eMedinewS
8th December 2014, Monday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Why should we eat seasonal fruits and vegetables?

God will grow only those fruits and vegetables, which are necessary in that season in that particular location. For example, during summer, the body requires more liquids and regular flushing of the kidney because of extreme heat so that dehydration does not damage kidney. To prevent this, nature produces vegetables and fruits in this season that are juicier and increase urination.

All summer fruits like mango, lichi, watermelon, musk melon, wood apple (bel), etc. are juicy fruits. All vegetables grown in summer such as bottle gourd (ghiya), snake gourd (torai), apple gourd (tinda) grow on creepers and they all have a mild diuretic action.

In summer, where the humidity is not so high like in Delhi, one need not take coconut water, which is only required as a treatment of humidity-related diseases. Therefore, nature grows coconuts only in the coastal areas.

66th Annual Conference of Cardiological Society of India (CSI) -2014

Dr Ajay S Chaurasia

An Interview with: Dr Ajay S Chaurasia, Mumbai

There is an increased usage of Rosuvastatin in PCI setting. Which trials on rosuvastatin have helped build your confidence in this regard?
PCI is associated with up to 30% incidence of myonecrosis, as reflected by elevation of cardiac enzymes even in a successful procedure. Apart from technical complications, myonecrosis after PCI might be due to a distal embolization of atherogenic materials from plaque disruption, causing a secondary inflammation and finally a microvascular obstruction. Statins therefore may have important role in reducing this complications - Roma II trial confirms this. It had significant decrease in periprocedural myonecrosis rate and C-LDL fraction (Kim Ji-won et al.) High dose rosuvastatin loading before PCI reduced myocardial damage and major adverse cardiac event (MACE) in patients with stable angina and acute coronary syndrome
The recent IBIS-4 trial has concluded that rosuvastatin therapy helps shrink plaque volume in non culprit vessel. What is your opinion on this?
Coronary atherosclerosis is a chronic inflammatory disease, which may go undetected for decades before it gives rise to disease manifestations such as stable, obstructive coronary artery disease, or ACS. Statin therapy effectively reduces cardiovascular events in the setting of primary and secondary prevention, with a particular benefit occurring early after treatment initiation in ACS patients. High-intensity rosuvastatin therapy has been shown to more effectively lower LDL-C and increase HDL-C compared with other statins (Nicholls et al in Journal of American College of Cardiology 2010). Patients with STEMI are at high risk for recurrent atherothrombotic events, which is related to multifocal disease with a high prevalence of vulnerable plaques (Goldstein study et al in NEJM 2000) typically extending beyond the culprit site due to widespread inflammation in other plaques including increased protease activity. Though it is in early stages, reduction of non-culprit vessel plaque volume may have a role in prevention of further acute coronary events. This is also confirmed in Korean study by Kyeong Ho Yun (Circulation 2009).
Rosuvastatin has proven in PRATO-ACS trial to prevent contrast-induced acute kidney injury. Is it something you look out for?
Patients undergoing PCI are definitely at risk of CIN. Therefore prevention is definitely desirable. Patients with ACS are at high-risk for acute kidney injury (AKI) during PCI. Results of the PRATO-ACS trial showed lower risk of contrast-induced AKI in patients assigned rosuvastatin vs placebo (6.7% vs. 15.1%; adjusted OR 0.38; 95% CI 0.20-0.71; P=0.003). Solomon also cited a study published in 2014 in the Journal of the American College of Cardiology. The largest trial to date on the topic, enrolling nearly 3,000 patients with diabetes and chronic kidney disease (most statin-naive), observed a reduction in AKI incidence with rosuvastatin (2.3%) compared with control (3.9%; P=0.01).These are the two largest and most recent trials and are the only trials that show a statistically significant benefit of statins on contrast-induced nephropathy. But more study has to be done before it becomes a standard line of treatment.
In your experience how do you step up or step down post PCI patients with rosuvastatin?
Post PCI we start with a moderate to high intensity dose of statin irrespective of baseline lipid profile i.e. 40 mg of rosuvastatin for 3 months. Patients with low risk factors are then shifted to 20 mg daily. Patients with high risk factors are continued with 40 mg of rosuvastatin for obtaining its maximum pleiotropic effects.

Cardiac nutrients & CVD protection: New frontiers

  Dr H K Chopra(Dr. H.K. Chopra, President Elect. CSI & Chairman Scientific Committee )

  • •   CVD assuming epidemic proportions in India. CAD is 4 times higher in Indians at all ages. It is 10 times  higher in young Indians (< 40yrs). India will be the world capital of CVD (65% of the world CAD burden- 2015). India is already the world capital of diabetes and hypertension. CVD mortality is decreased  by 60% in Japan, Finland, 50% in Australia, Canada and US, and  25% in W. Europe. WHO Projections are  that there will be 100%  rise in mortality from CAD in India By 2015.

Heart failure especially diastolic heart failure (abnormal relaxation of heart ) due to increase stiffness is very common after the age of 50 in obese individual. 

To be an Indian is risk for CAD, the disease is premature, diffuse, 10 year early, with poor distal  run off, EXTENSIVE,  three vessels disease, with higher prevalence of metabolic syndrome upto a tune of 65-70% in the age group of 40-60 with higher prevalence of vulnerable plaque and carotid intimal media thickness.    

Prevalence of hypertension  is very high upto an extent of 70-80% in metabolic syndrome. In the recently published data in Indian Heart Journal. 

Most of the Indian are suffering from Erratic over consumption  or under consumption malnutrition. 

Co Q10 & Omega 3 FA are the need of the hour for CVD Protection. 

Co Q10 is Bioenergizer, Cardioprotective, Vasoprotective, Antioxidant and Anti Inflammatory reduce CVD morbidity and mortality. 

Recently published data in SYMBIO Study has shown significant benefits of Co Q10 in CVD morbidity and mortality reduction  especially in patient with CAD, Hypertension and Heart Failure. 

Co Q10 has shown significant improvement in muscle pain and muscle weekness produce  by  Statin Induced Co Q10  reduction. 

OM3: OM6 ratio of 1:4 is the need of the hour. 

Omega 3 FA such as ALA found in Walnut, Flaxseed Oil & soybeans required in doses of: 1.5-3 gms/day DHA found in fish required in doses of : .5- 1.5 gm /day. It has tremendous cardio protective potential.  It Reduces Adinopectin, Platelet Aggregation, E Selectin and help Plaque Passivation.  

Recently published data favours regular consumption of omega 3 PUFA to have CVD morbidity and mortality reduction. 

Vitamin D, Omega 3 and Co Q10 optimization is the need of the hour for CVD Protection.

 

Synopsis of Giant Legend of Cardiology Interactive Session 
Dr H K Chopra    Dr N C Nanda             
Dr. H.K. Chopra, India …..Dr. Navin C. Nanda, USA       
Please tell me about the tips for becoming the World Father of Echocardiography for our attendees?
 First of all, I am most humbled that on behalf of the Cardiological Society of India  you have included me in the Giants and Legends in Cardiology in the world and have called me the World Father of Echocardiography. To answer your first question,  to my mind,  hard work, dedication and innovation are the three most important aspects for success in any field including echocardiography. To master a technique and attain thoroughness, it is most important to pick up some research projects because this will make you search the internet and digest all the information published in the world on the subjects concerned and will spur your mind to develop innovative strategies. You will have a very clear concept of what is lacking and what needs to be worked on. Humility is also important. I remember once at a farewell dinner for a young Fellow who had worked with me for a long time, he mentioned to my wife Kanta that " after having worked with Dr Nanda for a long time and learning everything from him  I have become an expert in  the technique and now  I know everything about echocardiography" to which my wife replied "that is really fantastic because your teacher Dr Nanda complains all the time he is still learning echocardiography and there is so much more to imbibe and grasp !"
I also remember a  Fellow who worked very hard on a project  involving two- and three- dimensional echo assessment of LV noncompaction and when he went for an interview for a Residency position  he was queried on any research he had done.  At that time not too many people had knowledge of LV noncompaction  and the Fellow began explaining the lesion. The Program Director was so  impressed with his knowledge that he  asked him to give a lecture to all physicians and residents that afternoon on the subject. Having learnt and fully grasped  the subject because he had done  research on it,  the Fellow was able to give a masterly presentation and was immediately selected for the position. He  is now a fully fledged cardiologist.
How do you get this idea to choose Echocardiography as your career?
I learnt cardiology from Dr K.K. Datey and Dr Ivan Pinto and their team at Seth G.S. Medical College and King Edward Memorial Hospital in Mumbai, then relearnt it at the Institute of Cardiology and National Heart Hospital in London where I was selected as a Fellow and again had to relearn when I went to Rochester, New York.  Having thus  gained some knowledge of  conventional cardiology, I began to look for newer techniques which I could learn. At that time, I came across a 4 to 6  page paper which contained all the information available on the newly developed technique of echocardiography and found that it could noninvasively image the mitral, aortic and tricuspid valves but not the pulmonary valve because it was believed to be located under the  left lung. As a cardiology fellow, I had to attend some autopsies and talking with pathologists  found  the pulmonary valve was not located under the lung especially in patients with  a dilated pulmonary artery. This spurred me to make efforts to use echocardiography to find the pulmonary valve and together with Dr Raymond Gramiak, a radiologist, we succeeded in finding it. With this innovative landmark development, all the four cardiac valves could now be studied by echocardiography and this tremendously helped in the further growth of echocardiography. It also spurred the  development of pediatric echocardiography since now potentially fatal conditions such as transposition of the great vessels could be diagnosed by this modality. The first papers on the subject were published from our Laboratory and I remember often being called at night to make the diagnosis or exclude transposition in newborn cyanotic infants. Once the pulmonary valve was found, it became important to publish the findings as quickly as possible. Dr Gramiak, being a radiologist had some connection with a Radiology Journal and thought he might be able to publish it in that journal very quickly especially if he put his name and not my name as the first author. I agreed to this and that is the reason the paper was published in a radiology and not a cardiology journal. After publication of this paper, I had to travel to many centers  in USA and other countries to teach cardiologists the echo technique of imaging the pulmonary valve  and also had many cardiologists  spend time with me in our Laboratory from many centers including the Mayo clinic. These developments encouraged me to devote my career to echocardiography and contribute to its further growth and it is heartening to know it is currently the most cost effective non-invasive technique in the field of cardiology.
How many Books and Original Papers of Echocardiography published by you till date?
Answer. The number of publications exceed more than 1000, of which over 500 are original research papers. The number of books and video-textbooks exceed 20 including the latest one titled " Comprehensive Textbook of Echocardiography " which is in 2 volumes with 2000 pages, over 3000 illustrations and 8 DVDs containing 1800 movie clips. This is probably the largest and most comprehensive manual on echocardiography to-date covering all aspects and is published under the aegis of the Indian Academy of Echocardiography and the International Society of Cardiovascular Ultrasound.
The following is an abbreviated list of some of the research done by me:       
  • First to discover the pulmonary valve by echo.  This led to the development of pediatric echocardiography. 
  • First to diagnose a bicuspid aortic valve by echo.
  • First to characterize myocardial texture by echocardiography.
  • Invented treadmill exercise echocardiography.
  • Introduced color Doppler to the USA. Developed currently used criteria for semi-quantitation of mitral, aortic and tricuspid valve regurgitation.
  • Invented the technique of transpharyngeal and transgastric ultrasound.
  • Developed the technique of three- and four--dimensional transesophageal echocardiography.
  • Pioneered the use of echocardiography in cardiac pacing and electrophysiology
  • First to study and show high incidence of myocardial infarction in young adults in India and also relationship of diabetes mellitus to myocardial infarction.
Q. 4. Can you say a word how many doctors trained by you in Echocardiography in the globe and the importance of research.
Echocardiography is still a relatively young technique and there is considerable room for further developments and innovations in many areas including three- and four -dimensional echocardiography, speckle tracking imaging, contrast echocardiography and newer aspects of LV and RV function assessment including twist and torsion measurements. Further innovations on the horizon include plane wave ultrafast imaging with up to 20,000 frames per second, elastography and tissue characterization, miniaturization of  transducers and other equipment, therapeutic ultrasound, acoustic-optical imaging and vortex and particle imaging. These will undoubtedly enhance patient care throughout the world. 
Young and budding physicians in India should devote  a part of their time to  research which will  not only broaden their general outlook but also ensure in depth mastery of the subject and technique they are trying to learn rather than acquiring only superficial 'get by' knowledge. The government as well as other institutions should institute scientific research  as part of the  curriculum for both undergraduate and postgraduate medical education. It is also important to make it financially rewarding and competitive for those who choose a  career entirely in cardiac research or those who opt to go  for  both cardiology practice and research  as happens in academic institutions realizing this will pave the way for creativity, innovation and progress in cardiology. If this were to happen, India  with its huge population base of young individuals   could find itself  in the forefront of medical progress in the world. 

It is very difficult to ascertain how many individuals have been trained by me over the past  four or five decades or have been influenced in their clinical cardiology practice by the research, publications and books that I have written but their numbers, I am sure, run into thousands.

News Around The Globe

  • The first eating disorder guidelines to incorporate the latest recommendations from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including the new disorder of avoidant restrictive food intake disorder (ARFID), have been released. The evidence-based, multidisciplinary guidelines are produced by the Royal Australian and New Zealand College of Psychiatrists with a special focus on anorexia nervosa (AN). The guidelines are published in the Australian and New Zealand Journal of Psychiatry.
  • Patients with psoriasis exacerbation closely associated with recurrent tonsillitis may benefit from having their tonsils removed, suggests a literature review published online in the Journal of the American Academy of Dermatology.
  • Metabolic abnormalities in the pituitary region of the brain seen on 18-FDG positron emission tomography-computed tomography (PET/CT) may help differentiate veterans with post-traumatic stress disorder (PTSD) from those with mild traumatic brain injury (mTBI), suggests a new study presented at the Radiological Society of North America (RSNA) annual meeting.
  • In patients with transient ischemic attack (TIA) or a nondisabling stroke, subtle findings on computed tomography (CT) indicating acute ischemia may help identify patients at high risk for impending stroke, pointed a new study published online December 4 in Stroke.
  • Abdominal radiotherapy for testicular cancer increases a patient's risk of developing stomach cancer for several decades, suggests a new study published online in the British Journal of Cancer.

Dr KK Spiritual Blog

Why do we not offer Vanaspathi Ghee at the time of cremation or worship?

Vanaspati Ghee is never offered to God at the time of Aarti in the Diya or to the dead body at the time of cremation. Only pure ghee is offered.

It is considered a bad omen to offer Vanaspati ghee at the time of the last cremation ritual even though the consciousness has left the body.

What is not offered to God should not be offered to our consciousness and that was the reason for this ritual in a temple. Vanaspati ghee increases bad cholesterol and reduces level of good cholesterol in the blood. On the other hand, pure ghee only increases bad cholesterol but does not reduce the level of good cholesterol. The medical recommendation is that one should not take more than 15 ml of oil, ghee, butter or maximum ½ kg in one month.

It is a spiritual crime to offer vanaspati ghee to God.

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at Sarvodaya Kanya Sec. School, Pushp Vihar on 7th November 2014

nova

video of day
press release

Weight loss may improve sexual health of obese diabetes

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 101090 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation: A patient wanted to know if a gel was available for use along with a condom for a high–risk sex.
Dr Bad: There is no such gel.
Dr Good: There is one such gel.
Lesson: In July 2010, the Centre for the AIDS Programme of Research in South Africa (CAPRISA) reported that a vaginal gel containing the antiretroviral drug tenofovir reduced the risk of male–to–female sexual transmission of HIV by approximately 40%. NIH funding provided the training and research infrastructure for this study.

Make Sure

Situation: A 7–month–old infant presented with grunting respiration, fever, anorexia and irritability. On chest x–ray, pneumatoceles were present.
Reaction: Oh my God! Why did you not start erythromycin immediately?
Lesson: Make sure to remember that erythromycin is an effective drug for Staphylococcal acquired pneumonia.

eMedinewS Humor

The border

Juan comes up to the Mexican border on his bicycle. He’s got two large bags over his shoulders. The guard stops him and says, "What’s in the bags?" "Sand," answers Juan.

The guard says, “We’ll just see about that. Get off the bike." The guard takes the bags and rips them apart; he empties them out and finds nothing in them but sand. He detains Juan overnight and has the sand analyzed, only to discover that there is nothing in the bags. The guard releases Juan, puts the sand into new bags, hefts them onto the man's shoulders, and lets him cross the border.

A week later, the same thing happens. The guard asks, "What have you got?" "Sand," says Juan. The guard does his thorough examination and discovers that the bags contain nothing but sand. He gives the sand back to Juan, who crosses the border on his bicycle. This sequence of events is repeated every week for three years. Finally, Juan doesn’t show up one day and the guard meets him in a cantina in Mexico. "Hey, Buddy," says the guard, "I know you are smuggling something. It’s driving me crazy. It’s all I think about. I can’t sleep. Just between you and me, what are you smuggling?"

Juan sips his beer and says, "Bicycles."

Twitter of the Day

Dr KK Aggarwal: Travel more than doubles risk of blood clots
Dr Deepak Chopra: Love is the ultimate truth at the heart of the universe and transcends all boundaries

Inspirational Story

Changing a Lifestyle 

Where I do begin this story as the title states "Changing a Lifestyle"? I believe the best place to begin is to return to two years ago when I faced one of my fears of getting on the dreaded scale and seeing what the scale read. The scale read 265 pounds. That is the heaviest I had ever been in my life and even at 5' 7" that is too much weight. I came to the realization that there was not anything stopping me from getting heavier except for the fact I could do something about it.

At first, I had to just contemplate how was going to lose the weight and tried to make small adjustments in my eating patterns. Then two years ago in September, while I was at my annual physical at my Doctor's office, I asked her about what I could do concerning my need to not only lose weight but keep in good health.

My health had been good up to this point with my blood pressure just starting to be borderline high. I thought at 46yrs of age, it would be good to do something about the weight before someone told me I had to do something about it. My Doctor gave me several suggestions that we talked about extensively.

The suggestion we chose included drug therapy along with a diet that allowed no more than 30 percent or less fat. Now at this point, I am not particularly saying that the drug is for everyone or that it is a magical pill. I do believe that it did help with my weight loss with very few side effects.

Part of what I did, as suggested, was to keep a food diary. I found that it was very helpful for me in the beginning. It made me accountable for what I was eating and I could easily see my eating patterns at a glimpse.

I did gradually lose weight over the next six months going from 265 pounds down to 224 pounds while using the drug and keeping my diet at 30 percent or less fat. Of course, at first, I did not need to do any extra exercise because my work and activity level were enough to help with the weight loss. I knew that I would have to add some sort of formal exercise program, at some point, to be able to continue my weight loss.

This was not an easy decision for me because I will stress, at that point, I was the one of the original couch potatoes. I had, at one time in my life, lost a substantial amount of weight but I had never really exercised or toned my body. I had never felt any different, even with losing the weight. I decided that this time it would be different. Not only would I lose weight, but also be toned, fit, and healthy, no matter what weight I would end up at.

Then a year ago, at the end of March, I joined the SVH Wellness Center as a member. The first exercise program I joined was the water aerobics program. I had always loved the water and knew this probably would be an excellent exercise to start with, as there is less impact on the joints. I have to tell you I love water aerobics, but as you may have read somewhere, in any number of magazine articles, it is best to find an exercise activity that you really like to do.

I am happy to tell you, as of this writing, that I have made my first major goal of weighing in at 200 pounds and shortly to drop under that mark. Also, my blood pressure is now within the normal limits. I am now doing water aerobics, jazzercise, riding my new 15-speed bicycle and walking a mile and half easily, which a year ago I would not have been able to do. I have found that I really do enjoy exercising and how it is a wonderful stress reliever.

Dear reader, I do not want you to think that I have done this "Lifestyle Change" by myself because that it is not the case. My family and friends have been great source of encouragement and help through these last two years. Their encouragement came so many times in the form of a well-timed comment of how good I looked.

Even though, at the time, I was a bit discouraged or at one of the inevitable weight loss plateaus, I want to thank them for all the love and support that they have given me. I could not have come as far as I have without it. I believe their greatest gift to me has been that it never truly mattered what I weighed; they still cared for me. They now are very happy for me because of the change they see in me for a variety of reasons.

This is the end of this particular story but I will continue on what I have started two years ago. I am not exactly sure where I will be, but I do know will be happy at whatever weight that I end up at.

Rabies News (Dr A K Gupta)

Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.

Cardiology eMedinewS

  • Adding the angiotensin-receptor blocker (ARB) olmesartan on top of an ACE inhibitor and/or a beta-blocker did not improve clinical outcomes and worsened renal function in hypertensive patients with stable heart failure, suggested a large trial presented at the American Heart Association (AHA) 2014 Scientific Sessions.
  • A new study has shown that a new technique which wraps chemotherapy drugs in a fatty cover (called a liposome) reduces heart damage. The study was presented at EuroEcho-Imaging 2014.

Pediatrics eMedinewS

  • Teenagers whose hearing loss was detected very early in infancy had better reading comprehension than their hearing-impaired peers who were diagnosed later, suggests a new study published online in the Archives of Disease in Childhood. The results suggest that detecting hearing loss, and intervening at an early stage, can make a lifelong difference in development.
  • Pediatric patients with tracheostomy who are asymptomatic during capping can safely undergo decannulation, and 24 asymptomatic hours of observation after decannulation should be adequate, suggested a review of medical records published online in JAMA Otolaryngology - Head & Neck Surgery.

Quote of the Day

  • Most people have no idea of the giant capacity we can immediately command when we focus all of our resources on mastering a single area of our lives. ~Anthony Robbins

Wellness Blog

Differentiate Between Different Types Of Fever

Different fevers can be differentiated clinically.

Following are few tips

  • If a patient comes with fever with chills and rigors, think of Malaria in north and filaria in Vidarbha region in India.
  • In malaria, chills are in the afternoon; in filarial, the chills occur in the evening.
  • Fever with joint pains on extension often is due to Chikungunya (flexion improves the pain)
  • Think of dengue if there is fever with itching, rash and periorbital pain.
  • In presence of fever with single chills think of pneumonia.
  • Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children.
  • Fever with red angry-looking throat: Think of streptococcal sore throat
  • Fever with red epiglottis: Think of Hemophilus infection
  • Fever with cough and or nasal discharge: Think of common flu
  • Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu
  • Fever with toxic look, persistent fever: Look for typhoid
  • Fever with no or low rise in pulse: Look for typhoid
  • Fever with urinary symptoms (burning, frequency): Rule out urinary infection.
  • Fever with high TLC (white cell count) and liver pain: Rule out liver abscess
  • Fever with watery diarrhea, with no blood or mucous: Rule out acute gastroenteritis
  • After the fever is over, jaundice appears: This is viral hepatitis
  • After the fever is over, one feels very weak: Rule our dengue hemorrhagic fever.

ePress Release

All hypertensive patients should keep their sugar lower than 90mg%

Hypertension is a risk factor for type 2 diabetes. If not properly managed they are likely to end up with diabetes with subsequent high risk of kidney damage, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India & National Vice President Elect IMA.

The results of the anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) study has shown that the major predictor of new-onset diabetes (NOD) in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg%. The risk increases by 5.8 times for each 18mg% rise above 90 mg%.

Other risk factors are higher weight, higher blood pressure and higher triglyceride levels. Apart those high BP patients taking the drugs atenolol (beta blocker drug) regimen with or without a diuretic are also at risk.

On the other hand high BP patients on amlodipine (calcium blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use, and age older than 55 years had protection from developing diabetes.

eMedi Quiz

All of the following conditions may predispose to pulmonary embolism except:

1. protein S deficiency.
2. Malignancy.
3. Obesity.
4. Progesterone therapy.

Yesterday’s Mind Teaser: A patient using contact lens develops corneal infection. Laboratory diagnosis of acanthamoeba keratitis was established. The following is the best drug for treatment:

1. Propamidine.
2. Neosporine.
3. Ketocanazole
4. Polyhexamethylene biguanide.

Answer for yesterday’s Mind Teaser: 1. Propamidine.

Correct answers received from: Dr Poonam Chablani, Dr. Thakor Hitendrsinh G, Dr Avtar Krishan


Answer for 6th December Mind Teaser: 2. Sympathetic ophthalmia.

Correct answers received from: Dr G V Premkumar, Dr Sajeev Kumar, Dr Rakesh Sharma, Arvind Diwaker, Dr Avtar Krishan, Dr Nirmala Agarwal

Send your answer to email

medicolegal update
  1. Dear Sir, Very Informative. Regards: Dr Karan

eMedinewS Special

1. IJCP’s ejournals (This may take a few minues 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)