal Luminary presided over the award function. Dr. KK Aggarwal, earlier this week was conferred with the Padma Shri for his contribution to the society.

Dr Aggarwal who is also a recipient of Dr. B.C. Roy National Award, was given this excellence award for his devoted and profound service in health care of the people.

Dr Aggarwal is known for organizing Perfect Health Mela for the last 16 years. He is also a Senior Lifestyle Cardiologist at Delhi's Moolchand Medcity, Member Delhi Medical Council and Past President, Delhi Medical Association. He has also served as the Head of Research and Academic Wings of IMA.

Some of the past recipients of the award include Dr. Naresh Trehan, Dr. Yatish Agarwal, Pandit Birju Maharaj, Ms Yamini Krishnamurthy, Dr. SP Bajaj, Dr. PK Dave, Ms Shovna Narayan, Dr. SP Manchanda, Ms Sonal Mansingh, Prof. Ram Gopal Bajaj, Pandit Rajan Sajan Mishra, Ms Madhu Mudgal, Dr. U Kaul, Raja Radha Reddy, Dr. Geeta Chandran, Dr. Amita Chauhan and Dr. Mohan Nair.

Silicic Acid (Sodium Meta Silicate) helps Improve Memory Loss in Old age, Especially in patients with Alzheimer's Disease , by Reducing the Uptake of Aluminium into the Brain Tissue.. It provides Stronger Bones and Smoother Joints by Mobilising Calcium and Increasing the Bone Mineral Density.Recent Studies have shown Sodium Meta Silicate to help Reduce the LDL and VLDL levels and Increase the good Cholesterol,the HDL. In the Year 2009, Sodium Meta Silicate has been rated as one of the most Popular and Effective Immunity Boosting Health Supplement available in the United States of America and Europe and has been Recognised as one of the ADVANCED SCIENTIFIC HEALTH FORMULAS ( ASHF).

(Advertorial section)

eMedinewS-revisiting 2010

The second eMedinewS-revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on 2nd January 2011. The event will have a day long CME, doctor of the year awards, cultural hangama and live webcast.  Suggestions are invited.

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

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 BRMS Update

TAKING strong exception to the Union Health Ministry's proposal for a rural MBBS course to provide treatment in far-flung areas, the National Human Rights Commission (NHRC) on Friday termed it discriminatory. At a day-long meeting of State Health secretaries, NHRC member PC Sharma said people in rural areas were entitled to treatment from fully-qualified doctors just as in urban areas.

Referring to a suggestion of having three and half years of short-term training for deployment in rural areas, Sharma said, "This step would be discriminatory to both the people who get treatment from such half-baked professionals and also to medical students who take eight to ten years to become a specialist."

In a bid to combat acute shortage of doctors in rural areas, the gover nment proposed a unique three-and-ahalf-year bachelor course for students from villages. Once the rural doctors get their degrees, they will be allowed to practice only in notified rural areas. NHRC acting chairperson Justice Mathur said that in the absence of recognised medical practitioners, rural and tribal population were dependent on unqualified doctors.
Justice Mathur said that one of the big challenges facing quality medical care was untrained and unqualified people or quacks practicing medicine even in a city like Delhi.

By Anandkumar , New Delhi/ NEW INDIAN EXPRESS 30.01.2010/ Posted by Dr. Paul Samuel, e-Communication Committee , JAC



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