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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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

7th November 2012, Wednesday

Aspirin Update in cardiology

  • According to guidelines from the American Heart Association/American College of Cardiology (AHA/ACC) and the American College of Chest Physicians (ACCP), aspirin therapy should be started and continued uninterrupted indefinitely unless absolutely contraindicated in virtually all patients with established coronary artery disease.
  • A meta-analysis demonstrated an approximately 25% reduction in death from any vascular cause, myocardial infarction, and stroke with antiplatelet therapy in patients with preexisting cardiovascular events.
  • However, the risk-vs-benefit ratio for primary prevention is less clear than for secondary prevention.
  • In a meta-analysis of primary prevention, aspirin reduced the incidence of vascular events (12% proportional reduction or 0.07% per year absolute reduction, P = .0001), mainly for nonfatal myocardial infarction (23% proportional reduction, P < .0001).
  • The net benefit of aspirin in primary prevention is most pronounced in high-risk patients.
  • The 2009 US Preventive Services Task Force recommends aspirin for primary prevention for women 55 to 79 years old when the benefit of reduction in ischemic stroke outweighs the risk of bleeding, and aspirin therapy for men 45 to 79 years old when the benefit from a reduction in myocardial infarction outweighs the risk of increased bleeding.
  • A 2010 position statement by the American Diabetes Association (ADA), AHA and ACC Foundation recommends aspirin for people with diabetes who are at increased cardiac risk (10-year risk for a cardiac event of > 10%).
  • Overall, aspirin in primary prevention does not seem to affect cardiovascular mortality (except in high-risk diabetic patients), and its benefit in preventing adverse cardiovascular events is proportional to the degree of underlying risk.
  • On withdrawal of aspirin therapy, the restoration of platelet function is variable.
  • After a single dose, new platelet production begins to recover by approximately 10% per day, and it may take up to 10 days for full restoration of a platelet supply.
  • A robust body of literature substantiates an increased risk for cardiovascular events during the acute aspirin withdrawal period.
  • However, it is still common practice for surgeons or other clinicians to counsel their patients to stop aspirin therapy 7 to 10 days before surgery.
  • Available literature suggests that stopping aspirin confers a risk for increased rates of significant perioperative ischemic events in patients undergoing noncardiac surgery.
  • A patient history of a remote myocardial infarction is independently associated with a serious and severe perioperative cardiac event (odds ratio, 2.2; 95% confidence interval, 1.4 - 3.5).
  • A perioperative myocardial infarction has an in-hospital mortality rate of approximately 17% to 21%.
  • Thus, the discontinuation of aspirin in a population with known coronary artery disease or atherosclerotic disease increases the chance of an ischemic event in the perioperative period.
  • In 1 study, recent withdrawers of oral antiplatelet therapy had a 2-fold increase in rates of death vs prior users and nonusers of aspirin therapy.
  • The average interval between stopping therapy and a cardiac event was 11.9 days, consistent with the expected interval for platelet rebound.
  • Cessation of oral antiplatelet drugs was found to be an independent predictor of both death and major ischemic events.
  • A recent systematic review of 50,279 patients receiving aspirin therapy for primary and secondary prevention reported that the risk for an adverse cardiac event with discontinuation of aspirin was 1.82 (95% confidence interval, 1.52 - 2.18; P < .00001).
  • Surgical procedures that involve particular anatomic sites (middle ear, posterior chamber of the eye, intracranial, intramedullary spine, and possibly TURP) confer the highest risk for a complicating hemorrhage during receipt of aspirin therapy. For these procedures, aspirin discontinuation should be considered.
  • For other procedures in which an increase in surgical blood loss results in no change in transfusion requirements or increase in major morbidity or mortality risks, aspirin should not be discontinued.
  • The authors recommended that discussion about the safety of aspirin continuation vs aspirin cessation should differ on the basis of the level of cardiac risk for the patient and the specific type of surgical procedure.
  • Overall most patients, especially those taking aspirin for secondary cardiovascular prevention, should continue taking aspirin throughout the perioperative period.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more of the following:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in form (appearance) of stool

For comments and archives

Dr K K Aggarwal
    eMedinewS Audio PostCard

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

Uric acid and endothelial dysfunction

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Seminar on Chronic Constipation

A seminar on Chronic Constipation was organized by eMedinewS , IJCP and Heart Care Foundation of India at Constitution Club of India as part of 19th MTNL Perfect Health Mela celebrations. Panelists were Dr Ajay Kumar, Dr Rajiv Khosla, Dr SK Thakur, Dr AK Jhingan, and Dr Kailash Singla. The seminar was moderated by Padmashri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India,
Dr KK Aggarwal

Dr K K Aggarwal
    National News

19th MTNL Perfect Health Mela 2012

For comments and archives

CPR 10

For comments and archives

Today in MTNL Perfect Health Mela

1. Inauguration of 19th MTNL Perfect Health Mela 2012 Constitution Club of India, Rafi Marg, New Delhi

2. Live Recording of Health Interactive Program with Dilli Aajtak
Time: 12 noon, Anchor: Ms. Penash, Topic: Obesity, Venue: Constitution Club of India, Rafi Marg, New Delhi Telecast time: 9th November, 6 pm

3. “HARMONY” School Festival (Inter School Competitions) Catalyzed & Supported by: Rashtriya Vigyan Evam Prodyogiki Sanchar Parishad, Dept. of Science & Technology, Govt. of India Venue: Constitution Club of India, Rafi Marg, New Delhi, Coordinated by: Birla Vidya Niketan, Sector - IV, Pushp Vihar, New Delhi, Time: 8 Am to 1 Pm

National Workshop on Ayurveda in Cardiology

In association with Integrated Medical Association
Time: 1.00 pm - 5.00 pm; Topic: All about Cardiac Diagnostics an Ayurvedic Doctor should Know
Venue: Constitution Club of India, Rafi Marg, New Delhi

School Teachers Workshop on Health and Hygiene

Heart Care Foundation of India, Coordinated by Birla Vidya Niketan, Sector - IV, Pushp Vihar, Time - 10.00 am - 12.00 Noon, Venue: Constitution Club of India, Rafi Marg, New Delhi

Workshop for MCD School Teachers on Health and Hygiene

Heart Care Foundation of India with MCD South Zone; Time - 3.00 pm - 6.00 pm
Venue: Constitution Club of India, Rafi Marg, New Delhi, Coordinator School: Ryan International, Vasant Kunj, New Delhi

Cultural Show by Punjabi Academy

Time: 6 pm onwards; Venue: Constitution Club of India, Rafi Marg, New Delhi

My Profession My Concern


ANM/LHV/Staff Nurse

  • It was suggested that the training could be for a period of 4-8 weeks; the number of cases to be seen/assisted should be specified; and that there should be a certification process for the same.
  • For the new batches of ANMs, this training would be included in their curriculum; for the others, it would obviously be “on-job training.”
  • A smaller group to go into the suggestions made by the experts regarding the training.
  • We may, in the first instance obtain administrative approval on the recommendations made by the Expert Advisory Group for use of selected life saving drugs and interventions in obstetric emergencies by Staff Nurses LHVs and ANMs before seeking permission from DCG(I).

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Valvular Heart Disease Update

Congenital left ventricular outflow lesions can occur at valvular, subvalvular and supravalvular levels. The most common lesion is bicuspid aortic valve.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

TACT: Surprising, puzzling benefit from chelation therapy after MI

A randomized, double-blind trial of chelation therapy has suggested that the alternative-medicine mainstay may modestly improve clinical outcomes in patients after an acute MI, leaving its own investigators and other knowledgeable observers scratching their heads. (Source: Medscape)

For comments and archives

Influenza rapid tests show variable performance

A study evaluating the performance of 11 US Food and Drug Administration–cleared rapid influenza diagnostic tests (RIDTs) in 23 recently circulating influenza viruses showed that lower concentrations of influenza virus types and subtypes are differentially detected by these tests. (Source: Medscape)

For comments and archives

Risk classifier may predict CKD in patients with type 2 diabetes

Based on distinct urinary proteomic patterns, a chronic kidney disease (CKD) risk classifier could predict microalbuminuria 4 years before it develops in patients with type 2 diabetes. Speaking during a poster session here at Kidney Week 2012: American Society of Nephrology 45th Annual Meeting, Morten Lindhardt, MD, from the Steno Diabetes Center in Gentofte, Denmark, said such a risk classifier may allow earlier intervention for at-risk patients. The CKD risk classifier ("CKD273") is based on a specific pattern of 273 urinary peptides generated by capillary electrophoresis–mass spectrometry from previous cross-sectional case-control studies. (Source: Medscape)

For comments and archives

Five servings a day may keep acid away in CKD

Eating more fruits and vegetables can help chronic kidney disease (CKD) patients with borderline metabolic acidosis, researchers said. Fruits and vegetables, as well as drug-based alkaline therapy, increased plasma CO2 and preserved estimated glomerular filtration (eGFR) rates over 3 years compared with untreated patients in a small randomized trial, reported Nimrit Goraya, MD, of Texas A&M University, and colleagues at Kidney Week. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Join me on MTNL Perfect Health Mela 2012...Inauguration @ 11 AM tomorrow ( 7th Nov) @ Constitution Club of India, Rafi Marg, New Delhi

@DeepakChopra: The idea that we are all one makes me feel very alone. Can you help? My #askdeepak reply http://tinyurl.com/8gousbw

    Spiritual Update

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

The Vedic meaning of Mahamritunjaya Mantra and the Gayatri Mantra

Any activity should always engage the 3 H model of Heart, the Head, and the Hand. The same has been advocated by the western scholars of today. The concept involves that while doing any work one should ask the head for choices and then refer these choices to the heart to chose one and finally to order the hands to do the action.

For comments and archives

    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

Is hysterosalpingoram uncomfortable?

An HSG usually causes mild or moderate uterine cramping for about 5 minutes; however, some women may experience cramps for several hours. The symptoms can be greatly reduced by taking medications used for menstrual cramps.

For comments and archives

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)


  • Blood group genes are inherited in pairs
  • Blood group systems have 2 (three) major genes
  • Two identical genes homozygous
    ? (Lea+Leb-)
    o Two different genes heterozygous
    ? (Lea+Leb+)

For comments and archives

    An Inspirational Story (Ms Ritu Sinha)

Keep moving!

A college class was graduating on a hot and humid day. As the graduates walked across the platform and received their diplomas from the president of the college, he smiled, shook their hands, and said loudly, “Congratulations!” Then, in a much lower voice, one that was firm and could be heard only by the graduates, he would say, “Keep moving.”

He was only trying to keep the line moving across the stage, but his words were good advice for a lifetime: “Keep moving.” After every achievement growing up, graduation, marriage, job promotion, even retirement the best advice is, “Keep moving. Don’t stop. Don’t stagnate.”

There is more to life than you have found thus far. This is not the end; it is only the beginning. “Keep moving.” When we approach life with this attitude, we look forward to the future and what God has in store for us.

For comments and archives

    Cardiology eMedinewS

Omega-3 improves working memory in healthy young adults Read More

Bypass a winner over stents in diabetics Read More

    Pediatric eMedinewS

Third MMR dose may help in mumps outbreak Read More

Procalcitonin helpful in well-appearing young febrile infants Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient, diagnosed with falciparum malaria came for prescription. Dr Bad: Take quinine plus tetracycline.
Dr Good: Take artesunate.
Lesson: Artesunate (to be given in combination) is preferred over quinine plus tetracycline in patients with uncomplicated falciparum malaria as it is more effective, better–tolerated and more cost effective.

For comments and archives

Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise a macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

For comments and archives

  Legal Question of the Day (Dr MC Gupta)

Q. Please answer the following questions:
a. Is it permissible to buy and get registered a portable ultrasound machine?
b. If yes, what are the restrictions on its use?
c. What would be the impact in other states of the recent Bombay HC order allowing portable machines?


  1. The position in law is as follows:
    a. Portable ultrasound machine can be used in a vehicle which is registered as a mobile unit provided the ultrasound examination is performed in the vehicle itself without taking the machine out of the vehicle.
    b. The above position is clarified in a circular issued in Delhi, reproduced below:

    Office order no. F.09/AA/PNDT/SWD/Corres./7177-79 dated 7th / 13th September 2011, issued by the Appropriate Authority (South-West District, Delhi), stated as follows:

    “Government of NCT of Delhi vide letter no. F.9/1/59/DFW/PNDT/06/13176-13185 dated 14-10-2009 has stated that except in case of a registered mobile units in which an ultrasound is done in the vehicle, there is no provision in the PC-PNDT Act, 1994, by virtue of which an ultrasound machine or the scanner or any other device capable of detecting sex of the foetus can be moved. ………………….Henceforth, the movement of ultrasound machine to and fro the ‘stand-Alone’ ultrasound clinics running in diagnostic centre is not allowed. Such clinics have to arrange a fixed ultrasound machine at the earliest in case they prefer to continue with ultrasound facility…..”
  2. The restrictions on the use of a portable ultrasound machine are as follows:
    a. It cannot be taken out of the place / centre where it is registered.
    b. The PC&PNDT authorities in some states have issued instructions to the effect that that an affidavit needs to be filed if portable ultrasonography is to be conducted in a patient’s home. This is not practicable at all. Portable ultrasonography is to be conducted in a patient’s home only in emergency situations. It is not possible to attend to such emergency situations if there is a requirement of prior submission of an affidavit.
    c. Bombay Municipal Corporation recently denied permission to three Mumbai-based cardiologists and an anaesthetist, restraining them from taking the machines outside the clinics/hospitals, where the machines are registered. They challenged the denial recently in Bombay HC. On 17-9-2012, the HC issued an order allowing the portable ultrasonography machines to be taken to patients' home for any purpose other than sex determination, subject to prior installation in the machine of a gadget, known as “silent observer (SIOB)”, which is a device which monitors scans done by USG machines. The concerned news can be viewed at-- http://articles.timesofindia.indiatimes.com/2012-09-18/mumbai/33925319_1_usg-machines-silent-observer-genetic-clinics
  3. A question arises whether the above order passed by the Bombay High Court would be applicable to others also. The legal position is as follows:
    a. The order provides a relief to the petitioners only. However, any other doctor in Maharashtra wanting similar relief can make a request to the PNDT authorities in the state and, if refused, can approach the Bombay HC. He is likely to succeed.
    b. A doctor outside Maharashtra wanting similar relief can make a request to the local PNDT authorities and, if refused, can approach the state HC. Though the state HC is not bound to follow the order of the Bombay HC, chances are that a relief may be granted.
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central bank

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

Photos of Doctor’s Day Celebration

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  Quote of the Day (Dr GM Singh)

Life is too complicated; don’t try to find the unnecessary answer…… because by the time you find the answer, life changes the questions.

    Mind Teaser

Read this…………………

The nurse knows that a client with Pernicious Anemia understands the teaching regarding the vitamin B12 injections when she states that she must take it:

A. When she feels fatigued
B. During exacerbations of anemia
C. Until her symptoms subside
D. For the rest of her life

Yesterday’s Mind Teaser: Health teachings to be given to a client with pernicious anemia regarding her therapeutic regimen concerning vitamin B12 will include:

A. Oral tablets of vitamin B12 will control her symptoms
B. IM injections are required for daily control
C. IM injections once a month will maintain control
D. Weekly Z-track injections provide needed control

Answer for yesterday’s Mind Teaser: C. IM injections once a month will maintain control

Correct answers received from: Dr.K.Raju, SHAGUFTA MOIN, Dr. P. C. Das, Dr.A.K.KELA, Muthumperumal Thirumalpillai, Dr K P Chandra, Sagar Tucker

Answer for 5th November Mind Teaser:D. 2.0 ml

Correct answers received from: Dr. B. B. Aggarwal, Dr K P Chandra, Sagar Tucker

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

A matter of Will

When her late husband's will was read, a widow learnt he had left the bulk of his fortune to another woman.

Enraged, she rushed to change the inscription on her spouse's tombstone.

"Sorry, lady," said the stone cutter. "I inscribed 'Rest in Peace' on your orders. I can't change it now."

"Very well," she said grimly. "Just add, 'Until We Meet Again'."

    Medicolegal Update

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

How is the age of a scar determined by doctor?

The doctor conducting the autopsy is duty bound to take samples for toxicological screening and send them to Forensic Laboratory for toxicological/chemical examination

  • A scar is produced from the healing of wound made of fibrous tissue covered by epithelium without hair follicles, pigment.
  • The scars are bluish and reddish in the first week and look like angry face of an extremely fair complexion boy; they are also called angry scars.
  • In the second week, the scar is soft and sensitive on touch and looks pale. It remains so for about two months however its softness and sensitivity decrease.
  • After approximately two months and up to six months, the scar looks white and glistening; however, the softness changes to harder and harder and finally wrinkled
  • The shape of scar almost remains permanent and indicates the nature of weapon that caused the injury in majority of cases
  • As per IPC if a person is disfigured due to scar it becomes a grievous injury.
  • Bullet injuries causes mostly circular depressed scar seen in medicolegal cases.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

19th MTNL Perfect Health Mela will open to the public today

In an open chat with the public on the occasion of MTNL Perfect Health Mela, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India, said that gasping is not a sign that the person is alive. Cardiopulmonary resuscitation should be started even while the patient is gasping. The chances of successful resuscitation increase if CPR is started early enough in such cases.

The 19th MTNL Perfect Health Mela which will open to public today at 8am and will be formally inaugurated by Delhi Health Minister, Dr. Ashok Walia in the presence of many dignitaries and celebrities.

The main Perfect Health Mela will begin at Constitution Club of India and will have a mix of exhibitions, competitions, workshops, seminars, entertainment incorporating all pathies under one roof. The entry to the Mela will be free.

Dr. Aggarwal also released following facts for cardiac first-aid:

  • About 12 lakh people in the country can be revived from cardiac arrest if 1% of the population learns CPR technique without using mouth to mouth breathing. It is based on the Formula of 10 i.e. within 10 minutes of cardiac death for the next 10 minutes the chest of the victim should be pressed with a speed of 100 per minute (10x10).
  • The first-aid for acute heart attack is to chew a tablet of water-soluble aspirin at the onset of chest pain.
  • Any first attack of acidity or asthma after the age of 40 may be a sign of impending heart attack.
  • For women heart attack symptoms may be atypical and may have only abdominal presentation.
  • Sometimes, heart attack may present with pain in the jaws or in the teeth.
  • In diabetes, heart attack may occur without chest pain.
  • Age is no bar for heart attack. Heart attacks are known to occur even in people between 20-30 years of age.
  • Resuscitation can be effective even in people above the age of 80 when sudden death occurs due to heart attack.
  • Normal resuscitation involves giving electric shock on the heart but if the machine is not available, one can attempt two thumps on the centre of the chest from a distance of 1 foot.
  • Sudden cardiac death can be anticipated and prevented.
    Readers Responses
  1. Dear Sir I really appreciate your effort. Regards: Dr JP Singh
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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