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eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
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 ...

7th September, 2010, Tuesday

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

Management of spontaneous intracerebral hemorrhage: New AHA/ASA guidelines

  1. Outcomes of spontaneous intracerebral hemorrhage (ICH) can be greatly improved with timely, appropriate medical treatment.
  2. Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively.
  3. Patients with ICH whose international normalized ratios (INR) are elevated due to oral anticoagulants should have oral anticoagulants withheld; receive therapy to replace vitamin K–dependent factors and correct the international normalized ratio, and receive intravenous vitamin K.
  4. Consider the following risk factors: lobar location of the initial ICH, older age, ongoing anticoagulation, presence of the apolipoprotein E 2 or E4 alleles and greater number of microbleeds on MRI.
  5. After the acute ICH, with no contraindications, blood pressure should be well controlled, especially in those whose ICH at basal ganglia, thalamus, or brainstem, is typical of hypertensive vasculopathy.

These guidelines were published online July 22 will appear in the September issue of Stroke.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook

  Photo Feature 

2nd Acharya Sushil Muni Ahimsa Peace Award
Dr Naresh Trehan, Chairman and Managing Director, Medanta – The Medicity, received 2nd Acharya Sushil Muni Ahimsa Peace Award in a function held on 5th September, 2010 at Acharya Sushil Muni Ashram, Defence Colony. In the photo: Shri and Dr BC Roy National Awardee Dr KK Aggarwal, Dr Mohini Giri, Dr Naresh Trehan, Sardar Buta Singh ji, Acharya Dr Sadhvi Sadhna ji Maharaj, and Dr GM Singh

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

13-valent pneumococcal conjugate vaccine (PCV13)

A pneumococcal vaccine with additional serotype coverage was licensed in the United States in February 2010 and will replace the 7–valent vaccine for routine childhood immunization.


  1. Licensure of a 13–valent pneumococcal conjugate vaccine (PCV13) and recommendations for use among children – Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep 2010; 59:258-61.
  National News

Vote Appeal

Dr. K.K. Aggarwal, Padma Shri and Dr. BC Roy National Awardee is contesting for the post of Vice President of the Indian Medical Association. Kindly vote, support and elect him, if you are a member of the Central Council of IMA or know somebody who is a Central Council Member.
Dr. KK Aggarwal is well-known for his work in the field of academics. The unique concept of eMedinewS, the first national daily emedical newspaper of India, which is being circulated to 40000 doctors every day, is his brainchild. If elected he will be of immense help to the medical community as an Educationist and also enhancing the image of the medical profession.


The word ‘Vedanta’ means ‘end of Vedic knowledge.’ The word ‘Medanta’ has been derived from two words – ‘Medicine’ and ‘Vedanta’ and denotes the end of all medical technology and treatment. This was his dream, said Dr. Naresh Trehan, when he named his institution as Medanta – The Medicity. He was addressing a gathering of 500 delegates after receiving the second Acharya Sushil Muni Ahimsa Peace Award.Dr. Trehan said that the vision of Medanta is that everything ultimate in medical treatment and technology should be available in Medanta. Medanta is also an amalgamation of allopathy with other systems of medicine albeit in a scientific way.

Don’t pass the buck, fight dengue instead: Azad

With dengue cases crossing last year’s figure of 1,153 in the city, the Delhi government on Friday said a special cleaning drive will be launched from September 6 to prevent mosquito-breeding, also assuring the strain prevalent this year was far less lethal. After a meeting with all civic agencies of the Capital as well as the Delhi Government, Union Health Minister Ghulam Nabi Azad told reporters that from Monday, a massive, coordinated cleaning operation for two days would be launched which would cover all roads, lanes and bylanes. The operation would be conducted by MCD, NDMC, CPWD and the cantonment board. (The Indian Express)

  International News

Studies show higher BMI + high alcohol consumption increases risk in both men, women

Obesity and alcohol act together to increase liver disease risk, an effect seen in both men and women, according to research published online March 11 in BMJ.

(Contributed by Dr. GM Singh)

Sibutramine increases risk of heart attacks

A new study has found an association between sibutramine and an increased risk of non–fatal heart attacks and stroke, even though taking the drug did not seem to increase the risk of death in patients with a history of heart problems. The first author of the study, Dr. Philip T. James, a professor at the London School of Hygiene and Tropical Medicine in England, said that the only time there was an increase in heart attacks or strokes were in those patients who had had previous heart disease or strokes, who are not candidates for the drug at the very outset. The study is reported in the Sept. 2 issue of the New England Journal of Medicine.

Double–dose clopidogrel benefits certain patients but higher-dose aspirin is no more effective than low dose

Two studies have found that high–dose clopidogrel may be beneficial for some patients, but not all; while aspirin administered in high doses is no better than a low dose for preventing new heart attacks, other cardiac problems, stroke and death. In an editorial in The Lancet, Dr. Gregg Stone stated that patients who are at high risk for heart attack and stroke and low risk for bleeding are going to do well on a higher dose of clopidogrel. He further added that patients at lower risk for atherosclerotic complications, but high risk for bleeding should be treated with a more conservative lower dose. The reports are being published in the Sept. 1 online edition of The Lancet and in the Sept. 2 issue of the New England Journal of Medicine.

Metformin Linked to Lower Lung Cancer Rate in Mice

Preliminary findings from a study appearing in the September issue of Cancer Prevention Research have shown some encouraging results for metformin in the prevention of tobacco–induced lung cancer. In the study, metformin was associated with a substantial reduction (up to 73 %) in the number of tumors mice developed when they were given a common carcinogen found in tobacco

Childhood migraines often overlooked by medical community

About 10 percent of young children and up to 28 percent of older teenagers suffer from migraines. Migraines are still perceived as an adult condition. Migraine in a child may present differently from that in an adult. While adult migraines may be = 4 hours in duration, in children, the duration of a migraine can range from as little as one hour up to 72 hours. Migraine is usually unilateral in adults. In children, the headache is often felt across the front of the forehead or on both temples rather than on just one side. So, childhood migraines are often dismissed as sinus headaches. At times, the child may have abdominal pain, vomiting or feelings of vertigo instead of a headache.

  Liver Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta Medicity

Can ondansetron be used for gastroenteritis in children? 

A large retrospective study from two pediatric emergency departments showed the use of oral ondansetron to reduce vomiting in children with presumed gastroenteritis. It does not increase the risk of missing other serious alternate causes of vomiting . Alternate diagnoses included appendicitis, intussusception, bacteremia, pyelonephritis, small bowel obstruction, and intracranial tumor. This study also confirmed previous observations that ondansetron therapy reduced the rate of hospital admissions for gastroenteritis (3.7 versus 6.4 percent).

Sturm, JJ, Hirsh, DA, Schweickert, A, et al. Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses?. Ann Emerg Med 2010; 55:415.

  Infertility Update

Dr. Kaberi Banerjee, Infertility and IVF Specialist Max Hospital; Director Precious Baby Foundation

Q: We were told that we need IVF treatment what is our chance of achieving a live birth?

A. The overall live birth rate per treatment cycle is in the region of 20-30%.

  ENT Update: Question of the day

What antibiotics can be used in acute otitis media?

Although most experts agree on the continued use of amoxicillin as the drug of choice for the initial treatment of acute otitis media (AOM), there is less consensus on the appropriate drug to use when amoxicillin fails.1,3

  • The AAP/AAFP guideline recommends high–dose amoxicillin/clavulanate (90 mg/kg/day amoxicillin and 6.4 mg/kg/day of clavulanate in two divided doses).
  • The package insert suggests that this dose and formulation may be used for children weighing upto 40 kg, but it should not be used more than 3 g of amoxicillin per day.
  • Adolescents ≥16 years who can take large tablets may use the extended–release formulation (1 g amoxicillin/62.5 mg clavulanate) with a dose of 1–2 g every 12 hours.
    • The alternative to amoxicillin is cefpodoxime.
    • For patients with persistently refractory AOM, tympanocentesis to define the etiology provides critical information to optimize therapy.


  1. Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451.
  2. Block SL, Busman TA, Paris MM, Bukofzer S. Comparison of five–day cefdinir treatment with ten–day low dose amoxicillin/clavulanate treatment for acute otitis media. Pediatr Infect Dis J 2004;23:834.
  3. Steele RW, Thomas MP, Begue RE. Compliance issues related to the selection of antibiotic suspensions for children. Pediatr Infect Dis J 2001;20:1.
  Medico legal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

How can a doctor determine the direction of firearm?

The direction of fire may be determined from the nature of the entrance wound and examination of bullet path in the tissues. But at times, due to the potential instability of some bullets, the bullet track may bear no resemblance to the track shown by entrance and exit wounds, or the site of lodgment of the bullet where through–and–through penetration of the body has failed to occur. There can even be a sharp bend in the track within the soft tissues, without the bullet having struck a bone. The bullet may strike the skin at right angles or at an angle and the entrance wound may have a circular or oval appearance, according to the direction of fire. Under certain circumstances, a bullet entrance wound may be irregular in shape, even though the bullet was fired at right angles. The spin which is imparted to a bullet when it is fired exerts a gyroscopic effect on the bullet, and its motions are therefore comparable to those of a spinning top. Similar to the spinning top, a bullet too has a slight wobble again when it shows down. If the skin is struck by a wobbling bullet, the entrance wound may be irregular in shape.

  • As a bullet strikes the skin more obliquely, the entrance wound becomes more oval.
  • As the obliquity of fire is increased, the wound becomes elongated in shape
  • If the skin is struck at a tangent, penetration may fail to occur and only a slight linear furrowing of the skin is produced.
  Medi Finance Update

Is getting of permanent account number (PAN) compulsory?

Ans. Yes, if a doctor has an income which exceeds the basic exemption limit.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Pancreatin or Pancrelipase containing amylase, protease and lipase with any other enzyme.

Sept. 1,2000

GSR 814(E)

  Lab Update


Platelet count < 150,000/microL (Note: 2.5 % of the normal population may have a platelet count lower than this)

A fall in platelet count to levels < 150,000/microL may herald severe clinical problems, and requires active follow-up, although thrombocytopenia is not usually detected clinically until the platelet count has fallen to levels significantly below 100,000/microL.

  IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine was put on the herb, Butterbur.
Dr.Bad: It is a drug of choice for preventing migraine.
Dr.Good: It benefits still remain unproven
Lesson: Herbal therapies like the Butterbur and Feverfew have been evaluated for the treatment of migraine headaches. Of these, Feverfew has been the most widely studied. Some studies have found it to be effective for migraine prevention, although most experts agree that the benefits are still unproven. Neither treatment is recommended.

Make Sure

Situation: A patient of suspected MI died after receiving sublingual nitrate.
Reaction: Oh my God! Why was a history of intake of Viagra drug was not taken?
Lesson: Make sure to take a history of Viagra drug intake before giving nitrates, because the two drug co-administered can cause fatal fall in blood pressure.

Quote of the Day

"Don't see others as doing better than you. Beat your own records daily because success is a fight between you & yourself"

(Contributed by Dr Paramjit Chadha)

Hypertension Alert

Hypertensive Crises: Goal of Therapy

  • The initial aim of treatment in hypertensive crises is to rapidly lower the diastolic lower blood pressure to about 100 to 105 mmHg
  • This goal should be achieved within 2 to 6 hours, with the maximum initial fall in BP not exceeding 25 % of the presenting value.
  • This level of BP control will allow gradual healing of the necrotizing vascular lesions.
  Mind Teaser

Read this………………

no ways it ways

The answer for yesterday’s Mind Teaser : "Too stuck up for words"

Correct answers received from: Dr Jayashree B Keshav, In Charge - Scientific Publications,The Himalaya Drug Company, Dr Simran Singh, Dr Anurag Jain, Dr.A.K.Saxena, DR. MANJESHA

Correct answers for 5th September Puzzle 'Red in the face'

Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr.K.Raju

Send your answer to ijcp12@gmail.com

  Humor Section

Interesting aspect of mathematical calculation in human life
Smart boss + smart employee = profit
Smart boss + dumb employee = production
Dumb boss + smart employee = promotion
Dumb boss + dumb employee = overtime

(Contributed by Dr. D.R.Nakipuria)

Funny One Liner

Boss: "Funny but true fact !!
A woman worries about her future till she gets a husband, A man never worries about his future until he gets a wife !! ..What do u say?

(Contributed by Dr Chandresh Jardosh)

  An Inspirational Story

A 4-year-old girl, the 20th of 22 children, contracted double pneumonia and scarlet fever at a very early age, which paralyzed her left leg. Thereafter at 9 years of age she removed her leg braces and started walking without them.
At age 13, she decided to become a runner but kept falling miserably in all races that she entered in. She kept trying inspite of several detractors and finally started winning every race she entered.

She is Wilma Rudolph, who went on to win 3 Olympic Gold Medals

  Readers Responses
  1. "Happy B'day Sir!!":  Hantanu Singh Tomar
  2. "Many many happy returns of d day to the bestest doc on the planet and my superduper favorite darling dr kk.xoxo. aap jiyen hazaaron saaal , saal ke din ho pachas hazaaar.......": Amber Sharma
  3. "varshgath ki shubhkamnae":   Smita Mishra
  4.  "Happy birthday to u, love n regards, charu pn Aggarwal: Charu Lata Aggarwa
  5. Happy b'day. I was travelling and could not access my mail.........: Ashish Sabharwal
  6. Dr. uncle.. Wishing U A Very HAPPY BIRTHDAY... All the Best Wishes....": Deep Malik
  7. "Wish u manny manny happy returns of d day.": Farahim Chaudhary
  8. "Happy B' day!!": Susheela Gupta:
  9. "Medical interpretation" of Bhagavadgita by Dr Agarwal in a beautiful way.:  Madanmohan Trakroo:
  10. Respected Sir, Wish you a very happy birthday, Dr Sanchita
  11. Happy Birthday and many many returns of the day: Narinder Pal Singh
  12. "Happy Birthday Dr KK.": Umesh Upadhyay
  13. Happy birthday sir....: Mitul Jain
  14. "Happy birthday sir...": Suprabha Sharma
  15. Dear sir, I wish you many many happy returns of this day . and a happy teachers day . May you live a long and prosperous life.  your sincerely, Dr. Vishnu Singhal
  16. "Happy birthday sir.": Ranjeeta Rani:
  17. Dear Dr KK Aggarwal, Many Many Happy Returns of the Day and a happy teachers day.  DrIndu Grewal
  18. "Some things r left undone, some words r left unsaid, some feelings are left unexpressed, but some ones as nice as you could never be left unwished,  HAPPY BIRTHDAY TO YOU !!!": Bachan Singh Barthwal
  19. "Saabji, very Big happy birthday with a big smile to your great self, we love and respect your work to human being,": Vijay Singh Gill:
  20. "Ishwar aapko dirghayu evam achcha swasthya dein...janmadun ki hardik shubhkanayein.....":  Shailendra Bhartti:
  21. Happy Birthday Dr. K. K. Aggarwal. May god fulfill all your wishes. Dr.O.P.Jain
  22. "Wish you a very HAPPY BIRTHDAY Sir": Swapna Kumar
  23. "wishing u a very HAPPY BIRTHDAY Sir": Vibha Girotra
  24. HAPPY BIRTH DAY SIR: Manoj Aron
  25. Belated Happy B'Day KK":   Tarun Gupta
  26. Belated Happy Birthday. Hope you will a grand year ahead – Shrishti
  27. I am thinking of the nice things you always say and do and I am wishing every happiness will always come to you. Happy Birthday – Manjuli Prakashan
  28. A very happy birthday – Mukul Rohatagi
  29. Remembering you with respect and affection for making of lessons and enjoyable session. Happy Teachers Day – Dr.Kamlesh
  30. A very happy birthday and happy teaches day. This is for sharing a piece of your knowledge with us and motivating us to aim high. – Vibha
  31. Dr KK Aggrawal, wish you many happy returns of the day. Many more years full of happiness, health, success and prosperity. – Vineeta, HK, Karishma and Parikshit Chopra.
  32. I just wish to say thank you for being there for me forever. Happy teacher’s day. – Dr.Ravinder
  33. Kindly accept Guru Pranam. We pray to God for your good health and peace.- Dr.Shrikant Sharma
    Many many happy returns of the day – Dr Usha & Anil
  34. Salute to my teacher. With him I learnt and stand up for the truth. Wish you a happy teacher’s day. – Dr.Vivek Arora
  35. Dear doctor sahib, many many happy returns of the day. Apko hamari umar lag jaye ye hamari apke liye prarthana hai – Arun & Neema Kaushal
  36. Happy teachers day sir – Dr.Manoj Kumar
  37. Happy birthday – Dr.Rajesh & Poonam Mishra
  38. Wish you a happy birthday – Dinesh
  39. Wish you a many happy return of the day and many more to come – Mayank Sharma
  40. Very happy birthday sir. May you keep doing work for ages. – Sangeeta Bhagat
  41. Happy birthday – Maa, Veena, Anil, Hitesh, Nakita, Yogesh, Khusboo.
  42. Many many happy returns of the day – Swapna
  43. Many many happy returns of the day. May God fulfill all your wishes – Sunita Tiwari.
  44. Happy teacher’s day and happy birthday – Dr Shyam Sunder Sharma.
  45. Happy birthday – Manjula
  46. Dr KK Aggarwal – It is started an ordinary day, I paused and realized it is your birthday, suddenly it was an extra ordinary day. God bless you – Shelly, Sanjeev.
  47. Happy teacher’s day to you – Dr.K.P.SinghWishing you many happier returns of the day, MAY YOU LIVE ALL THE DAYS OF YOUR LIFE, Amen!!!! Dr N. K. Safaya
  48. Wishing you a vey happy belated birthday. We recognise your contributaion to medical profession and with you continue to guide the younger generation. Dr.R.S.Bajaj, Consultant Paediatrican ,rohini Delhi
  49. Dear Dr.Aggarwal, Nice to know that a great man was born on Teachers day who is not only a good doctor but also a renowned teacher. Happy B’day Sir. With regards. Dr. Lalita Chugh, Scientist, IGIB
  50. Dear Dr K K aggrawal, Wish you many many "Happy returns of the Day". I think it is one of the biggest coincidences that a wonderful teacher like you was born on teachers day. Waise Anda Pahle aya ya Murgi? Aap 5th Sept  ko paida hue the isliye achche teacher hain ya aap achche teacher hain isliye 5th ko paida hue the. Warm Regards, Dr P H Mishra
  51. Dear KK Mamaji: Wishing you a very happy birthday. Love, Brahm, Monica, Krish and Eshaan
  52. "Dear Dr you deserve even higher appreciation from fellow medicos  since you have taken our profession to next level maintaining dignity and honour.":  Bachan Singh Barthwal
  Public Forum

(Press Release for use by the newspapers)

Heart Care to dedicate Commonwealth Games in healthy way

Heart Care Foundation of India is organizing its two major events, one before and other after the Commonwealth Games in association with Health Department, Government of Delhi, World Fellowship of Religions, NDMC, MCD and other NGOs and public sector. The first event will earmark World Heart Day falling on 26th September, BSNL Dil Ka Darbar where thousands of heart patients will get an opportunity to interact with top cardiologists of the city and get answer to their queries. On that day, Cardiologist of the Year will also be honored.
Addressing a press conference today, Dr. K K Aggarwal, Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela, Ms Shibani Kashyap, the noted singer of national repute and Acharya Dr. Sadhvi Sadhna Ji Maharaj Chairperson of World Fellowship of Religions, said that these events will form continuity with the Commonwealth Games and provide an opportunity to the general public to know all about fitness and health.

The second event will be the 17th Annual Perfect Health Mela 2010 to be organized from 23rd to 31st October at NDMC Grounds, Laxmibai Nagar, New Delhi. The events typically will be a mix of entertainment, exhibition, education, competition, checkups, all themed on health incorporating all pathies under one roof. One of the highlights of the event will be the Medico Masti where youth from over 30 colleges will participate in events like Rock Band, fashion show, choreography, western dance, Indian dance, classical dance, T-shirt painting; pot painting, poster making, mehendi, slogan writing, and all the events will focus on health directly or indirectly. The events will be co-organised by Muzzafarnagar Medical College, Maulana Azad Medical College and DIPSAR.

Mr S Bhatnagar (GM Sales) MTNL,  Mr Deepak Chanduka DGM Mkt. Corporate Office MTNL, Mr Sanjay Sinha (DDG PR) BSNL Delhi, Dr. K.S. Bhagotia from DHS, Dr. P.K. Sharma, MOH NDMC, Dr. N.K. Yadav, MOH MCD, Mr Subodh Pande DGM PR from OBC, Mr Praveen Aggarwal from Coca Cola India Ltd. and Sr Representative from LIC also addressed the press conference in a joint statement and said that every person should aim to live up to the age of 100 years and live healthy and active till the last moment of life. They further said that these events will provide the right opportunities to the public to know how to live healthy up to that age of 100.

  Conference Calendar

The World Pharma Trials Asia 2010

Date: September 13–16, 2010

Venue: Gran Melia - Shanghai, China

  Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

26th September: Sunday– BSNL Dil ka Darbar A daylong interaction with top cardiologists of the city. 8 AM  5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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