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Dr KK Aggarwal

From the Desk of Editor in Chief
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 ...

27th October 2010, Wednesday

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

Updated Appropriate use criteria for
cardiac CT released

Updated criteria for the appropriate use of cardiac computed tomography (CT) have been released by The American College of Cardiology, in collaboration with the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. The criteria were published online 25 October 2010 issue of the Journal of the American College of Cardiology. Appropriateness criteria for the use of cardiac CT were first for the first time in 2006 and included 39 clinical scenarios.
As a general rule, the guidelines have labeled the use of cardiac CT for diagnosis; for risk assessment in patients at low or intermediate risk; as a pretest for probability of coronary artery disease or evaluation of cardiac structure and function as appropriate usage. Noncontrast CT for calcium scoring among intermediate-risk patients or low-risk patients who have a family history of premature coronary heart disease, as well as for testing prior to electrophysiological procedures for anatomic mapping, or prior to a repeat sternotomy in reoperative cardiac surgery were regarded as the other appropriate uses of cardiac CT.
Cardiac CT was regarded as inappropriate use or of uncertain value, if used for for high-risk patients, for repeat testing, for general screening of asymptomatic patients, and for preoperative risk assessment for noncardiac surgery in patients who do not have a cardiac condition.
The current updated guidelines include 93 common clinical scenarios in which cardiac CT may be considered. All the 93 scenarios developed by the writing group were scored by a separate technical panel on a scale of 1 to 9, and were designated as appropriate use, inappropriate use, or uncertain use.

  • Appropriate rating: Cardiac CT is generally acceptable and is a reasonable approach.
  • Uncertain rating: Cardiac CT may be acceptable and reasonable.
  • Inappropriate rating: Cardiac CT is not generally acceptable and is not a reasonable approach.

However, the authors have cautioned that an uncertain rating should not be used to restrict the use of or reimbursement for cardiac CT in that particular clinical situation. Judgment of the clinician should be used in individual cases to determine whether cardiac CT would be appropriate.

Dr KK Aggarwal
Editor in Chief
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  Chikungunya Update

(RP Vashist, Consultant and Head Public Health, Govt. of Delhi)


  •  There is no specific treatment.
  •  No vaccine or preventive drug is available.
  •  The illness is usually self-limiting.
  •  It will resolve with time over a week to 10 days.
  •  No relapses occur.
  •  No second attacks.
  •  Convalescence may take longer.
  •  Symptomatic treatment only.
  •   As no vaccine or medication is currently available to prevent or cure the infection, control of Chikungunya involves vector control measures and encouraging people to avoid mosquito bites.
  Photo Feature (from the HCFI Photo Gallery)

 17th MTNL Perfect Health Mela 2010
Panel discussion 

A panel discussion on ‘Lifestyle Disorders’ was organized as part of the ongoing Perfect Health Mela. Top Experts of the city participated in the discussion. Dr Raman Kapoor; Mr. Vijay Dhaiya, Former Indian Cricketer; Padma Shri & Dr BC Roy National Awardee Dr. KK Aggarwal, President HCFI; Dr Neelam Mohan and Ms Ishi Khosla were among the notable participants.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

Prophylactic platelet transfusions

A randomized trial of the dose of prophylactic platelets transfused in hospitalized patients with platelet counts ≤ 10,000/microL found similar rates of bleeding with low, moderate, or high doses of platelets.

(Ref: Slichter SJ, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 2010 Feb 18;362(7):600-13).

  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

Population stabilisation target date pushed back to 2070

With the Total Fertility Rate (TFR) continuing at 2.8 per cent, the Union Health and Family Welfare Ministry has pushed back the target date for achieving population stabilisation to 2070 from 2045, stipulated in the National Population Policy (NPP) 2000. It is "extremely difficult" to achieve it by 2045. At the current rate of implementation, we expect population stabilisation to be achieved only in 2070, with a population of 170 crore, Health and Family Welfare Minister Ghulam Nabi Azad told members of the National Commission on Population. It is chaired by Prime Minster Manmohan Singh. Mr. Azad said one of the key challenges was to effectively implement laws on prevention of child marriage, sex determination and foeticide, and domestic violence.

Spelling out the plans to achieve population stabilisation, Mr. Azad said a special division would be set up in the Ministry at the Central and State levels. Similar administrative set-ups would be established at the district and block levels. Also, post-partum centres would come up for facilitating institutional deliveries. A proposal to substantially enhance compensation for women undergoing sterilisation from Rs. 600 and to make available contraceptives on the doorstep at the village level through Accredited Social Health Activists was being considered, Mr. Azad said. (Source: The Hindu)

  International News

(Dr Monica and Brahm Vasudev)

FDA turns down Loxapine inhaler for agitation

An inhaled version of the antipsychotic drug loxapine for treating agitation in patients with schizophrenia or bipolar disorder won't be approved anytime soon. The FDA told drugmaker Alexza Pharmaceuticals that it was concerned about data from phase I studies suggesting impaired lung function associated with the product's proprietary inhaler, according to a statement from the company.

Company halts 'female Viagra'

Boehringer Ingelheim has announced it is halting development of flibanserin (Girosa), a pill to treat female hypoactive sexual-desire disorder. The decision to stop development of the drug dubbed "female Viagra" or "pink Viagra" follows an June meeting of an FDA advisory committee during which the panel voted 9 to 2 that flibanserin doesn't seem to work any better at increasing female sexual desire than placebo.

Post-MI treatment falls short for RA patients

Patients with rheumatoid arthritis who experience an acute myocardial infarction are significantly less likely than controls to be given acute reperfusion, a retrospective Australian study showed. In a structured chart review from three hospitals in the city of Victoria, only 16% of the RA patients received acute reperfusion compared with 37% of the matched controls (Dr Sharon Van Doornum, of the University of Melbourne, and colleagues.)

Bisphosphonates may increase risk for stroke, atrial fibrillation in cancer patients

Cancer patients treated with bisphosphonate drugs such as pamidronate disodium zoledronic acid to reduce or delay bone complications from cancer may be at higher risk for atrial fibrillation and related stroke. According to the paper in the Journal of Clinical Oncology, receiving bisphosphonates intravenously upped the risk for both atrial fibrillation and the risk for stroke by about 30 %.

  Gastro Update

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

What is the etiology of IBD?

The etiologies of both ulcerative colitis (UC) and Crohn's disease (CD) remain unknown. The consensus is that both diseases are probably a response to environmental triggers such as infection, drugs, or other agents in genetically susceptible individuals. The genetic component is stronger in CD than in UC. Smoking increases the risk of CD, but decreases the risk of UC through unknown mechanisms. Epidemiological studies have considered diet, drug, and vaccination history, seasonal variation, water supply, and social circumstances. Mutations of CARD15/ NOD2 gene, located on chromosome (Chr) 16, have been associated with small intestinal CD. There is a high rate of concordance in monozygotic twins (~45%) compared with dizygotic twins (~4%). Additionally when one or both parents have IBD, the lifetime risk for their offspring is 8% and 36% respectively.

  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

What is pelvic inflammatory disease?  

Pelvic inflammatory disease (PID) is the major cause of infertility worldwide. PID comprises a variety of infections caused by different bacteria that affect the reproductive organs, appendix, and parts of the intestine that lie in the pelvic area. The sites of infection most often implicated in infertility are in the fallopian tubes, a specific condition referred to as salpingitis. PID may result from many different conditions that cause infections.

•  Sexually transmitted diseases (cause of most PIDs). Chlamydia trachomatis is an infectious organism that causes 75% of infertility in the fallopian tubes. Gonorrhea is responsible for most of the remaining cases. These diseases are often widely under-diagnosed and undertreated.
•  Pelvic tuberculosis (a growing global problem as tuberculosis cases increase)
•  Nonsterile abortions
•  Ruptured appendix
•  Herpesvirus (suggested for some cases, but not confirmed as a causal agent)

  ENT Update

Dr. Aru Handa MS, DNB (Department Co-ordinator and Senior Consultant Deptt. Of ENT Moolchand Medcity)

ENT symptoms of reflux

Reflux can cause various ear, nose and throat-related symptoms as below.

Laryngeal symptoms: Chronic dry cough, laryngitis, choking episodes, hoarseness, laryngeal granulomas and ulcers.  It can cause sleep disorder and even SIDS (Sudden infant death syndrome).
•  Pharyngeal symptoms: Feeling of a lump in the throat, frequent clearing of the throat, pharyngitis, burning /raw feeling in the throat, difficulty in swallowing, halitosis (foul smell from the mouth) etc.
•  Ear and nose symptoms: Reflux can even lead to sinusitis, adenoiditis, ear pain and otitis media.

Most of these patients may have silent reflux with no heartburn that is seen typically in GERD. A thorough ENT examination should be done. Treatment is diet and lifestyle changes along with twice-daily dose of PPIs for 3 to 6 months.

  Medicolegal Update

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

What is artificial or fabricated bruise?

Artificial bruise is a fabricated, self-made or false injury produced by a person themselves or by the help of some person with malign intention to make false allegations to implicated somebody in false criminal offences. Some irritant substances like juice of marking nut, used by washer men for marking the clothes is generally used to create false bruise. Juice of marking nut when applied to the skin produces injuries, which look like a bruise. These injuries are very superficial and on close examination are found to be granulated. They are always present on accessible parts of the body; but, in same cases, false bruise may be created on non-accessible part of the body, mostly with the help of somebody.

The false bruise is usually very small in size, may be multiple in numbers with absence of continuity in each other and can be differentiated on examination. These false contusions are produced with a malign intention to support a false allegation or charge of criminal infliction of injury. I have come across such cases on many occasions. If the examining doctor is in a dilemma about false bruise, he must refer the case to a forensic doctor for further medicolegal opinion.

  Medi Finance Update

When you want to invest and you are listening to someone, the story is important but more important is the storyteller. For stock market, you need a planner, you cannot do it yourself. As Doctors have no time, they must hire consultants for advice

  Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

Fixed dose combination of Sedatives/ hypnotics/anxiolytics with analgesics-antipyretics.

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Adrenocorticotropic Hormone (ACTH)

To help diagnose adrenal and pituitary diseases such as Cushing's syndrome, Cushing's disease, Addison's disease, adrenal tumors, and pituitary tumors.

emedinews 3D echocardography
  IJCP Special

Dr Good Dr Bad

Situation: A patient of CAD developed dengue.
Dr Bad: Start paracetamol.
Dr Good: Start paracetamol and stop low-dose aspirin.
Lesson: In dengue, lose-dose aspirin needs to be stopped.

Make Sure

Situation: A patient after receiving 40 units of insulin developed severe hypoglycemia.
Reaction: Oh my God! The order was 4 units.
Lesson: Make sure that 4 unit is not written as 4.0 units as it may be read incorrectly as 40.

Quote of the Day (Dr Chandresh Jardosh)
"Manners easily and rapidly mature into morals.”   Horace Mann ."


Read this…………………

A 65-year-old diabetic female has recently been diagnosed with Multiple Myeloma. She is admitted to your critical care unit with sepsis secondary to a community-acquired pneumonia (CAP). Her serum sodium is noted to be 150 (normal 136 - 145). Which of the following is true regarding the sodium abnormality and which one test can you do to confirm it?

A. Relative hyponatremia, check serum osmolality
B. Pseudohypernatremia, check lipid panel
C. Pseudohyponatremia, check blood glucose
D. Pseudohyponatremia, check blood urea

Contributed by Ashish Verma MD  

Answer for yesterday’s Mind Teaser: "Keep in shape"

Correct answers received from: Dr Virender Prakash Gautam, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai, Dr U.C.Vasavbada, Dr Nageshwar Rao, Dr Vishanji Karani, Dr.K.P.Rajalakshmi, Deepti Katyal Uppal, Dr Jayashree B Keshav, Dr.Satish Gunawant.

Answer for 25th October Mind Teaser is: "Partly cloudy"
Correct answers received from: Dr Jayashree B Keshav, Dr Sudipto Samaddar, Dr Rashmi Chibber, Dr Anurag Jain, Dr.Mahesh M.Shah, Dr Deepti Katyal Uppal, Dr Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

  Humor Section

Joke (Dr G M Singh)

Bernie was unfortunate enough to be hit by a truck and ended up in the hospital. His best friend Morris came to visit him. Bernie struggles to tell Morris, "My wife Sadie visits me three times a day. She's so good to me. Every day, she reads to me at the bedside." "What does she read?" asks Morris. "My life insurance policy."

  An Inspirational Story

(Contributed by Dolly Aggarwal)

10 virtually instant ways to improve your life

Many of our problems come from within our own minds. They aren’t caused by events, bad luck, or other people. We cause them through our own poor mental habits. Here are 10 habits you should set aside right away to free yourself from the many problems each one will be causing you.

Don’t invent rules 

A huge proportion of those 'oughts' and 'shoulds' that you carry around are most likely unnecessary. All that they do for you is make you feel nervous or guilty. What's the point? When you use these imaginary rules on yourself, you clog your mind with petty restrictions and childish orders. And when you try to impose them on others, you make yourself into a bully, a boring nag, or a self-righteous bigot.

  Readers Responses
  1. Dear Dr. KK Aggarwal, Thank for the regular updates on Dengue and Chikungunya. Pedal edema in post chikungunya patient is not rare but not common. Dr. Alex Franklin
  Public Forum

(Press Release for use by the newspapers)

Karva Chauth celebrated at MTNL Perfect Health Mela 

A major attraction on the fourth day of 17th Perfect Health Mela was celebration of Karva Chauth festival where Karva Chauth and Mehendi stall attracted a large number of women observing Karva Chauth.

Giving details, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President of Heart Care Foundation of India, said that Karva Chauth as a festival is in sequence following Navratras and Dussehra. Every fourth day after Dussehra has some benefits, to begin with Sharad Poornima Health benefits; on Karva Chauth longevity benefits; Hoi Ashtami, infertility benefits; Dhan Teras, wealth benefits and on Diwali, inner happiness.

The Mela also had a panel discussion on Lifestyle Disorders. The panelists included Dr. KK Aggarwal, Dr. Neelam Mohan, Ms. Ishi Khosla and Dr. Raman Kapoor. The discussion ended with message that obesity in Delhi is due to refined carbohydrates and not excess of fat.

Other star attractions of the Mela were the visit of cricketer Mr Vijay Dahiya and noted Kathak dancer, Ms Nalini In his message, Mr Vijay Dahiya said that a person cannot become a sportsman without regularly exercise.

Ms Nalini in her message said that dancing is good for health as classical dance is a mix of exercise, pranayam, yoga, meditation and control of emotions.

The results of Heritage Bharatnatyam competitions were announced as under:

Bharatnatyam-Sr Solo
Akanksha Chauhan -
I Prize
Sapna Anil Atawar - I Prize
Akshita S. - II Prize
Swati Sharma - III Prize
Anakha Pillai - III Prize

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists
17th MTNL Perfect Health Mela 2010 day programme
Dr. Sood Nasal Research Foundation Announces

Rhinology Update 11th to 15th November
22nd National Endoscopic Sinus Surgery Course on 11th & 12th November, 2010 2010 at Dr. Shroff’s Eye & ENT Hospital, New Delhi
Cadaveric Sessions on 13th November, 2010 at Lady Hardinge Medical College.
33rd All India Rhinoplasty Course, on 14th & 15th November, 2010, at Metro Hospital, Preet Vihar, Vikas Marg, New Delhi.

For information contact: Dr. V P Sood, Course Chairman, Ear, Nose & Throat Center, 212, Aditya Arcade, 30, Community Center, Preet Vihar, Vikas Marg, Delhi–110092 (India). Tel: 011–22440011, 42420429. E–mail:drvpsood@gmail.com,vpsood@drsoodnasalfoundation.com
Website: www.drsoodnasalfoundation.com

eMedinews Revisiting 2010

The 2nd 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 Hungama and Live Webcast. Suggestions are invited.

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