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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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eMedinewS Presents Audio News of the Day

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

Photos of Workshop on Stress Management and How to be Happy and Healthy

  Editorial …

12th May 2012, Saturday

Aishwarya’s weight gain

Aishwarya has been in the news again post delivery. She has gained a lot of weight. It has become a topic for discussion in the social media.

Physiological changes relating to pregnancy result in weight gain in the absence of pathological water retention. Excessive weight gain causes increase in fat stores. Post partum weight retention is a problem for a large proportion of mothers even at one year after the birth.

Women with high BMI have the highest risk of excessive weight gain and postpartum maternal weight retention, which can be associated with lifelong medical complications.

Women with BMI> 25 should not gain more than 11.5 kg during pregnancy and with BMI > 30 should not be allowed more than 9 kg of weight gain during pregnancy. These women should receive thorough counseling regarding risk of obesity in and out of pregnancy and they should be counseled for proper weight gain and weight loss in the postpartum period. For women with BMI > 35, one should try for either a small weight loss or maintenance of weight during pregnancy.

Weight gain in pregnancy involves the following:

  • Fat stores: 2.7 to 3.6 kg
  • Increased blood formation: 1.3 to 1.8 kg
  • Increased fluid formation: 0.9 to 1.3 kg
  • Breast enlargement: 0.9 to 1.3 kg
  • Uterine placenta: 0.9 kg

It is evident that weight gain in the postpartum period invariably means gain in fat, which is dependent on lifestyle and dietary habits. Women, therefore, should be counseled during pregnancy so that they do not continue gaining weight after the pregnancy.

Progesterone levels during pregnancy are responsible for fat accumulation during first and second trimesters and for fat mobilization during third trimester. Leptin levels correlate positively with body fat content and BMI, increase during pregnancy and play a direct role in pregnancy-related weight gain and postpartum weight retention.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Sister Sapna

One can predict acute lung injury

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day organized at DPS Mathura Road

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal interacting with the students of Delhi Pulic School, Mathura Road on the occasion of World Earth Day 2012

Dr K K Aggarwal
    National News

ID proof must for ultrasound in Haryana

GURGAON: The state health department has asked medical officers in the city to keep tabs on the ultrasound centres of the city. In a measure to curb female foeticide, the department has made it mandatory for pregnant women to present their ID proof. The director general of the health department on May 3 directed officials concerned to give guidelines to the hospitals and the private centres to check the ID proof and the department would later keep a check on the date of birth. If the childbirth does not take place, the health department will find out the reason. A district task force has been constituted with the deputy commissioner as chairman and chairperson of the zila parishad as co–chairman for the effective implementation of the laws and monitoring of the schemes. The task force would also review the progress % of prosecution launched against the errant diagnostic centres or doctors and design strategies for involving civil society and general public in curbing the malpractice of female foeticide. (Source: TOI, May 11, 2012)

For comments and archives

Rickshaw driver’s son drives into top gear

RAJKOT: Having to live in a relative’s house due to poor financial condition is something that pains 17–year–old Darshan Parmar the most. But, after scoring 99.64 percentile in class XII (science), Darshan, son of an autorickshaw driver and a student of S G Dholakia School in the city, is confident of building a house of his own for the family. Darshan’s achievement is an inspiration story for all who want to achieve their dreams. (Source: TOI, May 10, 2012)

For comments and archives

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

(Contributed by Dr Monica and Brahm Vasudev)

WHO issues malaria alert to those travelling to India

NEW DELHI: Travelling to India this summer? Better be prepared against malaria. The World Health Organization (WHO) has alerted international travelers against the active threat of malaria in India. In its latest ‘International Travel and Health Bulletin 2012’, the WHO has said that malaria risk exists throughout the year in the whole country at altitudes below 2,000m. The bulletin cautions travelers against malaria infections, especially while travelling to the northeast, the Andaman & Nicobar Islands, Chhattisgarh, Gujarat, Jharkhand, Karnataka (with the exception of Bangalore), Madhya Pradesh, Maharashtra (with the exception of Mumbai, Nagpur, Nasik and Pune), Odisha and West Bengal (with the exception of Kolkata). According to the global health watchdog, 40%–50% cases of malaria in India are caused by the deadly P Falciparum, with an estimated 18,000 deaths in a year due to the fatal disease. The WHO bulletin also warns against anti–malarial drug resistance cases being reported in India. The advisory, however, adds that there is no danger of malaria transmission in parts of Himachal Pradesh, Jammu & Kashmir and Sikkim. (Source: TOI, May 11, 2012)

For comments and archives

Male breast cancers less common, more advanced at diagnosis

Breast cancer in men represents only about 1% of all breast cancers; however, the tumors tend to be larger, the cancer more advanced, and overall survival is substantially lower than for women, according to research presented here at the American Society of Breast Surgeons 13th Annual Meeting. (Source: Medscape)

For comments and archives

Chronic disease tops infection as global issue

As the world’s population ages, an increasing number of people in low– to middle–income countries are now dealing with chronic disease, according to a report from the the U.S. Census Bureau and the World Health Organization (WHO). Chronic diseases such as hypertension and arthritis were once thought to be "diseases of affluence" while infectious diseases were more problematic for countries with lower income. But the new report, which examined the health of people 50 and older who live in China, Russia, India, Mexico, South Africa, and Ghana, confirmed an earlier finding that chronic diseases are by far the leading cause of mortality in the world, and provided some specificity on the nature of chronic disease in those countries. Those six countries were home to 42% of the world’s 1.4 billion people who were 50 or older in 2010, so the health of people living in those countries is "certain to have a remarkable impact on the world’s overall disease burden and healthcare," the authors wrote. (Source: Medpage Today)

For comments and archives

Dynamic shifts seen in vaginal bacteria

The bacteria that inhabit the vagina appear to vary greatly from woman to woman, researchers found. While some women have a stable population of vaginal bacteria, others have more rapid turnover, Jacques Ravel, PhD, of the University of Idaho, and colleagues reported in Science Translational Medicine. (Source: Medpage Today)

For comments and archives

  Twitter of the Day

@DrKKAggarwal: Natural Fast Food Is Good For Health

@DeepakChopra: Asthma is one of the most common diseases in the world & it is still on the rise

    Spiritual Update

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

Four Types of Insults

Insulting someone invariably means hurting somebody’s ego. In politics, as per Chanakya Neeti, there are three types of insults that a person will never forget. The first two of them are attacking someone by character assassination or financial irregularities.

In politics, we have seen that whenever a person is charged with immorality or financial corruption, he or she has had to step down from his/her political post.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

Failure is common in any first IVF cycle, so what does a couple do to cope up from this emotional roller coaster?

Couples may feel frustrated, angry, isolated, and resentful. At times, frustration can lead to depression and feelings of low self–esteem, especially in the immediate period following a failed ART attempt. The support of friends and family members is very important at this time. Couples are encouraged to consider psychological counseling as an additional means of support and stress management. Many ART programs have a mental health professional on staff to help couples deal with the grief, tension, or anxieties associated with infertility and its treatment.

For comments and archives

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

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

Whole Blood

A 450ml whole blood donation contains:

Up to 510 ml total volume (volume may vary in accordance with the local policies

  • 450 ml donor blood
  • 63 ml anticoagulant–preservative solution
  • Hemoglobin approximately 12g/ml
  • Hematocrit 35–45%
  • No functional platelets
  • No labile coagulation factors (V and VIII)

Unit of issue: 1 donation, also referred to as a ‘unit’ or ‘pack’

Infections risk: Not sterilized, so capable of transmitting any agent present in cells or plasma which has not been detected by routine screening for transfusion–transmissible infections, including HIV–1 and HIV–2, hepatitis B and C, other hepatitis viruses, syphilis, malaria and changes disease


  • Between+2° and +6° in approved blood bank refrigerator, fitted with a temperature chart and alarm.
  • During storage at +2° and +6°, changes in composition occur resulting from red cell metabolism
  • Transfusion should be started within 30 minutes of removal from refrigerator


  • Red cell replacement in acute blood loss with hypovolemia
  • Exchange transfusion
  • Patients needing red cell transfusions where red cell concentrate or suspensions are not available

Contraindications: Risk of volumes overload in patients with chronic anemia and incipient cardiac failure


  • Must be ABO and RhD compatible with the recipient
  • Never add medication to a unit of blood
  • Complete transfusion within 4 hours of commencement

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

Some thing you keep

Some things you keep; like good teeth, warm coats and bald husbands. They’re good for you, reliable and practical and so sublime that to throw them away would make the garbage man a thief. So you hang on, because something old is sometimes better than something new, and what you know often better than a stranger.

These are my thoughts. They make me sound old; old and tame and dull at a time when everybody else is risky and racy and flashing all that’s new and improved in their lives. New spouses, new careers, new thighs, new lips.

The world is dizzy with trade–ins. I could keep track, but I don’t think I want to. I grew up in the fifties with practical parents – a mother, God bless her who washed aluminum foil after she cooked in it, then re–used it– and still does. A father who was happier getting old shoes fixed than buying new ones.

They weren’t poor, my parents, they were just satisfied. Their marriage was good, their dreams focused. Their best friends lived barely a wave away.

I can see them now; Fifties couples in Bermuda shorts and Banlon sweaters, lawn mower in one hand, tools in the other. The tools were for fixing things – a curtain rod, the kitchen radio, screen door, the oven door, the hem in a dress. Things you keep.

It was a way of life, and sometimes it made me crazy. All that re–fixing, re–heating, renewing, I wanted just once to be wasteful. Waste meant affluence. Throwing things away meant there’d always be more.

But then my father died, and on that clear autumn night, in the chill of the hospital room, I was struck with the pain of learning that sometimes there isn’t any ‘more’. Sometimes what you care about most gets all used up and goes away, never to return.

So, while you have it, it’s best to love it and care for it and fix it when it’s broken and heal it when it’s sick. That’s true for marriage and old cars and children with bad report cards and dogs with bad hips.

You keep them because they’re worth it, because you’re worth it. Some things you keep.

For comments and archives

  Cardiology eMedinewS

Mitogen–Activated Protein Kinases In The Regulation Of The Cardiac Fibroblast Cell Cycle Read More

L–Arginine/No System And Oxidative Stress: From Basic Science To Applied Clinical Investigation Read More

Matrix Metalloproteinase: A Potential Target In Treatment Of Cardiovascular Complications Of Diabetes Read More

  Pediatric eMedinewS

Moms Often Blind To Toddler’s Weight Read More

Zinc May Shorten Cold Symptoms In Adults, But Not Children Read More

Calcineurin Inhibitors Helpful In Refractory Kawasaki Disease Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 25–year–old patient was brought to the medical emergency with kerosene ingestion.
Dr. Bad: Do Ryle’s tube aspiration and lavage.
Dr. Good: Refrain from doing Ryle’s tube lavage. Get a CXR done to check for lipid pneumonia.
Lesson: Never attempt Ryle’s tube insertion and lavage in kerosene poisoning as it can cause perforation. Instead, chemical pneumonitis should be suspected and an X–ray chest should be ordered for confirmation.

For comments and archives

Make Sure

Situation: A patient with Chikungunya had persistent joint pain.
Reaction: Oh my God! Why was hydroxychloroquine not given?
Lesson: Make sure that all post Chikungunya patients with persistent arthritis are treated with hydroxychloroquine

For comments and archives

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    Legal Question of the day

(Prof. M C Gupta, Advocate & Medico–legal Consultant)

Q. The radiologist in the district hospital was on leave/deputation. In her absence x–rays, including those of MLC cases, were done by an MBBS medical officer. The radiologist has joined back. The hospital authorities are asking her to report on the x–rays done in her absence. Is she bound in law to do so? She wants to avoid doing so because MLC cases mean visits to court.


A government servant has to do any job entrusted to him if the job falls in his area of duty and there is nothing illegal about it. Both these conditions are fulfilled in this case. The radiologist concerned should not shirk work. If she gets salary, she must earn it by doing her duties. Going to court is a part of duties. If she refuses to do as directed, the authorities will be within their right to start disciplinary proceedings against her.

For comments and archives

  Quote of the Day

(Dr GM Singh)

Test a servant while in the discharge of his duty, a relative in difficulty, a friend in adversity, and a wife in misfortune. Chanakya

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Mean corpuscular hemoglobin

MCH (pg/red cell) = Hemoglobin (in g/dL) × 10/RBC count (in millions/μL)

Reference values: 27–30 pg

MCH measures the average amount of hemoglobin per red blood cell.


  • Value of 27 is normochromia
  • Value –27±3, indicates hypochromia
    Microbial World: The Good and the Bad They Do

(Dr Usha K Baveja, Prof. and Senior Consultant Microbiology, Medanta – The Medicity, Gurgaon)

Testing of the exposed HCW for blood–borne viruses

As stated earlier that accidental exposure to blood and body fluid is treated as an emergency. Once the HCW has been counseled and PEP has been administered, the next step is to test the HCW for blood–borne viruses (BBVs) to find out the baseline status of HIV, HBV and HCV infection This is important as the subsequent management is determined by this fact. The testing for BBVs (HIV, HBV and HCV) is done as below.

The blood is collected at zero hour i.e. immediately after the initial management as above, and tested for the above markers. This is done to know the pre exposure status of the HCW as far as these infections are concerned.

  • If the HCW is already positive for HIV, then post exposure prophylaxis (PEP) is not recommended. In such a case, the HCW should access the ART services like any other HIV infected individual.
  • In case the HCW is positive for HBV and negative for HIV, then PEP should be given for HBV after evaluation of the severity of exposure.

Irrespective, whether the HCW decides to take PEP or not, the testing for BBVs should be done at zero hour, 6 weeks, 12 weeks and 6 months after exposure to ensure that transmission of BBVs, particularly HIV has been prevented.

In case the source blood is positive for HBV and HCW is found to be negative for the same, PEP for HBV must be administered (already discussed in earlier columns).

If the source blood is positive for HCV and HCW is found to be negative for HCV, then refer the HCW to the specialist for further care.

    Mind Teaser

Read this…………………

A client is admitted to the hospital with benign prostatic hyperplasia, the nurse most relevant assessment would be:

a. Flank pain radiating in the groin
b. Distention of the lower abdomen
c. Perineal edema
d. Urethral discharge

Yesterday’s Mind Teaser: Kenneth who has diagnosed with uremic syndrome has the potential to develop complications. Which among the following complications should the nurse anticipates:

a. Flapping hand tremors
b. An elevated hematocrit level
c. Hypotension
d. Hypokalemia

Answer for Yesterday’s Mind Teaser: a. Flapping hand tremors

Correct answers received from: Dr Ragavan Sivaramakrishnan Moudgalya, Dr Jainendra Upadhyay,
Dr PC Das

Answer for 10th May Mind Teaser: d. Cottage cheese
Correct answers received from: Y J Vasavada, Dr KV Sarma.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Law of Refrigerator Observation

If a cat watches a refrigerator long enough, someone will come along and take out something good to eat.

    Medicolegal Update

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

How can the direction of firearm be determined from the bullet track?

I have observed many surgeons to opine the direction of fire arm missile on the basis of the position of wound track. A bullet usually travels through the tissues in a straight line, so that the direction of fire may be determined from its track. But sometimes, a bullet may be deflected from its course; this occurs most commonly when it strikes a bone while passing through the tissues. It can also occur due to the inherent instability of a bullet as it penetrates tissues, and it may undergo changes of direction within the soft tissues in its track. This is illustrated by a case in which a man was struck by a bullet, which traveled through the tissues in the following order: gall bladder, hepatic flexure of colon, duodenum, pancreas, inferior vena cava, then passed medially through the bony part of the vertebral column, to strike the left kidney, spleen and pass through the diaphragm and pericardium, before coming to rest in the chest cavity. The only part of the track of bullet which was in a straight line was through the vertebral column, and sharp bends occurred in the soft tissue track before and after.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Give your mother a health check on Mother’s Day

Over 60% of mothers believe their biggest health threat to be breast cancer but heart disease kills six times as many women as breast cancer, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President, Heart Care Foundation of India.

Some risk factors are different for women than for men. Heart disease symptoms may be milder in women. Heart attacks often strike without warning. If a woman does not realize heart disease is a health threat, she will not make heart healthy changes or respond to symptoms once they occur. The best gift one can give to the mother on Mother’s day is a health check.

The woman is at risk if:

  1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  2. She is over 55 years old. (After age 65, the death rate increases sharply for women)
  3. She smokes or is exposed to secondhand smoke every day.
  4. Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise with 60–90 minutes with moderate–intensity activity on most days. About 70% of American women don’t exercise regularly.
  6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  7. Her HDL (High density lipoprotein or "good" cholesterol) is less than 50mg/dL. LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C <100mg/dL; HDL–C >50mg/dL; triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/day. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3T of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  8. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight).
  9. Either natural or through surgery, early menopause – before the age of 40 – is associated with increased risk for cardiovascular disease.
  10. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  11. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  12. A healthy diet consists of eating fruits, vegetables and whole–grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily); eating fish, especially oily fish, at least twice a week; limiting saturated fat to <10% of energy, and if possible to <7%, cholesterol to <300 mg/dL; limiting alcohol intake to no more than 1 drink per day; limiting sodium intake to <2.3 g/d (approximately 1 tsp salt) and avoiding all trans–fatty acids (listed as "hydrogenated oil" in the ingredients section)
  13. Pregnant and lactating women should avoid eating fish potentially high in methyl mercury.
  14. Having at least three of a cluster of symptoms that are listed below put a woman at risk: High blood sugar >100 mg/dL after fasting; High triglycerides at least 150 mg/dL; Low HDL (<50 mg/dL in women); blood pressure of 130/85 or higher and waist >35 inches. (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).
    Readers Response
  1. Female infanticide should be taken seriously. It is like a murder and so doctors doing it and the father should be sent to jail for at least one month. Mother can be spared to look after the family. But in India who cares for the law. Cases are decided in ten to twenty years as is seen Aarushi Murder case. B R Bhatnagar
    Forthcoming Events
Dr K K Aggarwal

Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions

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