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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 …

30th April 2013, Tuesday

Malaria, Dengue, Chikungunya and Filaria are diseases spread by mosquitoes and are totally preventable. Here are a few tips:

  • Both malaria and dengue mosquitoes bite during day time.
  • It is the female mosquito which bites.
  • Dengue mosquito takes three meals in a day while malaria mosquito takes one meal in three days.
  • Malaria may infect only one person in the family but dengue will invariably infect multiple members in the family in the same day.
  • Malaria fever often presents with chills and rigors. If the fever presents together with joint and muscle pains, one should suspect Chikungunya.
  • Both dengue and malaria mosquitoes grow in fresh water collected in the house.
  • The filaria mosquito grows in dirty water.
  • There should be no collections of water inside the house for more than a week.
  • Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is cleaned properly once in a week, there are no chances of mosquito breeding.
  • Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered.
  • If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
  • Some mosquitoes can lay eggs in broken tires, broken glasses or any container where water can stay for a week.
  • Using mosquito nets/repellents in the night may not prevent malaria and dengue because these mosquitoes bite during the day time.
  • Both malaria and dengue mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
  • Wearing full sleeves shirt and trousers can prevent mosquito bites.
  • Mosquito repellent can be helpful during the day.
  • If you suspect that you have a fever, which can be malaria or dengue, immediately report to the doctor.
  • There are no vaccines for malaria and dengue.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

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Vitamin D intake associated with reduced risk for Crohn’s disease

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Life After Death

Dr. Aggarwal in conversation with Swami Parmananda Bharati at a Symposium organized by the Heart Care Foundation of India at IMA House

Dr K K Aggarwal
    National News

Only 25% of Indians have access to modern health care: Union minister

CHENNAI: To achieve significant progress in implementation of National Rural Health Mission and in higher education, the private sector needs to play a pro-active role, said Dr M Mangapati Raju, Union minister of human resource development on Saturday. "No doubt that the government has to facilitate an incentivizing mechanism to involve private sector. Government of India had taken a policy decision of developing public private partnership models in all these activities. I hope these models may attract more private sector participation during the XII Plan period," he said addressing the 17th convocation of Sri Ramachandra University, Porur.

Only 25% of the Indian population has access to the modern tertiary health care, which is practiced mainly in urban areas, where two thirds of India's hospitals and health centres are located, Raju said "India also lags behind the developed nations in the doctor-patient ratio. There is one doctor for 1,953 people or a density of 0.5 doctors per 1,000 population coupled with acute shortage of nurses and health delivery personnel. There is an urgent need for strengthening public health through creation of necessary human resource capacity at all levels," he said.

The Union minister also quoted a study by WHO which estimated economic losses for India due to deaths caused by all diseases in 2005 was 1.3% of its GDP. "Due to increase in the number of non-communicable diseases, this loss is estimated to increase to 5% of GDP by 2015, if left unchecked," he said. (Source: TOI, Apr 27, 2013)

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

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

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)


Sexual Harassment and Punishment Therefore

A person is said to commit sexual harassment upon a child when such person with sexual intent,—

  1. utters any word or makes any sound, or makes any gesture or exhibits any object or part of body with the intention that such word or sound shall be heard, or such gesture or object or part of body shall be seen by the child; or
  2. Makes a child exhibit his body or any part of his body so as it is seen by such person or any other person; or
  3. Shows any object to a child in any form or media for pornographic purposes; or
  4. Repeatedly or constantly follows or watches or contacts a child either directly or through any means; or
  5. Threatens to use, in any form of media, a real or fabricated depiction through electronic, film or digital or any other mode, of any part of the body of the child or the involvement of the child in a sexual act.

Explanation: Whoever commits sexual harassment upon a child shall be punished with imprisonment of either description for a term which may extend to three years and shall also be liable to fine.

For Comments and archives…

    Valvular Heart Disease Update

Progressive fibrocalcific stenosis requiring surgery eventually occurs in over 75 percent of patients with bicuspid aortic valve.

(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)

Road to HIV vaccine hits another speed bump

HIV experts reacted with dismay and resignation to the news that the National Institute of Allergy and Infectious Diseases halted its HIV Vaccine Trials Network 505 trial because it wasn't working

Pacing both ventricles best for heart block XAS

Biventricular pacing improves outcomes compared with standard right ventricular pacing for patients with atrioventricular block and depressed left ventricular ejection fraction, according to a randomized trial.

Incidence of cancer higher in WTC rescue workers

An ongoing registry study, the incidence rates of all cancers combined among World Trade Center rescue workers were found to be 15% higher than expected. (Source: Medpage Today)

Candida: New rapid blood test could cut mortality

A new, rapid test for Candida infections of the bloodstream may reduce mortality from 40% to 11%. Researchers combined polymerase chain reaction (PCR) and nanotechnology with T2 magnetic resonance (T2MR) technology to create an assay that identifies 5 common species of Candida fungus in just 3 hours, which is up to 25 times faster than the current gold standard of blood culture. (Source: Medscape)

ECG worthwhile for pre-sports check-up

Two European studies state that ECG screening of students before participation in sports to pick up potentially fatal cardiac problems is useful. (Source: Medpage Today)

Living near freeway may clog arteries

As per a population-based study, living near heavy traffic holds double trouble for arteries, with independent effects from road noise and air pollution on atherosclerosis. (Source: Medpage Today)

    Twitter of the Day

@DrKKAggarwal: CT not required in appendicitis When a patient has all the signs of acute appendicitis, waiting to get a CT scan... http://fb.me/1eQyawMzX

@DrKKAggarwal: "What is more effective: Power of Belief OR Living in the Now?" My reply http://tinyurl.com/c6f9orz #askdeepak

    Spiritual Update

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

What are the thirteen steps of a Vedic marriage ceremony?

The basic purpose of marriage is the union of mind, body and soul of two persons. This can only occur when a person has acquired full knowledge about the ‘self’ which is the purpose of Brahmcharya. Once a person has decided to enter THE Grihasth Ashram, he has to abandon his childish behavior and start behaving in a mature manner.

For Comments and archives…

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

How is the egg donor evaluated?

  • Donors should have attained their state’s age of legal majority and preferably should be between the ages of 21 and 34.
  • Both anonymous and known donors should complete an extensive medical questionnaire that details their personal and family medical history. Included in this questionnaire should be a detailed sexual history, substance abuse history and psychological history. For anonymous donors, the questionnaire should assess the donor’s motivation for donating her eggs and provide insight into the donor personality, her hobbies, educational background and life goals. This document ultimately will be shared with the recipient and provides her with insight into a donor she will never meet.
  • The laboratory testing of all donors should include screening and testing for syphilis, hepatitis B and C, HIV–1 and HIV–2, Neisseria gonorrheae and Chlamydia trachomatis, as well as screening for human transmissible spongiform encephalopathy and testing when risk factors for it exist.
  • Donors should also have documentation of their blood type and Rh status, complete blood count and rubella titer.
  • Donors may be required to undergo drug testing.
  • Genetic screening of donors should be based on ethnicity. Caucasian donors should be tested for the presence of a cystic fibrosis (CF) mutation. Donors of Asian, African, and Mediterranean descent should undergo a hemoglobin electrophoresis as a screen for sickle cell trait and thalassemias. If the donor is of Ashkenazi Jewish origin, CF mutation analysis, and screening for Tay–Sachs disease, Canavan disease and Gaucher disease is indicated. Donors who are of French Canadian descent should be screened for CF as well as Tay–Sachs disease.
    Tat Tvam Asi………and the Life Continues……

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

Blood transfusion

Venous access

  • It depends on integrity of the patient’s veins, volume to be transfused and expected duration of intravenous therapy
  • Steel needles or plastic catheters are commonly used for short–term transfusion therapy.
  • For medium and long–term therapy or for administration of solutions potentially toxic to the vein lining, central vein catheters are used.
  • The administration of fluids incompatible with blood is never encouraged in transfusion setting.
  • An 18–gauge needle is commonly used, but patients with small veins require much smaller needles.
  • Thin walled, 23–gauge needles may be used for transfusion in pediatric patients

Infusion sets

Blood and components must be administered through a filter designed to retain blood clots and particles that are harmful to the recipient.

Standard blood transfusion sets

  • These should have inline filters with pore size 170–260 µ, drip chambers and tubing in a variety of configurations.
  • Filter should be fully wetted and drip chambers filled no more than half full.
  • In order to reduce the risk of bacterial contamination, a reasonable time limit for an infusion set is 4 hours.
  • Filter can be used for 2 to 4 units of blood provided maximum time does not exceed 4 hours and if the manufacturer permits.

Compatible IV solutions

  • It is advisable not to add medications to blood or components.
  • If red cells require dilution to reduce their viscosity or if a component needs to be rinsed from the blood bag or tubing, 0.9% normal saline is the product of choice. ABO–compatible plasma, 5% albumin, or plasma protein fraction can also be used with approval of the concerned clinician.
  • Lactated Ringer’s solution, 5% dextrose in water and hypotonic sodium chloride solutions should not be used for addition to blood components or for simultaneous administration via the same intravenous line.

Suggested infusion rate for adults

  • Concentrate of human red blood cells (packed cells): 100–200 ml/hour.
  • Fresh frozen plasma/platelets: 200–300 ml/hour

Suggested infusion rate for pediatric patients

  • Concentrate of human red blood cells: 2–5 ml/kg/hour.
  • Fresh frozen plasma: 1– 2 ml per minute
  • Platelet: As tolerated.

For Comments and archives…

    An Inspirational Story

The 4 Wives

There was a rich merchant who had 4 wives. He loved the 4th wife the most and adorned her with rich robes and treated her to delicacies. He took great care of her and gave her nothing but the best.

He also loved the 3rd wife very much. He was very proud of her and always wanted to show her off to his friends. However, the merchant was always in great fear that she might run away with some other men.

He loved his 2nd wife too. She was a very considerate person, always patient and in fact was the merchant's confidante. Whenever the merchant faced some problems, he always turned to his 2nd wife and she would always help him out and tide him through difficult times.

The merchant's 1st wife was a very loyal partner and had made great contributions in maintaining his wealth and business as well as taking care of the household. However, the merchant did not love the first wife and although she loved him deeply, he hardly took notice of her.

One day, the merchant fell ill. Before long, he knew that he was going to die soon. He thought of his luxurious life and told himself, "Now I have 4 wives with me. But when I die, I'll be alone. How lonely I'll be!"

Thus, he asked the 4th wife, "I loved you most, endowed you with the finest clothing and showered great care over you. Now that I'm dying, will you follow me and keep me company?" "No way!" replied the 4th wife and she walked away without another word.

The answer cut like a sharp knife right into the merchant's heart. The sad merchant then asked the 3rd wife, "I have loved you so much for all my life. Now that I'm dying, will you follow me and keep me company?" "No!" replied the 3rd wife. "Life is so good over here! I'm going to remarry when you die!" The merchant's heart sank and turned cold.

He then asked the 2nd wife, "I always turned to you for help and you've always helped me out. Now I need your help again. When I die, will you follow me and keep me company?" "I'm sorry, I can't help you out this time!" replied the 2nd wife. "At the very most, I can only send you to your grave." The answer came like a bolt of thunder and the merchant was devastated.

Then a voice called out: "I'll leave with you. I'll follow you no matter where you go." The merchant looked up and there was his first wife. She was so skinny, almost like she suffered from malnutrition. Greatly grieved, the merchant said, "I should have taken much better care of you while I could have!"

Actually, we all have 4 wives in our lives

a. The 4th wife is our body. No matter how much time and effort we lavish in making it look good, it'll leave us when we die.

b. Our 3rd wife? Our possessions, status and wealth. When we die, they all go to others.

c. The 2nd wife is our family and friends. No matter how close they had been there for us when we're alive, the furthest they can stay by us is up to the grave.

d. The 1st wife is in fact our soul, often neglected in our pursuit of material, wealth and sensual pleasure.

Guess what? It is actually the only thing that follows us wherever we go. Perhaps it's a good idea to cultivate and strengthen it now rather than to wait until we're on our deathbed to lament

For comments and archives

   Cardiology eMedinewS

Global alliance will target CVD prevention Read More

   Pedia News

Childhood catatonia commonly missed, badly managed 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 pre-exposure vaccination?

Pre-exposure (Prebite) vaccination means immunization before the bite.

    IJCP Special

Dr Good Dr Bad

Situation: A 25–year–old male with normal body mass index (BMI) came with mild abdominal obesity.
Dr Bad: Do not worry.
Dr Good: Rule out diabetes.
Lesson: Indians are susceptible to diabetes at a younger age and at a relatively lower BMI compared to the white Caucasians. This is partly explained by the fact that the thin–looking Indians are quite adipose (higher body fat percent).

Make Sure

Situation: A patient with acute chest pain died before reaching the hospital.
Reaction: Oh my God! Why was water–soluble aspirin not given?
Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.

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  Legal Question of the Day (Dr MC Gupta)

Q. There is much confusion about who all can use the term Dr. as a prefix to their name. What is the legal position? Physiotherapists in our hospital are unwilling to stop using the prefix “Dr.” before their name. They have told our HR that they have been empowered by their Council to use Dr. as prefix and PT as suffix. They say the matter is pending in Court. Can physiotherapists use the prefix “Dr.”?


  1. Ordinarily, one would not bother what one calls oneself. The government and the law have to step in so that the public may not be duped. There is no dearth of quacks out to make a quick buck through unscrupulous means. A person acquires a medical degree after much hard work and only when he proves his credentials is he allowed to enroll himself with a medical council and call himself a doctor and hold out as such to the public at large. The aim of regulating who all can call themselves as doctors is to save the public from harm at the hands of unscrupulous persons.
  2. On 25-11-2003, the Ministry of Health and Family Welfare, Government of India issued an order wherein it was clarified who all can use the prefix “Dr.” before their names. This letter does not so permit physiotherapists. The permission is available only for modern medicine and the already recognized traditional systems of medicines, viz. Ayurveda, Siddha, Unani, Homeopathy and Yoga & Naturopathy. The full text of the letter can be seen at
  3. On 25th August, 2008, the Executive Committee of the MCI issued a letter No.MCI-5(3)/2008-Med./ dated 25th August, 2008, which stated that “wherever any person found to be using the title of ‘Doctor’ as a prefix when such a person is holding a qualification in physiotherapy but not possessing any recognized medical qualification, he would be violating the provisions of Act of 1916 and as such he would expose himself for necessary action by filing or requiring the filing of a complaint in accordance with Section 7 of the 1916 Act for violation of Sections 6 and 6A of the extent applicable.”
  4. On 9-9-2009, the Government of Tamil Nadu Health and Family Welfare (Z1) Department issued an Annexure dated 9-9-2009 to the G.O. (Ms) No.338 Health and Family Welfare Department, dated 16.10.2008, wherein it was stated that in reference to Tamil Nadu State Council for Physiotherapy:

    "Physiotherapist means a person who possesses recognized physiotherapy education and whose name has been entered in the Register of Physiotherapy Council. He shall not use “Dr.” before his name and prescribe drugs.

    This may be viewed at-- http://iapchennai.org/annexure.php
  5. In addition, the Chairman, Delhi Council for Physiotherapy and Occupational Therapy, has also stated that: “As per the Council’s Act there is no provision as of now allowing physiotherapists to use the title ‘Doctor’ but a discussion on the matter is currently on.” This can be seen at the link given below— https://mail.google.com/mail/?hl=en&shva=1#search/physio/1267127bda20d7bb
  6. I am not aware of any pending litigation in this regard. You should ask the concerned physiotherapists for details. A pending litigation does not alter the above picture unless the court has granted a stay in favour of the physiotherapists. That does not appear to be the case. It may be stated that the GOI order dated 25-11-2003 was issued pursuant to the writ in the Delhi High Court bearing no. CWP 4015/1996.
  7. In the fitness of things, dentists are not doctors. They do not practice a system of medicine. Even otherwise, their qualification is titled BDS, which means Bachelor of Dental Surgery. It is well known that in UK, surgeons are referred to as Mr., not Dr. It is only in India that everybody wants to be called a doctor
  Quote of the Day (Dr GM Singh)

The reason angels can fly is because they take themselves lightly. GK Chesterton

    Mind Teaser

Read this…………………

Discharge instructions for a patient with a newly-placed pacemaker include avoiding:

a. Cellular phones
b. Contact sports
c. Cordless phones
d. Microwave ovens

Yesterday’s Mind Teaser: An 8-month-old is admitted to the pediatric unit following a fall from his high chair. The child is awake, alert, and crying. Nurse Fatima should know that a brain injury is more severe in children because of:

a. Increased myelination
b. Intracranial hypotension
c. Cerebral hyperemia
d. A slightly thicker cranium

Answer for Yesterday’s Mind Teaser: c. Cerebral hyperemia

Correct answers received from: Dr Deepali Chatterjee, Prabha Sanghi, Dr PC Das, Dr Mrs. S Das,
Dr Avtar Krishan, Dr Jella, Dr BB Gupta, Anil Bairaria, Dr (Brig) C H Gidvani, Dr KV Sarma, Dr K Raju,
Dr pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Dr Santha Kumari, Dr Ayyavoo Erode, Muthumperumal Thirumalpillai, Dr Kanta Jain, Dr Jayant Shah.

Answer for 28th April Mind Teaser: a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually.

Correct answers received from: Dr K Raju, Dr pankaj Agarwal, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai, Dr PC Das & Dr Mrs. S Das, Dr Kanta Jain.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

When I was a kid I used to pray every night for a new bike. Then I realized that The Lord doesn't work that way, so I stole one and asked him to forgive me. Erno Philips

  Medicolegal Update

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

What is obsession?

  • In obsession, the sufferer constantly entertains an idea, without cause, in spite of all his efforts to drive the idea out of his mind. Obsession is a type of compulsive phenomenon. The classical example of this condition is, a person while going to bed at night, bolts the door of the room from inside, but after going to the bed he feels the necessity to verify and does so to see if he has bolted the door or not. He repeats this act again and again, in spite of his consciousness and in spite of his desire and efforts to stop the act.
  • Obsession is considered a borderline state between sanity and insanity. In the above case, a sane person will stop after repeating the act of verification for a few times. But an insane person may continue the act all throughout the night without sleeping.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Deep frying, burning or charring foods may produce cancers

Regularly eating burned or charred red meat, similar to that cooked on a grill can increase the chances of pancreatic cancer by 60%, said Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee and President, Heart Care Foundation of India.

Turning down the heat when grilling, frying, and barbecuing to avoid excess burning or charring of the meat may be a sensible way for some people to lower their risk for getting pancreatic cancer.

As per Dr Kristin Anderson of the University of Minnesota, charred meat contains several known cancer-causing chemicals, including heterocyclic amines.

Heterocyclic amines (HAs) are carcinogens produced by cooking meat and animal protein at high temperatures; metabolism of HA is influenced by polymorphisms in the N-acetyltransferase-2 (NAT-2) gene. Data from a variety of sources suggest that HA may play a role in human carcinogenesis and are liked to many cancers.

Anderson's team started with 62,000 healthy people and documented what they actually did eat. Over nine years, 208 were diagnosed with pancreatic cancer. When divided into five groups based on how much charred meat such as hamburgers they ate, the people diagnosed with pancreatic cancer were far more likely to be in the top two groups.

They found that those who preferred very well-done steak were almost 60 percent more likely to get pancreatic cancer as those who ate steak less well-done or did not eat steak. Those with the highest intake of very well-done meat had a 70 percent higher risk for pancreatic cancer over those with the lowest consumption.

The mutagenic activity and the mass amount of heterocyclic amines responsible for the mutagenic activity have been measured in some cooked foods. Cooked meats are the predominant source of mutagenic activity in the diet with values ranging from 0 to 10,000 revertants per gram reported in the Ames/Salmonella test with strain TA98.

Frying at higher temperatures and for longer times produces the greatest mutagenic response, and thus concomitantly, the largest amounts of heterocyclic amines.

Non-meat products such as baked breads can also form significant mutagenic activity, particularly when overcooked. Commercially prepared hamburgers made from meat substitutes such as tofu, wheat gluten or tempeh and fried at 210 degrees C have up to 10% of the mutagenic activity of a fried beef patty cooked under the same conditions.

    Readers Response
  1. Dear Sir, emedinews is very informative. Regards:Dr Trishna
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