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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

  Editorial …

15th May 2011, Sunday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

India’s first bloodless kidney transplant successfully done at Moolchand

Jehovah’s Witnesses, a Christian sect seek out quality healthcare and accept the vast majority of medical treatments. However, for Bible–based religious reasons, Jehovah’s Witnesses do not accept blood transfusion, they request non–blood alternatives.

Recently a patient with Hb 4.2 gm% needed a kidney transplant with a request from the family not to transfuse him. A dedicated team led by Dr Ramesh Kumar, Senior Consultant and Advisor in Nephrology and Transplantation, Dr H S Bhatyal, Senior Transplant Surgeon and Dr Vijay Langer, Senior Consultant, Anesthesiologist carried out a bloodless kidney transplant surgery, a first of its kind, at Moolchand Medcity.

Normally all major surgeries require blood transfusions during operative procedures. The requirement of blood during such procedures is a prerequisite component. The Moolchand team did this bloodless kidney transplant surgery with no blood loss and transfusion.

A Hb between 7 and 8 g/dL have no immediate adverse effect on mortality. There is a clear risk of death in the postoperative period when the hemoglobin is below 7 g/dL.

In a postoperative setting, an increased risk of mortality is noted in patients with a hemoglobin level <8 g/dL. The risk increases 2.5–fold for every 1 g/dL decrease in a patient’s hemoglobin concentration.

The 30–days in–hospital mortality for patients with various postoperative hemoglobin levels is: Hgb 7.1 to 8.0 (n = 99) — zero percent; Hgb 5.1 to 7.0 (n = 110) — 9 percent; Hgb 3.1 to 5.0 (n = 60) — 30 percent; and Hgb ≤3.0 (n = 31) — 64 percent.

Jehovah’s Witnesses

  1. While there are a number of situations in which a patient may refuse blood transfusion, the most well–known involve Christians known as Jehovah’s Witnesses.
  2. With over one million active members in North America and six million worldwide, Witnesses are encouraged to purchase health insurance and avail themselves of modern medical care with the exception of certain forms of blood transfusion.
  3. Aversion to transfusion stems from their interpretation of Biblical scripture (eg, Genesis 9:3,4; Leviticus 7:26,27; 1 Samuel 14:32,33; and Acts 15:28,29).
  4. Devout Witnesses generally will not accept transfusions of whole blood or any of the "four major components" (i.e, red cells, platelets, plasma, and white blood cells), and most are prepared to die rather than compromise this refusal
  5. Many Witnesses will accept blood subtractions, such as immunoglobulins, albumin, coagulation factor concentrates, and recombinant coagulation factors; the choice is left up to individual discretion and religious conscience.
  6. Devout Witnesses do NOT consider preoperative autologous blood donation as an acceptable alternative, due to a belief that blood should not be taken out of the body and stored for any length of time. However, if the blood circulates back into the patient (eg, cardiopulmonary bypass, certain intraoperative and postoperative blood salvage systems), this is acceptable to many Witnesses.

Therapeutic alternatives: If the patient is unwilling to be transfused under any circumstance one can do the following

  1. Reduce blood loss through reducing the volume of blood used for laboratory testing
  2. Reduce all causes of blood loss (more careful use of anticoagulants and anti platelet agents, use of anti fibrinolytic agents)
  3. Reduce oxygen requirement (100% oxygen, sedation, mechanical ventilation, control of body temperature, hyperbaric chamber)
  4. Increase the patient’s red cell production with autologous transfusion and/or erythropoietin (if acceptable) and supplemental iron and vitamins as needed
  5. Use of "blood substitutes" if available and acceptable to the patient.
  6. Use of laser/quatery instead of knife in the operation to reduce bleeding
  7. Controlled hypotension during anesthesia

Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Evidence which has changed practice in last one year

Revised HIV treatment guidelines for the US

For patients with a CD4 cell count between 350 and 500 cells/mm3 who are motivated to be treated, start ART.

    eMedinewS Audio PostCard

Diabetes Update

Dr Vinod Sanghi Speaks on
‘UKPDS: Effects of metformin treatment’

Audio PostCard
    Photo Feature

India’s first bloodless kidney transplant successfully done at Moolchand Medcity

India’s first bloodless kidney transplant successfully done at Moolchand Medcity, New Delhi, India on May 3, 2011.
In the Photo: Patient after the kidney transplant surgery at Moolchand Hospital.

Dr K K Aggarwal
    National News

Dr Sudipto Roy won from Kolkata

Congratulations to Dr. Sudipto Roy, Past National IMA President for being elected as the MLA from Kolkata. eMedinewS and all its readers wish Dr. Sudipto all the best and hope that he will bring laurels to the medical profession.

New MCI board

Noted cardiologist Dr K K Talwar, former director of PGI Chandigarh, was named the new chairman of Medical Council of India’s board of governors. The Union health ministry reconstituted the board of governors with five new names. The tenure of the current board, headed by Dr S K Sarin, ends on May 14. The new board includes Prof K S Sharma from Tata Memorial Hospital, Padma Shri Dr H S Rassam from Max Hospital, Dr Rajiv Chintaman Yeravdekar from Symbiosis International University and Padma Vibhushan (Padma Bhushan and Padma Shri) Dr Purushotham Lal, a chairman of Metro Hospital. Besides Dr Talwar, all other members of the new board are from the private sector. Contrary to earlier perception, not a single member from the previous board has been retained.

Supreme Court bans endosulfan

NEW DELHI: The Supreme Court Friday banned the production, distribution and use of endosulfan because the pesticide has debilitating effects on humans and the environment. A three–judge bench of Chief Justice S.H. Kapadia, Justice K.S. Radhakrishnan and Justice Swatanter Kumar passed the order after hearing a petition filed by the Democratic Youth Federation of India. The petition said the use of the pesticide for optimising agricultural production was creating an alarming danger to health and safety of human beings in general and agricultural workers in particular. The petition said that endosulfan also had hazardous effects on the environment.
(Source: http://expressbuzz.com/topnews/supreme–court–bans–endosulfan/274132.html, May 13)

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 Rajat Bhatnagar, International Sports & Fitness Distribution, LLC)

Training Tip

Treat your body like a fine sports car. Put good clean fuel into it, drive it mindfully and carefully on most days but take it out on weekends every now and then to really see what it can do. You will only have one body in this lifetime; don’t be afraid of it or what other people think of it. It is the greatest instrument you will ever own.

(Dr Monica and Brahm Vasudev)

Persevere with growth hormone Tx, study suggests

More than 70% of children who failed to show a good response with growth hormone in the first year of therapy achieved an average to excellent improvement in the second year of treatment, researchers said here. (Paul Kaplowitz, MD, PhD, of George Washington University and Children’s National Medical Center, in Washington)

Psych disorders may predispose soldiers to PTSD

For military personnel, having at least one psychiatric disorder before deployment to Iraq or Afghanistan appears to increase the likelihood of developing posttraumatic stress disorder (PTSD) after deployment, the prospective Millennium Cohort Study showed. The findings, which were reported in the May issue of Archives of General Psychiatry, "suggest that the Millennium Cohort or similar questionnaires completed before deployment might be useful to identify a combination of characteristics of deployed military personnel that could predict those most vulnerable or, conversely, those most resilient to post–deployment PTSD, thereby providing an opportunity for the development of pre–deployment interventions that may mitigate post–deployment mental health morbidity," the authors wrote. (Medpage Today)

LWPES: ADHD drugs okay with growth hormone

Drugs used to combat attention deficit hyperactivity disorder (ADHD) do not appear to interfere with hormone treatments in children who have growth disorders, researchers reported. (Medpage Today)

   Spiritual Update

Hanuman Chalisa

Sahastra Vadan Tumharo Jas Gaave
Asa Kahi Shripati Kanth Laagave

Meaning: Sesanaga with his thousand mouths is singing your glories: with these words, Rama embraced you

Spiritual Significance: Sesanaga here represents ego and by practicing regular Pranayama and Breathing awareness Meditation, the ego will have to surrender.

    IJCP Special

Dr Good Dr Bad

Situation: A 45–year–old male with community acquired pneumonia came for a prescription.
Dr Bad: Start azithromycin and cefuroxime combination.
Dr Good:
Start levofloxacin.
Lesson: In a meta–analysis that included 23 randomized trials, respiratory fluoroquinolones (levofloxacin, moxifloxacin, or gemifloxacin) were more likely to result in treatment success than the combination of a beta–lactam plus a macrolide for the treatment of CAP that was mostly mild to moderate in severity (odds ratio, OR 1.39, 95% CI 1.02–1.90) (CMAJ 2008;179:1269–77).

Make Sure

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh my God! Why were antibiotics not given when the meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

    An Inspirational Story

(Dr Prachi Garg)

Two seeds lay side by side in the fertile soil.

The first seed said, "I want to grow! I want to send my roots deep into the soil beneath me, and thrust my sprouts through the earth’s crust above me … I want to unfurl my tender buds like banners to announce the arrival of spring … I want to feel the warmth of the sun on my face and the blessing of the morning dew on my petals!"

And so she grew…

The second seed said, "Hmmmm. If I send my roots into the ground below, I don't know what I will encounter in the dark. If I push my way through the hard soil above me I may damage my delicate sprouts … what if I let my buds open and a snail tries to eat them? And if I were to open my blossoms, a small child may pull me from the ground. No, it is much better for me to wait until it is safe."

And so she waited…

A yard hen scratching around in the early spring ground for food found the waiting seed and promptly ate it.

Lesson: Seize the day!

    Pediatric Update

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

What are the causes of hereditary fructose intolerance?

Hereditary fructose intolerance occurs due to deficiency of an enzyme called aldolase B which is needed to break down fructose. If a person without this substance eats fructose and sucrose (cane or beet sugar, table sugar), complicated chemical changes occur in the body. The body cannot change glycogen, into glucose. As a result, the blood sugar falls.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation)

How can we evaluate the Male Partner?

The male partner should be examined for clinical evaluation. Medical records should be reviewed before the procedure and alternative treatments should be discussed. Human immunodeficiency virus (HIV) testing is compulsory which could help avoiding medical and legal issues. if the male partner is HIV infected, he should be counseled on safe sex practices for preventing HIV transmission. However, in the opinion of the ASRM (American Society for Reproductive Medicine), HIV–positive directed donors should not be used because the risk of viral transmission cannot be eliminated completely.

    Medicolegal Update

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

Postmortem examination in death due to Adverse Events Following Immunization (AEFI)

The detailed history of the patient is included in the autopsy form that is submitted to the team (Autopsy Surgeon/Pathologist/Forensic Specialist) conducting autopsy. The additional specific information to the autopsy team will help them look for any underlying disease/pathologies in the deceased which may be cause of death or contributed in the cause of death.

  • It is recommended that an autopsy in a death suspected to be due to an AEFI be performed as soon as possible (within 72 hours) to avoid tissue damage, development of postmortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
  • Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference laboratories through investigating police agencies. The samples should be collected and transported to forensic laboratories as early as possible to avoid loss of biological samples due to decomposition.
  • All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.
  • Sampling for histopathology examination to be sent to pathologist for underlying disease/pathologies in the deceased which may be the cause of death or contributed in the cause of death: The samples should be representative of the suspicious area of disease/pathology; however, in general 80 to 100 gms of liver, 100 gms of brain with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of Spleen and whole heart should be taken.
  • All the visceral specimens should be collected in separate containers, a wide – mouthed bottle as prescribed and 10% formalin should be added as preservatives. The quantity of the formalin should be sufficient to cover all the pieces of specimen viscera in bottle.
  • The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further pathological examination.
    Twitter of the Day

@DrKKAggarwal:Assembly results are as expected.

@DeepakChopra:I exist as I am, that is enough –– Walt Whitman.

    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Obesity in Pregnancy – National Health Service Guidelines

Maternal surveillance and screening

An appropriate size of arm cuff should be used for blood pressure measurements taken at the booking visit and all subsequent antenatal consultations. The cuff size used should be documented in the medical records. Women with a booking BMI >35 have an increased risk of pre–eclampsia and should have increased surveillance during pregnancy.

The Guideline states that:

  • Women with a booking BMI >35 who also have at least one additional risk factor for pre–eclampsia should be referred early in pregnancy for specialist care. Additional risk factors include: first pregnancy, previous pre-eclampsia, >10 years since last baby, >40 years, family history of pre–eclampsia, booking diastolic BP >80mmHg, booking proteinuria >1+ on more than one occasion or >0.3g/24 hours, multiple pregnancy, and certain underlying medical conditions such as antiphospholipid antibodies or pre–existing hypertension, renal disease or diabetes.
  • Women with a booking BMI >35 with no additional risk factor can have community monitoring for preeclampsia at a minimum of 3 weekly intervals between 24 and 32 weeks gestation, and 2 weekly intervals from 32 weeks to delivery.
    Mind Teaser

Read this…………………

What is not true about blind loop syndrome?

a. It manifests as diarrhea, weight loss and deficiency of fat soluble vitamins.
b. Megaloblastic anemia is commonly seen.
c. Surgery is almost always required to correct small bowel syndrome.
d. Broad spectrum antibiotics are the treatment of choice.

Yesterday’s Mind Teaser: Which of the following is not true about Pneumatosis intestinalis of small intestine?

a. It is seen equally in males and females.
b. The most common location is subserosa in the jejunum.
c. Operative procedures are required in most of the cases.
d. It is associated with COPD and immunodeficiency states.

Answer for yesterday’s Mind Teaser:

Correct answers received from: Dr Prabha Luhadia, Dr Anil Bairaria, Dr Jainendra Upadhyay,
Dr Chandresh Jardosh, Dr Anupama, Dr Girish, Dr Sumit, Dr Shreya, Dr Priyank, Dr Mukul

Answer for 13th May Mind Teaser: a.
Correct answers received from: Dr Sangetta, Dr Shreysh, Dr Pulkit, Dr Shorya, Dr Sushant, Dr Priya, Dr Maneek.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

Past tense

I was in an English exam and they asked "Write the past tense of Think." I thought and thought about this for ages. Eventually, I went for ‘Thunk’

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Lactate Dehydrogenase Serum

Also known as: LD, Lactate dehydrogenase, Lactic dehydrogenase, Total LDH, and LDH isoenzymes.

This test helps to identify the cause and location of tissue damage in the body and to monitor its progress. Increased levels of LDH and changes in the ratio of the LDH isoenzymes usually indicate some type of tissue damage. Raised levels of LDH may be seen with:

  • Cerebrovascular accident (CVA, stroke)
  • Drugs: Anesthetics, aspirin, narcotics, procainamides, alcohol
  • Hemolytic anemias
  • Pernicious anemias (megaloblastic anemias)
  • Infectious mononucleosis (Mono)
  • Intestinal and pulmonary infarction
  • Kidney disease
  • Liver disease
  • Muscular dystrophy
  • Pancreatitis
  • Lymphoma or other cancers

Low and normal levels of LDH do not usually indicate a problem. Low levels can be seen when a patient ingests large amounts of vitamin C.

    Medi Finance Update

(Dr GM Singh)


  • No investment in equity shares is safe.
  • A real estate investment is always viable. However, it is tough and one should be able to judge the right locality and the cash involved.
  • One should not have an ‘Abhimanyu’ approach in investing, i.e. know how to enter, but don’t know how to get out of it.
    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Ramipril 1.25/ 2.5/5/10 mg (Additional Indication)

For the treatment of non–diabetic overt glomerular or incipient nephropathy


    IMSA Update

International Medical Science Academy (IMSA) Update

Exercise blood pressure and cardiovascular outcome

A study of over 4800 asymptomatic normotensive individuals found that a hypertensive response to treadmill testing was associated with an increased risk for cardiovascular death.

  Thought of the Day

(BK Sapna)

Courage is a strength that comes from the core of your being; the strength that allows you to commit to life. It’s the willingness to go beyond your current limits and say I CAN.

    Readers Responses
  1. Dear Sir, I am one of the of silent admirers of u’r work. I have been reading u’r bulletin regularly and go through all the contents, they r really good. Thanks. Dr Prachi.
    Public Forum

(Press Release for use by the newspapers )

Age No Bar for Blood Pressure

The formula ‘Age + 100’ is normal blood pressure is no more true today. Blood pressure at any age should be kept lower than 120/80 mmHg.

Quoting an international study, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India, said that giving blood pressure reducing drugs even after the age of 80 reduces the risk of paralysis, heart attack, and deaths. The study, Hypertension in the Very Elderly trial, included 3800 above the age of 80 people with high BP.

Vegetarian diet helps reduce BP

Dr Aggarwal said that ingestion of a vegetarian diet may decrease systolic blood pressure by 5 mmHg.
A 5 mm reduction in blood pressure may reduce the risk of heart disease by 21%. One major feature of a vegetarian diet that may affect blood pressure is the amount of dietary fiber, with an increased amount being associated with decreased systemic pressures.

Several meta–analyses have shown benefits with dietary fiber intake on blood pressure.

As an example, a meta–analysis of 24 randomized placebo–controlled trials published between 1966 and 2003 on the effects of fiber supplementation found an average fall of 1.2/1.3 mmHg with fiber intake (average dose of 11.5 g/day).

More significant reductions were observed in older (greater than 40 years) and hypertensive individuals.

    eMedinewS Special

1. eMedinewS audio PPT (This may take a few minutes to download)

2. eMedinewS audio lectures (This may take a few minutes to open)

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

Activities eBooks


  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html

Key Contacts
Dr. (Col.) Satish Parashar, President Organizing Committee, + 91 9810146231
Dr. Rakesh Gupta, Secretary General, + 91 9811013246

Congress Secretariat: Rajat Khurana, C–1 / 16, Ashok Vihar – Phase II, Delhi 110 052, INDIA., Phone: + 91–11–2741–9505, Fax: + 91–11–2741–5646, Mobile: + 91 9560188488, 9811911800,
Email: worldcon2011@gmail.com, jrop2001@yahoo.com, worldcon2011@in.kuoni.com


Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011(Screening of films October 14–17, Jury Screening at Jamia Hamdarad University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi.
Entries Invited: from feature films, Ad Films, Serials, Documentary Films, Cartoon Films, Animation Films, Educational films; films on Yoga, Siddha, Ayurveda, Unani, Homeopathy; Indigenous Healing, Films promoting the Bio–cultural Diversity, Medical Tourism, Visual and Medical Anthropology, Gender sensitization, awareness drive on socio–medical issues and health journalism. The films can be of variable durations (0–1 minute, upto 3 minutes, upto ten minutes, upto 45 minutes and upto an hour and beyond).
Separate entries are also invited for "factual mistakes in feature films concerning health". This can be in the form of 1–5 minutes footages.

Categories:Competitive category/ Non Competitive category/ Special screening
Sub Categories:

1. General: Documentaries, animation films, corporate films, Ad films, TV health programs/reports, health chat shows.

2. Special: Short instances of "depiction of wrong health messages" through the films.

Subjects: Health, disease, sanitation, yoga, spiritual health, environment, social issues, food, better living, Indigenous healing, medical tourism, visual & medical anthropology, gender sensitization, health journalism. Duration: 0–10 seconds; <30 minutes, 30–60 minutes, 1–3 hours. Language: English or Hindi, or sub tilled in English/Hindi. Fee: No fees from participants. Entry to the film show free. Format: Any format duly converted into DVD (compatible to the latest players/systems) Boarding, Lodging and Travel Expenses: Own, the participants may raise their own sponsorships

For details contact: Dr KK Aggarwal/Dr Kailash Kumar Mishra/Mr M Malik at


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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 Naveen Dang, Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta