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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 ...

12th September, 2010, Sunday

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

Thrombocyte counts in mice after the administration of papaya leaf suspension.

A email has been circulating for few weeks that papaya leaves can raise the platelet counts in dengue. I thought it is just a mimic but when searched the medline and got the following animal study. One should do a thesis on the subject.

"Following up a popular use of crude leaf preparations from Carica papaya for the treatment of dengue infections, a suspension of powdered Carica papaya leaves in palm oil has been investigated for its effect on thrombocyte counts in mice, administering by gavage 15 mg of powdered leaves per kg body weight to 5 mice. Equal numbers of animals received corresponding volumes of either palm oil alone or physiological saline solution. Thrombocyte counts before and at 1, 2, 4, 8, 10, 12, 24, 48 and 72 hours after dosing revealed significantly higher mean counts at 1, 2, 4, 8, 10 and 12 after dosing with the C. papaya leaf formulation as compared to the mean count at hour 0. There was only a non-significant rise of thrombocyte counts in the group having received saline solution, possibly the expression of a normal circadian rhythm in mice. The group having received palm oil only showed a protracted increase of platelet counts that was significant at hours 8 and 48 and obviously the result of a hitherto unknown stimulation of thrombocyte release. The results call for a dose-esponse investigation and for extending the studies to the isolation and identification of the C. papaya substances responsible for the release and/or production of thrombocytes".
[Sathasivam K, Ramanathan S, Mansor SM, Haris MR, Wernsdorfer WH. Wien Klin Wochenschr. 2009 Oct;121 Suppl 3:19-22.] AIMST University, Kedah, Malaysia.

Dr KK Aggarwal
Editor in Chief
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  Photo Feature (from the HCFI Photo Gallery)

Book Release Function

‘Srijan’ written by Acharya Dr Sadhvi Sadhna Ji Maharaj was released at a function organized by Acharya Sushil Muni Ahimsa Peace Award Trust on 5th September.
In the photo:Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal, Dr Mohini Giri, Sardar Buta Singh, Dr Naresh Trehan, Chairman and Managing Director, Medanta –The Medicity and Acharya Dr Sadhvi Sadhna Ji Maharaj, Chairperson, World Fellowship of Religions.

Dr K K Aggarwal
  IMSA Update

International Medical Science Academy (IMSA) Update

High PEEP in patients with acute respiratory distress syndrome: For patients with acute respiratory distress syndrome (ARDS, PaO2 /FiO2 =200 mmHg) who require mechanical ventilation, use a strategy of high PEEP. (JAMA 2010;303:865)

  National News

eMedinewS wishes Happy Birthday to Dr Brahm Vasudev, our overseas editor today

IMA Election

Emedinews requests all its readers to support Padma Shri and Dr. B C Roy National Awardee Dr. K.K. Aggarwal, President Heart Care Foundation of India and MTNL Perfect Health Mela, who is contesting for the post of Vice President of the National Indian Medical Association (IMA). Members of Central Council of IMA, Working Committee Members, Presidents and Secretaries of IMA in addition to all office bearers are the voters in this election. Dr. Aggarwal is well-known for his work in the field of public health and academics.

No need to panic on dengue: Health ministry

Even as dengue cases continued to rise alarmingly, the health ministry on Friday said there was no need to panic as the dengue strain was of mild variety. It also gave a clean chit to the Commonwealth Games venues, saying they were clear of mosquito larvae. Briefing reporters on the dengue situation in the national capital on Friday, Health Secretary Sujatha Rao said the present strain of dengue has "high mobility but low morbidity" and only four deaths had been reported so far. "At present dengue serotype 1 virus is circulating in Delhi, which is known to cause large number of cases and fewer deaths," Rao said. The World Health Organisation, however, says that the peak of dengue may be in the beginning of October. (Source: The Hindustan Times)

  International News

Recurrent aphthous ulcers

Recurrent aphthous ulcers (RAUs) are one of the most common oral lesions. This condition seems to be a T-cell mediated immunologic reaction triggered by a variety of agents, such as an allergy, genetic factors, infections, hormonal changes, and systemic diseases. There are three types: minor, major, and herpetiform. All of them behave differently and are treated differently. Some diseases present with aphthous-like lesions e.g., Behcet's syndrome, celiac disease, and nutritional deficiencies. Minor ulcers are recurrent, extremely painful, and multifocal, and they heal without scarring. Duration is one to two weeks. The treatment for minor RAUs is usually palliative. The ulcer lasts 1 or 2 weeks and heals by itself.
(Contributed by Dr GM Singh)

(Dr Monica and Brahm Vasudev)

ACOG recommends HPV vaccines for girls aged 11–12 years

In an update to its recommendations, the American College of Obstetricians and Gynecologists (ACOG) has endorsed recommendations to routinely vaccinate girls aged 11–12 years, against the human papillomavirus (HPV) using either the quadrivalent or bivalent vaccines. It also stated that the vaccine can be given to girls as young as 9 years old and that catch–up vaccination should be offered through age 26 years. These recommendations are published in the September issue of the journal Obstetrics & Gynecology.

Simplified MRI score for RA correlates well with international standard

A pilot study published in the September 2010 issue of the journal Radiology demonstrates that the Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score (SAMIS) is less time–consuming and also provides comparable results as the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) for assessing and monitoring rheumatoid arthritis (RA). The patients were enrolled prospectively if they had painful, swollen wrists, and then underwent MRI of both wrists up to just distal to the metacarpophalangeal joints. In the study, the average exam time was 13 minutes with RAMRIS vs 5 minutes for SAMIS.

RAMRIS was simplified by assessing only the carpal bones and metacarpal bases; the number of bones was reduced from 23 to 15. Only the more painful hand was evaluated.

Short–term overeating has lasting impact

A new study says that overeating, even for short periods of time, may have lasting effects by increasing body weight and fat mass in normal–weight individuals. The study is published in Nutrition & Metabolism.

FDA and CDC issue guidelines for Fingerstick Devices

The US FDA and CDC recommend that fingerstick devices should never be used with more than 1 person to check transmission of bloodborne pathogens, in particular, hepatitis B virus. They have also released similar directions for point–of–care (POC) blood–testing devices such as glucometers and instruments for insulin administration. They also recommend single-use, auto–disabling instruments known as safety lancets. Insulin pens should not be shared and should be labeled for single–patient use. Physicians should wear gloves for any task that potentially exposes them to blood/body fluids; gloves should be changed between patient contacts, even when they work with patient–dedicated POC devices or single–use, self–disabling fingerstick devices.)

  Nutrition Update

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

Complimentary feeding practices between 6 and 24 months

Improving complementary feeding requires a combination of strategies.

Energy intake can be increased by increasing breastfeeding frequency, increasing food portion sizes, feeding children more frequently, and/or providing more energy–dense foods. Micronutrient intake can be increased by diversifying the diet to include fruits, vegetables, and animal products; using fortified foods, and/ or giving supplements. Choosing food combinations that enhance micronutrient absorption is also important.


  1. Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing Countries: A Review Of Current Scientific Knowledge. WHO/ UNICEF, 1998.
  2. Dewey KG. Guiding Principles for Complementary Feeding of the Breastfed Child. PAHO/ WHO, 2003.
  3. WHO. Complementary Feeding: Family Foods for Breastfed Children. Geneva: World Health Organization, 2000.
  Infertility Update

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

Q: How important is IVF if infertility is diagnosed?

A. Firstly, it is very important to diagnose the reason behind inability of a female to conceive. For those suffering with severe tubal block in females and very low sperm count in males, IVF is the only solution. Sometimes, if infertility is not treated at proper time through proper procedure, the lady grows older, the number and quality of her eggs goes down and also the chances of conception.

  Cardio Update: Question of the day

What lessons do we learn at the interface of HT with CAD? (Sukumar Mukherjee, Ajoy Biswas)

Hypertension is reported to be a major risk factor for CAD. BP levels have been shown to be positively and continuously related to major risk factors for CAD events.1 Rapid lowering of BP which can cause reflex tachycardia and sympathetic activation, should be avoided in patients with CAD. Target for BP control may be even below 130–140/90 mmHg. All other risk factor should be treated appropriately.

Hypertensive patients with acute coronary syndrome (ACS) need aggressive treatment.

Beta–blockers and CCBs are drugs of choice in management of angina in patients with hypertension and/or CAD. Beta–blockers have shown to reduce the risk of re-infarction and cardiovascular death by 25% following MI.2 Amlodipine has shown subjective and objective improvement in patients with angina with fewer hospitalizations and lower need for revascularization. Verapamil and diltiazem reduce the risk of developing non Q wave MI after MI, therapy with ACEI prevents subsequent heart failure, reduces morbidity and mortality.3 ACEIs, in combination with digoxin or low dose diuretics, are effective in reducing CHF related mortality and morbidity. Statins and aspirin, if otherwise not contraindicated for co–morbid disease conditions, are recommended in all patients with hypertension–related CAD.


  1. Milton Parker, European Society of Cardiology, 22 Annual Congress, March 2000, Carvedilol prospective randomized cumulative survival.
  2. Yusuf S, Peto R, Lewis J, et al. Beta–blockade during and after myocardial infarction: an overview of the randomized trial. Prog Cardiovas Dis 1985;27:335–71.
  3. Pfeffer MA, Braunwald E, Moye LA, et al. For the SAVE investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction; results of survival and ventricular enlargement trial. N Engl J Med 1992;327:669–77.
  Medicolegal Update

Forensic Column (Dr Sudhir Gupta, MBBS (Gold Medal), MD (BHU), DNB, MNAMS, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Can medical interventions be stopped?

Every medical intervention, including artificial nutrition and hydration, may be terminated at the patient’s request. Specific legal cases have sanctioned the withholding or withdrawal of respirators, chemotherapy, blood transfusions, hemodialysis, and major surgical operations. In Cruzan, the United States Supreme Court definitively stated that artificial nutrition and hydration are medical interventions that can be withheld or withdrawn under the guidelines that apply to other medical treatments*.

* Cruzan v. Director of Missouri Department of Health, 110 S. Ct. 2841 (1990).

  Medi Finance Update

Cumulative Bonus

Sum insured under the policy shall be progressively increased by 5% in respect of each claim-free year of insurance, subject to maximum accumulation of 10 claim–free years of insurance.

  Drug Update

Drugs prohibited for manufacture, sale and distribution from subsequent date

Drug Formulation

Effective date


Fixed dose combination of Nitrofurantoin and Trimethoprim

Jan 1,2002

GSR 170(E)

  Lab Update

Normal platelet count

The normal platelet count in adults ranges from 150,000 to 450,000/microL, with mean values of 237,000 and 266,000/microL in males and females, respectively.

  IJCP Special

Dr Good Dr Bad

Situation: A patient with migraine and palpitations came for treatment.
Dr. Bad: No drug is needed.
Dr. Good: Take Verapamil.
Lesson: Verapamil is frequently used as a first choice for preventive migraine therapy because it is easy to use and has fewer side effects.

Make Sure

Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lasson: Make sure that patient with LVOT obstruction are not given sublingual nitrates.

Quote of the Day

"Success does not mean the absence of failures; It means the attainment of ultimate objectives. it means winning the war, not every battle" Edwin C. Bliss
(Contributed by Dr. G.M. Singh)

Mnemonic of the Day

Clinical measures for axial spondyloarthritis: SPINEACHE

Sausage digit (dactylitis)
Psoriasis-positive family history of SpA
Inflammatory back pain
NSAID good response
Enthesitis (heel)
Crohn’s/Colitis disease - elevated CRP
Eye (uveitis)
(Contributed by Dr Varesh Nagrath)

Hypertension Alert

Goals of therapy

  1. More aggressive hypotensive therapy is both unnecessary and may reduce the blood pressure below the autoregulatory range, possibly leading to ischemic events (such as paralysis and heart attacks)
  2. Once the BP is controlled, the patient should be switched to oral therapy, with the diastolic pressure being gradually reduced to 85 to 90 mmHg over two to three months.
  3. The initial reduction to a diastolic pressure of approximately 100 mmHg is often associated with a modest worsening of renal function; this change, however, is typically transient as the vascular disease tends to resolve and renal perfusion improves over one to three months. Antihypertensive therapy should not be withheld in this setting unless there has been an excessive reduction in BP.
  Mind Teaser

Read this…………………

Can you name three consecutive days without using the words Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, or Sunday?

The answer for yesterday’s Mind Teaser: "Charcoal"

Correct answers received from: Dr Neelam Nath, Dr Sukanta Sen,  Dr Meera Rekhari, Dr Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Dr Ankur Mittal,  Dr Rohini Viswani, Dr Susheela Gupta, Dr Vikas Kumar, Dr. A. K. Saxena, Dr Virender Prakash Gautam, Dr Rawat Purushottam Singh, Dr Anurag Jain, Dr C H Srilatha, Dr Parvesh Sablok, Dr Ujjwala T Tirkey.

Answer for 10th September Puzzle: "The third. Lions that haven't eaten in three years are dead."

Correct answers received from: Dr. R. K.Goel, Dr Kushal  J. Manjesh, Dr Yogesh Saxena, Dr (Lt Col) Gopal Agarwal, Dr Rohini Dhillon

Send your answer to ijcp12@gmail.com

  Humor Section

Are you a deaf or blind?

A Man went to a Doctor and asked, "Doctor! I have been noticing that since few months my wife is not hearing properly; please tell me what shall do?" The Doctor replied, "Please be sure 700 whether it is true or not, if so, I think you are lucky but before being lucky be sure. Please go to your kitchen slowly from a distance of 15 ft while she is cooking something and ask her question from 15ft way and see she responds or not. If not move further close and see from what distance she responds your query."

Man followed Doctor's advice and called her wife tomorrow morning about 15 ft away while she was preparing breakfast," Darling! What are you preparing? As there was no reply, he moved closer and repeated the same question. Getting no reply, he moved further close and whispered the question in her ear. The Wife took a rolling pin in her hand and replied, "I know you are always deaf to my reply and queries as you did not listen my reply four times but you are blind too as even now being so close you cannot see the sandwiches in my hand" 
(Contributed by Dr. D. R. Nakipuria)

Funny But True Fact

Wife: Agar main kho gayi to tum kya karoge?
Husband: Main TV aur newspaper mein Ad dunga ki jaha kahin bhi ho……Khush raho.
(Contributed by Dr Chandresh Jardosh)

  An Inspirational Story

The Four Way Test

The man was Herbert J. Taylor, Chicago Rotarian, who surveyed the way the company did it’s business, which was the sale of aluminum pots and pans. The nature of the industry was fraught with unethical business practices. To bring the business out of bankruptcy Taylor knew that he had to change the way business was conducted. Ultimately he developed a very simple business philosophy that all employees were to follow in all of their business dealings with customers, suppliers and associates. The philosophy changed the business, turned the business around and ultimately brought it out of bankruptcy.

The business philosophy is a simple four step decision making tool. It didn’t tell people what to do or how to think, but it did give them a tool to use in all of their business dealings. The tool is now well known to anyone that has ever associated themselves with Rotary International. It is simple The Four Way Test. The tip is to use this simple decision making tool in your life and see if it doesn’t make a difference. As people, we must all stand by our personal honesty and integrity. This is a handy and simple test of what you say, do or think. Give it a try in your life.

The Four Way Test

  1. Is it the TRUTH?
  2. Is it FAIR to all concerned?
  3. Will it build GOODWILL and better friendships?
  4. Will it be BENEFICIAL to all concerned?

By the way, this tool made Herbert Taylor a multimillionaire in the 1930s. So it’s also a very profitable way of doing business.

  Readers Responses
  1. Recently, I first came across the emedinews as I used to hear a lot about it from my senior colleagues. After going through it, I was amazed to see that the news covered aptly informed readers about several topics. Now, when I have become a regular reader, I find that emedinews has a good mix of subjects from all specialties of the medical world. I really enjoy reading and solving mind teasers. Besides, Dr good Dr bad and make sure are the fun ways which help us to break the monotonous reading of news stories and at the same time, also increase the knowledge. Regards: Dr GM Singh
  Public Forum

(Press Release for use by the newspapers)

New Form of Heart Failure on the Rise

A form of heart failure that’s too often overlooked is on the rise and it’s just as deadly as the better–known variety said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela.

The standard description of heart failure is that the heart progressively loses its ability to pump blood. But there’s another form of the disease where the heart’s blood–pumping ability remains near normal. He said that in this condition the heart muscle becomes thickened. The chamber inside gets smaller and the heart is unable to relax to accommodate the blood it needs to pump out. There is no room for the heart to relax, so blood backs up into the lungs. This kind of aberration is not picked up by standard measurements of "ejection fraction" –– the percentage of blood in the heart that goes out with every beat.

Quoting two studies published in the New England Journal of Medicine, Dr Aggarwal said that this form of the disease is called "diastolic heart failure" because the problem occurs during the diastole portion of heart activity, as the heart relaxes after a beat.

Nearly one–third of those heart–failure patients have an ejection fraction greater than 50 percent, which is very near normal. However, the death rate for this kind of heart failure matches that of patients with the more common form of heart failure, with more than 20% of all the patients dying within a year. There is a steady increase over 15 years of heart failure with normal or near–normal ejection fraction.

For patients, the symptoms of both types of heart failure are the same: Shortness of breath, difficulty exercising, and fluid retention in the body. Physicians cannot make a diagnosis on the basis of symptoms or routine examinations. One has to have an echocardiogram and see the heart pumping and see if the ejection fraction is normal or reduced. Until now, relatively little attention has been paid to diastolic heart failure. Advances have been made against systolic heart failure, in which the ejection fraction falls below normal but not much has been done about diastolic heart failure.

Pacing for Heart Failure

For patients with advanced heart failure waiting for cardiac transplant, the new treatment involves putting three pacemaker wires a procedure called as biventricular pacing. It not only improves the quality of life but also prolongs life.

If the ejection fraction is low the combo device also gives an electric shock when the heart stops. It is said that all patients with low ejection fraction should ask their doctors for possible implantation of these devises.

Signals of Heart Failure

One of the commonest presentations is breathlessness on exertion, which is often confused as a part of aging or getting obese. Not being able to climb stairs may be the earliest sign of hypertensive diastolic heart failure. Other signals are:

  1. Feeling extra tired even after a good night’s sleep. People with heart failure may limit activities they like to do or take naps to avoid feeling tired.
  2. Weight gain: Call your doctor if you gain weight for more than 2 days in a row or if you gain 2 or more pounds.
  3. Shortness of breath: Heart failure makes breathing harder, especially during exercise. Lying position may make it worse.
  4. Swollen ankles, legs, belly, and/or lower back, the swelling is often worse at the end of the day.
  5. Going to the bathroom more at night.
  Conference Calendar

EFNS 2010

4th Congress of the European Federation of Neurological Societies

Date: September 25–28, 2010
Venue: Geneva Palexpo
Website: http://www.kenes.com/efns2010

  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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