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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


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  Editorial …

3rd October 2011, Monday

eGFR <45 may present with more serious heart attacks

Keep the kidney functions above 80 to avoid getting a heart attack.

Reduced kidney function is a predictor of a more severe initial presentation of coronary heart disease.

In a case–control study (ADVANCE–Atherosclerotic Disease, Vascular Function, and Genetic Epidemiology) by Dr Alan Go, of Kaiser Permanente of Northern California in Oakland published in Journal of the American College of Cardiology, a declining estimated glomerular filtration rate (eGFR)–a marker of kidney function, was associated with an increasing likelihood of presenting with an acute heart attack rather than stable exertion related heart pain or angina.

Patients who had an eGFR less than 45 mL/min/1.73 m2 were four times as likely to present with an acute MI compared with those with normal kidney function.

Patients with chronic kidney disease have a greater likelihood of more clinically unstable and severe heart blockages. Clinical efforts should be targeted to identify this high–risk population before they develop symptoms of atherosclerosis with an aim to shift the expression of coronary heart disease from acute heart attack to more stable presentations.

Remember most patients with chronic kidney disease do not die of kidney failure but heart attacks.

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

eGFR <45 may present with more serious
heart attacks

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Medico Masti–An Inter College Health Festival at Perfect Health Mela

Infotainment is a new concept of creating health education where education is inter linked with entertainment.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


ICMR–INDIAB study provides new figures for diabetes

New figures for diabetes prevalence in India indicate that the epidemic is progressing rapidly across the nation, reaching a total of 62.4 million persons with diabetes in 2011. Phase one results of the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB) Study have provided data from three States and one Union Territory, representing nearly 18.1 per cent of the nation's population. When extrapolated from these four units, the conclusion is 62.4 million people live with diabetes in India, and 77.2 million people are on the threshold, with pre–diabetes. These results have been published in an article authored by R.M. Anjana et al, published in the current issue of Diabetologia. "This is the first truly national diabetes study done in India in the last 40 years after the last ICMR Study in the early 1970s," explained V. Mohan, who heads Madras Diabetes Research Foundation, the national co–ordinator for the study. The first phase of the ICMR–INDIAB study covered Tamil Nadu, Maharashtra, Jharkhand and Chandigarh, with a sample size of 16,000 persons.
(Source: http://www.thehindu.com/news/national/article2497931.ece, September 29, 2011)

For comments and archives

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

(Dr Monica and Brahm Vasudev)

Oral steroids linked to severe vitamin D Deficiency

Patients on oral steroids are twice as likely to develop severe vitamin D deficiency, according to a study published in The Journal of Clinical Endocrinology and Metabolism.

For comments and archives

Preemies breathe easier with less invasive therapy

A minimally invasive way of helping premature babies breathe better reduced the need for mechanical ventilation, researchers said.

For Comments and archives

In Post–‘Mad Men’ world, smoking is blue collar habit

Workers in blue–and pink–collar jobs are far more likely to smoke cigarettes than those in white–collar occupations, CDC researchers said.

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  Twitter of the Day

@DrKKAggarwal: Watch Padma Shri Awardee Dr KK Aggarwal on Be cautious in giving pain killer to patients with high cholesterol…http://youtu.be/OriXhl5LT7s

@DeepakChopra: The neuroscience of "I love you" & other mysteries of the mind with@RudyTanzi http://huff.to/o9wBO5

    Dr KK Answers

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

How to calculate platelet counts from peripheral smear?

A: There are two methods: Platelet count per uL =

  1. Average number of platelets per oil immersion field multiplied by 20,000.
  2. Average number of platelets per oil immersion field multiplied by Hb (g/dL) and then multiplied by 1,000.

For comments and archives

    Spiritual Update

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

Science behind 3rd Navratri or Chandraghanta Worship (Controlling your negative energies) Navratri is the detoxification of body, mind and soul. Body detoxification involves Navratri diet containing eating less devoid of cereals. In Navratri diet flour is replaced with Kuttu or Singhara flour; pulses with amaranth or Rajgiri and Rice with Samak rice. Mental and soul detoxification involves practicing Yoga Sadhna as described in nine forms of respective Durga.

  1. Chadraghanta is worshipped on the third day of Navratri
  2. SHE is shown with golden skin and riding a tiger. She is depicted with ten hands and 3 eyes with a crescent moon on the head.
  3. Eight of HER hands display weapons. The rest two are in the mudras or gestures of boon giving and stopping harm (Varada and abhay mudra) indicating protection.
  4. Out of eight hands five contains Bow and arrow (to bend, focus, one point determination, The bow and arrows also represent energy. Holding both the bow and arrows in one hand indicates control over both potential and kinetic energies); Trishul (balance), sword (sharp intelligence) and mace (power to destroy the evil). Rest three hands contains rosary (tapas); lotus (detached attachment) and Kamandalu (acceptance).
  5. In Ayurveda SHE represents the control over the fire element.
  6. In Yogashstra SHE represents the solar or Manipura Chakra with the Bija sound RAM.
  7. Sound of her bell terrifies demons as well as all enemies.
  8. SHE represents protector and bravery.

Spiritual message on the 3rd Navratri: One should continuously (beaded rosary) control the fire (solar plexus) within by using our sharp intelligence (sword) and balancing the mind (Trishul) by focusing on one point (arrow and bow), practicing detached attachment (lotus), accepting things as they are (Kamandalu) and killing the negative energies by using gada (power) when needed.

    An Inspirational Story

(Dr Anil Kumar Jain)

The vajra

During a war between "Devatas"(Gods) and the "Rakshas"(Demons), the Demons had clearly dominated in the warfield and robbed the Devatas of their arms and weapons using some new black magic powers which were far behind the comprehension of the gods. The Devatas knew for sure that if they lost the rest of their weapons, no one could save their life. So in order to make sure that their weapons are safe, they went to the Sage Maharishi Dadhichi who agreed to keep the weapons in his protection even neglecting the danger to his own life.

The "Rakshasas"(Demons) used all their might to rob those weapons and hurt Maharshi dachichi but in vain. A long time passed and the Gods did not come to take away their weapons. Maharshi Dadhichi couldn't think of any way by which he could always have an eye on the weapons at all time. Finally, one day, with his divine powers, he put all the weapons in his sacred water pot and mixed them in the water and drank it. He was now free and could continue his regular penance undisturbed.

A short while after this, the Devatas returned and asked Dadhichi for their weapons. Dhadhichi Rishi replied, "I waited a long time for you to come and collect your weapons. I thought you wouldn’t return back. So I drank them".

Devatas went on pleading "Maharshi, we are now in a position to fight with Rakshasas. If we do not have our weapons, we will not be in a position to fight with them and to save Dharma and the universe". Dadhichi thought about it calmly and was convinced that Devatas deserved help.

Their weapons were now more powerful than before. He said to Devatas "Alright, take your weapons back by killing me. They are presently in the form of my bones". Devatas refused to do so and said "We certainly do not want to commit the sin of killing a great Rishi like you. We can not afford to do this cruel thing"

Now the weapons were inside the hermit’s body in form of flesh and bones and it was difficult to get them out. So he created a huge fire, entered into it and reduced his own body into flames. Devatas were in the state of bewilderment as they couldn’t comprehend what was happening. Lord Brahma suddenly appeared and converted each of the bones into various powerful weapons and gave them to the Devatas. Dadhichi's back bone was made "the vajra" and was given to Lord Indra with which he brought to an end to the most powerful Rakshasas like Vritrasur. The power of the divine virtue and powerful soul made the weapons more lethal than ever.

For comments and archives

  Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Dietary supplements could make athletes unwitting drugs cheats

Minute levels of banned substances in some dietary supplements are leaving athletes susceptible to failed drugs tests according to Loughborough University Professor of Sport and Exercise Nutrition Ron Maughan. Professor Maughan, who chairs the Sports Nutrition Group of the International Olympic Committee Medical Commission, has warned of the dangers of commercially available supplements which could turn athletes into unwitting drugs cheats. Professor Maughan has raised particular concerns about the presence of the steroid nandrolone (and its metabolic precursors) which are banned by the World Anti–Doping Agency (WADA). Maughan and his team investigated athlete responses to trace amounts of a nandrolone precursor (19–norandrostenedione) where subjects ingested either water or a commercial sports bar contaminated with minute levels of the banned substance. Despite contamination levels 1,000 times lower than concentrations typically scanned for during supplement manufacture, volunteers’ samples still registered a positive doping result for nandrolone.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

A patient dies and the hospital bill is pending. Can the hospital refuse to release the body till the payment is made? What other options are available to the hospital?


  1. 1. It is illegal to refuse to release the body till the payment is made.
  2. The options with the hospital are:
    • To file a civil suit against the relatives/legal heirs/estate of the deceased for recovery for the bill amount out of the actual/potential/accruable assets of the deceased.
    • To file a civil suit against the guarantor, if any, who had guaranteed payment of the hospital bill.
    • To show the bill amount as adjusted against the obligation to provide free treatment to poor patients in terms of the Delhi High Court judgment in respect of hospitals that have been granted land etc. at concessional prices.
    • To try to claim the bill amount from the government in case the patient was admitted under some government order/law making it obligatory for a private hospital to provide free emergency admission and treatment even if the hospital had not availed of any concessions given by the government. An example would be the Clinical Establishment Act, 2010.
    • To waive off the payment and show it as irrecoverable amount in the account book

For comments and archives

    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What is Rapid Diagnostic Test (RDT)?

HRP2–based tests for P. falciparum detect a circulating antigen excreted by asexual plasmodia. The RDTs have a sensitivity of about 95%, at the asexual parasite density above 200/μl. Malaria patients are rarely symptomatic at lower densities. If a suspected malaria patient has a negative RDT, it can be assumed that the patient does not have falciparum malaria and another cause of the symptoms should be sought. The test should be repeated after about 24 hours, if no other cause can be found and the clinical suspicion is high (e.g. intermittent fever with rigors and sweats). Special efforts should be made to obtain the microscopy result rapidly. HRP2 antigen can persist for up to 4 weeks after clearance of asexual parasitemia through treatment. False positive tests are therefore common, especially in patients with a recent history of treatment. RDTs should therefore not be used for following up patients after treatment.

Several types of Rapid Diagnosis Test Kits (RDK) are available in the market. Some of them can only detect P. falciparum, while others can detect other species of parasite also, in most cases by being sensitive to a P. falciparum antigen as well as a pan–specific malaria parasite antigen. The latter kits are more expensive and thermolabile and less sensitive than the P. falciparum specific test–kits. So far, NVBDCP supplies RDKs for P. falciparum to village volunteers and health workers and to Government health facilities, which do not have microscopy.

For comments and archives

    Medicine Update

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

Duty of care in administration of treatment to undertaken patient

Ingredient of mens rea exist where there is a charge of criminal negligence.

  • The ingredient of medical negligence is the duty of care. Person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed with skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties.
  • The standard of this reasonable care is definitely a flexible criterion, capable of setting the boundaries of legal liability of the professionals depending on the duties founded on principles of torts or contracts.
  • A medical practice acceptable to the profession on the day of medical care delivered he can’t be held liable for negligence merely because a better alternative course of treatment was available or a more skilled doctor would not have chosen to follow or resort to that practice which the accused followed.
  • The term negligence is not an absolute but relative and comparative one. No absolute standard can be laid by which negligence can be infallibly measured in a case. All the facts have to be taken in to account to determine whether negligence occurred or not.
  • He should not be held liable for taking one choice out of the different schools of treatment (Medical Council Act (102 of 1956), S.20A).

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th–9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Under the aegis on AOGD

Organizing Chairperson–Dr Kaberi Banerjee

Day–1 Interesting Highlights

Session 1–Foundations of Infertility Management

This session will focus on the basics of infertility diagnosis without which successful treatment is not possible. This will also highlight which patients will benefit from IVF treatment sooner rather than later.

Speakers: Dr Neena Malhotra (AIIMS), Dr Sunil Jindal (Meerut), Dr Suneeta Mittal (New Delhi), Dr Anjani K Agarwal (New Delhi), Dr Bishwaranjan Dash (New Delhi)

Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan–e–Hindustan–Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Contact: Address: E–23 Ayurvigyan Nagar New Delhi–110049, For details contact +91 9871250235

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Plasma Free Metanephrine

To help diagnose or rule out a pheochromocytoma.

Related tests: Catecholamines, Plasma and Urine; Urine Metanephrines; Vanillylmandelic acid (VMA)

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient of ulcerative colitis was a chain smoker.
Dr. Bad: Stop it.
Dr. Good: Shift to nicotine patch and slowly withdraw it.
Lesson: Nicotine has remittance producing properties in ulcerative colitis.

For comments and archives

Make Sure

Situation: A patient developed rifampicin toxicity.
Reaction: Oh my God! Why was history of Ayurvedic drugs not taken?
Lesson: Make sure to enquire if a patient is also on Ayurvedic drugs. Trikatu can enhance the action of anti-TB drugs.

For comments and archives

  Quote of the Day

(Dr GM Singh)

In world, everybody makes mistakes. But…only a Wife has the God–gifted talent of finding them, remembering them & reminding them throughout life.


Mum’s the word: To keep quiet. To say nothing.

  Sri Chanakya Niti–Sastra: The Political Ethics of Chanakya Pandit

(Dr Anupam Sethi Malhotra)

A wise man should marry a virgin of a respectable family even if she is deformed. He should not marry one of a low–class family, through beauty. Marriage in a family of equal status is preferable.

    Medicolegal Update

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

Taking someone else’s medicine is also a kind of misuse.

  • People who take someone else’s medicine may be harmed if they take the wrong dose or take a medicine that is not meant for treating their condition.
  • Women who take medicine to try to end a pregnancy are misusing the medicine, and may poison themselves.
  • Poisoning accidents can happen when safety warnings are ignored and chemicals are used in the wrong way. For example, there is usually a warning on a bleach container that bleach should not be mixed with any other cleaner.
  • If people ignore the warning and use bleach with another household cleaner, they may be poisoned by the gases given off.
  • Another example of misuse of a product is when insecticides that are meant to be used on plants or buildings are used to kill insects living on people, in their hair or on their bodies.
  • Sometimes people poison themselves by misusing medicines. They may take more than the doctor prescribed because they think, wrongly, that a larger dose will make them better more quickly.
  • Taking someone else’s medicine is also a kind of misuse.

For comments and archives

    Mind Teaser

Read this…………………

If you were running a race, and you passed the person in 2nd place, what place would you be in now?

Yesterday’s Mind Teaser: How much dirt is there in a hole that measures two feet by three feet by four feet?

Answer for Yesterday’s Mind Teaser: There is no dirt in a hole.

Correct answers received from: Satyanarayana Akupatni, Dr. Anupam Sethi Malhotra, Dr.Anil Kumar Jain, Dr S.Upadhyaya, Dr Neelam Ohri, Dr. T. Samraj, Dr.K.Raju, Gita Arora, Dr. Bharat Bhushan Aggarwal, Dr Govinda, Abid Ahmed, Dr Rawat Purushottam Singh

Answer for 1st October Mind Teaser: Johnny of course
Correct answers received from: Dr.R.K.Goel, Dr. Bharat Bhushan Aggarwal, Dr. Anupam Sethi Malhotra, Dr. Prashant Bharadwaj, Dr Rahul Sharma, Dr Bharti Bhandari

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Veena Aggarwal)

Murphy’s Laws for Humour

All the desirable things in life are either illegal, expensive or fattening or married to someone else.

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Donating blood reduces chances of heart attack

On the occasion of Blood Donation Day falling on 2nd October, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India and MTNL Perfect Health Mela, said that one should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities one can do as it can save multiple lives through various components taken out of one blood transfusion.

Advocating autologous transfusion, Dr. Aggarwal said that all those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

Dr. Aggarwal said in the current medical tourism scenario, many Christian patients, those who are Jehovah’s Witnesses, are refusing blood transfusion on religious grounds. A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

These Christians do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receiving the blood. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation. These Christians do not accept even transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time.

For comments and archives

    Readers Response
  1. Dear Sir, Thanks for the emedinews....this is full of knowledge and basket full of each and everything. Regards:Dr Priya
    Forthcoming Events

18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals

Dr K K Aggarwal

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    eMedinewS Special

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  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

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  Pesticides Safely

    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