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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 …

13th November 2012, Thursday

Elderly Beware of Commonly Prescribed Group of Drugs

Anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

Two reports from Wake Forest University School of Medicine support findings that anticholinergic drugs – used to treat acid reflux, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than those who do not take the medicines.

Anti-cholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.
Older adults taking anticholinergics become more likely to walk more slowly and to need help in other daily activities. These results are true even in older adults who have normal memory and thinking abilities.

For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function is similar to that of someone three to four years older.

Common anticholinergic medicines include blood pressure medication, nifedipine; the stomach antacid, ranitidine and the incontinence medication, tolterodine.

Cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine include donepezil, galantamine, rivastigmine and tacrine. About 10 percent of patients may be taking tolterodine and dozepezil together. The two drugs are pharmacological opposites, which led to the hypothesis that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drug

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Even when large volumes are ingested, PEG induced diarrhea is associated with minimal electrolyte losses or gains. PEG 3350 electrolyte solutions are thus safer than osmotic salts such as magnesium and sodium sulfate or phosphate, especially in patients with impaired renal or cardiac function. (Attar A, Lémann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999;44(2):226)

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

Proton–pump inhibitors to carry warning
about C

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Heart Checkup camp at Dept. of Science & Technology

Padma Shri and Dr BC Roy National Awardee Dr. KK Aggarwal demonstrated CPR 10, the technique of hands-only cardiopulmonary resuscitation.

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

4% malaria drugs substandard in India: Study

New Delhi: A study published in the Malaria World Journal has found that worldwide 2.6 per cent of all WHO-approved artemisinin-based anti-malaria drugs are substandard, as they have less than the prescribed quantity of active ingredient. For India, the figure stands at 4 per cent while in China it is 12.3 per cent, the highest. The study by the American Enterprise Institute took precautions to eliminate counterfeit products from among its samples. Out of 1,203 artemisinin-based combination therapies (ACTs) examined in the study, 684 were produced by WHO-approved manufacturers and 519 by non-WHO approved ones. It said that 2.6 per cent (18/684) of the ACTs of WHO-approved manufacturers had insufficient active pharmaceutical ingredient (less than 75 per cent), while 12.5 per cent (65/519) of ACTs of non-approved manufacturers had too little active pharmaceutical ingredient, and were considered substandard. Though the aim of the study was to ensure more effective utilisation of donor funds and it concluded that donors should emulate the practice of the US President’s Malaria Initiative of testing every batch of medicines sent out to foreign countries, for India the findings were medically significant given the high disease burden and the looming shadow of drug resistance. The three Indian cities from where drug samples were lifted were Delhi, Chennai and Kolkata. “We use artemisinin as the second line of therapy as a large portion of malaria cases caused by the parasite, Plasmodium vivax, are resistant to chloroquine, which has been the first line drug. In fact, chloroquine resistant malaria is common in India so artemisinin-based therapies are often drugs of choice. We really have no option but to follow the WHO recommendations and approvals they grant to drugs blindly,” said Dr Mukesh Mehra, senior consultant at Max Superspeciality Hospital, Patparganj. The artemisinin group of drugs are believed to be the most effective among the current crop of anti-malaria drugs in killing the protozoa, Plasmodium falciparum. However, in 2004 the World Health Organisation had banned artemisinin. The present findings are significant because earlier this year a study published in The Lancet said that artemisinin-resistant malaria that had been found in Thailand is spreading towards India. (Source: Financial Express, Dec 10 2012)

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

Valvular heart disease is common in patients undergoing maintenance dialysis. Predisposing factors include secondary hyperparathyroidism, an elevated calcium-phosphorus product, vascular calcification, hypercalcemia, uremic milieu and hyperphosphatemia.

(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)

Crowded EDs associated with higher risk for inpatient death

Patients admitted to hospitals via crowded emergency departments (EDs) may be more likely to die in the hospital than similar patients admitted during slow periods, according to a study published online December 5 in the Annals of Emergency Medicine. Findings also suggest that ED crowding is associated with a slight increase in length of stay and a 1% cost increase. (Source: Medscape)

Medical food aids in the treatment of major depression

Adjunctive L-methylfolate is safe, effective, and "relatively well tolerated" for patients with major depressive disorder (MDD) who are resistant to selective serotonin reuptake inhibitors (SSRIs) alone, new research suggests. (Source: Medscape)

First guidelines for managing prosthetic joint infections

The Infectious Diseases Society of America has published a set of clinical practice guidelines for the evaluation and management of prosthetic joint infections (PJIs). The guidelines, the first on the subject issued by the society, call for close collaboration among all clinicians involved in a patient's care. (Source: Medscape)

ATLAS: 10 years of adjuvant tamoxifen offers more benefit

Ten years of adjuvant treatment with tamoxifen was significantly better than the standard 5 years in terms of reducing the risk for breast cancer recurrence and disease-specific death, according to findings from the international ATLAS (Adjuvant Tamoxifen, Longer Against Shorter) study. Just how clinical practice will be affected was less clear than the statistical results, noted a number of experts here at the 35th Annual San Antonio Breast Cancer Symposium (SABCS). (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Women above 65 to take extra care of their health Women aged 65 and above should take low dose aspirin routinely... http://fb.me/1pqvsO2hK

@DeepakChopra: Do you love yourself as completely and effortlessly as you love this other person? http://tinyurl.com/cf4a659

    Spiritual Update

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

3 Cs of violent communication

Three Cs of violent communication are – do not condemn, criticize and complaint. Gossip, which can be defined as talking about somebody in his or her absence without any facts or reference is nothing but full of

For comments and archives

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

What are the complications of Multiple pregnancies?

Complications increase with each additional fetus in a multiple pregnancy and include severe nausea and vomiting, Cesarean section, or forceps delivery:

  • Premature birth: Premature labor and delivery pose the greatest risk to a multiple pregnancy. Feasibility of a vaginal delivery depends on the size, position, and health of the infants, as well as the size and shape of the pelvic bones. Cesarean section is often needed for twin pregnancies and is expected for delivery of triplets. Pelvic pressure, low back pain, increased vaginal discharge, or a change in the frequency of "false labor" pains should be reported to the physician, who can sometimes delay premature delivery by a few days or more if it is detected early.
  • Placental problems: The placenta is attached to the wall of the uterus, and the fetus is attached to the placenta by the umbilical cord. The placenta provides blood, oxygen, and nutrition to the fetus through the umbilical cord. Placental function is likely to be abnormal in a multiple pregnancy. The placenta ages prematurely and may slow fetal growth, especially late in the third trimester. If the placenta is unable to provide adequate oxygen or nutrients to the fetus, the fetus cannot grow properly. Twins and multiples that are more than 30% “underweight” by ultrasound measurements are at increased risk of complications and have death rates of nearly 25%.
  • Preeclampsia: Preeclampsia, also known as toxemia, occurs 3 to 5 times more often in multiple pregnancies. It is diagnosed when the mother’s blood pressure becomes elevated and protein is detected in the urine. The condition may progress and threaten the health of the mother and the pregnancy.
  • Diabetes: Women with multiple pregnancies are more likely to develop gestational diabetes during pregnancy. Babies of diabetic mothers are more likely to experience respiratory distress and other newborn complications.
  • Fetal and newborn complications: Premature delivery places an infant at increased risk for severe complications or early death. A baby’s lungs, brain, circulatory system, intestinal system, and eyes may be too immature. Survivors of premature birth may have lifelong handicaps. Of the premature babies who die, 50% succumb to respiratory distress syndrome, the inability to circulate oxygen from the lungs throughout the body. Brain damage is responsible for almost 10% of premature newborn deaths. Birth defects and stillbirths account for about 30% of the deaths in twins and multiple pregnancies. Low birth weight of less than 5 and half pounds (2,500 grams) occurs in 50% of twins. The average birth weight is approximately 4 pounds (1,800- 7grams) for triplets and 3 pounds (1,400 grams) for quadruplets. As a result of prematurity, the risk for cerebral palsy is four times more likely to occur in twins.
    Tat Tvam Asi………and the Life Continues……

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

Platelet concentrates (prepared from whole blood donations)

Single donor unit in volume of 50-60 ml of plasma should contain:

  • At least 55x109 platelets
  • <1.2x109 red cells
  • <0.12x109 leucocytes

For comments and archives

    An Inspirational Story

Why is there war?

It was my first day at school. I felt nervous and scared. I went to all my classes with no friends. It felt like no one cared.

I listened anxiously to all the lessons and waited for lunch break at one. Then finally the bell rang. It was time to talk and have fun.

In the lunch line I met a new friend who wore a hijab on her head, and though I am Jewish, we got along fine, and I was so relieved when she said, “Sit with us, at our table.” She pointed to the one next to the door.

So I agreed, and took my tray and was about to walk with her across the floor, when suddenly I felt a nudge. “Hey, I saw you on the bus,” said a tall girl in a long skirt. “I see your Jewish star necklace. You should sit with us.”

At that moment I looked around, and that’s when I noticed, to my surprise, the nations of the world, isolating themselves. That’s what I saw through my own eyes.

The Spanish only sat with Spanish, the Russians always with the Russians, and never the Arabs with the Jews. I saw the reason why war gets started. Everyone sticks to their own kind. The lunchroom was a map of the world. Why was everyone so blind?

And so I turned down this girl, and went with the first, and there was no enmity. I built a bridge between two worlds when I sat with those different from me. Hope you will do the same.

Source: http://academictips.org/blogs/why-is-there-war/

For comments and archives

    Cardiology eMedinewS

Aspirin in search of optimum dose: Dr RM Chhabra Read More

Systemic right ventricle: Dr Biswajit Bandyopadhaya Read More

    Pediatric eMedinewS

Iron may give small babies behavioral boost Read More

Risk of heart disease higher in kids with HIV Read More

    IJCP Special

Dr Good Dr Bad

Situation: A patient developed asthma within a year of menopause.
Dr. Bad: It is not asthma.
Dr. Good: It is associated with menopause.
Lesson: The onset of asthma within a year of menopause is a separate asthma phenotype.

Make Sure

Situation: A patient with chest pain with normal ECG died half an hour later.
Reaction: Oh my God! Why was acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

    Legal Question of the Day (Dr MC Gupta)

Q. Why should courts be deciding medical matters? They simply don’t understand medical facts. Why not let the medical profession decide such issues?


  • A medical matter that goes to courts is a dispute between two parties. A dispute has to be decided as per law by people who understand law. There is no other possible way. Medical profession does not have knowledge of law.
  • The medical profession has two components—The Medical Councils and the IMA. Both have proven themselves to be incapable of playing a responsible and impartial role in deciding disputes related to medical matters.
  • The medical councils are established by statute and have powers conferred on them by law. They have jurisdiction over RMPs and have to follow the procedure prescribed by law. They very often operate in a manner inconsistent with law. This illegality is often results in miscarriage of justice. Such injustice is often tolerated by the affected parties, including the doctors, meekly. Some examples of such injustice are given below:
    • The constitution of the inquiry committee is, as frequently in the case of DMC, not in accordance with law.
    • Complaints are entertained, as frequently in the case of DMC, against the rules prescribed.
    • Complaints are entertained and decided without jurisdiction (to be quashed later by the HC on this ground).
    • Legal defence is denied to accused doctors, as frequently in the case of DMC.
    • Decisions are often given without application of mind resulting in bizarre situations, such as the following:
      • In one case, the DMC let off a doctor who gave 5000 mg. Furosemide by IV bolus injection to a 70 years old man who died immediately as a result.
      • In another case, the MCI (wrongly) punished a doctor even without hearing him merely because the appellant was an IAS officer.
      • In another case, the MCI held primary trial against a doctor, found negligence and gave punishment. The judgment was challenged in the HC on grounds of jurisdiction and was quashed. Then DMC held the initial trial and found negligence. As appellate authority, the MCI quashed the decision of the DMC!
  • The IMA has no statutory power but it can play a meaningful and effective role by putting in place a mediation and reconciliation mechanism for disputes between the physician and the patient. It has not played that role.
  • If the medical profession has proved itself incapable of playing a responsible and impartial role in deciding disputes related to medical matters, it has no right to protest the jurisdiction of courts?
  Quote of the Day (Dr GM Singh)

Make it thy business to know thyself, which is the most difficult lesson in the world. Miguel de Cervantes

    Mind Teaser

Read this…………………

Dennis receives a blood transfusion and develops flank pain, chills, fever and hematuria. The nurse recognizes that Dennis is probably experiencing:

A. An anaphylactic transfusion reaction
B. An allergic transfusion reaction
C. A hemolytic transfusion reaction
D. A pyrogenic transfusion reaction

Yesterday’s Mind Teaser: Unconscious client is admitted to the ICU, IV fluids are started and a Foley catheter is inserted. With an indwelling catheter, urinary infection is a potential danger. The nurse can best plan to avoid this problem by:

A. Emptying the drainage bag frequently
B. Collecting a weekly urine specimen
C. Maintaining the ordered hydration
D. Assessing urine specific gravity

Answer for Yesterday’s Mind Teaser: C. Maintaining the ordered hydration

Correct answers received from: Sagar, Dr Jella, Dr Thakor Hitendrsinh G,
Dr PC Das, Dr Pankaj Agarwal, Dr (Maj. Gen.) Anil Bairaria, Dr KV Sarma,
Dr Arpan Gandhi, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Ambuja Choranur, Archna Parwani, Dr Ashok Barat, Prabha Sanghi.

Answer for 11th December Mind Teaser: B. Regular meals and snacks to limit gastric discomfort

Correct answers received from: Dr KV Sarma, Dr Arpan Gandhi,
Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Ashok Barat, Prabha Sanghi

Send your answer to ijcp12@gmail.com

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

Photos of Doctor’s Day Celebration

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    Laugh a While (Dr GM Singh)

A man hasn't been feeling well, so he goes to his doctor for a complete check-up. Afterward, the doctor comes out with the results. "I'm afraid I have some very bad news," the doctor says. "You're dying, and you don't have much time left."

“Oh, that's terrible!" says the man. "How long have I got?"

“Ten," the doctor says sadly. "Ten?" the man asks. "Ten what? Months? Weeks? What?!"

The doctor interrupts, "Nine..."

    Medicolegal Update

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

Facilitate cadaver organ retrieval for transplantation

In India, certain amendments to the Human Organ Transplant Act 1994 are required to enhance cadaver organ retrieval and transplantation to bridge the huge demand–supply gap. The pool of donors, including increasing the supply of organs by widening the definition of ‘near relatives’ by allowing organ swaps among needy families, as well as, simplifying cadaver transplant procedures. The paired matching should be permitted i.e. if patient A’s donor does not match A, and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families unable to fulfill the need of their family member in need of a transplant.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Heart disease has doubled in the last two decades

The incidence of heart diseases has doubled in the last two decades. The risk in Indians is four times that of white Americans, six times of Chinese and 20 times of that in the Japanese. Indians have more diabetes, small vessel disease, diffuse disease and often present late. The average age of heart disease in India is 56 years versus 64 years in the West. This was stated by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal while delivering a lecture in a seminar organized by Dept. of Science & Technology, Government of India.

Dr. Aggarwal also demonstrated CPR 10, the technique of hands-only cardiopulmonary resuscitation.

Dr. Aggarwal further said that 17 states in India have already banned manufacture and sales of Gutka and other smokeless tobacco products. The time has now come for the country as a whole to ban these products.

Dr Inderjeet Singh, IAS, Joint Secretary, Dept. of Science & Technology, said that a healthy lifestyle can prevent diseases like heart attack, diabetes and blood pressure. He said that one should exercise every day and should live a life devoid of stress.

Dr. Aggarwal also said that only 8% of heart patients in India receive clot-dissolving or removal therapy as compared to 40% of heart patients in the West. He said that the time of onset to admission in a hospital is 300 minutes in India as against 170 minutes in Europe and 120 minutes in the US.

All pathies should work together

All systems of medicines work at different levels and are therefore complementary and not in competition with each other said Dr KK Aggarwal. He was speaking on the topic ‘Therapy and Treatment of Various Systems of Medicines’ at an International Seminar on Mind and Body in Health and Harmony in Asian Systems of Medicine at the India International Centre, New Delhi.

Dr. Aggarwal said that universe is made up of five elements and the science which deals with balance of these elements is Naturopathy. These five elements in the body form three humors based on movement, metabolism and structure and in Ayurvedic language they are called Vata, Pitta and Kapha.

Balancing these three functions is what Ayurveda is. These three elements make seven dhatus (tissues) and they are Rasa (plasma), Rakta (blood), Mamsa (muscle), Medha (fat), Majja (bone marrow), Asthi (Bone) and Shukra (essence) of the human body. Ayurveda is balancing these seven dhatus. Tissues form receptors and organs; organs make up systems and therein lies the role of Allopathy.

When medicines are given in the form of matter, they can be from allopathy (opposite effect), tincture homeopathy (similar effect), fresh herbs (naturopathy) and extracts of the whole (Ayurveda).

When a matter is converted into non-matter before giving it as a medicine, it can be based on the principle of energy (homeopathy) or bhasma therapy of Ayurveda or void, which is beyond energy, and this is what Yoga and Meditation are.

Instead of all pathies working against each other, they should work in harmony with each other. The time has come for doctors of all pathies to sit together in one clinic and decide about a patient.

Earlier the conference was inaugurated by Prof. MGK Menon, an eminent scientist and introduced by Padma Shri Awardee, Dr. Ranjit Roy Chaudhury, National Professor of NAMS.

    Readers Responses
  1. Dear Sir, Nice coverage of CSI 2012. Regards: Dr PS Bhatia
    Forthcoming Events

4th eMedinews Revisiting 2012

(a day long single hall medical conference on 2012 happenings, followed by doctors of the year 2012 awards)

Sunday 20th January 2013, Maulana Azad Medical College Auditorium

Dilli Gate Delhi


Dr KK Aggarwal
Padmashri and Dr B C ROY National Awardee President

Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman

Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

4th eMedinewS Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Register at: www.emedinews.in/


4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

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4. eMedinewS ebooks (This may take a few minutes to open)

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    Our Contributors

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