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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 …

26th April, 2011, Tuesday                                eMedinewS Present Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Recommendations on initial choice of antihypertensive drug
class (ABCD rule) as per NICE guidelines

  • In patients aged =55 years or in black (African or Afro-Caribbean descent) patients of any age, the first choice for initial treatment should be either a C (calcium channel blocker) or a D (thiazide-type diuretic) drug.
  • In patients aged <55 years, the first choice for initial treatment should be an A drug (ACE inhibitor or an ARB if an ACE inhibitor is not tolerated).
  • If initial treatment was with a C or D drug and a second drug is needed, add an A drug (ACE inhibitor, or an ARB if an ACE inhibitor is not tolerated).
  • If treatment was started with an A drug, add a C or D drug.
  • If treatment with three drugs is needed, the combination of A, C, and D drugs should be used.
  • B drugs (ß blockers) should be reserved for patients for whom there is a separate indication additional to hypertension, and for combination therapy.
  • (Source: BMJ, April 16)
Dr KK Aggarwal
Editor in Chief
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    Changing Practice – Evidence which has changed practice in last one year

Carboplatin dosing

For most patients, carboplatin dosing uses the Calvert formula, which is based upon desired exposure (area under the curve [AUC] of concentration X time) and the glomerular filtration rate (GFR). When the GFR is estimated based upon measured serum creatinine, limiting the maximal GFR to 125 mL/min is recommended for this calculation. (October 8, 2010)

(Ref: Rustin GJ, van der Berg ME, Griffin CL, et al. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet 2010;376:1155).

  eMedinewS Audio PostCard

Diabetes Update

Dr. Vinod Sanghi Speaks on
‘Estimated costs of diabetes’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

World Earth Day 2011 Observed

Delhi Public School, Mathura Road was awarded the Best Eco School Club by Delhi Govt. at a function held on 21st April 2011 to mark the World Earth Day.


Dr K K Aggarwal
    National News

Bhagwan Sai Baba attains Nirvana

Bhagwan Sai Baba left his body yesterday. Why did most news headlines talk about his death? In my opinion great leaders do not die but attain nirvana. The term death is for an ordinary man and not for the realized souls.

Some facts about Nirvana

Nirvana is a central concept in Indian religions. In sramanic thought, it is the state of being free from suffering (or dukkha). In Hindu philosophy, it is the union with the Supreme Being through moksha. The word literally means "blowing out" or "extinguish" — referring in the Buddhist context, to the blowing out of the fires of greed, hatred, and delusion.

Nirvana in Buddhism: Buddha described nirvana as the perfect peace of the state of mind that is free from craving, anger, and other afflicting states (kilesas). It is also the "end of the world;" there is no identity left and no boundaries for the mind. The subject is at peace with the world, has compassion for all, and gives up obsessions and fixations. This peace is achieved when the existing volitional formations are pacified and the conditions for the production of new ones are eradicated. In nirvana, the root causes of craving and aversion have been extinguished, so that one is no longer subject to human suffering (Pali: dukkha) or further rebirth in samsara.

Nirvana in Jainism: It means final release from the karmic bondage. When an enlightened human, such as, an Arhat or a Tirthankara extinguishes his remaining aghatiya karmas and thus ends his worldly existence, it is called nirvana. Technically, end of lifespan of an Arhat is called nirvana of Arhat, as he has ended his worldly existence and attained liberation. Moksha, that is to say, liberation follows nirvana. An Arhat becomes a Siddha, the liberated one, after nirvana.

Nirvana in Hinduism: In Hinduism, moksha is the liberation from the cycle of birth and death and one's worldly conception of self. A person reaches the state of nirvana only when moksha is attained. The Union with the Supreme Being Brahman and this experience of blissful ego-lessness is termed nirvana. In Advaita Vedanta philosophy, however the concepts of moksha and nirvana are nearly analogous with certain views overlapping.

Nirvana in Brahma Kumaris: The organization of Brahma Kumaris calls Nirvana as Paramdham (Supreme abode) or Shantidham (Abode of peace) and is highest of three world, original home of the soul and Supreme Soul Shiva.

Keoladeo sanctuary to go solar

JAIPUR: The Keoladeo bird sanctuary in Bharatpur would soon be contributing to conservation in more ways than one. Apart from being one of the finest birding areas, the sanctuary would soon go solar. It will be one of its only kind of park to be completely free from conventional energy sources. According to R N Mehrotra, principal chief conservator of forest and head of forest forces, Rajasthan, "Work is on at the sanctuary to make it go solar. All sources using conventional energy would be replaced with those dependent on solar energy." The Keoladeo Ghana National Park or Bharatpur Bird Sanctuary, as it is called, is famous as one of Asia’s finest birding areas, with over 380 resident and migrant species, including the common, demoiselle and the rare Siberian cranes. It is also an excellent place to watch mammals like golden jackal, striped hyena, fishing cat, jungle cat, nilgai, sambar, blackbuck and wild boar. The park also finds a place in the world heritage list. (Source: TOI Apr 22, 2011)

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)

Weight perception is linked to healthy behaviors

Would you classify your weight as "normal" or "overweight"? According to a new study conducted at the Harvard University School of Public Health, the answer to this question could be directly related to your health-related attitudes and behaviors. The current research in this area focuses on the prevalence of weight misperception. However, the researchers who conducted this particular study wanted to dig a bit deeper to find the consequences of weight misperception. Researchers used data from the from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) to identify people who misperceived their weight and then analyze their responses to the rest of the survey. Weight misperception occurred in approximately 23 percent of people included in the survey; these people were overweight or obese, yet classified themselves as "underweight" or "about the right weight." The results of the study show that people who misperceived their weight were 71 percent less likely to report that they wanted to lose weight and 60 percent less likely to have tried to lose weight within the past year compared to those who accurately perceived themselves as overweight. They were also significantly less likely to engage in physical activity and watch their food intake.

(Dr Monica and Brahm Vasudev)

Fourth generation progestin increases risk of clots

Women using oral contraceptives that contain the progestin drospirenone (Yaz, Yasmin) have approximately twice the risk of nonfatal venous thromboembolism as those using levonorgestrel contraceptives, a case–control study found. The odds ratio for venous thromboembolism among women using drospirenone contraceptives was 2.3 (95% CI 1.6 to 3.2), according to Susan S. Jick, DSc, and Rohini K. Hernandez, MPH, of Boston University sponsored Boston Collaborative Drug Surveillance Program in Lexington, Mass.

Newer antiplatelet quells reactivity after PCI

Platelet reactivity after percutaneous coronary intervention (PCI) reached significantly lower levels with prasugrel (Effient) compared with high–dose clopidogrel (Plavix). High on–treatment platelet reactivity occurred in five times as many patients treated with clopidogrel as with prasugrel). Carriers and noncarriers of the loss–of–function allele CYP2C19*2 had significantly lower platelet reactivity values when treated with prasugrel, Greek researchers reported in the April issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

High-fat, low–carb diet may reverse kidney disease in type 1, type 2 diabetics

A type of low–carb, high–fat diet that’s typically used to manage seizures for children with epilepsy could reverse kidney disease in type 1 and type 2 diabetics, according to a study published in the journal PLoS ONE.

Prehypertension, hypertension link to diabetes stronger in whites than in African Americans

Prehypertension and hypertension are independently associated with increased risk for Type 2 diabetes in people of White ethnicity, according to a study in the journal Diabetes Care.

    IJCP Special

Dr Good Dr Bad

Situation: A patient of typhoid was not responding to ciprofloxacin.
Dr Bad: Start ofloxacin.
Dr Good: Add cefuroxime.
Lesson: The current trend has shown that in many areas typhoid fever is resistant to all quinolones.

Make Sure

Situation: A patient with asymptomatic sinus bradycardia after PPI developed lead infection.
Reaction: Oh my God! Why was PPI (Permanent pace maker implantation) done?
Lesson: Make sure that PPI is not done in patients with sinus bradycardia without significant symptoms; sinoatrial block or sinus arrest without significant symptoms; asymptomatic prolonged RR intervals with atrial fibrillation or other causes of transient ventricular pause and asymptomatic bradycardia during sleep.

    An Inspirational Story

(Dr Prachi Garg)

Think, Believe, Dream and Dare

An eight–year–old boy approached an old man in front of a wishing well, looked up into his eyes, and asked: "I understand you're a very wise man. I’d like to know the secret of life." The old man looked down at the youngster and replied: "I’ve thought a lot in my lifetime, and the secret can be summed up in four words.

The first is think. Think about the values you wish to live your life by.

The second is believe. Believe in yourself based on the thinking you’ve done about the values you’re going to live your life by.

The third is dream. Dream about the things that can be, based on your belief in yourself and the values you’re going to live by.

The last is dare. Dare to make your dreams become reality, based on your belief in yourself and your values."

And with that, Walter E. Disney said to the little boy, "Think, Believe, Dream, and Dare."

    Pediatric Update

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

What are the features of appendicitis in an infant?

In the first 9 to 12 months of life, the cecum is tapered and the appendix is funnel–shaped making it less prone to obstruction. This anatomic characteristic, a soft–food diet, and less prominent lymphoid tissue are believed to account for the lower incidence of appendicitis in infants.

  • The most common symptoms in children 2 years or younger are vomiting (85% to 90%), pain (35% to 77%), diarrhea (18% to 46%), and fever (40% to 60%).
  • Temperature > 37°C (98.6°F) (87% to 100%) and diffuse abdominal tenderness (55% to 92%) occur in most infants, whereas localized right lower quadrant tenderness is noted in less than 50%.
    Medicolegal Update

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

Is Touch DNA test different from a DNA test?

Human being shed tens of thousands of skin cells each day, and these cells are transferred to every surface with which human skin comes into contact.

  • Both are the same. But, a DNA test is done using visible biological samples like blood, saliva, semen etc. While, samples for touch DNA are usually not visible and since they are often deposited in smaller amounts than the DNA found in bloodstains or other body fluids, it is more difficult to obtain DNA profiles from these samples. This means that low copy DNA profiling allows a very small amount of DNA to be analyzed, from as little as 10 to 30 cells. DNA in skin cells that are left at a crime scene may be sampled from a variety of items including gun grips, steering wheels, eating utensils, luggage handles, and clothing
  • Touch DNA samples are also processed exactly the same way as blood, semen, and saliva etc. Touch DNA analysis may be able to link the perpetrator to the crime scene, by collecting the skin cells and analyzing them.
  • The key to obtaining successful Touch DNA results depends on recognizing items which may be suitable for Touch DNA analysis and using the sampling technique or collection method that will recover the highest number of skin cells.
  • Locard exchange principle states that with contact between two items, there will always be an exchange. So, when a crime is committed, if the perpetrator deposits a sufficient number of skin cells on an item at the scene, and that item is collected as possible evidence.
  • The techniques used are:
    • Swabbing: The surface of the item is rubbed with a cotton swab to collect possible cells. This method is preferred for hard items such as glass or plastic.
    • Cutting: May be used for soft items, such as clothing, in which fabric from areas of interest is cut to collect possible cells.
    • In addition to the commonly used swabbing and cutting methods, the latest technologies has recently started using the "Scraping" and "Tape Lift" methods, in which the surface of soft items such as clothing are either scraped with a blade, or sampled with a small piece of tape, to collect possible cells.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Bariatric surgery for the treatment of diabetes and obesity

Over the last 15 years, it has become increasingly clear that weight loss surgery can improve type 2 diabetes (up to 80% of patients) or even, in some people, put the diabetes into remission. Remission of type 2 diabetes means a normal blood sugar (less than 100), no diabetes medications and an HbA1c of less than 6.0. HbA1 is a test that measures the amount of glycated hemoglobin in blood.

In 2009, the American Diabetes Association (ADA) guidelines included the consideration of bariatric surgery as part of the strategy for patients to gain control of their high blood sugars.

    Mind Teaser

Read this…………………

Eye E
See Except

Yesterday’s Mind Teaser: plans

Answer for Yesterday’s Mind Teaser: Change of Plans

Correct answers received from: Dr Raju Kuppusamy, Dr Chandresh Jardosh, Dr S Upadhyaya, Dr Muthumperumal Thirumalpillai, Dr Neelam Nath, Dr Binit Sureka, Dr YJ Vasavada.

Answer for 24th April Mind Teaser: d.
Correct answers received from: Dr Rakesh Bhasin, Dr. Anjani.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr. GM Singh)

A One–wish Genie

A woman was walking along the beach when she stumbled upon a bottle. She picked it up and rubbed it, and lo–and–behold ‘a genie’ appeared! The amazed woman asked if she got three wishes. The genie said, "Nope, sorry, three–wish genies are a storybook myth. I’m a one–wish genie. So… what’ll it be?" The woman did not hesitate. She said, "I want peace in the Middle East. See this map? I want these countries to stop fighting with each other and I want all the Arabs to love the Jews and Americans and vice–versa. It will bring about world peace and harmony."

The genie looked at the map and exclaimed, "Lady, be reasonable. These countries have been at war for thousands of years. I’m out of shape after being in a bottle for five hundred years. I’m good but not THAT good! I don’t think it can be done. Make another wish and please be reasonable." The woman thought for a minute and said, "Well, I’ve never been able to find the right man. You know, one that’s considerate and fun, likes to cook and help with the house cleaning, gets along with my family, doesn’t watch sports all the time and is faithful. That’s what I wish for… a good man."

The genie let out a sigh and said, "Let me see that map again…"

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

TB Skin Test

  • Also known as: Purified Protein Derivative; PPD; Mantoux; Latent tuberculosis infection test
  • To help determine whether or not you may have been exposed to and become infected with the Mycobacterium tuberculosis bacteria.
    Medi Finance Update

(Dr GM Singh)

I have not received TDS certificate from my employer. Can I claim TDS deducted from my salary?

Yes. The claim can be made in your return. However, there is a possibility that the revenue authorities may not grant credit for taxes deducted in absence of the TDS certificates. Where credit for taxes deducted is not granted, demand for taxes remaining unpaid maybe raised on the payer i.e., the employer since liability to deduct lies with him. However, this does not preclude the revenue authorities from issuing demand to the employee. To avoid such a situation it is advisable to follow up with your employer for the TDS certificates

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name
DCI Approval Date
Erlotinib HCl 25/100 mg Tablet (Additional Indication)
As monotherapy for maintenance treatment in patients with locally advanced or metastatic non–small cell lung cancer with stable disease after 4 cycles of standard platinum based first line chemotherapy.
    IMSA Update

International Medical Science Academy (IMSA) Update

The ACCORD Lipid trial in high–risk patients with diabetes showed no decrease in a composite cardiovascular endpoint in patients treated with fenofibrate plus simvastatin compared with simvastatin alone.

(Ref: Ginsberg HN, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010;362:1563)

  Quote of the Day

(Dr GM Singh)

We come nearest to the great when we are great in humility. Rabindranath Tagore.

    Readers Responses
  1. I thank emedinews for publishing my views on conferring of Bharat Ratna award. I also thank emedinews for helping me keep in touch withthe latest trends and advances in the medical field. My special thanks and warm regards to Padma shri and Dr. BC Roy awardee Dr. KK Aggarwal. Regards: Dr. S Ramaswamy.
    Public Forum

(Press Release for use by the newspapers)

A slight move is all that matters

Middle-aged women who move around more in their daily life have lower levels of intra-abdominal fat, a risk factor for heart disease, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India. A minor modification in daily routine: Reducing the time watching TV or increasing the walk time to work can make a difference in the long-term health.

Visceral fat is a hot topic because of metabolic syndrome which predisposes people to disease. Intra-abdominal fat, or the fat that wraps around the organs in the abdomen and chest, tends to accumulate at midlife and can contribute to developing diabetes, hypertension and heart disease. The fat around the organs is known to be more related to heart disease and diabetes. A woman does not need to appear outwardly heavy to have a potentially troublesome extra "tire" around her organs.

Exercise for long has been known to reduce the amount of intra-abdominal fat.

    eMedinewS Special

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

2. 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

  Towards Well Being


    Forthcoming Events

May 7–8, 2011, National Seminar On Stress Prevention

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris.
Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)
Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.
Timings: Saturday 7th May (2 pm onwards) and Sunday 8th May (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9899974439, emedinews@gmail.com, rekhapapola@gmail.com; BK Sapna: 9811796962, bksapna@hotmail.com.


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
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 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.

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 AK 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 Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr Rajiv Parakh, Dr Sudhir Gupta.