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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 1–7
DD Take Care Holistically Video 1–7 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

23rd September 2012, Sunday

New York Ban High–Calorie Soft Drinks

To curb the epidemic of obesity the New York City Board of Health has passed a rule banning sales of big sodas and other sugary drinks at restaurants, concession stands, and other eateries. The measure puts a 16-ounce size limit on cups and bottles of non–diet soda, sweetened teas, and other calorie–packed beverages. The ban exempts convenience stores as well as vending machines and some newsstands. The rules do not apply to 100% fruit juices, dairy–based drinks like milkshakes, or alcoholic beverages and zero–calorie diet sodas. Establishments with self–service drink fountains, like many fast–food restaurants, would not be allowed to stock cups larger than 16 ounces. (Source AMA News and other US agencies)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What is the treatment of chronic functional constipation?

The first step in the treatment of chronic functional constipation is lifestyle and dietary modification. Increased fiber intake and adequate hydration are important in maintaining bowel motility and regularity. Laxatives are used when these nonpharmacologic measures are not successful. Bulk laxatives are most beneficial in patients with functional normal transit constipation. But not all patients respond to bulk laxatives. Patients with slow transit constipation or anorectal dysfunction may not be helped by bulking agents. Osmotic laxatives can be tried if the bulking agents are not appropriate or are ineffective.

For Comments and archives…

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Uric acid and endothelial dysfunction

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal with Famous Pakistani Singer Adnam Sami

Dr K K Aggarwal
    National News

4th Dil Ka Darbar

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

A non stop question answer–session between all top cardiologists of the NCR region and the public.

72% of Indian urbanites heart–unhealthy

MUMBAI: Good cholesterol spells bad news for Mumbaikars. A new survey analyzing risk factors for heart diseases among Indians shows that 54% of Mumbaikars over 30 have low levels of good cholesterol, better known as HDL. Since HDL draws out the body’s excess fatty cholesterol molecules and ejects them through the liver, Mumbaikars have a reason to worry. But it isn’t only Mumbai. The survey found that across Indian urban hubs, the number of heart–unhealthy people is high at 72%. "This means 72% of the total respondents had a moderately high risk of developing cardiovascular disease (CVD)," said cardiologist Dr Akshay Mehta from the Asian Heart Institute while releasing the results in the city on Friday. That is not all. Around 64% of the respondents between 30 and 34 years had more than one elevated risk factor, implying that young India is far from healthy. If one considers the 40–44 age group, the ‘at risk’ population goes up to almost 80% across the country.

Ahead of the World Heart Day on September 29, experts said the growing epidemic of heart disease among Indians could be traced to two main factors — improper diet and poor activity levels."One should eat five servings of vegetables or fruits every day and dedicate 150 minutes for physical activity every week. But Mumbaikars rarely follow this rule," said Dr Saloni Benjamin, chief dietician of the BMCrun Nair Hospital in Mumbai Central.

A new survey released underlined the diet–lifestyle problem among Indians. It said that almost 80% of the respondents in the 40–44 years age group had a very unhealthy diet and lifestyle: they ate fried or fatty food four times a week and worked out once a week. On the physical activity front, 72% of the respondents in Ahmedabad confessed to doing 15 minutes of exercise less than 4 times a week, thereby exhibiting a sedentary lifestyle. Mumbai, too, fared poorly with only 36% doing exercises more than four times a week. The saying — An apple a day keeps the doctor away — is not enough to get Indians to have their fruits. The study found 94 % Indians failed to take the requisite 3–5 servings every day. Both Mumbai and Delhi were on a par with the national average, but Ahmedabad was worse with 96%of the respondents confessing to staying away from fruits. "Low consumption of fruits, vegetables and salads and wholegrains, together with low levels of physical activity, affects heart health. This has been observed simultaneously in both the genders and across age groups," said D r Benjamin at the release of the survey’s results on Friday. (Source: TOI, Sep 22, 2012)

For comments and archives

My Profession My Concern

Include this in your practice

  • Pre–exposure prophylaxis against HIV: In addition to counseling about consistent condom use in all HIV–uninfected adults at high risk, and who are committed to drug adherence and close follow–up advise pre–exposure prophylaxis with tenofovir–emtricitabine. In July 2012, the US FDA approved the same. The risk reduction is 48 to 75 percent with daily use of tenofovir–emtricitabine compared with placebo.
    • FDA approves first drug for reducing the risk of sexually acquired HIV infection, July 16, 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm (Accessed on August 02, 2012).
    • Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral Preexposure Prophylaxis for Heterosexual HIV Transmission in Botswana. N Engl J Med 2012.
    • Baeten JM, Donnell D, Ndase P, et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. N Engl J Med 2012.
    • Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363:2587.

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

What is very severe aortic stenosis?

Very severe AS is defined as an aortic valve area of ≤0.75 cm2 (critical AS) accompanied by a peak aortic jet velocity =4.5 m/sec or a mean transaortic pressure gradient ≥50 mmHg.

(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)

Cancers on the rise in pregnant women: Study

The number of pregnant women diagnosed with cancer has increased over the past couple of decades, a new study from Australia suggests. In 2007, the most recent year studied, researchers found 192 out of every 100,000 pregnant and postpartum women received a cancer diagnosis – up from 112 per 100,000 women in 1994. (Source: Medscape)

For comments and archives

Calcium ionophore increases pregnancy rates in male factor infertility

Ready–to–use calcium ionophore (GM508 Cult–Active, Gynemed) improves outcomes from fertilization to live birth in patients with severe male factor infertility, according to Austrian and German researchers. "The present study showed that healthy offspring can be expected," Dr. Thomas Ebner told Reuters Health by email. The findings were published online August 23 in Fertility and Sterility. (Source: Medscape)

For comments and archives

Blood test helps predicts likelihood of premature delivery

Researchers have come up with a promising new method for predicting which pregnant women presenting with symptoms of premature labor (PTL) are likely to deliver within 7 days. The method is based on a statistical model that uses measurements of 27 maternal serum proteins, along with assessment of cervical length. A report detailing the research appears in the June issue of BJOG. (Source: Medscape)

For comments and archives

BG–12 reduces relapses, disease activity in MS

Full results of two phase 3 trials evaluating the effect of oral BG–12 (dimethyl fumarate, Biogen Idec) in patients with multiple sclerosis (MS) show the investigational agent reduced relapse rates, disease activity on imaging, and, in 1 trial, progression of disability. Full results of the Determination of the Efficacy and safety of oral Fumarate IN rElapsing–remitting MS (DEFINE) trial, and the Comparator and an Oral Fumarate in RRMS (CONFIRM) trial, are published in the September 20 issue of the New England Journal of Medicine. Both trials were funded by Biogen Idec. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: A mix of exercise protocol is better A combination of weight training and aerobic exercise is the best… http://fb.me/1IaQZ7yyD

@DeepakChopra: Eminent physicist and author Menas Kafatos continues his discussion on The Riddle of Consciousness. http://tinyurl.com/8rglhcw

    Spiritual Update

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

Symposium on Diet, Health & Religion

Keynote address by Shri J Veeraraghavan

A symposium on Diet, Health & Religion, second in a series was held at Bharatiya Vidya Bhavan on 5th September, 2012. The Chief Guest was Shri J Veeraraghavan, Chairman, Bhavan’s KM Munshi Institute of Educational Leadership and Management.

For comments and archives

    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is a normal BMI?

A BMI between 19 and 24 is considered normal; less than 19 is considered underweight. A BMI between 25 and 29 is considered overweight and greater than 30 places you in the category of obese.

For comments and archives

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

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

What special diets should a donor take after giving blood?

A donor is given some liquids (fluid). It may be a cup of coffee or milk or fruit juice etc. along with a few biscuits or fruit. The donor needs no other special diet. With the routine balanced diet, which we take normally, the blood is replenished quantitatively within 24 – 48 hours.

For comments and archives

    Liver Abscess Update

(Dr. Neelam Mohan, Director, Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation Medanta – The Medicity Hospital)

What are the common sources of liver abscess?

  • Biliary tract – 60%
  • Portal venous – 25%
  • Cryptogenic – 18%
  • Hematogenous/seeding – 15%
  • Direct extension – 4%
  • Traumatic – 2%

For comments and archives

    An Inspirational Story

Who I Am Makes a Difference

A True Story by Author Unknown

A teacher in New York decided to honor each of her seniors in high school by telling them the difference they each made. She called each student to the front of the class, one at a time.

First she told each of them how they had made a difference to her and the class. Then she presented each of them with a blue ribbon imprinted with gold letters, which read, "Who I Am Makes a Difference."

Afterwards the teacher decided to do a class project to see what kind of impact recognition would have on a community. She gave each of the students three more ribbons and instructed them to go out and spread this acknowledgment ceremony. Then they were to follow up on the results, see who honored whom and report back to the class in about a week.

One of the boys in the class went to a junior executive in a nearby company and honored him for helping him with his career planning. He gave him a blue ribbon and put it on his shirt. Then he gave him two extra ribbons and said, "We’re doing a class project on recognition, and we’d like you to go out, find somebody to honor, give them a blue ribbon, then give them the extra blue ribbon so they can acknowledge a third person to keep this acknowledgment ceremony going. Then please report back to me and tell me what happened."

Later that day the junior executive went in to see his boss, who had been noted, by the way, as being kind of a grouchy fellow. He sat his boss down and he told him that he deeply admired him for being a creative genius. The boss seemed very surprised. The junior executive asked him if he would accept the gift of the blue ribbon and would he give him permission to put it on him. His surprised boss said, "Well, sure." The junior executive took the blue ribbon and placed it right on his boss’s jacket above his heart. As he gave him the last extra ribbon, he asked, "Would you do me a favor? Would you take this extra ribbon and pass it on by honoring somebody else? The young boy who first gave me the ribbons is doing a project in school and we want to keep this recognition ceremony going and find out how it affects people."

That night the boss came home to his 14–year–old son and sat him down. He said, "The most incredible thing happened to me today. I was in my office and one of the junior executives came in and told me he admired me and gave me a blue ribbon for being a creative genius. Imagine. He thinks I’m a creative genius. Then he put this blue ribbon that says "Who I Am Makes a Difference," on my jacket above my heart. He gave me an extra ribbon and asked me to find somebody else to honor. As I was driving home tonight, I started thinking about whom I would honor with this ribbon and I thought about you. I want to honor you. My days are really hectic and when I come home I don’t pay a lot of attention to you. Sometimes I scream at you for not getting good enough grades in school and for your bedroom being a mess, but somehow tonight, I just wanted to sit here and, well, just let you know that you do make a difference to me. Besides your mother, you are the most important person in my life. You’re a great kid and I love you!"

The startled boy started to sob and sob, and he couldn’t stop crying. His whole body shook. He looked up at his father and said through his tears, "Dad, earlier tonight I sat in my room and wrote a letter to you and Mom explaining why I had killed myself and asking you to forgive me. I was going to commit suicide tonight after you were asleep. I just didn’t think that you cared at all. The letter is upstairs. I don’t think I need it after all."

His father walked upstairs and found a heartfelt letter full of anguish and pain. The envelope was addressed, "Mom and Dad."

The boss went back to work a changed man. He was no longer a grouch, but made sure to let all his employees know that they made a difference. The junior executive helped several other young people with career planning and never forgot to let them know that they made a difference in his life… one being the boss’s son.

And the young boy and his classmates learned a valuable lesson.


(Source: http://www.inspire21.com/stories/educationstories)

For comments and archives

    Cardiology eMedinewS

Heat waves are heart breakers Read More

Low blood sugar raises risk of death in ICU Read More

    Pediatric eMedinewS

Bovine lactoferrin does not prevent childhood diarrhea Read More

BP check in children often overlooked Read More

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was diagnosed with sarcopenia.
Dr. Bad: It is unrelated to diabetes.
Dr. Good: There is an association between the two.
Lesson: In the Korean Sarcopenic Obesity Study (KSOS), type 2 diabetes was associated with increased risk of sarcopenia. These characteristics may contribute to physical disability and metabolic disorders in older adults with diabetes.

For comments and archives

Make Sure

Situation: A patient who had multiple blunt injuries on his abdomen is admitted for management.
Reaction: Oh my God! Why did you not do a peritoneal lavage?
Lesson: Make sure to perform a peritoneal lavage in patients of multiple blunt injuries to exclude peritoneal hemorrhage from ruptured abdominal organs as the peritoneal reaction is often mild and a thorough clinical examination is not possible.

For comments and archives

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central bank

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

Photos of Doctor’s Day Celebration

eMedinewS Apps
    Quote of the Day (Dr GM Singh)

A true one love doesn’t start in morning and doesn’t end in evening. It starts when u don’t need it and ends when u got it the most.

    Legal Question of the Day (Dr M C Gupta)

What are the ideal containers for viscera preservation?

Each container must be carefully labeled and preferably countersigned by the autopsy surgeon. Some jurisdictions will require actual seals on the containers themselves or the package into which they are placed for transport, or both. Accompanying signed ‘exhibit labels’ with serial numbers corresponding exactly with numbers on the jars may be required. The containers must be given by the doctors to the investigating office. The police officer must hand over the samples personally to a member of the laboratory staff and a record of this chain of evidence must be kept, so that there can be no criticisms leveled at any one when the matter comes to court, raising doubts about the correct identity of the samples.

  • Glass bottles of one liter capacity is used for viscera preservation
  • Clean, wide mouthed fitted with glass stoppers should be used for each viscera.
  • Rubber inserts should not be used under caps because it can extract from the contents, certain poisons such as chloroform and phenols.
  • Glass containers should be washed with sulfuric acid chromate solution, rinsed with distilled water and dried.
  • Polyethylene bags or containers can be used, but volatile poison may diffuse through plastic.
  • When lungs or other tissues are to be preserved for analysis of volatile substances nylon bags should be used, as they are not permeable to such substances.
  • Blood should be collected in screw–capped bottle of about 30ml or in plastic capped tubes of 10ml.

For comments and archives

    Lab Update (Dr Navin Dang and Dr Arpan Gandhi)


  • Increased: Renal failure including prerenal, drug–induced (aminoglycosides, vancomycin, others), acromegaly.
  • Decreased: Loss of muscle mass, pregnancy.
   Rabies Update (Dr. A. K. Gupta, Author of "RABIES - the worst death")

Can a vaccinated dog transmit rabies? How effective is dog vaccine?

If a potent veterinary vaccine is given correctly as per pre–exposure schedule, it will mostly prevent rabies in the vaccinated dog, unless the exposure is severe. Ideally, its sera should be tested for protective antibody titre level but this is rarely practicable due to scare facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:–

(1) 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history and that
(2) 40% of dogs’ vaccinated only one time lost most of their immunity 4–6 months later.
(3) Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs.

    Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: The Heimlich maneuver (abdominal thrust), for acute airway obstruction, attempts to:

A. Force air out of the lungs
B. Increase systemic circulation
C. Induce emptying of the stomach
D. Put pressure on the apex of the heart

Answer for Yesterday’s Mind Teaser: A. Force air out of the lungs

Correct answers received from: Dr Prabha Sanghi, YJ Vasavada, Dr KV Sarma, Dr Kanta Jain,
Dr Jainendra Upadhyay, Dr K P Chandra, Dr Pankaj Agarwal

Answer for 21st September Mind Teaser: C. Palpable carotid pulse
Correct answers received from: Dr Gopal M Shinde, Dr Kusum Surana.

Send your answer to ijcp12@gmail.com

   Laugh a While (Dr GM Singh)

Side effect of excess study

A guy went to a restaurant; he wanted to see the menu. But he forgot what it is called.

He asked the waiter, "Syllabus Lana Zara".

    Medicolegal Update

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

Can a doctor disclose the medical condition of the patient?

  • The conclusive summary of the Principle of "duty of care", as applicable to persons in medical profession, includes the duty to maintain confidentiality.
  • From ancient age in India the medical ethics has viewed the duty of confidentiality as a relatively non–negotiable tenet of medical practice.
  • The Hippocratic Oath express about patient confidentiality as Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
  • Patient Confidentiality is mandated in America by laws known as Health Insurance Portability and Accountability Act (HIPAA) of 1996, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years in view of medico–legal cases.
  • Many American states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles.
  • Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient’s parents.
  • In India a law like HIPAA is required or should be incorporated in code of medical ethics by MCI

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Dengue is preventable and manageable

Dengue has once again made its appearance in the capital, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India, Dil Ka Darbar to be held on 23rd September at Talkatora Stadium and MTNL Perfect Health Mela. Dengue is both preventable and manageable. The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.

A platelet transfusion is not needed if the platelet counts are more than 10,000. Unnecessary platelet transfusion can cause more harm.

Most complications of dengue occur after the fever is over. The two days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar. The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration. Giving fluids orally or by intravenous routes, if given at a proper time, can save fatal complications.

Physicians should remember the ‘Formula of 20’ i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high risk situation and the person needs immediate medical attention.

The onus of preventing dengue lies with the public and not with the Government authorities. The dengue mosquitoes are found only in water collected outside the house and not in dirty water in the drains or ‘nallas’.

In dengue, one should NOT use aspirin for fever as aspirin also has antiplatelet effects.

    Readers Responses
  1. Dear Dr. K.K.Aggarwal, eMedinews has become a cup of morning tea for me. Thoroughly enjoy reading it. My compliments and big thanks, Dr. Mithilesh Chandra, Consultant Histopathologist.
    Forthcoming Events
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    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, Dr Usha K Baveja