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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 (March 10-13); 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 …

22nd May 2013, Wednesday

Most People Unaware That CT Radiation Can Cause Cancer In Future

One-third of people getting a CT scan are not aware that the test carries radiation risk and future cancer.

The risk of cancer depends on how many scans a patient gets and which organs are exposed to CT radiation.

CT scans are high-powered X-rays that provide clearer images but expose patients to between ten and 100 times more radiation than a normal head or chest X-ray.

The radiation dose from one CT scans typically ranges from a couple of millisieverts – comparable to the yearly background radiation from natural sources – to close to 20 millisieverts, the annual exposure limit for nuclear industry employees.

Although each scan only has a small impact on a person’s long term risk of cancer, that risk can build over time with more scans and more radiation exposure. For examples repeated ct scans are being dine in kidney stones, nasal sinuses or for dementia without reasons.

As per JAMA there would be about 29,000 future cancers related to scans done in 2007 alone. That year, Americans had about 72 million total CT scans.

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

ACE inhibitors better ARBs in new meta–analysis in hypertensives

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Awardees meet on 18th May 2013

Dr K K Aggarwal
    National News

Delhi gets latest tool to detect breast cancer

New Delhi: Early detection of breast cancer just got easier as the world’s most accurate mammography system has made its way into north India, reports HT. What’s more, the new machine provides 20% less radiation dose than the ones available now. The machine- AMULET- by Fujifilm was launched at a summit organised by Mahajan Imaging on ‘Advances in Medical Technology in the Fight against Breast Cancer’ in the Capital on Sunday. In less than 10 seconds, the machine breaks down the images to as small as 50 micron, providing a much clearer picture during the scan. There has been a sea change in mammography technology in the past couple of decades. It started with screen-film mammography and gradually moved to computer-assisted mammography that is still the most popular form in India. (Source: Hindustan Times, May 20, 2013)

For comments and archives

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

    Be Human Stop Child Abuse (Team IMA for CMAAO)


DNA testing

  • DNA parentage testing is primarily used to determine whether a man can be conclusively excluded as the biological father of a given child.
  • It has legal, financial, and social indications.
  • The testing uses tandemly repeated DNA length polymorphisms to compare DNA samples between individuals.

For comments and archives

    Valvular Heart Disease Update

When is antithrombotic therapy indicated after heart valve replacement?

Treatment with warfarin (or other vitamin K antagonist) and/or aspirin is recommended in patients with prosthetic heart valves to prevent valve thrombosis and thromboembolic events.

(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)

ARDS survival improved by prone position

Mortality in acute respiratory distress syndrome (ARDS) was cut in half in patients who had early and prolonged sessions of prone positioning, a multicenter randomized trial showed. (Source: Medpage Today)

For comments and archives

Frailty predicts worse surgery and dialysis outcomes

Frailty can be a predictor of poor outcomes for patients following cardiac surgery and for patients on hemodialysis, according to 2 new trials presented at the American Geriatrics Society (AGS) 2013 Annual Scientific Meeting. (Source: Medscape)

For comments and archives

No major benefit for IV feeding in ICU

Early parenteral nutrition in critically ill adults who could not tolerate early enteral nutrition did not lead to better survival outcomes or a shorter stay in the intensive care unit when compared with standard care, researchers found. (Source: Medpage Today)

For comments and archives

Algal beta-carotene may be helpful in retinitis pigmentosa

Dunaliella bardawil powder rich in 9-cis beta-carotene can significantly increase measures of retinal function in some patients with retinitis pigmentosa, according to Israeli researchers. (Source: Medscape)

For comments and archives

Seasoning may cut salt needs in hypertension

A greater taste for salt among older hypertensive adults might be sated by seasoning instead, a small experimental study showed. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Zero Hour: Dr KK Aggarwal talks about correct CPR practices- Part 1 (May 17, 2013) ….. http://www.youtube.com/watch?v=jg-CKajo5JY

@DrKKAggarwal: The world turns into a dream only if you are conscious of your inner feelings, sensations & images http://tinyurl.com/lwk2pm6 @SFGate

    Spiritual Update

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

What is the significance of silence?

True silence is the silence between the thoughts and represents the true self, consciousness or the soul. It is a web of energized information ready to take all provided there is a right intent. The process of achieving silence is what meditation is.

For comments and archives

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

What hormonal changes occur during the menopause transition?

One of the first hormonal changes that occur as a woman gets older is a decrease in levels of an ovarian hormone called inhibin, which causes a decrease in the production of FSH. As inhibin levels fall, FSH levels rise higher and higher during the menopause transition. FSH levels cause estrogen (female hormone produced by the ovaries) levels to rise. Just as FSH levels fluctuate, so do estrogen levels. In fact, estrogen levels may be temporarily high at times during the menopause transition. This shows that there is higher stimulation by FSH.

    An Inspirational Story

Student Counting Apples

A teacher teaching Maths to seven-year-old Laiq asked him, “If I give you one apple and one apple and one apple, how many apples will you have?” Within a few seconds Laiq replied confidently, “Four!”

The dismayed teacher was expecting an effortless correct answer, three. She was disappointed. “Maybe the child did not listen properly,” she thought. She repeated, “Laiq, listen carefully. If I give you one apple and one apple and one apple, how many apples will you have?”

Laiq had seen the disappointment on his teacher’s face. He calculated again on his fingers. But within him he was also searching for the answer that will make the teacher happy. His search for the answer was not for the correct one, but the one that will make his teacher happy. This time hesitatingly he replied, “Four.”

The disappointment stayed on the teacher’s face. She remembered that Laiq liked strawberries. She thought maybe he doesn’t like apples and that was making him lose focus. This time with an exaggerated excitement and twinkling in her eyes she asked, “If I give you one strawberry and one strawberry and one strawberry, then how many you will have?”

Seeing the teacher happy, young Laiq calculated on his fingers again. There was no pressure on him, but a little on the teacher. She wanted her new approach to succeed. With a hesitating smile young Laiq replied, “Three?”

The teacher now had a victorious smile. Her approach had succeeded. She wanted to congratulate herself. But one last thing remained. Once again she asked him, “Now if I give you one apple and one apple and one more apple how many will you have?” Promptly Laiq answered, “Four!”

The teacher was aghast. “How Laiq, how?” she demanded in a little stern and irritated voice. In a voice that was low and hesitating young Laiq replied, “Because I already have one apple in my bag.”

When someone gives you an answer that is different from what you expect, don’t think they are wrong. There shall be an angle that you may not have thought about yet.

For comments and archives

    Cardiology eMedinewS

Intensive BP lowering on trial again Read More

    Pediatric eMedinewS

Sugar-free fizzy drinks limit weight gain in kids 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)

How is RIG injected locally? What is the mode of administration of full dose of RIG?

It is important to infiltrate all wounds with rabies immunoglobulin (RIG). Intramuscular (IM) administration of RIG is of very little value. The previous recommendation to give antirabies serum half into wounds and half IM no longer holds true and may lead to treatment failure. As much of the calculated dose of RIG as is anatomically feasible should be infiltrated into and around all the wounds. In the event that some volume of RIGs is left over after all wounds have been infiltrated, it should be administered by deep IM at a site distant from the vaccine injection site.

If the calculated dose of RIG is insufficient to infiltrate all wounds, sterile saline can be used to dilute it 2 or 3 fold to permit thorough infiltration.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with heart failure had a total lymphocyte count of 1000.
Dr. Bad: Lymphocyte count does not matter.
Dr. Good: You have a bad prognosis.
Lesson: In heart failure, a lymphocyte count of less than 1600 is associated with greater risk of death and hospital admission. The cut–off value of lymphocyte count is 1800 and low ejection fraction is defined as lower than 35% (Charach G, et al. Usefulness of total lymphocyte count as predictor of outcome in patients with chronic heart failure. Am J Cardiol 2011;107(9):1353-6).

Make Sure

Situation: A patient with LBBB in ECG developed acute pulmonary edema.
Reaction: Oh my God! Why was the underlying low cardiac functions not suspected?
Lesson: Make sure all patients with LBBB undergo echo to rule out ejection fraction. This may not be true for RBBB.

  Quote of the Day (Dr GM Singh)

If I have the belief that I can do it, I shall surely acquire the capacity to do it even if I may not have it at the beginning. Gandhi

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    Legal Question of the Day (Dr MC Gupta)

Q. Does the MCI have power to entertain an original complaint for violation of MCI Ethics Regulations, 2002?


  1. The MCI should not have such power because it would be in conflict with the concept of the SMC being equivalent to a trial court and the MCI being equivalent to an appellate court. Such concept is clearly reflected in Regulation 8.8, reproduced below:

    “8.8 Any person aggrieved by the decision of the State Medical Council on any complaint against a delinquent physician, shall have the right to file an appeal to the MCI within a period of 60 days from the date of receipt of the order passed by the said Medical Council:

    Provided that the MCI may, if it is satisfied that the appellant was prevented by sufficient cause from presenting the appeal within the aforesaid period of 60 days, allow it to be presented within a further period of 60 days.
  2. If the MCI acts as the trial court and decides an original complaint, there is nowhere for the aggrieved party to go in appeal. The right to appeal is a valuable right and cannot be taken away lightly. It is written nowhere in the IMC Act, 1956 or in the 2002 regulations that the MCI can decide on original complaints.

    iii) That the MCI is not supposed to decide an original complaint is clear from the fact that the IMC Act, 1956, does not confer such power on the MCI and does not provide any mechanism, including the composition of an ethics committee. On the other hand, the acts under which the SMCs are established specifically provide in detail a mechanism for the composition and functioning of an ethics committee. For example, section 21 of the Delhi Medical Council Act, 1997, has detailed provisions in this regard.

    iv) Section 24 of the IMC Act, 1956, clearly states that the removal of name from the IMR can be effected only subsequent to removal of the name from the State Medical Register. It is thus clear that the MCI has no power to punish an RMP on its own.
  3. An apparent anomaly is found in Regulation 8.7 which is reproduced below:

    “8.7 Where either on a request or otherwise the Medical Council of India is informed that any complaint against a delinquent physician has not been decided by a State Medical Council within a period of six months from the date of receipt of complaint by it and further the MCI has reason to believe that there is no justified reason for not deciding the complaint within the said prescribed period, the Medical Council of India may-

    (i) Impress upon the concerned State Medical council to conclude and decide the complaint within a time bound schedule;

    (ii) May decide to withdraw the said complaint pending with the concerned State Medical Council straightaway or after the expiry of the period which had been stipulated by the MCI in accordance with para(i) above, to itself and refer the same to the Ethical Committee of the Council for its expeditious disposal in a period of not more than six months from the receipt of the complaint in the office of the Medical Council of India.”

    However, it is to be noted that Regulation 8.7 has been included to provide for a specific situation when the SMC concerned is not able to dispose of the original complaint within the time limit provided. In my opinion, even this provision is faulty because it confers powers on the MCI which were not intended by the legislature as per the 1956 Act. The proper remedy in the given circumstances would be to transfer the complaint to the ethics committee of another / adjoining SMC so that the right of appeal to MCI remains intact.
  4. A single bench of Delhi HC (JUSTICE S.MURALIDHAR) held as follows in its judgment / order dated 13-4-2010 in WP(C ) 4438 titled as “ Dr. Saroj Jain v. MCI & Ors.”

    “3. It is the considered view of this court the appropriate course for the MCI to have adopted was to have referred the letter of the Commissioner of Police in the first instance to the DMC for its decision. Thereafter, the party aggrieved could have appealed to the MCI. There was no question of the MCI directly dealing with the complaint, bypassing the DMC”.
  5. A single judge bench (RAJIV SHAKDHER, J) of Delhi HC held in Dr. Alka Gupta vs Medical Council Of India & Anr., decided on 30 November, 2012, that the MCI has power to entertain an original complaint. However, the facts of the case were a bit complicated and the SMC had actually given its decision before the appeal was heard by the MCI. It is clear that the MCI, which was aware of the judgment in Dr. Saroj Jain v. MCI & Ors., concealed the same from the Hon’ble HC at the time of hearing in Dr. Alka Gupta vs Medical Council of India. Such an act was patently unfair on the part of the MCI. The 2012 judgment is clearly assailable by the 2010 judgment.
  6. A W.P.(C) 7987/2010 titled as Dr. DHARAM PRAKASH versus UNION OF INDIA and ANR is currently pending before a single judge bench of JUSTICE S.MURALIDHAR in the Delhi HC. The specific issue in this WP is whether the MCI can entertain an original complaint. Judgment is expected this year.
  7. SUMMARY—My opinion is that the MCI does not have original jurisdiction and has only appellate jurisdiction.
    Mind Teaser

Read this…………………

When developing a postoperative plan of care for an infant scheduled for cleft lip repair, nurse Elaine should assign highest priority to which intervention?

a. Comforting the child as quickly as possible
b. Maintaining the child in a prone position
c. Restraining the child’s arms at all times, using elbow restraints
d. Avoiding disturbing any crusts that form on the suture line

Yesterday’s Mind Teaser: The nurse applies mafenide acetate to Clara, who has second and third degree burns on the right upper and lower extremities, as ordered by the physician. This medication will:

A. Inhibit bacterial growth
B. Relieve pain from the burn
C. Prevent scar tissue formation
D. Provide chemical debridement

Answer for yesterday’s Mind Teaser: A. Inhibit bacterial growth

Correct answers received from: Dr Kanta Jain, Dr. P. C. Das & Dr. Mrs. S. Das, Dr. B.B. Gupta, Dr Gajveer , dr arpan gandhi, Dr Pankaj Agarwal, Dr.Nageswara Rao Patnala, Dr.K.V.Sarma, DR AYYAVOO ERODE, Dr Jainendra Upadhyay, Dr. Thakor Hitendrsinh G, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr.Chandresh Jardosh, Dr B K Agarwal, Dr.Bitaan Sen & Dr.Jayashree Sen.

Answer for 20th May Mind Teaser: B. A tracheostomy set and oxygen

Correct answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

A man was in the kitchen making a lot of noise! His wife comes in and asks why he was making so much noise? The man replies: "I am killing flies." A short time later his wife came back and he was still making lots of noise! She asks: "Well, Mr. Big Shot, how many flies have you killed?" He says: "I have killed seven flies! 4 males and 3 females." She says: "Right, how can you tell the gender of flies?" He says: "Very easy: the 4 flies in my right hand are males. When I killed them, they were all on beer cans!" Then she asks: "If you are so smart, how can you tell the gender of the females?" He says: "The three in my left hand, they were all on the phone!!!"

    Medicolegal Update

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

What is an impulse and its medicolegal importance?

Impulse is a sudden and irresistible desire or force in a person that compels him to the conscious performance of some act for which there is no motive; for example, kleptomania means an irresistible desire to steal articles which may be of small value and even, may be of no use to the person stealing the article. A sane person who has self–control and judgment capacity may not finally give shape to his impulsive or compulsive desire. But an insane person, who lacks in self–control and judgment capacity, cannot resist the impulse and may commit any offence. Thus, in connection with commission of an unlawful act, impulse is a good defense for an insane person which is not so for a sane person. Some types of impulses are:

  • Dipsomania: This is found in alcoholics who have an irresistible desire to take alcoholic drinks.
  • Pyromania: Here, there is an irresistible desire to set fire to things, which may be important and valuable. The person is not conscious or careful, at least temporarily, to the possible dangers of his act.
  • Mutilomania: This is an irresistible desire to injure and mutilate animals, commonly the domestic pets.
  • Sexual impulse: The person may feel compulsive urge to perform sexual intercourse, often in a perverted way. There may be some psychic problem concerning the sexual behavior; or the person may be a victim of mental sub normality.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Two or more drugs may interact with each other

Two or more prescription or over-the-counter drugs interact negatively with each other and cause adverse drug reactions, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

To reduce the risk of drug reactions, one must follow the following guidelines:

  • Read labels carefully.
  • Understand the ingredients in each drug.
  • Understand any possible side effects they can cause.
  • Before taking a drug speak with the doctor or pharmacist if you don't understand the drug label.
  • Make sure the doctor is aware of all the drugs you are taking.
  • Don't mix pills.
  • Don’t break capsules into any food or drink.
  • Don't take any medication with alcohol.
  • Don't take medication at the same time as vitamins or mineral supplements.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 50457 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Responses
  1. Good morning Doc'saab, You are truly a very inspiring figure and a treasure-trove of wisdom. Regards, Geetika Sharma, Additional Director, Deptt of WCD, GNCTD.

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

    eMedinewS Special

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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