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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

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  Editorial …

11th June 2013, Tuesday

Checklist for a doctor’s consultation

When you go to a doctor, make sure that you have reviewed your checklist.

  1. You know the name and credentials of your doctor.
  2. Write down the history of your illness and a brief summary of your illness before you plan a visit to the doctor, so that you don’t miss anything when you are with the doctor.
  3. Arrange all your previous records date-wise and not according to hospital or doctor.
  4. You must ask the following questions to your doctor:
    • About your diagnosis
    • About your investigations
    • Detailed information about drugs prescribed: Whether to be taken on empty stomach or full stomach; with water or with juice; morning, afternoon or evening dose; strength; if brand substitution is allowed or is a generic version available etc.
    • When to come for review or follow up?
    • If you are late for review by one day, should you continue with the prescribed medicine or stop taking them?
    • How long will the medicines need to be taken?
    • What happens if you miss a dose?
    • What happens if you take a double dose by mistake?
  5. You should ask your doctor about your personal life (any restriction in diet, exercise, sexual life, effects of drug on driving, sleeping or wake time etc.)
  6. Also ask your doctor to update your vaccination status so that you do not miss out on any important vaccination.
  7. Ask your doctor about any prevalent seasonable disease in the society so that necessary precautions can be taken in time.
  8. If you are suffering from a contagious disease, ask your doctor for precautions so that others do not get it.
  9. Ask about SOS signals and when to call a doctor.
  10. Regarding diet, specifically ask about precautions for eating out.
  11. Also ask your doctor to write drugs for emergency drugs in the society, first aid kit etc.

For Comments and archives…

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

Treating vitamin D deficiency in the country

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Excessive use of mobile phone can be injurious to your health

A press conference was organised by Heart Care Foundation of India on the occasion of World Environment Day.

Dr K K Aggarwal
    National News

'Adolescents' health should be top priority

Bangalore: As 30 per cent of India’s population is aged between 10 and 19 years, it is high time the country focused on health problems of this age group, doctors say. “It is estimated that there are 331 million adolescents in India; they represent a resource for the future,” Dr Hema Divakar, President, Federation of Obstetric and Gynaecological Societies of India (FOGSI), said at a function where FOGSI unveiled Vision 2022 —its initiative to build a healthy generation. It has identified four issues in women and adolescents — anaemia, cervical cancer and diabetes besides building contraceptive choices. “These problems are common in both. Fifty-six per cent of adolescent girls are anaemic. If these issues are tackled, the maternal mortality ratio can be reduced,” she added. Dr Harshad Sanghvi, Director and Vice President of John’s Hopkins Program for International Education in Gynecology and Obstetrics, said that technological innovations could be rapidly adopted and implemented. The participants also threw light on shortage of trained doctors and health care staff.

Prevention model

“We will introduce a primary prevention model that addresses, through innovations, the root cause of all problems. It involves raising the standards of the medical and paramedical staff. Obstetricians, gynaecologists, medical officers, primary health centre staff and nurses will be trained rigorously. We will also open DIP (Diabetes in Pregnancy) clinics,” Dr Hema added.( Source: Deccan Herald, June 7, 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

    Valvular Heart Disease Update

The iota is an important source of emboli in patients with unexplained paralysis and arterial emboli. In elderly when valvotomy surgery is done this should be kept in mind and accordingly precaution taken.

(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)

    Be Human Stop Child Abuse (Team IMA for CMAAO)



  • Male migration to urban areas
  • Demand for commercial sex
  • Liberal sexual behavior
  • High risk behavior groups
  • Adolescents
  • Truck drivers
  • Isolated professionals viz. Defence personnel, touring businessmen
  • Growth of tourism
  • Myths and misconceptions on sexuality/ STDs and HIV/AIDS
  • Demand for younger girls
  • Medical/ psychiatric disorders viz. pedophilia
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Healthy living pays dividends

Exercising regularly, eating a healthy diet, avoiding smoking and maintaining a healthy weight were associated with a lower risk of dying over the next decade, researchers affirmed. (Source: Medpage Today)

Avoid high-dose steroids in elderly with COPD and diabetes

In a study of elderly Australians with chronic obstructive pulmonary disease (COPD) and newly diagnosed diabetes, those who received high-dose corticosteroids had an increased risk of being hospitalized for a diabetes-related complication within a year. (Source: Medscape)

Serial ketamine infusions more effective for depression?

Serial infusions of the N-methyl-D-aspartate (NMDA) antagonist ketamine at a lower dosage than commonly used may be more effective than a single infusion in reducing symptoms of depression, new research suggests. (Source: Medscape)

Low vitamin D linked to hepatitis B

Vitamin D deficiency might be a key player in hepatitis B (HBV) replication, researchers reported. (Source: Medpage Today)

Higher-protein weight loss diets may be OK in diabetics with kidney disease

Higher-protein weight loss diets appear safe for people with type 2 diabetes and renal disease, researchers from Australia report, despite earlier concerns that the extra protein might hurt kidney function in such patients. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Carbohydrates substitute to saturated fat not the answer http://blog.kkaggarwal.com/2013/06/carbohydrates-substitute-to-saturated-fat-not-the-answer/ …

@DrKKAggarwal: Religious fundamentalists & militant #atheists are bamboozled by illusion one in the belief of an external deity the other an external world

    Spiritual Update

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

Do not give health advised unless you are an expert

Once a foreigner visited India and when he returned back, somebody asked him to tell three things about India. He said – All time is tea time; all behave like doctors and every street wall can be used as a urinal.

For Comments and archives…

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

What are fertility–enhancing treatments?

Fertility is enhanced in women with minimal or mild endometriosis by controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI). This treatment is also called superovulation with IUI. Without treatment, women with minimal/mild endometriosis–related infertility have spontaneous pregnancy rates of 2–4.5% per month. The monthly pregnancy rate with IUI alone for endometriosis is around 5%, and it is approximately 4–7% per month for clomiphene citrate, human menopausal gonadotropin (HMG), or follicle stimulating hormone (FSH) injections, when used without IUI. However, combination of clomiphene + IUI improves the monthly pregnancy rates to about 9–10%, at least for the first four treatment cycles.

    An Inspirational Story

Two castle builders

Hot sun. Salty air. Rhythmic waves

A little boy is on his knees scooping and packing the sand with plastic shovels into a bright blue bucket. Then he upends the bucket on the surface and lifts it. And, to the delight of the little architect, a castle tower is created. All afternoon he will work. Spooning out the moat. Packing the walls. Bottle tops will be sentries. Popsicle sticks will be bridges. A sandcastle will be built.

Big city. Busy streets. Rumbling traffic.

A man is in his office. At his desk he shuffles papers into stacks and delegates assignments. He cradles the phone on his shoulder and punches the keyboard with his fingers. Numbers are juggled and contracts are signed and much to the delight of the man, a profit is made.

All his life he will work. Formulating the plans. Forecasting the future. Annuities will be sentries. Capital gains will be bridges. An empire will be built.

Two builders of two castles. They have much in common. They shape granules into grandeurs. They see nothing and make something. They are diligent and determined. And for both the tide will rise and the end will come.

Yet that is where the similarities cease. For the boy sees the end while the man ignores it. Watch the boy as the dusk approaches.

As the waves near, the wise child jumps to his feet and begins to clap. There is no sorrow. No fear. No regret. He knew this would happen. He is not surprised. And when the great breaker crashes into his castle and his masterpiece is sucked into the sea, he smiles. He smiles, picks up his tools, takes his father’s hand, and goes home.

The grownup, however, is not so wise. As the waves of years collapse on his castle he is terrified. He hovers over the sandy monument to protect it. He blocks the waves from the walls he has made. Salt-water soaked and shivering he snarls at the incoming tide.

“It’s my castle,” he defies.

The ocean need not respond. Both know to whom the sand belongs…

I don’t know much about sandcastles. But children do. Watch them and learn. Go ahead and build, but build with a child’s heart. When the sun sets and the tides take – applaud. Salute the process of life and go home.

For comments and archives

   Cardiology eMedinewS

Better heart health brings lower stroke risk Read More

   Pedia News

Hydrocortisone seems safe in infantile bronchopulmonary dysplasia
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 the incubation period in animals?

The incubation period in dogs and cats is 10 days to 6 months; most cases become apparent between 2 weeks and 3 months. In cattle, an incubation period from 25 days to more than 5 months has been reported (in vampire bat-transmitted rabies).

    IJCP Special

Dr Good Dr Bad

Situation: A 24–year–old female suffered migraine attacks after physical exertion.
Dr. Bad: It is not related.
Dr. Good: It is related.
Lesson: Migraines can be triggered by stress, worry, menstrual periods, birth control pills, physical exertion, fatigue, lack of sleep, hunger, head trauma, and certain foods or drinks that contain chemicals such as nitrites, glutamate, aspartate, tyramine.

Make Sure

Situation: A patient developed high altitude cerebral edema while traveling to Leh.
Reaction: Oh my God! Why was acetazolamide not started before the journey?
Lesson: Make sure all high–risk patients are given acetazolamide before they go to mountains.

  Quote of the Day (Dr GM Singh)

Any man's life will be filled with constant and unexpected encouragement if he makes up his mind to do his level best each day. Booker T. Washington

    Mind Teaser

Read this…………………

An older adult patient is discharged from the hospital with nortriptyline for neuropathic pain. Which statement indicates the patient's need for additional education?

1. “I will chew sugarless gum and mints.”
2. “I will drink carbonated beverages.”
3. “I will take my medication at breakfast.”
4. “I will use a humidifier at bedtime.”

Yesterday’s Mind Teaser: A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior:

1. is an emotional reaction to the anticipated pain.
2. is in anticipation of future pain.
3. is more indicative of the need for pain medication than the pain rating.
4. may be in conflict with the pain rating, and accepts the report of pain.

Answer for Yesterday’s Mind Teaser: 4. may be in conflict with the pain rating, and accepts the report of pain.

Correct answers received from: Deepali Chatterjee, Dr Bitaan Sen &
Dr Jayashree Sen, Dr KV Sarma, Dr Bharat Bhushan Aggarwal, Dr Gajveer Singh, Dr BB Gupta, Dr PC Das, Dr Monica Gandhi, Dr Arpan Gandhi, Dr Kanta Jain, Dr Jainendra Upadhyay, Dr K Raju, Dr PC Das.

Answer for 9th June Mind Teaser: d. Unilaterally

Correct answers received from: Muthumperumal Thirumalpillai, Dr Pankaj Agarwal, Dr BB Gupta.

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

Customer: Hi, this is Maureen. I can't get my diskette out.
Tech support: Have you tried pushing the Button?
Customer: Yes, sure, it's really stuck.
Tech support: That doesn't sound good; I'll make a note.
Customer: No , wait a minute... I hadn't inserted it yet... it's still on my desk... sorry....

  Medicolegal Update

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

What are ordinary and extraordinary medical care?

Catholic teachings and the Pope advocate a distinction between ordinary and extraordinary care, with ordinary care being mandatory, whereas extraordinary care may be withheld or withdrawn.

One commentator explicated this distinction in the following way. According to him,

  • Ordinary means of preserving life include all medicines, treatments and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or inconvenience
  • Extraordinary means of preserving life include all medicines, treatments and operations, which cannot be obtained without excessive expense, pain, or other inconvenience, or which, if used, would not offer reasonable hope of benefit.

Many ethicists and courts have concluded that this distinction is too vague and has "too many conflicting meanings" to be helpful in guiding surrogate decision makers and clinicians As one lawyer noted ordinary and extraordinary are "extremely fact–sensitive, relative terms…what is ordinary for one patient under particular circumstances may be extraordinary for the same patient under different circumstances, or for a different patient under the same circumstances". Thus, the ordinary/extraordinary distinction should not be used to justify decisions about stopping treatment.

(Ref: Pope Pius XII. The prolongation of life. In: Ethics in medicine. Reiser SJ, Dyck AJ, Curran WJ (Eds), MIT Press, Cambridge 1997).

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Nine modifiable risk factors for heart attack

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

Nine potentially modifiable factors: include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, and one should daily consume of fruits and vegetables and do regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 54572 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

    Readers Response
  1. Dear KK, this is an excellent piece of analytical information and important from epidemiological studies. This prompts any student of Community Medicine/Health/PSM to have a research paper/thesis on this. KK Arora
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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