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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 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 (07–08); 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

2nd December 2011, Friday

OPD management of acute pulmonary embolism

Not all symptomatic patients with acute pulmonary embolism need to be admitted to the hospital for initial therapy.

Patients with symptomatic acute PE and a low risk of death (PE severity index– PESI– low risk) can be treated as an OPD case with subcutaneous low molecular weight heparin (LMWH) followed by oral anticoagulation.

Prognostic models

The simplified PESI assigns a point for each of the following variables

  1. Age >80 years
  2. History of cancer
  3. Chronic cardiopulmonary disease
  4. Heart rate ≥110 beats per minute
  5. Systolic blood pressure <100 mmHg
  6. Arterial oxyhemoglobin saturation <90 percent.

A total point score of zero indicates a low risk for mortality, while a score of one or more indicates a high risk.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

OPD management of acute pulmonary embolism

Audio PostCard
    Photo Feature (From HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011
Medico Masti, an inter college health festival

At MTNL Perfect Health Mela, NDMC Grounds Laxmibai Nagar, New Delhi. competitions like Fashion Show, Choreography, Rock Band etc. were organized on the spot. Over 50 colleges from NCR including medical colleges will be participating in the event.

Dr K K Aggarwal
    National News

Half of HIV patients in Asia live in India

India houses half of Asia’s HIV patients and is way ahead of China in disease burden. It also finds a place in the list of 22 countries prioritised for preventing mother to child transmission infection, according to the latest UNAIDS report, drafted jointly with the United Nations Children’s Fund (UNICEF) and the World Health Organisation (WHO). About 48 lakh people were living with HIV in Asia in 2010 and nearly half of them – 49 per cent to be precise – are in India, says the report released on the eve of World AIDS Day. The percentage of pregnant women who tested positive for HIV infection in India also rose from 2 per cent in 2005 t0 23 per cent in 2010. Seven Asian countries report an estimated 100,000 or more people living with HIV in 2009, collectively accounting for more than 90 per cent of people with HIV in the region. India tops the list followed by China, Thailand, Indonesia, Malaysia, Myanmar and Vietnam, though the highest prevalence rate, one per cent, was observed only in Thailand. (Source: http://www.thehindu.com/health/article2675546.ece, December 1, 2011)

For comments and archives

Kindly visit Facebook for CSI News. It will cover minute to minute happenings of the 63rd CSI conference at Mumbai 8–11th December

For Facebook Page

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

Surveillance may be viable option after molar pregnancy

Surveillance instead of chemotherapy might be sufficient for women after a molar pregnancy, and would prevent unnecessary exposure to the toxic effects of agents such as methotrexate. According to a study published online November 29 in the Lancet, high levels of human chorionic gonadotropin (hCG) will spontaneously decline in most cases, negating the need to actively intervene with chemotherapeutic agents. (Source: Medscape Medical News)

For comments and archives

RSNA: A fish a week keeps the brain at its peak

Eating fish at least once a week could help lower older patients’ risk of developing dementia, researchers said here. Those who ate baked or broiled –– but not fried –– fish on a weekly basis had a greater volume of gray matter in areas of the brain associated with Alzheimer’s disease than people who didn’t eat fish as often, Cyrus Raji, MD, PhD, of the University of Pittsburgh, and colleagues reported at the Radiological Society of North America meeting. (Source: Medpage Today)

For comments and archives

Study names 4 EHR vendors that are good bets

Physicians shopping for an electronic health record (EHR) system increasingly discover that most products are look–alikes — at least when it comes to the functions they perform, such as e–prescribing. So on what basis, then, should a physician pick one EHR vendor from hundreds on the market? A new report from a research and consulting firm called IDC Health Insights lays out other selection criteria for EHR shoppers aside from software functionality and identifies 4 vendors that stand out from the pack. These companies — Cerner, eClinicalWorks, NextGen Healthcare, and the Sage Group — are well positioned to dominate the EHR scene in the years to come for practices with 20 physicians or more, according to report authors Judy Hanover and Sven Lohse. (Source: Medscape Medical News)

For comments and archives

   Twitter of the Day

@DrKKAggarwal: Yoga helps with chronic low back pain, study says Individuals who suffer from chronic low back pain can get… http://fb.me/1mjWFJ4dD

@DeepakChopra: You probably know what atherosclerosis is. Watch how it progresses and get a few tips on how to deal with it.

    Spiritual Update

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

Soul does not leave the body immediately after death

According to Prashna Upanishad, at the time of death, the Prana Vayu (life force and respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body.

For comments and archives

   An Inspirational Story

(Ms Ritu Sinha)

The Comfort Zone

I used to have a comfort zone where I knew I wouldn’t fail. The same four walls and busy work were really more like jail. I longed so much to do the things I’d never done before, but stayed inside my comfort zone and paced the same old floor

I said it didn’t matter that I wasn’t doing much. I said I didn’t care for things like commission checks and such. I claimed to be so busy with things inside my zone, but deep inside I longed for something special of my own.

I couldn’t let my life go by just watching others win. I held my breath; I stepped outside and let the change begin. I took a step and with new strength I'd never felt before, I kissed my comfort zone goodbye and closed and locked the door.

If you’re in a comfort zone, afraid to venture out, Remember that all winners were at one time filled with doubt. A step or two and words of praise can make your dreams come true. Reach for your future with a smile; Success is there for you!

For comments and archives

   Cardiology eMedinewS

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

3D Echocardiography: Reaffirming its Utility

For comments and archives

VVI Pacemakers Still Good For Indians

For comments and archives

The Heart Rhythm Society (HRS) 2011: Key Trials

For comments and archives

Midwall Fibrosis in Aortic Stenosis

For comments and archives

    Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Weight loss and exercise can help prevent knee arthritis

Knee osteoarthritis, which was once mostly prevalent in persons over the age of 50, is being diagnosed in younger populations. Nearly 6.5 million Americans between the ages of 35 and 84 will receive a diagnosis of knee osteoarthritis in the next decade, according to new projections. Experts say that this trend is largely due to increasing obesity rates, because excess weight is directly linked to arthritis, particularly in the knees. A new study conducted by researchers at Wake Forest University found that a program consisting of diet and exercise reduced pain and improved mobility by as much as 50 percent in people who suffer from arthritis in the knee. According to the authors, exercise is especially effective at relieving pain associated with arthritis and increasing mobility. Additionally, exercise (along with diet) is important in causing weight loss, which helps alleviate the strain on the knee joint and prevents the condition from worsening.

For comments and archives

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

The use of alcohol and other substances is hazardous for drivers of any age. However, the physiologic changes of aging such as a decrease in lean body mass and increase in adipose tissue, as well as the potential for multiple drug interactions, make this a significant issue for older drivers. The areas of the physical examination most closely related to driving safety are mobility and functional status, visual attention and cognitive status.

    Medicine Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta

Prevention of diarrhea in children with HIV infection or who were born to an HIV–infected mother

Diarrhea is a common cause of illness in children, especially in low and middle–income countries where it accounts for nearly 2.5 million deaths per year. Infants and children with HIV infection or maternal exposure through birth or breastfeeding to HIV infection may be more vulnerable to diarrhea due to weakened immune systems, nutritional deficiencies or from having other infections.

A review evaluated three interventions to assess whether they can prevent death or illness from diarrhea in infants and children with HIV infection or exposure: vitamin A, zinc and cotrimoxazole. Vitamin A and zinc may correct micronutrient deficiencies that are prevalent in children with HIV infection or exposure, as well as prevent other infections. Cotrimoxazole is an antibiotic that helps prevent opportunistic infections in immunocompromised hosts, and may also prevent other infections. This review found nine studies that addressed these interventions in infants or children with HIV infection. It indicated that vitamin A shows reduction of mortality and morbidity due to diarrhea in children with HIV infection and a trend in lower illness from diarrhea. Zinc prevented visits due to watery diarrhea and cotrimoxazole decreased death and respiratory infections.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim was advised MRI post discharge.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Post hospitalization related medical expenses incurred during period upto 60 days after hospitalization of disease/illness/injury sustained are covered as part of the claim.

For comments and archives

Make Sure

Situation: A 60–year–old male developed acute heart attack after consuming Viagra.
Reaction: Oh my God! Why was cardiac clearance not taken before?
Lesson: Make sure that all older patients get a cardiac clearance before they are given Viagra group of drugs.

For comments and archives

  Quote of the Day

(Dr GM Singh)

The only way to avoid being miserable is not to have enough leisure to wonder whether you are happy or not. George Bernard Shaw

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

CO2 content

Increase in serum CO2 for the most part reflects increase in serum bicarbonate (HCO3–) concentration rather than dissolved CO2 gas, or PCO2 (which accounts for only a small fraction of the total). Increased serum HCO3– is seen in compensated respiratory acidosis and in metabolic alkalosis. Diuretics (thiazides, ethacrynic acid, furosemide, mercurials), corticosteroids (in long–term use), and laxatives (when abused) may cause increased bicarbonate.

Decrease in blood CO2 is seen in metabolic acidosis and compensated respiratory alkalosis. Substances causing metabolic acidosis include ammonium chloride, acetazolamide, ethylene glycol, methanol, paraldehyde, and phenformin. Salicylate poisoning is characterized by early respiratory alkalosis followed by metabolic acidosis with attendant decreased bicarbonate

    Mind Teaser

Read this…………………

Gun Jr.

Yesterday’s Mind Teaser: thought an

Answer for yesterday’s Mind Teaser: An afterthought

Correct answers received from: Dr Prabha Sanghi, Rakesh Bhasin,
Dr Anupam Sethi Malhotra, Dr Amit Kochar, Yogindra Vasavada, Raju Kuppusamy, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Neelam Nath, Anil Bairaria.

Answer for 30th November Mind Teaser: Business before pleasure
Correct answers received from: Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Anil Bairaria, Dr NeelamNath, Dr A K Kela.

Send your answer to ijcp12@gmail.com

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emedinews revisiting 2011
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    Laugh a While


Gut Buster

A pharmacist comes back from his break and sees a man leaning against the wall, his face strained and nervous. He asks his assistant: "What’s wrong with that man over there?"

"He came in looking for cough medicine," she replies. "I couldn’t find any, so I gave him a whole bottle of laxatives."

    Medicolegal Update

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

Contributory medical Negligence

A pregnant woman delivered a child with spina bifida however she failed to attend regularly advised dates for antenatal ultrasounds that would have identified this problem. The patient was found to be 100% at fault.

  • In a medical malpractice case, medical negligence is the foremost ingredient to establish the liability of damage and dereliction in provided medical care. However, it is important to establish the difference between malpractice and contributory negligence when determining liability
  • Contributory negligence means the patient/legal heirs/parties are partially to blame for the maloccurrence or medical untoward incident. For e.g., a patient is admitted to the emergency room for treatment and they fail to inform the doctor about a pre–existing condition e.g. any allergy to a drug. The patient is guilty of contributing to the negative outcome/damage of the treatment
  • If the victim is found to be even one percent at fault, he/she will be unable to recover compensation for their injuries. However, comparative negligence is used to determine degree of liability of the doctor/medical care provider
  • Contributory negligence will determine who will receive compensation for their losses and how much they may be entitled to receive in compensation for their injuries. Pure comparative negligence means that in case of an aggrieved patient, damages will be calculated and then reduced to reflect his or her contribution to the injury.

In India, the doctors take the defense against malpractice cases when determining how the parties involved are responsible. In US, 4 categories applied in compensation cases in many of its states: Pure Comparative Negligence/Pure Contributory Negligence/Modified Comparative Negligence—50% Bar Rule and Modified Comparative Negligence—51% Bar Rule. Twenty–one states that recognize the 51% bar rule which means that the party who is less than 51% liable can seek compensation; only 11 US states use the 50% bar rule, which means that if the damaged party is less than 50% responsible, they can collect damages.

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    Public Forum

(Press Release for use by the newspapers)

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

First cigarette of the day most harmful

Heart patients should avoid smoking and taking coffee early in the morning in winter said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Both smoking and caffeine can acutely raise the blood pressure by as much as 10 mmHg. The rise in blood pressure can be greater in susceptible individuals. The effect is most prominent with the first cigarette of the day in habitual smokers.

In patients with mild high blood pressure, habit of smoking and drinking coffee, elevation of daytime upper or systolic blood pressure can be up to 6 mmHg during winters.

Heart patients, therefore, should avoid taking cigarette, coffee, tea, with or without a cigarette early in the morning.

It was proved that smoking a cigarette in the first 30 minutes after waking up in the morning increases the risk of getting lung cancer by 79%. According to a recent US study, the morning cigarette increases of risk of getting lung cancer substantially.

The cause of this phenomenon has not been precisely determined, but it seems that if we smoke as soon as we wake up in the morning, the smoke and all its harmful components penetrate the lungs. Still, we must remind the fact that those that feel the need to smoke right after they wake up in the morning are hardcore smokers and they smoke more during the day.

The results of this new study are what the doctors advice their patients who cannot manage to quit smoking, to delay the first cigarette of the day for as much as possible.

For comments and archives

    Readers Responses
  1. Dear Sir, Thanks for the CSI News Updates. Dr AP Shukla
    Forthcoming Events

CSI 2011

63rd Annual Conference of the Cardiological Society of India

Date: December 8–11, 2011.
Venue: NCPA Complex, Nariman Point, Mumbai 400021

Organizing Committee

B. K. Goyal – Patron
Samuel Mathew – President CSI
Ashok Seth – President Elect & Chairman Scientific Committee
Lekha Adik Pathak – Chairperson
Satish Vaidya & C. V. Vanjani – Vice Chairman
N. O. Bansal – Organizing Secretary
B. R. Bansode – Treasurer
Ajit Desai , Ajay Mahajan , G. P. Ratnaparkhi – Jt. Org. Secretaries
Shantanu Deshpande , Sushil Kumbhat , Haresh Mehta – Asst. Org. Secretaries
D. B. Pahlajani, A. B. Mehta , M. J. Gandhi , G. S. Sainani, Sushil Munsi, GB Parulkar, KR Shetty – Advisory Committee

Contact: Dr. Lekha Adik Pathak, Chairperson, CSI 2011; Dr. Narender O. Bansal, Org. Secretary, CSI 2011 Tel: 91 – 22 – 2649 0261/2649 4946, Fax: 91 – 22 – 2640 5920/2649 4946.
Email: csi2011@ymail.com, csimumbai2011@gmail.com Website: www.csi2011mumbai.com

eMedinewS Events: Register at emedinews@gmail.com

3rd eMedinewS Revisiting 2011

The 3rd eMedinewS – revisiting 2011 conference will be held at Maulana Azad Medical College, New Delhi on Sunday January 22nd 2012.

The one–day conference will revisit and cover all the new advances in the year 2011. There will also be a webcast of the event. An eminent faculty is being invited to speak.

There will be no registration fee. Delegate bags, gifts, certificates, breakfast, lunch will be provided. The event will end with a live cultural evening, Doctor of the Year award, cocktails and dinner. Kindly register at www.emedinews.in

3rd eMedinewS Doctor of the Year Award

Dear Colleague, The Third eMedinews “Doctor of the Year Award “ function will be held on 22nd January, 2012 at Maulana Azad Medical College at 5 pm. It will be a part of the entertainment programme being organized at the venue. If you have any medical doctor who you feel has made significance achievement in the year 2011, send his/her biodata: emedinews@gmail.com

    eMedinewS Special

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

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  Towards Well Being

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  Dil Ki Batein

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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