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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 …

6th April, 2011, Wednesday                                 eMedinewS Presents Audio News of the Day

View Photos and Videos of 2nd eMedinewS – Revisiting 2010

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

Sri Satya Sai Baba: The living GOD

“Sri Satya Sai Baba still on ventilator” was the headline on April 4 in The Times of India.

Sri Satya Sai Baba, the living God of Puttaparthi, is on ventilator and assisted by regular dialysis. The
85-year-old Sai Baba was admitted to Satya Sai Baba Hospital on 28th March following pneumonia and respiratory problems. A pacemaker has also been implanted because of his irregular heart beats.

When this news was read by many of my friends, they asked me, “How can a person with God likequalities suffer and be on ventilator?” My answer was straightforward. People with qualities of a sacred leader are beyond visionary people and are worshipped in the society. But as they are human beings, one day they too will have to depart from the earth to take a rebirth. And we know medically that nobody dies of old age. They have to have a disease and leave their body through some acute illness.

People who have attained spiritual qualities will invariably get diseases but they will not suffer from them as the death often is peaceful and at will. We have seen Swami Chinmayanand suffer from cardiomyopathy and diabetes, Maharishi Mahesh Yogi with diabetes and coronary artery disease and multiple angioplasties etc. The same is true for Satya Sai Baba. Even if he is on ventilator or dialysis, his body will not suffer and the nirvan whenever happens will be in a calm and composed manner.

People with God like qualities are born only once in a while. With crores of followers and assets worth billions, it's expected that there would undercurrents in the organization about a succession battle. But it is impossible to have a successor who will be worshipped like God the way Satya Sai Baba has his following, whenever it happens.

Dr KK Aggarwal
Editor in Chief
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    eMedinewS Audio PostCard

 Pediatric Echo

Dr Savitri Srivastava Speaks on
‘Unusual Sites of Shunts’

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

11th Perfect Health Parade Inaugurated

The 11th Perfect Health Parade was flagged off on 3rd April 2011. Dignitaries present on the occasion were Shri Pawan Kumar Bansal, Union Minister for Parliamentary Affairs, Science & Technology and Earth Sciences, Dr. SY Quraishi, Chief Election Commissioner of India, Padma Shri and Dr. BC Roy National Awardee, Dr. KK Aggarwal, President HCFI

Dr K K Aggarwal
    National News

Ministry finalises National Health Research Policy

NEW DELHI: To overcome the weaknesses of the publicly funded health structures that restricted research in priority health areas, the Union Health and Family Planning Ministry has finalised the National Health Research Policy. It would maximise the returns on investments in health research through creation of a health research system to prioritise, coordinate and facilitate conduct of effective and ethical research and its translation into products, policies and programmes aimed at improving health especially of the vulnerable population. It proposes to ensure at least two per cent of the national health funding is utilised for research. The Policy envisages creation of an overarching National Health Research Management Forum having representation from all stakeholders and will function from the Department of Health Research that has drafted the new proposed policy. (Source: The Hindu, Apr 04, 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)

Exercise may cut salt’s effect on blood pressure

Regular exercise and a low–sodium diet are two lifestyle changes that are often recommended to lower high blood pressure. Now a new study shows that one appears to influence the other. Specifically, physical activity appears to help keep blood pressure from climbing after people eat eye–popping amounts of salt –– 18,000 milligrams a day to be exact. That’s about 10 times the recommended daily intake for sodium.

(Dr Monica and Brahm Vasudev)

Novel procedure may be potential surgery alternative for BPH

A new, minimally invasive procedure designed to shrink the prostate could offer an alternative to surgery for benign prostatic hyperplasia (BPH), according to findings presented at the Society of Interventional Radiology annual meeting. The procedure, prostatic artery embolization, uses a catheter through an artery in the groin to place tiny particles into prostatic arteries.

ICU cleaning model may reduce MRSA infection rates

An enhanced cleaning protocol appeared to cut the risk that a patient in the intensive care unit would get methicillin–resistant Staphylococcus aureus (MRSA) from the room's previous occupant, according to a in study the Archives of Internal Medicine.

Study suggests 75% of PSA screens on elderly men are unnecessary

The ‘excessive’ use of prostate–specific antigen (PSA) screening in elderly men with limited life expectancies is a ‘significant problem’' in the US, according to a new study of men 40 years and older who participated in the National Health Interview Survey.

    IJCP Special

Dr Good Dr Bad

Situation: A diabetic on Glimepiride came with fasting sugar of 170 mg/dL.
Dr Bad: Start insulin.
Dr Good: Add metformin.
Lesson: Combinations of drugs are often necessary to achieve optimal glycemic control. Metformin can be given in combination with sulfonylureas, insulin, glinides, alpha–glucosidase inhibitors, thiazolidinediones, exenatide and DPP–4 inhibitors.

Make Sure

Situation: A patient on treatment for tension type headache was found to have brain tumor on CT scan.
Reaction: Oh my God! why was a brain tumor not suspected early?
Lesson: Make sure that all patients with tension type headache are thoroughly investigated to rule out brain tumor.

    An Inspirational Story

(Dr Anupam Sethi Malhotra)

A young man wished to marry the farmer’s beautiful daughter. He went to the farmer to ask his permission. The farmer looked him over and said, "Son, go stand out in that field. I’m going to release three bulls, one at a time. If you can catch the tail of any one of the three bulls, you can marry my daughter." The young man stood in the pasture awaiting the first bull.

The barn door opened and out ran the biggest, meanest–looking bull he had ever seen. He decided that one of the next bulls had to be a better choice than this one, so he ran over to the side and let the bull pass through the pasture out the back gate. The barn door opened again. Unbelievable. He had never seen anything so big and fierce in his life. It stood pawing the ground, grunting, slinging slobber as it eyed him. Whatever the next bull was like, it had to be a better choice than this one. He ran to the fence and let the bull pass through the pasture, out the back gate.

The door opened a third time. A smile came across his face. This was the weakest, scrawniest little bull he had ever seen. This one was his bull. As the bull came running by, he positioned himself just right and jumped at just the exact moment. He grabbed… but the bull had no tail!

Life is full of opportunities. Some will be easy to take advantage of, some will be difficult. But once we let them pass (often in hopes of something better), those opportunities may never again be available.

So always grab the first opportunity.

    Infertility Update

(Dr. Kaberi Banerjee, Director Precious Baby Foundation)

How common is infertility?

About 10% of all couples trying to conceive suffer from infertility.

    Medicine Update

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

How do we manage a case of obesity?

Prevention–Plus Protocol for the treatment of childhood obesity

  • Eat five or more servings of fruits and vegetables daily.
  • Use television and computer for no more than two hours per day.
  • Do not keep a television in child’s bedroom.
  • Participate in at least 60 minutes of moderate to vigorous physical activity per day.
  • Do not consume sugar–sweetened beverages.
  • Eat breakfast daily.
  • Limit meals outside the home.
  • Have family meals at least five to six times per week.
  • Allow child to self–regulate food intake and avoid food restriction (e.g., a child should be permitted to eat portions of food until satiated, no more, or less).
    Medicolegal Update

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

What are commonly complained surgical errors?

Surgical errors occur for a variety of reasons, the foremost being poor surgical technique, faulty equipment or defective monitoring machinery. Some of the more common types of surgical errors include:

  • Operations performed on the wrong body part or organ
  • Incorrect procedures carried out
  • Accidental perforation of organs, particularly during keyhole procedures
  • Foreign bodies such as swabs and surgical equipment left inside the patient
  • Excessive evident scarring
  • Burns caused by diathermy
  • Injuries and nerve damage due to incorrect positioning of a patient in theatre
  • Surgical injuries to nerves, tissues and blood vessels
  • Damage to bile ducts during gall bladder surgery
  • Complications with laser due to incorrectly set equipment, inexperienced practitioners or errors in technique
  • Complications with a hysterectomy
  • Lack of informed consent
  • It is also important that surgical patients receive the correct post-operative care, to avoid other potential complications such as avoidable infections, hemorrhage, blood clots and pressure sores.
    Legal Question of the Day

(Dr. M C Gupta)

Q. Can a doctor having PG qualification from abroad practice in India if the degree is not recognised by the MCI?
Suppose a doctor having his name in the Indian Medical Register gets a postgraduate degree in a clinical subject from a university in a foreign country where such degree is recognised by its medical council but is not recognised by the MCI. Can such a person practice as a specialist in that specialty without legal complications?

Ans. He can, with the following precautions:

  1. He should clearly state on his letterhead etc. as “Dr. ABC, MD (DEF University, Uzbekistan)”. By doing so, he is not holding out that he is an MD from a university recognised by the MCI. Thus he is not keeping anybody in the dark.
  2. This information should not be concealed from the hospital where he is working as a consultant. The appointment letter should refer to him as “Dr. ABC, MD (DEF University, Uzbekistan)”. The significance is that if at all some legal complications occur, the hospital would not be able to wash its hands off..
  3. In case of major procedures, such as surgery, the consent form should clearly state, in the patient’s / authorised attendant’s handwriting that he understands that the specialist’s degree is from DEF University, Uzbekistan, and is not recognised by the MCI.
  4. If the above precautions are taken, it will be difficult to blame such a physician for practising that specialty fraudulently or in violation of law.
  5. In his own interest, such a physician should get membership of the concerned special societies and, if possible, write scientific papers / books in the specialty.
  6. If such a physician has to defend himself in a consumer court where a complaint of medical negligence has been filed, the judgment will depend upon occurrence and proving of negligence and not upon his degree being not recognised by the MCI.
    Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

What should the changes be in the eating habits?

A balanced diet for obesity reduces the number of calories ingested while improving dietary habits. Doctors recommend a diet low in fat and sugars. A balanced diet includes at least five servings of fruit and vegetables a day.

A balanced diet should be high in whole grains, and include lean meats and low–fat dairy products. High–calorie, high–fat or sugar–rich foods should be avoided, as well as processed food and alcohol. Calories may be divided between three meals and two snacks a day. A breakfast high in fiber is also recommended.

    Head Injury Update

Dr Shameem Ahmed, Dr Atanu Borthakur, Dr Sajida Sultana, Dr Shabbir Khan. Dept. of Trauma and Neurosurgery, Hayat Hospital, Guwahati, Assam.

30% of total head injury cases die without increase in ICP but with primary damage to brain stem, and 70% die due to increased ICP.

    Mind Teaser

Read this………………… 

Which is true regarding therapeutic HPV vaccines?

A. They target E2 or E4 oncoprotein.
B. They are best used for first line treatment of cervical cancer.
C. DNA vaccines are the most promising.
D. Linking the DNA vaccine protein to Y–tubulin will enhance binding to the dendritic cells.

Yesterday’s Mind Teaser: I'M you

Answer for yesterday’s Mind Teaser:
I am bigger than you

Correct answers received from: Dr Rakesh Bhasin, Dr Sandeep Thadani, Dr Nandini Kapoor, Dr Meera Rekhari, Dr Rashmi Chhibber, Dr. Manjesha

Answer for 4th April eQuiz: A
Correct answers received from:Dr. Neelam Ohri, Dr. Amol R Hartalkar.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr Veena Aggarwal)

The Leave Application

Another leave letter written to the headmaster: "As my headache is paining, please grant me leave for the day."

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Western blot test

Like the ELISA procedure, the western blot is an antibody detection test. However, unlike the ELISA method, the viral proteins are separated first and immobilized. In subsequent steps, the binding of serum antibodies to specific HIV proteins is visualized. Specifically, cells that may be HIV–infected are opened and the proteins within are placed into a slab of gel, to which an electrical current is applied..

There are no universal criteria for interpreting the western blot test. The number of viral bands that must be present may vary. If no viral bands are detected, the result is negative. If at least one viral band for each of the GAG, POL, and ENV gene–product groups is present, the result is positive.

    Medi Finance Update

(Dr GM Singh)

In case the deductee comes back stating that the original TDS certificate is lost, can a duplicate certificate can be issued?

Yes. The deductor will have to issue the certificate in a plain paper giving necessary details of deduction and remittance.

    Drug Update

List of approved drugs from 01.01.2010 to 31.8.2010

Drug Name


DCI Approval Date

Activated Dimethicone 50mg + Magnesium Hydroxide 250mg + Dried Aluminium Hydroxide 250 mg + Sorbitol (70%)1.25 gm /5ml Solution

For treatment of symptoms of hyperacidity (e.g. heartburn, epigastric discomfort, or their equivalents) that are often associated with dyspepsia, peptic ulcers, gastritis, peptic esophagitis and indicated for relief of flatulence


    IMSA Update

International Medical Science Academy (IMSA) Update

Optimal rate for patients in atrial fibrillation

One should go for a lenient rate control goal of <110 beats/min, compared to a stricter rate control goal of <80 beats/min and heart rate during moderate exercise <110 beats per minute, for patients in atrial fibrillation in whom a rate control strategy has been chosen. The randomized RACE II trial showed no significant difference between the two groups in the primary composite outcome (cardiovascular death, hospitalization for heart failure, and stroke, systemic embolism, bleeding, and life–threatening arrhythmic events) at three years.

(Dr Vinay Sakhuja)

Latin Quotes

Ad calamitatem quilibet rumor valet.

Any rumor is sufficient against calamity i.e., when a disaster happens, every report confirming it obtains ready credence.

  Quote of the Day

(Dr GM Singh)

Bureaucracy is the art of making the possible impossible. Javier Pascual Salcedo

    Readers Responses

Dr. KK Aggarwal, we enjoy reading emedinews daily, thank you very much. Carry on the good work. Warm Regards: Dr.Santosh Sahi,The Academey of Laughter Yoga, Delhi.

    Public Forum

(Press Release for use by the newspapers )

Identifying Fatal Asthma

Assessing patient risk for fatal asthma exacerbation is important because many, if not most, asthma-related deaths are preventable if risk factors are recognized and addressed early. Annual per capita mortality from asthma is 1-33 per million population. This was stated by Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee and President, Heart Care Foundation of India.

Near-fatal and fatal asthma exacerbations may occur in patients with mild, moderate, or severe asthma and the course may be either slow or rapid in onset.

Increases in breathlessness and wheezing, frequency of night time awakenings, use of beta-adrenergic agonist rescue inhaler drugs, increased diurnal variability in peak expiratory flow rate all indicate a pattern of poor or partial control of asthma.

Other factors like long duration of asthma, poor adherence to medical therapy, systemic steroid dependence, psychosocial problems, aspirin or NSAID sensitivity, cigarette smoke exposure, prior hospitalization for asthma and atopic allergy attack, alone or in combination, alert one to the fact that the patient is at high-risk for near-fatal asthma.

Tests for airflow obstruction, such as spirometry or peak expiratory flow rate, obtained at the time of doctors’ visits may help predict which patients are at increased risk for future emergency room visits and hospitalization.

Poor perception of breathlessness has been noted in survivors of near-fatal asthma and likely contributes to delays in seeking medical care. Identifying patients prone to severe exacerbations is important because education of the patient and provision of a detailed action plan for these patients can reduce the risk of fatal or near-fatal asthma.

Efforts to modify risk factors for fatal and near fatal asthma include: avoidance of asthma triggers such as aeroallergens, aspirin, and NSAIDs; adherence to use of inhaled steroids; smoking cessation; appropriate treatment of exercise -induced bronchoconstriction; and avoidance of illicit drugs. Approximately 80 to 85 percent of patients who die of asthma have a history of progressive symptoms for more than 12 hours and often for one to three weeks. At autopsy, the airways of these patients feature an eosinophilic inflammation and obstruction of airway lumens by tenacious mucus and desquamated epithelium. These changes probably develop over days to weeks. This suggests that most of these patients would have had sufficient time to seek medical attention for worsening shortness of breath.

In a minority of patients, 20%, with fatal or near-fatal exacerbations of asthma, death occurs less than 2 to 6 hours after symptom onset. The airways of these patients do not have eosinophil-predominant inflammation or widespread mucus plugging typical of status asthmaticus. Instead, severe airway obstruction appears to be mainly due to smooth muscle bronchospasm and neutrophils are the predominant inflammatory cell in the airway mucosa. Neither the severity of baseline asthma symptoms, years of asthma, smoking habits, asthma medication use, nor history of hospitalization for asthma help in identifying these patients. However, patients with rapid onset asthma exacerbations may more commonly report sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs).Rapid-onset asthma exacerbations do not appear to be due to anaphylaxis, although that diagnosis must be considered given the rapidity of the deterioration.

    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
    Situation Vacant

Vacancy for a post of Consultant in Pediatric ICU at Medanta – The Medicity Hospital, Sector –38, Gurgaon.
Interested candidates may please contact: drneelam@yahoo.com/9811043475.
*Eligibility: Post M/DNB/DCH

    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

Delhi Medical Association WHO Day celebrations

Symposium & Panel Discussion on "Anti Microbial Resistance"
Thursday April 7, 2011
Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, Chairman, WHO Day
Dr Vinod Khetarpal, President, DMA                                    

CME: 8.30 pm – 10.00 pm
Topic: Minimising antibiotic resistance
Speaker Dr. Chandramani Punjabi, HOD Resperative Medicine Mata Chanan Devi Hospital
Topic: Management of sepsis and septic shock,
Speaker Professor Baljit Singh, Senior Anaesthetist & Intensivist G.B. Pant Hospital, New Delhi
3. Resistant HIV, Speaker Dr. Nalin Nag Sr. Consultant Internal Medicine Apollo Hospitals
4. Resistant TB, Speaker Dr. Rupak Singla HOD, TB & Chest Diseases LRS Hospital
5. Panel Discussion on Recent Developments Regarding Antimicrobial Resistance:
Moderator: Dr K K Aggarwal, Padama Shri and Dr B C Roy National Awardee


April 16–17, 2011, National Conference on Gynae–Endocrinology–2011 under aegis of FOGSI, ICOG and AOGD , Focus on newer advances in management of endocrinal problems in gynaecology with emphasis on PCOS, hyperprolactinemia, amenorrhoea, hormonal contraception. Gyne–endocrinology is a topic of high importance especially for practitioner. Detailed programme http://www.aiims.edu and http://www.aiims.ac.in
For details please contact: Prof Alka Kriplani, Organizing Chairperson, 9810828717 kriplanialka@gmail.com/Dr Nutan Agarwal, Organizing Secretary, 9810107464/9868397310 nutan.agarwal1@gmail.com


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 30 – October 02, 2011;XVIth World Congress on Cardiology, Echocardiography & Allied Imaging Techniques Venue: The Leela Kempinski, Delhi (NCR), September 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
Highlights of Pre – Conference CME: Case based learning experience & audience interaction, Maximum 250 delegates for CME will be accepted, who will be divided in 5 batches and will rotate to different halls every 90 minutes. The topics are:(A) Right heart pressures & functions (From basics to newer methods (RV anatomy, echo views, echo assessment of RV function, prognostic impact of RV function) (B) Carotid Doppler: How do I assess and interpret in my daily practice.: Technical tips (Anatomy of the vessel, views of ultrasound scanning, Normal & abnormal Doppler hemodynamics, how to measure IMT) (C) Valvular stenosis: Assessment, limitations and their solution: (Anatomy of the valves, 2–D findings of stenotic lesions, quantitation of lesion, limitations) (D) How do I assess and report ventricular dyssynchrony in my lab. (What is ventricular dyssynchrony, what are the types of dyssynchrony, in whom, when & why do we assess it, various echo methods to assess it ) (E) Live 3–D Echo: Protocol for acquisition. How to slice and get full information. Aim is that by end of the day, every participant is well conversant with all the topics.
Dr (Col) S.K. Parashar, President, e–mail: drparashar@yahoo.com, Mob:09810146231/Dr Rakesh Gupta, Secretary General, email:jrop2001@yahoo.com, Mob:09811013246
worldcon2011@in.kyoni.com, www.worldcon2011.org


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