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Dr KK Aggarwal

From the Desk of Editor in Chief
Dr B C Roy National Awardee,

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant and Dean Medical Education, Moolchand Medcity; Member, Delhi Medical Council; Past President, Delhi Medical Association; Past President, IMA New Delhi Branch; Past Hony Director. IMA AKN Sinha Institute, Chairman IMA Academy of Medical Specialities & Hony Finance Secretary National IMA; Editor in Chief IJCP Group of Publications & Hony Visiting Professor (Clinical Research) DIPSAR

Dear Colleague

9th February 2010, Tuesday

Breast mammography new guidelines
A US government task force has released new guidelines on how often women should get mammograms to test for breast cancer. The task force says for most women, mammograms should start at age 50, not at the previously recommended age of 40. When screening begins at age 40 to 49, the benefits are smaller, the false positive rates are higher, than when screening at older ages. In younger women, breast tissue is more dense than in older women and finding tumors in younger women is more difficult. The task force also recommends less screening––every two years for most women after age 50 instead of every year starting at age 40.

 Dr KK Aggarwal
Chief Editor

News and Views

ECG by paramedics in acute heart attack (Dr G M Singh)
People with chest pain who are given an ECG by paramedics before reaching the hospital don‘t wait as long to receive treatment to open their arteries. They often were able to bypass the emergency room and go directly to the cardiac catheterization laboratory for treatment with angioplasty. They were treated 60 minutes, on average, after reaching the hospital, compared with 91 minutes for people who did not have an EKG before arriving at the hospital. (Source: Catheter Cardiovasc Interv 2007 Feb. 1;75 (2):174–8)

Complications of TORCH infection during pregnancy
(Dr G M Singh)


Small–for–gestational–age, or SGA
Congenital heart disease (heart defects the child is born with)
Cataract (clouding of the lens of the eye), blindness, or significant visual impairment
Hearing impairment, including deafness
Microcephaly (Small head size)
Mental retardation or other learning, behavioral, or emotional problems
Low blood counts (anemia)
Liver or spleen enlargement
Skin rash–usually reddish–purple or brown
Involvement of the central nervous system (encephalitis, calcium deposits in the brain tissue, and seizures)
In addition to these symptoms, each of the TORCH infections has its own characteristic differentiating symptom cluster in newborns.

Steroids for sore throat
Many patients receive antibiotics for sore throat. A systematic review and meta–analysis by Del Mar and colleagues, published in the October 2006 issue of the Cochrane Database of Systematic Reviews, found that antibiotics significantly reduced complications of sore throat such as rheumatic fever, sinusitis, and otitis media, but that there were not enough cases to demonstrate efficacy in preventing glomerulonephritis. Antibiotics also reduced throat pain and fever by approximately one–half, with the greatest effect noted on day 3 to 4 of the antibiotic prescription.
Corticosteroids could reduce the inflammation and pain of sore throat. (Dr G M Singh)

FDA warns of higher risk for weight gain with olanzapine
FDA has issued a warning to doctors that adolescents taking the drug olanzapine have an increased potential––in comparison with adults taking the new–generation antipsychotic drug––for weight gain and metabolic disturbances that could result in diabetes or elevated blood cholesterol levels.

Didanosine label to include liver damage warning
FDA has updated labels of the HIV drug didanosine to include warnings for potentially serious liver damage. The drug may cause non–cirrhotic hypertension.

Nicotine patch for extended period may increase success. According to a University of Pennsylvania study in the Annals of Internal Medicine, cigarette smokers trying to quit who wear a nicotine patch for six months, rather than the standard two, may stay away from smoking longer.

Green tea and cancer
Green tea may reduce the risk of developing lung cancer, particularly for smokers. At least a cup a day was associated with a 5.16–fold lower lung cancer risk among Taiwanese adults (P<0.001), according to I–Hsin Lin, MS, of the Chung Shan Medical University in Zhonghe City, Taiwan, and colleagues.

Cancer blood tests
A blood test for 21 inflammatory, angiogenesis, and other cancer–related biomarkers had 92% accuracy in picking out stage I lung cancer from at–risk controls, according to Gina Lee, MD, of UCLA, and colleagues.

Conference Calendar
Criticare 2010 International Critical Care Congress & 16th Annual Conference of Indian Society of Critical Care Medicine (ISCCM) February 10–14, 2010
Venue: Hyderabad, Andhra Pradesh

Public Forum
Press Release

New Form of Heart Failure on the Rise: Experts

A form of heart failure that is too oftenoverlooked is on the rise and it‘s just as deadly as the better–known variety.

The standard description of heart failure is that the heart progressively loses its ability to pump blood. But there‘s another form of the disease where the heart‘s blood–pumping ability remains near normal, said Dr. K K Aggarwal President, Heart Care Foundation of India and Editor eMedinewS.

In this condition, the heart muscle becomes thickened making the inside chamber of the heart smaller. The heart is thus unable to relax to accommodate the blood it needs to pump out. As there is no room for the heart to relax, the blood backs up into the lungs.

This kind of aberration isn‘t picked up by standard measurements in echocardiography of "ejection fraction" ––the percentage of blood in the heart that goes out with every beat. This heart failure is called " heart failure with normal ejection fractions or with normal LV functions"

Nearly one–third of heart–failure patients will have normal ejection fraction. However, the death rate for this kind of heart failure matches that of patients with the more common form of heart failure with low ejection fraction and with more than 20% of all the patients dying within a year.

For patients, the symptoms of both types of heart failure are the same: Shortness of breath, difficulty exercising, and fluid retention in the body. Doctors cannot make a diagnosis on the basis of symptoms or routine examinations. A tissue Doppler echocardiogram is needed to see the heart pumping, its ejection fraction and diastolic relaxing functions of the heart.

Advances have been made against systolic heart failure, in which the ejection fraction falls below normal but not much has been done about diastolic heart failure.

Question of the day (Dr G M Singh)
Q: I know high heels are bad for the feet, but when I switched to flats, my feet started to hurt. Why?

A: Wearing heels for long periods can result in a shortening and tightening of the Achilles’ tendon. When you walk in a relatively flat shoe, your foot flexes up (dorsiflexes) when your heel hits the ground and then flexes down (plantarflexes) as you toe is off the ground If the Achilles’ tendon is short and tight because of high heels, the foot loses its ability to flex up and down, so switching to a flat footwear can cause heel and calf pain. Flats can also aggravate conditions like plantar fasciitis if they lack good arch and heel support.
If you‘re moving away from high heels to flats, do so gradually, wearing lower heels at first. That will give your Achilles‘ tendon time to relax and stretch out. You might also try doing some of the standard exercises for stretching the Achilles’ tendon. the basic maneuver involves keeping your heel on the ground and your leg straight as you lean forward.

 Last mounth,  the court dismissed lawsuit on the sale of I-PILL without doctor prescription (Dr G M Singh)

A bench of chief justice K.G. Balakrishanan  & justice Deepak Raveendran dismissed the lawsuit with petitioner Krupa Prolifers contention that I-Pill leads to abortion in violation of relevant law of pregnancy. The petitioner contended that a child is conceived in the womb soon after intercourse and I-Pill leads to destruction of the foetus within 1st 72 hours after fertilisation , the serious effects of medicine are nausea, vomiting,headache, weakness, breast tenderness etc and regular intake reduces the chances of pregnancy again. But the bench did not appear convinced of these arguments and dismissed the lawsuit.

Punjab & Sind Bank
Central Bank of India

eMedinewS Try this it Works
Laughter‘s therapeutic effect
While examining apprehensive patients with elevated blood pressure, help them relax by telling a joke (in good taste, of course!).

Dr Good Dr Bad
Situation: A diabetic patient was consuming 6 pegs of alcohol a day.
Dr Bad: You can have it as long as your sugar is controlled.
Dr Good: Reduce it to lower than 2 pegs per day.
Lesson: Five or more drinks per day are an independent risk factor for ischemic stroke and heart attack.

Make Sure
Situation: A patient intolerant to penicillin was denied rheumatic prophylaxis Reaction: Oh my god! Why was he not put on sulfa.
Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.

Laughter the best medicine
Doctor, doctor, I keep thinking I’m a dog."
"Sit down and tell me all about it."
"I can’t, I’m not allowed on the furniture."

Formulae in Imaging
Pyogenic liver abscess: For single abscesses with a diameter ≤5 cm, either percutaneous catheter drainage or needle aspiration is acceptable. Drainage catheters should remain in place until drainage is minimal (usually up to seven days). Repeat needle aspiration may be required in up to half of cases if a catheter is not left in situ. (Source: AJR Am J Roentgenol 1998; 170:1035;Clin Radiol 1997; 52:912.1–2).

ENT Facts
Otitis media with effusion (OME) is characterized by hearing loss or aural fullness, and possibly a history of recurrent episodes of acute otitis media (AOM).

SMS Anemia
A reticulocyte percentage of zero with normal white blood cell and platelet counts suggests a diagnosis of pure red cell aplasia.

Milestones in Neurology
Guillaume–Benjamin–Amand Duchenne (de Boulogne), (1806–1875) was a French neurologist who is best known for his research in disorders related to the nerves and muscles. In 1868, he provided the most comprehensive description to date of what is now known as Duchenne muscular dystrophy. Duchenne’s other contributions were made in the myopathies that now bear his name, Duchenne–Aran spinal muscular atrophy and Duchenne–Erb paralysis. He is also regarded as the inventor of electrotherapy and the first to practice muscle biopsy.

Mistakes in Critical Care
Never write ‘TIW or tiw’ for 3 times a week. It can be misread as ‘3 times a day or twice in a week. Always write ‘3 times weekly’

LIST OF APPROVED DRUG FROM 01.01.2009 TO 31.10.2009

Drug Name Indication Approval Date
Cinacalet (as HCl) Tablet 30/60/90mg
For the treatment of secondary hyper parathyroidism in patients with chronic kidney diseases (CKD) on dialysis and for hypercalcemia in patients with parathyroid carcinoma


(Advertorial section)

Green Tea (Camellia sinensis) when used along with Unique Health Supplements like Sodium Metasilicate, Sodium,
Phosphate and Ammonium Chloride may help boost Body Metabolism to aid weight loss, block allergic response, slow down the growth of tumours, protect bones, fight bad breath, improve Skin, protect against Alzheimer's and Parkinson's disease and even delay the onset of Diabetes. The Combination is known to reduce the VLDL and LDL Levels and thus reduce the incidence of Stroke and Heart disease.

Advertising in emedinews
emedinews is the first daily emedical newspaper of the country. One can advertise with a singe insertion or 30 insertions in a month. Contact: drkk@ijcp.com. emedinews@gmail.com 

eMedinewS-PadmaCon 2010 
Will be organized at MAMC on July 4, 2010, Sunday to commemorate Doctors' Day. The speakers, chairpersons and panelists will be various past and present medical Padma awardees of NCR.

eMedinewS–revisiting 2010
The second eMedinewS–revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hangama and live webcast. Suggestions are invited.

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Dr K K: Congrats for Padam Shri Award . One suggestion: to add on daily basis the medicolegal problems / medicolegal discussion / medicolegal cases decided by various medical councils; district; state; national consumer forums / high courts / supreme court. This will add more knowledge in present scenario. With regards. Dr V K Goel
    eMedinews response: Thanks for your suggestion, we will surely incorporate the column in the coming issues of eMedinewS
  2. Hello Dr Aggarwal, congratulations for padmashree award. Your dedication to medical work and your consistent work has made you proud. I am forwarding a mail to you, pls. go through and confirm if you can make it. I shall wait to hear from you. Thanks: Dr. Ashok Kakar, 9811300388
  3. Respected sir, congratulations for the award. U really deserves it. Keep it up. Thanks: Dr Rajeev Chugh
  4. Dear Dr. Aggarwal, My heartiest congratulation to you for Padmashri award, I am really proud of you because I feel a lack of leadership in medical professionals at national level, I believe that your dedication for medical profession will play a critical role to develop leadership at national level. I am sure your excellent work will inspire many people in our country, like me. Good Luck: Dr. Shailendra Singh Tomar, School of Rural Public Health (SRPH), Health & Science center, Texas A & M University, College Station, Texas–77801. U.S.A. doctorshelendra@gmail.com
  5. Dear Dr Aggarwal, I would like to put on record my sincere appreciation for compiling very useful information and tips in the various fields of medicine in the form of emedinews. Pls keep up the good work. Also pls accept my heartiest congratulations on being awarded Padma Shri: Col (Dr) Shashi Dangwal