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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…

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

17th April 2013, Wednesday

New Social Media Guidelines Issued for Physicians

Medscape Cardiology: A new social media policy urges doctors to "pause before posting" and to not "friend" patients online. The guidelines issued by the American College of Physicians and the Federation of State Medical Boards, was released at ACP Internal Medicine 2013 in San Francisco, California, and published April 11 in the Annals of Internal Medicine. It addresses the benefits and drawbacks of a number of online interactions, and proposes safeguards.

A recent survey of state medical boards showed that 92% reported at least 1 online violation of professionalism that led to a major action, such as license re vocation (JAMA. 2012;307:1141-1142).

  1. Email and electronic communication should be restricted to individuals with whom the physician has an established physician–patient relationship. One need to be very careful about the type of information provided. It places ONE at a professional and ethical risk.
  2. Another challenge is ensuring confidentiality. Posts on Facebook, Twitter, and other social media sites can be widely read, and even emails can be forwarded. We have to be careful about the kind of information we provide, particularly private and confidential information that the patient may not want shared.
  3. Look for and use only portals for confidential interactions with patients rather than standard social media or personal Websites. A post can be taken out of context and go viral.
  4. Social media however enables communication with a larger audience than you might be able to in a practice, which can be helpful when disseminating information on issues such as public health reform or vaccines. However, any posted comment can have a life of its own and might spread in a fashion you hadn't intended.
  5. Posts can be objective, such as referenced health information, or subjective, such as opinions on matters of public policy. We have to be clear which hat we're wearing, whether it's a personal opinion or we're representing an institute or organization.
  6. Physicians should keep their professional and personal personas separate; they should not "friend" or contact patients through personal social media.
  7. Email and other electronic communications should only be used by physicians within an established patient–physician relationship and with patient consent.
  8. When a physician is approached through electronic means for clinical advice in the absence of a patient–physician relationship, the individual should be encouraged to schedule an office visit or go to the nearest emergency department.
  9. Text messaging should never be used for medical interactions, even with an established patient, except with extreme caution and consent from the patient.
  10. Trainees can inadvertently harm their future careers by not posting responsibly or actively policing their online content.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

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

5 of the Best Workouts You Can Ever Do: Harvard Medical School

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

WHO Day Celebrated

Over 11459 people were trained in Hands-only Cardiopulmonary Resuscitation (CPR 10) in one day

Dr K K Aggarwal
    National News

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, Telecast every Wednesday 9 AM in DD National

DD Programme “Take Care Holistically”, Dr KK Aggarwal as an Anchor, every Thursday 4:30 PM in DD India

First mother's milk bank opens in Udaipur

JAIPUR: The first mothers' milk bank in Rajasthan was inaugurated by health minister AA Khan in Udaipur on Sunday. It's a unique milk bank, opened with an aim to provide milk to those infants whose mothers are not healthy enough to feed their infants. Khan said that such milk banks are the need of the hour. The milk bank will be called Divya Mothers Milk Bank which has been opened at Panna Dhai Hospital, Udaipur with the support of NGO called Maa Bhagwati Vikas Sansthan. Khan said, "Foster mothers and wet nursing has been a tradition of India and through modern techniques of pasteurization and storage this milk can be made available to thousands of infants and millions of young lives can be saved." He added, "If more banks like this are established in the state and the nation then the infant mortality rate can be reduced tremendously."

Devendra Agarwal, founder of the NGO, who is supporting this initiative, said, "We have taken this step as malnutrition and infant mortality is high. Providing mothers' milk to infants can save lives of countless babies who are deprived of mothers' milk due to many reasons." He claimed that it is not only the first one in Rajasthan but it is one-of-its kind in North India. The donation of milk will start from Monday and the infants requiring milk will start getting it from Tuesday. Agarwal said that the milk will be provided to the infants in intensive care unit, infants with life-threatening diseases or conditions, multiple birth babies whose mothers can't keep up with the milk required to nourish their infants, mothers who are on medications that may pass into their milk and which can be harmful for the infant. The milk bank officials said that the women who can donate milk will be mothers of premature infants, mothers who have given birth to stillborn infants. They would be provided adequate counselling so that they come forward and donate milk whole heartedly. Even lactating mothers - who are nursing their own babies but still have surplus milk can donate. The official said the women who will donate their milk will not be financially compensated. They will donate because they know their milk can save the lives of premature and ill babies. (Source: TOI, April 15, 2013)

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


Physical abuse in children

  1. Physical neglect– Failure to provide adequate food, clothing, shelter, hygiene, protection; inadequate supervision with risk of harm to the child.
  2. Emotional neglect– Failure to provide love, affection, security, and emotional support; failure to provide psychological care when needed; spouse abuse in presence of the child.
  3. Educational neglect– Failure to enroll the child in school or ensure school attendance or home schooling; failure to address specific educational needs.
  4. Medical neglect– Refusal to seek or delay in seeking medical care resulting in damage or risk of damage to the child’s health.

For comments and archives

    Valvular Heart Disease Update

Valvular thickening or sclerosis of the aortic and mitral valve is a frequent occurrence in hemodialysis patients and occurs in 55 to 69 percent of individuals.

(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)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Preop ketamine may lower pain in fibromyalgia

In fibromyalgia patients undergoing knee or hip replacement surgery, low-dose, intraoperative ketamine appeared to reduce the need for post-surgical opioid therapy, researchers said at the American Academy of Pain Medicine meeting. (Source: Medpage Today)

For comments and archives

New research confirms spinal cord is key to chronic pain

For the first time, researchers have demonstrated the involvement of the spinal cord in chronic pain. Using resting-state functional MRI of participants in whom central sensitization had been induced and who were not experiencing pain, researchers showed the spread of functional connectivity in the spinal cord. (Source: Medscape)

For comments and archives

Drug-eluting stents may save ischemic limbs

Drug-eluting stents provide good outcomes for patients with critical limb ischemia in whom balloon angioplasty has failed, a single-center study showed. (Source: Medpage Today)

For comments and archives

Shortage of tuberculin skin test antigens across US

There is a shortage of tuberculin skin test antigens in the United States, the Centers for Disease Control and Prevention (CDC) said April 12 in a Health Alert Network advisory. (Source: Medscape)

For comments and archives

Polycystic ovary tied to higher diabetes, CVD

Women with polycystic ovary syndrome have a higher incidence and age-specific prevalence of cardiovascular diseases and diabetes, researchers found. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Summer diarrhea treatment by Dr K K Aggarwal http://bit.ly/139itON #Health

@DrKKAggarwal: Our prayers are with all those affected by the tragedy that occurred in Boston today. #prayforboston

    Spiritual Update

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

Peacock In Mythology

In Hindu mythology, peacock is the vahan or the vehicle of Kartikeya and the Buddhist Goddess Mahamayuri. In imagery Lord Krishna is always represented wearing a peacock feather tucked in his headband. Ma Saraswati is also depicted with a peacock standing by her side. Traditionally peacock is a symbol of vastness (beauty), peace and poise (santulan).

For comments and archives

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

What is pelvic adhesion?

Adhesions in and around the pelvic cavity may form if you have endometriosis, a pelvic infection, surgery on your pelvis, a cyst on an ovary, or have had surgery on your pelvis. Scar tissue causes organs that normally are separate from each other to become attached.

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

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

Blood Donation - Gift of Liquid Love

The dependence of human source for the reagents will also be reduced if the hybridoma technology is applied for preparation of reagents. Recent advances in medical knowledge have significantly increased the volume and complexity of the work of the hospital blood bank.

For comments and archives

    An Inspirational Story

House of 1000 Mirrors

There was place known as the House of 1000 Mirrors.

A small, happy little dog learned of this place and decided to visit. When he arrived, he bounced happily up the stairs to the doorway of the house.

He looked through the doorway with his ears lifted high and his tail wagging as fast as it could. To his great surprise, he found himself staring at 1000 other happy little dogs with their tails wagging just as fast as his. He smiled a great smile, and was answered with 1000 great smiles just as warm and friendly. As he left the House, he thought to himself, "This is a wonderful place. I will come back and visit it often."

In this same village, another little dog, who was not quite as happy as the first one, decided to visit the house. He slowly climbed the stairs and hung his head low as he looked into the door.

When he saw the 1000 unfriendly looking dogs staring back at him, he growled at them and was horrified to see 1000 little dogs growling back at him. As he left, he thought to himself, "That is a horrible place, and I will never go back there again."

All the faces in the world are mirrors. What kind of reflections do you see in the faces of the people you meet?

For comments and archives

    Cardiology eMedinewS

Enlarged heart no excuse for inactivity Read More

Adverse drug events found by mining clinical notes in HER Read More

    Pediatric eMedinewS

Skin cancer on the rise in U.S. kids Read More

H7N9 human infection of 'public health significance' Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

What is the dose and schedule of IDRV?

For PEP, the modified “TRC ID” schedule (2-2-2-0-2) is the only schedule approved by the DCGI at present. Intradermal (ID) vaccine is given on days 0, 03, 07, and 28.

The dose of each ID shot has been specified to be 0.1 ml. of the permitted vaccines. For pre-exposure vaccination, 0.1 ml of ID-approved vaccine is to be given ID over one deltoid on days 0, 7 and 21 or 28 days.

    IJCP Special

Dr Good Dr Bad

Situation: A 63–year–old male with pneumonia had blood urea of 44 mg/dL.
Dr Bad: He needs ICU care.
Dr Good: This can be treated as an outpatient case.
Lesson: Patients with a CURB–65 score of 0 to 1 could probably be treated as outpatients, those with a score of 2 should be admitted to the hospital, and those with a score of 3 or more should be assessed for ICU care, particularly if the score was 4 or 5 (Thorax 2003;58:377–82).

Make Sure

Situation: A diabetic patient’s wound was not healing.
Reaction: Oh my God! Why is his A1c still more than 8?
Lesson: Make sure to control diabetes in such cases. Every 1% increase in hemoglobin A1c was associated with almost a 0.03 cm2 reduction in daily rate of wound resolution.

  Quote of the Day (Dr GM Singh)

Where there is determination there is success

Think of all that you wanted to achieve in the past few days. Now check if you have achieved it or are still trying for it. Check if you have left anything midway. Pick out one of the things that you wanted to achieve or create an aim for yourself and think, "I am the one who is victorious and I will achieve whatever I set out to. I will not leave any task unfinished."

    Mind Teaser

Read this…………………

Nurse Dave is conducting an examination of a 6-month-old baby. During the examination, the nurse should be able to elicit which reflex?

a. Babinski’s
b. Startle
c. Moro’s
d. Dance

Yesterday’s Mind Teaser: Nurse Wayne is aware that which finding would be least suggestive of necrotizing enterocolitis (NEC) in an infant?

a. Hepatomegaly
b. Distended abdomen
c. Gastric retention
d. Blood in the stool

Answer for yesterday’s Mind Teaser: a. Hepatomegaly

Correct answers received from: Dr Anusha Sudhakar, Prabha Sanghi, Dr BK Agarwal, Dr PC Das, Dr Suresh Arora, Dr Pankaj Agarwal, Anil Bairaria, Dr Arpan Gandhi, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Jainendra Upadhyay, Dr Jella, Dr PK Sahu, Yamini Alsi , Dr K Raju, Dr Jayashree Sen &
Dr Bitaan Sen, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr Deepali Chatterjee, Dr Kanta Jain, Dr U Gaur, Abid Ahmed.

Answer for 14th April Mind Teaser: a. Comforting the child as quickly as possible

Correct answers received from: Dr K Raju, Dr Thakor Hitendrsinh G, Arundhati Malviya, Dr Deepali Chatterjee, Dr Kanta Jain, Dr U Gaur, Abid Ahmed.

Send your answer to ijcp12@gmail.com

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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Laugh a While (Dr GM Singh)

A doctor got a phone call from one of his colleagues.
“We need a fourth for poker,” the voice on the phone said. “I’ll be right over,” replied the doctor.
As he was putting on his overcoat, his wife asked, “Is it serious?”
“Oh yes, quite serious,” he said gravely. “They’ve had to call in three other doctors as well.”

    Medicolegal Update

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

Should a doctor perform CPR in already injured chest patient?

When a person needs CPR or cardiopulmonary resuscitation, this means that he/she is unconscious, not moving and not breathing normally. If this is the case, the person is presumably in cardiac arrest or in a state that justifies cardiopulmonary resuscitation.

  • If the person is awake, is breathing normally and therefore does not appear to need CPR, it would be correct that chest compressions and CPR may complicate the already damaged chest and further complicate the victim’s injuries.
  • As soon as the victim becomes unconscious, is not breathing normally and now appears to need CPR, Emergency Services should be contacted and CPR should be initiated regardless of the injuries of the patient.
  • If the person needs CPR, this means that they are clinically dead. If the victim does not receive CPR, they will simply graduate to permanent death.
  • This is why, regardless of the chest injury, if the person is "dead" or in need of CPR, compressions are to be given per the American Heart Association (AHA) guidelines even if the complications could include those of punctured lungs, lacerated organs or bruised/punctured heart muscle. These injuries must be recorded in the clinical sheet.
  • This would be based on the theory that a person in need of CPR is already dead and will not be harmed more even if there are negative side effects from providing chest compressions. If a person remains dead, surgery is not an option but if the person is resuscitated with CPR, and alive at the hospital, we have an opportunity to fix the injuries that may have been aggravated by doing CPR.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Smell check, scratch and sniff, a new test for Parkinson’s disease

Olfactory dysfunction presenting as odor detection, discrimination, and identification is a common finding in patients with early non vascular Parkinson's disease, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

As per a study of 2,267 men published in the Annals of Neurology, an impaired sense of smell could be an early indicator of Parkinson's disease, occurring up to four years before motor skill problems appear.

In the study decreased odor identification was associated with older age, smoking, more coffee consumption, less frequent bowel movements, lower cognitive function and excessive daytime sleepiness, but even after adjusting for these factors, those with the lowest odor identification scores had a five time greater risk of developing Parkinson's disease than those with the highest scores.

Nerve loss and the formation of Lewy bodies -- abnormal clumps of proteins inside nerve cells that are thought to be a marker of the disease -- are known to take place in the olfactory structures of patients with the disease.

An impaired sense of smell could also be caused by impaired sniffing, which may be another motor symptom of Parkinson's.

Early indicators of Parkinson's disease are olfactory abnormality, constipation and sleep disturbances.

Besides Parkinson's disease, obesity, diabetes, hypertension, malnutrition, Alzheimer's disease, multiple sclerosis and Korsakoff's psychosis are all accompanied or signaled by smell disorders.

    Readers Responses
  1. Dear Sir, This enewspaper is not only informative , but also very interesting to read.Thanks for mailing to me.

    Sincere Regards, Dr Mamta Joshi
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