Head Office: E–219, Greater Kailash, Part 1, New Delhi–110 048, India. e–mail: emedinews@gmail.com, Website: www.ijcpgroup.com
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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 and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08c); 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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eMedinewS Presents Audio News of the Day

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

Photos of 1st Mega Ajmer Health Camp 2012

  Editorial …

28th March 2012, Wednesday

What’s New in Medicine

  • Do not prescribe citalopram at doses that exceed 40 mg per day because of dose–dependent QT interval prolongation.
  • For most patients with LVEF of 35 percent or less and coronary artery disease (CAD) amenable to CABG surgery, initiate course of optimal medical therapy alone rather than medical therapy plus CABG surgery.
  • Four types of commonly–used medication (warfarin, insulin, oral antiplatelet agents, and oral hypoglycemics) accounted for 67.0 percent of the adverse drug events in elderly.
  • In 2012, the US FDA revised its labeling information on statins to only recommend liver function testing prior to initiation of statin therapy and to only repeat such testing for clinical indications. Routine monitoring of liver function tests in patients receiving statin therapy is not necessary.
  • Proton pump inhibitors may be associated with an increased risk of C. difficile–associated diarrhea.
  • Rifapentine is a rifamycin derivative with a long half–life and greater potency against M. tuberculosis than rifampin. A 3–month regimen of weekly isoniazid and rifapentine given as directly–observed therapy has been shown to be non inferior to a 9–month self–administered regimen of daily isoniazid in a randomized, open label international trial in predominantly HIV–negative individuals at high risk for progression from latent tuberculosis infection to active infection
  • Exercise may modestly improve obstructive sleep apnea (OSA) even in the absence of significant weight loss.
  • Intravenous paracetamol is available in a concentration of 10 mg/mL. Ten–fold iatrogenic overdoses have been described in hospitalized young children receiving it. The typical error occurs when the dose in mg is mistakenly given as the volume in mL.
  • A high sodium diet is associated with both a blunting of the proteinuria reduction induced by the ACE inhibitor ramipril and a higher incidence of end–stage renal disease in proteinuric patients with chronic kidney disease enrolled into the REIN and REIN–2 trials
  • A prolonged corrected QT interval on a resting ECG has limited sensitivity for the detection of long QT syndrome. A multicenter study found that a prolonged QTc during exercise recovery provided greater sensitivity.

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Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

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

Communication skills for Health care Professionals part 1 at Pushpanjali Hospital

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Lecture on Communication Skills For Health care Professionals

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal presenting a lecture on Communication Skills For Health care Professionals at Pushpanjali Hospital, Vaishali, Ghaziabad.

Dr K K Aggarwal
    National News

India to roll out common entrance medical exam from 2013

NEW DELHI: It’s now official – the common National Eligibility–cum–Entrance Test (NEET) for admission to Under Graduate (UG) will be conducted by the Central Board of Secondary Education (CBSE) while it will be the National Board of Examination that will conduct the Post Graduate (PG) exams. India is all set to roll out NEET from 2013–14. Putting ghosts to rest, the Union health ministry has informed state governments that their existing reservation policies would not be disturbed under the proposed scheme and state wise eligibility merit lists will be prepared for the respective state authorities to admit students for admission in accordance with their admission criteria in the institutions located in the respective states. The Medical Council of India has also revised the syllabus for NEET–UG.

The qualifying criterion has been changed from percentage of absolute marks to percentile to ensure that no seat remains unfilled. Ghulam Nabi Azad said on Monday "A few state governments had expressed concerns about the proposed NEET particularly with regard to the syllabus for the NEET for UG, reservation of seats, medium of examination, as well as their own preparedness to introduce the scheme from the academic year 2012–13 and whether once introduced some of their seats would go unfilled because of high merit. The government has addressed all the concerns." NEET would mean a single entrance examination will be held for MBBS and MD courses offered by all 271 medical colleges, 138 run by governments and 133 under private management. These colleges offer over 31,000 seats for MBBS courses and another 11,000 seats for PG degrees. (Source: TOI, Mar 27, 2012)

For Comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

Cardio groups address imaging safety

Although the use of radiation in cardiovascular medicine cannot be eliminated, there are actions that can be taken to ensure patient safety, a gathering of professional societies and others concluded. The American College of Cardiology, the American Heart Association, and the Duke Clinical Research Institute convened a think tank on Feb. 28, 2011, with the aim of developing a plan to improve radiation safety for patients in cardiovascular care. "Although unnecessary radiation exposure is clearly undesirable, the judicious and appropriate use of low levels of ionizing radiation in medical applications is intrinsic to the current state of the art of cardiovascular care," members of the group wrote with simultaneous publication online in the Journal of the American College of Cardiology, Circulation: Journal of the American Heart Association, the Journal of Cardiovascular Computed Tomography, and the Journal of Nuclear Cardiology. "The goal should be appropriate use rather than the elimination of radiation exposure," according to the writing/steering committee, which was chaired by Pamela Douglas, MD, of Duke University Medical Center. (Source: Medpage Today)

For comments and archives

New Preterm Birth Risk Guidelines Address Cervical Length

Two new clinical guidelines address taking cervical length measurements to help determine risk for preterm birth, as well as using progesterone and other treatments for women found to be at increased risk. Recommendations from the Society for Maternal–Fetal Medicine (SMFM) were published online March 19 in the American Journal of Obstetrics and Gynecology, and those from the American College of Obstetricians and Gynecologists (ACOG) were published as a committee opinion. (Source: Medscape)

For comments and archives

FDA panel review may ground wingspan stent

The FDA’s Neurological Devices Advisory Committee has indicated that there is insufficient evidence to say that the Wingspan intracranial stent has a long–term benefit that outweighs the device’s risks. (Source: Medpage Today)

For comments and archives

Less cervical cancer screening passes muster

A public health approach to cervical cancer screening in the Netherlands led to mortality rates similar to those in the U.S., where a "medical service" model incurred far more testing, a three–decade comparison showed. (Source: Medpage Today)

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    Twitter of the Day

@DrKKAggarwal: WMA declaration of Malta on hunger strikers – Guidelines for medical management The doctor must assess the mental…

@DeepakChopra: Healing is the return to wholeness

    Spiritual Update

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

4th Chaitra Navratri: Kushmanda Worship

Keep smiling and be happy in all situations

Spiritual summary: One should continuously (beaded rosary) control the air (anahata plexus) within us by using our sharp intelligence (sword) and balancing the mind (Trishul) by focusing on one point (arrow and bow), practicing detached attachment (lotus), accepting things as they are (Kamandalu), keep smiling in both acceptable and difficult situations (smiling face) and killing the negative energies by using discus (power) when needed. This can be assisted by chanting YAM focusing on 4th heart anahata thymus plexus chakra".

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

What is Prolactin?

Prolactin is a hormone produced by your pituitary gland, the gland that sits sat the bottom of the brain. Though prolactin plays a role in the growth and development of your breasts, its primary function is in milk production after a child is born. It is present in small amounts throughout your bloodstream (and in men’s), kept under control by another hormone called a prolactin inhibiting factor (dopamine). When you get pregnant, however, prolactin levels increase significantly.

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    Tat Tam Asi………and the Life Continues……

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

What are the types of liver transplantation?

There are two options for liver transplantation: cadaver donor transplantation, living donor transplantation.

For comments and archives

    Celiac Disease Update

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

What are the atypical presentations of celiac disease?

Celiac disease usually presents with symptoms related to gastrointestinal system; however, other systems can also get involved due to the autoimmune nature of the disease and chronic malnutrition. The atypical presentations seen in children are as follows:

  • Delayed puberty
  • Unexplained short stature
  • Rickets
  • Dermatitis herpetiformis (a specific type of awfully itchy rash)
  • Infertility
  • Peripheral neuropathy
  • Dental enamel abnormalities
  • Epilepsy
  • Autoimmune endocrine disorders, as well as thyroid disease
  • Elevated liver function tests
  • Depression and anxiety
  • Ataxia
  • Hypocalcemia
  • Hypoproteinemia

For comments and archives

    Medi Finance Update

(Tarun Kumar, Chartered Accountant)

Capital Gains

  • In cases where consideration for transfer of capital asset is not determinable, fair market value of the asset to be treated as sale consideration.
  • Exemption available for capital gains on sale of residential property (house or land) where the net consideration is invested in a small and medium enterprise (SME) subject to specified conditions

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Be Enthusiastic

Nothing great is ever achieved without enthusiasm. ––Ralph Waldo Emerson

Enthusiasm and success go hand in hand, but enthusiasm comes first. Enthusiasm inspires confidence, raises morale, and builds loyalty! And is priceless. Enthusiasm is contagious. You can feel enthusiasm by the way a person talks, walks or shakes hands. Enthusiasm is a habit that one can acquire and practice.

Many decades ago, Charles Schwab, who was earning a salary of a million dollars a year, was asked if he was being paid such a high salary because of his exceptional ability to produce steel. Charles Schwab replied, "I consider my ability to arouse enthusiasm among the men the greatest asset I possess, and the way to develop the best that is in a man is by appreciation and encouragement."

Live while you are alive. Don’t die before you are dead. Enthusiasm and desire are what change mediocrity to excellence.

Water turns into steam with a difference of only one degree in temperature and steam can move some of the biggest engines in the world.

That is what enthusiasm helps us to do in our lives.

Source: http://great–motivational–stories.blogspot.in/2008/05/be–enthusiastic.html

For comments and archives

    Cardiology eMedinewS

ACC 2012: American College of Cardiology update

Events cut, but bleeding up with novel drug Read More

Stem cells flop in heart failure study Read More

    Pediatric eMedinewS

Maternal smoking may hurt infant skin most before birth Read More

Look For warning signs of sudden death in kids Read More

Clostridium difficile: Low risk for household contacts Read More

    Microbial World: The Good and the Bad they do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity)

Normal Skin Flora and HAIs

The normal resident flora of the skin can invade and become infectious in different situations. About 6–10% of hospital–associated infections (HAIs) are caused by this resident flora. The normal resident flora gains entry to other organs/different parts of body, such as through a cut, during surgery, and accidents and these results in corresponding area infection. These infections include surgical site infections, blood stream infections, urinary tract infections and others.

Some metabolic diseases like diabetes and immunocompromised status of the host (due to any reason) also predispose to infections by the normal skin flora. One example is urinary tract infection caused by Candida albicans in individuals with diabetes, and another is Pseudomonas aeruginosa, which normally is beneficial as resident skin flora, causes toe web infections, green nail syndrome and Ecthyma Gangrenosum in immunocompromised patients. Staphylococcus aureus causes pyogenic infections of skin like boils, carbuncles, furuncles particularly in diabetics.

Transmission of skin flora usually does not happen amongst people. Only 0.07% natural hand flora may get transmitted after 30 seconds of moderate friction and dry hand contact. However, healthcare workers need to observe strict hand hygiene so that the skin flora is not transmitted from patient to patient, from health care worker to patient and so on.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A CAD patient needed long–term painkillers.
Dr Bad: Take any NSAID.
Dr Good: You cannot take painkillers for long time.
Lesson: Nonselective NSAIDs should be used with caution, following a stepped–care approach in patients who have known cardiovascular disease or are at increased cardiovascular risk. NSAIDs should be used in the lowest effective dose and the shortest duration necessary for the given indication.

For comments and archives

Make Sure

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis (IE).
Reaction: Oh my God! Why was IE prophylaxis not given?
Lesson: Make sure that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.

For comments and archives

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  Quote of the Day

(Dr GM Singh)

All that I am, or hope to be, I owe to my angel mother. Abraham Lincoln

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Lipid Profile

The lipid profile Lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. They have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels or hardening of the arteries (atherosclerosis).

typically includes: Total cholesterol, High density lipoprotein cholesterol (HDL–C), Low density lipoprotein cholesterol (LDL–C) and Triglycerides (TG).

An extended profile may also include very low density lipoprotein cholesterol (VLDL–C) and Non–HDL–C.

    Mind Teaser

Read this…………………

Prophylactic surgery for asymptomatic cholelithiasis is done in:

a) Diabetes
b) Hemolytic anemia
c) Hypertensives
d) Stone size more than 1.5 cm

Yesterday’s Mind Teaser: Which of the following is not a treatment modality for radiation proctitis?

a) Steroid enema
b) Argon beam coagulation
c) Formalin instillation
d) Hyperbaric oxygen

Answer for yesterday’s Mind Teaser: a) Steroid enema

Correct answers received from: Raju Kuppusamy, Dr Jainendra Upadhyay, Shipra, Dr Naman,
SP Verma, Srikant.

Answer for 26th March Mind Teaser: a) Surgery

Correct answers received from: Vaishnavi, Richa, Divya, Kanak, Dr BP Sharma.

Send your answer to ijcp12@gmail.com

For comments and archives

    Laugh a While

(Dr GM Singh)

The Lawyer and the Car Accident

A very successful lawyer parked his brand–new Lexus in front of his office, ready to show it off to his colleagues. As he got out, a truck passed too close and completely tore off the door on the driver’s side of the Lexus.

The counselor immediately grabbed his cell phone, dialed 911, and within minutes a policeman pulled up.

Before the officer had a chance to ask any questions, the lawyer started screaming hysterically. His Lexus, which he had just picked up the day before, was now completely ruined and would never be the same, no matter what the body shop did to it.

When the lawyer finally wound down from his ranting and raving, the officer shook his head in disgust and disbelief. "I can’t believe how materialistic you lawyers are," he said. "You are so focused on your possessions that you don’t notice anything else."

"How can you say such a thing?" asked the lawyer.

The cop replied, "Don’t you know that your left arm is missing from the elbow down? It must have been torn off when the truck hit you."

"My God!" screamed the lawyer. "Where’s my Rolex?!"

    Medicolegal Update

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

False accusations of sexual assault

Allegations of sexual assault can be made easily, hard to prove but even harder to disprove

The sexual offenses which are recognized in our legal system are rape, sodomy, oral sex, drug–related sexual assault such as the molestation, inappropriate touching, forced kissing, forced oral, anal, vaginal penetration by fingering/fisting or any means, child sex abuse, sexual torture or any other form of complain as selling and buying of minor girls for illicit sexual intercourse, adultery, incest etc. In almost all of the above cases, a medical examination of accused and victim is required and the medical report as well as collected biological samples are very crucial and provide the strongest scientific evidence of the case since in crime of sexual offenses. An eye witness is rarely found.

The investigator/examining doctor should keep the possibility of false accusation of rape in mind and find out the truth. Medical examination must be conducted in a transparent manner in the interest of truth and justice without fear and favor as an obligation of medical ethics.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Good news for ageing Indian patients with aortic valve disease

This year the WHO Health Day focuses on Ageing and Health. This is especially relevant to India in view of its increasing ageing population. More and more people today are crossing the age barrier due to advancements in medical fields, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India.

Recently, India saw two advancements in the elderly population with a heart disease called aortic stenosis, where one of the valves gets narrowed and reduces the life span.

Firstly Padma Shri Professor Jagdish Prasad, Chief Cardiothoracic Surgeon, Dept. of Cardiothoracic and Vascular Surgery, Vardhaman Mahavir Medical College, New Delhi and Director General of Health Services (DGHS) successfully implanted a tissue bovine pericardial artificial aortic ‘Trifecta’ valve in a patient at Safdarjang Hospital, New Delhi. The valve is the most advanced pericardial aortic stented tissue valve design available by St. Jude Medical, a global medical device company.

The newest Trifecta valve is a clinically proven replacement valve designed for patients with diseased, damaged or malfunctioning aortic heart valves. The next–generation tissue valve has a tri–leaflet stented pericardial design that offers excellent hemodynamic performance (circulation and flow of blood through the valve) and long–term durability.

We have been eagerly anticipating the launch of the Trifecta valve in India and are pleased to report the first successful implant of the same by Dr Jagdish Prasad. The valve will offer numerous benefits to the patients including a durable design that reduces stress on the valve and allows it to last longer, and exceptional hemodynamic performance that allows the valve to perform more like a natural heart valve, which will allow patients to live a more active life.

The valve is constructed using a polyester and tissue–covered titanium stent, or base, to ensure structural integrity of the valve. The valve features leaflets manufactured from pericardial tissue attached to the exterior of the valve stent. This design allows the leaflets to open more fully and efficiently, mimicking the performance of a healthy aortic heart valve, while also mitigating tissue abrasion through tissue–to–tissue (stent–to–leaflet) contact, said Dr Yugal Mishra from Fortis Escorts Heart Institute.

India now has another alternative for patients who are not fit for surgery. A few weeks back Fortis Escorts Heart Institute launched replacement of the valve without surgery via a catheter.

About St. Jude Medical

St. Jude Medical develops medical technology and services that focus on putting more control into the hands of those who treat cardiac, neurological and chronic pain patients worldwide. The company is dedicated to advancing the practice of medicine by reducing risk wherever possible and contributing to successful outcomes for every patient. St. Jude Medical is headquartered in St. Paul, Minn. and has four major focus areas that include: cardiac rhythm management, atrial fibrillation, cardiovascular and neuromodulation. For more information, please visit sjm.com.

    Readers Responses
  1. Dr. Aggarwal, Sir, emedinews sounds like a wonderful way to start the day. I love to be a part of it!
    Forthcoming Events
Dr K K Aggarwal

BSNL Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

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    Our Contributors

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