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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 9 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
  Editorial …

2nd February 2013, Saturday

You can die because of treatment and availability of medical technology

Medscape gives the following 10 examples.

  1. Surgical fires: There are an estimated 600 surgical fires per year in US alone leading to devastating consequences, including disfigurement and death. The fire triangle is oxidizers, ignition.
  2. Texting while performing surgical procedures: Mobile devices now make it easier for clinicians to be interrupted for non-work-related reasons. Half of the respondents to a 2010 survey of perfusionists acknowledged texting during heart-lung bypass procedures 2) with 15% further admitting that they accessed the Internet and 3% reporting that they visited social networking sites during procedures. These devices can divert the caregiver's attention away from the patient or the task at hand.
  3. Dirty endoscopes and surgical instruments: Cross-contamination hazards can occur when flexible endoscopes aren't properly reprocessed.
  4. Using technology for adults on children: Technology designed for adults are used on children as no alternatives exist. They can be risky
  5. Air embolism hazards: Intravascular air embolism is a potentially lethal complication of certain medical and surgical procedures. The largest percentage of reported events is associated with the use of central venous access devices.
  6. Devices and IT systems that don't interface: Interfaces between medical devices don't always function as intended and can allow dangerous conditions to exist. For example monitoring system may not communicate audible or visual alarms from an interfaced ventilator to warn caregivers of a critical patient circuit disconnection.
  7. Patient data errors in EHRs and health IT: One patient's data can end up in another patient's record.
  8. Radiation burns from diagnostic radiology procedures: Inappropriate use and dose levels of CT can lead to unnecessary radiation exposure for patients. Image quality typically improves as the dose increases. As a result, there is a tendency to use higher doses that are associated with greater risk to the patient. Acute reactions such as radiation burns and hair loss are relatively rare but still occur too frequently.
  9. Medication administration errors using infusion pumps: Infusion devices are the subject of more adverse incident reports to the US Food and Drug Administration than any other medical technology, according to the Association for the Advancement of Medical Instrumentation. From 2005 through 2009, more than 700 deaths associated with infusion devices were reported.
  10. Alarm hazards alarms on infusion pumps, ventilators, and other devices: sheer number of alarms in a hospital can overwhelm staff, leading to complacency and delayed response. Caregivers often turn down the volume of alarms. Too many alarms sounding can lose its purpose.


Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

How does chronic constipation affect quality of life for a patient?

Chronic constipation has been associated with considerable impairment in quality of life as it can be physically and mentally troublesome for many patients, and can significantly interfere with their daily living and well-being. Individuals with constipation have higher medical care (outpatient and emergency) use, which leads to large individual healthcare costs, and represents a burden to healthcare delivery systems.

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

AHA – ACS update new–2

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions. Doctor of the Year award function was one of the main attractions of the conference.

Dr K K Aggarwal
    National News

Handwashing is the answer for most of the communicable diseases in India - IMA

In the recent International Conference held in China on the subject "Infection challenges in South Asian countries", Dr. Narendra Saini, Secretary General, India Medical Association who represented IMA in the conference said that major issues concerning the country are antibiotic resistance re-emergence of chikungunya and diseases like typhoid, drug resistant tuberculosis, malaria, japanese encephalits etc. In all Asian countries, water sanitation and hygiene is a major concern.
Hand washing is one of the answers to reduce the burden of infections in the society.
IMA is presently running a project under which it is training students, school children, residential welfare associations members and health care workers in the correct hand washing technique. The correct hand washing involves six steps in which we wash our hands - palm to palm, palm to back, palm to palm with finger interlaced, back of fingers to palm, thumb to palm and fingertips to palm.

New board to check hospital services

The department of health research of the Union health ministry has constituted a technology assessment board for hospitals across the country, to prevent fleecing of patients and monopoly of doctors and hospitals, reports Shimona Kanwar from TOI.

The already set up board will define guidelines on how to treat patients and which medicines should be prescribed. The pattern is based on the UK's National Institute for Health and Clinical Excellence. The centre follows a regime of providing guidelines to all public hospitals in the UK for medicines and procurement of medical equipment. The board will be headed by Prof MS Valiathan along with experts like Dr V M Katoch. These treatment guidelines will be put on the network of the ministry of health and family welfare, the commercial aspect will be reduced extensively. Another objective of the board is to curb the malpractice of companies selling exorbitant equipment to hospitals.

eMedinewsS views: It’s good to build guidelines but that will make doctors work like bonded labor with no innovations. Also it will increase litigations on the grounds why the guidelines were not adhered. We already have international guidelines and framing Indian guidelines will take a lot of time and by the time guidelines are made and circulated they will be outdated. The job of making guidelines is that of the associations and not the government.

For comments and archives

Satish Dwivedi (Gaya) 1 day ago in TOI article response

We need more Dr K K Aggarwals--Others can be brute: Around three years back, I went to a renowned private trusts hospital in South Delhi because of high BP on a homeopathy doctor's advice. After paying the requisite amount a so called cardio specialist Dr. X (doctor’s name withheld), after examining me and prescribing a few medicines, he asked me to get a TMT done after a week. To cut the long story short, not satisfied with the TMT, he recommended angiography to be done from the same hospital. Three years back they charged me Rs. 15,000.00 plus hospitalization charges for a day. Anyway, baffled and hassled, I went for it. Now the nightmare starts. Once on the table for angiography, the doctors there turned the monitors towards me, describing the so-called blockage in all the three arteries and its consequences.

Already nervous, with only a friend round, who had accompanied me, the doctors started talking about the cost of stents, which came to around 1.5 lakhs for two. Repeatedly, while I was lying on the table with the instrument inside my artery that we do not get the stents implanted now, latter it will not only cost more, the risk to life will also increase.

Those 90 minutes seemed like a hundred years of torture. Finally, I said no and got relieved from the hospital the next morning. For me it was a great escape.

There I came to know that forget the interning cardiologists; even the Doctors who refer get a cut. But mind it, Dr X did not give up. His next gambit was to send me to some other private clinic to get some other test done (name I don’t remember), which cost twenty five thousand. But having lost faith in X, I decided to hell with him and his advice.

Anyway, a lot of friends came to see me and one of them a journalist, Prabhat Dabral advised me to meet Dr K K Aggarwal. He told me that he is not only a great doctor but a nice person to meet. Moreover for journalists, he has a soft corner. So the very next day, I met Dr Aggarwal and he after examining me and learning about my medical history and agony, he had a hearty laugh but without uttering a word against his colleague and malpractice, he prescribed a few medicines and asked me to start walking more. As per his advice, when again I met him after a month, he got a TMT done and reduced my medicines to less than half, to be precise, just two medicines--one of them is aspirin 25. When I told him that I was doing 9 kms five times a week, he laughed and asked why not 10 kms.

From that day till this date, I have done a lot of tracking in the hills and the plains, but swear, not an iota of trouble. Some times I even walk 25 kms without getting tired. Like a teacher Dr KK Aggarwal explained, how these blockades are like speed breakers in a tunnel and by changing one’s lifestyle, reducing cholesterol and thinning the blood, one make the traffic flow smoothly without any surgical interventions. The tragedy is that Dr K K Aggarwal belongs to an endangered species and Dr X is growing like the Chinese.

My views: No ethical doctor will put a stent when it is not absolutely required. There can be three scenarios. Situation 1: Stent not needed, nobody should put a stent. Situation 2: stent is an absolute must, and every one should put a stent unless contraindicated. Situation 3: stent may or may not be needed. In this situation the opinions may differ. Putting or not putting stent is not negligence. Only in the first situation where stent is not required and is put will be an unethical practice where the council can take an action. (Dr KK Aggarwal, Also Chairman Ethical Committee Delhi Medical Council)

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


A total of 63 infanticide case were reported in India in the year 2011

The incidence decreased in the year 2011 (63 cases) from 100 cases in the year 2010. A total of 132 cases of feticide were reported in the country in the year 2011 as compared total 111 cases in the year 2010. 0.222% children presenting in emergency care are victims of child abuse.
In United States alone, upto 2500 children die of inflicted injuries annual with children under one year of age affected disproportionately. Higher rates of child abuse are reported from minority children

For comments and archives

    Valvular Heart Disease Update

Bicuspid aortic valve can be associated with ventricular or atrial septal defect, hypoplastic left heart syndrome, patent ductus arteriosus, bicuspid pulmonic valve, and Ebstein’s anomaly.

(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)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Ranibizumab fails to beat saline in avoiding vitrectomy

Patients with vitreous hemorrhage from proliferative diabetic retinopathy (PDR) experienced about the same rates of vitrectomy by 16 weeks whether they received intravitreal injections of ranibizumab (Lucentis, Genentech) or saline. The results of this short-term study, published online January 31 in JAMA Ophthalmology, suggest little likelihood of a clinically meaningful difference on vitrectomy between the 2 interventions. Longer follow-up is planned. (Source: Medscape)

Little evidence for nondrug Tx for ADHD

Nondrug treatments for attention deficit/hyperactivity disorder have limited evidence of efficacy and their use for core symptoms is not supported, a European guideline committee concluded. (Source: Medpage Today)

New AHA/ASA guidelines for acute stroke treatment

The American Heart Association/American Stroke Association has released new guidelines on the early management of acute ischemic stroke. The document is published online January 31 and will appear in the March issue of Stroke. The American Academy of Neurology "affirms the value of this guideline as an educational tool for neurologists," and it is further endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. (Source: Medscape)

Antisense drug gets OK for inherited high cholesterol

The FDA has approved mipomersen (Kynamro) for treating an inherited cholesterol disorder called homozygous familial hypercholesterolemia (HoFH). It's the first antisense oligonucleotide drug for systemic use to win the agency's approval. (Source: Medpage Today)

Interferon may be harmful in retreatment of hepatitis C

When patients with hepatitis C and chronic liver disease suffer relapses or fail to respond to initial treatment, monotherapy with interferon may not be a good idea, according to results from a recent meta-analysis. In fact, employing that approach may raise the risks for death and adverse effects. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Kiran Bedi has backed amended Lokpal Bill draft even as Anna Hazare and Arvind Kejriwal have rejected the bill. Will there be another split?

@DeepakChopra: Should we believe in astrology? I explore the roots of our ancient way of relating to the cosmos http://tinyurl.com/a8c8hwk

    Spiritual Update

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

Why do we flame camphor in any pooja?

No Aarti is performed without camphor. Camphor when lit burns itself out completely without leaving a trace of it. Camphor represents our inherent tendencies or vaasanas. When lit by the fire of knowledge about the self the vaasanas burn themselves out completely, not leaving a trace of ego.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What percentage IVF cycles gets cancelled prior to egg retrieval and why?

According to western figures 20% of cycles may be cancelled prior to egg retrieval. IVF cycles may be cancelled for a variety of reasons, usually due to an inadequate number of follicles developing. Cancellation rates due to low response to the ovulation drugs increase with a woman’s age, especially after age 35. a cycle may be cancelled to reduce the risk of ovarian hyperstimulation syndrome (OHSS). Treatment with a GnRH agonist or antagonist reduces the possibility of premature LH surges from the pituitary gland, and thereby reduces the risk of premature ovulation.

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

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

Why is CT scan Triphasic Angiography carried out on the donor ?

  • HAV           : 3
  • Cryptogenic:  8
  • Wilsons      : 14 (2 had associated Hepatitis E)
  • Autoimmune: 5 (1 case each had associated Hepatitis A & E)
  • HEV           : 1
  • Tyrosinemia : 1
  • PFIC

For comments and archives

    An Inspirational Story

The important things in life

A philosophy professor stood before his class with some items on the table in front of him. When the class began, wordlessly he picked up a very large and empty mayonnaise jar and proceeded to fill it with rocks, about 2 inches in diameter.

He then asked the students if the jar was full. They agreed that it was. So the professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles, of course, rolled into the open areas between the rocks.

He then asked the students again if the jar was full. They agreed it was. The professor picked up a box of sand and poured it into the jar. Of course, the sand filled up everything else. He then asked once more if the jar was full. The students responded with a unanimous “Yes.”

“Now,” said the professor, “I want you to recognize that this jar represents your life. The rocks are the important things – your family, your partner, your health, and your children – things that if everything else was lost and only they remained, your life would still be full. The pebbles are the other things that matter – like your job, your house, your car.

The sand is everything else. The small stuff.” “If you put the sand into the jar first,” he continued “there is no room for the pebbles or the rocks. The same goes for your life.

If you spend all your time and energy on the small stuff, you will never have room for the things that are important to you. Pay attention to the things that are critical to your happiness. Play with your children. Take your partner out dancing. There will always be time to go to work, clean the house, give a dinner party and fix the disposal.

Take care of the rocks first – the things that really matter. Set your priorities. The rest is just sand.”

For comments and archives

  Cardiology eMedinewS

Prolonged tachycardia after stroke linked to poor outcome Read More

Alogliptin wins FDA go-ahead for type 2 diabetes Read More

  Pediatric eMedinewS

CDC advises on meningitis vax for babies Read More

Tight glucose control no help in PICU Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine was put on the herb, Butterbur.
Dr. Bad: It is a drug of choice for preventing migraine.
Dr. Good: It benefits still remain unproven.
Lesson: Herbal therapies like the Butterbur and Feverfew have been evaluated for the treatment of migraine headaches. Of these, Feverfew has been the most widely studied. Some studies have found it to be effective for migraine prevention, although most experts agree that the benefits are still unproven. Neither treatment is recommended.

Make Sure

Situation: A patient of suspected MI died after receiving sublingual nitrate.
Reaction: Oh my God! Why was a history of intake of Viagra drug not taken?
Lesson: Make sure to take a history of Viagra drug intake before giving nitrates, because the two drugs when co–administered can cause fatal fall in blood pressure.

  Quote of the Day (Dr GM Singh)

Life does not obey our expectations. Life obeys our intentions, in ways we may not expect. Lloyd Strom

    Mind Teaser

Read this…………………

According to the American Hospital Association's Patient's Bill of Rights, patients are responsible for:

A. Accepting the treatment decisions of the medical and nursing team.
B. Allowing HIV testing when a staff member experiences a body fluid exposure.
C. Participating in the hospital's research studies.
D. Providing information about past illnesses, hospitalizations, and medications.

Yesterday’s Mind Teaser: Patients taking furosemide (Lasix) are instructed to notify their health care practitioner if they develop:

o A change in appetite.
o A disruption in sleep patterns.
o Increased urinary frequency.
o Leg cramps.

Answer for Yesterday’s Mind Teaser: Leg cramps

Correct answers received from: Rajiv Kohli, Dr SK Bansal, Dr BN Gangadhar, Prabha Sanghi, Dr Bharat Bhushan Aggarwal, Dr Jella, Dr Archna Parwani,
Dr PC Das, Dr (Maj. Gen.) Anil Bairaria, Dr D Chatterjee, Dr Pankaj Agarwal,
Dr Chandresh Jardosh, Dr Thakor Hitendrsinh G, Dr Valluri Ramarao, Dr Avtar Krishan, Dr Kanta Jain, Dr B K Agarwal, Dr PC Das, Dr Sudesh Agarwal.

Answer for 31st January Mind Teaser: Inform the neurosurgeon of the patient's status.

Correct answers received from: Dr B K Agarwal, Dr PC Das, Dr Sudesh Agarwal.

Send your answer to ijcp12@gmail.com

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

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    Laugh a While (Dr GM Singh)

Missing Homework

After teaching high school for nearly 20 years, I thought I'd heard every possible excuse for missing homework until one parent sent me this note: "Please excuse Lori for not having her algebra homework. The cat had kittens on it last night."

    Medicolegal Update

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


The name Morphine originates from Morpheus – the Greek God of dreams.

Morphine is an alkaloid of opium – white crystals, has bitter taste and alkaline reaction. It is very sparingly soluble in cold water but soluble in boiling water.

Morphine hydrochloride and morphine sulfate are medicinal preparations and morphine acetate is a non–official preparation, the dose of each being 8 to 20 mg. These salts are bitter in taste, neutral in reaction and are 5 to 8 times more powerful than opium.

Morphine has a depressant action on the cortex, the respiratory and cough centers in the medulla are depressed but the vagus and vomiting centers are stimulated.

The spinal cord is also stimulated. Its most outstanding effect is pain relief, partly due to depression of the pain perception in cerebral area and partly due to its euphoric effect.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Neck artery wall plaques suggest proneness to heart attacks

Presence of plaques in the neck artery wall is highly suggestive of underlying plaques and blockages in the heart arteries. If a patient with acute coronary syndrome, who presents with chest pain is found to have an ultrasound detected echolucent neck artery plaque in the emergency room, it is highly suggestive of a high risk patient with increased chances of heart attack and sudden death said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA. A calcification in the plaque is highly predictive of underlying heart diseases compared to a plaque with no calcification.

An artery thickness of more than 1 mm is called as a plaque. Some define a plaque as to when the thickness is more than 1.5 mm. In a patient with diffuse neck artery thickness, any focal additional thickening of 0.5 mm or more than 50% of the neck artery thickness is classified as a plaque. If a patient has plaque in both neck and the leg arteries, he/she will invariably also have plaque in the heart artery.

Patients who demonstrate a plaque of more than 1.5mm have a very high history of premature heart-related deaths in the family. In the presence of plaques, risk of acute coronary syndrome is 6.7 times more than in a person with no plaques in the neck artery.

    Readers Response
  1. The new law regarding rape and sexual assault should be made with extra caution; it may not have the same fate as that of anti dowry act, people may start using it to settle their personal score. Vivek Kumar, Varanasi.
    Forthcoming Events
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    eMedinewS Special

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Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta