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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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    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 to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal

5th October 2012, Friday

Obese Children Face Higher Heart Risks

Obese children have an even higher risk for heart disease, diabetes, and other weight-related diseases later in life than has been thought according to a study published in the journal BMJ.

The investigators found that, compared to normal-weight children, obese children had significantly higher blood pressure, cholesterol and blood sugar levels as well as thicker heart muscles.

It is known that obese children tend to have slightly higher blood pressure and cholesterol levels but the study doctors were shocked at the differences compared with those of normal weight. This was particularly true for obese girls, who had far higher blood pressure than healthy youngsters.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Levocarnitine Update

What is the clinical presentation of carnitine deficiency?

Deficiency of L-carnitine is usually secondary to another disease process and so the clinical presentation also includes symptoms of the primary disease. Due to carnitine deficiency, the energy available to the muscles is decreased leading to muscle weakness, myalgia and hypotonia. In the cardiac muscle, it can result in cardiomyopathy.

  • Acute metabolic decompensation with hypoketotic or nonketotic hypoglycemia usually occurs in infancy; cardiac and skeletal muscle disease manifest later. The episodes of metabolic decompensation, triggered by fasting or common viral illness, may cause encephalopathy which presents with lethargy, seizures, apnea, hepatomegaly or cardiorespiratory arrest.
  • Patients with organic acidemias causing secondary carnitine deficiency may present with hypoglycemia, ketoacidosis and hyperammonemia.
  • In patients with mitochondrial respiratory chain defects, carnitine deficiency may present with lactic acidosis, encephalopathy and storage myopathy.

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

Why BP should be kept < 120:80 mm Hg

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

19th Perfect Health Mela in November

The 19th MTNL Perfect Health Mela is being organised by Heart Care Foundation of India jointly with Department of Health, Delhi Government from 7th to 11th November, 2012 at Constitution Club of India, New Delhi. Addressing a press conference, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that focus of the Mela this year will be “Prevention of Non-Communicable Diseases”.

Dr K K Aggarwal
    National News

Breast cancer cases in city to double by 2025, predicts study

A 30 year-long study conducted by the Tata Memorial Hospital, Parel, has revealed the incidence of breast cancer is higher among older women. It projected that there will be a two-fold rise in number of breast cancer cases in Mumbai by 2025. According to the study, of 4,731 breast cancer cases recorded between 1976 and 2005 in the Mumbai Cancer Registry, the total number of cases detected among older women (50 to 74 years) was higher at 2,536 as compared to 2,195 among younger women (25 to 49 years). While 1,337 cases were reported in the city between 2001 and 2005, the study projected the number to rise to 2,664 by 2025. The study, 'Increase in breast cancer incidence among older women in Mumbai: 30-year trend and prediction to 2025', was published in the international Cancer Epidemiology Journal in March. "Lifestyle changes such as late marriages, delayed pregnancy and obesity are factors contributing to the rise in incidence of breast cancer among older women. Less number of children and less breastfeeding is also putting women at higher risk of breast cancer," said Dr Rajesh Dikshit, principal investigator of the study. It predicts that from 698 breast cancer cases reported between 2001 and 2005 among the older age group, the number will rise to 1,545 cases by 2025. (Source: Hindustan Times, October 2, 2012)

For comments and archives

My Profession My Concern

Include this in your practice

Voiding cystourethrogram following febrile urinary tract infection

Voiding cystourethrogram should be done to evaluate possible vesicoureteral reflux (VUR) for children of any age with =2 febrile urinary tract infections (UTIs) or a first febrile UTI and any of the following: a family history of renal or urologic disease; poor growth; hypertension; or a non-E. coli organism.

(Ref: Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595)

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

The 2006 American College of Cardiology/American Heart Association (ACC/AHA) and the 2007 European Society of Cardiology (ESC) guidelines for the management of valvular heart disease guidelines made the following general recommendations

  • A mechanical valve is recommended in patients who already have a mechanical valve in the mitral or tricuspid position.
  • A mechanical valve is reasonable in patients under 65 years of age who do not have a contraindication to anticoagulation.
  • A bioprosthesis is recommended in patients of any age who will not take or have major contraindications to warfarin therapy.
  • A bioprosthesis is reasonable in patients =65 years of age who do not have risk factors for thromboembolism and in patients under age 65 who choose this approach for lifestyle reasons after a detailed review of the risks of anticoagulation compared to the greater likelihood of a second valve surgery in the future.

(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)

Cardiac care 'implied' in diabetes guideline

Although recent recommendations to individualize therapy for type 2 diabetes don't focus on managing cardiovascular comorbidities, heart risk reduction is an overarching theme, diabetes specialists said at the European Association for the Study of Diabetes meeting. Silvio Inzucchi, MD, of Yale University, co-chair of the writing committee for the recommendations, said that even though there are no specific instructions for cardiovascular risk in this guidance, comprehensive risk reduction should be a major focus of therapy. (Source: Medpage Today)

For comments and archives

Telemedicine can expand screening for retinopathy

Screening for diabetic retinopathy may be feasible in a primary care setting using telemedicine, researchers found. (Source: Medpage Today)

For comments and archives

New depression guideline goes beyond symptom relief

The treatment of major depressive disorder (MDD) should go beyond the goal of symptom relief to include a more global target of improving patients' overall and occupational functioning. This shift is reflected in new consensus recommendations currently being finalized by the Canadian Network for Mood and Anxiety Treatments (CANMAT). (Source: Medscape)

For comments and archives

RA patients may face higher blood clot risk

Rheumatoid arthritis patients appear to be at an increased risk for venous thromboembolism (VTE) in the first decade of diagnosis compared with the general population, Swedish researchers reported. (Source: Medpage Today)

For comments and archives

   Twitter of the Day

@DrKKAggarwal: 5 Ways to Stop A–Salting Your Kidneyhttp://blog.kkaggarwal.com/2012/10/5-ways-to-stop-a%e2%80%93salting-your-kidney/

@DeepakChopra: The candidate who inspires hope, stability, compassion & trust & specific action steps to achieve greatness deserves to win

    Spiritual Update

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

Shradhs in Hindu Mythology

Shradhs are observed by every family in Indian Hindu culture to seek forgiveness from the deceased person and our ancestors for their unfulfilled known or unknown desires.

Traditionally, people observe shradh either on the day of Amavasya every month or on the death anniversary of the deceased person/s or during Shradh days observed in Chaturmas coinciding with the Hindi Tithi or the date on which the deceased person had died. Shradhs are observed until Mahashradh is observed which is usually at a place near Ganga in Gaya, Pushkar or Haridwar etc.

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)

What are the risks of tubal surgery?

The biggest risk after tubal surgery is the possible development of a tubal (ectopic) pregnancy. A tubal pregnancy is a serious health problem that is more likely to happen after tubal surgery or tubal disease. The fertilized egg does not travel to the uterus. Instead, it stays in the fallopian tube and begins to grow there. The tube is too small to hold a baby, and the tube will burst if the pregnancy continues. The mother may have internal bleeding or rarely could even die.

For comments and archives

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

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

Blood Donation - Gift of Liquid Love

  • Surgical techniques are becoming increasingly sophisticated and complex procedures more numerous.
  • Cancer surgery, reconstructive operations, open-heart procedures, and organ transplantation all make special demands upon the blood bank.

For comments and archives

    Liver Abscess Update

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

When should follow up imaging be done?

USG is best for follow up, although it is not routinely necessary. The abscess cavity takes many months to finally resolve and lags behind clinical resolution by months.

For comments and archives

   An Inspirational Story

The story of a blind girl

There was a blind girl who hated herself just because she was blind. She hated everyone, except her loving boyfriend. He was always there for her. She said that if she could only see the world, she would marry her boyfriend.

One day, someone donated a pair of eyes to her and then she could see everything, including her boyfriend. Her boyfriend asked her, “now that you can see the world, will you marry me?”

The girl was shocked when she saw that her boyfriend was blind too, and refused to marry him. Her boyfriend walked away in tears, and later wrote a letter to her saying:

“Just take care of my eyes dear.”

For comments and archives

   Cardiology eMedinewS

Dabigatran not ready for valves Read More

Risk model may optimize ICD placement Read More

   Pediatric eMedinewS

Sleep disturbance linked to CV risk in adolescents Read More

Infection diagnosis in children: MD gut feeling is important Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with pain in abdomen was found to have TLC > 20000.
Dr Bad: Repeat TLC.
Dr Good: Rule out liver abscess.
Lesson: Liver abscess typically has TLC > 15000.

For comments and archives

Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/70 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored. It is an impending sign that the patient is going into shock.

For comments and archives

    Legal Question of the Day (Dr M C Gupta)

Q. I think that by introducing the BSc (Community Health) course, the government is violating the Bhore Committee recommendation not to have a medical course lesser than MBBS. What are your comments?

Ans. My comments are as follows:

  • The Committee headed by Joseph Bhore, ICS, gave its recommendations around 1946. Much has changed since then. No committee report can be valid for eternity.
  • It is true that Bhore Committee suggested stopping the licentiate course and gave a utopian call that every villager must be treated by an MBBS serving 5000 population through one ANM per 1000 population. Those were the days, in mid-forties, when: female literacy in India was probably around 10%; ANMs were at the best semi-literate; there were no motorized vehicles in rural areas; and roads were mostly non-existent. Mobile phone and internet were unknown. If a semi-literate, immobile ANM could serve 1000 people living in places without roads and electricity as per Bhore Committee recommendations, why a mobile BSc with internet compatible cell phone cannot provide health care to those “who want his services”? Anybody who does not want can always go anywhere else.
  • Even otherwise, a committee report/recommendation is just that—a report/recommendation. It is not a law. Even laws can be changed. Even the Constitution can be amended. There is no reason why the concepts put forward by the Bhore Committee cannot be changed.
  • The question of violation of the Bhore Committee recommendation not to have a medical course lesser than MBBS does not arise. The BSc (Community Health) course is, obviously, not a medical course.
  • There are some people in India who swear by the excellence of US health system. They need to appreciate that nurse practitioners and osteopaths are a reality there. I have never heard the American Medical Association objecting to them.
  • Even otherwise, the concept of a GP is declining among doctors. Everybody, after MBBS, wants to get a PG degree. In the coming days almost all MBBS graduates will go for specialization as there is a talk of increasing PG seats to about 80% of the MBBS seats. Doctors, particularly the PG degree holders, may continue to be concentrated in cities. The public, especially in non-urban areas, where 70% Indians live, will certainly need basic health care. There must be someone to provide it.
  • It would be in the fitness of things to develop the following two types of personnel who may provide basic health care with limited treatment rights.
    • The BSc. Community Health cadre proposed by the government at present. They should be registered with a non-medical, non-nursing council.
    • The nurse practitioner cadre who may be given the degree of MSc (Nurse Practitioner) after appropriate training. Those given such training should have completed, a specified period of service as a nurse. They may continue to be registered with the nursing council.
  • It is useful at this stage to briefly review the concept of a NP. Wikipedia has this to say—

    “A Nurse Practitioner (NP) is an Advanced Practice Registered Nurse (APRN) who has completed graduate-level education (either a Master of nursing or Doctor of Nursing Practice degree). Nurse Practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, ordering and interpreting diagnostic tests. NPs can then diagnose certain diseases and provide appropriate treatment for the patients, including prescribing select medications.[1] NPs can serve as a patient's primary health care provider, and see patients of all ages depending on their specialty (family, pediatrics, geriatrics, etc.). The core philosophy of the field is individualized care that focuses on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. In addition to health care services, NPs conduct research and are often active in patient advocacy activities. To become licensed/certified to practice, Nurse Practitioners hold national board certification in an area of specialty (such as family, women's health, pediatrics, adult, acute care, etc.), and are licensed through the state nursing boards.

    According to the International Council of Nurses, an NP/Advanced Practice Nurse is "a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which would be determined by the context in which s/he is credentialed to practice."(2)

    Additional Advanced Practice RN roles include the Certified Registered Nurse Anesthetist (CRNA)s, Certified Nurse-Midwife (CNM)s, and Clinical Nurse Specialist (CNS)s.”

    -- http://en.wikipedia.org/wiki/Nurse_practitioner
  • For far too long have physicians abrogated to themselves the exclusive right to treat patients. It needs to be recognised that, in law, a patient can choose anyone of the following courses—
    • Not getting any treatment, including self- treatment.
    • Treating oneself.
    • Getting treatment from another layman as long as that layman does not violate some law while giving such treatment.
    • Getting treatment from a paramedical person.
    • Getting treatment from a quack. (NOTE—It is the patient’s legal right to get treated by anybody, including a quack. However, the quack may be violating law by undertaking such treatment).
    • Getting treatment from an AYUSH practitioner.
    • Getting treatment from a physician qualified in modern medicine.
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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

Photos of Doctor’s Day Celebration

eMedinewS Apps
    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)

Prothrombin time (PT)

PT is done in a person with hepatitis or suspected hepatitis. Coagulation factors (proteins used in the formation of a blood clot) are mostly produced by the liver, and prolonged PT may indicate the severity of liver damage.

  Quote of the Day (Dr GM Singh)

Good friends care for each other… close friends understand each other... and true friends stay forever beyond words, beyond time...

    Mind Teaser

Read this…………………

Which is considered as the earliest sign of increased ICP that the nurse should closely observed for?

A. Abnormal respiratory pattern
B. Rising systolic and widening pulse pressure
C. Contralateral hemiparesis and ipsilateral dilation of the pupils
D. Progression from restlessness to confusion and disorientation to lethargy

Yesterday’s Mind Teaser: A post-operative complication of mastectomy is lymphedema. This can be prevented by

A. ensuring patency of wound drainage tube
B. placing the arm on the affected side in a dependent position
C. restricting movement of the affected arm
D. frequently elevating the arm of the affected side above the level of the heart.

Answer for yesterday’s Mind Teaser: D. frequently elevating the arm of the affected side above the level of the heart.

Correct answers received from: Dr Mohit Sharma, Dr PC Das, Dr Kanta Jain, Dr (Maj. Gen.) Anil Bairaria, Drjella, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Raju Kuppusamy, Dr Thakor Hitendrsinh G, Dr Avtar Krishan Dr KV Sarma.

Answer for 3rd October Mind Teaser: All of the above
Correct answers received from: Bal Kishan Agarwal, Dr KP Chandra.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr. GM Singh)

As an English professor, my father would often write little notes on student essays. Often he worked late, and as the hours passed, his handwriting deteriorated. One day a student came to him after class with an essay that had been returned. "Mr. McDonald," he said, "I can’t make out this comment you wrote on my paper." My father took the paper and, after studying it, sheepishly replied, "It says that you should write more legibly."

    Medicolegal Update

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

Post mortem test in surgical death with alleged negligence

The strict test to be applied should be: ‘Could death have occurred, if the operation had not taken place?’

  • Information is required before beginning the medicolegal autopsy. The patient’s notes are essential along with some other relevant information. Equally important is the attendance of clinicians at the autopsy, more indeed, in deaths associated with anesthesia.
  • Discussion among autopsy surgeon and the anesthetist may arrive at an amicable conclusion of opinion to offer the investigating authority.
  • The hospital lab may be requested to retain any antemortem blood or fluid samples sent to them so that they remain available for analytical checks, such as blood grouping in transfusion mishaps, or creatine phosphokinase activity in malignant hyperthermia
  • If death is due to a disease or disability, other than that for which the operation was performed, a distinction has to be drawn between those conditions that were known before the operation was and those which were unexpected. Naturally, operative and anesthetic techniques may have to be modified to take into account the known adverse conditions.
  • Death may occur due to failure of a surgical technique. This may be inadvertent, from a true ‘accident’ sometimes caused by unusually difficult operative circumstances, to anatomical abnormalities or even failure of equipment.
  • When death is a result of error of incompetence, then a legal action for negligence may ensue and the autopsy surgeon must be even more meticulous than usual in producing a detailed and impartial report.
  • When a failure of equipment may be responsible, then expert examination and advice is required. Anesthetic machines, gas supply, compatibility of connections and all the sophisticated hardware of Operation Theater must be subjected to the most rigorous inspection if a malfunction is suspected. This is an important concern of the autopsy surgeon, as he is responsible for the eventual decision about the cause of death.
  • Cardiac arrest was found to be the most common single mode of death, being seen on average once or twice a year in most busy operating suites even under the most careful surgical and anesthetic regimens. Most cardiac arrests occur either at the start or end of the surgical procedure.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

19th Perfect Health Mela in November

The 19th MTNL Perfect Health Mela is being organised by Heart Care Foundation of India jointly with Department of Health, Delhi Government from 7th to 11th November, 2012 at Constitution Club of India, New Delhi. Various activities will be organised at multiple locations, a week before the event.

Addressing a press conference, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that focus of the Mela this year will be “Prevention of Non-Communicable Diseases”.

Co-addressing the press conference, Mr A K Srivastav GM (Marketing) MTNL Delhi, Mr Deepak Chanduka, GM, MTNL Corporate Office, Dr N K Yadav MHO MCD South Zone and Sr representatives from DHS, Dept. of Health & FW Govt. of NCT Delhi, NDMC and SAIL said that the Mela will be a unique opportunity for people from all walks of life to get preventive awareness about non-communicable diseases incorporating all pathies and using the medium of exhibition, checkups, competitions, workshops under one roof.

Ms Nalini and Ms Kamalini, eminent Kathak exponents, guests for the press conference, released the theme and logo of the event. A chart containing various activities was also released. The highlight of this year’s Mela will be a series of workshops of all pathies in non-communicable diseases. Ten thousand members of the public will also be trained and certified in compression-only CPR.

Delhi Transport Corporation will also run special buses for the various locations from Mela venue. Over 3000 school children, 1500 nurses and 1000 youth will participate in various events. Over 1000 cardiologists from all pathies, totaling 1000 will participate in various workshops.

Special arrangements are being made and special counters are being made for the residents of Noida, Ghaziabad and Gurgaon.

    Readers Response
  1. Dear Sir, Good information in the emedinews. Regards: Dr Shreya
    Forthcoming Events
Dr K K Aggarwal

19th MTNL Perfect Health Mela

Heart Care Foundation of India and Depts. of Health & Family Welfare, Govt. of Delhi in association with World Fellowship of Religions, NDMC, MCD are organizing 19th MTNL Perfect Health Mela at Constitution Club of India Rafi Marg, New Delhi from 7th-11th November 2012 (8am-8pm). The focus this year will be Prevention of Non Communicable Diseases.

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