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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

  Editorial …

16th January, 2011, Sunday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Tigecycline linked to increased mortality risk

  • Tigecycline is linked to an increased risk for death in patients with certain severe infections
  • Increased mortality risk is most apparent in patients treated for hospital–acquired pneumonia, particularly ventilator–associated pneumonia.
  • The FDA has also discerned the increased risk in patients with complicated intra–abdominal infections, complicated skin and skin-structure infections, and diabetic foot infections.
  • Tigecycline is not approved for diabetic foot infections or hospital–acquired pneumonia. It is approved for complicated intra–abdominal infections and complicated skin and skin–structure infections, as well as for community–acquired pneumonia.

1st National Heart Valve Summit 2011, 15th Jan at Surya Hotel Delhi organized by Fortis Escorts Heart Institute

  1. 3D better than 2D echo in diagnosing mitral valve proplapse. One can diagnose A1 A2 A3 or P1 P2 or P3 with certainty (Dr Aasha Gopal)
  2. Operate low gradient low EF aortic stenosis but the results are better if you can demonstrate its true as and there is contractile reserve by dobutaminse stress echo (Dr OP Yadava)
  3. Severity of AS better assessed by 3D echo than 2 D echo (Dr Aasha Gopal)
  4. Percutaneous AV implantation: Transcatheter Aortic Valve Implantation (TAVI) may be considered as an alternative therapeutic option for patients with severe symptomatic AoS in addition to a formal contraindication to surgery or other characteristics that would limit their surgical candidacy because of excessive mortality (determined by the Heart Team). Dr Larry S Dean
  5. Trans apical AV implant: A left anterolateral intercostals incision is used to expose the left ventricular apex. Direct needle puncture of the apex allows introduction of a hemostatic sheath into the left ventricle. The valve prosthesis, constructed from a stainless steel stent with an attached trileaflet equine pericardial valve, is crimped onto a valvuloplasty balloon. The prosthetic valve and balloon catheter are passed over a wire into the left ventricle. Positioning within the aortic annulus is confirmed by fluoroscopy, aortography, and echocardiography. Rapid ventricular pacing is used to reduce cardiac output while the balloon is inflated, deploying the prosthesis within the annulus. Transapical aortic valve implantation without cardiopulmonary bypass is feasible in selected patients with aortic stenosis. (Dr Vinayak Bapat)
  6. Trans–catheter aortic valve implantation is rapidly becoming an established modality of treatment for patients with critical aortic stenosis who are high risk for conventional aortic valve replacement. This approach also has its limitations; however, with growing experience and improvements in the delivery system, it may be possible to overcome these limitations. We describe a case where conventional trans–catheter approaches, that is, transfemoral or trans-apical using the Edwards THV system, were not possible but successful implantation was achieved through the trans–aortic route. (Dr Vinayak Bapat)
  7. Among patients with aortic stenosis, NT–proBNP and BNP may correlate with disease severity and may be a useful adjunct to identity patients with equivocal symptoms who are at risk for rapid progression. Asymptomatic patients with NT–proBNP <80 pmol/L had, when compared to those with higher values, a much higher rate of symptom–free survival at six. Serum BNP was significantly higher in patients with truly severe AS than in those with pseudo severe AS. In addition, one year survival was significantly worse among patients with serum BNP ≥550 compared to those <550 pg/mL (47 versus 97 percent). (Dr O P Yadava)
  8. 3D should be the echo of choice in clinical practice in valvular assessment (Dr Omar)

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  eMedinewS Audio PostCard

  MEDICON 2010, 26 December 53rd Annual Delhi State Medical Conference

Dr A Soin speaks on ‘Liver Transplant as applied in Indian situation’

Audio PostCard
  SMS of the Day

(By Dr GM Singh)

"True dignity is never gained by place, and never lost when honors are withdrawn."

Philip Massinger

    Photo Feature (from the HCFI Photo Gallery)

2nd eMedinewS Revisiting 2010

The 2nd eMedinews revisiting was also webcast live. The graph illustrates the timeline of the users who viewed the live webcast of the conference.

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Get treated early, keep blindness at bay

BANGALORE: One way to deal with blindness is treating the symptoms at an early stage. To revive the good old school eye check-ups that are fast disappearing and to keep a check on the vision problems in children, a programme __ Find the Blind __ was launched on Thursday. Narayana Nethralaya Post–Graduate Institute of Ophthalmology, which has been involved in paediatric community eye outreach programmes announced the launch, prior to the inauguration of the 2011 meeting of the International Society of Genetic Eye Diseases and Retinoblastoma. The programme was launched by Dr Elias Traboulsi, head of the department of paediatric ophthalmology and director of the Centre for Genetic Eye Diseases at Cleveland Clinic's Cole Eye Institute. (Source: The Times of India, January 14, 2011)

Indian Global Psychiatric Initiative 2011

The Indian Global Psychiatric Initiative 2011 concluded at the India Habitat Centre, New Delhi yesterday.

The key speakers were Prof. Dinesh Bhugra, Institute of Psychiatry, London, UK who spoke on Leadership and Professionalism in the 21st Century – advances and challenges. Dr Bhugra is also President, The Royal College of Psychiatrists, UK. Dr Carol Bernstein, MD, who is currently the President, American Psychiatric Association spoke on ‘Graduate education in Psychiatry: current trends and the future’ a subject which holds great passion for her. She said that she was looking towards the next generation, and their leadership styles. She is Associate Professor of Psychiatry, Vice Chair for Education in Psychiatry, Associate Dean for Graduate Medical Education and DIO for ACGME Programs at the NYU School of Medicine. Dr Babu Rankupalli, University of Florida, USA spoke on the ‘Classification of Personality Disorders across Cultures: Towards ICD–11 and DSM V.’ Prof. Meera Narasimhan, University of South Carolina, USA spoke on ‘Treatment Refractory Depression: From Biology to Cutting Edge Treatments.’ She said that depression is a fairly under recognized and under treated illness in today’s practice. She discussed some of the evidence–based strategies on treatment of refractory depression in her talk.

    International News

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

Spanish Heart Risk Study challenges image of healthy mediterranean diet and lifestyle

A Spanish study has challenged the long–held belief that people in the Mediterranean all enjoy more healthy diets and lifestyles, after discovering alarmingly high cardiovascular risk factors similar to those found in the UK and USA. Research published in the January issue of the International Journal of Clinical Practice, also found strong links between low levels of education and increased risk. "Cardiovascular diseases account for 33 per cent of deaths in Spain, making it the main cause of mortality in the country" says Dr Ricardo Gómez–Huelgas from the Internal Medicine Department at Hospital Carlos Haya, Malaga.

(Dr GM Singh)

Why does orbital cellulitis occur, and why is it an emergency?

The bony entrance to the orbit is curtained by the orbital septum. This structure separates the eyelids andexternal structures from the orbit itself. Infection of the lid structures is therefore called preseptal cellulitis. It requires systemic antibiotics to resolve – oral in healthy adults but children may need IV – and does so without sequelae. But if the infection either begins in the orbit itself, usually from a nearby sinus, or a preseptal cellulitis breaks through the septum into the orbit, it is potentially much more serious. The reason for this is that the infection can then gain access to the brain. Orbital cellulitis is characterised by an acutely unwell patient with swollen, red lids, double vision (if the lids are opened) and signs of optic nerve dysfunction. It is a sight– and life–threatening emergency and the patient should be transferred to specialist care immediately

(Dr Monica and Brahm Vasudev)

AHA recommends reducing daily salt intake to 1,500 mg

Daily intake of salt should be limited to 1,500 mg for all Americans, according to an advisory statement from the American Heart Association (AHA). "The 2020 goal of the American Heart Association is to improve the cardiovascular health of all Americans by 20% while continuing to reduce deaths from (cardiovascular disease) and stroke by 20%," Lawrence J. Appel, MD, of Johns Hopkins, and colleagues wrote online in Circulation. (Medpage)

Epilepsy drugs raise fracture risk

The use of most antiepileptic drugs among patients ages 50 and older appears to be associated with a significant elevation in fracture risk, a Canadian population–based study found. In the retrospective matched cohort study of over 63,000 people, an adjusted analysis found that odds ratios for fracture ranged from 1.24 (95% CI 1.05 to 1.47) among patients taking clonazepam to 1.91 (95% CI 1.58 to 2.30) for those using phenytoin, according to Nathalie Jetté, MD, of the University of Calgary, and colleagues. An exception was valproic acid, which had a nonsignificant odds ratio of 1.10 (95% CI 0.70 to 1.72), the researchers reported in the January Archives of Neurology. (MedPage)

Effects of passive tobacco smoke on BP evident even in preschoolers

Dr Giacomo D. Simonetti of the University of Heidelberg, Germany, and his coauthors report online in the journal Circulation that parental smoking an independent risk factor for raised systolic blood pressure in preschool children. More than 4000 preschoolers participated in blood pressure screening project in Germany. Children who had a parent who was a smoker were significantly more likely to have higher systolic blood pressure, even after adjusting for risk factors such as body mass index, parental hypertension, and birth weight.


    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

Is infertility more common in any particular group? For example, IT industry, BPO sector, highly competitive and career minded people or any other group.

People in the cities are definitely more prone to it as the stressful life style and long working hours do not allow them to have contact at the right time with the desired frequency. Most cases are from people working in the BPO industry.

For queries contact: banerjee.kaberi@gmail.com

    Pediatric Update

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

Symptoms of lead toxicity in children

Symptoms caused by lead toxicity in children

  • Tiredness or loss of energy
  • Hyperactivity
  • Reduced attention span
  • Irritability or crankiness
  • Poor appetite
  • Weight loss
  • Trouble sleeping
  • Constipation
  • Aches or pains in stomach

Permanent damage is caused in the form of behavior and learning problems, impaired speech and language, slowed growth, kidney and liver damage, hearing damage.

    Medicolegal Update

Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

What is World Medical Association Declaration on Principle-Undergraduate Medical Education & faculty?

The goal of medical education is to educate physicians who are entitled and consistent with their training to practice the profession without limitation. Medical Education leading to the first professional degree must be conducted by an organized faculty and the faculty must possess the appropriate academic qualifications that can only be achieved through formal training and experience

  • The first professional degree should represent completion of a curriculum that qualifies the student for a spectrum of career choices, including patient care, public health, clinical or basic research or medical education. Each career choice will require additional education beyond that required for the first professional degree.
  • The research to advance medical knowledge and the provision of the highest quality of care must occur in academic settings to demonstrate the highest medical standards.
  • The content, format and evaluation of the educational experience provided are the responsibility of the faculty with participation of National Medical Associations.
  • The faculty is responsible for providing its own obligatory basic curriculum in an academic environment of freedom in which learning and inquiry can thrive in a maximal way.
  • Frequent reviews of the curriculum, allowing for the needs of the community and for input from practicing physicians should be conducted by the faculty,
  • The proper administrative structure and academic records must be maintained. When the necessary elements are available the clinical education of practitioner and specialist can be sponsored by either a university or a hospital.

(Adopted by the 39th World Medical Assembly Madrid Spain, October 1987)

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

When a patient gets treatment at a hospital, he is the consumer of the services provided by the hospital. The consumer complaint should lie against the hospital, not the treating doctor. Why do the Consumer Courts allow the patient to file a consumer complaint against an individual doctor?

Many reasons can be given as to why the doctor should be made a party.

  • It has been held in court judgments that a doctor cannot be held guilty behind his back. He must be given a chance to defend himself. Courts have therefore directed that the treating doctor must be made a party.
  • The treatment to an individual is directly given by the doctor, not by the aggregate body called the hospital. If the doctor is protected by professional indemnity insurance, there is no reason why the compensation awarded should be paid by the hospital and not by the insurance company providing the cover to the doctor. The insurance company would pay only when there is a court judgment against the doctor.
  • Some hospitals may preferably employ those consultants who are covered by insurance. The insurance company would pay only when there is a court judgment against the doctor.
  • There may be confusion as to whether the hospital is the service provider or not while there may be no controversy regarding the role of the doctor as the service provider. The patient cannot be made to suffer in the legal procedural wrangle about determining the role and status of the hospital as service provider.
  • When the complainant alleges medical negligence, it is inevitable that even if the hospital alone is made the respondent, the hospital will have to ask the concerned doctor to explain his stand. The doctor may choose not to respond to the hospital’s request and, in the interest of justice, summons may have to be issued to the doctor to testify in the court. This will entail avoidable delay and also harassment to the doctor. At present, doctors have rarely to be present themselves in the consumer court.
  • The legal nature of the hospital as an entity may be unclear. Some are corporate hospitals; some are government hospitals; some are small hospitals that may not even be registered. Only a few states have nursing home acts or clinical establishment acts. The ownership and management etc. of a hospital may be unclear. All this may delay the legal process at the "service stage" itself. (Service here means the act of serving the court summons upon the opposite party.)
  • The same doctor may treat a patient partly as a hospital patient and partly as his private patient in his private clinic. When he alleges negligence in treatment, the treatment cannot be artificially separated into private clinic treatment and hospital treatment.
  • The consumer courts have been established to dispense speedy justice as summary proceedings by avoiding arguments and delays related to procedure. Justice would be speedy when the doctor is a party.
  • Please also note that till today, probably no treating doctor has pleaded as to why a case has been filed against him and not against the hospital alone. Your question is, hence, merely a hypothetical/theoretical question.
Our Contributors
  Docconnect Dr Veena Aggarwal
  Docconnect Dr Aru Handa
  Docconnect Dr Ashish Verma
  Docconnect Dr A K Gupta
  Docconnect Dr Brahm Vasudev
  Docconnect Dr GM Singh
  Docconnect Dr Jitendra Ingole
  Docconnect Dr. Kaberi Banerjee
  Docconnect Dr Monica Vasudev
  Docconnect Dr MC Gupta
  Docconnect Dr. Neelam Mohan
  Docconnect Dr. Naveen Dang
  Docconnect Dr Prabha Sanghi
  Docconnect Dr Prachi Garg
  Docconnect Rajat Bhatnagar
  Docconnect Dr Sudhir Gupta
    Lab Update

Low platelet counts and bleeding

  • In idiopathic thrombocytopenic purpura, minimal bleeding after trauma is uncommon unless the platelet count is less than 60,000/microL.
  • Self–limited bleeding, spontaneous bleeding requiring special attention (e.g, nasal packing for epistaxis), and severe life threatening bleeding does not occur until platelet counts are < 40,000, < 12,000, and < 6000/microL, respectively
    Medi Finance Update

Asset Allocation Funds

  • Asset allocation funds are similar to balanced funds in that they invest in all of the asset classes.
  • Asset allocation funds differ from balanced funds because the fund manager isn’t restricted to the percentage of the money they can put in a specific type of investment (stocks, bonds, and so on).
  • A tactical asset allocation fund is one where the manager frequently makes decisions about the best asset allocation, sometimes every few months.
  • The manager of a strategic asset allocation fund will generally revise the fund’s asset allocation once a year.
  • Asset allocation funds provide a ‘one stop shopping’ approach to asset allocation.
    Drug Update

LIST OF APPROVED DRUG FROM 01.01.2010 TO 31.8.2010

Drug Name


DCI Approval Date

Dexamethasone Intravitreal Implant 0.7mg (in solid polymer drug delivery system)

For the treatment of macular edema following branch retinal vein occlusion (CRVO)


    IMSA Update

International Medical Science Academy (IMSA) Update

Maintenance rituximab in follicular lymphoma

For patients with newly diagnosed follicular lymphoma who have had at least a partial response to initial therapy, go for maintenance rituximab rather than observation. (J Clin Oncol 2010;28:574s)

    IJCP Special

Dr Good Dr Bad

Situation: A patient wanted to know if the cost of the spectacles would be covered by Mediclaim after cataract surgery.
Dr. Bad: It will be covered.
Dr. Good: It will not be covered.
Lesson: Mediclaim does not cover the cost of spectacles, contact lenses, hearing aids.

Make Sure

Situation: A known epileptic child died of a seizure while swimming.
Reaction: Oh my God! Why was he allowed to swim?
Lesson: Make sure that patients with uncontrolled epilepsy are not allowed to swim.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

The owner of a farm asked his child to work everyday at the farm. His friend said to him: "You do not have to make your son work so hard. The crops would grow just as good." Owner of the farm replied: "I am not cultivating my crops, but my child."

Moral of the story:

  • A simple way to groom a child is to let him experience some hardships.
  • If not cut, jade would not turn into useful ware.

— — — — — — — — — —

Mind Teaser

Read this…………………

word starts with an "e", ends with an "e" and contains only one letter? 

Yesterday’s Mind Teaser: o2ne
Answer for yesterday’s Mind Teaser:
Two in One

Correct answers received from: Dr Sudipto Samaddar, Dr S Upadhyaya, Dr Arvind Khanijo. Dr Aruna Tyagi, Dr Satish Gunawant, Dr sudha Nayyar, Dr Chandresh Jardosh, Dr Rajiv Dhir, Dr Suman Kumar Sinha  

Answer for 14th January Mind Teaser: I’m between jobs
Correct answers received from: Dr(LtCol)Gopal Agarwal, Dr Anupam Sethi Malhotra, Dr Sapna Ramani Sardana, Dr Vijay Kansal, DR S.K.Bansal, Dr Maneesh Gupta

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr GM Singh)

There are 49 blondes and one redhead, they are hanging from a rope on a flying plane, one of them has to get off or the rope will break. The redhead said she’ll let go. Then all the blondes clap. Can you guess what happend?

    Readers Responses
  1. Thanks and a very happy new year, sir: Dr Manoj K Jha
    Public Forum

(Press Release for use by the newspapers)

Fluctuating blood pressure more harmful

In the elderly persons with high blood pressure, further fluctuations and spikes in blood pressure readings can affect their ability to think clearly and other cognitive functions, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

As per a North Carolina State University study, in people whose systolic blood pressure is 130 mm Hg or above, the cognitive functions gets impaired on days when their blood pressure spikes and fluctuates.

On the other hand, in person with normal blood pressure, the cognitive functions do not get impaired if their blood pressure spikes or fluctuates.

Several studies in the past have found a link between high blood pressure and dementia, which is marked by a loss of memory and other cognitive abilities, including the ability to speak, identify objects or think abstractly. It has been shown that treating high blood pressure in the very elderly may help reduce their risk of developing dementia.

Carry home message: If you have blood pressure that fluctuates uncontrollably and you also have underlying high blood pressure, you might be in double trouble for poorer cognitive functioning.

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

IMSA Workshop on Rheumatoid Arthritis

Date: Sunday 16th January, 2011; Venue: Moolchand Medicity; Time: 10–12 Noon


  1. Understanding Biologics: Dr Rohini Handa, Former Head Rheumatology, AIIMS
  2. All what a practitioner should know about rheumatoid arthritis: Dr Harvinder S Luthra, Chief of Rheumatology, Mayo Clinic, Rochester USA

No fee. Register emedinews@gmail.com or sms 9899974439

ANCIPS 2011. 63rd Annual National Conference of Indian Psychiatric Society

Date: January 16–19, 2011; Venue:The Ashok Hotel, New Delhi, India
Theme of the conference: "Providing Mental Health Care to All"
Organising Committee – ANCIPS 2011
Dr. Neelam K. Bohra Vice Chairperson Dr. R.C. Jiloha Organising Secretary Dr. Sunil Mittal Treasurer Dr. J.M. Wadhawan

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